Laserfiche WebLink
Firefox • duvut.IJlallA <br /> 1 WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> LA <br /> (JOB ADDRESS 14230E French Camp Rd CITYMP Ripon, CA 95366 9 <br /> D <br /> 203-060-08 <br /> CROSS STREET S. Of Lone Tree Rd. APN PARCEL SIZE 97.34 LAND USE APPLICATION# p <br /> OWNER NAME <br /> Joe Beeler PHONE 209-608-1711 w <br /> OWNER ADDRESS 14230 E. French Camp Rd. CRYISTATEMP Ripon CA 95366 <br /> CONTRACTOR Henrims Bros Drilling Co lac PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd. Crrv1STATF/ZIP Modesto, CA 95356 <br /> ,SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CFTYISTATE/ZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 290813 EXPIRATION DATE 5-31-22 <br /> DOMESTIC WELL SAMPLING: XGeneral Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE X DomesticiPnvate Irrigation/Agricultural Industrial Water Quality Monitoring Soil SamplinglCharaclenzation <br /> Public Water System <br /> If ddloronl Iron Owrwr. Water System Name Conrad Namo or Phom Number <br /> TYPE OF WORK XNew Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells 7 Soil Boring(s) n of bonngs Geolechnical #of borings <br /> Out-Of-Service Well Out-0f-Service Well Renewal Cross-Connection Repair <br /> _ New Pump Pump Replacement -1 Pump Repair Raise Well Casio <br /> I WELL CONSTRUCTION <br /> Drilling Method XMud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> I Proposed Well Depth 950 11 Excavation 14 in diameter Open Bottom X Gravel Pack/Gravel Size r)()6_in diameter <br /> Conductor Casing in diameter I Conductor Casing Depth ft <br /> Well Casing Diameter 8 in Th ckness/GaugelASTM Sched SDR21 Steel XPlastic Stainless Steel Other <br /> Grout Seal Depth 100 If Neat Cement(94 Ib bag15-10 gal wafer) Sand Cement sack mix/7 gal water <br /> X Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> (PEDESTAL Installed By Driller XPump Contractor Other <br /> Concroto Pedestal .Dimensions:Width It Length it Thick <br /> I In Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br /> Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS <br /> Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br /> potential sources of contamination,sewers or private disposal systems. Include distance from two property lines. For Domestic, <br /> Agriculture,Industrial well,provide location of any water wells or surface water within 200'radius of proposed well. <br /> MININ1Il11l 24 110I'N '•.N('F.NOTWE RF./jPIRED FOR INSPECTIONS-PLEASF.(AI.I.1209)9c3-7697 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By /--� � Date u) rX Area Employed ID#� <br /> Grout Inspection By P• J0.`���5 Date 4WAV13 SPECIAL Well Permit q <br /> Pump Inspection By Date WAIVER Received R� <br /> Soil Boring Inspection By Date Constructed Well Depth <br /> COMMENTS (" C r', Q N1 I i P I J ♦n �, <br /> PE SC ReceivedCheck# Amount Permit/Codes Info B s Remitted a Service Re nest# Invoice# <br /> 431 J `f ° T 2 ' ! H M N7y <br /> 36.1 <br /> l <br /> LIII)nd?-11fi 111'_�".n•{ 1`x,:1 nf+ \t';II ILr•I:�*n2 <br /> t'> a2-- <br /> -171Z 0 <br /> 1 of 3 <br /> 2/3/2022, <br /> :1t M <br />