WORK PLANS - Laserfiche WebLink

Home Browse Search

pQUTAr SA N J 0 A U I N Environmental Health Department COUNTY rti� ¢ Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For INSPECTIONS Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. Job Address 950 Stewart Road City/State/Zip Lathrop,CA 95330 Phone 209-941-7430 Cross Street About 2,400 feet east of Somerston Pkwy and Stewart Road APN 21021001 Property Owner* City of Lathrop (Property was deeded to City in September 2022) Phone 209-941-7430 Address 390 Towne Centre Drive City/State/Zip Lathrop,CA 95330 C-57 Contractor Bradley and Sons Drilling and Pump Systems License# 414178 Phone 559-441-1401 Address 3625 S. Highland Aveunue City/State/Zip Del Rey,CA 93616 Consultant/Sub-Contractor Luhdorff&Scalmanini,Consulting Engineers License# n/a Phone 530-661-0109 Address 500 First Street City/State/Zip Woodland,CA 95695 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS x❑ MONITORING 2 ❑ HOLLOW STEM BORING DEPTH 1,250 feet ❑BOLTED TRAFFIC BOX El STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 12.25 Inches El MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA 2.5 inches ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS Sched 80/F4804-88A TYPE OF CASING: ❑STEEL ❑x PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Surge,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 150 feet TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE El PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? El Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS Sand Cement:10.3 Sac mix/7 gal water from 150'to surface Intermediate seals shall be bentonite grout comprised of OUIK-GROUT per manufacture specifications Or HOLEPLUG bentonite(Appendix D) DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED n/a ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: Test well is to remain longer than 30 days to allow for long term monitoring of ASR operations. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with Sa aquin County Ordinance Codes and Standards,and all other applicable California laws. Signed Title/Company Project Hydrogeologist, LSCE Print Name Andrew Francis Date 6/21/2023 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name FA Address FA# PR# FA PE WP Reviewed By Work Plan Date ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit $156 x 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 04-20-23 Site Mitigation Well Permit Application