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HomeMy WebLinkAbout041-140-072 EHWS23-0092 WELL APPLICATION PACKETWATER WELL CONSTRUCTION PERMIT Small Diameter Domestic Well (casing 8 inch diameter or less)Large Diameter Well (> 8 inch diameter) Public Water System Well Repair/Deepening (same pump capacity)Destruction Fire Suppression Replacement, Same Pump Capacity, 100 ft of destroyed well Frost Protection Update: May, 2022 Date paid: ______ $_______________ Receipt No. _________ APPLICATION APN #: ______________________________ TRAKiT #: ______________________________ Applicant Name (Please print) Property Owner Name Applicant Mailing Address Construction Site Address City State Zip City State Zip Applicant Phone Number Property Owner Phone Number Drought related (dry well, subsidence)?  Yes  No Subbasin:  Wyandotte  Butte  Vina  Outside of Subbsasin C-57 Well Driller Name GSA: Proposed Depth: Casing Diameter: The Important Information for Applicant/Property Owner (located on the back of this page) has been reviewed by applicant or, if the applicant is not the property owner, the information has been shared with the property owner.  Yes  No Additional Information for Large Diameter Wells Only Within Water District?  Yes  No Engineered Pump Capacity: GPM Name of Water District: Acreage of Parcel(s) to be Served: If other wells also serve the above referenced parcel(s), provide an attachment that specifies for each well: (1) APN, (2) Pump Horse Power, and (3) Pump Capacity in Gallons per Minute (GPM). Note: Maximum pump capacity is 50 GPM/acre served. Applicant Acknowledgement As the applicant, I am:  the property owner,  the C-57 licensed well driller,  the property owner’s authorized representative. I certify that the information in this application is correct to the best of my knowledge. Applicant Signature Date of Application PERMIT CONSTRUCTION APPROVAL This permit is issued based on review of the attached design and it has been determined that it meets the requirements of Butte County Code Chapter 23B, Water Wells. In coordination with Butte County Department of Water and Resource Conservation and local Groundwater Sustainability Agencies, the County determines that it is not likely that the proposed well will interfere with the production and functioning of existing nearby wells, and further, that the proposed well is not likely to cause subsidence that would adversely impact or damage nearby infrastructure. Environmental Health Specialist Date of Issuance Comments/Conditions: FINAL APPROVAL AND CERTIFICATE OF COMPLETION Well Construction/Destruction Approval Well Final Approval/Certification of Completion Environmental Health Specialist Date Environmental Health Specialist Date Completed by Environmental Health Completed by applicant Applicant: See important information on reverse side of application. Sacramento Valley - Vina 041-140-072 Big'N & Son Drilling, Inc.Dorothy Cuneo PO BOX 902 Palermo CA 95968 Oroville CA 95965 1477 Flag Creek 530-403-7611 / 530-370-3891 831-383-8594 Elias Medrano 400 6" August 28, 2023 WELL #2 BIG’N & SON DRILLING, INC. PO BOX 902, Palermo CA 95968 ● 530-403-7611 bignsondrillingoffice@gmail.com CA LICENSE# 1100071 Address: 1477 Flag Creek Road, Oroville CA 95965 AP# 041-140-072 Owner Name: Dorothy Cuneo / Dan Nichols Phone # 831-383-8594 Well Site Coordinates 39.361187° - 121.58341° N FLAG CREEK ROAD SITE PLAN 0.3 Butte County GIS WGS_1984_Web_Mercator_Auxiliary_Sphere Miles0.3 Notes Enter Map Description Legend This map is a user generated static output from an Internet mapping site and is for reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. 0.140 1:9,028 Butte County Information Parcels Butte County Boundary SITE PLAN FOR PREVIOUS PERMIT EHWS20-0124 WELL # 1 PAGE 1 of 3 13 '(:.t' a a SITE PLAN FOR PREVIOUS PERMIT EHWS20-0124 WELL # 1 PAGE 2 of 3 ·v(µ \. � i"1':::\ (-: t; j - SITE PLAN FOR PREVIOUS PERMIT EHWS20-0124 WELL # 1 PAGE 3 of 3