HomeMy WebLinkAbout002-110-007 EH-WP-20027 WELL DESTRUCT APPLICATIONWATER 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
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Applicant: See important information on reverse side of application.
002-110-007 B25-00461
Chico Area Recreation and Parks District
2051 Humboldt Road
Chico CA 95928 Chico CA 95928
Scott Schumann: (530) 520-6822
Vina N/A N/A
(805) 791-7610
Trevor Miller, on behalf of Chico VELO
Besser Well Drilling
4-17-2026
418 Broadway Street
Update: May 11, 2022
A.Well Seal Inspection
1.Requested by:Call in date/time:
2.Ready date/time:A.M.P.M.
3.Inspection date:Approved No seal inspection
4.Inspector name:
5.Comment (if seal not approved or inspection not performed):
B.Water Well Report/Destruction Report
2.Date received:Date reviewed:
3.Reviewer name:
Approved Not received
4.Comment (if report not approved or not received):
C.Disinfection Report
2.Date received:Date reviewed:
3.Reviewer name:
Approved Not received
4.Comment (if report not approved or not received):
D.Well Final Inspection
2.Inspection date:Inspector:
Approved Not inspected by EH but Certification of Completion
provided by a licensed well driller or pump contractor?
3.Comment (if final not approved or Certificate of Completion not received:
4.For large diameter wells only, capacity of installed pump verified by:
Pump “specification sheet”Other; please explain:
!!! Important Information for Applicant/Property Owner !!!
➢Permit valid only for construction in the location shown on the attached plot plan, stamped “Approved.” Variation from
the approved location must have prior approval by Environmental Health.
➢Permit valid only if drilled by a C-57 Licensed Contractor.
➢Environmental Health recommends that the water from this well be tested for water quality when the well is completed in
order to confirm that the water is potable (safe drinking water quality).
➢Environmental Health will not release for occupancy any future building permit for a residence served by this well that
has not been tested, at a minimum, to verify the absence of total and fecal coliform and a nitrate level of less than 10
milligrams per liter.
➢Permit valid 1 year from the date of issuance.
Official Use Only Below
Public Health Department Danette York, MPH, Director
Dr. David Canton, DO, MPH, JD, Health Officer
Environmental Health Division
202 Mira Loma Drive T: 530.552.3880
Oroville, California 95965 F: 530.538.5339 buttecounty.net/publichealth
Executive Order (EO) N-7-22 Exemption Declaration Form
Executive Order (EO) N-7-22 does not apply to permits for wells that will provide less than two acre-feet per year of
groundwater for individual domestic users, or that will exclusively provide groundwater to public water supply systems as
defined in section 116275 of the Health and Safety Code. Please select which exemption applies and complete all applicable
sections below:
☐Well for Individual Domestic Use
As the owner of the proposed well or existing well to be altered and as a necessary condition on the issuance of a water well
construction permit for a new groundwater well or alteration of an existing groundwater well, I hereby declare for myself,
successors and assigns, that the well is a small diameter well (casing 8 inch diameter or less) and that no more than two (2)
acre feet per year will be pumped from the well AND that all water pumped from the well will be used only to supply water
for the domestic needs of an individual residence. Without limiting the foregoing, I acknowledge that such needs do not
include any commercial use regardless of scale, including, without limitation, use for the growing of food or other crops
for sale in any venue, including, without limitation, at a local farmer’s market.
Property Owner: _____________________________________________________________________________________
Signature of Property Owner: ________________________________________ Date: _____________________________
Address: ____________________________________________________________________________________________
AP Number: _________________________________________________________________________________________
Well Pump Capacity (GPM): ___________________________________________________________________________
Pump Installer: ______________________________________________________________________________________
Signature of Pump Installer: ___________________________________ Date: ___________________________________
☐Well for a Public Water Supply System
The public water system name is: ________________________________________________________________________
The public water system identification number is: ___________________________________________________________
As an authorized representative for the water system identified above, I hereby declare that the proposed well or existing
well to be altered will be exclusively used to provide groundwater to the public water supply system for human consumption
as defined in Health and Safety Code Section 116275. I further declare that a previously constructed public water supply
system well will not be replaced by the proposed well such that the previously constructed well can be used for purposes
other than human consumption.
Signature: _____________________________________ Date: ________________________________________________
Printed Name: _______________________________________________________________________________________
Address: ____________________________________________________________________________________________
AP Number: _________________________________________________________________________________________
☐Does Not Apply
N/A - Application is for destruction of a non-functional well only.
Update: June 6, 2022
Job Site Locator
Dear applicant: It is very helpful for staff when you clearly describe the location of
the job site. This is especially important when the job site is in a remote area. Please
complete this form and use the marker tape provided by our staff to clearly mark
the entrance to the job site and proposed well location.
\
Provide Written Directions for Locating Job Site
Provide Vicinity Sketch to Assist in Locating Job Site
See Attachment A - Location and Vicinity Map
The project is located at 2051 Humboldt Avenue within the City of Chico limits in Butte County, CA.To access the job site: From the south - Take Highway 99 North, exit Highway 32 and proceed east (turn right). Proceed south on Forrest Avenue (turn right) then east on Humboldt Avenue (turn left); project entry point will be on the south side of Humboldt (right).
From the north - Take Interstate 5 south, proceed to Highway 99 South to Chico exit. FromHighway 99, exit at Highway 32 and proceed east (turn right). Proceed south on ForrestAvenue (turn right) then east on Humboldt Avenue (turn left); project entry point will be onthe south side of Humboldt (right).
Update: June 6, 2022
SITE PLAN REQUIREMENT CHECKLIST
GENERAL INFORMATION
Your site plan may be reviewed by various departments: Development Services, Public Works, CDF,
Agriculture Commission, etc. so you will need to include information to satisfy numerous agencies.
➢Please label all elements as clearly and completely as possible
➢Site plans must be fully dimensioned and clearly drawn on clean paper, 8.5’ x 11 ‘ minimum or up to
11’ x 17’ maximum
➢Blow-ups or insets should be used to provide more detail where required. A scaled site plan may be
required, if necessary for septic system permit or other plan review.
GENERAL INFORMATION ITEMS REQUIRED
❑Owner’s name
❑Assessor’s Parcel Number
❑North arrow
❑Property lines with dimensions: As shown
on the assessor’s map or parcel map
❑Distances between improvements and
from property lines
❑Setbacks
❑Any features, such as cliffs or areas of
slope: Include direction and approximate
degree of slope
EXISTING AND PROPOSED ON-SITE
IMPROVEMENTS, INCLUDING:
❑Buildings and other structures
❑Pools
❑Tanks
❑Retaining walls
❑Cuts and/or fills
ROAD FEATURES, INCLUDING
❑Location and name of frontage road(s)
serving property
❑Locate of driveways
❑Right-of-way
❑Easements
ALL WATER RELATED FEATURES, INCLUDING:
❑Flood zone
❑Septic/sewage disposal systems (original
and replacement)
❑Wells
❑Waterlines
❑Springs
❑Creeks or streams
❑Seasonal creeks and drainage ditches
The information provided on the attached site plan and application is accurate and complete to
the best of my knowledge. (Please attach this signed document to your site plan.)
_____________________________________________________
Applicant Signature Date
N/A
N/A
N/A
N/A
N/A
N/A
N/A - no replacement planned
N/A
N/A
N/A
N/A
N/A
(See Attachment B - FEMA FIRMETTE Map)
* Current and future water lines pictured
4-17-2026
SITE PLAN APN: 002-110-007 Trakit # B25-00461 (City of Chico )
Owner Name: Chico Area Parks and Recreation District
Address: 2051 Humboldt Road, Chico, CA 95928
Site Location: South of Humboldt Rd., North of Little Chico Creek,
East of Forrest Ave., West of Notre Dame Blvd.
Contact: Trevor Miller Phone: (805) 791-7610
I certify that the information in this site plan is
accurate and complete to the best of my knowledge.
Signature Date
APN:
002-110-007
Scale:
1” = 50’
N
Well #1 Discovery
Site
(already abandoned)
Chico
Bike Park
Well #2 Discovery
Site
(to be abandoned)
National Flood Hazard Layer FIRMette
0 500 1,000 1,500 2,000250
Feet
Ü
SEE FIS REPORT FOR DETAILED LEGEND AND INDEX MAP FOR FIRM PANEL LAYOUT
SPECIAL FLOODHAZARD AREAS
Without Base Flood Elevation (BFE)Zone A, V, A99With BFE or Depth Zone AE, AO, AH, VE, AR
Regulatory Floodway
0.2% Annual Chance Flood Hazard, Areasof 1% annual chance flood with averagedepth less than one foot or with drainageareas of less than one square mile Zone X
Future Conditions 1% Annual
Chance Flood Hazard Zone X
Area with Reduced Flood Risk due to
Levee. See Notes.Zone X
Area with Flood Risk due to LeveeZone D
NO SCREEN Area of Minimal Flood Hazard Zone X
Area of Undetermined Flood Hazard Zone D
Channel, Culvert, or Storm Sewer
Levee, Dike, or Floodwall
Cross Sections with 1% Annual Chance
17.5 Water Surface Elevation
Coastal Transect
Coastal Transect Baseline
Profile Baseline
Hydrographic Feature
Base Flood Elevation Line (BFE)
Effective LOMRs
Limit of Study
Jurisdiction Boundary
Digital Data Available
No Digital Data Available
Unmapped
This map complies with FEMA's standards for the use of
digital flood maps if it is not void as described below.The basemap shown complies with FEMA's basemapaccuracy standards
The flood hazard information is derived directly from theauthoritative NFHL web services provided by FEMA. This mapwas exported on 8/5/2025 at 11:13 PM and does notreflect changes or amendments subsequent to this date andtime. The NFHL and effective information may change orbecome superseded by new data over time.
This map image is void if the one or more of the following map
elements do not appear: basemap imagery, flood zone labels,
legend, scale bar, map creation date, community identifiers,
FIRM panel number, and FIRM effective date. Map images for
unmapped and unmodernized areas cannot be used for
regulatory purposes.
Legend
OTHER AREAS OF
FLOOD HAZARD
OTHER AREAS
GENERAL
STRUCTURES
OTHER
FEATURES
MAP PANELS
8
B 20.2
The pin displayed on the map is an approximatepoint selected by the user and does not representan authoritative property location.
1:6,000
121°48'27"W 39°44'32"N
121°47'49"W 39°44'4"N
Basemap Imagery Source: USGS National Map 2023