HomeMy WebLinkAbout2017-1081
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RESOLUTION NO. 2017-108
RESOLUTION OF THE MAYOR AND CITY COUNCIL OF THE CITY OF SAN
BERNARDINO, CALIFORNIA, AUTHORIZING AND DIRECTNG THE
EXECUTION OF A LICENSE AGREEEMENT WITH LOCKHEED MARTIN
CORPORATION FOR AN ENCROACHMENT AT 1188 SCENIC DRIVE, 1364
CAMINO REAL, AND 463 MCKAY DRIVE WITHIN THE CITY, FOR THE
INSTALLATION OF THREE GROUNDWATER MONITORING WELLS
BE IT RESOLVED BY THE MAYOR AND CITY COUNCIL OF THE CITY OF
SAN BERNARDINO AS FOLLOWS:
SECTION 1. The Mayor and City Council of the City of San Bernardino hereby
approve a License Agreement with Lockheed Martin Corporation for an encroachment at 1188
Scenic Drive, 1364 Camino Real, and 463 MacKay Drive in the City of San Bernardino, for
the installation of three groundwater monitoring wells.
SECTION 2. The City Manager or his designee is hereby authorized and directed to
execute on behalf of the City a License Agreement, a copy of which is attached hereto and
incorporated herein as Exhibit "A".
SECTION 3. The authorization to execute the above referenced license agreement is
rescinded if the parties fail to execute it within ninety (90) days of the passage of this
Resolution.
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RESOLUTION OF THE MAYOR AND CITY COUNCIL OF THE CITY OF SAN
BERNARDINO, CALIFORNIA, AUTHORIZING AND DIRECTNG THE
EXECUTION OF A LICENSE AGREEEMENT WITH LOCKHEED MARTIN
CORPORATION FOR AN ENCROACHMENT AT 1188 SCENIC DRIVE, 1364
CAMINO REAL, AND 463 MCKAY DRIVE WITHIN THE CITY, FOR THE
INSTALLATION OF THREE GROUNDWATER MONITORING WELLS
I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and
City Council of the City of San Bernardino at a Joint Regular Meeting thereof, held on the 21"
Jay of June 2017, by the following vote, to wit:
Council Members: AYES NAYS
N 1 ARQUEZ X
ARRIOS X
ALDIVIA X
HORETT X(S)
ICKEL X
LVIHILL X(M)
ABSTAIN ABSENT
Georgeann 41anna, CMC, ity Clerk
]'he foregoing Resolution is hereby approved this 21St day of June 2017.
R. Carey Da is, Mayor
City of SaTyBemardino
,approved as to form:
Nary D. Saenz, City Attorney
By:
2
LICENSE AND AGREEMENT
THIS LICENSE AND AGREEMENT is made and entered into this
day of —Tt,t n & , 2017, by and between LOCKHEED
MARTIN CORPORATION, hereinafter referred to as "Licensee," and the CITY OF SAN
BERNARDINO, a municipal corporation hereafter referred to as "City."
WITNESSETH:
For and in consideration of the mutual promises and covenants herein
contained, the parties hereto do hereby agree as follows:
1. City hereby gives permission, removable and terminable as hereinafter
provided, to Licensee for encroachment of three (3) groundwater monitoring wells and
appurtenances thereto ("Wells") to be located in and under Scenic Drive, Camino Real and
MacKay Drive, all public streets in the City of San Bernardino, as shown on Figures IA, 2A,
and 4A of Exhibit "1" ("Encroachment Area"), attached hereto and incorporated herein by
reference in accordance with that letter dated May 9, 2017, from Tetra Tech, a consultant for
and on behalf of Licensee, as set forth in said Exhibit "1 ", and subject to any requirements or
conditions as may be imposed by the Director of Public Works of the City, or his/her
designee. Use of said Encroachment Area shall be for the right to construct, maintain, inspect,
operate, protect, repair, replace and retain in place the Wells as indicated schematically on
Figure 5 of said Exhibit "I". Licensee agrees to install, use and maintain said Encroachment
Areas required by this Agreement. All Wells installed, located or maintained pursuant to this
Agreement shall be so placed and maintained as not to interfere with the use of any public
streets, highways, alleys or bridges by the traveling public to any greater extent than is
reasonably necessary, and the placement of any Wells shall be subject to approval of the
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
1 of 8
Director of Public Works so as not to interfere or conflict with any existing, or future storm
drains, sewers, water lines and any other utilities or improvements owned by the City. In
installing, replacing, repairing or maintaining said Wells, the Licensee shall fill all trenches
and leave the surface of said streets, highways or alleys in as good condition as it was prior to
excavating for said installation, replacement, repair or maintenance to the satisfaction of City,
and shall comply with any and all Federal, State and local laws, rules and regulations
applicable thereto, including the requirement for obtaining street cutting permits. Street cuts,
temporary encroachment permits and restoration of street cuts shall be completed pursuant to
City Standard 310 and subject to the requirements as set forth in Chapter 12.03 of the City of
San Bernardino Municipal Code.
2. The City shall deliver to the Licensee, a signed Well Permit Application from
the County of San Bernardino, Department of Public Health, Environmental Health Services,
a copy of which is shown in Exhibits 2-A, 2-13 and 2-C, attached hereto and incorporated
herein, to be replaced by the issued permits, for the purpose of installing said Wells. Licensee
shall keep said permit in full force and effect during installation of said Wells.
3. The Encroachment Area shall be maintained at all times in a safe, neat, sightly
and good physical condition. City shall be the sole judge of the quality of maintenance, and
upon written notice by City, through its Director of Public Works, stating in general terms
how and in what manner the maintenance is required, Licensee shall be required to perform
such maintenance. If Licensee fails to do so, then City shall have the right to perform this
maintenance, the cost of which shall be borne by Licensee. Licensee shall, at its own
responsibility and expense, obtain and keep in effect all licenses, bonds, insurance and
permits necessary for the installation and existence of said Encroachment.
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
2 of 8
4. City reserves the right to improve, widen, vacate or relocate any highway,
street, alley or other public places, or portion thereof, over and within which this Agreement
is granted, including the widening, change of grade, construction or reconstruction of such
highway, street, alley or other public places or portion thereof, for the purpose of any public
improvements. If notice is given by City to Licensee that work is to be done pursuant to the
rights reserved herein, which notice shall specify the general nature of the work in the area in
which the same is to be performed, Licensee shall at its expense, do all things reasonably
necessary to protect, disconnect, relocate or remove its property during the progress of such
work at the required time in order to accommodate such work. All such things to be done and
work to be performed by Licensee shall be at the sole cost and expense of the Licensee. In
the event that City shall hereafter construct, install, reconstruct or repair any bridge or
artificial support in, on, over or underlying any highway, street, alley or other public place or
improvement in which the Licensee's property is located pursuant to this Agreement, and in
the event that the cost of such work as may reasonably be required is increased in order to
provide for the installation, maintenance or operation of Licensee's property in, on, over or
under the area covered by such project, then Licensee shall pay to City the full amount of
such increase of cost, upon completion of such construction, installation or repair. Any
damage done directly or indirectly to any public street, highway, alley or other public place or
improvement by the Licensee, in exercising directly or indirectly any right, power or privilege
under this Agreement, or in performing any duty under or pursuant to the provisions of this
Agreement, shall be promptly repaired by Licensee at its sole cost and expense, to the
reasonable satisfaction of City.
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
3 of 8
6. Licensee hereby acknowledges the title or paramount interest of City to the
public right-of-way and agrees never to assail or resist said title or interest and to observe
present or future set -back requirements relating thereto while this Agreement is in force and
effect.
7. Licensee shall, as and for the consideration for the granting of this License, pay
to the City of San Bernardino, forthwith, the sum of $625.00 due immediately upon approval
of this Agreement by the City. This Agreement shall not take effect until such payment has
been made by the Licensee to the City. Licensee shall also make an annual payment of
$150.00 to the City which shall be due and payable on January 1 of each year while this
Agreement is in effect.
8. City reserves the right to terminate this License Agreement at any time for any
reason by giving Licensee at least thirty (30) days written notice of such termination, except
that City may, at its election, terminate said permission forthwith at any time if Licensee shall
fail to comply with or abide by each and all of the provisions hereof or keep each and all of
the Licensee's promises herein. Waiver by City of any breach of any term or provision hereof
shall not be deemed a waiver of any subsequent breach of the same or any other term or
provision hereof. If not otherwise terminated, this Agreement shall be for a period of five (5)
years commencing on the latest date of execution of this Agreement by the parties hereto and
ending five (5) years from that date.
9. This Agreement may be extended for any additional terms by written mutual
consent and approval by the Licensee and the Director of Public Works.
10. Upon termination of this Agreement, Licensee agrees to immediately remove
said Encroachment from the public right-of-way and to restore the public right-of-way to the
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
4 of 8
satisfaction of the Director of Public Works. If Licensee fails to exercise its duties under this
paragraph, City shall have the right to remove said Encroachment Area and to restore the
premises at no cost or liability to the City. Licensee covenants and agrees to reimburse City
for such cost of removal and/or restoration.
11. City shall in no way be responsible for loss of or damage to said Encroachment
Area or for any property belonging to or leased by Licensee, its officers, servants, agents or
employees, that may be stolen, destroyed or in any way damaged during the installation, use
or maintenance of said Encroachment.
12. Licensee shall exercise its privileges under this Agreement at its own risk.
Licensee shall indemnify, defend and hold harmless City, its elective and appointive boards,
commissions, officers, agents and employees from any costs, claims, damages, injuries, and
liability resulting from, arising out of, or in any way connected with, the City's approval of
this Agreement, the construction, installation, use and maintenance of said Encroachment
Area, the occupation or use of the public areas of such structure, both during and after the
installation thereof, and including but not limited to any costs, claims, damages, injuries, and
liability resulting from the conduct of Licensee or the employees, invitees, guests or agents of
Licensee, or Licensee's failure to perform its promises in connection herewith.
13. While not restricting or limiting the foregoing, during the term of this
Agreement, Licensee shall maintain in effect policies of comprehensive public, general and
automobile liability insurance, in the amount of $1,000,000.00 combined single limit, and
statutory worker's compensation coverage, and shall file copies of said policies with the City's
Director of Public Works prior to undertaking any work under this Agreement. City shall be
set forth as an additional named insured in each policy of insurance provided hereunder. The
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
5 of 8
Certificate of Insurance furnished to the City shall require the insurer to notify City of any
change or termination in the policy. If the Licensee is self-insured, a Certificate of Self -
Insurance, in a form acceptable by the City, may be furnished.
14. This Agreement is personal to Licensee. It is non -assignable, except with prior
written consent of the City. Any attempt to assign this Agreement without consent will
terminate the privileges granted to Licensee under this Agreement. The City will not
unreasonably withhold consent.
15. This guarantee shall be governed by and construed and interpreted in
accordance with the laws of the State of California without regard to principles of conflicts of
law. The parties hereto further agree that all actions or proceedings arising in connection with
this Agreement shall be tried and litigated either in the State courts located in the County of
San Bernardino, State of California or the U.S. District Court for the Central District of
California. The aforementioned choice of venue is intended by the parties to be mandatory
and not permissive in nature.
16. In the performance of this Agreement and in the hiring and recruitment of
employees, Licensee shall not engage in, nor permit its officers, employees or agents to
engage in, discrimination in employment of persons because of their race, religion, color,
national origin, ancestry, age, mental or physical disability, medical condition, marital status,
sexual gender or sexual orientation, or any other status protected by law, except as permitted
pursuant to Section 12940 of the California Government Code.
17. Licensee shall hold City, its authorized officers, agents and employees,
harmless from and against any and all liability or loss resulting from claims or damages by
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
6 of 8
any person arising out of the acts or omissions of Licensee, its agents or employees in the
performance of any work authorized hereunder.
18. In the event that litigation is brought by any party in connection with this
Agreement, the prevailing party shall be entitled to recover from the opposing party all costs
and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the
exercise of any of its rights or remedies hereunder or the enforcement of any of the terms,
conditions, or provisions hereof. The costs, salary and expenses of the City Attorney and
members of his office in enforcing this Agreement on behalf of the City shall be considered as
"attorneys' fees" for the purposes of this paragraph.
19. All official notices relative to this Agreement shall be in writing and addressed to
the following representatives of Licensee and City:
City:
CITY OF SAN BERNARDINO
CIO Public Works — Real Property
290 North "D" Street
San Bernardino, CA 92401
Licensee:
LOCKHEED MARTIN CORPORATION
Energy, Environment, Safety & Health
2550 North Hollywood Way, Suite 406
Burbank, CA 91505
20. This Agreement may be modified only in a writing signed by the parties in
interest at the time of the modification. No modification shall be binding upon City unless
formally approved by a vote of the City Council of City.
21. This Agreement constitutes the entire Agreement between the parties with
respect to any matter referred to in this Agreement, and supersedes any and all other writings
and oral negotiations with respect to any matter referred to in this Agreement. The terms of
this Agreement shall prevail over any inconsistent provision in any other document relating to
this Agreement, including exhibits to this Agreement.
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
7 of 8
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN
SCENIC DRIVE, CAMINO REAL, AND MAC KAY DRIVE; IN THE CITY OF SAN BERNARDINO,
CA.
IN WITNESS, the parties have executed this Agreement on date first written above.
CITY OF SAN BERNARDINO:
MARK SCOTT, City Manager
Approved as to form:
GARY D. SAENZ, City Attorney
M
Georgeann
CMC, City Clerk
LOCKHEED ART RPORATION:
=er:
I��i Y !'1t•�3•w � D:rts.k� o f Qs•M.�d.�rth'�
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
8 of 8
EXHIBIT "I"
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
OTETRA TECH
City of San Bernardino May 9, 2017
Public Works Department — Real Property Section
300 North D Street — Yd Floor
San Bernardino, CA 92418
Attention: Ryan Aschenbrenner
Subject: Encroachment/License Agreement Request for Colton Narrows Monitoring Well Installation —
1188 Scenic Drive, 1364 El Camino Real, and 463 West MacKay Drive,
San Bernardino, California
Dear Mr. Aschenbrenner:
Tetra Tech Inc. (Tetra Tech), on behalf of Lockheed Martin Corporation (Lockheed Martin), requests and
encroachment/license agreement to install groundwater monitoring wells at three City of San Bernardino properties:
1188 Scenic Drive, 1364 El Camino Real, and 463 West MacKay Drive. Locations for the three proposed
monitoring well locations are shown on Figures IA, 113, 2A, 2B, 4A, and 4B. The proposed work involves drilling
and installing monitoring wells in the street using a drill rig and supporting equipment. There will be two adjacent
boreholes advanced at each well site to monitor groundwater at different depth intervals. The conceptual well
construction design for each well site is provided on Figure 5.
This letter is being sent in response to an email received by Tetra Tech on May 8, 2017 stating that a license
agreement/encroachment permit is needed for long term monitoring which must be requested in letter format. A
copy of the email request is provided as Attachment A. The City of San Bernardino is already in receipt of the
Lance Closure and Excavation permit applications for drilling field activities for these groundwater monitoring
wells.
Tetra Tech is the environmental consultant for the well owner, Lockheed Martin. Please make the
Encroachment/License Agreement in Lockheed Martin's name as follows:
Brian T. Thorne
Senior Technical Project Manager
Lockheed Martin Corporation
Energy, Environment, Safety & Health
2550 North Hollywood Way, Suite 406,
Burbank, CA 91505
Tetra Tech appreciates the opportunity to work with the City of San Bernardino on this project. If you have any
questions please contact either Roy Marroquin at 949.809.5234 and rot .marroguin &tetratech.com or James
Gonzales at 949.809.5223 and iames.gonzales.,t tetratech.com. y
Sincerely,
Tetra Tech, Inc.
l oy J,�anO uin
Principal Hydrogeologist/Project Director
cc: Patrick T. McCullough, Lockheed Martin Corporation
James A. Gonz s, PSG, CHG
Senior Hydrogeologist
Tetra Tech Inc.
17885 Von Karman Avenue, Suite 500, Irvine, CA 9614
Tel 949.809.5000 www.tetratech.com
FIGURES
Tetra Tech, Inc.
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LOCKING CAP
4 -IN SCH 40 PVC BLANK
-'
1. ACTUAL WELL CASING I SCREEN DEPTH, SLOT SIZE,
CASING, APPROX. 50 FT
SEAL INTERVALS, ETC. TO BE DETERMINED BASED
LENGTH
2. SCALED TO APPROXIMATE DEPTH.
BENTONITE -CEMENT
71
GROUT
TITLE
30 -MESH
CONCEPTUAL MONITORING WELL DESIGN
_
TRANSITION SAND
LOCATION LOCKHEED MARTIN CORPORATION
GROUNDWATER LEVEL
(3 FT MIN)
SAN BERNARDINO COUNTY, CALIFORNIA
_
4 -IN SCH 40 PVC SCREEN
APPROVED WG 11GUIE
=_
0.010 -IN OR 0.020 -IN SLOT,
- -
TETRATECH 2 cv
APPROX. 90 FT LENGTH
----------------
FT BGS FEET BELOW GROUND SURFACE
BENTONITESAND
e�
5
SLURRY SEAL
f DATE 1-20-17
4 -IN SCH 40 PVC BLANK---.._
CASING, APPROX. 20 FT
LENGTH
30 -MESH- .
TRANSITION SAND
(3 FT MIN)
4 -IN SCH 40 PVC SCREEN
0.010 -IN OR 0.020 -IN SLOT, —
APPROX. 20 FT LENGTH
END CAP
Hsu -3
HSU-4
RAISED 2 -FT X 2 -FT LMW-5
TRAFFIC -RATED WELL GEOPHYSICAL LOG
VAULT
T B FT BGS
SHORT NORMAL (RSN) AND
LONG NORMAL (RLN) RESISTIVITY
— 4 -IN SCH 40 PVC BLANK
CASING, APPROX. 160 FT
LENGTH
BENTONITE -CEMENT
GROUT
-Ir--• -- AwPROX. 115 FT BGS
30 -MESH
TRANSITION
SAND (3 FT MIN)
�7— #2/16 SAND FILTER
PACK
— 4 -IN SCH 40 PVC
SCREEN 0.010 -IN OR
0.020 -IN SLOT, APPROX.
70 FT LENGTH
�••- END CAP
BENTONITE -SAND
SLURRY SEAL
4 -IN SCH 80 PVC BLANK
CASING, APPROX. 485 FT
LENGTH
100 FT BGS 1
200 FT BGS 200 - {••� '
"`N
250
ii ill
300 FT BGS 300
- I
350 ---f
I
400 FT BGS 400 ..�_
30 -MESH 41
TRANSITION
T
SAND (3 FT MIN)
44N SCH 80 PVC SCREEN
0.010 -IN OR 0.020 -IN
SLOT, APPROX. 20 FT
'... LENGTH T 500 FT BGS
__
APPROX. 505 FT BGS — +==-•-- -•-•= •--•-• I - �`I(( PAC SAND FILTER
.::e_._L J PACK
tS.iN END CAP
NOTES:
1. ACTUAL WELL CASING I SCREEN DEPTH, SLOT SIZE,
SEAL INTERVALS, ETC. TO BE DETERMINED BASED
ON FIELD DATA AND CONDITIONS.
2. SCALED TO APPROXIMATE DEPTH.
3. CENTRALIZER AT 40 -FT INTERVALS AND AT BOTTOM
WELL CASING.
TITLE
CONCEPTUAL MONITORING WELL DESIGN
LEGEND
LOCATION LOCKHEED MARTIN CORPORATION
GROUNDWATER LEVEL
SAN BERNARDINO COUNTY, CALIFORNIA
APPROVED WG 11GUIE
HSU HYDROSTRATIGRAPHIC UNIT
TETRATECH 2 cv
FT BGS FEET BELOW GROUND SURFACE
,D
EECTB 117-0507650
5
f DATE 1-20-17
EXHIBIT "2-A"
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
5,%N Hfl1NARU1a1 Public Health
COUNTY Environmental Health Services
APPLICATION FOR WELL PERMIT
www.sbcounty.gov/dph/dehs
Phone: (800) 442-2283
SIR
Page 1 of 2 Rev 11/6/15
1 —PROPERTY INFORMATION
Property Owner
Phone Number
Site Address
City
State Zip
Assessor's Parcel Number
Email
Township
WS Tier
E/W Range
Section
Well Head
Latitude (decimal)
34.070887°
Longitude (decimal)
-117.293123°
Property Owners Mailing Address
City
State
Zip
2 — CONSULTANT INFORMATION
Name of Consultant
Email
Phone Number
Tetra Tech Inc.
james.gonzales@tetratech.inc 949-809-5223
Address
City
State Zip
17885 Von Karman Avenue
Irvine
California 92614-6213
3 — REGISTERED WELL
DRILLER INFORMATION
Name of Driller
Phone Number
Cascade Drilling Services
909-931-4014
Email
C-57 License Number
joconnor@cascade-env.com
938110
Return well permit to ❑ Well Driller ■ Consultant ❑ Property Owner
Return by ❑ Mail ■ Email
4 — TYPE OF WORK
■ New LMW-CN-4B. LMW-CN-4D (nested)
❑ Reconstruction
O Destruction
Date of Work
Start Date
June 5, 2017
completion Date
September 30, 2017
5 — WELL TYPE
❑ Agriculture
❑ Geothermal
❑ Industrial
❑ Cathodic
❑ Horizontal
ice: Monitoring/Observation
❑ Community/PWS/City — Specify Use Below
❑ Residential — cannot be used as a
❑ Test
Use:
community well
❑ Other
6 — ANNULAR SEAL
Seal Depth (ft,) LMW-CN-4B: 2-158 feet bgs (bentonite -grout), LMW-CN-4D: 231-483 feet bgs (bentonite -grout
❑ Driven Conductor Diameter (in.)
❑ Wall (gauge) (in.)
■ Sealing Material Bentonite Grout
❑ Thickness (in.)
Sealing material shall be placed in one continuous pour. Annular seal thickness must be at least 3 inches for public water supply wells.
7 — DIMENSIONS
Proposed Depth of Well (ft,) 230 and 505,respective
Existing Depth of Well (ft.) N/A
Diameter of Bore (in.) 15
8 — CASING INSTALLED
Cl Steel IE Plastic
❑ Standard Casing ❑ Other ❑ No Casing
From (ft.)
To (ft.) Diameter (in.)
Wall (Gauge)
0
230 4
0.47
0
505 4
0.47
Gravel Pack ■ Yes
❑ No
From (ft.)158, 483
To (ft.)231, 505
Specify Other
From (ft.) N/A
To (ft.) N/A
Backfill Material
Page 1 of 2 Rev 11/6/15
9 — PERFORATIONS (list all If applicable)
From (ft.) 160 .485 To (ft.) 230 505 Pumping Rate (gpm) N/A
10 —SEALED ZONES (list all if applicable)
From (ft,) 231 To (ft.) 483
_ 11 — PLOT PLAN
a) In perspective to the well site, sketch and label the following items on a separate Paper: well lot property lines, other wells
(include abandoned wells), sewage disposal systems (sewers, septic tanks, leaching fields, seepage pits, cesspools), lakes
and ponds, watercourses and animals or fowl kept.
b) Indicate the distance, in feet, of any of the above which are within 500 ft. of the well site. The plot plan needs to be drawn to
scale (% inch = 100 feet). Show the approximate drainage pattern of the property and show access roads to the well site within
500 feet.
c) ❑ None of the above is within 500 feet.
d) Solid or Liquid Disposal Site within Two Miles ❑ Yes ❑ No Location
12 — METHOD OF CONSTRUCTION OR DESTRUCTION
Provide the method of construction/destruction in the space below or as an attachment if more space is needed. The method shall be in
accordance with the standards recommended in the California Department of Water Resources Bulletin No. 74-81 and 74-90. Title 22
standards shall also be followed for public water supply wells.
13 — AGREEMENT AND SIGNATURE
I have read this application and agree to comply with all laws regulating the type of work being performed.
Property Owner's�/
X
Date
Signature
Print Property Owner's Name
n,jWir wy� by
C-57 ContractorsX ^ �^ ^
Signature `"""`"2/1117
Date
Print Contractor's Name
Don Win�lewich
❑ Sent to Water Agency Permit Number.
❑ Water Agency conditions or recommendations attached Expiration Date:
❑ Denied WP Number.
❑ Approved subject to the following:
i Notify the Division's Safe Drinking Water Program at (800) 442-2283 at least seventy two (72) hours In advance to make an Inspection
A. ❑ of the following operations: (Inspections are conducted Monday — Friday between 8:00 AM to 5:00 PM). Failure to cancel or reschedule
appointments may result in an additional hourly fee.
❑ Prior to sealing of the annular space or filling of the conductor casing,
❑ After Installation of the surface protective slab and pumping equipment.
❑ After installation of the surface features.
❑ During destruction of wells, prior to pouring the sealing material,
B. ❑ Submit to the Division, within thirty (30) days after completion of work, a copy of.
❑ Water Well Driller's Report ❑ Bacterial Analysis ❑ Inorganic Chemical Analysis ❑ General Physical
❑ Radiological Analysis ❑ Nitrate ❑ Organic Chemical Analysis ❑ General Mineral
Comments
Fee: FA Number Record 1D.- PE Number:
Late Fee: ❑ Y ❑ N Designated Employee: Received By: Date:
Changes (please specify):
Check One: 171New E] Transfer [I Reactivate
EXHIBIT "2-B"
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
. ,AN 10 RN %RDI O Public Health
CoiJEnvironmental Health Services
APPLICATION FOR WELL PERMIT
www.sbcounty.govldph/dehs
Phone: (000) 442-2283
lle 10 111
Page 1 of 2 Rev 11/6/15
7 —PROPERTY INFORMATION
Property Owner
Phone Number
She Address
City
State ZIP
Assessor's Parcel Number
Email
Township
N/S Tier
EIW Range
Sectlon
Well Head
Latitude (decimal)
34.078693°
Longitude (decimal)
-117.301532°
Property Owne s Malling Address
City
State
Zip
2 — CONSULTANT INFORMATION
_
Name of Consultant
Email
Phone Number
Tetra Tech Inc.
fames.9 onzales aatetratech.inc 949-809-5223
Address
City
State
Zip
17885 Von Karman Avenue
Irvine
California
92514-6213
3 — REGISTERED WELL
DRILLER INFORMATION
Name of Driller
Phone Number
Cascade Drilling Services
909-931-4014
Email
C-57 License Number
joconnor@cascade-env.com
938110
Return well permit to ❑ Well Driller ■ Consultant ❑ Property Owner
Return by ❑ Mail ■ Email
4 — TYPE OF WORK
■ New LMW-CN-1 B. LMW-CN-1 D (nested)
❑ Reconstruction
Cl Destruction
Date of Work
Start Date
June 5, 2017
Completion Date
September 30, 2017
5 — WELL TYPE
❑ Agriculture
❑ Geothermal
❑ Industrial
❑ Cathodic
❑ Horizontal
■ Monitoring/Observation
❑ Community/PWS/City — Specify Use Below
❑ Residential — cannot be used as a
❑ Test
use:
community well
❑ Other
6 —ANNULAR SEAL
Seal Depth (ft.) LMW-CN-1 B: 2-158 feet bgs (bentonite -grout), LMW-CN-1 D: 231-483 feet bgs (bentonite -grout
❑ Driven Conductor Diameter (in.)
❑ Wall (gauge) (in.)
{ ■ Sealing Material Bentonite Grout
❑ Thickness (in.)
Sealing material shall be placed in one continuous pour.
Annular seal thickness must be at least 3 inches for public water supply wells.
7 - DIMENSIONS
Proposed Depth of well (ft.) 230 and 505,re5peCtlVe
Existing Depth of well (ft.) N/A
Diameter ar Bore (in.) 15
_
8 — CASING INSTALLED
❑ Steel ■ Plastic
❑ Standard Casing ❑ Other Cl No Casing
From (ft.)
To (ft.) Diameter (in.)
Wall (Gauge)
0
230
4
0.47
0
505
4
0.47
Gravel Pack ■ Yes
❑ No From (ft.)158, 483
To (ft.)231, 505
Specify Other
From (ft.) N/A
To (ft.) N/A
Backfill Material
Page 1 of 2 Rev 11/6/15
9 — PERFORATIONS list all If applicable)
From (ft.) 160 485 To (ft.) 230 .505 Pumping Rate (gpm) N/A
10 —SEALED ZONES 1111st all If applicablej
From (ft.) 231 1 To (ft.) 483
11— PLOT PLAN
a) In perspective to the well site, sketch and label the following items on a separate Pape r: well lot property lines, other wells
(include abandoned wells), sewage disposal systems (sewers, septic tanks, leaching fields, seepage pits, cesspools), lakes
and ponds, watercourses and animals or fowl kept.
b) Indicate the distance, in feet, of any of the above which are within 500 ft. of the well site. The plot plan needs to be drawn to
scale ('/2 inch = 100 feet), Show the approximate drainage pattern of the property and show access roads to the well site within
500 feet.
c) ❑ None of the above is within 500 feet.
ell Rnliti nr I im dri nionnnal Sita within Twn Milan n YPs 171 Nn Lnration
12 — METHOD OF CONSTRUCTION OR DESTRUCTION
Provide the method of construction/destruction in the space below or as an attachment if more space is needed. The method shall be in
accordance with the standards recommended in the California Department of Water Resources Bulletin No. 74-81 and 74-90. Title 22
standards shall also be followed for public water supply wells.
13 — AGREEMENT AND SIGNATURE
I have read this application and agree to comply with all laws regulating the type of work being performed.
Property Owners�/
X
Date
Signature
_Print Property Owner's Name
C-57 Contractors Date
Signature ��`•p°' 12/1/17
Print Contractors Name —'A"—
Don Win lewich
_S170 OF PERMIT
Jse Only DISPOSITION OF PERMIT For Office Use Only DISPO N
❑ Sent to Water Agency Permit Number:
❑ Water Agency conditions or recommendations attached Expiration Date:
❑ Denied WP Number:
❑ Approved subject to the following:
Notify the Division's Safe Drinking Water Program at (800) 442-2283 at least seventy two (72) hours in advance to make an inspection
A. ❑ of the following operations: (Inspections are conducted Monday — Friday between 8:00 AM to 5:00 PM). Failure to cancel or reschedule
appointments may result in an additional hourly fee.
❑ Prior to sealing of the annular space or filling of the conductor casing.
❑ After installation of the surface protective slab and pumping equipment.
❑ After installation of the surface features.
❑ During destruction of wells, prior to pouring the sealing material.
B. ❑ Submit to the Division, within thirty (30) days after completion of work, a copy of:
❑ Water Well Driller's Report ❑ Bacterial Analysis ❑ Inorganic Chemical Analysis ❑ General Physical
❑ Radiological Analysis ❑ Nitrate ❑ Organic Chemical Analysis ❑ General Mineral
Comments
For Office Use Only , Office Use Only For ■ffice: Use,only Foir Office Use Only s ■ - ■ lily
Fee: FA Number Record 10 PE Number -
Late Fee: ❑ Y ❑ N Designated Employee: Received By: Date:
Check One: ❑ New ❑ Transfer ❑ Reactivate Changes (please specify):
131
EXHI:BIT "2-C"
LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN SCENIC
DRIVE, CAMINO REAL, AND MACKAY DRIVE; IN THE CITY OF SAN BERNARDINO, CA.
S,%N 141 RK.IIMI\t)Public Health
I
COUNTY Environmental Health Services
APPLICATION FOR WELL PERMIT
www.sbcounty.govidph/dehs
Phone: (800) "2-2283
1
Ell :
THIS SECTION TO BE COMPLETEC BY APPLICANT •HEALTH PERMITS ARE NQTTRANSFERABIr
��—Pperty Owner – P 0 ERTY INFORMATION Phone Number
Site Address
City State Zip
Email
Assessor's Parcel Number
Township NIS Tier
ENV Range
Section
Well HeadLatitude (decimal)
34.075454°
Longitude (decimal)
-117.297593°
Properly Owner's Mailing Address
City
State
ZIP
2 — CONSULTANT INFORMATION
Name of Consultant
Email
Phone Number
Tetra Tech Inc.
james._gonzales a@tetratech.inc
949-809-5223
Address
City
State
zip
17885 Von Kerman Avenue
Irvine
California
92614-6213
3 – REGISTERED WELL
DRILLER INFORMATION
Name of Driller
Phone Number
Cascade Drilling Services
909-931-4014
Email
C-57 License Number
joconnor@cascade-env.com
938110
Return well permit to ❑ Well Driller
■ Consultant ❑ Property Owner
Return by ❑ Mail ■ Email
4 – TYPE OF WORK
■ New LMW-CN-2B. LMW-CN-2D (nested)
❑ Reconstruction ❑ Destruction
Date Of Work
Start Date Completion Date
June 5, 2017 September 30, 2017
..........
5 – WELL TYPE
_
❑ Agriculture
❑ Geothermal ❑ Industrial
❑ Cathodic
❑ Horizontal Lo Monitoring/Observation
❑ Community/PWS/City — Specify Use Below
❑ Residential — cannot be used as a ❑ Test
Use:
community well ❑ Other
6 — ANNULAR SEAL
Seal Depth (ft.) LMW-CN-2B: 2-158 feet bgs (bentonite -grout), LMW-CN-2D: 231-483 feet bgs (bentonite -grout
❑ Driven Conductor Diameter (in.)
❑ Wall (gauge) (in.)
■ Sealing Material Bentonite Grout
i
❑ Thickness (in.)
Sealing material shall be placed in one continuous
pour. Annular seal thickness must be at least 3 inches for public water supply wells.
7– DIMENSIONS
Proposed Depth of Well (ft,) Existing Depth of Well (ft.) Diameter of Bore (10230 and 505,respective NIA 15
S – CASING INSTALLED
❑ Steel ■ Plastic
❑ Standard Casing ❑ Other ❑ No Casing
From (ft.)
To (ft.)
Diameter (in.)
Wall (Gauge)
0
230
4
0.47
0
505
4
0.47
Gravel Pack ■ Yes
❑ No
From (ft.)158, 483
To (ft.)231, 505
Specify Other
From (ft.) N/A
To (ft.) N/A
Backfill Material
Page 1 of 2 Rev 1116/15
9 — PERFORATIONS Ilst all If applicable)
From (ft.) 160 , 485 To (ft.) 230 1505 Pumping Rate (gpm) N/A
10 — SEALED ZONES list all if applicable)
From (ft.) 231 To (ft.) 483
11 — PLOT PLAN
a) In perspective to the well site, sketch and label the following items on a separate Daper: well lot property lines, other wells
(include abandoned wells), sewage disposal systems (sewers, septic tanks, leaching fields, seepage pits, cesspools), lakes
and ponds, watercourses and animals or fowl kept.
b) Indicate the distance, in feet, of any of the above which are within 500 ft. of the well site. The plot plan needs to be drawn to
scale (% inch = 100 feet). Show the approximate drainage pattern of the property and show access roads to the well site within
500 feet.
c) ❑ None of the above is within 500 feet.
d) Solid or Liquid Disposal Site within Two Miles ❑ Yes ❑ No Location
12 — METHOD OF CONSTRUCTION OR DESTRUCTION
Provide the method of construction/destruction in the space below or as an attachment if more space is needed. The method shall be in
accordance with the standards recommended in the California Department of Water Resources Bulletin No. 74-81 and 74-90, Title 22
standards shall also be followed for public water supply wells.
13 — AGREEMENT AND SIGNATURE
I have read this application and agree to comply with all laws regulating the type of work being performed.
Property Owner'sv Date
X
Signature
Print Property Owner's Name
Digitally signed by Don fflgkwicfi
C-57 Contractor's�/ ,� •�,
signature /�
Date
2/1/17
Print Contractor's Name A1r20VA2 D114d9:36 -08'9
Don Winglewich
❑ Sent to Water Agency Permit Number.
❑ Water Agency conditions or recommendations attached Expiration Date: ... ........
❑ Dented WP Number: i
--............. ...
❑ Approved subject to the following:
Notify the Division's Safe Drinking Water Program at (800) 442-2283 at least seventy two (72) hours in advance to make an inspection
A. ❑ of the following operations: (Inspections are conducted Monday — Friday between 8:00 AM to 5:00 PM). Failure to cancel or reschedule
appointments may result in an additional hourly fee.
❑ Prior to sealing of the annular space or filling of the conductor casing.
❑ After installation of the surface protective slab and pumping equipment.
❑ After installation of the surface features.
❑ During destruction of wells, prior to pouring the sealing material.
B. ❑ Submit to the Division, within thirty (30) days after completion of work, a copy of:
❑ Water Well Drillers Report ❑ Bacterial Analysis ❑ Inorganic Chemical Analysis ❑ General Physical
❑ Radiological Analysis ❑ Nitrate ❑ Organic Chemical Analysis ❑ General Mineral
Comments
For Office Use Only For Offi.-e Use Only For Office Use Only For Office Us�ie Only For Office Use Only
Fee: FA plumber Record to PE Number
Late Fee: ❑ Y ❑ N Designated Employee: Received By: Date:
Changes (please specify):
Check One: El New ❑Transfer [I Reactivate