HomeMy WebLinkAboutWEC99-0023 - WEC Application - 2/16/1999 (3) i
Mason County
Department of Health Services lIN
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SURFACE SEAL CONSTRUCTION PERMIT Sh Iton, WA 98884
Amount Paid: °� 360) 427-9670
Receipt Number: gel, 6AOif7--7798 .
Permit Number: 3 1� lei
Instructions: F B 16 193
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PART 1: Applicant/PRreel Identification
Site House Address: At'a t/0- 4V FN 'O"Start Card#:
I)rillingFirmName: tQ ILU Iq L✓ Telephone#:
Owner's Name: ( J e j7F1L kEj5/1-14ZTelephone#: — 9
Mailing Address:
UMA/ 7 �7 wA 9£39a
Assessor's Parcel Number:
low
A�%--_-Subdivision(If applicable):
Directions To Site:
PART 2: Heath Department Review(Staff Use Only)
TAG#: ALA z b Date Called In:'2�1 - -
Driller on site? ❑
Is the well capped&vented? .. . .. ... ... .. . .. . .. . .. .. . .. .. . .. . .. . .. . . .. . .. . .. . . ... . . . ... .
Is there evidence of a surface seal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vk ❑
Is there a continuous seal surrounding casing? . . . . . . . . . .Bt ❑
Has the seal slumped?. .. . .. . .. .. . .. . ... .. ... . .. .. . . . .. .. . .. . . . . ... . .. . .. . . ... . ... . . . .. ❑ 7$
Is the well flowing or is there evidence of other leakage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
Is there evidence of cascading water?
Is there evidence that the seal is at least 18 feet long?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do the well site set-backs appear to be appropriate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
PART 3: Conclusions
Inspector Comments:
)4 nnWell
Construction Satisfactory ❑ Well Construction Unsatisfactory
V lir qk(i�t q L.4 l
lnagpktor Signature Date
NJ:NISERWSCOMMON.ADhA WAMAT \WELCONSr.WPD
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File Original with WATER WELL REPORT Notice of Intent w 1 298
Department of Ecology UNIQUE WELL I.D.A
Second Copy-Owners Copy STATE OF WASHINGTON
Third Copy-Drillers Copy Water Right Permit No.
(1) OWNER: Name Lammep Reisinger _ Address
(2) LOCATION OF WELL:-County MasOn i' _1/4—& _1/4 sec-30--T N.R._2W--WM
(4a) STREET ADDRESS OF WELL:(or nearest address) 140 NF. Ralypn T.LC
TAX PARCEL NO.: 22330-50-00290
(3) PROPOSED USE: IN Domestic ❑ Industrial ❑ Municipal (10) WELL LOG w DECOMMISSIONING PROCEDURE DESCRIPTION
❑ Urigation ❑ Test Wet ❑ Other Formation:Describe by color,character,size of material and structure,and
D DeWater the kind and nature of the material in each stra urn penetrated,with at least
(4) TYPE OF WORK: Owners number of well(t more than one) ore end'for each change of inkinnadon.India its at water encountered.
IS New Well Method: MATERIAL FROM TO
❑ Deepened ❑ Dug ❑ Bored
❑ Reconditioned EX Cable ❑Driven
❑ Decarrmhisslon ❑ Rotary ❑ Jetted
(5) DIMENSIONS: Diameterofwell 6 indres
Drilted 243 feet Depth of completed well 943 RBrown haix1pan
(6) CONSTRUCTION DETAILS
Casing Installed:
EX Walled 6 Dim.from--Q_ft.te 7�R R
❑ Liner Instated Dim.from to R
❑ Threaded Diem.from R.to tt
Pedomflons: Dyes ID No Cippipatcd
Type of perforator used .. With Water 2
SIZE of perroretions _ in.by in.
mertoretions from R.te IL
. . Screens: 9VIes ❑No. IN K-Pac Location 236 -.
Manufacturers Name johnsan
Typo c a, Model No. .
Diam. 5 - Sat size from. _238 - R.to 243
Dim. - Slot Size - _ from ft to
I i _
GreveVRiter packed: ❑Yes sT No ❑Size of gravellsand
f "
Materiel placed hem R.to
Surrare seat: 94Yes ❑No To what depth? 18 R. 11.1
Material used in seal Rptnni t p r C
Did any strata contain unusable water! ❑Yes QiNo
Type of water? Depth of skate
Method of sealing strata of
(7) PUMP: Manufacturers Name Callds
Type: sub. H.P. 1
(8) WATER LEVELS: Land-surface elevation above mean sea level R.
Static level 170 ft.below lop of well Date work started 3/8/99 Compl ed 4/1 01,99';
Artesian pressure lbs.per square inch Data
Artesian water is controlled by
(Cap,valve,eft.) WELL CONSTRUCTION CERTIFICATION:
(8) WELL TESTS: Dmwdown is amount water level is lowered below static level I constructed and/or accept responsibility r construction of this welt,and it.
Was a pump test made? []Yes OC No If yes,by wlom7 compliance with all Washington well tonsil an standards. Materials use,
and the information reported above are trut to my best knowledge and belie'
Yield: aalJmin.with R.drawdown after him
Yield: cal./min.with ft.drawdown after M. Type or Print Name�1 $ License No. 0797
Yield: calJmin.withft.drawdown after ins. (Licensed DrillorlE sneer)
Recovery data(time taken as zero when pump turned off)(water level measured from t
Trainee theme License No.
well lop to water larval)
Time Water Level Time Water Level Time Water Level Drilling Compan
(Sig License No. 0797
(Lire for gin r)
Date of test Address Rel fni r i
A R
Bailer test 20 oalJmin,wish ') R.drawdown atter�_hrs. ors
Registration
No DA Date A,., 1 , 9
Airtest aalJmin.with R.drawdown after hm. —"P��
Artesian flow a.p.m. Date (USE ADDITIONAL SHEETS IF NECESSARY)
Temperature of water Was a chemical analysis made? ❑Yes)p No
Ecology is an Equal Opportunity and Affirm tive Acton employer.For specs
accommodation needs, contact the Water F esourres Program at (360)40