HomeMy WebLinkAboutWEC Well Report / Log File.Original and First Copy with Start Card No:lW �
Department of:Ecology WATER WELL REPORT
Second Copy-owner's Copy STATE OF WASHINGTON -
Third_Copy Driller's Copy
Water Right Permit No.
(1) 'OWNER: Name f).�ti K° �� a1A/ Addreaalk)• ;_7 . .) n lFJf1 V -i%'%;
(2), LOCATION OF WELL: County �.. ,.y�w Al IV s ��f T.L O N..R a' W.M.
(2a) STREET ADDDRESS OF WELL (or nearest address) - t (u A sft4Li �"A)
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(3) PROPOSED USE: .Domestic Industrial ❑ Municipal ❑ -(10), WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION
❑ Irrigation -
- ❑ DeWater 'Test Well ❑ Other ❑ Formation: Describe by color, character, size of materal and structure, and show
thickness of aquifers and the kind and nature of the ma,terie Iin each stratum penetrated,
(4) TYPE OF WORK' Owner's.number of well . . with at least one entry for each change of information.
(If more than one) MATERIAL FROM TO
Abandoned El Newwell ,`�1 Method: Dug ❑ Bored El - ,
Deepened . ❑ - Cable �X* Driven ❑
Reconditioned ❑ Rotary ❑ Jetted -❑'
(5) DIMENSIONS: Diameterofwell - 4" - inches. �t"fp +. ' h ' cT
r Drilled / i- . JA ^•% \IrJ- A/)� 7e. . C.l it. .
feet. Depth of.completed well /' / /_eft.
G C 4- - c -1 Lt�4 _
(5) CONSTRUCTION DETAILS: - „/. �
Casing installed: _L Diam.from ft.to 3l ft.
i J
Welded Diam.from ft.to ft. t�r2 rJc.1.v�1 _.�cii: -i �!1'jin `7'7
Liner installed
Threaded -❑ I�^ Diam.from ft.to - tt.
Perforations: .Yes❑ NON]
Type of perforator used
SIZE of perforations in.by in. -
perforations from � ff.to t
P III. .
'- perforations from - ff.to - ft. -
perforations from ft.to ft.
Screens: .Yea❑ No4 . - -
Manufacturer's Name
Type Model No. -
Diam. - Slot size from It.to-ft.
Diem. Slot size' from-ft.to IL
Y - -
V Gravel packed. es Ll No V Sze of gravel III
Gravel placed from �L�ll ft.to- �) ff.
Surface seal: Yes.0 No❑ To what dapth7 /f7 ff.
t dept
Material used in seal r •'r (�/ /"""'1•• 1 '
- Did any strata contain unusable water? Yes[-] No® -
Type of water? - Depth of strata-
Method of sealing strata off
(7) PUMP: Manufacturer's Nama
Type. H.P .
8 WATER LEVELS' Laod surface elevation - - -
( ) above mean sea level ft.
Static level. ` ft.below top of well Data I'll�i
Artesian pressure lbs.per square inch Date _
Artesian water is controlled by - -
(Cap,valve.etc.)) -
Work started/1-4-l.9 S •,19. Corti leted 19—
(9) WELL TESTS: Drawdown Is amount water level is lowered below static level
Was a pumptest made?Yes❑ Nok If.yes,bywhom? WELL CONSTRUCTOR-CERTIFICAI ION:
Yield: gal./min.with it.drawdown after hrs. I.constructed and/or accept responsibility for construction of this well,
and its compliance with all Washington well construction standards.
•• Materials used and the information reported a ove are true to my best
Recovery data(time taken as zero when pump turned off)(water level measured knowledge and belief.fro.well top to water levee _
Time Water Level Time Water Level Time Water Level - r(LO is( , / /. C�._ ql.t��
NAME !' J�l(PERS. C.c / SJ K
I (PERSON;FIRM, OR CORPORAITION) (TYPE OR PRINT).
Addressb_).Z(Z r'k'0 (�f
1 f
Out.of test 7 •� 1
.Saner test I (Signed/ )Zlze:-. -1 i a-- License No..��� (b
- gal/min with ff.drawdown after hrs. (WELL DRILLER)
Contractor's - _d
Airtest gal./min.with stem set at ft for hrs. Registration
'�r„vz ,!n,,.�
q Artesian flow -g.p.m Date Me .1 - Data
Temperature of water Was chemical analysis made? Yes El NO LL (USE ADDITIONAL SHEETS IF NF ESSARY)
ECY 050120, (10187), 1329-
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