HomeMy WebLinkAboutWEC2002-00010 - WEC Application - 1/11/2002 MASON COUNTY
DEPAR OF HEALTH SERVICES
C� �or3o'VI N 1 2Gp0Q2 SURFACE SEAL CONSTRUCTION PERMrTPO BOX 16"s TOLAX�AL N,4 7 o
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PART 1: Applicant/Parcel Identification
Site House Address Nicole Ln. (Harstene Is. ) Start Card# W151635
DrffNvFimName Arcadia Drilling Inc. Telephone# 360-426-33 5
Property Owner Name Lawrence & Joann Black Telephone# 360-705-4563
MaiGngAddress 2001 Holiday Circle SE Olympia, WA 98501
2 2 0 2 6 _ 1 0 9 0 0 8 4
Assessors Parcel Number _---- -- -- —
Subdivision(If applicabi I Div_Blk_ of
Directions To Site please see attached map
PART 2: Health Department Review (Staff UseOnly)
TAG# YES NO
Drilleron site?...................................................................................................................... ❑ ❑
Isthe well capped&vented?................................................................................................ ^u ❑
Is there evidence of a surface seal? ................................................................................... ❑ ❑
Is there a 2"annular space on all sides of the casing?..................................................... ❑ ❑
Hasthe seal slumped? ....................................................................................................... ❑ ❑
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?....................................................... ❑ ❑
Pass...................................................................................................................................... ❑ ❑
Comments Called in_
kWpector Date d laspedion