HomeMy WebLinkAboutWEC2002-00190 - WEC Application - 9/24/2002 JPP
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
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SURFACE SEAL CONSTRUCTION PERMIIPO BOX 1666 SM '0'
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Instructions
PART 1: Applicant/Parcel Identification
Site House Address 200 E. Catfish Lake Road Start Card# W165374
Drilling Firm Name Arcadia Drilling Inc. Telephone# 360-426-3395 —
Property Owner Name J.D. Masters Telephone# 425-778-8091 —
Mailing Address 7304 213th Place SW Apt #110 Edmonds, WA 98026
Assessor's Parcel Number 3 2 1 3 4 7 5 - 0 0 00 4 0
Subdivision(If applicable) Div—Blk—Lol
Directions To Site -
P4pase see attached maps
PART 2: Health Depart ent eview (Staff Us6nn y)
31 ES NO
Drilleron site? .............................................................................................. ....................... :1 0
Isthe well capped&vented?................................................................................................ D 0
Is there evidence of a surface seal? ................. .............
Is there a 2"annular space on at sides of the basing?..................................................... :1
❑
Has the seal slumped? ....................................................................................................... :1
❑
Is the well flowing or is there evidence of other leakage?.................................................. :1 0
Is there evidence of cascading water? ............................................................................... 3 0
Is there evidence that the seal Is at least 18 feet long?.................................................... :1 0
Do the well site set-backs appear to be appropriate? ....................................................... 3 0
Pass..................................................................................................................................... :1 0
Comments Called In
Inspector Date of Inspection