HomeMy WebLinkAboutWEC2001-00122 - WEC Application - 8/22/2001 r#
MASON COUNTY
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DEPARTMENT OF HEALTH SERVICES
SURFACE SEAL CONSTRUCTION wA"S$4
427A670
4 275.1467
Na AUG 2 F 427-7198
2:2001 x p: Date*17"nkest
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PART 1: Applicant/Parcel Identification
;Y ySi<etlouseAd 3080 E. Pickering Rd gtart
ad* W151583
tDd >aF1mi.Name Arcadia Drilling Inc Telephone# 360-w426-3395.
Owner Name James Hill Telephorrei 360-426-333
� � "'Poddress: 3380 W. •Martin Road Shelton, WA 98584
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Parcel Number— -- ----
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�PA(tT 2: Health Department Review (Staff UseOnly)
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TAG 0 MIS NO
Drilleron sb?....................... ..................................................................... ❑ ❑
thewell capped 6 vented?................................................................................................. ❑ ❑
Is,ihere evidence of a surface seai?........................................................................... ..
Is there a 2'annular space on all sides of the casing?..................................................... ❑ ❑
Hasthe seal slumped?.. ............................................................................... ❑ ❑
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le the well flowing or Is there evidence of other leakage?.................................................. ❑ ❑
Is there evidence of cascading water?..........................................................................
❑ , ❑. um
le there evidence that the seal is at least 18 feet long?...........................................- • . ❑ ❑
w Do the well all a ad-backs appear to be appropriate?........................................................ ❑ ❑
=3 ',;rid�'�r�:•� .. _....................... . .. ......................... ...........................................
Called in
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Date of iiipp
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