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HomeMy WebLinkAboutWEC98-0107 - WEC Application - 5/18/1998 Mason County Department of Health Services a SURFACE SEAL CONSTRWTION PERMIT Shelton, WA 98884 AmountPaid i (36M 427-9670 Receipt Number � FAX(360) 42 7-7798 Permit Number. Instructions: r . PART 1: ApplicanttPareel Identification Site House Address: 102 Juno Court Start Card W101351 Drilling Firm Name: Arcadia Drilling Inc Telephone# 360-426-3395 Owner's Name: Keith Fuller Telephone# 360-426-2646 MailingAddress: 920 W. Railroad Avenue Shelton, WA 98584 Assessor's Parcel Number. 3 2 1 3 4 7 5 _ 9 0 1 4 1 Subdivision(if applicable): Div_Blk_Lot_ Directions To Site: Take Mason Lake Road to Catfish Lake Road then take left on Catfish Place See Attached Maps PART 2: Heath Department Review (Staff Use Only) �y TAG#: Irr,' q'' 3 DateCalledhr: NO Drilleron site? ........... .... . .. .. . ... .. ....... . ... .... ... . ... . . . ... . .. ... .. . . .. .. . .. . ❑ 10 Is the well cspprd&veated? .... ........ . .... .... .......... . ..... ...... . ............ . .... Sr ❑ Is there evidence of a surface seal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in ❑ Is there a continuous seal surrounding casing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . is ❑ Has the seal slumped?... .. . .... .... .... ... ... ... . .. . . . . . . . . ... . .. .. . .. . . .. . . . .. . ❑ 25 Is the well flowing or is there evidence of other leakage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 17 Is there evidence of cascading water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Z Is there evidence that the seal is at least 1 g feet long? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12' ❑ Do the well site set-backs appear to be appropriate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TO ❑ PART 3: Conclusions htspector comments: Q�aw ��'j Well Construction Satisfactory ❑ Well Construction Unsatisfactor7� n .,ry n � t ILLs.''l+++JJJ' ,�::IJI lG"JI �Q ' `_r Signature Date YV l 4 J:WSERW=MMON.AD/MWP$lAWPDATMYVB.CONar.WPD