The URL can be used to link to this page

Home My WebLink AboutWEC2004-00072 - WEC Application - 4/2/2004 MASON COUNTY ICES DEPARTMENT OF HEALTH SERVICES \Ay IV/ 11-A I SURFACE SEAL CONSTRUCMINMI"UBWI 4To�WA 98594 360)4 7-9670 APR 22004 BELFAIR(360)275-W7 Receipt No. FAX(360)427-7798 Date of P TIDEMARK# SERVICES Instructions ............. ............. ........... ...... PART 1: Applicant/Parcel Identification Site House Address Greenvipw Lane Start Card# W1 Q1 grr) Drilling Firm Name Arcadia Drilling Tnr- Telephone q 60-4 16-I I D-5.— Property Owner Name Arent Trwin Telephone# 36n-j-49-QQAA Mailing Address 4771 E. Stai-P Route 3 WA 98594 Assessors Parcel Number 3 2 1 3 5 2 3 q n I Subdivision(if applies Div—Blk—Lot Directions To Site 67nm Mikkpl -qpn Pei f,i�n Prnrped apprnx. 1 mile and look for post wit'9'MT"'and hlArk eagle--turn left and nrnramA to and of ' nua r^.A nA ... .4 *. 0 zjQh+- PART 2: Health D=paf 4'tment Rev!Sw (Staff UseOnly) - TAG# #K4 4;! YES NO Drilleron site?...................................................................................................................... 0 M--, Is the well capped&vented?................................................................................................ G-� El Is there evidence of a surface seal? ................................................................................... 2� 0 Is there a 2"annular space on all sides of the casing? ..................................................... gi,*, 0 Hasthe seal slumped?....................................................................................................... 11 Is the well flowing or is there evidence of other leakage?.................................................. 11 � Is there evidence of cascading water? ............................................................................... 13 R", Is there evidence that the seal Is at least 18 feet long?.................................................... � 11 Do the well site set-backs appear to be appropriate?....................................................... a-' 0 Pass...................................................................................................................................... R/ 13 Comments Called in 4/1P ,79,0 Inspector Date of Inspection