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HomeMy WebLinkAboutWEC Well Report / Log File Original with WATER WELL REPORT Notice of Intent 1 I l I S Department of Ecology UNIQUE WELL I.O.A Rg6 SaZ Second Copy-Owners Copy STATE OF WASHINGTON Third Copy-Drillers Copy �� r^� �A] a Water Right/Per�mitit No".�� ,� p (1) OWNER: Name E4A.n.p� —W-mik w� Add ''ress ( %a L�C C UA'- (2) LOCATION OF WELL:County .0(}1 I V LO 1/4 Cr 1/4 Sec_2 To.1 tvf MR J 0f�WM (2a) STREET ADDRESS OF WELL:(or nearest address) 3/1 S t• SY1 O-0 I bun- C t AR-- S Q4. . LA / TAX PARCEL NO.: u 24�� fl .06411 'I n 1'/ I (3) PROPOSED USE: ®'Wmestic IC Industrial C Municipal (10) WELL LOG or DECOMMISSIONING PROCEDURE DESCRIPTION ❑ Irrigation ❑ Test Well C Other Formation:Describe by color,character,size of material and structure,and ❑ DeWater the kind and nature of the material in each stratum penetrated,with at least (4) TYPE OF WORK: number of well(if more than one) one entry for each change of information.Indicate all water encountered. New Well Method: MATERIAL FROM TO ❑ Deepened C plrcr ❑ Bored ,^. ,�1I o Cl Reccoditioned Cable D Driven l'^�"�y.�foq ❑ Decommission Rotary ❑ Jetted f" - 4 .4 rtiti G (5) DIMENSIONS: NDiameter of well ��YY inches ffff ____ , Drilled%�!®l�Met. Death of completed well V/-®" ft. ,CP. 2aA.KA 2 f a 4' 471g (6) CONSTRUCTION DETAILS ✓ ¢'Wa• g Dam.from fl ft to Installed: lled: - ISO f. 01"'..a../ C -3o-.- set Sg49 ❑ Liner installed Diam.from _ X.to X. ( ""tt1 `.,L) V- O Threaded ' Diam.from ft.to X. rib,e,i G"v� 0 nh-�., SC. i84/ Perforations: ❑Yes 1? yJ( O_ �8� g� Type of perforator used bra Lf.o- ,wi��}J % SIZE of perforations in.by in. „�r yd ^ - , /0 �' h 3 // R /cedoratio05 from tt.to fl. (yf //' 0 `) Fl D Screens: '�Yes �TJO L K-Pac Location � �e,/ 4 Few 1 //& /3 t Manufacturers Name `-'r'7) Type Model No. Sy Diam. Slot Size from ft.to X. y de.4c or4/ 4ne•-✓(9sA,)/3`/ /9} Diam. Slot Size � from ft.to X V Y el Gravel/Filter packed: '2 Yes (5Nq ❑Size of graveVsan IP Y- /4; / Material placed from ft.to X_ ` /a ~ Surface seal: U o , ?o what depth? /g 4 fL •_ _ Material used in seal Did any strata contain unusable water? ❑Yes . . r - Type of water? Depth of strata Method of sealing strata off o (7) PUMP: Manufacturers Name Type: H.P. (6) WATER LEVELS: Land-sWace elevation above mean sea level tt. /� Static level //0'-/02/✓'• ft.below top of well Date'Z O -erne-erneWork Started22Je �.Completed. lt1,p Artesian pressure lbs.per square inch Date Artesian water is controlled by (Cap,valve.etc) WELL CONSTRUCTION CERTIFICATION: (9) WELL TESTS: Orawdown is amount!dater level is lowered below static level I constructed and/or accept responsibility for construction of this well,and its Was a pump test made? L Yes If yes,by whom? compliance wi all Washington well constructor standards. Materials used and the infor (ion reported above are true to my best knowledge and belie(. Yield: gal/min with ft drawdown alter hrs. / Yield: gal./min.with X.drawdown after hrs. Type or Ef/n r) No. (D YYield: 9a1./min.with X.drawdown after M1rs. tl Drill /EngineeQ Recovery data time taken as zero when pump turned off)(water level measured from Trainee Name Gc¢nse No welltop to water r level) Time Water ev LevelTime Water Level Time Water Level Drilling Co y (Sign tl [�.,QL. License No. ce Sf (Licgpse suer/En ineer),r Di �� Address Li7/0 �•lYC!/ Date of test Contractors Bailer test gal/min.with © -3 X.drawdown after l/M1rs. RegistraVon No/44 are/�Q3> Date p . Airiest Dal/min.with ft drawdown after hrs. Artesian flow 9.P..m. Date (USE ADDITIONAL SHEETS IF NECESSARY) Temperature of water Was a chemical analysis made? _'Yes Ecology is an Equal Opportunity and Affirmative Action employer.For special accommodation needs, contact the Water Resources Program at (360) 407' ECY 050 1-20(I MC 6600.The TDD number is(360)407-6006. File OrginalwM1h WATER WELL REPORT Not'Ice of ntent u1 inise ` Department of Ecology UNIQUE WELL I.D &.R r S 2./ Second Copy-Owners Copy STATE OF WASHINGTON Third Copy-Drillers Copy ^T� � � J� ' y /f Water�Right Permit No. � �� (I) OWNER: Name P)A.O4 L&2Ji L(+—_ Address gad go Pan I rb�rt�l Ltmw�L&)/4 (2) LOCATION OF WELL:County f ti r 1/4 \ P 1/4' Sec 7i S_T 1 p N`R_ '3 �`NM (2a) STREET ADDRESS OF WELL:(or nearreesttaaddrese) a°I tR F n4S -51wNR TAX PARCEL NO.: H2./25 / / yO13O `/oi-i I (3) PROPOSED USE: YDomestic ❑ Industrial C Municipal (ID) WELL LOG or DECOMMISSIONING PROCEDURE DESCRIPTION Bi Irrigation ❑ Test Well C Other Formation:Describe by color,character.size of material and structure,and C DeWater the kind and nature of the material in each stratum penetrated,with at least (0) TYPE OF WORK: Oxyers number of well(if more than one) one entry for each change of information.Indicate all water encountered. New Well Method: MATERIAL FROM TO Deepened Cug C Boren a1 ' / I 6.. ��d / ,f Reconditioned YCable ]Driven CttH V!-y C Decommission O Rotary C Jetted A o kfE..w (5) DIMENSIONS:�/ �j Diameter of well /O " C inches r.L at)t Mir//Misr'i 7 V Drilled /5t/ /'T "I feet Depth of completed well /53.-II- f. Oh; ( (IM-).klnl.f) i (6) CONSTRUCTION DETAILS Casing Installed: • 11 .. ne. .#/F H(/ 69 melded .6 Diam.from/ / - ft.to' 153- ft. C/ ❑ Liner installed Diam,from ft.to tl.❑ Threaded Diem.from h to ft. (QM l teen OC1 F/lf s( 68 /03 Perforations: Yes EtNo (fD.A-y/per-. ),ra,.d /03 //Z Type of perforator used r1a/yL f SIZE of perforations in.by In. f — -rA) rased . ' 'yst /( Z /3 Z /penoatana from ft.to _a 9.1o...t1, tea }lip II ? /Y2 Screens: ❑Yes 14o E K-Pac Location A" / (; 'YA�w/ /H2 /53 acturers Name ) Type Model Na. Diam. Slot Size from ft.to Diam. Slot Size // from n.to - ft. /�n ; ei /5.- /5 4/ )Gravel/Filter packed: ❑Yes fllNO C Size of gravel/sandU w�TFll Material placed from X.to h. _ Surface seal: lees ONo - Towflat depth? /R/ tt. ( -- - Material used In seal -2'.-•"µ C Di any strata contain unusable water? ❑yes Type of water? Depth of strata Method of sealing strata oft (7) PUMP: Manufacturers Name I - t v_ _ -' - r ' Type: H P r _ (8) WATER LEVELS: Land-surface elevation above mean sea level M' ft ` ..w....ff a�pp 'A9 Static level 1/N'' " ft.below top of well Date2y 2 !p - work Stalled 1 SIr / Ot completed 0) Y//a.--ri Artesian pressure lbs.per square inch Date Artesian water is controlled by (Cap,valve,etc-) WELL CONSTRUCTION CERTIFICATION: (9) WELL TESTS: Drawdown is amount„peter level is lowered below static level I constructed and/or accept responsibility for construction of this well,and its a pump test made? 0 Yes '/No If yes,by whom? compliance with all Washington well construction standards. Materials used Was W as gal/min.with ft drawdown after hm and the information re fl ed above are true to my test knowledge/ and belief. Yi Yield. gal/min.with ft.drawdown after Firs. Type or Print Nam a Na err 9' Yield gat/min with ft.drawdown after hrs. (Lce Driller Engineer) Recovery data(time taken as zero when pump turned of)(water level measured from Trainee Name License N well top to water level) Noo. Time Water Level Time Water Level Time Water Level Drilling Comp �� L.lr' - (Sign etl �.[. l( ,can dq[ryllerlEngineer)iceen e No. 4)' f Address 2/270 Y✓ly/V ,v, a.5 W9 Date of test x (((/// Bailer test jn gallmin.with l''l�w q ft.drawdown after s Firs. Contractors a�_ Bm Airiest oallmin.with X.drawdown alter hrs. Regrs12ti0n No.� .F� Date Artesian flow gp.m. Date (USE ADDITIONAL SHEETS IF NECESSARY)- Temperature of water Was a chemical analyse made? ❑Yes 2'I�o Ecology is anEqualOpportunityand Affirmative Action employer.Fors 1 special accommodation needs, contact the Water Resources Program at (360) 40T- EOY 050-1-20(11/98) 6600.Tie TDD number is(360)407.6006.