HomeMy WebLinkAboutWEC Water Sample Results / 3223S - H3 - 90IL2
WATER WELL REPORT � DEPARTMENT OF Notice of Intent No. WE51494
; - r ECOLOGY
=____ Unique Ecology Well ID Tag No.BNM841
Type of Work: State of Washington
l Construction Site Well Name(if more than one well):
-;. D• ecommission ==> Original installation NOI No. Water Right Permit/Certificate No.
Proposed Use: J Domestic 0 Industrial 0 Municipal Property Owner Name PHILIP SIMONS
❑Dewatcring 0 Irrigation ❑Test Well 0 Other Well Street Address 1290 TIMBER TIDES DR
Construction Type: Method:
0 New well )Alteration L Driven 0 Jetted 0 Cable Tool City UNION County MASON
C Deepening 0 Other 0 Dug t Air- 0 Mud-Rotary Tax Parcel No. 322354390162
Dimensions: Diameter of boring 5 ia,to 580 ft.
Was a variance approved for this well? 0 Yes 'i)No
Depth of completed well 560 ft.
if yes,what was the variance for?_
Construction Details: Wall
Casing Liner Diameter From To Thickness Steel PVC Welded Thread
E I 0 6 in. +1 530 .250 in. 41 I 0 E I 0 Location(see instructions on page 2): E WWM or 0 EWM
p I ❑ 5 in. +1 555 .280 in. 3 I 0 0 1 0 SE 1/4-1/4 of the SE SG;Section 35 Township 22N Range 3
• 0 in. _ in. 3 I ❑ 0 I 71 47.348125
O I 0 in. _ in. 0 I 0 0 I 0 Latitude(Example:47.12345)
Longitude(Example:-120.12345) -123.021138
Perforations: 0 Yes Lti No Type of perforator used
No.of perforations_ Size ofperforations in.by in. Driller's Log/Construction or Decommission Procedure
Formation:Describe by color,character,size of material and structure,and the kind and
Perforated from ft.to ft.below ground surface nature of the material in each layer penetrated,with at least one entry for each change of
Screens: Yes J No s K-Packer b Depth ft. information. Use additional sheets if necessary.
Manufacturer's Name Material From To
Type STANLESS Model No.
Diameter 4 in. Slot size 10 in.front 555 ft.to 560 ft, CLAY&GRAVEL BROWN 0 520
Diameter_ in. Slot size in.front ft.to ft. SAND H2O BROWN 1 GPM 520 535
CLAY BROWN 535 545
SandlFiltcr pack:C Yes No Size of pack material in. SAND&GRAVEL H2O BROWN 545 560
Materials placed from_ft.to ft. ''
Surface Seal: N Yes 0 No To what depth? 20 ft.
Material used in seal BENTONITE
Did any strata contain unusable water? _i Yes LM No
1
Type of water? Depth of strata
Method ofsealing strata off '
I
Pump: Manufacturer's Name GOULDS Type: SUB
11.P. 3 Pump intake depth:536 ft. Designed flow rate: 10 gpm
Water Levels: Land-surface elevation above mean sea level ft.
Stick-up of top of well casing 1 ft.above ground surface
Static water level 478 ft.below top of well casing Date 11-30-23 '
Artesian presume lbs.per square inch Date
Artesian water is controlled by (cap,valve,etc.)
Well Tests:
Was a pumping test performed? 3 No M Yes U by whom?
Yield 14 gpm with° ft.drawdown after 4 hrs.
Yield gpm with ft.drawdown slier_hrs.
Yield gpm with_ft.drawdown after hrs.
Recovery data(time- zero when pump is turned otT-water level measured from well
top to water level)
Time Water Level Time Water Level Time Water Level t
Date of pumping test
Bailer test gpm with ft.drawdown after`hrs.^, 1
Air test gpm with stein set at_fi.for_hrs. r- Date
Artesian flow_gpm
Temperature of water_°F Was a chemical analysis made? 0 Yes i No Start Date 4-24-23 Completed Date 11-21-23
WELL CONSTRUCTION CERTIFICATION: 1 constructed andior accept responsibility for construction of this well,and its compliance with all Washington well
construction standards.Materials used and the information reported above are true to my best knowledge and belief.
!-a_ Driller 0 Trainee C PE- nt Name LE PITTS Drilling Company COOLWATER DRILLING,INC.
Signature - Address 10921 NW HOLLY RD
License No.177 City,State,Zip BREMERTON WA 98312
IF TRAINEE:Sponsor's License No. Contractor's
Sponsor's Signature Registration No.COOLWDI941QM Date 12-21-23
ECY 050-1-20(Rev I 1 i 1 S) If you need this document in an alternate fen•ntat.please call the i4'ater Resources Program al
360-407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call
877-833-6341.
f•
26276 Twelve
Trees Ln NW
Ste.0 t. SPECTRA Laboratut•ies - Kitsap
Pouisbo,WA __Whore ezzerisacs marten
98370
(360)779-5141 COUFORM BACTERIA ANALYSIS FORM
Date Sample Collected Tine Sample County
Collected
13c1' Z3 3 0Mt
lttet Day year : 'r' t >4-1 f• 01"'
Type of Water System(check only one box)
❑Group A ❑Group S /21,Other —_.-_.-.-
Group A and Group B Systems-Provide from Water Facilities Inventory(WFI):
IC*
System Neme: p,>r t. r p S,rtti o,✓
Contact Person: r n o L.tJ A-rr4/t 4 X L L x I
Day Phone:'L L' S 3 - c{vex: Cell Phone:
Email: I Eve.Phone:
Send results to:(Print hell nave,artless and zip code a we above for electronic copy of mutts)
Cr.e7 aq f.C.1 3c.4. 11LFLt nl-� Q /-Fo revA:p
SAMPLE INFORMATION
Sample collected by(name). ea o£ 4-
Specific location where sample collected: Special instructions or comments:
t z-SO TTµeur t` rJ4
Type of Sample(check only one box)
1.❑Routine Distribution Sample(AR) 2.❑Repeat Sample(AfP)
Chlorinated:Yes lJ No❑ (from 6strtbr5on system ale(ursat.routine)
Unsatisfactory routine tab number.
Chlorine Residue Total Free__1
3.Ground Water Rule Source Sample —
S I I Unsatisfactory routine collect date:
/ —
Chlorinated:Yes No
❑Triggered ( ) Chlorine Residual:Total_Free_
❑Assessment(A/P)
4.Surface or GWt Raw Source Water Sample(Enumeration) I S I II
1 ❑ E.cog 0 Fecal Mend Yea No
5.tEj Sarypte Collected for Information Only:
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
0 Unsatisfactory Total Coliform Present and Satisfactory
❑E.collpresent ❑E.cobabsent
Bacterial Density Results:Total Cotfomt mpn/100m1.E.coli mpn/100m).
Fecal Colifonn_ _ __- c(tl/l00m1. HPC _ ctu/tml.
Replacement Sample Required: ❑TNTC 0 Sample too old
0 Sample Volume ❑Damaged Container 0
Da /Tin R ived: •
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Receipt Temp Ce: Method •SM92238! T-COUNT/SIt92220
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