HomeMy WebLinkAboutWEC2023-00025 - WEC Application - 3/14/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269.EXT 400
FAX:360-427-7787
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
WELL PERMIT: CONSTRUCTION OF NEW WELL WEC2023-00025
APPLICANT Brewer, Mike Phone: 3605071000
Address: po box 14996 Tumwater, WA 98511
OWNER JIMINI CONSTRUCTION LLC Phone: 360-349-9875
Address: PO BOX 2079 SHELTON, WA 98584
DOE Start Card: we52154
Well Tag (if avail.):
Well Site within 100ft of saltwater? No
DOE Variance?
Site Address: 60 E North Bay Rd
Primary Parcel Number: 122205091532
Contractor/Driller: American Pump and Drilling
Date Received: 03/14/2023
Date Requested: 03/14/2023
Date Inspected:
Inspected By:
Inspection Status: IN PROGRESS
Inspection Results:
Is there a 2" annular space on all sides of the casing? S [ ] NO [ ] Not Observ.
Is there evidence of cascading water? [ ] YES [ ] NO „j_f Not Observ.
Was the driller on site? .121-1\( ,[--]-YES [ ] NO [ ] Not Observ.
Is the well flowing pti'is there evidence of other leakage? -r ES [ ] NO [ ] Not Observ.
Is there evidence that the seal is at least 18 feet long? Z [ ] YES [ ] NO JNot Observ.
Has the seal slumped? [ ] YES [ ] NO [.-]'Not Observ.
Is there evidence of a surface seal? 4 ,v,t\--a ,&_ S [ ] NO [ ] Not Observ.
Is the well capped and vented? [ j YES ( ] Not Observ.
Is there evidence of improper well siting or sources ofpD �j AYES [ ] NO ( j Not Observ.
contamination? y,((�k u.wv� 14
Comm ts/Summary:
WQ . ‘1'-' c- lL(,�{-1 [ ] PASS [ ] FAIL [ ] Not Insp.
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