HomeMy WebLinkAboutWEC2006-00215 - WEC Application - 7/19/2006 MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
426 W. CEDAR ST., PO BOX 1666, SHELTON WA 98584
SHELTON (360) 427-9670 ELMA (360) 482-5269 BELFAIR (360) 275-4467
WEB http://www.co.mason.wa.us FAX (360) 427-7798
APPLICATION FOR WELL SURFACE SEAL CONSTRUCTION PERMIT
Receipt Number: 552-00( '30 WEC: '06' - c01/5-
1. Complete Part 1, incomplete applications will not be accepted
2. Attach a plot plan and vicinity map
3. Submit this completed application with appropriate fees a minimum of 24
hours in advance of initiating a well
4. The Mason County Health Department must receive notification at least 24
hours prior to the drilling of the well
Date Received
PART 1: Applicant/Parcel Identification
Site Address E. Banty, Shelton, WA 98584 Start Card #WE05271
Drilling Firm: Arcadia Drilling Inc. Phone:
360.426.3395
Applicant Fred & Ruth Richard Phone:
360.459.5384
Mailing Address 7508es Island Rd. S.E., Olympia, WA 98503
Parcel Number(s) 321207590203
Directions to Site From Shelton traven north on Hwy 101 and turn right on Brockdale
Rd. and then left on McReavy at stop sign. After couple miles turn right on Pinderosa,
then left on Banty Lane. Follow to site at end with Arcadia Drilling sign.
Is the well site within 100 feet of salt/seawater? ❑ Yes No
If yes, a variance from DOE is required. Have you applied /received a variance? ❑ Yes ❑No
Connie Williams for Arcadia Drilling Inc.
Applicant/Agent Signature
PART 2: Health Department Review Staff Use nly)
YES NO TAG # LAJ 3 Called In 5/3
❑� � Driller on Site?
,mil Is the well capped and Vented?
❑ Is there evidence of a surface seal?
❑ Is there a 2" annular space on all sides of the casing?
❑ J 3) Has the seal Slumped?
❑ Is the well flowing or is there evidence of other leakage?
❑ 'ED Is there evidence of cascading water?
j2"-- Is there evidence that the seal is at least 18 feet long?
CIZIJ ❑ Do the well site set-backs appear to b appropriate?
Ime is RECEIVED
Vass Fail Inspector Date (�%/
—
F'EALTH SERVICES, i
i .. . / Q. /
C. ///{//7y .
o� P,u,306 IP �e7
XSHORT PLAT OF A PORTION OF THE
NORTHWEST QUARTER (NWk) OF SECTION `
20, TOWNSHIP 21 NORTH, RANGE 3 WEST, W. . .
Ram.) D, RUTS ‘
‘
1217 Seurat oz,3,•ca En sr -II.:.414
,, _ _.....
SELLER: ril '
Danny L. Lloyd a`. —- Ili ra3:a
MI b
C/o Gary L. Payne . , nwy,�
25057 Prager Road S. ` Na'
gent, WA., 98032 be., u�?. writo-4
Q
1111111
N.
cF ' • •
M ` . • 4 41
U.
O e
1 0 . �.s . .
.m. \ c.
•
+
• at
•
ri,
. ,
,..
kl
M `
.Z' .4 O
co
JJJ���' ,
. 1
• w y ra
n I n
au
ter„ :
0
i\ `
F t, , kl
•
,4° may. K.:)) .
1�b LL G 311
3
,i-t\-'''' ... ..,11:4,7;
S In o
row$.. 3- s 11 VI,
+ b.
6 tlJ
T i
o ihJf: PIS t it.C+V b ,- acvrc«G -
•
�;. . r .�.. ..RECEIVED w
...Aria.., •
JUL 19 20e6
HEALTH SERVICES, EH
06/18/2007 MON 9:28 FAX 3604268493 shelton@washhome.com a002/003 1
JUN-15-2007 FRI 10:04 AM FAX NO, P. 02
I
1
Arcadia Drilling Inc. •
P.G. Box 1790
Shelton,WA.98584 ;
Customer: Jim&Kim Robertson Date of Test: 5/16/2007
Contact; 1 Well Tag#: ALN346
Wall Site Address : 150 E. Banty I Shelton 1 Depth : 260ft
Water System : Static: 203.2ft
I
TIME GPM LEVEL PPM TIME GPM LEVEL _PPM
1 Min _ 11 203.5ft 4Hr 30Min
2 Min 11 203,55ft 5Hr
3 Min 11 203.55ft 5Hr 30Miri_
4 Min 11 203.55ft 6Hr I
_
5 Min 11 203.55ft 6Hr 30Min ,
6 Min 11 203.55ft 7Hr
7 Min 13 203.55ft 7Hr 30Miri
8 Min 13 203.7ft 4 8Hr, _, _
9 Min 13 203.7ft
10 Min 13 203.7ft RECOVERY
15 Min 18 203.7ft TIME LEVEL TIME LEVEL
20 Min 18 203.85ft 1 Min I 203.2ft 2Hr 20Min .
25 Min 18 203.85ft 2 Min i 2Hr 30Min _
30 Min 18 203,85ft _ 3 Min 2Hr 40Min
35 Min 18 203,85ft 4 Min 2Hr 50Min
40 Min 18 203.85ft 5 Min 3 Hr
45 Min 18 203.85ft r 6 Min 3Hr 10Min
50 Min 18 203.85ft 7 Min I 3Hr 20Min
55 Min 18 203,85ft 8 Min 3Hr 30Min
1 Hr 18 203.85ft 9 Min 3Hr 40Min'
1Hr 10Min 18 203.85ff 10Min _ 3Hr 50Min
1Hr 20Min 18 203.85ft 15 Min 4 Hr'
1Hr 30Min 18 203.85ft 20 Min 1 4Hr 10Min
1Hr 40Min 18 203.85ft 25 Min' 4Hr 20Min
1Hr 50Min 18 203.85ft 30 Min• 4Hr 30Min
2Hr 18 " 203.85ft 35 Mini 4Hr 40Min
2Hr 10Min 40 Mini 4Hr 50Min
2Hr 20Min ,
45 Min 5Hr _2Hr 30Min i 50 Min, 5Hr 10Min
2Hr 40Min 55 Mint 5Hr 20Min
2Hr 50Min 1 Hr 5Hr 30Min
3 Hr 1Hr 10Min 5Hr40Min
3Hr 10Min 1Hr 20M1n 5Hr 50Min
3Hr 20Min 1 Hr 30M n - • Hr
3Hr 30Min A 1 Hr 40M n •
6Hr 30Min
_3Hr 40Min '1Hr 50M n 7 Hr
3Hr 50Min 2 Hr 1 7Hr 3oMin
4Hr 2Hr 10MIin 8 Hr
—
06/18/2007 MON 9: 30 [ JOB NO. 5746] 0002