HomeMy WebLinkAboutWEC2024-00053 - WEC Plot / Site Plans - 3/28/2024 r
j MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360d27-9g70,ExT 400
] Public Heafth & Human Services BELFAIR:360-275-4467,EX7400
ELMA:360-4825269,EXT 400 I
FAX:360327-]]8] I
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD FABE X:
AS I
PERMIT REPORT
WELL PERMIT: CONSTRUCTION OF NEW WELL WEC2024-00053
APPLICANT Brewer, Mike Phone: 3605071000
Address: po box 14996 Tumwater,WA 98511
OWNER JOHNSON CHARLES THOMAS&ERIN
Phone:SAMANTHA LESLIE
Address: 7703 HOLIDAY VALLEY DR NW OLYMPIA, WA 98502 1AS C'/Y
DOE Start Card: WE55979
Well Tag (if avail.):
Well Site within 100R of saltwater? No
DOE Variance?
Site Address: 1485 E Pickering Rd
Primary Parcel Number: 221332150001
Contractor/Driller: American Pump and Drilling
Date Received: 03/28/2024
Date Requested: 04/01/2024 Fare y z 1 2-4
Date Inspected:
Inspected By:
Inspection Status: IN PROGRESS
Inspection Results:
Is there a 2"annular space on all sides of the casing? ,OYES
[ ] NO [ ] Not Observ.
Is there evidence of cascading water? 11 YES
[ ] NO �[-jwot Observ.
Was the driller on site? H-YES
[ ] NO [ ] Not Observ.
Is the well flowing or is there evidence of other leakage?
[ I YES ENO [ ] Not Observ.
Is there evidence that the seal is at least 18 feet long? S
�]''Y� [ ] NO [ ] Not Observ.
Has the seal slumped? (�
[ I YES [ ] NO _[,J-Not Observ. il!LJ`
Is there evidence of a surface seal? Lj-YES
[ I NO [ ] Not Observ.
Is the well capped and vented? [ ] YES
Ij N6 [ ] Not Observ.
Is there evidence of improper well siting or sources of
contamination? [ I YES [ O [ ] Not Observ.
Comments/Summary: -TACT. Ex PE L'i5 '" (vr r [0�4.5
[ ] PASS [ ] FAIL [ ] Not Insp.
St taPEc-C�D- gy ' [ /Vl1 'yaczt 1 L L� GIS Let: 4 ? . 7, 1 04 yv
GIS t`n: 12= 44 >'(,O L{
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
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