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Home My WebLink AboutWEC Well Report / Log WATER MANAGEMENT LABS 15 15 BOTH STREET E TACgNA, seaoa _ It (- 121 WATER BAMRIQLOGICAL ANALYSIS AMPLE CO.LECTION.LEAD INSTRUCTIONS ON BACK OF GOLDENROD COPY N Inetroclbne ere not lalbwetl,bnlPk WIN Not r.JWW. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR 1 W 1 ❑AM C pM TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLETE; SOLI PUBuc --�--�1� ®INDIMWAC I.D.N CIRCLE GROUPo' narrea amyl ladoenee) A 9 NAME OF SYSTEM J PIS ft kftICLCCAIIpy WNENE IPLE CCUUSCEU TELEPHONE NO. IM MIkMn taP®ecM1ON.fin sleliro-,,ryynlein) wall Head SAMPLE COLLECTED BY:INamel EBENINGI ) SYSTEM OWNER I MGR;INemel ARC;ADTA DBILLT'NG, SOURCE TYPE GRO TER UNDER SUR ACE NIFLUENCE ❑ SURFACE ® YYELL ELO SPRING EIPURCHASEDw 0CCM&NATION SEND REPORT N:Iprint Poll Name,Mdress INTEgTIE OTHER and LP coast TYPE1OF SAMPLE(cMck only ore in IMs column) WASHINGTON W ROUTINE DRINKING W R Cf e N%ACul: _Toal chak reamnt s,Free) � 0 Filteretl ❑ Untreatetl or COLA, REPEAT SAMPLE previous colfwm Presence lab x P AWV .11AN m Presence Pata�y� ❑ RAW SOURCE WATER Scurce x S❑ m NEW CONSTRUCTION Or REPAIRS Total CWlI 13, eFecal OTHER 1 ec CFIUN Oil ) REMARKS LABORATORY RESULTS IFOR LAN.UNE pryyyl __—___..____ METHOD USED MF MPN MMO PRG TOTAL CULIFORMJj�.m FECAL DDLIFDRM ECOLI�_ytPp ml R HETEROTROPHIC RT—t I ANOTHER SAMPLE REQUIREDSAMPLE NOT TESTED BECAUSE: ❑Sample too old TEST UNSUITABLE BE Wmng cpnlaiepf ❑Confluent NO, OImomWefe form TNTO w �I T Idtl culture UI ❑E ees tletne r... DRINKING WgTER SAMPLE RESULTS UNBATISFgCTORY Colilorms praseN REPEAT A q SAMPLES ❑E Coli present �E.Col.absent CiOliforms absent REQUIRED ❑RNNN resent ❑Fecal ebeenl SEE REVERSES OF GREEN COPY FOR EX PLANATION OF RESULTS WATER WELL REPORT N�"Inten,a, W165374 ::v:r�:k:�:;Odgad&1st copy-Ecology,2nd wpy-owner,3rd copy-ddller AGR314 Unique Ecology Well ID Tag No. ConstructumMecomnusslon Ck'w rud,) Exempt Well a Construction WderRighlPermitNo. emp 0 Decommission ORIGINAL CONSTRUCTION Nonce o,f� GdentNumber propelryowne Name J D Masters rp PROPOSEDUSE: n.•nmaac Olnduarud ❑Muoicipd wen Street Add.. 200 E. Catfish lake Road ❑DaWme, ❑Irrigation ❑Tatweu DOdma Shelton Commy: Mason EOPWORK: Owncrs nurobn of wen(ifmme than one) Gry SE SE 34 iN 3W Ew'M nrcle 13NCw Well 0 Rewodiaoocd Medmd. []Dug ❑Romd ❑Drivm LlCetlon_I/4 I/d—1/d Sec— Tw� R_ m ow ❑Dapmed ❑table ®Rotary ❑lamed I bung: L. N47° r DeB Iat MRJSec ffNSIONS: DiameterofwcJ1 mem,.ddned 138 It (^,vain i.mK Dca.212�3° lfisec 36'11" Depth of completed ww 138 It REQUERED) 321347500040 �� CONSTRUCTION DETAILS Tax parcel No. Caaft 9VIelded 6 D'am.Rom +1 Rto AlLft CONSTRUCTION OR DECOMMISSION PROCEDURE lunmlled: Dtam'noodled Dian.Rom ft m R. Fonvadom Describe by mar,ratter.sirs of material and mueture,and the and to_R and nahve of We marmial in each snaWm peoem ent a¢d,with at l ❑Th ceded Diem Rom h ova entry far omh change of iom meow.Indicate W water eneouomrad. Perf.dom: ❑Yet ®No (USE ADDITIONAL SHF.EIS IF NECESSARY.) Type of perfomtm own MATERIAL FROM TO IZEofperfs_th.by_imwdno.ofperfs_Rom_Rm R Brown fine to coarse 0 Stew:0Ya [NNo 0K-Pat Loa grave , -im to coarse Manufxmoefs Name sand d dense a - a Typc Model No. Dian Slot sirs fom Rm R Brown fine to coarse 23 Diem. Slue Sio, fun ft.a R zravelly. fine to coarse erawevini tun Paved: ❑ra (MN. ❑sirr ofgnwevsavd sand with silt i t den Mav'ala placed fiory Rm R well- raded 37 surface Seal: ®Yes []No To wbar dwth? 20 R Brown fine zravell mediuL37 Mam;att mad steal Bentonite to coarse sand moist loose Did any armor contain unusable water? DYa [RNo poorly graded 47 Type Ofw"er? Depth or soda Black fine gravelly, fine 47 Wdodofmativgmanoff to medium sand wet loose PUMP: bftm. uera Noma poorly gradect 55 T) . H.P. Gray c ayey silt,moist,soft 55 99 WATER LEVELS: Iand.tafaa de,moh above man:,level 269 ft Black fine gravelly, fine 99 Smdc level 87 h.beam top of weft Dam 11-19-02 Aran.presaae_1M.pa snare lath Nam t0 medium sandwet loose A"aiaa ware u camwRad try poor y graaer 102 ( •°dwe•or.) Gray clayey silt moist sti f 102 114 wP.u,Trs-rs: DrawCowo is.1—lade 1pwe"d Maw-Uric level grown silty clay dry stiff 114 122 Was a pump ant came? DYea ElNo It yea,by whom? Black fine to coarse 122 Yidd:,�dJma.with ftdmwdown afla hrs. Yidd: gdJrwn.wim ft Oawdawo aaa M. avail Illedllgll to coarse Yield:,1dlma.aim hdm fterwdowa a loa. S , water, OOSe, a Recovery dara(tow rake,w rem when pump ta,ed off)(wmer level memaredfro graded, gray clayey silt w'U cop ro warn levee) Trine Wdarl.avd Time wamrl el Time Water lewd moist, stiff 138 Dateofe Rails ten-30 mice m.w with R Mwdowo dter� A'utest fit/ aalJmiv.with V.tea at- 33—R for ba. Artesian flow e.p.m. Date S plete 11-19-D2 Tcmpemtvm of wder�3_Wazachardnl avdysis made? DYa ®No un Dam 11-19-D2 Com d Da k WELL CONSTRUCTION CERTITICATTON: I constructed and/or accept responsibibry for comtrucdon of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are one m my hest knowledge and belief. IRDduer Elagiocer OTmioee Nama(Po ) Jermv P&Iin Dniungcompany Arcadia Drilling Tne. Drillm/Fnglnealfrainee Si ,_ e^ Address 170 SE Walker Park Road Driller or Trainee LCenseN 260 City State,Zip Shelton WA 98584 Conuac*or's ARGADDI098KI 11-20-02 IDtrainee,licensed driDMs Regjsoatim No Date Si�mhne and License no' EwI,RY is an Fgml Opporm,iry Fmulover. ECY 0 0-1-20(Rev"l)