HomeMy WebLinkAboutWEC Well Report / Log W-I _ ((206S)A 511-3121TEoa
WATER BA( TERIOLOGICAL ANALYSIS
SAMPLE COLLECTION
Inalrucllene afAD NSTR,,nMS ON EMOK Of ro nM loll mld sample eXB pe Dro)epletl.COPY
GATE OOLLECTE0 TIME COLLEva D COUNTY NAME
MONTH DAY YEAR n' PU��+ yy474 SJt���Y�
TYPE O EM IF PUBLIC SYSTEM,COMPLETE
CIRCLE GROUP
❑ PUBLIC g
INDIVIDUAL (.Q FOP A
Iservss aNv t rsslaenwl
NAME OF SYSTEM /
l! b{ze
SPEGFIC LOCATION WHERE SA LE COLLECTED TqV PHON;NO.
(i..klalren up®wnml,nre cWan.Nunreln) /7/
EVENING( )
SAMPLE COLLECTED BY:(Narne)
Sy STEM OWNERIMGR.:(Name)
GPO 0 WATER UNDER SURFACE INFLUENCE C ISNATION
SOURDE TYPE ❑)WELL m ❑SPRING ❑PURCHASED or ❑a OTHER.
❑SURFACE )J WELL FIELD AU4ry�j INTERTIE
� - /i(/ ananpc�l
SEND RE TO:(Ptl,Full N pp
m T A xc o�
5E /-2u ij' tk' .
` )f WASHINGTON S�
lL+ N I )
TYPE OF SAMPLE(check nIY Free)
POUTINE ❑ CNlodnaletllPesitluel:�Toml�-
DRINKING
l neelmeME� Oer¢tl
FiH
/ Uemd tl or Omer ---
❑ REPEAT SAMPLE
Prwiou¢oalXprm presarae Lap A----�—�—�-
Previous mjIWm presence Dale O m ❑.TMeI Coolorm
❑ RAW SOURCE WATER Somw N S ❑Fecal Coliform
❑ NEW CONSTRUCTION or REPAIRS
❑ OTHER(Specify)
REMARKS
METHOD USED
MF MPN
PA MO
E.COI 100 ml
TOTAL COLIFORM_J100 ml HETEPOTROPHIC per ml
FECAL COLIFOPM_J
op ml
ANOTHER SAMPLE REOUIRED II
TEST UNSUITABLE BECAUSE:
SAMPLE NOT TESTED BECAUSE: ❑Confluent 91e P
❑ Sample tW old ❑TNTC
❑W.K]contelner ❑ TuvW culture
❑ IAcpmplem form ❑ Excess eebns
DRINKING WPTEP SPMPLE RESULTS �TISFAGTOBY,
UNSATISFPCTORV,Calilorms present
Colllerms aMenl
( REPEAT ❑E.Colipresent ❑E.Coll absent
SAMPLES REQUIRED ❑Fecal pmsem ❑ Fecal absent
SEE REVERSE 510E OF GREED hP TIMER EXpLAED��TIIION a BECE TS_BY
I LAB NO. '1 L�
89-� -.3Lq 0 y ,,q 19 I m
ROUTE ACCT.N
4{ ��REP ORTED
I I JV UI l
-1
N A T R R N 8 L L R 6 P O R T Star[ Card No. 087944
STATE OF NATIINONN Nate[ Right Permit'No.
......................................................................................................................
Ill CNNBR: Name 1648LY, BILL Md[eee MIRWBW RMU N.. ..f, A 9-- P-
• . - 8N 1/1 M8 1/a Sec )a T ]111 N.. R lW NN
(I STREETWATION OF SELL: County r neN
13a1 STREET AWR85S OF l nearest address..... ..... ... MOAN
...... ..___ .................... .. ....... ....................
(l) PROPOSED USE: pPRBTIC I I30) NBLL LCO _________
....TYPE.. . ... . . ............... .
Pormatien: Meec[Sbe by color, cMrac[er, mSze of material
(p Typg OF WORK: Owner's Number of well I and atfucture, and Show thickness of aquifers end the kind
(If more than onel :aterial in each stratum penetrated, with
New Np•L Method: ROfABp I entl reture of me
Y ET......................EY........w..........inch ...I at least ens entry for each clung. in fermaklon.
O3ametm of well 6 Snchas I_____________________________________________________
I51 DrilleDIFURNSd 63 MATERIAL I 0 116
Drilled 0l ft. Depth of eted Nell .l ft. I
.. . ..P ............................................� GRaysi.aw, BRUIN GWY I 0 116
I61 CYINSTRUinsta OCI'AI18: I GRAVEL RRONR C1J.Y F SAW 16 I lT
Casing installed: 0 Oia. free F] ft. to Be ft. RRowx Many PAT I lT I S3
WQDW ' Dim. from ft. t0 ft. I &FAVE RAW NASER 16] I Tl
E N1i. f[OIII ft. CO f[. I GMVQ• BROWN SAW F WATER
i ]S ; al
_____________________ I
PerTypet loop: fo
Type of perforator used
SI38 of perforations in. by in. I I I
Perferati from ft_ Co ft. I I I
perforat lone... fr. ft. to ft.
per I
fcu[ions fran ft. to ft. I
_ ___________
Scram.: YENS
rlanu[aceuxere Name
Type SIO1TW Model No.
Dies. 9 slot size .014 Iran 63 ft. to 00 ft I I I
Ties. Blot eI.. flan ft. to ft.
-------------------------
Gravel packed: NO Mize of gravel I I
Gravel Placed from ft. Co ft.------------------------------------------
----_..I
Surface .Galt YES To what depth? 20
Wtezfel used in seal 8Of®IT8 I .
Did awry strata contain unusable water? W i I I
Type Of watnrl Depth of atrmte ft.
.....E-Method of s`elln9 strata.. off..............................
IYI PUMP: Manufacturer's Name
Type H.P. I I I
........................................... I I
(RIT'am LRVRIC: Land-surface elevation I I I
above ..an sea level ... ft, I
static level 31 ft. below top of well at. 04/I7/93 I I I
Ar[esfen Pressure lbs. Per Square inch Data
Artesian water controlled by I Work started 04/27/93 Completed 04/27/11
......TTY.....Y.TP....T_TT.PP..P...............Y..
Tv.......E-v v.rte
CERTIF
(91^NBLL TESTS: Orawdorn'fa ..not water level fa I...red below i NW; constructed NL aM/o[ICATION accept [eaponslb111ty for con-
ataCic level. ith
maw a pump test made? W If ye., by whom? I .Cructlon of this well, end iee compliance ter? all
Yield: gal./min with ft. drawdown after Are. and thefnforreation reported above Gas true toimy banals e
I kne.ledge and belief. e
Recovery data
Time Water Level Ties Water Level Time Mate[ Level i NAME MIA -.-I-
firm NN.cvvvosaavrpaamo..[mL6ationl (Type or print)
I "DRESS Os 1?
Date of tee[ / / ILicenae No. 1093
Bailer tee[ gal/min. f[, tlra+down after hra. I I6IGNR01
Air test 10 gal/min. w/ Stem set at 63 ft. for 1 hr..I
Artesian flow g.P.m. Mete I Con[raetor'e04/27/93
Temperature of water Nae a Chemical ...lysl. made? NO I Regi.tra[Son No. AWCANDI09e81 Pete ................
........................... .......... .. ....... ....... ....T ......
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