HomeMy WebLinkAboutWEC Well Report / Log - 5/30/2006 Please print,sign and return to the Department of Ecology
Water Well Re Cur
Report,1) NNoticeo
of Intent No. //
Orhlwl-Ec°laa. I•�eapy-vwnn.x+<roY-drlllar /iI l^ 5E
E En a a's% Unique Ecology Well ID Tag No.
Construcuon/Dmommluion f Water Right Permit No.
MConstmction -
, Decommission ORIGINAL INSTALLATIONNnrice Property Owner Nam�eV(r k .1_K?]' Vq`
oflntenl Number
WellSvEctAddresS V
FROPsED USE: _❑ iv LWvslnal e MuWwI CIty5 y IS ou.n�T=W fry
❑Daw mimb rcl wdl y�vaua u4Laeatio
(TbL
wwM
TYPEOF WORK: Owrer'anumbmore`e'(UMDee Uenme)
.—U p R ".ed Mwaw:O Du� RBmW on Lat/Long(a.t,r Lat Deg— Lat Min/Sec
❑D
DIMENSIONS: Meeheteettfteell .dnnW R. still REQUIRELD,1) Long Deg_Long MiD/S=
oevm nrmmplebJ wen a Tax Parcel No. I OI r (err`
CONSTRUCT}ONDfTNLS� O"J
C.O., $weMW O11"` v Rw R CONSTRUCTION OR DECOMMISSION PROCEDURE
IntlWkO: U' ttealbd__" Diw.fi.
HLI,"' J Dieberf.m—Rw a' Fomatim. Descnh by cvlrc,tlwaenr,siec ormv¢ml anJ r m,end the Yimlee)
Rrfvsaebw: Ys nmurt ofNe muteri4 in«nalNum Pe.N.wilM1 Ylevuarcemryfm and cMgeaf
TypeofpeA awr wed intbm O_Micate vll w,.r oun¢ret. IUSE ADDITIONAL SHEETS IF NE MoOkYJ
SIZEWperfs_in MATERIAL FROM TO
Sereene: ❑Yn o OK.Px Lmvtim r
Manuntlura'e Nmrc
TYR
MmRI Nv.
Aw R.
Diw.�sld Wrz 1 obe
D'um. Slu:..
Oe.vWIRS., ..;OTa No ❑SiR mpuveUond R
MelciWsplacaJ(ry
Sufbce Se.I:AYm EJW,s TAldePC, R'
Metentiv,ednsml Opel
".'OMacmminwweablewtle(! ❑Yea
Type vfwatef! OapIdeer.
Me bW ofteebag Nmm oR
PUMP. MenaPoclweer.Name .P.
Typ H
WATERLEVEIS' WW Ueedews,t.ebv beteeeea hrid r
S,e ie level er Rbtlowwpvf—H PJ< D
Aneeivn pn.eule lbs.M W.tech pew__
MesianwWeriacaM1o11edby valve e
WELLTESTS: 0.wdow � wvkrlevelialoweedbelo Wiclevel
wee.peter.,wJe''lly. )&No Ifyee,bYwMm?
yield' uvllmin.wiN I Jmw,Wwn al4t Fn.
YieIJ ullinin.wil RJnwJawnuMr__M.
Yield: OUe in wix Rtla &wnaner M.
Neeovery JWu(nmewkenm aw Men pump'—a tl)@'urce lew(meuvMf{A^^TIf
rem
nle,N/
Tie w/ Wtlm Level Time Water Level Time water level
Dtle of. —
DailerRs "J....wM��yflJawdawnabY�ua
Ai�sal/min.wilE Lem•en •T�.�mr�-°"'
Anee...Dow ep.m. De.-
wee.chemko amlpis mWe'! ❑Ym Jallo CompMlatl Deb (/
SMn DWe
WELL CONSTRUCTION CERTIFICATION: I consmb,.d anNor accept responsibility for consradion Of this well,and its compliance With ell
Washington well conMruction sMnd' Materiels ux nd the information reposed above arc Stl tm 1'Y be t bw�ed a en(' iet
pilletlfli6iwe?nirce Name(Praill � / �/ ,l1 Onlliq Conpen) _
AJJeu n. n •_'
OnILtlFne�r?nime 5iyiwlurz - t i C
prillLror woes Licaun No
IfTRA1Nfif. RemyieY.lrm No.l
Dnu..•.u..tee,
n..
Oriaer'e 6i I e &nloSyif en Fgwl Opponwily EnipluYer. ECY DWIaD(4v YQi)
Masan county oewnment of xeattn Services - - T d =MchaWan ace of at mrough ea lialed bekm)
ato Nanh<In,snenon,wA aeseo,asTaaTO en.sao YPe Sampal N
COLIFORM BACTERIA ANALYSIS t,pR yM Diaelwaan Sample 0. Semple(Idlwup
Date SWrpYCasecMd Time Samoa Cdleded Colrlty pmyiW inwrmadon baloW roan roetlataOrory ample)
Chbdnated Yes No Prairie inlarmmlon below, --
D5/ Ql .:`n ❑ aN aanatadory rouble lab Weber,
3 s4p GemiePesWal:Toe_ Fea_ Un
elumn Day
Required
eq Raw WMer Sou SempN - Umateyctpy raMne called oeY:
§ Typed WaterAPub (gMalmly Oneibw)va sonne wiles SurtSwaca Water,GWl,and I—J_
8 eJ ❑ APuhit PIrvsM NamMld mma SMin85oumas) I S I I
Grout
Cleanness:
P . $ l Ch e Yes. No_
❑ GmpBPitp ❑ ONm Chase Res"
lle Fw"(WFh TOps.-_ Fre =
—Pli s alBes WMmFa
GroupAndGmqBSyeems
a.❑Sample Canada for lydm=Wn Only
leadenly(WFp.
IN__———— COnebudwn�RWalrs_PrHale PesitlMwe Omar
—
IN Raw; LAB W ONLY DRINKINGWATER RESULTS LAB USE ONl
tk, $ r a i i ❑tllleatislsctay ri SatiNadory
e Total Coli(am Present and Tddl Colgorm Absen`
g ❑E.Cdi preuml ❑E.Cdi absent
B Coot�Ponarl: ❑Fecal color.present ❑Feral caliwmt absent
U ❑ RepWumeM Sample Rinlwed
Day PhorM: Cal Phonon:
13hp 1o) J_18I - 3 Sample hot tested because: Test unsuitable because:
Ea.Ph": I FAX _ �. ❑Samoa wo dot(i3D hours) ❑TNTC
2 � �l� ❑ Improper o0dalner ❑TMOid astam,
SAMPLE INFORMA11ON Hecate,W*R,,,,: pas fCwn__ rnl. E.Wi _—.1108
Sample Collected by lnamel' �p TOW Cddam J100M. Feel CaliHm__n0pd,
(2f —^ �1 MM ad Code: �ami _�„r 1
Specific location Where sample collected(addlas or a"We. MICR-1800
and rMOf laucet): r 58 2 Analysed: 5-3 Data Reported:
ale:
Special inslrucitow or comments: ^(.
sample Nunbm(DOR nFLm w�al^e dipas� .