HomeMy WebLinkAboutWEC Well Report / Log - 4/8/2005 o0ep�eranmYlal aiAtl��y WATER WELL REPORT IWE�L�.o:03A R4S�-_
Second Copy-owners copy STATE OF WASHINGTON Wdn Right Permit Na. NIA
Thiel Copy-Ddlers copy
(1)OWNER: Name JIM GREGERSEN.._ _ Addees 6g EAST WATcerueu Y Rcl uw wA 98528
(2)LOCATION OF WELL: County MASON _MW 101 all 1 T. -2A N.,R
(2a)STREET ADDRESS OF WELL for newest seb®) -
TAX PARCEL NO. 22302420. NVIR
(3)PROPOSED USE: XDomasdc ❑RdustrlM ❑MutlpalLJp LL LOG or DECOMMISSIONING PROCEDURE DESCRIPTION:
�bmuapion ElTea1WNl E1Olher HE nlre by cdw.nlwrwnr sass of mnerieleM nuowre.aMow xiMaM
I I oewied' rose—dew mwwvA in eM:n alreNm eBnBUeIM,wi°I i MCLLG19eM/1v YOI WP
UMwmetim IdoessolwTriatic eM.
Owners numberdwed(li mare than one) TD
µ)TYPE OF WORK: 1M
New wen MshlPd D AN
Deepened ❑Dug 06dred BROWN CLAYS ND AN GRAVE GEM D 0 5
-- ReconEWpded ❑Cable QDawln LARGEBOULDERB G EL 165
_Derommisapn XRolery ❑Jaded GRAVEL SAND /CLAY 65
(5)DIMENSIONS: DiameYrdwen SIX inches. CEMENTED ANDANDGRAVELC YS S 1 WEE 5
Dated 203 fast. Dean dcompdeded wen 203 n.
LO SE SAND AND GRA EL W 1 5 3
(6)CONSTRUCTION DETAILS:
Casing installed:
XyYemetl 6 Drew.from +211b M R
❑Linerinatalled _ ' Diem.kom M110 R
OThnatled _ ' Diarrh°m 11.10— M1
Perforations: ❑Yea XNw
TM of perforator used
SREdperforalians in.by M.
mb
perforetiana troth RY R
pedamtthnamom fr.de R
pe mwnsham RY M1
Saran: xYes IINo OXK-Pau Laesibn 198
Manufacturers Name JONNSON
Type STAINLESS STEEL Made No. TEL
Drew. 6 Sldsize 16 ham 198 E.tu 203 R
Dtam state. from d.re M1 --
Greve0Fi0arpaeked: Elyse XNa ❑ Sbe d9mvewnd
Material placed from d.fo a.
Surface seal: XYee []No To whit depth? 18 a.
Msherrel used In and RFYTf1N1TE
Did any amend consist unusable wade" QYe XNo
Troadwater? Dep9 dMRde
Method of sealing shade ell -
(7)PUMP: Musub uWrera Name GOIN I
Type. SUS—. H.P. 1
(6)WATERLEVELS: Lana-sudaaselersnon Wark Stethol 312212005 ,19. Completed 312212005 ,18
eb wi nnam sea level n -
6tenc level 11 d.throw as,dwell Data 312212005 WELL CONSTRUCTION CERTIFICATION:
Avestan praaeun IIN.px squaw inch Data I co rstmnsa anaor accept respormmliilyf er convection of this wall,and as
Artesian water Is controlled by compliance with all Washington well conseudin standards. Matenals used
alp,velw,shut -- and the information reported above are ime to my best knowledge and belief
(9)WELL TESTS:Dresaewn is mount water fowl is lowered below awl byel Typaor Pnm Name NICHOLA$J.ERNST License No. 2147 _
Wes a pump teat made? XYn []NO n yes,by whom? TDDC Rkerwsd Pitwrr=NhweN
YieM: 16_ pf min.wM _4 d.drewdown ader has. Tralnn Name License No.
YeM: ga n l,knin.a it drawmwn alder has. --
YieM: gal.hnin.with _ d.drawdown aser has. Drilling comp�arrA
Recovery data(lime tent as zero when pump armed elf)(water level measured (Signed) /A� a �I N 2147
much well top to water level) {'
Time Water Level Time Water Level Time Water Level
Address PO BOX 2227 Rol FSIY WA.98528
-- — — - _ cndacmre
Re latrHlon No. TOPD0DC054RA _— Date 312MG05 .18
Date ofieM 3/S212o06
general 1s gal.lmin.wah S— d.dmwdowrVl�_ hire (USE ADDITIONAL SHEETS IF NECESSARY)
Akreat galial with s an so Y R far M. Ecology is an Equal Opportunity and AMrmatiw Action employer. Fur
Ar abin now, _ A p.m. Dare 3/2212005 special accommodation needs,conduct the Water Resource Program M
Temperaluredwaw Wn a chemical analyses made? 'Yes IXINo 1 (360)4076600. The TDD number is(360)4076DD8.
•1
•
T,.��S INCIVALYI'ICA4C
26276 Twelve Trees Lane,Suite C
Poulsbo,Washington 98370
(360) 7795141
WATER BACTERIOLOGICAL ANALYSIS
sAMPLE COLLECTION:mMN D IN lob 1 CTTIONiem BACK a 11 F GO DENNR 0 COPY
DATE COLLECTED TIMELOLLECTED COUNTY NAME
". , Qo �274Ju�
AM_ �
EOF VS M I P IG eY TEM,COMPLETE
❑PUe OV
DIVI AL LD.No. CIRCLE DS Sml A B
NAME OF SYSTEM
r/ i/✓1 �' t L� P/i S Q r� .
gPECIFIC— LOCR1011 YM REBWPIEflEC1ED TELEP IdE
lN1 i ;. % aa a'� 'S" RECEIVED
EVENING( ) p 9oQ5
SAMPLE COLLECTEO BY,�;}iM.)f SYSTEM CWNEANGR:(Neme) APR 0 O L
�J Ue ,Vr . 1 r•T y 426 W, CEDAR STc
SOURCE TYPE ❑OROUND WATER UNDER SURFACE INFLUENCE
❑SURFACE WOLLaI D0SPRING �PURC
E�EHASEDw ❑wO NERTICN 1
SENO REPORT TOfi}��M� NNme,Ad4reO Zip Cab)
ttPEg�OgF�T9T1A1qqM��PLE Ialyak elNywM FNle eolumml � xxa+ox
kr
0 DR1MOtN3 WATER Cbloritwed(Rnldu-I,__ Tow _RIM)
cM1ecy VUMeM--� Flllered
O Ummwl or OMer _
0 REPEAT SAMPLE
Previous coliwT weeena M
MIN_.
pe ._I— r— I
I
SDURCE WATER
N❑ m
CONSTRUCTION or REMISS RI ❑FMI CdIWM
❑OTHER(Spec0y)
REMARKS:
--_� (EABMM bwYI DIIeLRRIa wAIERREEUL
❑UNSATISFACTORY•CdIkI—Preeenl TISFACTORY.
Collbrme errant
REPEAT ❑E.Cdi proem ❑E.Cdl eNbelll
SAMPLES
REWIRED 0Rea2l.weNM .. ❑Fql
---OfNER LABORATORY R[aYLTB '.
TOTAL COLff01pd _I100 TI E.COLT__/100 ml
FECAL COLIFOiNA _.1100 W PLATE COUNT_ I ml
ANOTHER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: I
❑Sampw boats 0C luenl gro
❑Wrong wmairl ❑TNTC
❑InmmgeM hrm Exaeee Wt..
.b
❑ _
BOB REVERSE WOE OF GREEN COPY FOR EXPLANATION OF RESULTS
LAB NO.(70101T31 DATE,TIME RECEIVED RECEIVEOBY
01
10
DATE REPO�TEO .,�. LABORATORY.
WATCO CI 1001 IPP R'npv