HomeMy WebLinkAboutWEC2024-00109 - WEC Inspections - 9/20/2024 WA 98584
® MASON COUNTY 415 N6TH LFAIR: 60-275ON, ,E)(Tt0
SHELTON:36043]-96]0,EXT 400
BELFAIR:360-2]54481,EXT d00
Public Health & Human Services ELMA:3604825269,EXr 400
FAX:36042]-n8]
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
WELL PERMIT: CONSTRUCTION OF NEW WELL WEC2024-00109
APPLICANT Greg Allen Phone: 2532299855
Address: 17358 E State Route 3 Allyn,WA 98524
OWNER ALLEN GREGORY WAYNE&TIFFANI Phone: 253-229-9855
JEAN
Address: P O BOX 1914 ALLYN,WA 98524
DOE Start Card: WE5787 (vim
Well Tag (if avail.):
Well Site within 100ft of saltwater? No Lh 9
DOE Variance? Ip
Site Address: 233 E WILLIAMS PL
Primary Parcel Number: 122292400010
Contractor/OdIler: Tacoma Pump &Drilling Co., Inc.
Date Received: 0912012024 qj `1
Date Requested: 12/1012024
Dale Inspected: I.L11VI2oT..{ Stoe1 ok." _ I,h T2��
Inspected By:
Inspection Status: IN PROGRESS
Inspection Results: �yq
Is there a 2°annular space on all sides of the casing? I ] YES [ ] NO Y4 Not Observ.
Is there evidence of cascading water? [ ] YES ( ] NO [A Not Observ.
Was the driller on site? VIL YES [ ] NO [ ] Not Observ.
Is the well flowing or is there evidence of other leakage? I I YES [ ] NO [ANot Observ.
Is there evidence that the seal is at least 18 feet long? [ I YES [ ] NO Y Not Observ.
Has the seal slumped? [ ] YES I ] NO [p Nat Observ.
Is there evidence of a surface seal? I 1 YES I ] NO Not Observ.
Is the well capped and vented? [ ] YES Yv NO [ ]. Not Observ.
Is there evidence of improper well siting or sources of [ I YES NO [ ] Not Observ.
contamination?
Comments/Summary: f10 PASS [ ] FAIL [ ] Not Imp.
Y� GIS Let: 4i , mn-'
GIS Lon:-A'77 , gs125%
A-e
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
Sell
I-�-- 325'+/-
77
i POS�IBLE
i \ r WELL PITE
II II R100' 4
I 11
AOPROx. i
BUI BRING
,LOCATION,�
S/T
,o
PROPOSED I
4, PRAINFIEL
J ATTN.
ZONE
I I
I I
STREAM PER GI5
NO SURFACE WATER
OR SIGNS OF SURFACE I I
WATER DURING
SITE VISIT. — —
e ..
APPROVE - - - - - -
+AA80N000NTVENyIR0MMENTALHEALTF E011M
rvr
DESIONNOTEB. INSTALIATIONDDIONERSIGNOFFUSBVILTFEEWIUBECHARGEDATTIMEOFINSTALL nON. ANYPIQP Ev STeV XN ARESVBIECTTO
OTHERDEPARTMENTREVIEWS,DESIGNERNOTRESPONSIBLEFORSETBA MVNRELATEDTOSEPTICCOMPONENTS.
CIDTOMER: MAN AILEN E('AI F.I'w
PIONEER DIGGING, INC PARCEL t.m2924o00io TESFM L TEbT1I 2:
SEPTIC DESIGNS ADDRESS: xxwLILVJSROAD O19G 0-29(
29.TILL. 29 TU
30B3EMASONBFTEONRD GRM 11M.WANB DESIGNER: ROBERTPAYSSE
OFFICE-36O4261803 FM 360427-2353 DESIGN PAGE _OF_