HomeMy WebLinkAboutWEC2021-00101 - WEC Inspections - 5/3/2021 ® MASON COUNTY 415NBTH STREET,SHE WA98584
SHELTON:360427-9670,EXT 400
BELFAIR:3fi0-2]5,14654467,EXT 400
Public Health & Human Services ELM:3604825288,EXT 400
FAX 360427-7787
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 WEC2021-00101
APPLICANT FIROUZBAKHT ETUX REZA Phone: 425-894-5709
Address: 7977 170th Ave HE REDMOND,WA 98052
OWNER FIROUZBAKHT ETUX REZA Phone: 425-8945709
Address: 7977 170th Ave NE REDMOND,WA 98052
DOE Start Card: 43778
Well Tag(9 avail.):
Well Site within 100ft of saltwater? No
DOE Variance?
Site Address: 181 NE TIGER WAY EAST
Primary Parcel Number: 123055000025
Contractor/Driller: Davis Drilling
Date Received: 05103/2021
Date Requested: 01/08/2025 St-4rl- tl9 r 4
Date Inspected:
Inspected By:
Inspection Status: IN PROGRESS
Inspection Results: f
Is there a 2"annular space on all sides of the casing? YES [ I NO [ ] Not Observ.
Is there evidence of cascading water [ I YES NO [ ] Not Observ.
Was the driller on site? [ ] YES 118 NO [ ] Not Observ.
Is the well flowing or is there evidence of other I kage? [ ] YES NO [ I Not Observ.
Is there evidence that the seal last least 18 f et Iong? YES [ I NO [ ] Not Observ.
Has the seal slumped? ,[ ] YES Y`NO [ ] Not Observ.
Is there evidence of a surface seal? ] YES It NO [ I Not Observ.
Is the well capped and vented? [ ] YES I ] NO [ ] Not Observ.
Is there evidence of improper well siting or sources of [ ] YES [ 'NO [ ] Not Observ.
contamination? *y"
Comments/Summary:
[ ] PASS ] FAIL [ ] Not Insp.
GIS Lat: O o
GISLon:_ IZ-L • 4,'S V97
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
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