HomeMy WebLinkAboutWEC2025-00034 - WEC Inspections - 3/12/2025 416 N SIN STREET,SHELTON,WA 98584
ON
MASON COUNTY SHELT :360-4273870,EXT 400
BELON:360.2754487,EXT 400
Public Health & Human Services ELMA:360482-5269.EXT 400
FAX:360427-7787
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO Si WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT
WELL PERMIT: CONSTRUCTION OF NEW WELL WEC2025-00034
APPLICANT TRIANA,JOSE Phone: 3607483805
Address: 1162 NW STATE AVENUE CHEHALIS,WA 98532
OWNER BURICH ALEXANDER&LARISA Phone: 1.206.458.2890
Address: 31706 47TH CT S AUBURN,WA 98001 I
DOE Start Card: WE59146
Well Tag(if avail.):
Well Site within 100ft of saltwatel) No -
DOE Variance?
Site Address: 20 W SIMPSON RDA
Primary Parcel Number: 520013490083
Contractor/Driller: MOERKE AND SONS PUMP AND DRILLING
Date Received: 03/1212025
Date Requested: 0311812025 �&-N f
Date Inspected: Z3T�'II r�.�rr A b fJ
Inspected BY:
Inspection Status: IN PROGRESS 12S I2_S —TV
Inspection Results:
Is there a 2"annular space on all sides of the casing? &ES I 1 NO I 1 Not Observ.
Is there evidence of cascading water? ] YES +,d NO [ ] Not Observ.
Was the driller on site? [ ] YES !*NO [ ] Not Observ.
Is the well flowing or is there evidence of other leakage? [ ] YES �NO [ ] Not Observ.
Is there evidence that the seal is at least 18 feet long? ' /YES [ ] NO [ ] Not Observ.
Has the seal slumped? [ 1 YES 'FkNO [ ] Not Observ.
Is there evidence of a surface seal? RYES [ ] NO [ ] Not Observ.
Is the well capped and vented? )dYES ```[ NO [ ] Not Observ.
Is there evidence of improper well siting or sources of I ] YES N(7n0 [ ] Not Observ.
contamination?
Comments/Summary: ( ] PASS [ ] FAIL/ [ ] Not Insp.
GIS Lat: q-j. T 1 o
GIS Lon: i7 S ,2.(7(,CID
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE U OAS
PERMIT REPORT /-
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