HomeMy WebLinkAboutWEC2025-00026 - WEC Inspections - 2/27/2025 A-P- CA/-b( /9 Ta
415N6SHELTR
EET,SHELTON,WA 98584
MASON COUNTY ON 3 0<27-967 EXT400
Public Health & Human Services BE ELMA:360482-5269,EXT 400
ELMA:3fi0i82-5269,ERr 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 WEC2025-00026
APPLICANT Robinson,Savannah Phone: 3606696858
Address: 1213 S Yew St Centralia, WA 98531
t OWNER HOLLIS BOB Phone:
Address: 4551 E PALOBREA LN CAVE CREEK,AZ 85331
DOE Start Card: 5B949 A-f"CO( A 'KID 8-PW'Z6-
Well Tag (if avail.): I i 4u-4u$
Well Site within 100fl of saltwater? No
DOE Variance?
.3 LT-1 JSST p4TYALNALLA //
Site Address: ,I6H{(NeWN APA"IR as kl*- 71l�
Primary Parcel Number: 220287590012 Ip/n2d, a /V'
Contractor/Driller: Moerke and Sons Pump and Drilling
Date Received: 02/27/2025
Date Requested: 03/14/2025 L —3 l Z I '-2
Date Inspected: 1
Inspected By: �QI
Inspection Status: IN PROGRESS
Inspection Results:
Is there a 2"annular space on all sides of the casing? [ ] YES [ ] NO (�} Not Obsely.
Is there evidence of cascading water? [ ] YES hf NO [ ] Not Observ.
Was the driller on site? [)0 YES [ I NO [ ] Not Obsew.
Is the well flowing or is there evidence of other leakage? ( I YES [ ]+,NO [ ] Not Observ.
Is there evidence that the seal is at least 18 feet long? [ I YES [ ] NO r$ Not Observ.
Has the seal slumped? [ ) YES W NO ,�[.r -WI Observ.
Is there evidence of a surface seal? YE [ ] NO id.Not Observ.
Is the well capped and vented?, YES [ ] NO [V Not Observ.
Is there evidence of improper well siting or sources of
contamination? [ I YES NO [ ] Not Observ.
Comments/Summa Rat 6to
2ry: Lon [ ] PASS [ ] FAIL) [ ] Not Insp.
GIS Lat: "I'MI aL
GIS Lon: ^lu , 9S tdj
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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