HomeMy WebLinkAboutWEC2025-00042/WELL PERMIT - WEC Application - 3/27/2025 TikkkoVA / H u 1 .0 1-zi
61)4Z-
415 N 6TH STREET,SHELTON,WA 98584
L MASON COU TY SHELTON:360-427-9670,EXT 400
-�— BELFAIR:360-275-4467,EXT 400
.-- " : Public Health & Human Services ELMA:360-482-5269,EXT 400
� FAX:360-427-7787
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 WEC2025-00042
APPLICANT Leeper, Aaron Phone: 2535377332
Address: PO Box 44427 tacoma, WA 98448
IOWNER EGGIMAN GEORGE WILLIAM II &CINDY Phone:
Address: 15666 SE 303RD PL KENT, WA 98042
DOE Start Card: WE58756 N , SI->,t)re_ > N C'v\ e-c r,yo `^ k-to(Z..D
Well Tag (if avail.): e-r-
Well Site within 100ft of saltwater? No ���� --���Ni,, Q To U R D
DOE Variance? l
Site Address: 110 NE BEAR RDG
�{,o , co vA e.> G-r-< G1
Primary Parcel Number: 322247600030 b v\H1or S•-e.I' S pr4Lr-049
Contractor/Driller: RICHARDSON WELL DRILLING ( rvI
a-c )
Date Received: 03/26/2025
Date Requested: 03/27/2025 `ro-2 3 12 (2 fR% ) c _�,,
Date Inspected:
Inspected By: 07
Inspection Status: IN PROGRESS
Inspection Results:
Is there a 2"annular space on all sides of the casing? ['S [ ] NO [ ] Not Observ.
Is there evidence of cascading water? [ ] YES <O [ ] Not Observ.
Was the driller on site? [ ] YESIOO [ ] Not Observ.
Is the well flowing or is there evidence of other leakage? [ ] YES [ij -C1O [ I Not Observ.
Is there evidence that the seal is at least 18 feet long? [ I YES [ ] NO [-]'Not Observ.
Has the seal slumped? [ ] YES . L]-NO [ ] Not Observ.
Is there evidence of a surface seal? ES [ ] NO [ ] Not Observ.
Is the well capped and vented? .{'ES [ ] NO [ ] Not Observ.
Is there evidence of improper well siting or sources of [ ] YES [�]'NO [ I Not Observ.
contamination? «<
Comments/ Summary:
t 1, 1 \ [ ] PASS [ ] FAIL ] Not Insp.
GIS Lat: q 7 . 3?, 11 S 7
(jJvv ii l i t h/S` GIS Lon: _ I L y . bo 9 t v
THIS FORM IS TO BE USED ONLY AS TRANSFER OF DATA INTO SG. WEC RESULTS REPORT SHOULD BE USED AS
PERMIT REPORT