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Home My WebLink AboutAquifer Recharge 921332013 . ,...~ May 15, 2006 , ^pl"i,'d Gr<1I1,,,lilJula S"IIII"uu BENDER CONSULTING. LtC Mr, Michael VanValkenburg P.O. Box 306 Carnation, WA 98014 ,- ~ - 'i <.';,1 i'J ,.- \\t..\ 630 lith Street South Kirkland, WA 98033 425 828 7545 425828 7S48 fax Ul1JJ'W.Mut~rrIc.com RE: AQUIFER RECHARGE REPORT, 32 V ANY ALKENBURG PI" PORT LUDLOW, WASHINGTON Dear Michael: This letter presents the results of our critical aquifer recharge area evaluation of your property near Mats Mats Bay in Jefferson CoWlty. This letter is intended to confurm to the requirements ofthe Jefferson CoWlly Unified Development Code (UDC) paragraphs 3.6.5, Critical Aquifer Recharge Areas; and 3.6.10 Special Reports, paragraph (e) Aquifer Recharge Area Report. This analysis is required by Jefferson CoWlly due to the location of your property within a high risk Seawater Intrusion Protection Zone (SIPZ). The UDC requires an analysis of the well and groundwater system to evaluate the potential use of a well to cause adverse groundwater quality impacts, The overall intent ofthe code is to ensure that existing water rights are not impaired and that the use of the well is not detrimental to the public interest, The fullowing confunrn to the requirements ofUDCparagraph 3.6.10 (e), and follows the organization of that section. AQUIFER RECHARGE AREA REPORT 1. Response not required. 2. Aquifer Recharge Area Report 1. Project Description The property is located on the north side ofMats Mats Bay (Figure 1). We understand that Mr. VanValkenburg plans to construct an approximate 3,500 square fuot two story home. The home will have three bedrooms and a water demand of360 gallons per day. The home will be located on property parcel numbers 921332013 and 921332014. There are currently no structures on the property. We understand that the home will be placed about 50 feet back from the top of the bluff: The site topography is slightly sloping to the south. The groWld surfuce elevation at the site is about 15 to 20 feet. Mr. VanValkenburg retained Gresham Well Drilling to drill a new well in March 2006. The well is located about 400 feet north of the bluff: The well was drilled to a depth ofl 00 feet. The boring encountered about 25 feet of clay, which is likely glacial till, and then basah bedrock to depth. The well yield was reported to be about 0.4 BENDER CONSULTING, LLC 06/5-0/ D;\06IS-{l1 VanValkeoburglVllDV~buIJ,AquifaRecharJeReport.doc Letter to Mr. Michael VanValkenburg May 15, 2006 Page 2 reported to be about 0.4 gallons per minute. The static grOlmdwater level was measured by the driller to be about 14 feet below ground surface, or about elevation 5 or 6 feet. We understand that the site is not served by a public water system II. Hydrogeologic Evaluation A. Hydrogeologic Setting of the Aquifer Region. The site is located on the north side of Mats Mats Bay. The bay is located on the eastern extent of the Olympic MOlUltains, and inside the western extent of continental glaciation of the Puget trough. Basah bedrock lUlderlies most of the shallow soil deposits in the area. The basah is lower to middle Eocene aged Crescent Formation; these are the oldest and most dominant rock type exposed in the area. The basalt is mostly of colWIIDar to massive flows with oxidized tops and locally developed paleosols (Schasse and Slaughter, 2(05). The Crescent Fonnation is overlain by sandstone and other bedrock fulUld to the west and north of the site. Between about 13,000 and 15,000 years before present, glacial and non-glacial processes were responsible for the deposition of soils that now mantle bedrock in much of the area. At the site, bedrock is exposed to the southeast and to the east and along the shoreline; much of the area is covered by a thin to moderate thickness of advance outwash, till, and recessional outwash. Review of water well logs and lidar mapping of the area indicates that the bedrock surface elevation changes dramatically in the vicinity of the site. To the east ofthe site, and to the southeast at the Mats Mats quarry, basah bedrock is exposed. However, soil thicknesses between 50 and 140 feet are fuund adjacent to bedrock in both of these areas. In filet, one ofthe VanValkenburg fiunilywells (located to the northeast) encolUltered sand and gravel to a depth of over 140 feet. This is a somewhat dramatic change in bedrock surface elevation when considering that Michael VanValkenburg's well encolUltered only 25 feet oftilL In our opinion, this subsurface topography is likely the resuh of glacial scouring and fluting of the bedrock during advance ofpre-Vashon glaciation, and then deposition of Vas bon-aged sediments in the troughs. The lUlduIating bedrock surface and glacial-related filling of the troughs has resulted in the creation of two aquifer systems. The most prolific of the aquifers is the result of glacial deposition, where pervious advance outwash sands are fulUld beneath till The second system is in basalt bedrock. The basalt may be found beneath only a thin veneer of glacial till (a unit that does not yield significant quantities of groundwater), or beneath or adjacent to pervious sands. The VanValkenburg well is completed in the latter aquifer type, a bedrock aquifer. BENDER CONSULTING, LLC 0615-01 D:\06IS-01 VanVaIlcCl\bll'iWan V.Ikcnburi Aquifer RcdlIlliC ReportAoc Letter to Mr. Michael VanValkenburg May 15, 2006 Page 3 Groundwater in basah bedrock aquifers is principally transported in fractures in the bedrock and along flow tops. Groundwater may be stored in the more fractured and weathered portions of the unit. As such, the basalt may exhIbit a dual porosity system where the initial discharge to a well is from groundwater in the fractures, with a lesser and more gradual supply from a release of storage from the matrix. In this setting, wells must intercept fracture zones in the bedrock in order to collect groundwater for withdrawal This unit has been structurally fuulted and contorted, and some of the wells completed in basalt have relatively high yields. Groundwater recharge to the bedrock aquifer is through precipitation. Precipitation will infihrate though the till, and into the advance outwash (where present) underlying the till Groundwater is then recharged into the bedrock aquifer. Infihrated water may move laterally along the tilVbedrock contact until it reaches a fracture system, where it then may infiltrate into the bedrock. Water that does not infiltrate will eventually seep out at the bluffS. Groundwater fluctuations in this type ofhydrogoologic setting are usually dramatic. Groundwater levels will rise quickly during the wet season as the fracture sets and bulk matrix are saturated. Depending on the number of wells in the area, groundwater levels will likely drop at a slower rate over the dry season. The slower decline rate is more typical because the recharge area and aquifer volwne are still greater than the amount of groundwater extracted by wells. Iffracture sets are connected to areas of outwash, then water level decline will also be slower. Connate (old) water can also be fuund in these settings where the fracture sets are not frequent enough to allow sufficient groundwater recharge to flush out the older water. Sea water intrusion has occurred in the areas where groundwater has been over-pumped. Jefferson County has recognized salt-water intrusion as a potential threat to maintaining drinking water quality and has developed ordinances with respect to salt -water intrusion. One well within I, ()()() feet ofthe site is identified as high risk on the Jefferson County SIPZ map. B. Site location, topography, drainage, and surface water bodies. The VanValkenburg property is located in Water Resource Inventory Area (WRIA) 17. Figure 1 shows the general location of the property and surrounding topography. The property is located in the southeast quarter of the northwest quarter of Section 33, Township 29 North, Range I East. The site elevation is between roughly 15 and 20 feet. The upland topo~phy slopes slightly to moderately from north to south. The bluffS are low, about 10 to 15 feet high. The bluff exposures indicated weathered till above a fresh to weathered, moderately fractured, basah. BENDER CONSUL T[NG, LLC 0615-{)1 D:\06IS-()] VanValkcnbw1:\VlDl Valkcdbwg Aquifer Rechaqe Repon.doc \ " Letter to Mr. Michael VanValkenburg May 15, 2006 Page 4 A ditch crosses the site about 400 feet to the north and northeast ofthe future home site, The ditch carries surfuce water runoff and possibly some shallow interflow primarily from adjacent properties. It nms IUlder the driveway about 200 feet north of the home site; near the western property boundary, the ditch is oriented south and drains into the bay. We estimated the flow in the ditch was about 10 to 15 gallons per minute during our April 2006 site visit. We understand that the ditch flow is seasonal and it is dry much of the year. C. Soils and Geologic Units Underlying the Site, The surficial soil type on and in the vicinity of the VanValkenberg property is the Alderwood gravelly sandy loam. This is a well drained soil funned by glacial processes on top ofbasah bedrock. As presented above, bedrock is exposed along the bluff at the property. The rock was fresh to moderately weathered, and moderately fractured. Weathered till was exposed above the bedrock. No seeps were obsetVed at the bluff D. GrolUldwater Flow and Water Quality Characteristics The hydrogeology ofthe area was evaluated using geologic and lidar maps, and local wells logs obtained from the Washington Department of Ecology web site. Select well logs are enclosed with this letter; we have labeled the logs fur reference purposes for this letter. The hydrogeologic setting of the area is descnbed in Paragraph B of this letter. From an area perspective, groundwater is recharged in upland areas, and flows to and discharges into the SOlUld or Mats Mats Bay. As shown in Figure I, the site is located in a shallow drainage that flows toward Mats Mats Bay. This also indicates, by the higher topography to the north, east, and west, that the area is also likely in a grolUldwater discharge area; where groundwater moves from the upland areas north of the site, and discharges into Mats Mats Bay. GrolUldwater levels identified in the boring logs were between 2 and 30 feet above sea level The reported water levels varied dramatically. This often is due to the driller measuring the water level before the well has coInpletely recovered from the drilling process; this may be also due to seasonal fluctuation. Mr. VanValkenburg collected a water quality sample from the new well on March 20, 2006 and submitted the sample to Twiss Analytical, Inc. The laboratory report showed satisfuctoryresuhs fur colifurm, and 99.9 mgil chlorides. The well has not been pumped fur supply of any type to-date. Water quality from neighboring wells was generally not available. Jefferson ColUltyprovided us with the water qualityresuhs from two wells in the vicinityofthe site: the well at parcel number 921 33201 7, about 720 feet east of the site, had a chloride concentration of181; as such it is in an "at risk" seawater intrusion protection zone. BENDER CONSULTING. LLC 0615-01 0:\0615.01 V8D.ValkenbuliW811 Vatkc:DbulJ Aquifer Recharge Report.doe Letter to Mr. Michael VanValkenburg May 15, 2006 Page 5 protection zone. The water quality ofthe well at parcel nwnber 921332026, about 200 feet west of the site, was 691 mgfl chloride; as such that well is in a "high risk" seawater intrusion protection zone. Both of the wells are completed in the basah aquifer. E, Location and Description of Existing Wells and Springs within 1,000 feet of the Site Logs from the wells in the general vicinity of the site are attached. The logs were obtained from the Department of Ecology's web site. The approximate well locations are shown in Figure 2. The logs have been assigned a location nwnber corresponding with the figure. The wells have been descnbed in previous sections. There are no documented springs within 1,000 feet ofthe VanValkenburg property. Based on water elevation differences and soil types, there does not appear to be a relationship between flow in the ditch and the basalt aquifer in the vicinity of the site. F. Local and Regional Grotmdwater Recharge Precipitation is the only source of recharge to the sea level aquifer. A percentage of the precipitation that falls in the area is lost through evapotranspiration processes. Grotmdwater recharge mechanisms for this area are discussed in earlier portions of this letter. According to the Jefferson Cotmtyweb site, the site receives between about 22.5 to 27.5 inches ofprecipitation per year. As discussed in paragraph C above, the soils on your property are moderately- to well-drained and should infiltrate most precipitation events. Groundwater recharge maps provided by Jefferson Cotmtyindicate that the site may receive 0 to 10 inches of recharge per year. Based on the location of the site in the basin, as discussed above, the amotmt of recharge to the site is probably in the higher part of this range, G. Evaluation of Potential Project Impact on Grotmdwater Recharge The chloride concentration in the VanValkenburg well borders on being classified as "at risk." The well is also located within 1,000 feet of a high risk well However, given proper operation and placement of other infrastructure, it is our opinion that use of the well will not adversely impact the groundwater regime. It is our opinion that the site is available to annual recharge from the adjacent trough occupied by glacial soils. Those soils furm a local aqUifer and exlnbit a lateral influence on the water level in the VanValkenburg well The site is also located proximate to a groundwater discharge zone, as such; there should always be a greater grotmdwater head upstream of the well that acts on the water level in the well We also understand that Mr. VanValkenburg will be constructing a 2,500 gallon storage tank fur the new home. Given proper operation of the well and management of water in the tank, the well should be able to supply the required 360 gallons of water per day without significant and long tenn drawdown in the well BENDER CONSULTING, LLC 0615-01 D:\()6IS-01 VanValkcnbulJWm Valkenbutg Aquifa RedllIIJC Repln.doc Letter to Mr. Michael VanValkenburg May 15, 2006 Page 6 It is our opinion that proper use ofthe VanValkenburg well will not significantly impact others. The wells located to the east are in more productive glacial soil aquifers, which will not be depleted by use of the well That aquifer also provides a hydraulic head that will reduce the potential for excessive drawdown in the basalt aquifer. It appears that the well on the Hoh Property (921332026) may have contnbuted to a degradation of groundwater quality in the aquifer; it is likely that use of that well may have more influence on the VanValkenburg well than the contrary. I. Contaminant Transport Analysis Since this site is used for residential purposes, a contaminant transport analysis may not be applicable. The land use activity is not considered a high impact land use as defined in UDC 3.6.5( 4).c. In addition, because the water-bearing zone lies beneath about 25 feet oflow permeability till soils, the potential for a contaminant spill to reach the water-bearing zone is likely small. Contaminants would likely be retarded in the low-permeability soils or travel as shallow subsurtace flow toward the sound before entering the groundwater system. II. Spill Response Training Not applicable for a residential site with no known use of chemicals. III. Best Management Practices. We understand that storm water on your property will be collected and infiltrated on site. We reconnnend that you fullow the Water Conservation Measures as outlined in Appendix Item 3 of the County's Seawater Intrusion Policy. We understand that you will be installing a 2,500 gallon storage tank on your site, and agree that this is a good water management decision. IV. Monitoring Program We reconnnend that you adhere to monitoring program as prescnbed in DOC 3.6.5 paragraph 9(B) fur at risk SIPZ regardless of your classification by the County. These actions include installation ofa flowmeter and periodic monitoring of chloride concentrations. 3. Qualifications REGISTRATIONS Registered Professional Engineering Geologist: Washington (874) Registered Professional Hydrogeologist: Washington (874) Registered Professional Geologist: Washington (874) BENDER CONSULTING. LLC 0615~1 D:\06IS-01 VanVaIkCllbUTJ:\Vaq Valkm~ Aquila Recharge Report.doc Letter to Mr. Michael VanValkenburg May 15, 2006 Page 7 Registered Professional Geologist: Oregon (GI642) Certified Groundwater Professional: NGWA (518) CORPORATE SUMMARY Bender Consulting, LLC is a consultancy in groundwater science and engineering - specializing in water rights support, dispute resolution related to hydrogeology, and construction dewatering design services. We support the legal, environmental, engineering, and construction industries. A unique hydrogeologic consulting firm in the Northwest that specializes in these fields; we offer the proven ability to develop innovative yet sensible groundwater solutions that satisi)' project performance, design criteria, and schedule. Our goal is to reduce risk for our clients engaged in design and construction, and to provide a sound, technical, and defendable understanding of the groundwater regime to our legal and engineering clientele. Scott Bender is the Principal ofthe firm with 22 years of applied experience in groundwater controL water supply, and water rights, His work is innovative and award winning. He conceptualized one of the first mitigated water rights since the 1996 batch denial by Ecology; this set a precedent for the current state of the practice in water right mitigation. He has won ASCE Engineering Excellence Awards for his groundwater control system designs for projects at the U.S. Embassy site in Bogota, Columbia and at the Boston Central Artery in Boston, Massachusetts. Thank you again for the opportunity to be of service, please call us at (425) 828-7545 if you have any questions. SCOTT F BENDER Scott. er L.H.G., c.a.w.P. Enclosures: Figure 1. Site Location Map and Chloride Data Figure 2. Parcel Map and Well Locations Well Logs (18) BENDER CONSULTING, LLC 0615-01 D;\{)61S..0I VanValkcnburgWlIII ValIr.enbutg Aquif~RcchlllJeReport.doc " ',"'" ~ BENDER cnN~III.1ING. I.tC _~rl':i~,f ,:"."",/';',"" -;"I"f,,'~" Van Valkenburg Property Aquifer Recharge Report Port Ludlow, Washington Site Location Map and Chloride Data Project Number 0615-01 Figure 1 ;...>,." - ~.. ........ '-\ ~ .. - - .;,..---.:.... . " ~Y'~" " ;;. , , "11 I 1'" ~ '~~3'~ i!' ~.... '. :J -4........ ! : Ij"'-'~..>' . . ... Pi", ,I I I I '-rll '. \ ,to' I 'I I ' ,i...:-, 1--';' . (j l" I r ,!' ,. ~,J' ". 'UI<<NQYoN' : Ii, ; ,lI'l)/ it' ......./l:f...._~____________..._______. 11 " ' _J> .\. '", ........ .~..OLEL1:' pOfNT~O'_..............._......,_ "'-, A' l , ,t ',. / ' ! 'T- ~ ''"'\ ,,/ we~s 2, 3.1, 14. 18. 21. 24- . ,,./ I , i'/ I ~ l -- - :Van Valkenburg \1 Property - Well 19 HiI'. l ,~ Parce19213~2026 - Well ! 'y I j 'I M1e1l20 I .' , Ii ' .;0..-' l:~ ___: _I ~ ~ '<.,...... t-'arceI921332017- ~ - '''''TeS.IAA~EACHRIl ---(~__/ ';". <:__' ...........well 22 .. well~.T ~_-:I: .,: ..i-' Wegs4 and 8 : i Wells ~aH' .:1~' ] \'" f I aAYSMOR\! Of! .' -:..:..;. U :r~'J [~ .e 6 and 27 .-<~. ; -~"- --,}" "J' ~'9; .t('", :1 .~ I """"-,,;:..//: r.; I' . I " j,. -- I ~): . l I (I---~": ...... g .: r....~ t ~ - :. "... ,: t,... -------~~-~-7~~; i~--~--~ ; {....i\...(iF ~~\:. =1'1, L~,__ r i:- '.r.... 'tft. .-<..,J.. I ,Jo :\.",,\. -z- -. . a- 10-,: n -'. -/':,I ~ " . J y. ,- ,,- "R ~- . i ~. _,t-\-_ .: I _~ ',..' .. .. '1:.1' ! -. ,\.. ." -, 0 ;- ! , - - t:'. \ ,~ .": t'~t~. ' '.: - ~. ....'L ~ '. ',\" L ~ l!' -,. . \. ":c.' "', .,'. "~' '. .:' '.,']. ...'.. .;.,.. -<1',''''''')- '< ,..': , c:l " ' , "i'!::. .'. \ -..(':,:" ,. .,!4t ',''';: : :- IS "$ II. U\.,. ','" .' f\ h. ~. { 'l> 1 I , , , ,'-'~ ' .,. ~Ca. Notes: Wells located to section Y. Y. See attachments for well logs , BENDER Van Valkenburg Property Aquifer Recharge Report Port Ludlow, Washington Parcel Map and Well Locations Project Number 0615-01 CONSUI.TING, LLC 1I1'r.1;~,1 {;',,"..,f......r~' ~"I..I','.., Figure 2 ~W~~-' ..~l J'l1e: Ortcmal and J'lrwt Cop,. wtt.b. . "-'\"1"'" ot IcoIol7 REPORT 11 A..Ilc.U.,. No 5eCoDd CDpJ' - 0.-.-', Copy J J / /' / t? ~ ";.:,;;r Th1nICoP'-DI1II<~'C..y STA.TE 01' WAlIIDNCI'l'O!II lV.f-.- L. u" ~.>.":'. .__..._....._____ (1) ()llNEB: N....__j!.j,~~~L~{~ __ Ad_,.&d:..,y{...JIL"./~~.._._.,_... __ g (2) LOCATION OF WELL: county.o.Z~ -...... ..J ___,__.s.!a-v.IL4.L\~ __3..1:.. T.2..1'.><.. R,J.LW:M. Q. _.... __ In>m __ or ,..dlVlslon ~. 3'3 E I <l.l 1:: i "" "" 'Jl ;: ::; :>. ... c:: <'CI ... ... ('(I > :> (3) PROPOSED USE: DomeoUe~ Indlldr1a1 .0 _clpol 0 (10) WELL LOG, lnipUoIl. 0 TeA. WeU 0 other 0 I'onDIlUOII: Duc11b~ COlo7'. dI~ P# oj fft4u71Gl And atna.c'tvn, 0'114 ~ ,hk'.lcJlal Of (I =.,., au u... II:t 0...... n.a.clln 01 tM m.crtntlll hI if'GC'1I TYPE OF WORK: OwJ\tt', nWftbu of w.u JItN.tImI PfUCnIlecl. II 0: leGIt ON ..,.try lop ~GCh. cha.,.. 01 ~ (4) Ul.more than one).... .__.______ JlATIWAL rHO'" TO H.. wdI. ~ .......: ~ 0 Bond 0 ..R I I /J ~ --- CobIo .. Drln:a 0 _J_ ~..'- ~ u...,"1 <.:;~ __0 Ilalu7 0 J_ D --;:.1~ ,~. (5) DIMENSWNS, """"'-:-...;..-:: ~~*-~ rJC YJ _ A7L L ,~....:: 1.3~ _./f1'-_.tt. ~J_ _ .. J~-'" .... , _.~ , (6) CONSTRUCTION DETAILS: CasIDc iDataUod: ..~" IlIuu. -- _...J:L.. ft. ... ffi ft, _y,c.- ,...~. r..I>Iam.......-.JII-...... ~... WoIdod 11 - .. DIao. _ _ - ... '" - ft. Perforations: y_o Kalil!_ T7Pt of ~ra'tor ~___.N__._._..___ S1%K of _b-...I. ... _ !D. b7 ___.__ .... ____ ~t:loaa fJom __.__. ft. to _.___" It. __ pGfDrUlou from: ft.to___ft. -, _000 ..... .--... k.'" .... ~ ~O Noj,l 1~:Mam._._.____..___ TrP- _.____ Model No 8 "'-- t--- .... ..... .-'.---' ...... --..- ft. ... -,,- It. D1aa. .......- mot lit>> __._~_ f:roIa, __ It. 10 ._ ft. III ~ Gg"el ~ Yet a No" SlU ot IRnl: __ o Gnvel pl.aced. frorI1 ..__~_____ ft. to .__...__ tt. . "" S~ace sMI: Y.. 0 NoA' To what <<leptb, .___ ft. !19 MIIta1.1:: 10 .uJ__~'_M' -- 0 DI4 ,uata coAtaln umuable ..terI Y-D NoD T7Pe of ..t...t_.________~.._ Depth of 1i:r8tI____ !4<<Ud of ..al.l.q rtrata oil.. -. .. ......_.~ -, ..- - (1) PUMP: !Ian~'. Name_.__....__..._._.~______ T7P0: _,,_,,______,,__,_,_,_ H.P_._____ (8) WATER L~: ;.::.--::=... -$Zf;.,-"- st.atle len) ._.~ _-fL below kip of WdlDa- ,/ A.rtmaEI. ~ ~. ---J.ba. per .;tuue tDda D.......__.____ ~ waWl'''' CDtltrolW by__.____._.__.__. COp, ........ etc.) I (9) WELL TESTS: Drawdown ... amowIt wat_ Jew-.. I. lowered. ~101ll' lJtalle levtl WOltllt&lted - . 11-_. COmp.l.t.ed__...... -_.-- _..lliL. -" Wu . pump tat ~ Y..~ NoO U ~. b7 whomL....___. ....--.-.-... Yleld~ ,aL/In.lD. wttl:Io ft. drawdoW'D .~r Iuo, WELL DRILLER'S STATEMENT: '. .. - . Tbk well wd drilled WIda' my jurisdicUoo and this report 1& ., " . - Inle lo~ know!edlle "Dd belief. R<<OVU7 data (\1m4: tu.n _ &UO when pump tumed off) (water Ine1 N_ ---- _'11 .-.e~~r m..und from wall top to ....ter level) :~~~~~~=~t3~~~:?:I~~~~~~~~ ( n. ftnn. 01' eorpol'aUanJ ( prilrt) ~L....L.+_..FJ.4~ ,,,,..,..,....ar... . ......~:;;;.;;,.;;;.;..-~7;~-:z>.:;j::~~:.:-........._...-.... .....-...,....-....... [SlllDed].,~~..4z...~.&.oIC'P.....~.-: ._.~......._..._..........- Ballor ~,4.Wnln, ...U1.....J'..Il_1I.. __ .......,.....,t......hn. (W.uD Arte&1aD 1Sa._~_______.-4.p.m. D&M-______.w___._. U""""" N<J.,l.J=:,I?,k:..{"l.I...s::: D.te)?:.."....:, K../..~..,. U.7. 1'empera1un ot .~t_~. W... . cbcnJc:&l uaJ,..u rnad4>t Y-..Il NoD """"-' o c: o ;:; ! - - ... '2P ::: <l.l 5 ... o a c:: ('(I ('(I ... ('(I ::J ~ .- ;:; J 2 '" <l.l o 1:1 :>. Cl o o o JJ I- o ... c: <l.l E ... ... ('(I Q. CII :::J CII .c 'S IVS& ,U]l)rrIONA.L SImE1'S rr HECl:SSARY) ~, L r.Ho.UM--OS-lReY.c-Ul. 'FIle Orlg1nlll and First COpy wilh . I)ep.-rtmmt of &olofl'Y Seeond Copy - Ownec" Copy 11I.Ird Cop)' ~ . Ortller's Copy W~~~~REPORT lITAD 01' WA81IDfGroN Application No. _'_"__'_~'__'_'_' P4tmJ.t No. .,.. .. ._._.... "'__"'___ (1) OWNER: Nome_G.l:H!};J~,!;;.~.!I_1>b.._....._ __~.Jia5_Q.. :?,.....a,_".'!I_a~_ jl.Oa,g,__.!{.eI\t,..w,I}_: _.... (2) LOCATION OF WELL: CDUI1ty_~-I!-Rt: r"'S1> ""____-_SE..I< J'i't!.._I< ......13_ "?...2.!':l..N., ,,!.~,...w.... Se..rh'\l and dIftanc8 uom feetk:1n. or aubd.tvt&ton comer ... L. o Q. CII a:: Gi 3: (3) PROPOSED USE: Do_ -II 1........01 0 ..........1 0 IrrllatScn 0 Ted WeU 0 Otbu 0 (4) TYPE OF WORK: 0....,.'. .wn"'.' weJI N.. .ell (II T th::.::r' ~.-'-D"'-.;;;o D~1. JIleo'J 0 c.b18 0 DrtftID 0 _cll_'" 0 ........~ J_ 0 III :E - c o c o ; I'll E ... .e c CII .r: - ... o - "C C I'll J3 I'll Cl CII .r: - >- - C I'll L. L. I'll 3: I- o Z III CII o "C >- DI o '0 (,) w '0 - c CII E - L. I'll Q. CII Cl CII .r: I- (5) ='~.~~8.~~~. Dtanwt,,. of ..u ... ._~._6_ , Jac:b-. Depth of completed ~1I.-"'2 ---1L (6) CONSTRUCTION DETAILS: Caslag IDslalled: ",..2.._" Dl..., .........:!:5- ..... ~_... 't'h.ruded 0 M'_" Clam.. froaa M_'.__ ft. ... ~_ n.. woldodJla _." DIom. ...... ,.....__ ... .. __ It, Perforatiom: Y. 0 N~ T7Pf of pettorator uaed.-_M~_'M"___"'____'_'____ SID of 9..d_' ___.____ m. b:r _ iD. _._._._ ~tioIIII trozn ._....~.__ ft. to __ ft. ____.._ pufonUou from ___._.__ It. to _ ft. ..__..._ pufora.tiODl frOm _____" tt. to :ft.. ScneDa: Y. 0 N.iI J4aD\I1acNru'1 NAID.._..________~_ T:rPe-_'N__ ..__ Mod.l ND_ Dtam. .-.____ Slat IIizlI _'___ from ...__....._ tL Ul __ ft. DlatA. _.____ Slot .1z:e _.__ !ram ._...._ ft. to .__ fL Gravel puked: Y.. 0 N.~ .... oJ .....d: GnYe1 plaoed tram ._.__.__.~__ ft. &D __ Surface seal: 'Yes Xl N. 0 T.....at "pth. _.l.!l- It. Material UMd tft NAl..._....__w.._..___.__. Did m, stnU contmft UD...ble wa&ert Y. C No'JJ T)'pe or Wllter'__~..___.___" Depth of KIa+'" Method of ~).ttollta olP._.w..____...._.-._____._ (1) PUMP: ..........owe,.. Namo__......___,...._, Type: .__...._.__.___.____.M.____.._._ HI__ (8) WATER LEVELS: ~:~'::'-=~.....' 90 _.Jt. SUUe level __.._.9,0-....--"- ........ lop .l"oIl ~.!I.,.~9. An_Ian p~ __._.__.__JbI. pv IIqI&&nl taeh :n.M__.__._ ~ water. COillltroll.s by._.._.__... . {Cap, vatve. dc.l (9) WELL TESTS: O.....down .. aJ'J\C1lmt traWl' IeftI ... lowued belo. ataUe It:YeJ No 121 If y~. by ..hom'._~_..______. ft.. dnwdOWll .ttar hn. W.. II pump test nude, Yeti 0 Yield: Jal./mlD. with R~er)' data (Ume taken .. IerO when 'P~ turned 011') (water It-Yel .In.U\U'~ from ...U tAop to wa~ lev.". . TtnuI W4&.r Ln-l l Ttm.. WCItCf' LaJeL 1 rtmc Wowr t.nd :::~=::::::== :::=::~:::~~~~~::t::::=::::~:: ~::=:~=:=:::::~:::: :~~:==::: :::=::~::=~=::= Date of t.... ......__._._____..._...__.__......_.... Boller ....,..-1_,_..oIJ""", wI"'-_..... ,_,-ll. dnwtDd~'r.'2-8~ .......... ..".........___"'",__..,_.,......... D...__.l?.._____ Ttunper_ture Of 1V1ltu_.~.':f... W.. _ chemk-al anaIya. :mIldIl' V_ C He ~ (10) WELL LOG: "onnatto.: D.~ tlJI eoIo'r. d14f'Clct..... me 01 ~riol au atn&C'tu~. .and t1IDuI eldelcM'. 01 sq1IIikn 4"" tM JdU 41td BON,.. 01 tM tnlIt.nal ilK HC'h ICnItKm ~cd, ww. .. lHd OM em", 1M' He"- ellaftee of 1~ .....T1:BIAL J'IIOK TO Brown sand 1 6 (l..."v ...,,,;, ha>'d nan b ')0 Ra....al t- ...n,,\r ')0 "0') _d_ -- - - rrl-f'r 11,_ -U'-IV~/J .... I,/,Qr _ol,^ 'vi,') ."<rARTMFNT 'or ..JUJI tI".'~S: {'oC",..~ . l..l"VlUey ""L VI fleE I I I -- ... I 1 I _ w_ .....~ ..__ 111__. C4m_.A.pri~...?a_ 1.2.9., WELL DR" II1.R'S STATE]IENT, Th1I well WaJ clr1Ued under my jurisdiction and this report ~ lnle to the b..t of my kDowJedCe and belief. NAME.__Jj.9.9,P......G,~,!"!A1...J>.B.!.~g!:'g...........,........._"....,.,.,_.._.. (PerkIn. ftnD. 01' corporaUonJ ITnMt 01' Prim) AddJao,..Q!:!.~...1.~.~n~.J..~.<;.~_Qin~t~!l...9.?J..7 ~...............,...,... [SllP1ed]...#~g ......d..:?-tZ,ll~,.l'...-......................... L1cenie No..........,..?J!5.............,.......... D.~p.:r::A:L.?,~......_, 19..7...9., .. F. No. f2>>-05-(Rev. f.n). (UB ADDmOBAL SHZETS D' NZCI3SABY) ~, 1-:, , , ~b~~~-- ill WATER WELL REP NotnoCIntmtNo. b ''''''''t':, ''''; Oris..",I& I,,""I'Y , Eallagy, 2nd copy -OWDU,l,d"'P)'-dnIle>-. --ilI:l /... '1 OR . " ., Unique Ecology Well II) Tag No. ConstructioWDecommission ("..:" in Cln:I~) illI Consttucl1on o Decommission ORiGINAL CONSTRUCI70N Nolie< .... .... o a. <II c:: G:i ~ Wasa Right Pcnnit No, IJl ~ - l: o l: o :o:l III E .... o .... .5 <II .c: - .... o - 'C l: III III - III Q <II fi >. - l: III .... .... III ~ I- o 2 IJl <II o 'C >. Cl o '0 tl W .... o - l: <II E - .... III a. C1l Q C1l ~ I- I."l&r ./'ir of lnJent Number Property Owner Name €. \ fr e. PROPOSED USE: ~meslic 0 Indos'm! IdMwUctpal 113 FEE W~SI?ea~LI\.Ic'" Olele. f+ pJ fOrt.& Onewalct' Obngao"" OTeslWell Olllhcr Ctty -pbA I.' \J.&:l. County: "'3eF-F-ef".!P>v rYPE OF WORK: Owner's Dumber of well <If more than one) . ( ~New Well 0 Rem.<hooned Method. 0 Dog 0 Bond OW'd 'A ~.U4-114 ~/4 Scc.3:l. TW1l~ P ,j.~, &B ,r ~M [lDecpcocd 0 Cabl, ill Rolary 0 Jetted LatILong: Ui1Deg La! MinlSec lMENSIONS: Dtametc:J of well '0 inches. dnllcd 3'ii'O II. (s,l,rslil1 Dcpl:b at completed weD ~i ft REQUIRED) CfDg ~ Lo.g MinISec CONSTRUCTION DETAILS ~ Tax Pan:el No, I '3 ':(fYl2 , I Casing ~ Welded . DJam. from n fL"~1I. CONSTRUCTION OR DECOMMISSION PROCEDURE Inslallcd: ~ [.,0... ODStl!lcd . Diam ham ~i ft..~ft. Format:lon. Descnbe by color. chilIacter. size of material and strucrure, and the o TIucadcd . Diam from lito n.. land and llature of the matenallo each stratum pc:nctt'3.ttd. With at least one entry for each cbange of tnfOrmabOD Incbcate all water encouotered Perforati8DS: DYes KINo (USE ADDITIONAL SHEETS IF NECFSSARY ) trYPe of pafOl1ltor used MA TBRIAL FROM TO !sIZE of periJ ilL by ID and no of peds ham ft<o ft. TdP_G'}/J D / Scneos: 0 Yes I5l No OK-Pac Loc:won ,., f. r, r.. ","" b I .1<"". ""'1 J 7 Manufacrure(s Nam.e , v , Type Model No. F'>~. ,'/1:: It? //? D,am Slot Size from ft.. ft / Own Slot Sue ham ft.'o ft GnvltWdtupadud: Dves l!SNo o SIZe of gJi!lvcVsaDd J.J-:."~ 1- 10 /6( MatenaJs placed from ft to ft. ,- SurfaaSea.l: tJycs ONo TOl"b"deplh? \11; .,.. ft N-S4f 'F r -LZ5 /~D /~J Matenals used ][I seal 8.....,., 't-o""x , Old auy str.ltaCODQla unusable warer? Dyes 1!INo 1<;- 0, Id'" Ib~ 7~ TypeofWdICl? Depth of SUilla I Method of sea.llDg strata off 1<:--. rlD ,rr ZJ-O 7.Ja- PUMP: Manufactluu'$ Name Type HP f$-_'fo /.,.- 7~J 3Zt? W A'fER LEVELS: I;yut-surface elevatIOn above mean sea level ft SlalIClcvcl ~-i ft bclow lOp of well Date-1'-~C-e....... " ArtesIan pressure lbs per square lOch Date 11::. <;Q rr I' 32'0 '-01;" Artesian waler IS controlled by J (cap, valve, de) lk. 9>1( ,.sZS .3Xt: WELL TESTS: Drawdown 1.1 amount water level LS lowered below static level Was a pump test made? Dyes liJ No Iryes. by whom? Yidd ----ial/min With ft draWdoWD after "" Yield It1I/rml1 wttb ft drawdown after "" IM:JC.,-"",. VJl:.1UI Yldd nJ/nu. Wllh ft drawdown after "" '-r;..Q_1 n ~nM RtCDVtry dJJUJ (hIM taJc,n as uro whtn plmlp tunwd offXwm,r IrtJ,1 rrwasur<<lfrom - " tilt/I lop to waler It.vtl) Tunc WaterLevei Time Water Level TIme Water Level DEr!'!:ft,~f!1T Of ~COl~GY - - - ......... .~"'LL."~ " - - - , - Date or test , :::(~ ~ g.JJrm.. wllh !3'~dow"a;g f2.lJmo With stem set al ft for hrs Ane:iaanflow ppm Dale - -o~ Start 0.", 1/- i"l. -07- Completed Date-Ll- 'Z..~ Temperature of waler Was a ehenucal analYSIS made? Dyes li3 No .oA\ I.J' . 1 yJ/fXl "lc ~ WEll CONSTRUcnON CERTlFICA nON: I constructed and/or accept responslbtilty for constnJctJon of this well; and its compliance wllh aJI WashlOgton well COIISlJUaiOD standanls. Malenals used and the IOformatJon reponed above are true to my best knowledge and behef, ISJDnllCf OEngln'''' OT...nee N....~') G<t''t'~... DnlbngCompany n'lg,1 -..ui/l:~{ 1),..; \\:I\'1:C~ 1lrillel-IEnglOeerfftainee Slgnarw-- Ll.g.u.L W f} ~ AddIess"" t..\ \ ~"-:)t S -e't"', "" -e, i\.y M Drillcro,Tr.uneeucenseNo, '2..S 7"" Cuy.Stale.Zip 5,,'{1o--;""- -...1ft ~~-yr,L. (If trainee, licensed driller's ) i':'=:'~ No I"<<-lwrOTO".llll Date i i- 2.. 7-~ Signature and Li<cose 00. Ecology IS an Equal OpportUnity Employer OCY QSo-.l-20 (Rev 4101) Q ~bU- ~ ~~ S1ottCanlNo A't267t, WATER WELL REPORT UNlQUEwaLlD .--4',4 ___No ..; ... ::> ~ 11 1::: FIle Crt;I".' .net RIWI Copy with lloparlmo.. 01_ SKoncI Copy - 0ImM. COpy Thln:l COpy Dr11"r'1 Copy ,... STATE OF WASHINGTON ....... Lv: ()<,J .J/tJ;"'~IJ4"'~T~N R~WY (1) OWNER ~ (2) LOCATIONOFWELL """",---=ref'-t=" ~f' SOy\. (211) STREETADORESSOfWEU.I"'__ _C:;~Me 11 ,. '" MunlClpaf 0 """" 0 g Do....be o Imgebon 00._ (3) PROPOSED USE _0 TestWeII 0 Il = Owner s number of weI (' mae than one! New....... 0 Deoponod 0 Reocnc>1l<lneOO (4) TYPEOFWORK C~X..J Method Dug 0 =~ :: ..... 0 llnven 0 _0 ::> 3 :: ~ 3 (5) DIMENSIONS _.."'" DnIed Ieet Depth -. - so ""'- . (6) CONSTRUCTION DETAILS (;p -t/ So l! :: c....._ ~~ Tl'<eadocl 0 Doom horn <>em horn OWn horn .ID 010 .10 ....... Ves D No D of perfofattl' used pe.1o...1k..~ """,-,""m perforabons from perlofallonsfrom 3 2 'ij 'II ~ 'II ::l ~ Q ,"by .ID OlD .ID NoD No >. ~ nom horn " .ID ,'IS Gravel packed Yes Gravel placed from s..mce '""' Ves D Matena! used Il'l seal Old any strata conlalO unusable w Type of watllf') Method of SMIano strata of Dopth at strata ~ ,'IS ::. ::. :> z: Il 11 ::> ::l >. OJ ::> 3 :J J.J 3 ~ - ~ ;:; ... III a. C1J :::l C1J .c (7) PUMP Manu~r... s Name T,.. HP (8) WATER LEVElS """""'"' "-~........ -...... Oate .."" Date eo ole (9) WElL TESTs Isamountw~"""1S ecIbe1ow.labC...... W...pu.mples:lmade'l' 0 NoD If)'tn by 'r'Ield IIlWl WIth II hn ta6len as zero when pump 11med 01) (watet Jevel .. """'... T.... -...... "me Date 01 test rl8Sl_gaI/mm wrIh Jt d'awdownafter Aartest gaJimll'1wrthsterl'lMtat ftfof Anes.an 1'Iow g P m Oal8 lempwaklre of water _ Was a chelTllCai analysis made" Yes 0 NoD ECY0&)1201'9o'93)"0' (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION Fcrrnabon Desettle by oolor ~ SIZe 01 matenaJ and structure and $how IhocMoa ci ~ and the land ..d I\Mure of the mtdenIIl m eeeh stmu'n penotra*:I W1th at IellSt one entry lot each -"- umlW. AIOII 10 . . o +-. t.t.. t.J Ie rl <: /, ,. " ft . ft . . L . A . Wa,hm~ton lute 'olo~v . _s...... :.:za (? 19 ;z '0 t9 eo.-.. WELL CONSTRUCTOR CERTIFICATION I c:omtructed andJrx accept I'8SpOn$lblIrty tor cons1rucbon of thIS well and Its compliance WlIh aI Washw1gton well construcIlOn standards Malenals used and the mtofmabon reported above are true 10 my best knowledge and beltef NAME Oa</~~~iLZ:/lh~.$. ....... 23~ &-:ff'YPE5'7U/t2:1 (Sognod) b.Ld c~;zt L.oconseNo /979" / .-..-- eon_ . ~eo'~~c;;-c,oIDR 0... ff/2/,k/.. (USE AOOFTlONAL SHEETS IF NECESSARY) In In Ecology IS an Equal Opportunity and A'Jrnnabve Acbon employer For spe- CIal accommodation needs. contact the Water Resources Program at (206) . 407-6600 Tho TOO number IS (206) 407-6006 0) C:~0 WATER WELL REPORT START CARD!\IQ UNIQUE \o\II:Ll' O. III OWNER: "_. .. ,_._____ Don Sbort._ STATE OF WASHINGTON ....... WATER RIGHT PERtKT NO (2) LOCAnONOFWELL:c",,",y .._.. Jeffer>llll..._,.._, (IaI SmEET ADDRESS OF WELL. '''' "'.... ......., .4ll..il.aY ShoreJld-.._ -. _ NE 1/4 SE. 1(4 s.a 32 ,_.. _40 Bay Shore Rd. Port Ludlow. WA (3) PROPOSED USE: t<i Da~"c I J It'I~bon I 1 OIhr LJ~Llo.'if.I;n- U """NO~I U Test 'WIll (4) TYPE OF WORK: ewnv, ~oIwd (IfmonI1enOl'ltl) __...1 I'l Nlw\/Yltl ~1I1hod I ~ 0uQ j I Bcred I I Abandored ~ ~ Cable ,.1 Ortnno I.J 0Mpenltd I I RoqIry :.J JelHd o RecondIliOned (51 DIMENSIONS: "".... -5Q,8 Oiam-.orwel ._.6'" __ o;he, ... DIlPlhot~eclwea 52=2- ,.. (6) CONSTRUCTION DETAILS: c."nG IIl.WI.cI: _6": Oem Frol'P' I!l """"' 5- o.am From lJl.ner .n n Tlrudod clam f'rom 46,1ll 0, To _47.1_ fIl _0 _ 1'1 To ~5_ It . To hrfOl".aon.: r: Y.. ~'J Ho Type perfo(liIor uloed SlI.lIaplrtof.loOns ___ p1rfDrMoQl"I~ FrorD perfotlliOns From ~rtClf'1'l n, '" ~ ., To 0 T. . . T. . ,,-, :-1 YM II No tuVlIC\l.n'" N;amlt .l:lcustOCl- T.... _ _ .5lainlestll-Slol_, ........... DiattI. -.5~ SIoIIiz4I .016 F~ 41=1 . t. To 52-:2.. It DUlm SIcl tile Fl'CIflI n.. To ft 0... SDl.i:J:1I Fronl It To It Grwe4 pKkMi; r1 y.. 1'''1 No SIZ..clgr...... _ __ __. ~.vel~.'~ _ .__. " To Sumc.....,: E:1Vu. I~No Towl'lllldepU\? MallNl usad '" ual Med..Chip Benlaoite Dod....,51nIilU'lntaotll..f'llAll~w.,..., I !Yu VI tto T)'Oecfwaler_.. DeplholloVltII U~t\OdofMI.JIng 51..1. en , ,_20_, ' (7) PUMP: u.....,(lIlacs... N...,.. Tp __ HP (8) . WATER LEVELS: l8l"Id -'.. .1e..Jl1Jft ,tlcN4 5N ...1 ....65.. .. SI~C."".1 J3-5 _.. 1'1 beIoWlopolweG 0.. _Nov 16. 1995. MH""p'.5l1Uf. lblper~.wd'l 0.1. A1W51an.....M.....eoradedtrw . -e,- ~_.c: (9) WELL TEST: er-d~..wn(U'ItW..,IeYOlIS~ed~--=.... WM.FU"Ol.Slmed." nv., :..1,,",0 1)'lN,bo;'~?_ YoeId _ Q111/fN" wllI'l It a..down."'" YieIct. _ _ gill trnn wilh . ft Qr,..&Jwn .,..r V.IG _. .._. g.lltnn...., .__ 11 <I,~aft.,. ~ d.~(bm.lalo_.. zwo when pump IurM<J ot) [*iI_leYlIl~tcm MlltOp 10 water ,....1} Tme W...l.... Tm. -.- T_ _L_ o.teatlMl e..rlllSl _3.5 ge:lJmor'l Wlll'l 29:6 It. <:!rawdoow!.ll... .4- ... ..... g.tIlrNn .....lth...",SCIt.. . ... ... Amslillnllow ~fmlf\ Dale .Nov...16.199:i w.,. chima.....,... rnadll7 l: v_ 2:J McI Telf'\p of.....I.r W 066071 ABE 820 T 29N . IE. WM (10) WELL LOG or AIIAHDONIIENT PROCEDURE DESCRIPTION fcwrnaUon: D"cllb. bY ~ CfW...Iii. fJ m.'.-l.JI.,d StruCtl,ft_ en:l ,t-ow ~~~deQ;,;Kn IltllIthe land.-ld~ 01 hII mal........ NCh IdnIYn peneCr,lad.1dh ill least anellf"l1l'y 101 N<tIl:1WIg. "....-;on MAlE~ . ~ 8m .andy..llIDsoi, Bm.~cIay-_ Bm.WlIUand .u EluLc.lay~y,U;batified..w1B __ ~ stratified wilhgravel layers. BmJighUao<l 5. araYeI, Wlfl Oad!..llmY cIlll( J" _ --~;. , .,. .. _ NoY.B. 1995 WELL CONSTRUCTOR CERTlF1CA TlON: w..... ..... In -,.0 '_1'1:._ ,-;:, ~3 ;:; I' J ,~" I. I , I I I I Co<opIo'" F~ TO_J 17 1 ;~ 2 2 ~ ,4 611 ,51 -.' I ;~_:~.. -I '--1- 1- Nov 17,,1995.... .... ICXI"Uruded ~aoc:epl r8t1)C1F'lsiMIyIor eortIIn.cloanCJItrJ._'. end lIS I;(JrflplolnCe..-n 811 Wethlf9o" _II :(I'Uol:l\)(;bOl1 st~. ~alfN.aI, used enGhdtnnlll.anrepalled~Il.''''IOll'l)'best~~be/IIIl .., .1 I I I I I I --j I I NAME Charlie's Drilling '. - c ~.fl'lTlor orpo'lIUJn] Add.... e.o.~)}T Por~ JJ^ r {Slg"ed) __.{;1fdL,?....I ~v~ Ucense No. _0458_. (lIMQriIler) Contracton Registration No. Date CHARLD"066 00 Noy 17. 1996 uj .... .. o c. ~ 0:: 4i ~ en :2 .... c: o c o :;:; l'iI E .. .e .5 ~ .c - .. o - "C C l'iI .lll l'iI Cl ~ .c - >. - c l'iI .. .. l'iI ~ I- o Z en ~ o "C >. Cl o "0 u w .... o - c: ~ E - .. l'iI C. ~ Cl ~ .c I- . -- ----- ~~"'-~~ ~ ~ t;l ::"',,='.~= Coo,... 'WnmrWELL R T~ ~,." CU< No. o;2fj '49 =--:;;;,~~"- ~ ."u__~ ';1 (11 OWNER:..... J.x-R0Z1tf.1/- 'i1i:=.. __ ~~~~ _J ~',-</!.J#'VJtl (21 LOCATION OF WELl: C_' J Er~~ :se:..~ N. ~ ~ T~. ..h:....w, (2a1 STREET ADODRESS OF WEll I.. _ _ (31 PROPOSED USE: 0 ~ o DeW.,... ......... 0 Tool w.n 0 ............0 0IIw 0 (~I TYPE OF WORK: :?;::'=r- __0 Now.... 1Il.-1f..IIod:Ovg 0 Bored 0 0_ 0 ,... C_O~O R..ondltl...... 0 R...... W'" _ 0 (51 (el DIMENSIONS: 01....... of_ 0riI0d / () b ,.... 0_ 0' 0.......... .oO CONSTRUCTION DETAILS: CMI"_"d:~. -.._~...~q ft. ~...t ~Dtua.tft1M7DliL~.~II. LMI_a TlwMdM . 0liI& IrOlft .. to . _. JOin Pef1or.Uonc v.. No T~'-pwtcratorMM /, SIZE "{:1)"" V,! ' --.... -- pertwaltoMtrOI'II 'Ve! ~3 ?lb .... ~~ .... !'I.te SCtMna: Y.. ~act&nr".N... T_ o... Slat ... DIMt Slot .iI 0....,. padc.d: VM - - ......... ft..t.. 't.t'" SbllIofgrllMl ar.w.4 p"c:.cI froM ft. to SUrtK.....: V... .......0..- To......degth1 '* "'"-,......_, ~~ Dld....,...'...CWII.IIt~bIe...." v..O No~ T)'p4IDf..I<<'i' '~ot""l. Mettlod of _/irlg ...1. aN (71 PUMP: ..........c:tw... ""....... (el ~: ~~ WATER LEVELS' =.:"'= ft. &.nc...... -;'70 ".~topol... 0... ~/'IC(! An....VI pr....... IMI. "'......,... a... AI'm..lIIl...... ccntrolled by \CIII........etc.n (8) WElL TESTS: CI'~..~I--'.~~..etk....... W".plldlplemmad.?Y..U HolM" tryM.,OywtlOlft1 V.IeI: 9.I.J"'~.'" ft.~.,.. tn.. A~d.t. (time I.leen.. z.ero""-,.... ,.,..oIt) (-.J.......--.ct fr~.....IIOf:lllJ..I.,I.....1 r- Wac.l....., Ts... W...,l""" n.. "...L...M D...oIl... &.1....'_1 ~1.1....wlth tt."~.tl:_ Airt.., c9't9_g.UrM.............. lOt." It.tar J~ Me..." flOw o.~.m. Dire l~.tllf'.o1_'.r~w...eNlfWict;IMlI~~ v..o No .Cl'tl6')+2O IID/.n .I~ 4100' (10) WEU. LOG or AIlANDONIIEHT PROCEDURl! DESCRPTlOI fonMl)on; 0M0rbI br color, cN~. __ of ...... Md .......... ana IIho thk:kMM at.~ ad ... 'lid ... ...... of lite......... In MdI.~ 1**1"1' ......I.....~......,.......~otlllfanftelbL ........ ,.. TO ft. /'- .. ~, .. o. o. .. o. .. WOftlI,.lted I., .. 1. ..., .... WELL CONSTRUCTOR CEIIT1FlCATION: I eonalrvde4 Met/or -accept r"poMibllttY for con~1VC1ion of ttUa w. and II. CO"i:MIMc. wittt .. W..hlnglon wet! coaatruc:tlon .tandard .....lwtAl. ueed ttMllh. IntonnaUon r.port.t .boI/Ie .ra true 10 my bet Adcb..1#:. -~ r7=r'~/01 (S_~~ 6'~Alll--No230,~ COfltractor', / /./ r-' ~... .J.e-/..:i?AI&,. e:;y'.s (USE AOOmONAL SHEETS IF NECESSARY}' ,-,,'" ... .. o a. Q,I 0:: G> ~ tJI S c o c o :w l'CI E .. .2 c Q,I .c - .. o - "tl C l'CI .5 l'CI CI Q,I .c: - >> - C l'CI .. .. l'CI ;:: I- o Z tJI Q,I o "tl >> Cl o '0 (.) w .... o - c Q,I E - .. l'CI a. Q,I o Q,I .c I- o .... Wl!LL RE~T STATE OF W~OTON - '- Wa., Righi PefM Mo. -- ~ ~ IM~UI"~ D~ " , ~.. 0r1giM1 and FIrwt Copy with ~...... 01 EOOIOOY Stooo1MI Copy-OMItir'. CGpy Th~ ~DrIIer'. Copy (1) OWNER: _ sn/u.:; ~ "I)/)' LOCAnON OF WEll: ea.,: 'Jl::FF eLrmJ (2) (2a) ImIEIT ADDDRUS OF W!U. 100 _...... ,) (3) PROPOSED USE, ~ =:::: _I 0 o DeW..., T...W" 0 Stut c.,cj No. ~....~~- "'-cr-/.. J~~ - .&.""'\7 .J/k.....~.....33 T~."/e:W,"', 1Iuolic:lpoI0 0IlI0r 0 (.) TYPE OF WORK' ""-'.-..- I (1f1ftDNm.0MI) AbondonodO __ 1iII Molhod: O"P'_ '[j R__O _0 -..0 _0 Dug 0 C_lit- RotOl'fO (6) DIMENSIONS: 0"_01_ t, DrIl*f IMt. 0..-. of _ r I ad.... " - "" N, (II) CONSTllUcnON DETAILS: I'if~ ~-' c-.....-, b '....._ ~.... (./ =7-"- - ~ . 0......... ".~ I. ...- ~ .,......... ft.- a. Pertorettone: v.. T~otpoertontor-.d SlZEolperlonl~ --- pertar_lIilIM trom -....- 10,,, "to ft,to 11.10 . ~IIIW".N_ T_ oo-. - - -- 1t.1" f/!V.' '"- -- -- Gr..... packe6: '1.. .Of~ Qr""'p1&C~frofro ft. to n. Surf-.:e...t: y_~ NoD TO-t'-tdepl1l7 ~f'). fl. _,....."'..., '13 ~AI7T1A1.,T"'ia+nAlLJ.I"JJ tHoU. DldanylMratllCOifl'&lnu~"""'" .....0 NO,g 1)'P4of...-" ~lIof.nt.. M.thod Of...tMQ ......t. off (7) PUMP: We...er...... NetM Typo: (8) WATER LEVElS: ~=-:-~ .. ....leloool ~1' (/"2 ............_ 0.10 "-'7'-9'" Art...... pr....". .....,...... ioocft O&ta Art-*" .0'''' .. comrDIM bf H.P lc.p.nM.<IIk>> (91 WELL TESTS: o.-~III~"'.I4N"i.~"""MIc"'" w...pvntpt...".ade?v...U No~ If,-.tq.r.om7 v.....: CMP./rn_.wMh '.dnI~..... .... Recovery ~,. Uhe f...... z.'" wfteII ~ IIlnIIId 0", (wal_""" ........ad frOlllweUtQOto..I..Ia<vel) n... ....al..l..... n- w.....~ ,.... ...u..I Oat. oft..t BaIW ..., '1 -'lrI... CilIl/mln.Mtti }2' n.~'f1"'*-hnl. g.I.J"'...wtIh........t fI.w htt. M..lall now l:I_p_1IL Da'e r.lIlpar.tvr.of..t__ W...chemk:al...........ed.-? v..D No~ 'ECToeD-l.20 . [IOlen .13>> ~, (10) WELL LOG or AlIAJIDONMENT PROCEDURE DESCRlPTION ~ DMcrtIMi ~ caklr. c~. aiM Of ~I Md ahVdlWe. Mcl .-ow ........ oI.~ Md.... kIN IMd Nt.. of the ,........ .. Nd'l a..tIn PMelraMf.. ..~..........ttyf<<_dl~.cI......11oa. '!tt, M..... : :"'i , " G!4 ... ft. ft. II. .. ft, I I WOlt.at.rt~ ...... " >e. WELL CONSTRUCTOR CERTIFlCAnON: t conllnlcled ancl10r accept r..pon.ItHlity for c:onatructloft of Ihi. ...841. and .. compkanee with aU Waa"lngton w.n conatruC1ion .tandarda. ....teti. "..d and the information repolted above are true 10 my b..1 .knowledge and belief, , . - ......E S"nJ1~ J)~l-LL"~ ~, /N-~ (KWSON. F1M1. M CCWOAAl'lOWt [T'I'PE OR I'flIHH Se d) 4./...... Cf- f.ff1tc;i ~~ L-tA " Ad...... tJl1/YlCle- SI/ql../t:. (a.t~ Lie....N., (J 'I'~ Contractor's 7 R....""".. Q _ 2..... _ No. Do.. z..J .19_0 .:s;ac.DC I:J 7'11 /l.. (USE ADDITIONAL SHEETS IF NECESSARY) Gl FU.Or'Ilin.1 ""d FI"t Co" w.1h W""T~REPOR~--' l)e.partmiM1t o( EeolollD' 4 ~ IJ. A,ppl.icauon No. ......,~........_...-....- ~nd Copy - Owner'. Copy Third Copy - Or1l1~I""s Cop,. 8'1'AB or WA8B'Jlf~N ~AV f'Jpf3-1 i P......t No. .... ..,..-..-.----- (1) OWNER: Name._.a/4-.A/...._~A4-AI,..u _ A-AC.8.1f.1I;"Ju..~:.zJ.~Pr..(l/.d.u,.n~V._,___ (Z) LOCATION OF WELL: cou,,,,-=r4rP-.€. ___,___--.:...- ~"S4I>_.I" __...l..4. T..#-J...N. R1.L..w:M. Bear1.~ aDd d.brt.ance trrxn ~ 01' subd1v1"'on corner ... ... o Q. III ~ ('l) PROPOSED USE: llomeotlc J;f In_ 0 ............ 0 tJ'J1pDoIl 0 Tell w~u 0 Other 0 III ~ :n E ... c o c: o ';:0 III E ... o 0- S III .l: ... ... o - 'C C III ~ III a Ql .c ... (4) TYPE OF WORK: Owno,., nwn'" 01 woIJ (If more tbaQ 0Mi).... "___H'___ Now weI1 .)i( ...."od: _ 0 ~. 0 Il"~_. Ul.ed [] c.bIe D Dtt:ftA 0 a-..alh>Ded 0 -11- 1- 0 (5) DIMENSIONS: ~o'''',____~"""", DrlI1ed.-..,./~-;2.--It. Doptll.. ....p_ ___.......,. 't. (8) CONSTRUCTION DETAILS: Cuia& iDatal1ed: .....t..-. DIam. ...... ..r..L.. ... 10 ...j.Z. ft. 'nl.re&dM 0 .~..___ - mam.. tram _._~~_ ft. 10 _ ft. W.......llI ..__. DIom. ...... ___ ... 10 ._ ft. Perforatio1U: Y_ 0 1<0..11 Type oll! perforator ~______._~.______.__ Stz& of p4rlora'tION ._.______ la. 1tJ' _.____._ in. ______ ~~ ~ ___"'_'_ tt:. tII'J ___.n. ___..~...__ PlI1icra1:i4Dl; frQm __._. ft. to __ :t. ~ ._. pufontioDA from _._. ft. to ___ ft. Sereens: Y.. If No 0 Wan............. N___,._.LRAAI~.JJ... T7P0-$IMlJl/. I .. ~ S __ ...... N.. OWn. ~_ ..... _ ~~,_ ...... JI.~- It,,, "''''~. D1an. .._~ _ Slat .lze _.._._ born ~_.._ It. to __ tL >. ... c: III ... ... III ~ :> z './I <ll o ~ >. Cl o "0 tl .lJ ... o ... c: Ql E ... ... III Q. Ql o Ql .c Gravel paeke4: Y.. 0 No I;a SID "'arnol: ._, Gravel pJactd from MM_~______'_'__ ft. to _.___~._ ft. Surface seal: Y.. JJ No.Q To whot dep"" ,..1..9.,___ ft. ........., ...... In ""',___f;J..JI..4tI.:r.u.J.r~____. Dld. aDT .u-.ta contain UD....w. ...., v_ 0 No. Tnle ot ..tv?w__.._.___._ Depth 01 atrata_______ Method of ..dDl' Itrata D1r_M...____M____.__. (7) PUMP: MoaUloctmer" N......_,__.._.______..__._,_ T)"p4I: ._...________,."__.~-_- K.P_______ (8) WATER LEVELS: ~::=-.:.'"'r::r,..,_ --'L Stat1c In,l ...-....1-&-..-..----"............. """ D.~~~ ~ A.rta1an. pnM\1ft _...__..__.__.~-1t.. pu *llJ.8n lDch Dat&-_ __._ A.rtem.an water ill C!Olltr'OUed bY_.M... _ (c.p. .,1Il... etc.) (9) WELL TESTS: Dr.wdown 11 &mDUIIt wMer lenl it lcnnNd below IbUe Inti NoJil U ,..., b)r whomt__~.__.___... ft. dnwdo_ alter hn. w.. . pump tu;t made? Ya 0 YIeld: lal./JD1n. wtth Recovery data fUme taka .. zero ..taen pWl\p turned oJt) (ow"- t-'e1 meuurl!C1 from ...u top to ...ter level) Time Wat.,. Lev.I.1 Tim. Wain ~ll. Ttm.c Watn' LftJeI .::=::::~:::: :::~::::=::::-:=}:::.::::=: ::.:-~:::=:::='j~=== :::::::~~:==:=:::: Date af' t~ ......__._...__._._..._....._..~..._.__.._ Baku' 1_...J..4J'M~lal/m1D. Wlth.._LQ.._.tt. C1nwdOW1l &nft_._..2-....hm. o\.rtc::IIan tlO...___..__..__.~_.~___..~__,I.P.Dl. D.w.....~..____.___ T~pera~ l)f w.tu~S.s_ W.. a chetr\1C.a1.nab'" made' Y.. 0 No"" (11) WElL LOG: ~: Dilacnbt'~Cl)1or. mGftlC&.T"..u:iI 01 'FftGu'ria! C*1 ftru.dU..... cmd IAoW tJUdCM.... of MV ~ cn4 rM JdM cmct _tun 01 1M ~ tn ilGCll dNCu... ......tnacad. .h. ac wan O'U ntr1l lor ilac.h. ll::PllmgiII 0/ tonnaJicm. KATERLU. ~ ,_.J1' I. ~, .J,~_)1 v:: -U.; "~. ~ -'.P_ 'Y ,{"j ,..... fL .tJ.r- 6 :..I. <; ~..v , ../ -,__.r "'I' " !'B01( TO ,/ r1.~ ~ 1. ~.lt ...1... 77 .. "T7 "" -q", -qL -q/. jAi... ^"~ ~ /1 ( ,: . . GO 1'\ ~ en - -- ,." ...... r. " l\ ~. .' 00 - - - ~ .. .J ,. W , . /'.f7"'-.. -y "-\/ - 'Y- A I'^-"' ........... ' .......... V ~ ....... Wodl ~~.~ _. _ _ .. 11__ . com.p..I.l4d._..._....~, _.J8- 'M' WELL DRILLER'S STATEMENT: ThlJl well we. drilled under my jurisdiction. and this report is true to the best of my lmowled8c Ind belief. NAME..~~"=-!..4..:::!.ll.~..~ PiiDtl,;'; Md.reu_,{f?..4.../$.t;L.s:::l./.._..L":J OJ,&...!.l..=s.........31 [Sl"'cd]..,~...I.I::'" tt/.._.lIz.. l-~....._ .,.....,...n... ?7 (W'~D~rl r Lloense No_..4:;J...~,~_.._.........'n Date. _.;.L~. 19.T.',E' I. F. No. '"&-OS-eRn. 4-711. (usa ADDmONAL s::KZn'8 IP' NECKSSAJlYI ~. (;,', ...: .... o c. CIl ct: Ci s: en :E .... s:: o s:: o .. tU E .... .E .5 CIl .s:: .... .... o - "C s:: tU tU .... tU C CIl .s:: .... >. .... s:: C! .... tU s: I- o Z en CIl o "C >. C'l o '0 tl W '0 .... s:: CIl E .... .... tU C. CIl o CIl .s::: I- c;~~ ,0 Y ATE I \I ELL STATE Of _lWGTal NT. JULIET, TN 37122- .~Z:====E~.~....~-==-==.......======.....~...-=eS*......""". j I E P a I T Start Card No. 11053450 \.hlquo Yell 1.0. . .uC17'l U.ter light pennit .o~ ___.......=.......~.=.a&..=~.....................ac-=...3 (1) OlnIEI: N.... PAIENT. JACX Addreu 10'7 IROCIGTalE 8L'ID. See: 33 T Z9 N., R 1E III ==....____====.....-=.====~..._====.=~...~=.=~.................__=~~.z...................z-===............==z=====.. (Z) LOCATlal OF \/EU; County JEFFER_ . WE 1/4 SII 1/4 (Z.) STREET _lESS OF YELL (or .......t oddr...) 5' $. BAYVIEIIIlI.. PT. UIII.GI ..a==..........=..........aaa.......................&..........................~aac~.====-.a=.....a:.~~......~==s===:. (4) TYPE OF _~; (3) PROPOSal USE; OOOfSTlC (10) \/ELL lOG ......z~.......&aa.......................==..................... .....--....-.....-....-........................................ NEIl YELL Q.ner'. IUlIbIr of well (If ~re than one) N..hod: IOTAn =.....................-.........~..~.......~.........~.. (5l DIMENSIOIIS, Dr; lied 68 Ol..tor of ""II 6 Depth of __I.locl ""II 66 i_ ft. ft. ...=;~~ss...;;.~==...E:a...=...-==..~=.....===sw=...-z--=-..... (6) OONSTautl1011 OE1AllS, c..ing installed: 6 WflOED u ota. freD 0 If oi.. frlDln . Dfa. frOll ft. to 55.5 ft. ft. to ft. It. 10 fl. .-.........---..----...--......-.--....-...-----.......-.. P.rforations: NO Type of perforator used SIZE ot perforations perforattons 'ram perfor.tlons fr~ perfor8tion& f~ In. in. by ft. to ft. to ft. to II. ft. ft. .........--.......---.......---..--...----.----........... Screens; YES Manufacturer's Mane TVP" STAINLESS D(8I'I. 5 alot sin 12 Dia~. S Ilot S'1. 10 HWSTOII Model No. trcA 56 frOll 61 ft. to 61 ft. 10 66 ft. ft. ................---.-...--.--.--........---.--............ Gravel packed: NO Gr8veL pleced fr~ Stze of gr.vel ft. to ft. .............---..---.-.--.-...............----.....----.. SUrface '~8l: YES To what deptb? 18 ""l..-ial used In .011 BENTOIIITE Did any strata cont.in unusable w.ter? NO lype of vater? Depth of strete Met~od of sealing Itrata off .====...=======...~~.===..=:;z.==...=~::z.............=....... (7) PUMP: Menufacturer's w.me Type SUBMEISIBLE H.P. ....=z...===.&=======..s=w;~===...=~.==~..==ca.==...==~~.---.. Lerd.SUrfKIt elevet ion above mean see level Static level 15.75 ft. below top of well Art..i.n Pressure lbe. per square tncn "rusl.., water c.ontroUed by (8) VATER LEVELS; ft. Date 04/24/tn Date 'OrMtton: Describe by eolor-, chal...cter, stz. of Mteri.l eM atruc:tut'e, en:I MOW thickness of ~iferll erd the kind ard neture of tM Mterial in each Itr.tUl pervtr.tl!d, ..ith at leest CIne entry for eech change in fo".tton. .-..-..--...-..-.----....-......-----.---...-......-..-...-.... NATERIA!. 1Ill1Ul a.AT GIfT ClAY & GRAm "_ISM GREY GRAVEL _ISll GRET GRAVEL & \Il\TEI GREY CLIoT & GRAVEL IUCl BASALT FI(JI o 6 53 50 59 64 TO 6 53 56 59 64 ft. fl. ,-,., n ;,. (9) YELL TESTS: Dr.wdown fs ~t vater level stetic \...,.l. Was . ~ test D8de1 NO . Yield~ sel.llnln ...ith iI lowered below =...=~Z.==.........................=...................D.........==&......a......~..c.....___......~.=-s......=~......===== ~rk atarted 04123/97 C_l.ted D41Z419T If ye., by ""","1 ft. drawdbwn after Recovery data Time Wet~r Lt~.l Time Weter Level T i_ "Ur L....l Dete of test , I Bailer tl5t 3.5 gat/.in. 30 ft. drawdown efter .4 Air teat 3 gll/.in. WI tt~ let at 56 ft. for .25 ArteSian flow g.p.ft. Dlt. Tt!q)er.tur. of wafer We. It l::hsicll _lyai. ...de? 110 hrs. WELL CONSTRUcTOR CUTIFlCATUIII: I tonltf'UCted wdlor accept reepon&lbilitv fo,. con- .truction of thil well, and tn ctnpltanc~ Idth eU w..hlngton Mell c:onItructian ttandards. ",uriala used end thl infof'8ation repot'ted above Ire tNe to rrt bett t_lsdge one! belief. lINE CUCr:wolTN P\M' & O~ILLlIIG (Person. fi,... Or" torpor.tlon) (TYPe or print) ADDIESS 18365 DIAMOND OlIVE NE hr.: hr.. 148 1147 [51 Contraetor.s Retfstntion ~. DUCIlF"148CJ Date 12/0ZJ~ .=~.......~=;..:=....=~.===......&:.....=z.=zz...:=.==_..............aa~==....==........=~=..._==.B.==...==...=....==z.==....~ (1) OWNER: Name.__ bf...4._ , t: (2) LOCATION OF WELL: o C. III 0:: iii ~ (II :E .. l: o l: o :;:; flS E .. .E .E III oS .. .e " l: flS flS .. flS C III .l: .. >. .. l: flS .. .. III ~ I- o :z <II III o " >. C) o '0 tl W .... o - c: III E - .. III C. III C Q.I .t: I- '''-. ~~ .., W ""'\..L.. f Z- WA . EPORT IlTAD: OJ' WASBINOTOJi' Pc1mt No. .... .._.__..._.._._....__ FlIt OrUrlnal and F1m Cop," W1th D.partmeftt of kamu s.con.d Cap)' - o-Ta"', Cop,.. ThIrd Copy - DrtI)et'8 CGp7 AppUe::aUon No. "'h'_~._.. _......._.._. B.UJnc ud dI.dance tram McUoD o:r w.bd1vi5lon <<ltMf P.'~~ d - -L .. - (3) PROPOSED USE: Dom..tic ~ IndUUW 0 "'_0 (10) WELL LOG: S IV YI./ o-fAl~~ Df-S<<..33 Irrl&t.tLon 0 'I'M WeU 0 .,..,... 0 I'oImaUon: o.lCf1" ~ color, rlutrackr tiu of mat.rf4l11M atru.C'tlu'l!. lmd .how tMcJullt.. 01 GqWh,"-' Glld t"- kiN{ aM ft.Gtw..... 01 t~ mct:1IricJ tn. Itack (4) TYPE OF WORK: Own~r'l number ot weU Itndvm pnolttnltH:. tel ~., laut 0714' ...u:rv lor Me" ch4aQe of Ionn.atiml. (1f more than one}.... ----.-.--- IltATERlAL I'1IOK TO N.w.ell AI Metbod: Dq 0 Bond 0 yo., ...'", ~ -~ DoopoDod 0 c..... 0 Dri'YeD (J ~ ;,~ ,~ /1") _" L'_.,... f W~ ", . - _nod 0 -Jf J...... 0 I <'...., oJ _, @_ - ~ - I <J_ -.,; :.c......i ...., (5) DIMENSIONS: .Diarrw!t." of weU __.1-.._ lAdl.eI. ~,,~ , -fl )~ ~ " - ~'I ..?~. DrlUe<L_,_,,r.:,,___.ft. Dopth 0' ........... ...u--4~--A " , --- (6) CONSTRUCTION DETAlLS: - CPing iDataUed: -8-.." 0...... Ito", *-.}- ft. .. _.~ ft. .......dod 0 ____.. I>Lam. tJ'ozn ____ tt. &0 __ ft. w_~ - .. DI.aID.. tr'om ._....~._ ft. kt _ ft. Perloratlo...: Voo [J No ill T7Pe at pedorator UMd-.__.._..._._.______._.____...__ SIn 01 pe.dorat1onI .~___.___ In. b1 ______ 1n. ____ p_tlOuU0r4 from __..~__. tL to ft. I ___._~_ perfon.UODI from. ______ ft. to ___. A. ... PftforaU.ou tr'CIm _...._.____..__ tl. to .~__ ft. Sueato: V.. 0 Noll 1I&n~ Nazaa...._.______. ...... __.__ Model No .- Dtam. __.___ S10t mze _._....__ ~ ..__~___ ft. ~ ._._ ft. D1am. .__.__ Sloe -.JJe ........._ .trcI%l ...._.._M.. It. tel .._ It. Gravel packed: V_O No~ SIze of ~ve1; .___..._ . . Gravel p1~ tl'um _ ...--....-..- . ft. to ___.__.__.__ ft. r.... ..v -J. . Surfa.. seal: To whot dopth, _"'_~ ... , v.. II{ NoO /. ." ,- ~. ./ --:~ ......rlal """ .n ..oJ...q,.~.~T.:-4.II.4,'::-4-.- ..__.__ ./ v I ,/ Did "'7 --- cantalD un1Uable ..ala'? V.. 0 No '=' T7PI of "'~r1_____.__...__ Depth ot atI'aU____.__ - u.tho4 0:1' Jlea11DI a~r.~ ott_.___~...~..__..._..._._.__.__.__.._.___ ..;t' (7) PUMP: --, .J \ lI4aJ:I.u:factarer'JI N~.....___..______....__._.______.__ ~-o -y~ 'l"ypo' _..._...,.._.___.._.._._.......,_,__...._._,_._,_ H.l'___,__._ ~ (8) WATER LEVELS: LaIld...urlac. tlevat10n ,-1.'" ..~'?A '(" .bov.. m~ .. Ind.... .... StMk leye1 ........_/--"-__.__..tt. Nlow top ot well Da"'/.!1~ - ';6 ..,,~ -,~. Arln:lan pr..u.re ..______....._--1_ per 1ClU&le Incb. Dalo.- - -- ArtHIan wlltln' .. ecm\roJJ.a by..._._. (cap. ......e, m.l -- <J_ "" .~., '(', .~ "' .,. (9) WELL TESTS: Dr.wdown II lUNM1JI1, 1ft" Ic-vet. fa ;;;;~~~~- s~~:;""Q-'---'''' 1oWft'*d Mia. .uatJe Inel ......- _.111.._.... W.. . pump test mad., V.. 0 NO~ U YK. by Whom? ___._._..._._. Ylllld: .aJJmln. with ft. dTnrdown alter hn. .. - - .. Th1a well wa.s drilled under my jurisdictIon and this report is .. .. .. .. true to the best of my knowled&e and bellef. Recent,. dllu (tl.me ~.D .. zero .boo pump \WUOd 0," (...... love! Noo..Ir!.a.,p.ul1...t:;.J/.A.,.L...D..It,;.IJ:I.,N,I1...,..6, meuured from 'top to w.t.e::r level I Tim. \Voln r...., I Time W.... !.n><' t TI... W_ r..... (Penon. tlrm. or cwporaUoll) (Tne ot prmlJ Add......Hz.::~.~~.I..f...!.l!..a'Iu.L~~_A("_.A<!. ::::::.:,::::,:: =:.::::=~=:::::::::r::::::=::~:: ::~::::==::::::':: ::~:::::::::: :::::::~~::::::::::::: ,", B~n;~:/ \1' ';::~~~~~"~~~.:.:L'~~~;. drawdown attIIr__~.Jera. [ss.ned]....~ .: it W~.._........u .....-ivi.iii..D.rlii~~i-- n_ - ...~.. .......... ..w_.._,___.__......,_._,....m. Da,~_~J...,,,,j~J.S' LIe...... NQ_..t2..~i?....r:::.......,.., D'le.bu. -,y. 19.2 Temperature of wa.tAl:r_.s'./,.. W.. a chcnJeal analyall: , Y.. 0 No.l\l 'L ~ f (UB ADDmONAL SB:ZEI'8 D' NECESSARY) -4iI&o ' .... N4. U""OS-tRev. 06-'11). .?"\ ...; ... o Co <II 0:: Qi ~ l/l .c .... s:: o c: o :w rei E ... o .... s:: <II .c .... ... ~ "tI s:: rei rei .... rei CI <II .s >. .... s:: rei ... ... rei ~ I- o Z l/l <II o "tI >. Cl o o o w .... o .... s:: <II E .... ... rei Co <II CI <II .c I- G~/0 j W ATE. W ELL . E POI T St.rt Card 110. 11053450 Un'quo 11011 1.0. . UCI7I1 STAlE Of \MSMUIGTCII \later I i;ht Pel1llit 110. .3==;===E~.."....;~=...."'.=;==#=~..."'..".=:S""'."'''''.'''''''...''.................~.=......................~~==.= (1) DllNU: _ PA.UT, JACK Addr... lOl7_TQIS 8L'ID. ~T. JULIET, TM 37122- ==....;;;;====......:.====........a;~===~....~~=...........................aa.=..............=.....-==.............~===:=.. (Z) LOCATION OF \/ELL: County JEFFElsor . ME 1/4 SII I" See: 33 T 29 M., I IE III (2.) STREET _lESS OF \/ELL (or .....r..t addr...) 51 S. BAYYIEII OIl., PT. LLDlCll/ ..-====........~~=-=-...........a...................c..........................==.===.....==;=z.==......==~~........~======- (3) PROPOSED USE: DOMESTIC ................a:a=.........==..a............................... (4) TYPE OF woaK: Owner'. '~r of well (If eore than one) ~.thod: ROTAIlY NEW \/ELL ................................=........~.................... (5) DIMENSIONS: Drilled 68 DI_te. of ..II 6 Depth of c"",l.tod ..II 66 1_ ft. ft. ..Z=;;~Z~__3~~=~...E:==..=2..-==..C:2....=z=S.=..~~....... (6) COMSTRUCTION DETAILS: C..lng inshlled: 6 \/ELDED I' Dta. frr:n D II Die. frCllll . Df.. tr~ ft. to 55.5 ft. ft. to ft. ft. to ft. .~.........--_..--._...__._..._.._.--.._-_.__....__..-.--- Perfor.tions: NO Type of perforator used SIZE of perforations perforations from perfor.tlons fron perforations f~ in. in. by ft. to ft. to ft. to ft. ft. ft. ....w__.___.._________________...._._.________..._______e. Sc reens: YES Manufacturer's Name Type STAINLESS Dhm. 5 slot sin 12 Di~. 5 alot stze 10 HCllSTON _I Mo. fral S6 f..- 6T ft. t.61 ft. to 66 U. ft. -...--.--..--.--.--.------------........--.---.....--..... Gravel packed: NO Gravel pleced fr~ St Ie of gravel ft. to ft. -.------..--.--------.----.....-.-....----..-----...------ Surface .~.l: YES To what depth? 18 Materi.l used In seal BENTONITE D;d any atreta contain unusable w.ter1 NO Type of wlter? Depth of stret. Method of sealing ~trat. off _==::...~:~::==...==~.c==..==a..c=...=~~=~..=.........~..... (7) PUMP: Manufacturer's N~ Type SUBMERSIBLE M.P. ==..====~==.E===~S~=..C=;;:===S..==.===..&:======...==..==...... (8) WATER LEVELS: Lend.surface elevation abavl' peen leII level ft. Static level 15.75 ft. below top of well Date 04/24/97 Arte.lan PresA~r. lbs. per squar. Inch Oatil' Art.5tln water controlled by (10) IIELL LOG ....................................................-.......... 'onnatlon: Deteribe by ~olor, charact.r, &Iz. of ..terti. erd .tructure. ard MOW thickl"'lHl of aquifera IIf1d the kind AId .,.ture of tt\e ",terial in eac:h ,tntua penetr.Ud. with at lust one entry for each chnge in fonA6tton. .-..----.................-.....-.--.......-........-........... !lATER! AL _ CUT GREY CLAY & GIAVEL _ISIt GREY GRAVEL _I SlI GREY GRAVEL & WATER GREY CLAY & G1lAVlOL lLACI: BASALT FRlJl D 6 ~3 56 59 64 TO 6 53 56 59 64 ft. ft. ,-", r"J ;,. (9) \ELL TESTS: Drawdown ts IIII1CU'\t water level st.tic lw.l. Was 8 pump test made1 NO Yi.ld~ gll./mfn whh la lowered below =...====.==...............~.................~..=..................S&..........~..c....~.............~...........-=.....====== ~~k .t.rted ~/2]/97 Coopl.ted 04/24/91 If Y". by ......1 ft. drawdoon .ft.. Recovery deu Ti~ Wat., L.vel tine Wlter Level 11_ WIIUr Level Dlte of test I / Bailer te.t 3.$ gal/.in" 30 ft. drawdown .ft.r .4 Air te.t 1 gall_in" wi IteR set at 56 ft. for .25 ArtMiian flow ShP.I!l. Date Tlllq)er.tura of water Wea It chllSliul .....lyai. MCX? NO h.... WELL CONSTRUCTOR CEITIFICATIOM: 1 ~onstructed and/or aceapt r-ellporw.ibi l ity for can- atruetion of this well. and in c~UIllCIll' tdth all W..hlngton IlleU COIWtructicn .t..ards. ..udala u&.d and the lnfo~tion reported above are trut to rrtI bct:t k_lcdlle ond bali.f. NAME DUCKWORTH PUMP & DRILLIMG (Per~on. fi~. or corporation) (Type or prtnt) _IUS 18365 DI.....D DI1VE HE hra: hr.. 143 1141 [51 Contractor'. Realstrat ion Iio. DUCJCI,FW14aCJ D.te U/OZ/98 .=.__.=~...=~zz==....~=~m===..~z====z....;.=~=z...;==.=-..............~.==z...=._..~....~._...._==~..==...==&===....=~..==...=== -~~~])EPORT STAft Olr l1fAllIIING'l'ON nle Ot1&lnal and First Cop, 'WIth n.p.rtment of EeoloU Second Copy - Owner', CoP7 1"hird COpy - DrtJler'. Copy App.ucaUoo lio. .. _.,...._. _, ,.._ ..... Permit No. .... (1) OWNER: N....__ -.~./L. ~ oLS PO.oJ.o_ A ..n'IA-___ED..E.:t:.....I.....u.d...L4.UJ, ..,~_ W~ '_.._,__ (2) LOCATION OF WELL: C4UA.._:sL...... --: H/ , _._.__..._,_.._SlIL. ..N.f...,~ ~...3.J.._ T..,:J.!/N.. a./-ftwx. Burll\l' and. dtstaDce from tIllIetioD or lubd.lridon corJ' ?J 3. F2.. (3) PROPOSED USE: Domatl<: 1J" InduotNl 0 """""pol 0 lrrlpUon 0 .... won 0 other 0 (4) TYPE OF WORK: g;ne~ ':."::.b:,.~'..~~__..._._____.. New ...u JlI. ..-: Due 0 - 0 DeoI>-" 0 Co'" t;f D".... 0 -0 .........0 1_0 (5) DIMENSIONS: D_ of ...u ._..__.~__,_ ....... Drllled....J..j...s::::.__..lt. "- of ....plotod _u.....;;.:L.3..r...a. (6) CONSTRUcrION DETAIlS: ~ CasIDi inataUed: ..~._ ~ 01.... tram __.4- .... '" ....>S:L It. oa-'Jt: r! ,- e1...:..&:- - DIo=, """" _.~ .... 10 ~ Welded,A' .___.. ot.m. from _._.....__ It. &0 __ 1L PedoratioDl: y..Jiit N.O T7Ptt 01 perforator 1."IoMd-__..___._........____.___._ SIZJ: of pa10n.t101L1 _ lD. b7 ,_._______ !D. -1='.!_'''''' ..-ratiooo "= ~,-, <t. '" ..)..~..s:::- It. .__."___.._ pedoratioaa from _"___'___ n. to __..__ n. .__.._.. per.fant;Jaaa trom. _.______ ". \0 ____ ft. S_.. y.. 0 NOJII 1lIaJ:luf.act'1.ncr'1 Name____.____ .._ TJplI_._~.. Model No. _ Dtam. ..__...__ Slot m. ___ froIn .....___._._ ft. to __...__ ft. Dib'L. ..___..._ Slot a1u ._~_ from _'__ tt. \0 tL Gravel packed: Y.. 0 If. " SUo of ,...vel: ._.___.__ Grnd placed trom _________. ft. to _.._~.w.___._ ft. Surface !leal: Yet 0 No 111 ro wbat depth? ..__._.._ It. l4atertal U60ed in aaal._.___._..w.~_..P._.______..___...._._____ Did all7 I'tl'aa contain Ub.tlaabJe> ..ter1 V_ 0 No 0 ~ o! waw?___._____...._.__ Depth of atzata_.._._____M l4t'thod of aeaJ.1nC IJtJ'ata Dfr...__.__.__.__....__._._.__.__._.__ (1) PUMP: M&DuUlC\U'U'. Name..__..__.__.......k"_._________._ 'l":rJ>e: __.____~...._.._______._____.___ H.P_........_._.__ (8) WATER ~EVELS: ;:::'--=.:'''I::'~,.._,_-:!t!..,q..-... S$atic lC'Yel._......~~._...._...n.. Wow top of..n Da.....~.L ., A..r"talan preuuN ...._...._..____.1bI. p.r Ml'Ul'e IlICh Dat.e...___._______ ~an water 111 eoatrolJ.t 'b7.-..----..--.-.-------._... ICap, valve'. ot'tlt.) (9) WELL TESTS: D..awdown 11 amouDt ...atel" leYaI 111 Jo...-.d bdcw -.Ue 1~1 No'" U :r-. b,. whom? .___.____._..._"m._._... ft. dr..Wdown f.fter hnI. w.. . pump test mad.' Yu 0 Yield: .a1Jm.ta_ with R.:ove", data I tJme takltft .. zero W'b4Ul pump tume'd 011') I.....ter 1eV~ mNallred from. well top 'to W."I' I_d) Thne Water z.w.l Time . Water LeV.'.t Tim. Wdft" 1A:vt& ::~~:~=:::~:~: :::~~::::::~::~~:~=. ....:.~::~=:~: ::::::~:=:::==:::i:::::=:::::::: :::=:::=::::~~_ D.u of tut ...._.___._.~._...~....~.__m__.__._.. BoUor .___.,.l...s.:'ol./mln, "'........s::att. "'.__ oAer__./......_. A~ f1ow..~.__.____..__..__.____.p.m. Datc..._._.__~_.._.~._..._..__ Temperature at ...tu,,~,L. Waa .. eb.em1W analy.U1 mad.' Ya 0 No 0 (10) WELL LOG: rormaUon: D.lC1ibe bll eoIor. elMnl.c'trr Au of 1R4Cn1411llftd #nK'naI, GAd """' ,.'cJr:..... 01 aIl11i!.... Gad iu Icb..illlUld. nahI.'I"C 01 lu 111Gtftia1 hi Hda dta.hmI. PR'ICtmr~. tDIfJt. .1: a.ut 17M e1tt1'JI lor ead1 c:~ 01 fonnatloft. ....TEJUAL 7.: '0 ,L3.A'''lJ- ". , ..L. JI LJ.-.b ~. t* .i_A, ~ ' .11.4 4 ~U_ ,. ~. 2. :F,,- wi- I AP:,.J1 .~. - [.,.. 0+ . -1 J1IO)( TO A / . .... ~".... Jl/n -ANJ '....L ~4__ .;';".n ~./- .... ,... '__6"'~..... 7~ WorK ~._.~H.M_ II ~_.. CC)lDple\c4- R~_' 1.8..-_ WELL DRILLEB'S STATEMENT: Thia well wu drilled under my jurisdiction and this report is true to the but of my kDowledp Bnd beltel. NAME..~.._~. Y!. ~! ~.....LL.,.. (Penon. arm. or rorporaUOI\) gor prmt) Mdrou...d:L...J..-,~._~~~.-. -f"" .., ..~- :. ....., ,.ttJ- [SllP1edl._..b,' ..~~.!~. ~b-~t;"'''--''-''''''''''''';- u...... N~3..._...f..:&,-1?uDaJ~......A~,_....... 19._3 a. r. No. n'f Cl$-(Rev. "71). (t1'SE ADCmOHAL SHUTS D' ~cuRY) .... . D. .w .. o Co CII ~ Qj ~ en :E - l: o c: o 'i:l Cll E .. .E l: CII .s:: - .. o - 'C l: Cll Cll - Cll Cl CII .s:: - :>. - l: Cll .. .. Cll ~ I- o 2: en CII o 'C :>. Cl o '0 tl W .... o - l: CII E - .. Cll Co CII Cl CII ..c: I- Please prjn~ ~,~~~m :u e;2rtment Of' Ecology i1! ~~"t~~~ ~~~,~~!'.~~!.."PY_'''''' telL", CODstructionIDec:ommission tKtonstruction t:J Decommission ORIGINAL INSTALLATION NOlice /51 ifll IN br Current Nolie. oC Int.nt No. VJ' 1t.~219 Unique Ecology WelllD Tag No. A 1-/ M 3 '18 Water Right Permit No, Property Owner Name"""~ 'hfJ,?; J<>_cA ~N~cc..r...ei'S as-.st:'. U; ;;;:33 0 n en um e Well Street Address ""em- 1H'.,7; &a.cl... ~ PROPOSED USE: ~racstiC o rndustrial o Municipal city:i=btTLud4.~ County :T~..rs 0" DDewaIef lnilf.uiM OTcaW~1I DOd," Locat;o,,9<J1/4-1/4)1t.1I/4 Sec3.S TwnZ9"l!..1 ~~~~.. TYPE OF WORK: O\lOncr's numbcro(weJl (i(morc lh;in U1C) 'WWM ~ o Nc~ well !f:!ewndi1iord M~,JwJ: 0 Oull ~ BoreiJ DOriven Lat/Long (s. ~ r La' Deg Lal MinlSec 00..",... ...: '1M <,,,1 DC.b. .....,. o JeUcd DI.\tENSIONS: DiunclcrOfwtll_~ inches. drilled ft. still REQUIRED) Long Deg _ Long MinlSec Depth or ComplCled _1I I-? l/ l\. CONSTRucnON Dn-AILS-,-- Tax Parcel No. Cl5illJ:: m'CLJed W DilU1l.1Tom~ft.IO.&ft. Installed: inerinsbllecJ_" Di:un.from Ilto ft. CONSTRUCTION OR DECOMMISSION l'ROC.E;DVRE Th~ ., Diam.from .... ft, rerforatWIlS;" U Yes LJ!iI No Form:uion; Describe by ~ol(N", char.K:fCl, size of material ani.! SIluCtlIre, a.Ill.I the kind and rnltllre ofd\e:matcrial irl each Slr.JNm penetr.ItetJ. "'1m alleastOllecnlry (oreach charlge of Typeo(paforatorused information inoJicafeaU.,u(ff encounlCretI. (USE ~ODmDNAl SHEFTS IfNEC.ESSARYJ SIZEo/perfs in. by in..1lki 110. ofpcrf~ 'rom !t.to . MATERIAL FROM TO ScrHn.: o y~ Jil"o OK.Pae locatiOll CL/lv ')- ~~ MaI'lufacttlfel'"'sNmIC: {".LA V )../. P. !? ~5 Typ, MocJeJNo. J ,,;, f- S ~G., Diam. Slot~j~ rr~m ft. 10 . Ciam. Slotsiu: from .... . ,",,,. '/i:',.,...K /.oJ/B e/-:zS .c:;c, 13'1 Gr.nllFillu p.cked: 0 y~ ;etNo o Siu of gnveV5Ull! Matenals plat'N from .,to . SurfaceSeaI::Ji(Yes DNo TO,:,"ha[dB.h?~_~ . r7 //15 IS a... J!>L:J .'D Lea M41erillJused inse:al Dty~f"J,ID e "In 15C1'PAce <"~I ,_,~ '" 'x .-r":/( ,.Jj TO I F7~ , I-.d D_'1'"... " e-PFl o /f1SPE k:-1<>r Didallystr.ltl.aml:linllnlolSabJewaler'! Dyes ~No Type of wOlter'! Depthof$tral:l '"' <;,'r" MethoJo/~ling.strauoff ~'''''''Il'": MalluactUrers HLL erH>\.U Co"rr,U I .J__, I", Typc: H.P. Cor:;,,,c1 s; or (" o"'...e.n le^~ n/.., , 1"', ........ WA.TER LEVELS: SurfxeeleV;d.ion above ~ 5ellevel _~ U ft. W<1.11 -'><> --m..,~J. II.. 1,73 Sc~iclevd ft..belowtopofweD DafeS/2qnO ~v' l- e.J r~"qJ D~ill' J "W Anaianpres4\lI"C Ib..per~inch [)au ~. '".fA", ~/.;~ , '1" . . Anesian'Il,-alais conttOJle1.lby cot . valve. de.) WELL TESTS: Dnwdown is amounl waler level is lowered below staCie: level Wu.. pumpt~stma.k.! .y~ DNo If yes, bywbont"! .,;p Q Yield: l!allrninwlth ft.oJnw,Jownafta- 'n. Yiel1.l; 1/:l11min.Vliitt. ft.Jra",'downafto- "", W',.,;, YiekJ: l/alJminll.'ith ft. LF.I""UoW!l:alter "", (') Q Recowrry dtltu (time' ruken US;:tIV Millerr pump tlJrnrd uJf) (WUIU level ~ure.J}ivI'fl ~( ;-.c ~ wpluwuterleve{J ~Wa~~ Timc: WaterLcvd T"" W.terl..evcl JnIC"""~IJ\'lf~ M I ..J.O..ht J2fJ ~ /7" ..--....." -- n>C - - - - -,"\f'T n ~ no. , C:C " ;;;;;,;;" "'7Ii7 /0/70 . - - v I .~u, ;;... - 'a":lerlni.~Pllmift.wirh qf) ft.dI1lwdown~r_hn. nl:p.dr.lU.tta,IT nc ern. n. , ,.,.. - Ail'tC:st plJmin. ",iUt stem 5d:l1 U.. Z .... WE!.L DRIII!iJr,irNIT ""c,.;a"f\o.... v.p.rn. Dale Tem(leuUlK of WUtI" s...L Was a chemieallnuJysis tlUlk? J5i[\'a 0 No p~ '(l'f _ Start. Dale Completed Dale WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well. and its compliance with all . Washington well construction stand ds. Materials uS<<;d and the infonnaoon reponed above are true to my best knowledge and belief. Dnll"IE"",_,rrrn~' N'~'Pn") ~ /JfTirr Orilhn,Compmy #;if1b; f)/II'~~ THL.- OritlerlEn~lneerrrr:II~<<!S'I~ure AJ.Jreu 23L.s=....~~__ __~ DrillcrorlnoUlcc1.lcemcNo 197t? CII)'.Sl:IlC'.z,P <). '/:. 90. '2... IrlRAINEE" Conll:K[o('S I Drin..r'1 UUllMd ND. Regi:.;lr.l.non SO. OMI<./JJnetc:hrJN D~le Q,/7/aQ DriU~r'l Sir.III.lurf E~oJco!i)"...... t<j_l Opp"'....,,;ly Em.ploy.... ECV OSU-I_JO \R.vUOJ) /\ ... ... o a. QI a:: Qj ~ .~ ,- - ... ~ ~I~!-~~I:.!!~9..~!-'rikT r'c',To',', .. ".. ConstructionIDecommlS510D ("x In circle) [!] Construction \ Decommission ORiGINAL INSTALLATION Notice CURRENT NotlceorInt.nt No. WJ89597 Unique Ecology Well 10 Tag No. AKR167 Water Right Pennit No. Property Owner Name MICHAEL V AN V AlKENBURG ~t.\(!)'l3 of Intent Number Well Street Address NORTH BA YVlEW DRIVE PROPOSEUUSI:: fZI Domestic. o Indusm.l ~..MwUcipal City PORT LUDLOW County JEFFERSON o DeWucr Dlrrigario. OTaaWell D ..... Location ~1I4-114 ~1/4 See.E.. Twn~ R~ EWM0rdc Owner's number of _II (if more than. ooe) ~ a TYPE OF WORK: ww",Oonc (ZJNcw....etl o Rcc.onditiOAI;d U,rhod:DDus o ..... DDri_ LatlLong (5. ~ r LatDeg Lat Min/Sec D_ O""'" IZlRowy OJ""" DIMENSIONS: DiametCfDfwdl.2.......- indlC:S,driUed~ft. Still REQUIRED) Long Deg _ Long MinlSec Depth of com pieced weU 100 a CONSTRUCT1ON DETAIlS Tax Parcel No. 921332013 &.014 Cuil:lC (ZJWeldcd 6 - Oiam.m:.. +1 alO 2S a InJtlllkd: ~LiIlcritlSlllled~~ Dian.liom 20 ft.to 100 a CONSTRUcnON OR DECOMMISSION PROCEDURE Thmdod " Diarn.fiom D, '" a Fonnabon.: Desaibc by color, d\arKU:r, size oCmaterialllftd SIIUaUR, and dlekindaad Puleraliolll:l: IZl Ye$ U~o a..-uteofthe matcriaI ill c:adt. SD'UUmpenctqlcd, with alleast.;m entry for each change of Typeofpetfon.r:orused SAWCUT in~ iUSE ADOmONAL SHEETS IF NECESSARY\ S[zEofpl:'l'tS- - ai("liy -in:".ul no;-o(pcrfs ....:...fron:l.J!2...=ft.1O-1OO-ft.. '.- - MATERIAL ~ "FROM - ~To- Sutt:IU: DY~ IllN. o K-Pae '""'""" BROWN GRA YELL Y CLAY 0 4 M....v.fact\lrer.sN_ GRAY CEMENTED CLAY 4 25 T,.. Mood N6. HARO BLACK BASALT 2S '7 [);~ SIotAze &om au. a [);= Slotsiz.c .... ..'" a REO BASALT 47 54 Cnvelr'Fdtu packN: U Yes UNo o Siuo{gnveVAnd BLACK BASALT 5. 69 Matmal.s pl~ from a", ft. GREEN BASALT WIWHTTE CHIPS 69 7B Surfate Seal: IZl Y t:S ONe To....hatdepdl718 a BLACK BASALT 7B B1 Mataia!used iDscaI BENTONITE GREEN' BASALTW/WHITE Cl-DPS BI so .Didaro)'stra&a~ontai..ullllSaba.w~ DYu IZlN. BLACK BASALT 89 . 100 TyPll~r,.,au:r? DepdJofsttatl Methodcrsc:ali~snuoff PUMP: Manuf8Ctl&fa's Name UL T"", C;:l~~.n'R~lR' J:: 101 <:rx - H.P, In WA TER LEV~: LoAd-su.n...u ekverion Move _ sea level a ..... Suriele'Yd 15.7 fl~lopofVt"CU 0Il:c 'nM'lfli Anesiupra.siU'e lbs.palq.UJeincb 0.. ArteJiaa....eriseoQ'ol,ledby , ,... 0< WELL 1T.STS: OnwdoW'll is IIIQ)(llJQl wllet In'el is lowered bGlow stati~ kvcl Wu apwnpteAmade1lZJ YeI ON. lryes. by whom? GRESHAM Yield: .40 u1Jrrin. with 97 fl. dnwdowa Ifl:er 4 h<< Yidel: ulJmin.with ft. rh...down afta "" Yiekl: uI}mia. with ft. dnwdowa.fla- h<< Runwry dtJIg (,~ ,gJ,;rlIQS urn WMIt punrp ",.-tl oJ/) (wotcr /~ 1N2QSwrrd{fTl1II _/I IDp10 WQ,u/r;ol) s-fi> ~;.:;; ~ \$161- Time Water Lrvel Time WarerLeveJ Timo Watcrln'el I' 2L- llilllIL. . .- I "'-10' r_-.z.=~ 'WA,.t"..M - - - - - - , ~ - - - - I rr; L If Datcoftesl 3120106 5ailerlest _S.ll.lmin.with ft.drawdo..-naftec' _In ." W" ::;U.!J'.g~on ;:,tate ,,",w pI.Imin.wilhsa:msaal. D.'" bn. Anesie ftow I!.p.m. o.rc uepm trn~ni 01 Ec(\!o.l!V TempenltUl'eoi"'''Ia"_WalchlllnkallllalyJistNdc? IZIYes DNo St8f1 [)a(e 3116106 Comp/etctd Cate. 3/16.'06 - ,5 - o -.::; ~ E ... o <0- .5 <ll ... ;; ... o - 1:1 C <a <a ... <a :l <ll .c ... >. ... c <a ... ... <'II ~ ;) z: <n <ll o 1:1 >. OJ o 5 '-> .u - o ... C <ll ... ,.. :; ... <a Q. <ll :) <ll .c WELL CONSfRUCfJON CERTIFICATION: I constructed and/or acc;ept responsibility for"construction of this weB. and its compliance with all Washi.ngton well. coDstruction standards... Materials used and the information reported above are lruc: to my best knowledge and belief. ODrillerDEniilieer-OTrainCc'Naroe' )M-C A: HAM . DrillillsCoJllfWiy GRESHAMWB..LDRlLLINGlNC' DrilloedOlllin<<r:frrMoce Sign.atw~ Addre$$ P.O. BOX 1600 DrilJerOl"~Licm5CNo. 0761 City,Stlte..Zip . POULSBO, W^ 93370-0195 I!TRAlNEE. DrilJ.er'.l...ktnscdNo. DrilI.r'a Sit_,.re ContnCror's Regislrlrion No. GRFSHWDOSSBC Dal:e 3f27106 ECY 0.51)..1-20 (Rev 3..0') Eeology i! <lR Equal Opportunity Unpioycr. r::\ (1) OWNER: Nalno..,/JfJJ.L (2) LOCATION OF WELL: Co""",_",__" Be:&rlnl and d.1.rtancc !rom .ctlon or l\Ibd.h,iIl1on COI'1W2' ewe,^- :l2 WATER w~- REPORT STATE 01' WA/IIIDfGTON nit! Odctn.al and Firat Copy wJtb Dep.rtment D' EcoIoIY Stcond. Cop,. - ()wMio'. Cop)' "nlrd. Cop>, - Drill..... CoN' Applic.tJon No Puaut. No. .... ..; .. o a. Ql 0:: Qj s: .!!! .c - c o c o ~ ~ E .. .E c Ql ;; A_t3:l.7..:".II",OdJ WtAlh' 21.M .","_'... W_._lt.__S_.l,_ ,s.f...1> .IJ.,.!;"..., Sec_3.2..... T_~.'1..".. R_LllW:N., Mil. - (3) PROPOSED USE: nom-u. IS IndUd:r1lJ 0 11_0 (10) WELL LOG: IntI.doll 0 ..... Well 0 Otbor 0 F01"ZIUltlon: o.oIC'T'tb4' ~'- color. ch4facWf' .rtn Df ma:tniaI G!u:e drv.ctKN, I'J1Sd afIalW tl'&t.eJruu at CIQIIl'nr af14 tra" 1f.tml tmd. _fNN 011'" matnf4' t. each (t) TYPE OF WORK: Owner'.. nwab4l' 0( ...u ~ ~H. 10UIl d &cad O'M t1ltr'1l 1m .ce" ch.aftgll of formalton. , 111 mor-e than ane).... ...----.--- 1lATZ1UAL J1lOM TO H... well \I .......d: Dull 0 - 0 Ll AA.J.tJll,:tPjL J.;), 0 J D-. ..~ 0 c..blo 0 D..... 0 '.... -- 1Ioc<>nd1_ 0 .iA -.., 3_ 0 /VI J~ J I'" (5) DIMENSIONS: Dlametu of ..... ..-.f..-Z7IJ'- C1 Dd11ed 1t'D...,..".._..tt. r/i'ilA-'1 {fl...'" " o.ptb. 01 C'OIIlIlktl'd. -...IL'h ~ ... g -:17 DETAIlS: 1711u- y""lh<< ~ . d ,- (6) CONSTRUCI'lON AfV,pd", 1iL ~7 t.i"1".- Casini insJl}r ./t..-_.- DIam. ...... ,,"~ .....$..... '. n V 'l'I1rUd . 414.-.." DIom. trom ..Yo ... to J.y.D.... It- FL J, , JJ.. U2 .~ Welded. _.___" ....... trom ., ,,_,,__ ft. to ____ fL , Perforations: '(-Ill No 0 j 11 1JJJi.u.. n. ~ r..'~.oL LL~.u ..nI JIJ7 Typot ot potduator UMd~_ & _'M" ._~. ", .... SIZS of l)I!ftorat1olla ... _J-'MM'-' tD.. by "-"'-Zfii.- I:L ~Jl.u ~v...", ' [JJln //'J7 J79 ..8'...__,. -....... ...... 144._._.... It. to - __ II. V I _~.~_._...___.. plr1ora1ioa.l traro:I. _....____..._. fl. to ____ It. ~ Fi.4r/.1- I.J/n J::l9 JlI" '''-...-.-.- perforaUooll trotn ..._..._~.._.. ft. to M____.___ft. , SaeeDs: '(.. 0 No" ~u1.~. Nam.e...._.__________.._.___ .. T7pe-......--........----.-----.--- lIoOIl No..___.. Dlam. _._...,,__ Slet .lR .__...._.... trDIn ......__...... n. tu _ ft. Dbm. ......_...__ Slot IU. ". ~'_'_ frun ._._~__. tt. to .____ tL Gravel packed: v.. 0 Noll Slse of ~.ve.I: ..... .. Gravel plt.ced h'0Rl0 .."..__.._.._..__...._. ft. to _........_____ ft. ....11 --al- -. 711 Surface seal: YuSl ~ To -& dh:t _~___ n. ~.~ Material \DCld. In seal. ,,(It:#:_ j'j . ~_._____ ~ = ~ DId any ...... '"'n.... Po1D.u.wble ......, y..O NGpl M TypiI ot W.t.er1_..............M.._._...._ Depth of a\rau________._ - I Method ol uaUnl ..ua.b atr.._.... ..._._.. ._............._._.______._ 1-'- --L_ - 0, ""tl (7) PUMP: M.anul,cluNr". Nam.._... "__"_"_'__~ ..___._._____---"_ ... Type: ....._.~.._...._._._....______.___~_____.... ..... RP___ ___ ~ (8) WATER LEVELS: ~:=..::r~~..A,~.ft. st.auc Inel ... .._.!:/.a~_.. "_'_'d_..ft,' bdow top ol w.u o.t... ~. ~_. Art.eRan prall~ '"_'P'_''' ...___.._JblI. per ~uar. l1'ch D.te. '''.'_'__'''_ A.rt.eallUl w&~r U oontroUed by_. __..._.___._.___..______.__ (Cap. ..lve. ete.) , I (9) WELL TESTS: Drawclawn is amount w.ter JlI~ . Worl< ..........11:..:J.._ ..,_. 1.1lJ. COJD.lt.....,!.!:"f......",___. loWft'led bllto.. s1.IFt:k level ., '"' ,- w.. . pump tot made? YuD No,. U yes. by wh.orr.i1'.......___.__.___._ Yleld: .aLlmJD. .111> n. drawrdown. after -- WELL DRn,T,I'.R'S STATEMENT: ., .. ,. .. Thb well WOI drillecl under my jurisdiction and this report is .. " ., - !rue to the best of my JcnowledQ:e and bellol, , Recovor;r datD (time talr.eo. .. %erG ...hen pump ,""'... olr) (water levm NAME...ff.:!P!..'!.~...,!J;"!.I.l.iJo,.~...!.!!..r!:.,.......,. .,...._ mft.lu~d tram well top 10 ""&-W' !ev,l) TOm. Wat., ""'.. T'.... Woo., lAw. l TIme W..... IAn' (Person. ftrm. or corpo nl (T7P* or print) ....._.._...... h_........._......._. ..........___.. ......_.....h__... ._...._... "_'_'_'''_'''_ Ad_....~-::I.J.~.1Ct.!..._.J.~.J.l1mJ.l.tn_,.2..l.~.~i ::::: .:: ::::,:: .:::::: :::::,::::::::: l :::: ::: :::::::: :::::: ::: :.:::~ :::.: ::::::: ::::::~ ~~::::::::~::~::=:: &1l~a:":L~...~~:;~~~-~;Wi -"~.'.'.~. ctrawdown .ltu_..J~.....hn. [~j~;;..~...d~~~'ii';;~'i..~~1d.~....'1.,..,n ~:e:::~~"~;~~.~f~~M;_~'~-~:'::~.'~"~-;';;-';-.;[] No 9" U<eIllIe No........._.,...t!l.SJ.f......_..., D.te..JL:.S....,.,__....., 19.~ xs- .. o - 'tI C ~ ~ - ~ Cl Ql .c: - :>, - C ~ .. .. ~ s: I- o Z 1Il Ql o 'tI :>, Cl o "5 u w .... o - c: Ql E - .. ra Co Ql Cl Ql .c I- ~ r (un ADDrnOBAL 8BZE'J"8 IF l't'I:CZSSARy) ~. ECY~'.20 ...--. -~~~';::IO~.t:i~COP7 wi" W'~R~~I~ORT SeCond Cop)" - Owber's CoPT Tb1rd Cop)' - DrUler's Cop:r 8TA.'I'E OW W.&IIIINGTON' Pennlt. No. .... .... ._.__._.._.~..__ (1) OWNER: N"'L_J.l,l::..!._c..!lg,:r1.~~.Ji e b R___ .._,tq!'l59....~-'--_;.!.. W2.~U~,f!.!".J<;~~_~ L..!'.~~.......__..._.. (2) LOCATION OF WElL: Co",,'" Jeffj!rson __..__,_....s.~._....'" _If!_..,,, ~.....JJ_ T._?.9.x., ,,-~11;_WJ4. ...: .. o a. CU c:: Bearlnc and datanee from IectioD 01' JUbdivWon comer (3) PROPOSED USE: Domea1c}Q. Indutr1al CJ ~atlon 0 ,.. Well 0 ............ D "",.. D Gi ~ .!!! :5 c o c: o :0:: III E .. .2 .E CU .c: - .. o - "t:J C III .5 III o ell .c - >. - c: III .. .. III ~ I- o Z en ell o "t:J >. Cl o '0 () w ... o - C ell E - .. III a. ell o ell .c I- (4) TYPE OF WORK: O""..".wnber oe_u :2 III more than. one).... __.._.____.~_ N_woU a. _'CUI D Bond D _ 0 Cable 0 em... 0 a-mdlu..... 0 ~1iI J_ 0 (5) DIMENSIONS: c........ of woU ,..-,6..I1(' ........ CrWod..,..._lJ.<L-_._lI. Ooptb o' ......Iet<d _IL.... 0 .. (6) CONSTRUCTION DETAILS: Casing JD.talled: .....,6..._." DIam. ...... ._:otL II. 10 ...5..5- lI, '%'hruci.d 0 . ___w_" DIam. t.rom .____ tt. to _ tL W4l1ded .Ii! NW___O. Dtam. tram. ._____ ft. to ..._ It. PerioratiollS: Y.. 0 NCIIlC T)rpe 01 ~rator u.-d_'_'_'__"_"_'__'___~_N'_____"__ SIZK 01 pcr1onUona .____ 1b. by ___.M iD. .._..~_____ pe.rfo"~ hID. __'M.'__. ft. to ______ tt. '.....__'_ _...... ""'" ..___..._..__ ft. to ___ ft. ______ potI'fontloDll from .".....~...__ ft. t.D ___ ft. Screens: Y.. D N.%) ldaufact~ NI.I::OC______._.___._..____ T71*---------.----- Model No Diam. .~____ !Dot alze _____... trom ........__ tt. to ___ ft_ D:!.am. .____._ Slot a!m _..__~_ trotta __._ n. Co _ ft. Gravel pawd: Y.. 0 N. 0 .... of ....el, ____ Gram placed tnJm ___..._.___ ft. to ______.__. tL Surface .eel: Y.. Ii N.X1 T. ...,. d_, ~__ 1I. ......r1ol UHd tn ....L__, ......_....B.entDn..:t,lL-.__ Old. atI1 mata contain UDUMtII. wata'7 Y_ 0 No Ql T)"pe ot ..te.r7__....._____.__ Oeptb. of Rnita....___.__ Method ot aaline atrat.a 011........._..._.__.__.___.____._ (7) PU1KP: M:a.autactllNf" Name_.__.____._._..___.._.__._____.__._ TYPe: .__.._..____....;____........_______ U7_________ (8) WATER LEVELS: ~."==-.::."~~... ........l.Q.lL.l\. Stat11: I_e! ...-.98.-.-.----.--ft. below 10p of...u D.1&_....5.=..1.7.=.7..9 Artcsi&a preAlUe __.__.____.lbII. pw "-U&nI l.Jw:b Data-____ A.rtae::lan wawr ill controlled by_...._.___._.__._ (Cap. valve, dc.) (9) WELL TESTS: DnwdoWn 11 amount water level II Ioweftd bUGw "Ue level Nom It)'a. by whom?__.....__..______.. n. d:r.wdown .lter hra. w.. . pwnp tr.Jt made? Yea 0 Yield: lal./min. 1ri1b Rtoeovery dAta (time' talten. .. z.ero when P'\IDlD turned off) (.._tv JeveJ meuured from wall top to water lewel) _.~.:..... ..:~.:~~-~. ..~.:_.- .:.~~:~~~~-t.~:..- _::.:.:~~ : ::~~::~:~ ~~:~~~ ~~~:~:::::::~~=~:~~:: :~~::::::: ::: ~:: : =:::~:: =~::=::=: ~:::~~::~~::: ::~-=: ::::::::: ::~=:: o.te of tom __._...__~....__.__._......_.__._..._ .......,. ........._6....,.........1"".. W1...._.....,O......., .........".. ~:>1'"..........hn. Artnl.an B.ow..~_.__-:....._..___._.__...p.b1. D.k...._..J_:-...:!:.L:-~.(~z.__ T'onpcrature of .....w._.5.1 W.. .. chetn1eal Mab'.... 1l\ad.t Yes 0 N~ ADPlicaUon No. ... ......_ (1') WELL LOG: hbl"latloa: D..mH bV rolO'r, chlllNde9'"I riz. of ~ ga4 ..tT'UoCtu.... IInd 'Mw ~ of aqu{/cn and 1M kina 4nd n<<Nn oj tM m4hT14l UI Nell dftCurII ~"d., wUh alt ..... OM n.trJl/of' ifCICh. ~ oll~ .....TERIAL rao.. TO Grav clay hard pan 1 SS Grav basalt ss 110 H2O vien l<!b :ft. l.n brown ,.lav hand. I -- ..- --- , .... ~. ~ , ' , ....'r -, \ 'I'. .. - ., ,CoY::!I;> ..JUT' .' . . 17 .---- w_ ...............__.....:.........___, ,,,-_, Com.Io.....May.....%ll........... 10....2.9 WELL DBILLER'S STATEMENT: Thla well wu driUed. under my 'urisdktlon and this report is true to the beet of my knowJ.edce and belief. . NAME..J:!.QQP_.G,N'!.!.-l!..~~J.;b.r.._..P~~.r..~:!;~g.............,.................. (Per'IIOn. ftrm. or corporation) (Type or pttlltl M___..Q1LilL:,ene.+-...w,a.sh.ing.t~ln ,..9.JJJ1.Q...:...,............. [S1...od]......m..'Y."',.;;.!",L.~,~.t{..,...............,....,...., U_ No...............?.\15.................... Da......,Ma.Y.....?l..,....... 19,7.,9.. I.P.No.use OS t!\ev.4.71). (USK ADDrl'JONAL 8IIDT8 II' NlX3SSARy) ~. A Fie 0nglnaI- oepartment c( ~ Second Copy . Owner'. Copy Thin1 Copy . Drillef'. Copy WATE'~~ A~T SWE OF WASHINGTON (5 ?~~ ~K ~ (2) LOCATlON OF WEll: County rer;.C~ (2a) STREET ADDRESS OF WELL: (0( no..... address) t.: TAX PARCEL NO.. $'\ '1 \ ~ ~ :!i~ n =:=I~~ Water Atght Permlt No (II OWNER: Name ~2 N.R. WM (3) PROPOSED USE: tJ.~ 0,",""""" o Munk:opal (10) WEU LOG .. DECOUIIISSlONING PROCEDURE DESCRIPTlON Olmgallon o TestWeM o Otho< Fonnab::ln' Desa1be bJ color, chatacter, S&Z8 of matenal and nuctul"8, and o DeWater the lend and natunt 01 ttl8 rnatenaI ., each sD'bJm penetmed. ~ at Ieasl (') TYPE OF WORK: Owner'; number d welt (If more than 01'18\ one enty for each change of 1I'1formaoon Indscate all waler encountered }t New Well _' MATERIAL FROM ro o Deepened OOug 0_ ~,-\ ,....,. I D__ o Cal>Ie OC~ o Decomn"llSSlOn '5IAoI8ly OJolled (5) C'IIENS1ONS: , Dl8m9ter of weD (". ond1es (' \A.., RrN. r~,.a.."'\ t II cnned .? \b _ llep1h c( comploted .... :l 10' II. \ (6) CONSTRUCTlON DETAILS (l \1\ Rrn" 11.0., /I' ?t)' Cuing _: (,," ' , \ r Kw_ . Dlam.trom *ft.to~ft Q. .1>..":,, -a:- WA.;'J 'JA ?,:)\ ~ lJner Installed LJ-"-' . o.am.lrom 0, 'It. to ft. Threaded A . o.am. .rom 11 to fL . , u.ro.. ..L LIt Q 11"\1 ") r)rl. - DYe. !lINo , Type cJ perforator used ~.l ,,- '\ \l, ~;; J~" 1'1/{)' SIZEofperfOl'atJons n.by ~. ~":' oeriorabons from flle It ]>' '-'" RECE:IVl='n r~ -0 -.'" "-' -., OVe. b!:No o K.Pac LocaIJOIl :lief' Z 4 ;:::;..: Manutacturets Name ;:'c v Type "-' No ~ Doam Slot 80:. from It to It .nf;) C"'" SlotS"" from It to It -- A -- 0.... {ONo O_oIgllMlllsaOO Mal_placed from It to It Swfac8 ....: it 1l 0 No To whet depth? I~+ It Matenal used Itl seal # "~'^~-'tL ,Q. \.\ v'~ Old 8trf strata contain unusable wal8r" - DYes 'titNo Type of waler? 0epIft"'..... I>?O Method of sealing strata oft , (7) PUMP: Manutactu..-r's NMle 1yPe HP. (81 WATER LEVELS: ~U[faC8 elevatlOl'l above mean sea IewliI It __ S..rted c:; - ~ -03 S""is-QL StalJe level ft. beJow lq) ot we. Dot. 5' 1:',....:>3. Completed Arteslan pressure Ibs per square Inch Date An&sian waler IS controlled by (Cep. valve, 81<:.) WELl. CONSTRUCTION CElmFlCATION: (91 WELL TESTS: Orawdown IS amount watw IeYeI ts lowered below .s18bC level I constructed and/or eccept ~lt.Irty tor oon.stnJcbon of ttus weD, and tb W~a~testmade? DYes lkNo . "",,, by whom? c::ocnp1l3flC8 Wllt1 aI Washlngton weD constnJCtJon standards MatenaJs used YI6Id_gaIJmmWTth ft. drawdown atter M and the II1formabon reported a.bove are lnJe to rrrt best knowledge and bell8l Yoeld OIlIllmln wrth 1t dnIwdown after .... Type 0' Pnn' Nem. A \ \~ roe.~ ween.. No ~3-rl.f.... Y.... aal/mlfl WIth n drawdown atter ." (lJcensed OnlledEnglneer) R.eccMwy dala (1Jme taken as ZOIO when pufT1J tutned off) (water klw4 measured Irom well top toW81EH'1eve1) Tnunee Name Ucense No Tmo Water Lswli T"", WawrLevtM r"", Water LweI on,"ngcanrtIT~\ ~~~ {)rB~~J; - (SIg<1EdJ Q. l.K:enseNa. :;j - (Ucensed Onlle . eer) Date ottest - Ad,,,... "('-II W4.t S~'{ ""{Y' Rp.'t Rd ......'esI aaJJmltl.Wlth ft. drawdcwn atler tvs Ce",,,,,,,,,. /fJ j s-- \ AIMst 5 nalJmln with In' ft. drawdown attQ(~hrs Rego...""" No (W1:CIJ:'D'\ 10"1 0... - '3~ Artaman now apm Date 5'"- _'"b":!. (USE AOOITJO~ SHEETS IF NECESSARY) Temperalure 01 water Was a chemlC81 at'Ul}ysls made? OYes l!l'No Ecology JS an Equal Opporturuty and AtfJnnatlV8 Acllon employer. For speccaJ ECY 050-1,20 (11198) aocommodabon needs, contaCt the Water Resources Program at (360) 407- 6600 The TOO number IS (360) 407-6006 ~ ~) ( Wb"V- Z,-/l) WA~ REPORT S1,"c.'dNO~.1'-;~4G STATE OF WASHINGTON F~. 01'9".1 and F..,I C~., ...dh Deplr1",enl 01 Ecology Second Copy-o-If, Cop," Thifd Copy-Ord'-r'. Copy ....; ... o a. Q,I c:: Qj 3: UI ~ C o C o :w III E ... .g .E Q,I .c - ... o - 'l:I C III J!! III C Q,I .c - >- - C III ... ... III 3: I- o 2 UI Q,I o 'l:I >- CI o "0 () w ... o - c Q,I E - ... III a. Q,I C Q,I .c I- lfA I k'I' -4.1b... ~ LOCATION OF WELL: eoo....,\jIJFRIlv,V__ STReET ADDDRESS OF WEU (or "......t adm...' :Jlto (11 OWNER; .,.....f. H (21 ('01 w.t..- Right p.,,,,it No (101 --oPt' iJ{?)( .~~<!'Ift J.,~/h~{ I.A..___ - .~..dll.L, --.::13- T.~. ..lJi..WM 'db L';b{,." /,',0. , WEll. LOG 0' ABANDONMENT PROCEDURE DESCRIPTION I Oomestic [ I Irrigation [ I DeW8ter (3) PROPOSED USE; Indu.slfjal r I T&stWell fJ Municipall.J Oth.. fJ (4) TYPE OF WORK" ewn..'.nUfJlb<<ol_1I . (iI' more ttt..n 011.) , Abandoned.: Hew welt I~elhod: DLt9 I, J ~8d Cl Deepened r I Cable V O;~8n l I RKoRditi0P9d j I RotaI)' r I Jened [ I (5) DIMENSIONS; O"......toh..II_ '-,. .s;::t. :;/5," DrIlled C) i) leel Depth 01 completed well ft. (6) CONSTRUCTION DETAILS: :s):'" 01.111 "0ITl_ ._:::r...l1L,..IO 79., Casing In.t-7 Welded ( I _' C.am IrDnl____.ft.lO Ll....rlnl!ltall.-d. Tht..d.-d : i __~_~.jrom n.ta .. ';~;;~.-l;;;:- ;.Jj-- ~ .. - Type 01 p.tforAIOI va.!! __ SIZE 01 p.r10r.tI0l'1 ____.___._ 1ft b'Y___.___I"- pertot&IIonltlom_____lt.lo____ tt. _,._ _.~g.-rIOf.lIonIPlorn _.____11,10___". __. poart".liOnlfrom___ft.10 'S~-;.~I1.: v..fJ1'" NGU -----. Manufa(turM'aNam8__ +-I~...;t,lf hpll__. __._ Mod.Ho. Ot,,,, ,( StoI..n----J..~lr~ f)O It,to DIll"'_ .._SIot,i.I:. __from. II. to Grav~~ck.d: V.aU ~~"~rgr...." ~5tl. Gr....l pl'C.d frcxn ". to_ '~rfiil=al: v.,l~i To,*nllde-pII'l7'.__ Maleria. used JlI M.I _. ...1!1l....M/JOV./J; ~ Old 'nyalra'" conlaln LLnu."blll......t.r? y..[i NO~ T)1l.ol,*,ter?_ ___D4Ip'hDl.tl'''__ .. J&-t:Tt. M'lnodol'IIl"I,no ,Iraleoft (7) PUMP: M.nufacture". turn. _._---:-- Typ.' - WATER LEVELS: .~~'=:'.:,..=n_. SialiC 1..".1 _ .' ~ "I ~ 11 ~lOw 109 of_I "P, . D... ~c ii -4,- (8) ....nea... ~r.a'u" ._ ____ lb.. pe' aq..,.mc;h 0.,. _. . ..."."'.n...."..ri.ctNrtroll.dl1y -. . -CCIP._..c)i--- (9) WELL TESTS: Ofllwd<r....nl.amAAn.!..J"lll:.r.ev.I..~edDekMst.fK'-".. W"'lIu~teal"'eGa? v..f J Nol"f'" lty...b,....nOlll?_ '__ ._ g.llmOn ....In T.~ tl dI.wcIown .n_ _~ _ tv.. R(tco."e..., d.'e 11-. I.....".. :rero ~ Pllnlp IlJrllftd aln (w...r iev8'l ...,_d trom weM lop 1'1 wa1 er I..".l) "..... Will" l..... ,_ ""'&"" L.....l T..... "'.,. L...-..l D.t.ollesl 841l1erH.al /3 gal Imitl ....ith ._3a " d..""clawn an.. _ ~ t>re . oal!rnUl wl't)stemelll&l __.w._ It. lor __ .__/We A,'lell Arl.~QfIl1a\llf - _ _ Q.pm 0"'8 -- .h._ ~-o~_ r.mper.IUl"eol.....aI.r &/~ WeSfI r.hotmc.aJefl8l"all "'.de? Vesl.J " H."'('\~.{l, :", l,n "'\ IJ:>~ -,' f'OIIft.hon: oe.aibl b\, COIoc, ctI.ract.... .m of IIlIIlerl&l and structUI.. .lId eho. ,..Idatl... of ...... .IIftCIlnekind MdI natwe 01 tM ,..lIllIal ill iNCI'I .Ir.hl.. penetr.led. wI1tI.,I...tortt.....IoI.~:.~~h4I\CMo'~_"!!~ ....TE~u.L I""" TO . .' ~_~I ~tJ_,_ I . ' -- ._-.:..R 11. '7 (7 . __ 17P~?$ .--F-.-. -- ~ b-R/lve)'J.__ ~:y. ~~jy --- SAnA. ~,R:9,;,T -I-H':A-" "- n. ____..__ ___.....1____...__ n .-____J,______ ----==1---- --- ,.. , I _.-- ---=8= --. ---i-t= '-'_L-=C--'- 11. I I I ' .-R~ tyF::"D=t~.. 9B+. ~ +=~ I Wark,.l.6r1ed DEPAAHdl;t~ I uj. bbtJI.. '^'EllOCllli..l'JGtiNl -=--'-..-.- - ,1 m ~ WELL CONSTRUCTOR CERTIFICATION; . conetructed and/or acc.ept r8SpoIlsibihty for construction af Ihis well. and its compliance with IIN W.~inglon ....ell const(\lctiotl stand.ards.. Malerials used and lhe inlormallon reponed abovo are true 10 my best knowledge aAd belief. N_MEhJ4b?~~~.,~~{~JJ J I & ~p, on_" G~ .:l " ~.- P . I . n Ad....!/"-V-J-1/X. L;;Z.:;'n~~1.-!...<&..iIt!~..,_ !2J~ /)~, Uc.n..No i )/:) \lqWEll RlllERI ~Ol\tclor'-a , , '~JCl--'" / -;l '" ,';' r},- , 1_,_... D.,. " '_~,I._ {USE ADDITIONAL SHEETS IF NECESSARY) o ~ ! .' GbU- ~~ WATER WELL REPORT .... .. o a. CIl a:: -ai ~ .!:2 .c: ... c: o c: o :z:l CG E .. .E .5 CIl J:: ... .. o - 'tl c: CG oS CG o CII .s >. ... c: ra ... .. CG ~ I- o Z CII CIl o 'tl >. Cl o '0 u w ... o ... c: CII E ... .. ra a. CII '0 CIl J:: I- Fn, Ortglrwl ar1CI First Copy wlIta ~"'nl 01 Ecology SiIcOfMf CoP'/ - 0wMr".. Copy Third Copy - DrfIIw'. Copy {II OWNER: ......t!:4-y ~ I2l I.OCATJONOFWELL: """"" -:r~P.&'&R ~DN SIortConlNo, ld :;'3 '(00 lNOlJE WEU LD,' A 8B () 0 2. STATE OF WASHINGTON Wltw Rlgbl PwmIt.... _.ul &rd~........~ .eArLu:l4f.vVA- <j'P~5 -IIW"'~"""~T~",R~W". 128) STREETADllflESSOFWELL...__ ~, L..,.,.J.A_ L4I Awir f~,.../..-.- 1</-" (31 PROPOSEO USE; JIr aom..oe __ 0 __ 0 (1D) WEL1. LOG or ABAllDONMENl' PROCeDURE DESCRIPTION o lnigaliat o OeW.a.l8t T.s We~ 0 Othtr 0 (4) TYPE OF WOAK: ~~51~~rwtlll z Abandoned 0 New H' X Method: Dug 0 Bored 0 D_nod 0 CollI,g" ""-0 Racoroboned 0 Rotary a ..Ien8d 0 Diomete<o,...L"/a''A r ~Z~7s'1_, feel. Oepm or c:cmpleWd WIll '7 s: k. (5) DIMENSIONS: Drilled 7~ (6) CONSTRUCTION DETAILS: ~ <' ~/ 1.10 !l.;/p ".t:l I." 2<,; .. _<'2. ' " " fL ft. CaMng In...lltcI: """"" Jt' U"tI'insl;jllled.li!" TI\rOllded 0 Di.m.from Diam. from Oi..".. from Perlorl1lona: Yes e No 0 TyptQtperfor.a.lorused / II -r~t:!L I!.U;- SllEolperiaatlOnS ~.., C/AtJ/&~ IIl.by 'Ii! '/;:-r"""_,"m 28 1,10 ~ /~r r-1onmon!l Irom .Q &. it. to perioralions from '1'1. 10 "" ~O I. ~ I. .. _: ,.. 0 ~nut.dur&f"s NM1e Typo , O\am. _ Slot 51Z. Diem. SIotSile Gr..,.1 pKQd: Yes 0 Gravel pi.. from No/ii1" .......No. !rnm___ft.to 1rorn 'f.ro No ~ SIz.otgflMlt ... Surf8C'ellMl: v_$ No 0 Towhetdltpl:h7 ~V It. UalenaJ uMd it, Mal . 4/;;~ ra....J, ~ Old an,. SlTaIIl CCIrI1U\ unLJS.Ible waler' Vas 0 No ~ TVPrI of wallllf" Depth of !trBta l.4eltlod 01 Y.IIIng ~r.ata 011' (7) PUMP: Mar'II.i'~" Name _. H.P. (8) WATER LEVELS: ,...,....--_ ~~~_ ~ .atlCw mN".., IewI ~>> iC) .. S1a,<..... C f" L,/. ,,_...~_. Dolo ~/fl1' Altesllln pr___ Ib$. E* ~orch . c.. .v.__re,.l;OOIrollMlb\O lC.aP."-...~1 (D) WELL TESTS: o.8Wdown1'.moull1_"'Ie<o4I,s~beIowstatlc...,.. Waupumpleltrneo.? y~D No~ 11)'M,b,"IIIihOn'l? VoeId. OBI.1rnin with ft. df8Wdown atI.... tn. R<<:o"1lll'tliIloJ. (1irn1 taken as lero ilII'hwl PlImp turned otl{wfl1er IElvelInCtGur<<lfttlm.... toplOw~l....ltI). T1",,- w....L..-..I Time WawLIIIWI ~ Wat..~ DaI.~'~ 8ail9f '_Sol ~ gal.lmll"l. Wllh :.r z. ft. 0'1Mdoo.w'I &1'I&r / AirteST g.1l.lmin. wilh stsm HI at It. '.Of'L . Moci..._ ._, _ "p= 00.. /"~7/PJ T~atUT. of.at... :!It- Was It dwwnlCBI analysts made? YU~ No 0 _____ ",//..1: ~ ,,- Llo!Io:. ECl05Q1.2012I93l"j _______ v//tl>'rr"t,... .:JC.IrTT'( ~; o.:rbI by colOr. c;"'ecw, 11m 01' malII,...ancl nua~ ilnd 6110w ~of AQJiletI .-d __ Iuftd '"" NWrl of h I'I'IMINIlII'I Neb IlI:IIulI'\ P8'WT.Il8d. wiII'I allUar one .,.,., 'or MCll cN/IgIofl.....~ "'TBlIAl. fROOl JIlb.....v '70 '" <.. ,-, 0 RbA,'^' (~L_'.!L" l'.- .. b. ,/...LAu . / V ,&&..,..., <...~ d~V /~ ~,~~ .,1</' 2r> 11'Z""A """'.Hi/I!' /~ Z'L. ~ 4~. HI/.;t:"", ... ~... ~c,frM8 ?,-, ..-- -,. ,. II .. . -....... ..,,, . 19 CarTloleted TO z.. ~ ~~ Zo Z? ",?Q ;;>t:> 7.s- .,,~ WELL CONSTRUCTOR CERTIFICATION: I construcIed and/or ac:cept:. tMIXlRSlbIity for constnlc:1lOll or ttu:s well. Sr"(l its conopianoe wiltl all Weshinglon we'! CXJtlSt/'Udion standards. MateriDls used and IN lflformatlon reported 6bove ere tll.l8 10 mv best knowleOge and belief. IW.IE ~"Tl1"f!1.:!...1.i:!:-~ ,~<><~ ~ ....... ~ 4f:t"}-"' /6/ 5,,11/;'" t</.,+9r~rz ISoonodJ ~ ~.L .r--" p L~.".. NP,/ 9 r h ~tERl h" h~. ComroeIor's ~.nve4~ /I7~ 0... /c/e7 (USE ADDITIONAL SHEETS IF NECESSARY) .l9Es o