20090078 SIGNED WATER WELL RPT 101809FILE: ORIG. 8 FIRST COPY -DEPT. OF ECOLOGY WATER WELL REPORT
SECOND COPY -OWNER; THIRD COPY -DRILLER STATE OF WASHINGTON
START CARD NO. AE0869t
UNIQUE WELL ID N/A
WATER RIGHT PERMIT NO N!A
')OWNER NAME: TERRY HETLAND ADDRESS: 15802 104TH AVE. S.E. YELM WA. 98597
LOCATION OF WELL: County THURSTON NE 1/4 NW 1/4 SEC 24 TWP 17N R 01E
t1a) STREET ADDRESS OF W ELL (or nearest address): 8300 YELM AVE (103 83RD AVE. W.) YELM WA. PARCEL # 21724210600
(3) PROPOSED USE: ABANDONED
(4) TYPE OF WORK: DECOMMISSIONING
METHOD: PERFORATOR
.(10) WELL LOG OR DECOMMISSIONING PROCEDURE DESCRIPTION
MATERIAL
TO
(5) DIMENSIONS: Diameter of well 8" I
inches.! I I
DECOMMISSIONED EXISTING 8" WELL X 70 DEEP I
Drilled feet. Depth of completed well ft. I TO THURSTON COUNTY HEALTH DEPT. AND DOE
1 REGA WAC 173-160-381 1-A
I I 1
1
I PERFORATED 6" CASING FROM 70' UP TO 4' FROM
I I
(6) CONSTRUCTION DETAILS I GROUND LEVEL. CUT CASING AT 4' BELOW GROUND I I
Casing Instld: Diam. From ft. to ft. I LEVEL. PERFORATED 4 CUTS PER ROW, 1 ROW PER FT ( 1
Welded ^ Diam. From ft. to ft. ( I
Uner ^ Diam. From ft. to ft. i TREMMIED NEAT CEMENT FROM BOTTOM TO TOP. I
Threaded ^ 1 I 1
I 1
Perforations: Yes ^ No ~ i I I
Type of perforator used I 1
1 I
Size of perforations in. by in.1
In
I
perforations from ft. to . I
perforations from ft. to in. ~ I
perfora0ons from ft. to tn. l
I
I I
Screens: Yes ^ No ~ I
I 1 I
1
I
Manufacturer's Name: I
1
Type Model No. I 1
Diam Siot size from ft. to ft. ~ 1 I
Diam Slot size from ft. to ft. I
I I 1
I I
Gravel packed Yes ^ No 0 Size of gravel? I
I I 1
~ ~
Gravel packed from ft. to ft. ~ I
I 1
Surface seal: Yes ^ No ^ To what depth? I
ft. I I I
Matedal used in seal
Y
^ N
^
I
I
o
es
Did any strata contain unusable water?
Typa of water? Depth of Strata ft.
I
Method of sealling strata oft I
-- J I I
(7) PUMP: Manufacturers Name I
I 1 I
I 1
1
Type H. P. I
I I
I I
1
(8) WATER LEVELS: Surface elev above mean sea level ft. ~ I
I 1
I I
Static level below top of well Date 1 I
Artesian pressure lbs. Per sq. in. Date I
Artesian pressure is controlled by 1
I
I I
(9) WELL TESTS: Pump test made? By Whom ~ Work Started 08/06!09 Completed: OBlO6I09
Viek gal.lmin with R, drawdown after hrs.
vista gal./min with R. drowdown after hrc.l WELL CONSTRUCTOR CERTIFICATION:
view gal./min with ft. drewdown after nrs.l I constructed and/or accept responsibility for construction of
Recovery data: I this well, and its compliance with all Washington well construction
Time wtr Lvl. rime wtr Lvl. Time wtr Lvl. I standards, ,Materials used and the information reported
I
I above are,true to m~'beSt knowledge and belief.
\\ ~
Name: RI~HARD O WELL DRILLING COMPANY INC.
Date of test: (Address: P. .BOX 27 TACOMA, WA 98444
Bailer test gaLlmin with R. drawdown after
Airtest gal/min stem set at ft. for ~.I ~ `
hrs.l(Signed) - - ~ °~--^-- Lic No. 2246
~~~
Artesion flow gal/min Date
Temperature of water Was chemical analysis made?
~>P I !wen Ddtkr)
Contractors Registration No. RICHAW32108 DATE 10H9109