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20050684 Well Decomission Report 12022012 �Q� D:c, 2 20Q8 lO:OIA�� CASCADE UTILITIES No. 8215 P. 1 �� �� a� ����.e��� UTSLST�E�i:,� ■NC_ Plal&Short Plat Construction Road& Lot Gradrng December 2, 2008 -ro: Linda Stolzer �aX# ..���Ce���2��- ��Ot Page 1 of 2 RE: Well Decomissioning Report Piease let me know if you need anything further_ 7hank you, Kaley Darnel) (425)869-8787 Kaiey�a CascadeUtilities.com Post O�ce 8ox 322• Redmond, Wasfrington 9B07'3-0322-(q25)861-8787• Fax(425)883-0�91 CASGAUI 110 OP � � oEDec. 2. 2008�N10:OlAM CASCADE UTfLITIES No. 6215 P. 2�. 00iioot �7�E:oaio.a FrasT caav.pSPt.OP ECOtOGY WATER VY�LL AEPORT STaRr CAAD No.aaooixs SECOND coPy-owNER;�sHiRd CoP+�.Dpn.LBR srnTE oF W5f1n�OTON _`_ uNtquE wEti m w�_ . • ` Lv'ATER.RIGlff;D'BRMIT.NO �� (1)OWNERNAME CASCAD�tIT1UT1E3,lNC. ADCRE6St P.0.80x3?2REi1MOND1NA.98D7� r2)LDCA?ION OF WEIL: CoHnty THURSTOH N8 i/4 NE 1Ja SCC 7� TwP 11'N R 1E �ae�staEETa�DpESS oP wEt.�(orne.ras��ddrou�} aaza cUl.c.EN9 Ro s.E��1.rnwa eas9t �nite6Lazna���o�oo (�)PROPOSEO USE: ABA1tD�NED � (7n!wELI lOG OR OECOMMtSSfOt�1N0 pAOCEDURE OFSCRIP'cION (4)'fYPEOF WORK: �EC�l�N1981pTON0 � M6THOU: PERFORATOR i e• I MnTERU►L I FROM 1 Tn " i___._�._. . �x�s�u+owEU. _. . . , ... _i. ___ ._i. _.. (S�DiMEhRS10J3S: Olomolarofwoll 6' lnohvs.l_:.. _ 010.-B`__. .__,,.,,.. . .. �. .1_ ..._ �. 1 QrWed foal. depd+dcanDio100ti0f� ft;-- - OEP'iN-02B_ _,..._.�_,...,,,,. ,......i --- - .; � oEa?nnn+issio►+�n To iiea�ii+oev'r i�►ic b:o:��o's � �' � . 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BOX 7AGOMIq,WA BnJlarleat pm.nw..ph n.ersrao...ner tw�l ainne� pa1lmin�temaalet t� ior n�..l(sipnee) LIeNa � Artasbn flaw ppUmJR Doto � 7emt��,luroo�Walnr wao�►,om�wl.nna�s�a�neae,2_NO ��nw�r7�o�miaodanNvAtCantBCtziop on� •rlerao � Received Time�Dec, 1, T 4: 16PYI � 03/28/2011 18:06 FAX 3602737423 �002 - - — � V Roclfdsn.SepNc Serv/c�,/n� - P.O.Box 5574 : Phone: 36p-491-9459 Fax: Lacey,WA 98509-5574 PROPERTYINFORMATION ��sOibooiO' 184954 p�,�y�K Nwawn AmouM Nurtbsr. 2��24����0� eu.�..Ne�e M aw��) HORIZON BANK propuy Addrw: 9301 CULLENS RD SE NA ' ; ►+o�ito: HORIZON BANK Gy; courn�tcy„��: su�ert�Av 2211 RIMLAND DR STE 230 YELM Thurston WA BELLINGHAM,WA 98226 rn,�m r�s �v�a vvo pMa1T'E sE1NAdE sYS'il��i TANK PUMP OUT RL■PORT FumpllnaC�+on Uale: G�narM Carvnenu: 02101l2011 o�r�Gor�bando+drp ssptic tank. = SudritW N�e: Flndl�g+and de/ermin�tiona of Nds fmpectlon rollod condkbm�s thsy�aMteO on tM d�y the uptic t�nk vn�pump�d.�10 clalm la _ T 02/09/2�11 m�Ae by thls comp�ay,olthar acpnssW a Implsd.eonuminp wccess w fillure of tbc a�pUc system. PUMPING CONTRACTOR w�a�w�«�w�r� Rocklan Septic Service,lnc. Fba.�w•�«*�br Ken Rosa rtevoN a^�ered y" RIIB ROS@ � Septic Tank-2 Tank Type: Com rtment Tank Pumped(it NO,indicate any scum/sludge measuiements in noles): J S Tank Size(Gallons)(Number only,no text): � 25 EHiuent level within operational limits(if NO expiain in comments): S TolaV Gallons pumped from tenk(Number only,no text): _ _ 1 z5 Efifuent retuming beck into tank after pumping: rv0 Tank depih below grade(inches): � Access Rlsers inslalled to grade(N!A ii not present): �A Tank Construdion Material: Co aete ES Tank Condifion Good: ES Baffles in good condilio�(NIA if not present): A EHluent screen deaned(N/A if not present): p Eifluent suAaang around site components(N/A if noi checked): �A Pump/Air Mechanism operating as intended: �A Controls operating as intended: �A Alarm working as intended: ES Tank abandoned aHer pumping: � Were repairs made lo the 7ank or Tank Components?(if YES explain in comments): I i � ReportID:70626 R,:po��t.ow,;,;,��::;:�n.:uRl.tf_ .:�..a•,u�ii���.a:n-:::c:� Pa9e t of 1