y \ \2-~ Well Record 1 2 Page of \(.kon WATER WELL Government Deplftmeftt ment of Envll'Ofl Well ID: DRILLERS FORM W.U ~IOWC.H~Y410 . . \'ukOn Rec,tttry To hA lmnrrwin, ,1s,;ignAC1 ny Depl OI Env Metric l l Q mpe~a 0 Bo. 2103 Wlllte,,.,.., Yukon Y1A 2C6 INSTRUCTIONS FOR COMPLETING THE FORM it. Please print clearly in or black blue ink . 1. Additional information is provided lhe of this form Completion and submission or at bottom on page 2. 5. this form is the responsmmty of 2. Question can directed to Water Resources 667-3171. the drilling contractor. be al 867 AD weU construction 6. Piease specify Imperial units all r . 0.1 or ft. be 3. measuremen1s shall reported to m 0.3 metric or tor measu ements WELL LOCATION OWNER'S INFORMATION AND . ty A 1 Name: ._I _...,... ___ __,! Optional No. (i.e Ci Wei 2) Well lf f SIName Last Name D,gan!ZA!lon Company M ' )epart'"""' A2 Drilled For: ! \.-AU~€:.N =~..:..t2A.:...c...:C::...cL.E.==-' Y.______.I ~' --------~ IL. I Sketch of Well Location A3 Street Address of Well Locatlord 2...SA _' ..Q f2_11'.\6:£,r.? rzc:.41:'.2! In sketch, indicate p,operly dslancos k'om lne, eeplic Odd, rue lank(s) and bulding. Plebe lndude North anow. A4Town/Vlll age/Area/Lot#:! P\\.OT" Mi N SLtS ·\') iV\ s;&:,r;p AS UTM GPS): Coordinates (using handheld NAO ffiD zone l==:J Easling Northing A6 Elevation Top of Casing:'. ~! ____ ___,! m@ASL of m A7 Accuracy : - - ~of GPS ~--- ___,__. +/· I® AB Purpose of Wells l!l Domestic Test WeH D Irrigation D D Commercial Municipal D Observation • Water Level O lnduslrial Agricultural D Public/Recreational LOG OF OVERBURDEN AND BEDROCK MATERIALS /AM d6pllls providod) are below surlace, appropriate d,r,;criplors ground citcie use units, 1,-ac;a• I.._c:IO~( SILTl,w;egr.vr,II "'some•10-20~(1.e, SANOR11tWvnell EXAMPLE j'br)Mn. ~ , l ~blact. ctAY,SlT,SANO GRAVEL. ".s.fly undylgm'll,¥20-3fr;.(l..,lillySANOf W . fWidM, ~ . qBBI.ES. 80UtDERS, BEDROCK "Mtd untr.or •.andv.wr 3$-SQ~ 6 :·~ - ~ : tai'::t': ONLY ' tirowrrl 11_ SAND , f crau ~ !avel aome slit . 1 II --- t:"--::"- .,,..--,,-,---,-1 t-:-::--:- -- 1------ - --1 r-,--~---:, - ~ ----,--~----! i--~~---.....,,--,-----,-=-1 ,· ~ ~ -- I ~ ~ -=- -· t---=--- I--- - I--- ..--,:.;:.;....::..:..,_ ---- D BB Permafrost Encountered: NO Oves , ( m 11 yes lndlcaled depth tti): -~ to:.i=::J WELL CONSTRUCTION ,eon....,.,•• ,,.,,.11 E-: D1teWell 1i:o M I l ·of t> 2005013I Y M, -M Completed ~- ·v o' o . -,. C2We11Type .,,......-.,.,..., .. ,.,. : ; C1 DrllllngMalhod i)AlrRotary(C~lonaQ Dug o .0111er{p1NsespocJ'9) WM• p,oddmg taroa locaJ9d7 0 O R""'rso Air Rotary Cobio Tool ·1 J 0\/EAllUROEN ,leeoROcK Mud Stem) Rotary Auge, (Hollow/ Solid Casing , __ 11'""""-·.,_.,....,._,.'-"'•I : C6C~lhto C30ulsldw appmprislc ground surlaco, p/N~ a,r;1e unilsJ C17 from ~18 !O= I Perlor~ Dia: Sctfffl1.c::==J!m@i::::==J(m@ c=:Jn .... ,mml-€), 2 C14~::, C15~:':i:!':'~~!ei < C16 .~~n!~:usWireWrap Screen .c:=:::irm.@ i::::==J m@ c=:Jniou.,ffflll-0s , t::=:Jlcm,€))0 Steel .0 Louver Screen ScrHn3. t c:::::::J tm,€) c=:JlJ'O'.s /m mllr@:s m@ i::::==J D Plastic Perforated C19Screen 0 -0 NIA Slotted Comments : '-------------------,~ Open Hole 0 WELL DEVELOPMENT AND STATUS 05WellYleJd Estimate 01 Well DeYelopad by A Head Complallon 02 We 04 Static Waler Level 03 Well Head Stick-up ~, .... ,&, k D Surge Bloc Wen House 8 WalerJetting 0Pt11&u ·~awir~~ liJAtrJetting/A.,,Ulting l,_J tm ·:@· BaHing Woll Pit (lmpleteO). 08 Method Used to D7 Well Abandonment Status Ellti-eWellYleld wa, the properly decomml1stoned well D AirUttino D6 Final Status Wei with bentonite grout? DYES Baifing D Waler Supply (in use) Nol in use Abandoned °'Y D D D D ONO D 0 Sland (Back-up) ;.,""'o y OeepeneCI •_!W•-• D :t\ll by UYE S. !"°""'180..0: 11 = · D~:·r1 ~--~, plm•o~~~Y,1Jd Pwapi,,,gTntRM.ordJ Y V V V M M D 0 F1 wen water Level 0rawdownlRecoYe,y DATA PUMPING TEST QUALITY RECORD AND GROUNDWATER (Al d8Dlhs below~ c:lrd, un/QJ Orawdawn Recove,y ,_ 1~ .. lOf'"LflVei Time W•Wrt.l!t'el w E1 PumpingTest Information ( n i RECOMIIEHDA110NS (rrw1j mi /fnl //1 : Pum#ng Te51 Slart Date 0(SWL) O(FWL) Recomm,·, Pump _ · 9ts>th ,. 1 1 -~~-_.(m-@) v v v o· o v ),i t.4 Statlc Waler , 2 l.e,ef (SWL) 2 Reconvn. ~u-nping Rate: !- _ _ ,!(ml® 3 3 ~-,--~I Losi@I Pump lnlak;e Set al: • • It~. ptovlde rate: I . .. l!m'® 5 s .. __ .!(Lps/~) ··1 10 10 Ouralion o! pulliJ)l'lQ: c:J11r.;c:Jm;,, 15 15 ,. 20 Fi 20 nal Water Lewi (FWL) _ al end . : of-J~~ Tesl 25 25 l _ 1/m'® 30 30 i G1 GROUNDWATER QUALITY 40 40 . Field Data ' Turbidity/Sand Content 50 50 Dal• Mouurement.sT.i.;,; - 60 60 Sflghlly tlMtJ!d/cloUdy 0 Baet...ia Testing o· -~ V V Y V M U D Moderately turbidfeloudy D a 0 O YES Was san-c,le taken? NO yes. mo H Ind/cal• OTurt>!d/doudy Date Sample Taken: name ol th9 laboralol)l , EJ-ConductMPlica!>lo) Name of Conlraclor H 1 Orllhg Conl)any; athway"water" RtsOWCiti I 11 Company Name, .r,-'--'-~ ~-==,;....;=..~---;, H2 Name ol Orilel(,), L S . : 12 Company Address r=r::::::::::::::::::::jl HJ AdOraa ol Dr• !!ir; 101.B Copper R<>ad Whlloh0<>e 'tT YIA 2Z7 . ; . I 3 Aepo1t Reference: I I I; . . L .. ,r;;.Q. 14Rep01tDale· . r=========:--,-l Slgnatoriof. .. y y y y M M ~' ~- {) 0 Y Y M 'M O y y -o tlate~~ 1:0\'lr llOn',ent lo .0 ADDITIONAL INSTRUCTIONS ln~matioo conlained s lhe aulho,ity Porsono.l on lh tOl'm Is col:!ICted under of the ,4ca - ro 1 1fll'MICl>fflpl,llllrujitukNm, W.alOfRer.ourceaSoctlon1Y-310J, tnlorma/lOII ;Jtld ProllkJIOII Prlvocy 20 of (/tlTJpP) Acl, St!CMon (c) and will be co~ used P!HH mall : [)epa,imfll)l 01 la1t II to 01 E11vtronmen1, 10 d1labaae ol weit and i,ouod W<11ler 1nfo,m111il.lf't, 1nlouT11;1.to, -, For lOrlher 1 th • • cal iilJ {Ho/)titi/-J :it.flldll .V'!" ~<1 l9 W•ltt1.Fi~SOUft:t1S~~-- , ' :::s,:,":t~::,z;,.,t~~-----.:==:;;;;::;-;,=--....,..~_J · S190::iture o1WallO¥tr.e1