lJ T tv\ q, \(,kon ... .. ,_ ,.,, ... __ ,,_ 01~1n.c·11a:i.11 , , ,S. ,1,..""nfl'l -, :-1 We ll 10 I w;,1.v H,110,;,-.-,c~.1 'i•=tl .:i, r, '/ -! ') (•4(ll1W .• ;y 1e r-ll'Jl l~!-!) JH 3 Y·.:1 .cP))Nn;r, ... :,:i;, \.>,(1 ;), !-:i INSTRUCTIONS FOR COMPLETING FORM THE ~ T J ; . : .,' (i "l :;! .~,i •'d' -:r·• .~ ; _ ,': '/ .) ,, _., ._ J'. ·, ) ,~ '.)'.')!"' . ,i '.t',:i, ic,; ~• . ',·_. '. '1 ~~ 1 ) ) J · ,:7 '.:;" ::1 • ~ rJ~ '? ::.- , :- :,; ,\-:L l' ~-J:>:,1 .. :;=31· 3~.,. i.Er' •3'7' J= i · /:n ·:, ') l ,. ..1. ,\ · ·~ : ; : :;"' ·. > J' ~ :•~ ,;; Vi:,·? "'"".. ~, :v -1 , .)'3 ':.Dr J' •·, 1 WELL LOCATION OWNER'S INFORMATION ANO -•.;,J : 1 -:-! r>:;: A2 Orilie;J For: ~ETE:\Q, :: ] ----. .-::---,-- ____ _ _ _ _ _ _ l AJ Street Well . ~ Sketch Location Address of Location -,A RN eoui:zu - 1 of Well .I 1 ; , : _ , ~ -.F,t!;."'I "J• .}l '?'J1lt:t •.:;!;.'· T> r:...:m·,. "" '?' 1 . iY)!• :!'; ~!·:J i- ,?I ',::< ~I ,J 1j l•~ jr.,~ A4 Town : VIiiage ~ea Lot# @r'-'-i -- _~-- -~~-'-------1..\ -------i] I I I " - . :)!~ .,,: :> i~ ,...J'! -':..: ... i:-~ . .,: AS UTM (using Coordinates handheld GPSj: , MAil [1:fil Z:,ne CJ l - L -·2aS · ,l'y 11ng Nv•!n A6 Elevation of Top Casing: [ J "' 11 ASL of - ------ A7 Accuracy of GPS: ...... ------~ - ~ +.J-m,·tt of AB Purpose Wells 0 Domest:c Test'Nell 0 lrngalion D :J ~-:lmme.c,al ; D Envir [QualiJy) onmanlal D Municipal 0 Observati~n -Water Level 0 10.dustrtal .Other- :e ~< , to ::1~ ~nt ,y us~J D AgncuUural D Public/Recreat,onal 0 l 0 88 Permafrost Encountered: '10 Ov:, WELL CONSTRUCTION 'Conlin"" on P,g, ZI Date Well Completed LZ : o li'f fJ ll I y t 'I ·1 11.,1 M i) -.) ,conver.1loea Dug D C1 Drilling Method 0( .-1,, ; ~,,.,y 11 O Oltic, 1PU!d~~ :l~r.tc if r' 0 Aeve,3e .\J; A-,1a1y C2 Well Type: :. . · ~ .l~~· -~~--"'l:~• 1\Jt ~ ,i::••31 "'! Cablo1",:o/ 0 I J CJ Mu<1 )!,11 'r ~ • Q AuW,' Hl;1 1. ~', . ) piij ·J :n:3•;•,o!:., v"- .i!::D,.•' ~ .r:- 0 Casing Cl Out s ide C7 Other Comman1s Ragardi sing; ny C• Diameter ~ "-J cac .as ~to f b L---~- -, c:· ' 0 .i__ _ ' ! WELL CONSTRUCT•ON : · ,, , . , • ., ,, a,,,, , . ,. Grii el >J Pack ,. ·. "3 ) ~ l:l!:! 1) ~ i_ ;J .:l ~j ;- l VVi::? il 5 cr9er: :nfor~ation 1 C J Out31d~ = '.)1:1•; ';,!~;> ::;• e': • 1' - 1, iJ r11rr.l!ts?:' "?-- - : CJ --, ;_,..; ~:E/ ' j ( --·.···-· ·= · = - --· "-- ~ ~ ..:.l ~..c.....___.c===~------=-c....... C19 5cr2en :::.1 ', ' --- -~=:; CJ :: :;- :__ _____ _;C: 0 - · _ ... .J WELL DEVELOPMENT AND STATUS 05 Well Yield Estimate 01 Well !)ev!IOl)e2Well Head •i&ad !)4 Lave! Camp••tio~ Stick-ua Static Water c13We!I ! :_ :y ,. j C.» P"! 8 § ~?.~:~'..~:~~~.,: -g !),;, ,>~:, •~1 ~:' :i ,'~ •, §J . " •c~ :[ ~7' .. •~-•. \ '. ~ • L•~,r ~1 • 3.:l litf'g O W~JI ? 1 ! ·~IQT PERMIT:E.Di D Ύ~:il:n?j :J 'iO:"!':; \•;~!I "'-:)t :,,,1,0!~ ;~;; : ( :)11'9· -~!- · ---~ 06 Final Well Status 0 O ,, 0 Waret Suc.::,1y :1;,. -.1:mt '~ ,n '.JY. ;b3ndon?.rJ O :i ~ - 0 . .. 3ta~d )\.' " · ' r~_ 2u _. ~ ,.-~3ac. lw.. •J ;)j ]e~,:;~ ___ ,_. ... :,., C1 ... }.t J: O:>u , Ooina;;,s eaiJ.,~ ,! .. J , _, , .. ~'.'.·· ;; ,, o . ,., .... ,. ,, ,." ... "} ,, .. .,, :, 0 . • ~ :-.. _ F~ WeU Water Or31wdownfRecovsry Lav1Ji OATJ\ PUMPING TEST RECORD ANO GROUNDWATER QUALITY J·:3.\•::low:, R~c'.>-12:y E1 PiJmping Test l11formation RECOMMENDATIONS 3 , -"t. -Te~t :;n~ ra- Jate I 1:1 L 3_ 3 'L ! · ' ~ 11: .• H· p:ri, ------...,. ,_,i , ,:::> T-) ;.;~~-!- 3~! ~l . : - ·1 ; -- =~ Ju =J~' J i' { _; Jt,r!1:;1n~ ;1. , 1~ LJ-n , . , 0 r, '?: ·- ~ei .FW L} : ; .;,111\/at ~· =J;r).] ?I ~.Jf'T'):Jlf'] Te;t L - 1 ;" n , ~ I " • J .. ~ 1 j G1 GROUNOW4TER ClUAf.lTY Turbidity/Sand Content Field Data . t· :: ·J ~. J i ''t : •.;.;,5'll$ ki,,,. :hie "'~ T.i 1 ,, 5J ! o,_,\e,c,="') .,,.,.,.,...=_,. ...,! - : ' :lacteria Testing i ,\ '.. \I W:13 nm:::i1e ~3~~;1"' -J ·1::; \10 0 0 ,; , ,,·._. :,; ... ,t._ \ - i i"' •."'1/?l'.,-. :u , ~ • ;,. i:l~' •"Tf .):1ta: : : . 3a \'-O'A ~~~en S ='l3~U:::-:i1 :Jf.;zt:1 ty t:=J, •.J C;)il- \• -~:.-,,-l D Tr ace :;af'd ese t J: ri .,,,C:J 'I :> t M ) r tu·-; e,"'.:JIC': .:,, c::t C Chemical 4nalysis ofWater Groundwater Type Weil o,.lnfect,an Was• ;arnol~ Iakap> 0 •'::S ONO ;1 : 3;'. :;r· ~: ic=: .,,· : J • ·. 0 3111 ~ 1 }~ .F / ~'-' .. ? WB !r w~I\ .:fHmfe: :::m~·)dtiJ;, te•'j J.>•.)(• .-,, ·_ 1, .. -- .- J':l!?•·: ~ .>l . .Jata 5:1 t\i :<-;.>I h L d 1 ; = • :A rie .>•.111"3 st:1!1 ::1t;.:m l 0 :,•,4Qh,, :: Jg '.)~ Ou<· 0 0 NO ' ::3 0 ' ~::tl"fc T:i;~a J:,% D CJ M9!ll•: Tasia ,j o _ :)It-a, J- - ~ ""- ,- J' WELL CONTRACTOR 1 '.lf !J, g GomoaPy _'fl1P __ lc:A-:rt'.\ WA'{ ; W'AriE.R H Name CoNrac1or _ r'Jat~ :J 0• l!.:;,,r j! H2 I , ! F.":~~~~===-~::=oc==,;:;;vv=rti~1t.====H=02=~ - - -- '- i.i ::i- ·-y ~- J . a~t~ :L -u.Di .:'.J.::~ .)i : ": r.,is.·i~,r.t. ~. . ~· I ~ , .i : :: 'i- ;3,,, ,3; , .. , ' '!'• l ~~1 ,r•i?.1 .l' . -: nt·.~: .. 11 -1 ,• ,; )·' '~ .::i., -;-;, ·11 .111: !!'~ r-~ ii ,, ~• •i,· 1• A t ,- . .,. ; .; ADDITIONAL INSTRUCTIONS 1 :' ' , • J 1 ) I i ' _:- j.J:i ;;:, t'IJ,'i'",:"':J . , ~, ,; ""Ir' )l ~•'? · l: .;: ;, __; :-i ;:>"=' ""1 \; q " •\ " ' , · .. •• .' · ' .• 4 - ~ ' : "11) l . \ · • ~ ~" •;l .:,.;• ·. .• f.> --'•' ::;, _;,;: ..). ;..,,_ >- :) -,· ! •" , ':.l .!~ ..,:\J ): •,, ." l:J·· :', t> .• '':' ,, -, -=,--.• '.I LJ ,, , • : 1 ; .:·;~: ' ::;;_ '. ,',,~.~ '.: '' :.~•, <;:· ~-: ;" ·_ ,: ... '. '. .! ,:.- ·:/ :? ::::·:: \:, , , ~/ _: :~' ':'.: ,, , ,: ; ' ~ ,: ,: •:,,.. , , .. \ 3~.-; • ' : .;. --? "· ~;, I , ~- :..· , . ' :: -•. ! .; .. 't:: : L ... 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