'/ lCCo Well Record Page 1 2 of WATER WELL \C.kon Govemmanl DRILLERS FORM Dep.-tfflffll of Environment Well ID: w.terRHourc:H S1ctlonY.310 Vuk9"W.,.Wttt 1\...-.kY To be assigned Of Environment oy Dept Metric O Imperial ® Boa J7tllWhhhorN, YukonYfA 2CI INSTRUCTIONS FOR COMPLETING THE FORM 4. Please print cJearty In blue black ink. or subm is the 1. Addilional information is provided the this on 2. 5. Completion and ission this form responsibility al bottom of of of torm page 2. Question can the drilling contractor. be directed 667~3171 . lo Water Resources at 867 tor or 3. All well construction measurements reported to m or h. 6. PJease specify metric imperial units all measurements. shaH be 0.1 0.3 WELL LOCATION AND OWNER'S INFORMATION A1 Well Name: L---------' Optional No.2) ii.e.CHy Wei First Name i Las! Name · l OeP'trlnll!tJll grtnilalion c~ny Of A2 DrHled : For ~-L_A_So~lv __ l L...I _.c.A~B ..... F,..;-L....=-_ ____.I LI-----------' Sketch of Location Well A3 Street Address Well Location:! of '3S AL 1?,072£" ~o A Q I In sketch. tnck.ito clstanc~ trom P,Of)Ctty Mo, sepUc field. fuel bulldlng. lank($) and P$e&se Include No . tlh arrow A4 Town /VIiiage /Area/ Lot#: Mi IV€ 1:2.~ R f 9S'::E: <;;u f3 i) . ! l LOT ?JS~ AS UTM Coordinates (using handheld GPS): NAO "[II~] zono C:J i.JT lY\ 2-0n~ 9, Ea~ng Northing 4-i=)io=1~ A6 Elevatlon Top Casing: of of ~I ____ __,! m,@AsL (Q=l-4- =1~i2, of -------~ +/· m I® A7 Accuracy GPS: _ _ of AB Purpose Wells Iii Domestic Test Well D 0 Irrigation Environmental (Quality) 0 D D Commercial Municipal D Observation - Water Level D other (pklase, idiJntJ1y. e/ us Industrial Agricultural Public/Recreational 0 O D ·I I OVERBURDEN AND BEDROCK MATERIALS LOG OF (Al depths.,. b•/ow g,ounds~rlaco, drr:I•~••• units, use rk$,;rlptors !r.ta1" ..: 10% Sft.TltoCG (io (11'(1\"'1} '3oma• fO-.ll?~ (i.•, SA.ND j°Of711! !Jl",JN(/ EXAIIPt.E 9'8:1< fTN", blxit, CLAY. Sll1; S<(ND. GRAVEL •~siltySANDJ MOISTURE l·6illyJU,.,.,l9i.,...,,,-2'0-30!;. (J. drf :noi3l/:,4f~.ftl(W.rJ ,WIM,·~ ~ .~ ;.hJ . 8£0P.OCK , . .- pOSBli:S.80llLDERS ·.v.a~rx-.... HAADNESS.,onl.Nli:l '91)'hm'd d_ : ~ g:nmil".'.15 SO l. ONt.Y I btDwHI J I I 1 . · ·===: · I &AND j trK• ,ravet .,..... ~I===-===-=-:::::::::::::: ::'tlpt"-f "'. 1M Gener.I Colour BS Most Common MN'111 Bl Secondary Mater!lls B7 DHCl"lptton .,,. OJ,.,.-. L,Q_ arc."I' ti "l'fCJ tiii ,_ I-:-- I-- I-- - - - - I-- r-- ... ,___ .,_;;._ _ ,-..,- ,___ r-- ,___ 1-- - --~~---' ~------- --------- ~------------','------------' ea Permafrost Encountered: NO O.p!h ( Oves If yea, lnOicated 1€ ), 1,om:c::::J .. ,[:::::J D m WELL CONSTRUCTION re_,,,,_ on P,., 11 Data Well Ex.,;;,,,., Completed ._ _______ ___, 2005 Ot .Jf YYYYMMOD C1 Drtlllng Method iJ Au Rotary (Conve~uonal) Dug 0 omar /plda$irJ D C2We11Type: """'t~'°"'.~"'•.,. ..,.,.._,11 ,,me,lcw;a.fld'1 DA-•· Air Rota,y Coble Tool 0 I I O\IEl'8UROEN ja BEDROCK D 0MuORotary 0 Augo, (Hollow Said I Slerp) C7 i"' Comments Rog•nllng :., Cnlng C6C~to: L...JLl.1.1 I(} m Well Record Page 2 2 of WELL CONSTRUCTION {ConlmU#dlromP••• I) Surface I Environmental Seal (daplh below ground surface, un;l!\J l)kloso ~•de r,pprop,i•le C8 _ Seal Materlai Seal: Seal Depth.from: fype;, CB Diameter of C10 Cf1 Seal Depth to: C12Volume Placed: 1een1a .. 1e I I I /a ji,m€Ji o lim© ! / •- ltm@ ~----~ (m '€) . {i .e. Bentonlla) Gra"el Pack (dopth below gro-.,;nd surlaco. please aw,()pliatfJ cixlt, unilsJ CU Gravel Pack: If yes, lndicaled depth ( m 8 NO .@J: Material type: YES lndica 1 a1erial: from:~ to: c::=:=J 1e diameterofn C=:=J{!Tlm,~I Le. sil/Ca .) Well t,Screen Information (depth plo.,se arcl••pp,opl'filte I ~QIOUM surface. u,nts) C17 Depth fi:_um: C18 Dept~ o; Slot Size Perforation Dia: Screcn1,r:::=:J1m@ r::=:::J1m© c:::Jrho-J,/mmt-€,s C140~stde C16ScreenType . Screen 2 .· :.tmmtif@,s fm.tainless Sleet Wire Wrap :_ · cm ,@I D D COnrinuous ::====: - l:::::J Steel Screen . ( Louver Screen3 r:::=:J m.@ r:::=:J1m© c:::Jrhoo;Jmmlw@::s O O D D Plastic Pe11Drated C19Screen D NIA Sfoned 0 Other._ ___ Open Hole Comments: L.---~--~----------,-' WELL DEVELOPMENT AND STATUS D5 Well Yield Estfmate D1 W.'. t?•welop,icf !Jy 02 Well Head Completion 03 Well Head Stick-up D4 Static Water LeYel u SUilj!iBlock 0We!l.l'iouoe • ,_...,... .,,..,J ,....i..,.-,,...,_., 1 , 1tlps1@.1 B .,,,Wlll"!J~l(ln . g. : c::z;::::,cm@ I 110 lcm@ e:,,AirJ, ~ Alflilffo,g . · 1. L_J(m '® (Usenega/M>/1..,..,.,,,,.1 (Usonog,11w>ffbd1Jwgr.-1 salting ,gw.11Pi' (NeT:PERMfTTEDJ 08 Melhod Used to None()ollflilof""1l)leted) D7 Well Abandonment Stal us Estimate Well Yield Was lhe properly decommissioned wel 0 Airlifting D6 Anal Well Status D with bentonile grout? YES Balli ng D Waler Suppty (in use} ,Not in Abandoned use D')' 0 0 O D ONO . If YES. lnd lc a1e Do.le: D ,~~~J.!:t.~,. 0 Standby(Back•up) -~.'ffftW,o Pi,,mpno rnt RKOldl Observation v;•0ther:I D =~pk,.,..., ~~.., Jd D O I OMu; ,.,,,er.G ho!'I• YYYYMMOD F1 Well Water Level Drawdown/Recovery DATA PUMPING TEST RECORD GROUNDWATER QUALITY AND o,awdown Recovery (N de:JJJhs below Ulllls) ground cilcla aw1oµnal8 r,me Wolter Ll!Vel 1 L...,., '1Jlt Vl•ler 0 E1 Pumping Test Information frri•1} (n,lf,J "'- (ffl'ltf { f mlil RECOMMENDATIONS · ~nJiiiip Tes1 Sia rt : fute D(FWL) , 0 (SIM.} Recomm. Pump Oeplh: I I j•m@ I , YvYMll.00 v " 2 Stauc waw Level (SWLJ, _Recomm Pumping : Aale· ._ ____ _,,I Lpsl !@,) 1 1,m,® l_ ~ump ntake Set al: II HQ!iing,_ preylde ~te: I 'l