Well Record Page 1 2 of \{.kon WATER WELL Goveinmen1 Department of Envlrvnmtnt Well ID: DRILLERS FORM WM•r Rnoun:u Sectk>n D V-31 '\\Ikon Water Wen R•glslry To b& !. tronrr.ent assigned oy Cep Of Env Boa 2703 Whitehorse, Yukon Y1A ZC6 Metric Imperial O 0 INSTRUCTIONS FOR COMPLETING FORM THE 4. Please l clearly in blue or black pr nt ITTk. 1. Additional information is provided at the bottom of !his form page on 2. 5. Cornph3tion and submission of this form is the responsibility of Question can directed Water Resources at 867 667-3171. be lo 2. the drilling contractor. 3. All well conslrucUon measurements shall be reported m 0.3 lo 0.1 or tt. 6. Please specify metric imperlal units for or aD measurement,;. WELL LOCATION AND OWNER'S INFORMATION Well Name: A 1 Opuooal (i.e. Ci!y Well . LI ______ ....Ji Ne 2) Cornpany-f O!Jtattmeril i Of'g.1n12:i'1!illn A2 Drilled For: A3 Street Address ofWell Locatlon:I 8 A ct:G·I( 0 i ,£<; IZO Sketch of Well Location In SkM;h, Sldlcate property lino, dr.;La.nces lrum Npllc field, fuol lank(s) 1111d bl.aiding . PSease lnckJde Norlh arrow. · A4 Town /VIiiage /Area/ Lot#: ._I _ L -.,,&)....,__H""'A___,L=-""D;::___:VV_~G:::...;..A · .;..;~'/,____, .~ A5 UTM GPS): Coordinates (using handheld NAO Zone C=:J Easting Northing m A6 Elevation Top Casing: of of I._'. _____ ..,! ,®ASL A7 Accuracy . : _ ..._ of GPS _______ __, +/· m I® A8 Purpose Wells of Ii Domestic D Test Well D Irrigation D Environmenlal (QuaUty) D D Commercial Municipal D Observation • Water Level Otl:terJplease identify use) D D Industrial Agricultural Public/Recreational D I . I LOG OF MATERiALS OVERBURDEN AND BEDROCK (All belowg;~~na surface. circle use clescriplors depths appropriate units, provi;-- - - - ,__ ,__ I-- r,----, - - ,_,.._ -- - - - - - - 88 Permafrost Encounten,d: , 0 NO DYES II yes i ,caled depth ( _ nd miili):kom,t:=] 10,t::;:::J WELL CONSTRUCTION /Con#nw• on P••• 'I Eramp/6: c~::i::~ I '2. t9 °I O 15" ·j I I 2005 013, YYYYMMOO 0 C1 Drllllng Method ii Alr Rolary (Convenllonal) Dug !:t""/'_.., ,.,...,1,1,,.., C2We11Type: 0lhor{P./<,aH~) 0 . · i N•SWOUUC nf "-'•~"' D Reverse Air Rotary Cable Tool 0 I; I Iii[ OIIERBUROEN BEOAOCI< OMuo ROIDf'/ 0 Auger (Hollow I Solid Siem) _ d- Casing (tltlpfh ~low QIOU11 ~t1. plus• circltt app,QJriMt~ urulsJ C3 Outalde C4 Caatn:0 Nat8flal Caatng ThlckneH ,....,,._, C8 WIit C6 C!!!!!i!af>th to, Diameter crn.@) • ,crrit@ L..JL._J ( 11)6191!1 [m:11 ~ im,O 0PJ.,lic vth11,c:::==::i D Well Record Page 2 2 of WELL CONSTRUCTION /Canllnwd ,,.,. •••• 11 Surface / Environmental Seal (depth hcfow ground sorf•ct!, appropriate unUsl please circle C11 Seal to: C12Volume Plac'ed: °,Wh C8 Seal Material C9 Dia Seal: Seal Tyr: met~ of C10 0•: tro_m: f !,., !(,n@ (m ' -© JBenlomte _ ( /P lce circle approp,ia.trJ uru1sJ C13Grave1Pack: NO •1ritf1eateddepth ( m.@J. B ltyes. YES from: : lndk:alc diame1 of malerlal: 1..-@-. ) Materi type: c::::::::J 10 [:==J er c:=:] ( ,,.,, .; al {le.siica) Well Screen Information (deplh apptOPJiale bc/oWtJtound su~ce, p/NH units) ~m: C1B Depth to: Perforatlon circla t'ii'\ Screen1.L-...L.:ll2---J(m@ Ujit_J(fl•,\UJ ~ - Tl,ou.lmrn/1,~-. C1.t Outside C15 C16 Screen m · ·1 . / / 81eon ~1erlal ScrNnType z. c::::::J( .(ii) c=:::J m.@ c::::J Thou. mm 11@t.-. .Sleel ContmuousW1raWrap · . ..c.:,.._ Diameter ' (,;in~) Sbolen D .-----, .-----, © r----1 CD •,,::.i, 0 Louver Screen3 L-------J(m@ L-------J{m, L--..Jniou. tmmtr,"c!.r -S.leel . Screen , 0 O Pertoratca Plosllc ,, · · cig j 5 D NIA Slonad crNn • . _ 0 Olhe,._ ___ _,0 Open Hole Comments: .. L----------~-------~ WELLDEVELOPMENTANDSTATUS Estimate D5 Well Yield D3 Well Head Stic:k-up Water Level 04 Sta11c D2Woll Head Completion D1W1H~.llr I '.lo Ii Lps/ u)ll (MIOV•fto11rwlaurl.uJ (NMl/lqtol-iltfJ House . DSur9$Blocl< c'.::::X:]1 c:a:::J1 m,® m@ Dwatst,erling OP~~li"""'°'~---- ·, - ' ·L.....J1m,® ....,. @ Al< Jeltiag I All lill,,g /U..,_;;,,,., ...,.,• fPdel (tlu~l-o,adl,I . · _ 0 {NOT GBaiUng Wall Pll PERMITTED) D8 Molhod Used to D7 Woll Sl-l1wi Abando"""'(!i --(~ IIOi e<>mpleted) EslJrnate Yield WeU 8~'-'·'---- was properly decommissioned the well 0 Airlifting w1 tn grout? nen1omte DYES D6 Anal Well Status D Bailing ONO 0 D D O Waler Supply {in usa) in use Abandoned Not nr, JI YES ;: J,ndlcate Dale: &~'!i'!~.'e~,. CJ Stana by (Back·up) _ • D 0 Oaepei;r=imf~~--, ;h,-.JJ , P, I.~,, :=ir 0uu1111 Pu,np,ttgTnlRaconlJ D D D :f Obser on vati (?tt\e' = · w •"'l ·tr"'e"' "' 1n r!id .i:1 0MH.IJl'ICOtld:1.IOf13 V Y Y Y M "' D 0 F1 Well Water Level Orawdown/Recovery DATA PUMPING TEST RECORD GROUNOWATER QUALITY AND Crawcrown Recovety (A.JI depths g,r;und. Uf'dfs) btNOW drdB .approp1ialtJ 1 Et Pumping THI Information f½ ,~ .. - 1 ~~~': 7\ . . -~ . .,_ ;:;::, ~/;;: RECOMMENDATIONS umpwlg Sli1.r Dat& P :fest· f ;- . f(Fwi,j O(SWl . ) Recomm. Depth; PUf1'1) I Bm@i Y Y Y Y M M D .0 Slaiic Waler l8\lel (SWl): Recomm. ~f\ate: 3 • . .l J{Lps/@) r f Intake at Set If !)owing, provl_ de rate: 5 . r J(mi@ I !iLps/gw, ) 10 10 Oura1ion of pumping: 15 15 I LJh,.LJmin 20 _ 20 Final (FWL) Water LE!Yel 25 25 at end ol Pumping i:~sl: 30 30 I , ----- IJmJ® 40 40 G1 GROUNDWATER QUAUlY 50 Turbidity/Sand Cont&nt 50 Fleld Data 60 OClaar 60 Date MeasuremenlS Taken: SURhtly tull,;d/cloudy 0 B11eteriaTnting a sample Was taken? VES NO If yes. ind,cate lh9 D D YYYYMMOO D Moderately turbid/cloudy Oate Sa mp!e Tal(en: name of lhe labOfalory. : Turb id/cloudy D Electrical ConductMty: c:::J uS Trace sand present 0 - 1 pH : CJ YYVYMMDD No sand present D Temperatu1e: c::::J ·c Chemical Analyaia Water of Well Dlelnfoc:tlon GrouMW-Type was a sample If lal8 /IIIIOta/Olyi ·Oa : . Was the well dlsinfecled upon completlon Salty of lhe instaUallon? pu"1) YES NO D Sulphur/ Egg Odour I 11 L... --'_.;;;;;;;:...;....--1 ·y y · V V 'M M O 0 Organic Odour dislnfecffon. Taste 0 I . Bi/el,Y describe melhOd ol weH Metallic Tas1e D 0tnor:"f _ ___ D _ .. .,..,. _ _ ~ - - - ,. cai.isuLTANr iitapp/lcBql/,J______ ___ -- WELL CONTRACTOR I 1 Company Name: _ 1 L., H1 Namo of / Company: Calt)W¥ •Y:, eon1,acl01 OriNlng ~ler Rnpurcas I 2 COffl)ony Addross (, :· :· ;I ::::::::::::::::::::-- -- ,11 ~ - , H2Nameo1 · ~o~ny~E~E0,~.-,:. ~'5=:'ffi~'c"'"9~ffi'~w====~ 5 H3 Drller: • AddrOS$ or 1016 1A 2Z7 13 Aepo,I Aale,e~ce: 1 ~ ,,, ==========;---'· Aeporl I 4 Date: V y y y t WTltlnl (N Oa1• S~ 1 ed1o C olnciecl of Personal inlo,mation conlainltd "on ·· .. 1tii& loim 1..1. UfldOJ" lh8 i!Aho;tty !he Access io · ADDITIONAL INSTRUCTIONS lnlalmalJOflani.1PrOltCf.!Onl)f P1ivacy(ATJPP) Act. Sec!k>n 19(e)and "Mllbcll ~dlocompit•a Upon tlng lhis fotm, iV-310), c:Ofnpl& W~le,- Ror.01,m:~1 pulJhc and g,ot1nd walt!I lnlorn,al!on,._. ...iorm•IJon \he dalab•lifl o4 .,..It for lurther contacl please tax : Oep•,tmant Enwonmenl. maU o, it 1o -.)t (3()',le,nrr.0,,1 ol 't'ukon Box 2703, M1n1ger ot . Wate, Resm•ces 667-3223, Hyc1tology 111asn 1oU traa wiP'lin Vukor. Wj,,il.eh Yukon. C.n.,da VI lCG ~ A . ~;::~~:~~3.;,.41111 ,-__c:...:. · ---=,--~--...:..---~...;.... : Please ,,,.,. to conlac1 111111 LoS -! : · , Mo:11. ·600) 601-0fOtl, local 3171} PIM>Ot! 1867) 66"/ 3171 lcU 1ree Im {1 undenlilmllhl~•fM Fax 0!8 667 -ma' wa~ 1J !,,IOI£ V..J 11 -319':i E : .Hesou,ce.s ~ coUilcllon ,,.tsGnal ol infomvlion, Signaluro ot Well Own¢'