Well Record  Page  1  2 of 
l 
\{.kon 
WATER WELL 
G0vt1rnmen1 
0.pwtn.nl of EnvlR)nl'Mftl  Well ID:  DRILLERS FORM 
W... r Resources SecUonV•l10 
Y\ikot1WatarW1II  R~l5lry  To  be as s OI Environment 19ned  by Dep t. 
Metric  Imperial O  @ 
Boa  Z703WhlCIIIIDfM, Yla.onY1A 2C6 
INSTRUCTIONS FOR COMPLETING THE  FORM 
4.  Please print clearly  blue or black ink. in 
1.  Additional information is provided  the  of this f on  2.  5.  submission  form  e responsihilily 
al  boltom  orm  page 
Completion and  of this  is th of 
lo  867 
2. Question can be directed  Water Resources at  867-3171.  the drilling contractor. 
3. Al  well constructk>n measurements shall  reported  0.1  m  0.3  6.  specify metric  Imperial unils  all measurements. 
be  lo  or  or 
ft. 
Please  lor 
.._ _____ _. 
WELL LOCATION AND OWNER'S INFORMATION 
A1  Name:  Optional  (Le.C;tyWellNo.2) 
Well 
First Name 
I  I 
Name 
La5I  Company  Ofgamzation Dep:3rtm€ ?tl1 
A2 Drtlled For:  I Rol'l::A  \ a 
IL...I _l(.:..;;l.A'--'~=S=-E=-=--N _  _.L_ - -L...I  --- ----~ 
Sketch o!Well Location 
A3 Street Address o!Well Location:! iCM  1Co3Ce  ALASKA  +4W)" 
In  lkak;h,lndlcal ine, elhianceslromprope,1yl
.. p11c  r IMlk{a)  tui&dlng. idd, fuel  and 
Ple.a .. includeNOflharrow, 
A4Town/Village/Area/Lott:lu:>,  IOC\":t·l, )-\Ai Nla:S  JC.I  ] 
A5  .
UTM  : 
Coordinates (using handhold GP$) NAD  Zone 
c=J 
\JT"M  1-011e  <i 
3vto ~4 
Easting  Norlhing 
A6 Elevation o!Top of Casing: i  i m (ii)ASl 
<,  '1,  "'Z,-C,  t. 
-----~ 
A7 
of 
Accuracy  GPS:  _
__ ______  +/· m I® 
A8 Purpose o!Wells 
Envir nmenlal ci {Quali=---------
D 
Ii Domestic  O Test Well 
D 
Irrigation 
D  D Commercial  Municipal  Observation • Water Level D 
other (plea iden fy S(I  ll use }. 
0 
Industrial  Agricultural 
0  O  0 
Public/Recreational 
I  1 
LOG OF OVERBURDEN  BEDROCK MATERIALS AND  /All depths  belowgroun,J a,e  surface,  circls approJl(late units.  us•-JIIOVlded) 
lt«."clO~(l.• . ~TJ~ g,•~ 
EXAMPLE  (lltDwn.~IJIWM,bl,a,  CLAY,SU;SAND.GRAVEL.  / ~.. ~.t~.  MOISTURE~ f~(Wa/1 
ONLY  icoeeLEs.::;:RS. I 1 ~"r~· ~' i  BEDROCKI ·":::~::~~  ii  ~:.::;...-z . ,bad
~i'" "' : 
84 General Colour 
B5 Most Common Matertal  86 Secondary Mate11al& 
87 Gffleral Duc:"PtJOfl 
a
2,,-
.... 
h,"7)..,,,,, 
Cb._y 
,..Q_ 
·-
C l  .V rt"
Cle._.,,_  I 
Qr ,,v,-, 
-
v  C,/,',,, 
(; ,._ ,;.r.J 
-
!La! 
y 
' 
,--
r--
,--
- -
,--
r--
,--
,--
,___  ,__ 
,___ 
,--
r--
,___ 
,--
,--
r--
,--.. 
,___ 
,--
-
BB  Permafrost Encountered:  1€): 
ND  Oves 
D 
I 
It ye,, 
Indicated depth  m  •om:  : 
c:::::J  c:::::J lo •. 
coNSTRUCTION (ConUouH •• p,,. ,1 
· Well 
WELL 
Date 
Erampla: 
2005013t 
Completed 
YYYYMMOD 
Other  (p/NH~f  .,...,._,...,...,.  .,, 
D  C2We11Type:  • 
C1  Drilling Method  Iii A>  Rotary  (Conwnllonall  D<Jg 
O 
. 1  1 ,  MLsrp,ucb;ln9zon1~1d1' 
Rewrsa  Ca~e Air  Rotary  Tool 
D  D 
•  •  l!:)ovEJ1BUAOEN  8€DfKlCK 
D 
0  O 
Mud Rotary  (H Solid Augar  Stem) ollow/ 
C7  rh•r Comments Rog g 
fflf;n Cuing: I





- , 
WELL CONSTRUCTION 1c,n""w•1,.,.,,,. ,1 
Well Record  2  2 Page  of 
Surface  Environmental Seal I  (11e91h  baow grol.Wld  wrf,m1.  c1plea.se  ,t.1e  approp,i.ate 1.nts1 
·.Cl  · ··: S.al Ma!o<lal 'lir C9  h Diameter of  S..I:  C10  S111 from: 
C11  Sea~to:  C12VolumePlaced: 
@!ilorini  - I  I  . -ID  11,m.€)1  hm©  !  ·(  _  !1m©  ',_ ___ _,Im ,©! 
6
c .... a..,,;,;,,1 
Gravel Pack (deplhlMbwO'OIJftdsurl~ pleuecrc~app,oprl,11e,01sJ 
C13 Gravel Pack:  D NO 
II  indicated yes .  ( m dept_h_  @) 
fron,:  lo:  Indicate diameter or material: [=:::J  c:::J  [=:::J (mm/it@,) 
Malerlal rype: 
i.e.sllica 
I 
Well Screen  Information 1..,,.,, .. .,,,_,.,,,.,._,,,..,."',....,,,.,..,. """'I  to: C17  C18 Deplh  Deplh  Dia: fn,m: 
Slo1  Size/ Perfo<atlon 
n 
Scraen1. m® 
CZ?E::)1 ~Im© Ci:J ..... ,..., ,,e,. 
C140uts.lde  C15ScreenM11er1,1  .  tC16ScrnnType  Sc1Hn2.~ m© ~im@T=:L]-.., ,,(1),. ,.,.,
D 
cm  /8)  R9 Statnless  Slee  Continuous Wife Wrap 
{  I  ·  ·  · 
L.R-..J  os,eei  OLouverScreon  ScreenJ.c=:]1m©c=:J1m,©C=::Jlhoul=li.-$
, 
Q 
Pl,i~tk':  Perforaled 
N/A  Slotte<I  C19Screen 
0 
Olherl  Jo  Open  Hole  Comments:  '--------=-----------' 
WELL  DEVELOPMENT  AND  STATUS 
02 wen  Head CompleUon 
05 Well Yield Estimate 
QWI\IH-
; . . 
~1"'51~) 
L-J( m,® 
Pu  lN.OTJ)EmAITTEOJ 
ONo!ii (~no1.~111e~j' 
08 Method  UHd 
to 
D7Well Aba-~ 
Estimate  l 
Wel Yield 
Was  the  well property deconvnlsslOned 
0 
D6  Rnal W.U  l'Jrl.lting Status 
with  ben1.Dn DYES 
1 le grout? 
0 
Bailw,g 
0  0  D 
Water  St4>1Jly  (in use)  Not In  use  Abandoned  D c,y 
ONO 
0  0 Sland by (Back-up)  Deepened  11  _, w.u  t>ocr  o...wy 
YES.-lndlcale fl  Date: 
D  Obsemtlon  ~ :c:::::::J  lrrsulf-:ll'l'ilkl 
D Ar1H~n c:1nUa,1 
---
Y  Y  Y  Y  M  M  D 
o " 
F1  Well W.ter Level Drawdown.lR.ecovary  DATA 
PUMPING  RECORD  GROUNDWATER QUALITY TEST  AND 
(AR~o.fowgn:,ond.arc111~rialel.lf'll5)  Orawclown  A8C0Yery 
T,me  Wille, Lftl!I watff level  Jffle 
E1  Pumping Tut Information 
..... , 
RECOMMENDATIONS 
t11lln~  P,,lttl 
·
Pu mp1 ng resr&at1 Da te1 
·''" '"' 
0(FWL) 
; 
Reoomm.  Pum, o.j,lh O(SWLJ 
I  . 
1  1 
I  l<m® 
YYYYMMDD 
2  2 
> 
.
Stafic  Level Wa ter  (SVILI
Recomm..  Pumping Rate: 
I  ,m,® 
3 
3 
1
- (Lps/1@,J '-----~
4  4 
Pump  Lntake Sel at: 
If flowing, provide rale: 
5 
5 
I  l<m-© 
.  . 
(Lps/~J 
10  10 
D1.11aJion  ol  pumping: 
15  15 
c:::JtwsDmin 
20 
20 
Final  (FWL) Wale, l.e,el 
at encl  of Puff1)ir:ig  Test 
25  25 
30 
----~(m,©  30 
.. 
. 
.•.. 
4() 
G1  GROUNDWATER QIJALITY  40 
. . 
Ttubldlty/S1nd Content 
FlefdOele 
50  50 
Dale Measurements  Ti.kan
: 
60 
60 
SUghlly turbid/cloudy 
D 
Bacteria Tntlng 
YYYYMMDD 
D 
Moderately turbid/cloudy 
0  O 
Was a  laken?  YES  the Sl"l)le  NO  ffyes.  lm:llcate 
Date  Sample Taken ol lhe labofalo~ 
:  name 
0Turbid/~oudy 
Elaclrical ConductMty: CJ US 
Trace  sand  J)fesenl 
D 
11 
I 
pH,t:=r 
~Y,_Y,-,,- ,
Y-,-Y:-:M-M--,,0-,0~  .. -------' 
No sand pre sen 
D 
I 
TemperatJ.We : l:::::J ·c 
Chemical Analyall of Water 
WeNOlllnlecllon 
Groundwllter Type 
a 
Was  umple taken?  YES  NO 
0  O 
J"'S.  ind/cdfe  /ho 
H 
Was  me weU  dlsin1ected  upon complet!on 
Dale  &lnpJ& "Il!ken name  ol Uw  labonrlory. 
; 
Sal1y 
of  the pump  NO lnstalalion?  YES 
Q 
Sulphur/ Egg  Odour 
D 
1 .  -
11 
M  M  '-----~----
Y  Y  Y  Y  O  O 
Organic Tnte / Odour 
D 
Brilrlfy,de&ctlbe  melho4 ol  . 
well  disinfection
OMolalicTute 
.1 
CONSULTANT  I" applicable) 
WELL CONTRACTOR 
It Company Name ,..----------, 
: 
:ICathway Name  01  Company
H  1  Conltactor  Drillng  Water ResOll'ceS Ltd. 
I 
H21<amoof~J:IIOOY LltVtRSE 
: 
12 Company Address 11---===----;;=j 
H3 Addr8SI  of Orller:F. 11"01:'isl'c;;op:=pe':;r :'i m y·¥ 11<':oa':=i'd,';;v ,.1ei=hEo,::sEe:",<> 1vi':r1AR'2z;e7F====, 
13  Aoporl  Reference:  ~===========r--' 
1-4  ~•porl Dale: 
M  M 
O  0 
·  1
~:k · I y  y  y  y 
YYYYMMOO 
1t1 fiubmilted10 
'D r lt.Ofr:rwtinmwd , 
Pe,sonal  eonllined on  lolm  the Accttss 1nlormaoon  lhla  Is  coleci.d undlf 1h111Ulholliy  of  to 
ADDITIONAL  INSTRUCTIONS  .., Ao  saa1  IV-Jto 
tnlormalfan  •nd Prol.clion  PrillM:y  (cl and  used ol  (ATIPPJ  Acl,  Soctlon 29  \Ml be  lo~•• 
J, 
UPon  camplelng  ~rm, INs  , 
~.:':,C:~lf~nl
puhlic dalab&Mt  well  "ound Mier  nlonTWlon.  Foi h•lhef  cont,ct lhe 
ol  1nd  l lnlormaiion 
please  or  .  O0Ylt'MWII  2703. ~I  IH II  lo 01  VUkon  Box 
Manager  667-3223, ol  Hydrok>Qy  WIier  (867) Rnourcn ,1  Toi  Ira. wJNn '1\JkQn 
Whiahoru.'I\Jkon.CanadaYIA2C6 
1-I00-861,
<M08  E¥1.  l22J. 
Pleau IHI  : 
frn lo  ccntaa us ,111
·
11ww,.,..c,di,l'._rillllf'MII 
Phone:  (8671 667-3171, Toi  ·800) 661-0408, loc.1317
fcee  (in'ru,too)· (1 1) 
:::,n:::=-~'------:,s,g,-.,.--:--.,-.,-,,"'wc:,.c::°"",-'-' ____ ..., 
Fu 661•319S  WalW flHCIUfCn8p ytt c,1 
: (867)  E-mall: , . ,