ffi, Ministry  Well lDPlate Number:
ell Construction  Report THOHM,A.:{ CIiAItLING LTD
starmp  cornP#vR$SffiOresst
fl Confirmation/alternative  specs.  attached
CeryULrA
'  orrcneliaxJJll8lFffie.  El.&sr reo. Ministry Well Tag Number:
vlL eAs tr Original  well construction report attached
Environment tr Well Alteration Report
The  rd BRITISH on Eanh Ministry of n Well Closure Report
Bet ?lac 
Owner name:
Town Prov.  _ Postal Code-
Mailing  address:
Street name
Well Location (see note 2): Address: Street  no.  t"r" E. r*  -f-ir*  Y_**-.*T'
@Description  ol well location (attach sketch, if nec.):
@eto, 
t-rrcI_az  _
A'  Longitude:
@  urMNorthing,W* 
. 
Method ol drilling: B-angtary tr dual rotary tr cable tool tl mud rotary Ll auger LJ orlvrng u Jefilng LJ olner (specrry):Methodofdrilling:  $ffrfptary trdual rotary trcabletool trmudrotary trauger trdriving trjetting Dother(specify):
orientationofwel]:fu(errcaltrhorizontalGroundelevation:,-ft(asl)Method(Seenote5):-
Class of wett (see note o1:  --Lt] a-!1.]t=_-3 I / fl l*  Sub-class  of well: 
,;;;;;;;;ilffiilil;;*'*;;;;'tem  trirrisation dr  -Nad--ilAa*-Sf.;L- ^nri^torindustriar  nother(speciry):-  '--*-
Lithologic  description  (see notes 8-13) or closure description  (see notes 14 and 15)
Colour Hardness Water Content 0bservations
Surficial Material Bedrock  Material
(e.9. other geological materials
(e.9. boulders), est. water bearing
flow (USgpm), or closure details)
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Screen details
Casing details
lntake: E Screen tr Open bottom tr Uncased  hole
Surface  seal: Type:
Method of install Screen type: tr Telescope tr Pipe size
Screen  material: tr Stainless  steel tr Plastic tr Other (specify):
Depth:,_  ft
Screen  opening: tr Continuous  slot tr Slotted tr Pedorated  pipe
Liner: Edvc D Other (specify):
Thickness: Screen bottomr tr Bail tr Plug tr Plate tr Other (specify):
Diameter:  --  - -  --{-rn 
From'. // ft (bgr) To*7ft (bgr) Perforated:From:12/ft(bsl)  To*Zft (bgl) Filter pack: From:__-_  ft  To:_---ft Thickness: ___. *"_______  in
Type and size of material: 
Final well completion  ----
data:
;;,;;o"oln;;;:j€e-ft  Finishedwerr  oep*r:  &@ttlosr)
lifting tr Surging ! Jetting tr Pumping  tr Bailing.
Final stick up  2e  _ in Depth to bedrock:  ft (bgl)
Other (specify): Total duration: '7  hrs
swl: ____.__.3:_Z_  ft (btoc) Estimated  well yield:  ^AC__  USgpm
Notes:
USgpm, orArtesian  pressure:-  ft
Well yield estimaled by: Artesian  flow: ."* **_
tr  nate:  &t- 
Pumping V{r fiting tr Bailing tr Other (specify): Type of well cap: 17'a-12 Well disinfected:  trYes Ef(6
t/ 
Pumping  water level:-  lt (btoc) Well closure information:
ft (btoc)  Duration:  USspm hrs Where  well lD plate is attached:
SWL before test: _ 
Obyious water quality characteristics: Reason for closure:
W{r""n ESalty trClear trCloudy trsediment trGas Method  of closure: tr Poured tr Pumped





Casing  details Screen details
lntake: E Screen tr Open bottom tr Uncased  hole
Screen type: tr Telescope [1 Pipe size
Method of installation:  tr Poured
Screen  material: fl Stainless  steel tr Plastic tr Other (specify):
Depth:-  ft
Backfill: rype: KocK LLrr 15. 
Screen opening: tr Continuous  slotn Sbtted tr Perforated  pipe
Liner: EdVC U Other (specify):
Diameter:------.  ---- ----4---  rn  Thickness:*---  --*-.  Toz/Ifi(bgl) Filter pack: From:-ft  To:--  ft Thickness: tn
4  ," Screen  bottom: tr Bail 'tr Plug tr Plate tr Other (specify):
From:  // ft (bgl) Tol#ft (bgl) Perforated:From:&ttbgl) 
Type and size of material:
Fina! well completion data:
;;,;;;;;j$e-ft  Finished*erroep,., &@ttlosry
lifting tr Surging tr Jetting tr Pumping  tr Bailing,
Final stick up,  2A 
nt ,n
Total duration: 4  Depth to bedrock:  ft (bgl)
Other (specify):
swL:  ---*"---5A--  ft (btoc) Estimated  well yield: <;-O  -  USgpm
Notes:
Artesian  flow: USgpm, or Artesian  pressure:-  ft
Well yield estimaled by:
tr Pumping W{n mring tr Bailing tr other (specify): Type of well cap: <7dZ- Well disinfected:  trYes @itd
r*  O-  USgpm Duration:  ------1-n  Well closure information:
- 
s Where well lD plate is attached:
SWL before  ft (btoc) Pumping  water level:-  ft (btoc)
Reason for closure:
Obyious water  nate:  test:  quality characteristics:
tr Sediment  tr Gas Method of closure: tr Poured tr Pumped
W(r""n ESalty trClear trCloudy
- 
Water sample  collected:  tr Sealant  material: Backfill material:
Colour/odour:
Details of closure (see note 16):
Well driller (print clearly):
Name  (first, iast) (see note 19):
Registration  no. (see note 20):
Consultant  (if applicable;  name and company):
Date of work (!YYY/II/M/DD):
DECLARATION:  Well construction,  well alteration  or well closure,  as the case may be, has been  done
Started: tU] Completecl:
Comments:
Signature  of
c{L
Driller Responsible
PLEASE  NOTE: The  inlormation recorded  in describes  the works  and hydrogslogic conditions  at the time  of construction,  alieration white: Customercopy
canary:  Driller  @py
including  natural  variability,  human  activities  and condition  ot the works,  which may change  over time. pink: Ministry  copy | .** 
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