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HomeMy WebLinkAbout07090061 MiscellaneousRECORD OF WATER WELL INDIANA CEPT of NATURAL RESaDncES Number Di- Slate Form 35660 (FS / 9-09) sion DI Waier 402 w. Wasbugron 51, pm- W 264 DNR Variance Indianapolis, IN 46294-2641 Number - (677) 928.3755 tolidree or (3i;}232-4169 indikr•sieppficpble WELL LOCATION e?1 ` 1 Counrywhere ddlled r " Civil icwr*+ptname - Tovmship number(g.S) Fence nurpber(&W) am" SeC1tlo{n.?( ? "'t . I "Y C G z Driving directions to the well local on (in:lude r,;n orig.%n. Veer 6 road names, ;rnersecling roads, and cornpau dilectrons). UTM Northing f h id k e reverse. s space ora map on t e, Shew well adorers bebwand subdivision in box at lower right. There '4 +... :" £ TM F ti k as ng i, U V f ( = r - - _ Oatum 0 NAD 27 ?,NAD 83 GPS used - -, " Sr(."")1 "( Svbrlrvisiori name B lot number rd'. applf,-,e-bie) 6 Well address: ,,.. i-1' 4 '.?{,,. -'?: {'°? !L C..i?f£-v'? (:, 4.,r i if drilled for water supply, this well is: ? First well on property ? Replacement well ? Additional wen on property G Dry hole TRACTOFC','?..':::_._` Well owner-name Telephone number Address (number and starr, f, eiry. 5la te, ZIP Do(le) Building contractor-name ' Address {number and seeet, dry, stare, ZlPcode) ...?"!; ..F"I'P rf rl j ''" ? Telephone number /:' C},.;? 'b ?,'$?,{t: {-?' 3..L?'•?.;,,+ ?? ?? - „i "f /; Y ? Drilling contractor-name Address (mrnberarsdsrreer. illy, male. ZIP code) Tefephere number ,EcHLly Wt _Ir -DRzG I Cr Z 11 E_ I I?' ?srr ; SHGtz i Ybo3$ 30-8`N- 2535 Equipment Operator--name ? License mamb¢r of epe2lnr Dale of we co e,;-n? L 3t sEaH R Sc?sr 3 ID ''?`r'??`CO:STflUGTIOPIDETAILS'_r' ? '?,,;: ?'? >?_ •t-;WELL-._O/?????_'"'° .'?`'[?""``?' Use of well Drilling method Type of pump Type of material FORMATIONS, From To O Home ? Rotary U Submersible - {Ieeq (leeq O Public supply ? FtevaTse rotary ? Shallow-wePjst U Industrial ! c6mmercial ? Cade tool ? Deep-well jet © Livestock ? Jet U No pump installed ? Irrigation ? Bucket! bare Other: U Monitoring ! envircn. U Auger (including HSA) ' U Test hole U Direct push Pump depth Oth settin (feet) Other. er: g Total depth Borehole Gravel pack ? Yes ' of well {feet) t diameter (in,) inserted ? No ) / C si at i l ? PVC Casing Casin+} a ng m er a -, _ l th f t diameter (in ) / Oth r St l ` eng ( ee ) . . . e ee V , Screen Screen Screen material ONPVC; .t , L ;,: V" l th f t diam t r in r O h U 5t i eng ( ee ) ( .) e e : t e ee Screen Water quality slot size - (clear, odor, etc.) Test method static level Gallons Hours Drawdown ? Air below surface per min, tested (change in level) 0 Ba1Gng ? pumping feet leer -f?OUIIf ?G'm'Ei r e Grout material Groin depth Sealing in ceplt? filled from to €+ S.. l;.'< V' Irs+l "! ; Installation method No. of bags used h od Installation anot tic. of bags used p ` '' A i7iw¢! soave nor well roo and commends on reverse side I hereby swear or aYrm, under the penalties Signature of de ill ing ca tractor or aulhadeed rhpr 3 lfj ?, t•WL'ST BE SIGNED OF STAMPED Date IN perjury, that the infonnat'on subneTted herevAth is. to the hest of my knoMedge and / i) ?f f ,Ir •' f ! d l y I? fr ' heC.ef, true, accurate. an comp ete. T i?1()VV DID YOU' HEAR ABOUT CUR COMPANY? tiM?HI(FCri .. _.. _;MAf1I PAOGS RP.AN PA(?!l tit AA C)D PAGFr=S :)T,-DER - • NAME r ADD y • TOWN A SERI MAC'S SEPTIC SERVICE 4406 W. MORRIS ST. INDIANAPOLIS, W 41ya41 PHONEE (317) 241-1574 FAX: (317) 247-8297 }I I'] • DILL TO `7G INVOICE NO. 2EF I09?i7 HARGE OF 5,20 co Wit I RF ADfIFI) Th Al i RFTE IRNPn Cl-IFf'KS ORDER ATE RneR INVOICE OUST P.0. MO. TERMS: NET 30 DAYS A SBrvice Charge Ot 5% per month will to added to 311 past due invoices. QUANTITY DESCRIPTION UNIT PRICE I NET PRICE I TOTAL SEP71C PUMPED GAL. AMT g ? DIGGING FEE SYSTEM FLOODED YES „ NO - METHOD CF Pf YMENT- RUN BACK YES NO CASH 0-30X REPARRED YES NO CHARGE CARD D-BOX CLEANED YES NO CARP # I. REMARKS: Exp. DATE CHECK a i AM RAID 1 IP CHECK. VVEINEED SOC # Ory DRIVER'S AMT. OJE -PLEASE CHECK LICENSE# I SIGNATURE PAY FROM THIS INVOICE - NO MONTHLY STATEMENT WILL BE SENT 10 39vd OT1dAs/sOGW L6Z98LbZLTTT BZtzt !00Zf01/isk 11: t Cop a e 4404 N. Franklin Rd. Indianapolis.. IN 46226 (3; 7) 546-7473 FAX: (317)546-1272 August 29, 2007 Mr. Scott Casey Casey Bertram Demolition 5780 Fast 25th Street Indianapolis, IN 46218 Re: Asbestos Inspection - 12650 Clay Center Road Dear Mr. Casey: Asbestos Inspections & Removal Company (AIR Co.) is pleased to present the findings of the asbestos survey performed at the vacant residence located at 12650 Clay Center Road in Carmel. Indiana. The house is a split-level brick_ and wood structure with an attached garage. The following suspect materials were sampled: • Ceiling texture - upstairs bathroom Ceiling texture- half swirl Drvwal l Ceiling the 2' x 2'- white & gold Ceiling tile 2'x 2'- hole & pin Samples of the materials iisted above were submitted to Micro Air. Inc. for analysis by Polarized Light Microscopy (PLM). According to laboratory analysis none of the sampled materials were determined to be asbestos containing materials (ACM). Resilient floor coverings and roofing materials were assumed to contain asbestos and not sampled. Resilient floor coverings and roofing materials are category I non-friable materials which do not need to be removed unless subjected to sanding, grinding, abrading, burning or any other activity which will crumble, pulverize, or reduce the material to a powder. We appreciate the opportunity to provide our asbestos services, and look forward to assisting you in the future. If you have any yuestforts. or require additional information, please contact us at (317) 546-7473. Sincerely, Wayne Grelle Asbestos BuEding Inspector License Number: 1 93 91 504 5 Expiration Date: 05/22/08