10-97 Water Level Complaint Questionnaire

WATER LEVEL COMPLAINT QUESTIONNAIRE
Complainant(s)Name & Phone No. (if available): 010om Od i2awla as m,
Area of Concern (well, pond, wetland area?) with Distance and Direction from Mine:
WZA-eV S,nol,. �� `ri.�ahbr. 6wo.'t( i5 k'4 +Z' 6u) DF µ/(I'
F
How long has complainant(s) been familiar with the Area of Concern? 6�yyak', IA411 re'l 2a[{
it
Area of Concern History (total depth of well, water level decrease, depth below normal, timeframe, etc.):
�o°roY`✓+a1`�lo �° Fief �frrQtrirJ I��els NoherJ /v. �a�>-,��arac,Zozl
�/tL1 lJ"wh Qr'✓ � Odra- G4 4-tn.-e5 w,4, kt� y V3r.
Other possible water users in the vicinity (industry or potable water sources, other mines, etc.) /Uo iI
Recent weather conditions: 64� v,�-Ct c Ya i,t a 8 4 -rp m p A 50j - 9d 5 dulrrM10 d as
Any other comments/concerns (soil type, etc.): 5 a((ow we(( `YOOF I; 30-f VeopS Dld, 5avOw 50-1,5,
QUESTIONS FOR OPERATOR
Operator Name & Phone No.: A'Jacat2 ail- (o('n AkAa(catt(d
Permit No.: Mine Name: j/� f Fz"" Z"d A' '
?
County: /,t,v gwt (c River Basin: C o c F"✓
Closest natural water source (lake, stream, wetland) and direction from site? LW�PJ5 k .EGsf 0e)f
Total number of pumps in pit: I Number of pumps operating in pit: A1190A
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Location of pump(s) in pit: (ex: NW corner of pit, SE of scales, etc.)
1. 50 1+i,4 - A 6-)fAcr o� 0 2.
3. 4.
Pump(s) size and rating: 1. GwP -lo o �t_3—Np 2.
3. 4.
Pump(s) discharge rate: 1. 238(7pvt 2.
(indicate gpm or gpd, etc.)
3. 4.
Depth to water in pit and location of measurement(s): °&5ga Iu!t A Powu v of pr Yl-
General description of dewatering operations (how often, point of discharge, cycle of flow):
6A-5i k Lzie/I 41 Pu. rn Wd&,, A l(,WIv -hvzk. �, d wy l- Atp,(. 1401 QWW, S 61f5 I
1'1��PUCt'lCL•tl/ ,Pt71' Si4yi �li���y�� 7AZCb ,/,ttkarac l�. '1n Se�'lia_�� F»uvtwn Ebyaa,�arri
Depth to water in on-site well(s) (indicate well # and measurement): Al;, AA" Az,,Lj wells. �ccw/o ue�s
A/A'W S no(,J.PA� C2—) e- ^' 5-001 tmwA D,} 65 1 o issue. d�.w�
General topography of the pit and surrounding area: `1�+ is iv. In Ly- /oaf uw fie(A5 W rk /ow WVfkkds
PQS�� Sau'�-1 d' St9LHlt.wtl5f" (r(fVu.9b o� �'l r r)(elnA u/Crf2rn .�v✓y'ari "IS `J�rir iN Mr?�dlc o� yr4/r/5.
Any additional comments (any other ponds in the area, general water level in ponds): jD S
V`<'Y,e �nQa b� ION � �Mi�es Q�Y � uor�ua( I�e(s d- � lowv. c�yee(�. D � .�rrkSawRu r�a✓
ar (4an.w( l� Iu W� dI c of i[av d titrtKa va��c 11
i
Inspector's Name: &,h-All &I,, Date:
�—
Please return completed questionnaire to the Central Office—Mining Program. Thank you.
Rev. 5/27/2003
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