20240214_10-A04 WaterLevelComplaint

WATER LEVEL COMPLAINT QUESTIONNAIRE
Complainant(s)Name& Phone No. (if available):
Area of Concern (well, pond, wetland area?)with Distance and Direction from Mine:
How long has complainant(s) been familiar with the Area of Concern?
Area of Concern History (total depth of well, water level decrease, depth below normal, timeframe, etc.).
Other possible water users in the vicinity (industry or potable water sources, other mines, etc.)
Recent weather conditions:
Any other comments/concerns (soil type, etc.):
QUESTIONS FOR OPERATOR
Operator Name & Phone No.: A e �r �/j gQ- �f f�� r,�i SOr•
Permit No.: _16—I9Q¢ Mine Name: A17G
County: C River Basin: a r-
Closest natural water source (lake, stream, wetland) and direction from site? e qA
de-f l�S � Sw,vi+yP A r
Total number of pumps in pit: Number of pumps operating in pit:��
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Location of pump(s) in pit: (ex: NW corner of pit, 5E of scales, etc.)
1. u er'ne6rner 2.
3. 4.
Pump(s) size and rating: 1. 4 ; 2
3. 4.
Purnp(s) discharge rate: 1. _ADD a yrrl _,2
(indicate gpm or gpd, etc.)
3. 4.
Depth to water in pit and location of measurement(s):
General description of dewatering operations (how often, point of discharge, cycle of flow):
•s ,� - s d
i'�'1 i ►'1runa � e
hrou �L-' �' h45; �} As c�
Depth to water in on-site welI(s) (indicate well # and measurement):
General topography of the pit and surrounding area: 47t 4 �o Sur'r u,7 ;n
We i-lg nIs ,� duf 1) 4,0 NCDa T d%��l�
Any additional comments (annyJJ other ponds in the area, general water level in ponds):
_7h e, re_%5 np o Sher- Gb4CIs i,17 AC Ar'efi.
Inspector's Name: Date:
Please return completed questionnaire to the Central Office—Mining Program. Thank you.
Rev,5/27/2003
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