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HomeMy WebLinkAboutWEL Application, Design, Letter - 6/5/2023 ENVIRONMENTAL �3Loaaa n09 / R . l HEALTH WATER WELL REPORT DEFAR,'+1c?i• U Notice of Intent No. WE45156 m = ECOLOGY 'Unique Well ID No.. T✓lqa Type of Work: Stzze of;7;sfi-id_ton 9 8Y $ O Construction Site Well Name(if more than one well):Moran RECEIVED ❑ Decommission b Original installation Not No. Water Right Permit/CertiftIate No. Proposed Use: N Domestic 0 Industrial 0 Municipal ❑De-watering 0 Irrigation 0 Test Well 0 Odtcr Prop�Y Owner Name James Mor@n JUN —5 2023 Wrll grreet Address 261 E Gray Rd. Construction Type: Method: I 13 New well ❑Alteration ❑Driven ❑Jetted O Cable Tool City Shelton County Ma O Deepening ❑Other 0 Dug 0.air- O Mud-Rotary Tax Parcel No. 221325200010 J Alder Street Dimensions: Diamcl r of tarring 6 in,to 47 ft. Depth of completed well 47 ft. Was a variance approved for this well/ ❑Yes El No .. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread j v 6 in. .1 42 .250 in. i 1 u u j u Location(see instructions at page 2): J WWM or❑F.WM ❑ 1 0 in. in" ❑ 1 ❑ O I ❑ se / of the sw vi Section 32 Township 21n Range 2w ❑ I ❑ in. in. ❑ I ❑ ❑ 1 ❑ / ❑ I ❑ in. — _io. ❑ 1 ❑ ❑ 1 ❑ Latitude(Example:47.12345) Perforations: ❑Yes ©No TypeLongitude(Example:-120. 2345) of used No.of perforations Size of perforations in.by in. Dtiller's Log/Construction or Decommission Procedure Perforated from ft.to ft below Bound srface Formation:Describe by color.cuaracter,size of material and structure,and the kind and nature of the material in each la/er penetrated,with at least one entry for each change at Serena: 0 Yes Cl No t i K-Packer t=y Depth 40 ft, intormation Use additional sheer:it necessary. Manufacturer's Name Alloy Type stainless Model No. Material From To Diameter 5 in, Slot size 16 in.tram 42 f.to 45 IZ. Br top soil 0 3 Diameter— in. Slot size in.from ft.to ft. Br fine sand 3 19 Sand/Filter pack:0 Yes El No Size of pack material in fine to mad Br sand water bearing 19 47 Matctiiats placed from ft.to ft. burtaee Seat: fdi Yes ❑No To what(tepee? 13 it. Material used in seal bentonite chips Did any strata contain unusable water? 0 Yes EN No Type of water? Depth of strata Method of sealing strata off Pump: Manufacturers Name frankin Type:Sub fi3..5 Pump intake depth:38 ti. Designed flow tate: 13 aim RECEIVED Water Levels: Land-surface elevation above[Wean sea level 223 ft_ - _ Stick-up of top of well sing +1 f.above hound surface By Dept of Ecology SWRO at 8:36 am,Jun 01,2023 Static water level 6 tt.below top of well casing Date 11-27-22 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping tut performed? 0 No 0 Yes t > by whom? - Yield_ apm with_ __ft.drawdown after hrs. Yield spin with_It.drawdown after hrs. Yield—gm;with_fr_drawdown after hrs. Recovery data(time=zero when pump is turned off-water level measured from well top to water level) Time Water Level Time Water Level Time Water Level — 7 I. Dare of pumping teat Bailer test 15`gam with 20 ft.drawdown after4 his.} i Air test—gpm with stem set at_tl.for hrs. Date 2-21-23 i{ Artesian tlow-gent -- 4 Tempcmture of water—^F Was a chemical analysis made? ❑Yes 0 No Start Date 11-21-22 Completed Date 11-28-22 t i WELL CONSTRUCTION CERTIFICATION: I constructed andior accept responsibility for construction of this well,and its compliance with all Washington well a construction standards.Materials used and the information reported above are true to my bat knowledge and belief. l ©Driller U Trainee El PE-Print Name Drilling Company Knapp Drilling Inc Signature tt , /lr�r fJ Address 50 East Lesaea Dr. License No.1386 / City,State,Zip Shelton Wa.98584 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.944B1 KNAPPDRILLINGD1 Date 3-12-23 EC:Y u50-I-20(Rev OSi 191 i/i'ou need this doctmtent in an altentute tormut.please call the Water Resources Program a!360-407-610 2. Persons wall hearing hrs can call 7//jar Washington Relay Service. Persons with a speech disability can call 877-833-6341. Water Resources Program Well Report Change Form o[rnntrn[ur or ECOLOGY Mate Ot Wathlrgton Record any changes made to the Well Report record on this form. Asterisks(*)indicate required fields. This form is to be appended to the well report image and filed with the original well report. This Well Report has been changed on: 6/1/2023 *Month Day *Year Well Information *❑Not in Notice of Intent System(NITS) *E Well Report ID Number: *Regional Office: ❑ CRO ❑ ERO ❑NWRO ❑RR) ® SWRO ❑ IIQ *Well Type: ® Water Well ❑ Resource Protection Well ❑ Other d *Notice of Intent Number: WE45156 *Unique Ecology Well ID Tag Number: BPU396 Current Property Owner Name:Cathy and Jame Moren } *Well Site Street Address: 261 E Gray Rd*City: Shelton_*County: Mason *Zip: c _ _ 0 } Well Location *Tax parcel number: 0 *Township: *Range: *E ❑ or*W❑ *Section: *in the 1/4-' of * % Latitude: 47.261736 Decimal Degrees(valid range is 45.33186 to 49.11587) } Longitude: -122.959660 West Decimal Degrees(valid range is 116.91148 to 124.70419) d Horizontal Collection Method: Vertical Collection Method: x Horizontal Collection Datum Type: Vertical Datum Type: L Original Reported Type of Work *New Well❑ Decommissioning❑ Deepened❑ *Well Diameter: inches Well Depth: feet 0 0 *Well Report Received Date / / Completed Date: / / 0 0 w w o Driller Information Driller License Number: Trainee License Number: Other(specify): } oL Change Information v *Person Requesting Change: Cathy Moren Contact Phone Number: *Reason for Change:required latitude and longitude not included on log and unable to contact driller l)ate: 6/1/2023 *Tracker Signature: Barbara Conger Date: 6/1/2023 ECY 000-0001,hou need this document in a format for the visually impaired,call the Water Resources Program at(360)407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call(877)833-6343. EJL.I/ o - do/ ! I Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories -KRE C E I V E D 26276 Twelve Trees Ln NW Ste.C ..Where experience matters Poulsbo,WA 98370 JUN — 5 2023 Phone: (360)779-5141 www.spectra-lab.com 615 W. Alder strut ENVIRONMENTAL HEALTH Spectra Labs- Kitsap, LLC(Poulsbo)received samples for Knapp Drilling on Tuesday, May 9,2023 at 1:22 pm. Unless otherwise noted,all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures.A summary of the samples received are outlined below. Sample No. Description Location Sampled 226868-01 Moren 261 Gray Rd 05/09/2023 7:15 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360)779-5141 or email us at www.spectra-lab.com. This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized. If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 05/12/2023 Page 1 of 1 1 1786 SE Mile MD.' Port Orchard, it. SPECTRA I„a(X)Ciit(N'ic, -Kitc ip WAA6366 .v.aF _•--_... ...Altar er 'Wax readrarr COLFORM BACTERIA ANALYSIS FORM ate County rof i t3 Collected M* Dry Yee 7 r 3 ❑Pu �� ..Type of Water System(check only one box) ❑Group A ❑Group B a Other l'e _-- Croup A and Group B Systems-Provide from Water Facilities Inventory(WFI): lCrli tSystem Name: /(61 1/-14 Contact Person: �wa. — J-•“-If Dey Phone: 3G O' 7 4 i —t/Z yp Cat Phone: Emat Eve.Phone: Sand mein to.pirate.umyt,sM.as and 2iiipmdsorrubaMarsmoYwessridisebi 1_,...__p__5....._01-ej i-eicermin-........-__T._-_-......: • . SAMPLE INFORMATION Sample enacted by(numbr e G/r A.1/ I Spedtc *Nero coasted: Spedal inssu s or carmen 26 i 1 Type of Simple{check only one box) 1.❑Routine Distribution Sample(AlP) 2. Repeat Sample(A1P) Chlorinaled:Yes 0 No❑ (wort***Vice alter oust roudne) Unsatisfactory routine lab number: Chlorine Realdual:Total Free 3.Ground Water Rule Source Sample ——— lS I I 1 Unsatisfactory routine collect date: ---1 1 . 0 Triggered (NP) Chlorinated:Yes No Chlorine Residual Total Free ❑Assessment(ANP) 4.Surface or G1M Raw Source Water Sample(Enumeration) ISI I I ❑ Each 0 Fecal tared vr`rt4_ 5.tit sample Cotected fa Mormetlon Only: t AB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and Raattattactory ❑Ecob present ❑E.salt absent Bsderiat Denetly Resub:Total Cotten mpn1100mi,Eco6 mpnif0pny. Fecal Colitona cM100rril. Replacement Semple Required: 0 TNTC 0 Sample too rid 0 Semple Vdume ❑Damaged Container ❑ t'itTerti flit 122- Lab ".; ` , CD 1 Receipt Troup C: Method TCOtterTl sus= • r ,a' Dee RetxxOad ref mots embhe.lrrosem•terrrrrrvmwreye MAY 10 2023 dr » :re `ot• rrr,teensy P.Nardi;011111014611.444114 NI tea+lie-Berpaa OWN/ tang* f n U D me.,n.a.rd..�Wwwr.�.r wdalf�rwareyl» o / w Mt*Wix A oat.ao.,.odlim erawr4srw itunheka DON r..ghati Nbe o6171