HomeMy WebLinkAboutWEC2021-00072 - WEC Application - 3/15/2021 r0;;4G p� 415 N 6TH STREET, SHELTON,WA 98584
/t �c\, MASON COUNTY SHELTON: 360-427-9670, EXT. 400
4 '�i' '2 i COMMUNITY SERVICES BELFAIR: 360-275-4467, EXT.400
� ELMA: 360-482-5269, EXT.400
r .f Building,Planning,Environmental Health,Community Health
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NOTICE OF INTENT TO CONSTRUCT A WELL
Permit Number Payment Information Instructions
11 �, / 1. Complete Part 1. Incomplete applications will be rejected
WEC Receipt Numbest- 1153 2. Attach a plot plan and vicinity map.
c;L - 0 Cash 3. Submit this completed application with appropriate fee a minimum
❑ Check of 24 hours in advance of initiating well construction. Refer to
COCr `a Date of Payment 3l1$19-1 Mason County Environmental Health fee schedule for cost.
4. Mason County Public must receive notification at least 24 hours
prior to the drilling of the well.
PART 1: Applicant/Parcel Identification
Site Address 721 NE Tahuya River Rd Start Card# WE42981
Drilling Firm Gresh and Drilling, Inc /-i2, 4-IsI A 3� S Phone 360-779-'4323
Applicant Robert Nordnes Phone 360-710-1160
Mailing Address PO Box 37
City Seabeck State WA Zip 98380
Parcel Number 32212-75-00060
Directions to Site
w^�
Is the well site within 100 feet of salt/seawater? ,Yes Is(
\X NA' ,�
If yes, a variance from DOE is required. Have you applied-/received (circle one) a variance? Lies No
NOTICE:All proposed connections to new wells are subject to water adequacy requirements at time of building permit per Mason County Title 6.68.
Water usage restrictions and additional fees may apply to all new wells drilled after January 19t^,2018 per ESSB 6091.
eltad 4 Aa.m,
pplicant/Agent Signature
PART 2: Health Department Review(Staff Use Only)
YES NO TAG# Called In 4724(2( Fc-R 4112_142. t
El ❑ Driller on Site?
0 ❑ Is the well capped and Vented? �
O ❑ Is there evidence of a surface seal? /�i/_
0 0 Is there a 2"annular space on all sides of the casing? a,
O ❑ Has the seal slumped? 4i4,4
El El Is the well flowing or is there evidence of other leakage? ey 2�e, ''
❑ 0 Is there evidence of cascading water?
0 ID Is there evidence that the seal is at least 18 feet long?
0 ❑ Do the well site set-backs appear to be appropriate?
Comments 1\
10T f 'e-c-t-eA
0 Pass 0 Fail Inspector Date
This form may be scanned and available for public view on the Mason County Web site. Revised:2/7/2018
.19'el
Tahuya River Rd
SLs 1 0-32"Sand Loam
32"COMPACT
145'.
Sul 0-32"Sand Loam
.is* 100'Wen Circle 32"Compact
SLU3 032"Sand Loam
32"Compact
50'W[[et Cede
�[FThe goal of this project is to have
--••�� a convenient parking place for camping.
WN..w it is important that any RV's be dumped
at an approved RV dump site before
connecting to this system.
Chemicals used in RV's to control
oder are detrimental to septic systems.
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Tahuya River Rd
SL# 1 0-32" Sand Loam
• - 32" COMPACT
145't
SL#2 0-32" Sand Loam
+15'el 100'Well Circle . . 32" Compact
-z
F„ SL#3 0-32" Sand Loam
a32" Compact
50'Well Circle
The goal of this project is to have
a convenient parking place for camping.
Proposed It is important that any RV's be dumped
Well „ at an approved RV dump site before
connecting to this system.
lr--------.) Chemicals used in RV's to control
oder are detrimental to septic systems.
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• 32212-75-00060
721 NE Tahuya River Rd