HomeMy WebLinkAboutWEL2022-00026 - WEL Application, Design, Letter - 5/17/2022 MASON COUNTY Date Received al 11
i `l Ip SERVICES Am
'30 ; COMMUNITY eceiv •
/ Building,Planning,Environmental Health,Community Health �, Receivr
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415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L A C. 1r • O 0 0 Lic/1
Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 ��iit�//
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT PHONE
David and Martha Lindt 360-227-1051
MAILING ADDRESS-STREET,CITY,STATE,ZIP
600 E Wilson Way, WA 98546
SITE ADDRESS-STREET,CITY,STATE,ZIP
Same as above
PRIMARY PARCEL NUMBER(WELL SITE)
221 1 4-76-001 50
SECONDARY PARCEL NUMBER(IF APPLICABLE)
NA
WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE
0 New Existing i'Well 0 Spring 5.03 NA
PROPOSED WATE SYSTEM NAME(REQUIRED)
Well ye-espy-A.-1'
PRO ECT DESCRIPTION
Building a one bedroom 840 sqft ADU on property with an existing 3 bedroom home.
DIRECTIONS TO SITE/CONDITIONS
From downtown take HWY 3 towards Belfair. Turn right on East Grapeview Rd. Turn right on
East Wilson Way. Destination on the right at 600 E Wilson Way.
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100' radius, driveways, roads,septic/sewer components and lines,easements,etc...)
Septic Design site plan attached.
JIti) LE 1T1fl
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MAY 17 2022
Ir
Submittals Checklist: (these additional items will be required for approval)
Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled)
'Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled)
U' Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document)
U' Septic Records (additional locating requirements may apply if there is a lack of septic records on file)
This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021
Page 1 of 2
Staff Use Only
Review Step 1: Well Site Inspection:
YEEt210 NA �'% k� S,` "ek
❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields, tanks, buildings; indicate distance on plot plan)
❑ 2-1❑ Are there roads within the 100 foot radius of the water source? If so, is r d privat , unty or State.
What is distance to ROW? >pp' -1-
L❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan)
R❑ ❑ Is the well cap satisfactory?
E l— G ❑ Screened and vented?
—
ElThe well casing extends I a ve level ground / ncrete slab? (circle one)
g7❑ El Is there evidence of a surface seal? a c
'❑ ❑ Does the seal appear adequate?
❑ Ear ❑ Is a variance necessary for well site approval?
Comments 41 , 1009g 1 _ 1 - ->, g9 sq I
Pass ❑ Fail Inspector Date .3 11-4 t -
Review Step 2: Two-Party Review:
YES 0 NA
❑ ❑ Water Well Report with adequate pump test on file?
If NO, date of Capacity Test Driller 11 GPM
❑ Received Satisfactory Bacteriological Analysis? Date of test 61 t 0 )0 Y1
❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 4- 1 q Ito
❑ El ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
[Approved El Denied Reviewer , Date "((61)p7-7►
Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, express
or implied of the future success or failure of this system. Well site approval does not constitute water system approval. Water
System approval is a two-part process.
All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68.
Water usage restrictions and additional fees may apply to all new wells drilled after January 10, 2018 per ESSB 6091.
Revised: 10/13/2021
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
415 N 6TH STREET,SHELTON,WA 98584
, MASON COUNTY SHELTON:360-427-9670,EXT 400
j BELFAIR:360-275-4467,EXT 400
�!� COMMUNITY SERVICES
ELMA:360-482-5269,EXT 400
`�� 9ilding,PlannFny,EnvleorancntalMith,Cr>romuoity Flealtli
FAX:360-427-7787
07/05/2022
LINDT DAVID A & MARTHA J
600 E WILSON WAY
GRAPEVIEW, WA 98546
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL 2022-00026
600 E WILSON WAY
221147600150
The 2-party water system, Well, has been reviewed and is hereby APPROVED for 2 connections.
Please continue to follow best management practices with maintaining your water system including
regular water analysis, landscaping, keeping wellhead area free of contaminants, and stormwater
management around the water source.
If you have any questions, please contact me at 360.427-9670 Ext.353 or email at
Icencula@masoncountywa.gov
Sincerely,
uke Cencula
Environmental Health Specialist
Mason County Environmental Health
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WATER WELL REPORT State Card No.W177715
+,; STATE OF WASHINGTON UNIQUE WELL I.D.#AHR 466
L.
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N1 5 Q 1 9 o Water Right Permit No.
Ce
(1) ODUWNER: Name BRIAN LEHMAN Adresa GRAPEVIEW
O (2) LOCATION OF WELL: County MASON NW 1/4 NE 1/4 sec 23 T 21N N. A. 2W W.M.
(2a) STREET ADDRESS OF WELL(or nearest address)GRAPEWIEW
1/)
J4.+ (3) PROPOSED USE: Domestic Industrial ❑ Municipal ❑ (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION
Irrigation❑
O DeWater❑ 'test Well C Other ❑ MATERIAL FROM TO
O0 (4) TYPE OF WORK:Owner's number of well(If more than one) GREY HP 0 40
GREY CLAY 40 98
tC New Well ® Method: Dug ❑ Bored ❑ BROWN CLAY 98 106
E Abondoned❑ Deepened ❑ Cable 0 Driven❑
Reconditioned❑ Rotary ICI Jetted 0 GREY CLAY 106 110
O GRAVEL&WATER BROWN 110 141
C (5) DIMENSIONS: Diameter of well 6 inches.
Q) Drilled 141 feet. Depth of completed well 141 ft.
.0
i (6) CONSTRUCTION DETAILS:
O Casing installed: "6 Diam.from +l ft.to 141 ft.
'Q Welded [ Diam.front ft.to ft.
C Liner Installed❑
CZ Threaded ❑ " Diam.from ft.to ft.CZ Perforations: Yes ❑ No El f ) G 11 5 v
CZ
O Type of perforator used 6 2 4.
SIZE SIZE of perforations in.by in. j 1�1 �/
CI perforations from ft.to ft v (� O(�
4-1 perforations from ft.to ft Of ELG° v
>l perforations from ft.to ft 0Er 1 V
#s
C
Screens: Yes E] No ❑
Li. Manufacturer's Name WESTCO
L.CZ Type STAINLESS Model No.
Diam.6 Slot size 15 from 136 ft.to 141 ft.
Diam. Slot size from ft to ft_
I"-
0 Gravel packed: Yes ❑ No ® Size of gravel
Z Gravel placed from: ft.to ft.
(/1 Work Started 6-28-04 Completed 7-1-04
1301
Surface seal: Yes ® No ❑ To what depth? 20 ft. WELL CONSTRUCTOR CERTIFICATION:
Material used in seal:BENTONITE I constructed and/or accept responsibility for construction of this well,and its compliance with all
` Washington well construction standards.Materials used and the information reported above are
Did any strata contain unusable water'? Yes El No L'f) true to my best knowledge and belief
O Type of water? Depth of strata
O Method of sealing strata oft: Name:CooIWater Drilling,INC.
0
W Bremerton Washington
(7) PUMP: Manufacturer's Name: GROUNDFOS
O Type: SUBMERSIBLE H.P. 1.5C (signedx. License No 2516
4C c
Q. (8) WATER LEVELS: Land-surface elevation Con s Regis
Ull above mean sea level ft. No.COOLWD*044DN
E Static level 110 ft. l top of well Date: 7-1-04
L. Artesian pressure lbs.per square inch Date: DATE:7-9-04
CZ Artesian water is controlled by'.
Q (Cap,valve,etc.)
`9) WELL TESTS: drawdown is amount water level is lowered below static level Date of test 7-1-04
QU Was a pump test made?Yes El No❑ if yes,by whom?LYLE PITTS Bailer test 24 gal./min.with 2 ft.drawdown after 4 hn.
,.0 Yeild:24 gal./min.with 2 ft,drawdown after 4 hrs.
_ Airtest gal/min.with stem set at ft.for hn.
Artesian flow g.p m. Date
V Temperature of water Was a chemical analysis made? Yes ❑ No ❑
Thurston County Environmental Health Thurston County Environmental Health
2000 Lakeridge Dr.SW ®Olympia,WA 98502 --- - 2000 Lakeridge Dr.SW II Olympia,WA 98502
' " -- 360 867-2631 `-614,• �— 360 867-2631
THURSTON COUNTY THURSTON COUNTY
cienlaintimmass COLIFORM BACTERIA ANALYSIS COLIFORM BACTERIA ANALYSIS
Date Sample Collected Time Sample County Date Sample Collected Time Sample County
Collected ] Collected ,��1 .
Et' ' AM a
Month Day Year PM M nth Day' '+ Year� ' -'
Type of Water System(check only one box) ❑ Private Household Type of Water System(check only one box) ❑ Private Household
❑Group A ❑Group B ❑Other ❑Group A ❑Group B `0 Other '
Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): Group A and Group B Systems-Provide from Water Facilities Inventory(WFI):
ID# ID#
System Name: System Name:
Contact Person: Contact Person: c.h?Jr.sue>` N.CAP\
Day Phone:( ) Cell Phone:( ) Day Phone:'atop) —1`0 y 3C) Cell Phone:( atj(.he,
E-mail: Eve.Phone:( ) E-mail:irtNeco®p rr�: ®Q Iptko:QEve.Phone:( )
Send results to:(Print full name,address and zip code or email address) Send results to:(Print full name,address_ and zip code or email address)
-C\...Z.r. CEr\
. ,0 , k Lea
SAMPLE INFORMATION SAMPLE INFORMATION
Sample collected by(name): Sample collected by(name):
. R-Q-i'VR-CA._kNOVaiN
Specific location or address where sample collected: Special instructions or comments: Specific location or address where sample collected: Special instructions or comments:
( v-, CandieuJ
Type of Sample(must check only one box of#1 through#4 listed below) Type of_S ple(must check only one box of#1 through#4 listed below)
1.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine) 1. outine Distribution Sample 2.Repeat Sample(after unsat.routine)
Chlorinated:Yes No ❑Distribution System Chlorinated:Yes No ❑Distribution System
Chlorine Residual:Total Free Chlorinated:Yes No Chlorine Residual:Total Free Chlorinated:Yes No
3.Raw Water Source Sample Chlorine Residual:Total Free 1 3.Raw Water Source Sample Chlorine Residual:Total Free
❑E.coli-GWR(A/P) ❑E.coli-GWR(NP)
❑Fecal-Surface,GWI,springs(numeration) Unsatisfactory routine lab number: ❑Fecal-Surface,GWI,springs(numeration) Unsatisfactory routine lab number:
Filtered:Yes No Filtered:Yes No
❑Assessment Monitoring(AIP) Unsatisfactory routine collect date: ❑Assessment Monitoring(AIP) Unsatisfactory routine collect date:
❑Other / / ❑Other / /
S S
4.0 Sample Collected for Information Only 4.0 Sample Collected for Information Only
Investigative Construction I Repairs Other Investigative Construction I Repairs Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑Unsatisfactory Total Coliform Present and ❑Satisfactory ❑Unsatisfactory Total Coliform Present and Satisfactory
No Coliform detected No Coliform detected
❑E.coli present 0 E.coli absent ❑E.coli present ❑E.coli absent
Replacement Sample Required: Replacement Sample Required:
❑Sample too old(>30 hours) ❑TNTC ❑ ❑Sample too old(>30 hours) ❑TNTC ❑
Bacterial Density Results:Total Coliform /100m1. E.coli /100m1. Bacterial Density Results:Total Coliform. I100m1. E.coli 1100m1.
Fecal Coliform 1100m1 Enterococci /100 ml. Fecal Coliform /100m1 Enterococci /100 ml.
Method Code:❑SM 9223B OSM 9222D Date and Time Received: Method Code:g SM 9223B ❑SM 9222D Date and Time Received: "(Si
❑SM 9215B ❑Enterolert® ❑SM 9215B ❑Enterolert® (7•1 O-LL ,4,.1,,
Date and Time Analyzed: Date Reported: Date and Time Analyzed: ;.(0.LL ,,,,„, Date Reported: 5/t1 J 2-f
Sample Number(DOH number plus five digits) Lab Use Only: Sample Number(DOH number plus five digits) - Lab Use Only: y
0 8 0 0 8 0
- - Z t -?- Co
DOH Form#331-319(revised 01/16) DOH Form#331-319(revised 01116) v` w