Loading...
HomeMy WebLinkAboutWEL2022-00054 - WEL Application, Design, Letter - 12/21/2022 415 N 6TH STREET,SHELTON,WA 98584 ly MASON COUNTY SHELTON:360-275-4467,EXT 400 • BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360.482-5269,EXT 400 M„ FAX:360-427-7787 PINTER FRANCIS M & LAURA A PO BOX 1477 SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2022-00054 789 SE BINNS SWIGER LOOP 320273390082 The 2-party water system, Pinter 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 x581 or email at rhompson©masoncountywa.gov Sincerely, 1 Rhonda Thompson Environmental Health Specialist Mason County Environmental Health '• �,,, 3 fl ', MASON COUNTY Data Received: t a il_ COMMUNITY SERVICES Amou ive ' Received st.( � Buid'ng,Planning,Env iron mental Healt h,Community Health 415 N.6th Street,(Bldg 8)-Shelton,WA 98584 WEL ao Ia.OP potAvier Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION 1 APPLICANT '�t �Qr PHONE ��) ^,,, ^71J i'1 �ravAGlS 6v '�f /_ / [ V MAILING ADDLE©-ST ZIP �,Cm''S/ / 77 SL-rTO ff, tt/P- gfcY-/- L v���.s[ SITE ADDRESS( 0STREET,1S —ST 'Bi v, s S'w i e r- I--v 0 10 /�Lc-., S (D K (/U t ' � 7C N 1 PRIMARY PARCEL NUMBER(WELL SITE) 8 .027 — 33 — 900 fr 2— SECONDARY PARCEL NUMBER(IF APPLICABLE) WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE X New ❑ Existing sip Well ❑ Spring /,67 Ac,,-es PROPOSED WATER S TEM NAME(REQUIRED) i t-e r u/,1 ( '` ,.n /�/�J PROJECT DESCRIPTION I e t �1 0 c Abu u W i IA eiv Well 4 S' y/4— " - b U a_bo (S I-(1n1 SJ 1n3le fQ ( '� ►ses ide vc VVV DIRECT-SONS TO SITE!CONDITIONS It rI o' 3 + N rccZct,ik. .4-0 Iv,rts Swtger Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lid/, ---- ents,etc...) ey o`c,l� �� 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) Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) 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: YES NO NA ❑ .. ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) ❑ IX ❑ Are there roads within the 100 foot radius of the water source? If so, is road private, County or State. What is distance to ROW? • ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) • ❑ ❑ Is the well cap satisfactory? ® ❑ ❑ Screened and vented? ❑ The well casing extends l above level ground /concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? El ❑ ❑ Does the seal appear adequate? ❑ ❑ Is a variance necessary/for well site approval? Comments 7o �c) lj/C/ v ou ,/ `?t/`4"' 100-- fc cats : �/� ,® Pass ❑ Fail Inspector j� ,,,,ems Date I /LI 12OZ3 Review Step 2: Two-Party Review: YES NO NA ,10 ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test Driller GPM S ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 i J I fo l Zo 22_ • ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z-0 211 Z • ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments Approved ❑ Denied Reviewer Date \((1?-) /P-/ 3 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 1 , 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 WATER WELL REPORT DEPAR'MEN1 UI Notice of Intent No. WE49262 ECOLOGY Unique Ecology Well ID Tag No. BNVS39 Type of Work: State of Washington C■l Construction Site Well Name(if more than one well) ❑ Decommission n> Original installation NOI No Water Right Permit/Ceniticate No. Proposed Use: (at Domestic 0 Industrial Cl Municipal Property Owner Name Francis Pinter 0 Davatering ❑Irrigation 0 Test\Vell Cl Other Well Street Address 789 SE Binns Swiger Loop Rd Construction Type: Method: t']New well ❑Alteration 0 Driven 0 Jetted 0 Cable Tool City Shelton County Mason 0 Deepening ❑Other ❑Dug 0 Air- 0 Mud-Rotary Tax Parcel No. 32027-33-90082 Dimensions: Diameter of boring 6 iu.,to 132 ft. Was a variance approved for this well? ❑Ycs E No Depth of completed well 132 ft If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread p WWM or❑EWM p l Li in. 2,....... 132 .025 in. 13 I ❑ t) I ❑ Location(see instructions on page 2): ❑ I 0 in. _ _ in. ❑ I ❑ DID SW '/-1/4 of the SW V.;Section 27 Township 20N Range 3W ❑ 1 ❑ in. in. ❑ I ❑ ❑ I ❑❑ I 0 in. _ in. ❑ I 0 ❑ I O ►autudc(Example,47.12345) 47.186164 Longitude(Example:-120.12345) -123.053125 Perforations: 0 Yes Gil No Type of perforator used Driller's Log/Construction or Decommission Procedure No.of perforations Size of perforations_in.by_in. Formation:Describe by color,clwacter,size of material and structure,and the kind and Perforated from ft.to ft.below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes lil No 0 K-Packer c==> Depth ft information. Use additional sheets if necessary. Manufacturer's Name_ Material From to Tex Model No. Brown fine to medium sandy gravel,silty, 0 Diameter Slot size in.from ft.to_ft. 43 Diameter Slot size in from ft.to ft. tight,dry Brown fine sandy gravel,silty clay brown 43 Sand/Filter pack:0 Yes 0 No Size of pack material_in binding,dry 65 Materials placed from_ft.to ft. Brown medium sand,dry 65 71 Surface Seal: UJ Ycs 0 No To what depth? 20 ft. Gray clay,stiff,dry 71 89 Material used in seal Bentonite Chips Gray clay,soft,seams of black silt 89 99 Did any strata contain unusable water? 0 Ycs lD No Chocolate colored peat,hard,dry 99 102 Type of water! Depth of strata Gray clay,stiff,dry 102 1 11 Method of scaling strata off — 111 1 13 Black silt with clay chunks,wet Pump: Manufacturer's Name Type: Gray clay,stiff,dry 113 119 H.P._ Pump intake depth:_fl. Designed flow rate: gpm Black round and sharp gravel,tight,dry 119 127 Water Levels: Land-surface elevation above mean sea level 162 ft. Black round gravel,loose,water 127 132 Stick-up of top of well casing 1 ft.above ground surface Static water level H2 ft.below top of well casing Date 11/0/22 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? l]No 0 Yes r.^. by whom? Yield _gpm with_ft drawdown after hrs. Yield_____mini with_ft.drawdown after_ hrs. Yield gpm with_ft.drawdown after hrs. Recovery data(tine-zero when pump is turned off-water level measured lion]well top to water level) Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test gpm with fl.drawdown alter_hrs. Air lest 30 gin with stem set at 120 ft for 1 hrs. H Date 11/9/22 Artesian flow gpm Temperature of water 50 °F \Vas a chemical analysis made? 0 Yes 1 l No Start Date 11/9/22 Completed Date 11/9/22 WELL CONSTRUCTION CERTIFICATION: 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 true to my best knowledge and belief Ll Driller U Trainee U PE—Print geray Phythian Drilling Company Arcadia Drilling Inc. Signature / Address PO Box 1790 • License No. 2053 City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No Contractor's Sponsor's Signature Registration No.ARCADDI098K1 Date 11/9/22 ECY 050-1-20(Rev 09/18) !f your need this document in an alrernate format,please 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 877-833-634 1. 1786 SE Mile Hill Drive Port Orchard,WA 98366 l,, SPECTRA Laboratories-Kitsap www.spectra-lab.com inpidoice (360)443-7845 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County Collected 11 14 I221 Air 2 45 Mason • m PM Monti eel wrr -- Type of Water System(check only one box) ❑Group A ❑Group B ['Other Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# System Name: Francis Pinter Contact Person:Arleta Eisele/Arcadia Drilling Day Phone:380-4283395 Cell Phone: Email: arleta@arcadiadriIling.com Eve.Phone: Send results to:(Prod tul name,address and rlp code a e-mail) arleta@arcadiadrllling.com Arcadia Drilling,Inc SAMPLE INFORMATION Sample collected by(name):Max Specific location where sample collected: Special instructions or comments: Well Head#BNV839 789 SE Binna Swiger Loop Rd,Shelton Type of Sample(check only one box) 1.0 Routine Distribution Sample 2.Repeat Sample(after tinsel routine) Chlorinated:Yes❑ No❑ 0 Distribution System Chlorine Residual:Total Free Unsatisfactory routine lab number: 3.Source Ground Water Rule Sample —----- —— — I S I I Unsatisfactory routine collect date: I Chlorinated:Yes❑ No❑ ❑Triggered Chlorine Residual:Total_._Free ❑Assessment ° 4. Enumeration Source water Sampe 1 S I I I ❑E.coli ['Fecal-&dac.,owt.Spiny*:Mend vis ►a13 5.0 Sample Colkcled for Information Only: LAB USE ONLY DRINKING WATER RESULTS IA8 E ONLY 0 Unsatisfactory Total Conform Present and tisfactory • ❑E.cotpresent ❑Ecoli absent Replacement Sample Required: ❑Sample too o;d(>30 hours) ❑TNTC ❑ — __ Bacterial Density Results:Total CoINorm .-._J100ml. E.coli 1100m1. Fecal Coiiform__-__ _ 1100m1. HPC___ 11 ml. lab ID NumberIW O ^O NOV 1 SEei • c ( 1+ -) Method Code' Date and Time Incubated: SM 9223 B y�� NOV 15 2022 Date Analyzed' NOV r 6L1![! Date Reported' Nov 1 6 AIR DOH la lab tree Ddy: _D __ A 1 225 __ MIA Far;r�stJ19,'K14 'ea<n�YL 'V� ws ee_ t411 00.a7S0117(leem ad 7111. 1`:a r+a mr c*rr raw.rlr�llNAwar,.doAwMWekwpM/• 219277207CMASON CO WA 01/13/2023 10:44E IIIIII III IIII IIIIIII IIIIII IIII IIII IIIII IIIII IIIIIII III IIIII IIIII IIIII IIII IIII Return To: FVYJwvct s (?t v. e r `gip '3' P17 7 5LU-0• WIC ence NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I(We)the undersigned grantor(s), certify that the water source located on parcel situated in Mason Conty, State of Washington,herein described. R g-^ 6 4- 5U/ s W Pct- 9, OR 3 Subdivision Division Lot Range Township Section And having the Tax Parcel Number of 3 2 o _z 7--, .L-- a D d 81- Has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington;herein described: (abbreviated legal description(s) and tax parcel number(s) affected) rk g oc S w sw Pc_ Z OR 3 Al Subdivision Division Lot Range Township Section And having the Tax Parcel Number of: 2 Q A 7 -- 3 3 -- 0 g-z R 3 D,� `w SW pet v' OR 3 r20 ,L7 Subdivision Division Lot Range Township Section And having the Tax Parcel Number of: 3 Z O /7--3 3-- o o 2- The system owner is responsible for keeping this system in compliance. The name of the system is: PI vt4 e✓ w e(l This system is designed to provide for two service connections.Planning and design approvals must be obtained from the department prior to expanding beyond this number of services. Additionally, a water right,obtained from the Department of Ecology, is required if the water system exceeds exemption standards. This system(has/has not)been granted one or more waivers from specific provisions of the regulations. Signature of Grantor(s)- Printed name of Grantor(s): T CLv C 5 t i f r D i l V Page 1 of 2 I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this l 1' ' day of tlanualrt , 2023 , V-yaY\ c, r(1. Ptrktv personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. 'S""'""{"'"G; tary ub' Nolic d for th in ane tate of Washington, 44'-1,--; p IRES cSr residing at G,1nQ1toO = .�� NoTARy o':y'_ My commission expires: 04 Oqb- 219 riUBLIC •,," Np 2O'`?: G� $ 'i/411111i lIII' 0.0 • Page 2 of 2 F .- f is , c , . IA r L t.0` a fn k P T r — r,�iCiJe 32, 027- 33- gooBZ , A 4...4ti,), SC a - r 4. -7-t. .' ,4 ' Li, r 0 2 p Lb o Cep 50 •0 r 4I. 11n, ,1CJ14g ) .5:4 f."Ma S ©� �� S'�' 0 �.Q S 'dam- PAULA JOY JOMNSON ���y a,nk���a f gs TnIck' fl.. 45€.,"e `er. ,t-0-"er XIS' ("A*IXILA.t* .2ailla %tr.. / I A4.2 2 Li s L t CO0+5 t0 .4.`C' 4; [I Co(!4+< -d2-7, ......z j , 7-1 (A X SO r "Ccr j �Q r 1 / 1 dVatr -e i cl trt nC IAIS . 2.-pew )ds y 1..e.igtibb v w e-\\ v _ IAsq.) 1 9 00 Y \t oo .A 6,,;440,1 \. 2q' , eoir M ) pPROW ® Qo �1 3 ag ADO 2022 ,� r ® --t tato'qA- p1 darn MASON COUN'�''!EC i OAudio-Visual Alarm \ // / j �` l / I/ 41eci-Cleanout / , /�3} 1200 Gallon SeptC Tank �� �?�1 / l / /v 2-Compartment Sb_e_ ----ez�� Effluent Filter ,,e ►000 Crallon Pump Chamber • unt DMS Pri� d asorl �, : y - Printed from Mason County DMS • AS-BUILT FORM - PAGE TWO Ravisad 08/24/94 PARCEL IDENTIFICATION I i Applicant's Name tN Ai0 G' Permit Number SwG9 G} �. I Subdivision (Name/Division/HIock/Lat) ������ �' .. `�ODF a Instaler's Name ,G'' rn ! c1c/,ity Assessor's Parcel No. rweive-liigiL Number}' Designer's Name 0� L AS-BUILT DRAWING i VI e, \ . /�• s � 0 09, • ,2'q- f W K' - ob62/1y }+,,,, 11o1'41 Al Y bait Cl,` O�tJ CAUTION: Minor adjustments to septic—tank location and drainfield orientation made in the field by the instalaer are generally ac- ceptable to both the department and the designer, butlfrom eithernthesheal�department or�t�eideai9nere system. It be�ore making any e in- staller's responsibility to obtain prior written approval designmust be shown above. devi- ations from the design that affect system viability. Any deviations from the approved AS-BUILT CHECKLIST �Undisturbe ' native soil Drainfield orientation U Observation port location between tr native and layout LY Cleanout location North arrow Trench/bed dimensions and � Manifold placement nshown critical distances within U Scale of drawing layout Orifice placement on scale bar U D-Box/"T"/"L" location L� l� Lateral placement, with Additional Mound Information � � chamber distances to edge of bed u Endslope width U Septica nank/pump locationLocation of wells, roads I-1 U Overall fill dimensions u Location of buildings Printed horn Mason County DMS