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HomeMy WebLinkAboutWEL2022-00054 - WEL Application, Design, Letter - 12/16/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 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 Thompson@masoncountywa.gov Sincerely, Rhonda Thompson Environmental Health Specialist Mason County Environmental Health <e '%.. MASON COUNTY Date Received: 1 2 1 ter' '''r I COMMUNITY SERVICES Amou Se Received Building,Planning,Environmental Health Community Health 415 N.6d'Street.(Bldg 8)—Shelton,WA 98584 WE L a alai. pw 4 Shelton: 360427-9670 x400 Belfair:360-275-4467 x400 Elms:360-482-5269 x400 • TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT C I t + tDr PHONE _ �1� —1 .y� 0 ra.wC,ls T 4 r MAILING AD,,—STET,CITY,STATE,it ZIP7 _ /to, w 1 r f r1 SITE ADDREZIP SS—R-9EET,CITY,l AT 1 t vi S s W C f�C - t--V 0,v /^-K W-<4 s it cs v 4' 0 PRIMARY PARCEL NUMBER(WELL SITE) J 1 3z027 - 33 - 900i-2 SECONDARY PARCEL NUMBER(IF APPLICABLE) WATER SOURCE SOURCE TYPE PARCEL t LOT SIZE PARCEL 2 LOT SIZE (, New ❑ Existing Well 0Spring f,(�7 ,�rPS PROPOSED WATERS TEM NAME(REQUIRED) I1it er We-ll PROJECT DESCRIPTION / A A '\ j 01 K c I<i do o f A-U u w i 4 i''l e[d w�� -Iv� s- y/ A 1 ti ahoy crsi-;Ny Si,3le Fawtil6 r icp eSeAc. e- �/ DIRECT ONS TO SITE/CONDITIONS rI R. 3 "I-D A 1-rc,ctdik • �ivtvtS Swde►' Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius, driveways,roads,septic/sewer components and liri, --.-ments,etc...) 4 a-tr`�Q ,/ 0:;' , y 6' 0 ee / 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) X ❑ ❑ Is the well cap satisfactory? ® ❑ ❑ Screened and vented? ❑ The well casing extends l above level ground / concrete slab? (circle one) (z ❑ ❑ Is there evidence of a surface seal? 01 ❑ ❑ Does the seal appear adequate? ❑ ❑ Is a variance necessary for well site approval? Comments 20 f c b/C/ j0-i/v{ i00 + f-c) lea ►A/ 4,4d ,® Pass ❑ Fail Inspector /47:00 > � Date / /14 )2023 Review Step 2: Two-Party Review: YES NO NA Er ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test Driller GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 I I / to/Zo tkl ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN ?.--1e\ 2-71 Z l ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments Approved ❑ Denied Reviewer Date `((? /2 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 19`h, 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 1 WATER WELL REPORT DEPARTMENT Of Notice of InlertI No. WE49262 ECOLOGY Unique Ecology Well ID Tag Na BNV839 Type of Work: 11101111 State of Washington • Construction Site Well Name(if more than one well) • ❑ Decommission c> Original installation NOI No. Water Right Permit/Certificate No Proposed Use: CI Domestic ❑Industrial Cl Municipal Property Owner Name Francis Pinter 0 Dewatering ❑Irrigation D lest Well ❑Other Well Street Address 789 SE Binns Swiqer Loop Rd Construction Type: Method: Al Nev.well D Alteration 0 Driven 0 Jetted ❑Cable Tool City Shelton County Mason ❑Deepening Li Other ❑Dug Ii)Air- ❑Mud-Rotary Tax Parcel No. 32027-33-90082 Dimensions: Diameter of boring6 to 132 n. in, Was a variance approved for this well? 0 Yes O No Depth of completed well 132 ft Construction Details: Walt If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread l I ❑ 8 in. 0 132 .025 in. LA I 0 l l I ❑ Location(see instructions on page 2): ©WWM or❑EWM U i ❑ in. in. O I ❑ ❑ i ❑ SW 1-1/4 of the SW Y.;Section 27 Township 20N Range 3W ❑ I ❑ in. _ _ in. ❑ I ❑ DID O 1 0 in. in. LJ I 0 ❑ I ❑ Latitude(Example:47.12345) 47.1136164 Longitude(Example -120.12345) -123.053125 Perforations: 0 Yes Gil No Type of perforator used No.of perforations Size of perforations in.by in. Driller's Log/Construction or Decommission Procedure Perforated hom_R.to_R.below ground surface Formation.Describe by color,character,size of material and structure.and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes El No 0 K-Pucker v- Depth R. information. Use additional sheets if necessary. Manufacturer's Name Material From To Type Model No. Diameter Slot size in.from ft.to R. Brown fine to medium sandy gravel,silty, 0 Diameter Slot size in.front R.to ft. tight,dry 43 Brown fine sandy gravel,silty clay brown 43 Sand/Filter pack:❑Yes DO No Size of pack material in. binding,dry 65 Materials placed from ft.to_R. Brown medium sand,dry 65 71 Surface Seal: 11 Yes 0 No To what depth? 20 ft. Gray clay,stiff,dry 71 89 Material used in seal Bentonite Chips Did any strata contain unusable water? 0 Yes EJ No Gray clay,soft,seams of black silt 89 99 Type of water? Depth of strata Chocolate colored peat,hard,dry 99 102 Method of sealing strata off Gray clay,stiff,dry 102 111 Black silt with clay chunks,wet 111 113 Pump: Manufacturer's Name Type: Gray clay,stiff,dry 113 119 IT.P. Pump intake depth: ft. Designed flow rate: gpm Black round and sharp gravel,tight,dry 119 127 Water levels: I.and-surfacc elevation above mean sea level 162 ft. Black round gravel,loose,water 127 132 Stick-up of top of well casing 1 R.above ground surface Static water level 82 ft.below top of well easing Date 11/9/22 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test perforated? t9 No ❑Ycs =--;, by whom? Yield gpm with ft drawdown after hrs. Yield gpm with_ft.drawdown after hrs. Yield gpm with ft.drawdown after hrs. Recovery data(time=zero when pump is turned off--water level measured flout well top to water level) Time Water level Time Water level Time Water level Date of pumping test _ Bailer test gpm with ft drawdown after_hrs. Air test 30 gpm with stein set at 120 ft.for 1 hrs. — Date 11/9/22 Artesian flow gpm Temperature of water 50 o F Was a chemical analysis made? 0 Yes O No Start Date 11/9/22 Completed Date 11/9/22 WELL CONSTRUCTION CERTIFICATION: !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 hest knowledge and belief U Driller U Trainee U PE-Print eray 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-I-20(Rev 09/18) If you treed this document in an alternate format,please call the Water Resources Program at 360-407-6872. Pet-sons with hearing loss can call 711 for ll'ashingion Relay Service. Persons with a speech disability can cal!877-833-6341. 1786 SE Mile Hill Drive Port Orchard,WA 98366 SPECTRA Laboratories-Kitsap www.spectra4ab.com -.Where".lout,wcu., (360)443-7845 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected lime Sample County Collected 11 I 14 f22 12 45 DAM Mason mono Day Year Type of Water System(check only one tax) ❑Group A ❑Group B ['Other Group A and Group B Systems—Provide from Water Facilities inventory(WFI): ID# System Name: Francis Pinter Contact Person:Meta Eisele/Arcadia Drilling _ Day Phone:380-428-3395 Col Phone: Email: arletatarcadiadrilling.com Eve.Phone: Send results to:(Print trl name,address and zip cede a e-mail) arletat§arcadladrIlling.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 Binne Swiger Loop Rd,Shelton Type of Sample(check only one box) 1.Q Routine Disbibution Sample 2.Repeat Sample(after unsat.routine) Chlorinated:Yes❑ No 0 ❑Distrbution System Chlorine Residual:Total_Free Unsatisfactory routine lab number: 3.Source Ground Water Rule Sample ISI I I Unsatisfactory routine collect date: l ) j 1 1 ❑Triggered Chlorinated:Yes❑ No CI CI Assessment Chlorine Residual:Total Free_ 4. Enumeration Source WaterSampe I I I ❑E.coil ['Fecal-aramcrm.spress:Fluid Yes WO 5.Q Sample Collected for Information Only: — LAB USE ONLY DRINKING WATER RESULTS LAB ,E ONLY ❑Unsatisfactory Total Colton Present and tisfactory • ❑Ecol present ❑Ecoiiabsent Replacement Sample Required: • ❑Sample too old(>30 hours) ❑TNTC ❑_ Bacterial Density Results:Total Coliform 1100m1. E.cok _. /100ml. Fecal Coliform I100m1. HPC_ 11 ml. Lab ID Number Data and NOV 1eas tl. Method Code- Dale and The Incubated: SM 9223 B NOV 15 2021 Date Analyzed. Nov a C Dale Reported* NOV' 1 l l DOH Lab SuTrpl .. Lab Use ody: v 225 - _ CON can nJwl9!M«en catel:llje.KM.wplintonln ai .bmK crl:KC s$an)pDam ca 7111 — Tli.,i1 dAir p Rk,C.r•e.w.se.d.n..tliw..laW.q.Iv. Ic 2192772 MASON CO WA 01/13/2023 10:44 AM NOTCE FRANK PINTER Rec Fee:ill II III I I I II 111111I IIIIII�II 4 I 1 IIIII IIIII IIIIII1 II14III 11111111111111 Return To: FvCAMCtS 1 tv.. er `PO 'igv i'17 7 S L e- (-ov. w k eiv5 41- 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." B k SUl 5 w OR 3 w ,t Subdivision Division Lot Range Township Section And having the Tax Parcel Number of:3 2 0 2 7--3,L-- 5 0 0 82.- 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 (`.3 oc SW 9 Pa_ Z- OR 3 AV Al Subdivision Division Lot Range Township Section And having the Tax Parcel Number of: a 2.Q 2 7 -- 3.3_--_I 0 Q g-Z R D r8 04- sW SW pa 7i- OR 3 ,2-0 ,2-7 Subdivision Division Lot Range Township Section And having the Tax Parcel Number of: 3 2 0 2-7 --_3 3 --i 'D Os'2- The system owner is responsible for keeping this system in compliance. The name of the system is: Pl ti-�e✓ W e-(I 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)- i gi Printed name of Grantor(s): ¶..... CL�C :5 R• "—Pt.A.{c V D� I M UI V I F Page 1 of 2 Lill !r \I 1 A 3 r/J: 3 �r]1 it.:,) 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 t]grwaYLj , 2023 , V-Y0.01-,‘S yY\• P, Y 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. 1111111T►I II/IT, Notary ublic in and for the tate of Washington, �`•``� i es �oc�,y residing at SY1tlkt o r� Q,,.'`o NOT :r, ARy Q`;Z My commission expires: L Oq�'?.0�-y ^,N. o..' N =-A f-oOBLIC A % O.No 20. . :G•` Page 2 of 2