The URL can be used to link to this page

Home My WebLink AboutWAT2022-00324 - WAT Application - 12/12/2022 WA I .Q 21 - C 3D-1 MASON COUNTY y• COMMUNITY SERVICES RECEIVED 4t /�' Building Planning* Environmental Health,Community Health DEC !1 �. 2022 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 :• Belfair: (360)275-4467 ext 400 :• Elma: (360)482-52q9 x6 99 Alder Street FAX(360)427-7787 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application, with any required attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: Robb & Melissa Nicholas Date: 12/9/2022 Mailing Address: 6689 SE Cougar Mountain Way Phone: 206-384-8686 Parcel Number: 32231-43-00130 Type of Water System Reason for Application El Public/Community Water System (2 or more El Building permit t? 2O2Z.. -DV 32_ connections) ❑ Division of land: El Individual water source (one connection), #of Parcels? SPL El Well ❑ Boundary line adjustment El Spring/surface water ❑ Other (explain) El Other (explain) ,Replacement or Remodel (please indicate name If you have more than one residence connected of water system below if applicable— no to this well, check the Public/Community Water signature required) System box. eVre6 ICA(\ Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory (WFI) Number: (write "none" for two-party) ❑ I am the manager of this water system. The water system has been approved for services. There are presently connection(s) in use. This will be the connection. ❑ I am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s) without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date 12/9/2022 This form may be scanned and available for public view at www.co.mason.wa.us. J:\EH Forms\Drinking\Vatcr Revised 1/25/2018 Individual Water Well CI Water well report (attached to application). Depth 119 ft. I] Well capacity Test (attached to application) 20 gpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. El Satisfactory bacteriological test (attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa.us/planning 141-I 151-1 16Ix 122f1 Water use or limitation recorded N/A Yes I I/ Well Drilled Date 4/4/2022 Individual Spring/Surface Water ❑ WDOE permit (attach to application) ❑ Method of disinfection O I have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant • • Part 3: Mason County Community Services Evaluation (staff use only) -Ni:,. Satisfactory Determination: This determination does not address adequacy of the distribution system, guarantee an adequate supply of water indefinitely in the future, or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: � q Z� Environ. Health: Qh\CIA.IN)-- AWL Date 2°f2 CSD Director: Date 5�:;;". i DEPARTMENT OF NoticeoflntentNo. WE47145 WATER WELL REPORT ECOLOGY Unique Ecology Well ID Tag No. BNV892 Type of Work: Cggi State of Washington 1D Construction Site Well Name(if more than one well): ❑ Decommission r=> Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: O Domestic ❑Industrial 0 Municipal Property Owner Name Estes Builders 0 Dewatcring ❑Irrigation 0 Test Well D Other Well Street Address 4182 E State Route 106, Construction Type: Method: El New well CJ Alteration ❑Driven ❑Jetted 0 Cable Tool City Union County Mason 0 Deepening ❑Other 0 Dug O Air- 0 Mud-Rotary Tax Parcel No. 32231-43-00130 Dimensions: Diameter of boring 6 • in.,to 119 ft. Was a variance approved for this well? 0 Yes L7 No Depth of completed well 119 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread a 1 ❑ 6 in. 0 113 .025 in. DI I 0 O I 0 Location(see instructions on page 2): Q WWM or❑EWM ❑ I ❑ in, in. ❑ I 0 O I ❑ SW '/.-%of the SE '/.;Section 31 Township 22N Range 3W ❑ I ❑ in. _ _ in. ❑ I O CIO❑ I ❑ in. T in. ❑ I ❑ ❑ I ❑ Latitude(Example:47.12345) 47.347463 N - Longitude(Example:-120.12345) -123.108186 W Perforations: O Yes O No Type of perforator used Size ofperforations in byin Driller's Log/Construction or Decommission Procedure No.of perforations Formation:Describe by color,character,size of material and structure,and the kind and Perforated from ft to R below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: CI Yes ❑No III K-Packer > Depth 109 ft information Use additional sheets if necessary. Manufacturer's Name Alloy Machine Works Material From To Type Wire Wrapped Model No. Diameter 5 Slot size.020 in.from 111 ft.to 116 ft. Brown fine to medium sandy gravel,silt bound, 0 Diameter Slot size_in_from ft.to_ft. tight,dry 11 Brown gravelly medium sand,silty,tight,dry 11 20 Sand/Filter pack:❑Yes O No Size of pack material in. Brown medium sandy gravel,loose,wet 20 26 Materials placed from ft.to ft. Brown medium sandy gravel,silt bound, 26 , Surface Seal: Yes 0 No To what depth? 20 R tight,dry 44 Material used in seal Bentonite Chips Multicolored coarse sandy gravel,sharp, 44 Did any strata contain unusable water? ❑.Yes El No 5 tight,dry 63 Type of water? Depth of strata • 63 65 Method of sealing strata off Brown silt,stiff,dry Blue clay,stiff,dry 65 72 Pump: Manufacturer's Name Type: Brown gravelly clay,stiff,dry 72 79 H.P. Pump intake depth: R. Designed flow rate: gpm Brown fine to medium sandy gravel,silt bound, 79 Water Levels: Land-surface elevation above mean sea level 21 ft. tight,dry 96 Stick-up of top of well casing 1 ft above ground surface Brown fine sandy gravelly chocolate peat,dry 96 98 Static water level 28 ft.below top of well casing Date 4/4/22 Artesian pressure lbs.per square inch Date Brown medium sandy gravel,tight,dry 98 102 Artesian water is controlled by (cap,valve,etc.) Brown gravelly clay,dry 102 104 Brown medium to coarse sandy gravel,water 104 116 weu Tests: Brown fine sandy sharp gravel,tight,dry 116 119 Was a pumping test performed? (II No 0 Yes tz==> by whom? Yield gpm with_ft drawdown after hrs. Yield _gpm with_ft drawdown after_hrs. Yield gpm with_ft.drawdowu after i_hrs. Recovery data(time a zero when pump is turned off-water level measured from 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 20 gpm with stem set at 100 ft.for 1 hrs. Date 4/4/22 Artesian flow_gpm Temperature of water 51 °F Was a chemical analysis made? 0 Yes E No Start Date 4/4/22 Completed Date 4/4/22 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 hest knowledge and belief. 0 Driller 0 Trainee 0 PE—Print Namoger 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 4/4/22 ECY 050-1-20(Rev 09/18) If you need this document in an alternate 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 877-833-6341. Arcadia Drilling Inc. P.O. Box 1790 Shelton, WA. 98584 Customer: Estes Builders Well Tag #: BNV892 Phone: 360-516-0701 Depth: 119' Well Site Address: 4182 Washington Hwy 106, Union Pump Set: 100' Date of Test: 4/6/2022 Static 18' TIME GPM LEVEL RECOVERY 1 Min 7.5 22.0 TIME LEVEL 2 Min 7.5 24.5 1 Min 34.5 3 Min 7.5 25.0 2 Min 29.6 4 Min 7.5 27.1 3 Min 26.8 5 Min 7.5 28.0 4 Min 24.6 6 Min 7.5 28.4 5 Min 23.3 7 Min 7.5 29.0 6 Min 22.2 8 Min 7.5 29.4 7 Min 21.8 9 Min 7.5 29.7 8 Min 21.3 10 Min 7.5 29.9 9 Min 21.0 15 Min 12.0 30.5 10 Min 20.6 20 Min 12.0 37.6 25 Min 12.0 39.6 30 Min 12.0 40.4 35 Min 12.0 40.6 40 Min 12.0 40.8 45 Min 12.0 41.0 50 Min 12.0 41.0 55 Min 12.0 41.1 1 Hr 12.0 41.2 1 Hr 10 Min 12.0 41.2 1 Hr 20 Min 12.0 41.5 1 Hr 30 Min 12.0 41.7 1 Hr 40 Min 12.0 41.8 1 Hr 50 min 12.0 41.9 2 Hr 12.0 42.0 1786 SE Mile Hill Dr. Port Orchard,WA 98366 SPECTRA Laboratories - Kitsap (360)443 7845 ...Where experience matters IOC TEST PANEL Complete or Selected Inorganics System ID No: System Group Type: Private Sample Number: 225-0250I System Name: Estes Builders Sample Location: 4182 WA 106,Union-Well Head#BNV892 County: Mason Sampler: Max Source Number(s): Sampler Phone No: Sample Purpose: Other Date Collected: 04/06/2022 12:00 Sample Composition: Single Source Date Received: 04/06/2022 16:00 Sample Type: Untreated:DW Date Reported: 5/9/2022 Send Report to: Bill to: Arcadia Drilling Arcadia Drilling PO Box 1790 Tina Parker Shelton,WA 98584 PO Box 1790 Shelton,WA 98584 DOH# Analyte ' Results Qual. Units SDRL PQL Trigger MCL Exceed Method Analyst Analysis MCL Date 0004 Arsenic ND -- mg/L 0.001 0.001 0.01 0.01 EPA 200.8 118 04/29/22 0:00 NOTES: 'Confirmation Include the original lab number,sample number,and collection date of original sample in either lab or sampler comments section. SDRL: (State Detection Reporting Limitl)The minimum reportable detection of an analyte as established by the department.. Trigger Level: DOH drinking water response level.Systems with compounds detected at concentrations in excess of this level may be required to take additional samples or monitor more frequently.Please contact your DOH drinking water regional office for further information. MCL: (Maximum Contaminant Level)If the contaminant amount exceeds the MCL,please contact your regional DOH office to determine fcllow•up actions. NA: (Not Analyzed)In the results column,indicates this compound was not included in the current analysis. ND: (Not Detected)In the results column,indicates this compound was analyzed and not detected at a level greater than or equal to the SDRL. <(O.00x): The compound was not detected in the sample at or above the concentration indicated(usually the lab method reporting limit). mglL: milligrams per liter or parts per million. NTU: nephelometric turbidity units(a measure of water clarity). pmhoslcm: Micro ohms per centimeter(a measure of the ability of the water to conduct electricity).One micro ohm per centimeter is equivalent to one micro siemen per centimeter(uS/cm). No existing trigger or MCL value. 1: Secondary MCL(Established for aesthetic purposes,not health based). Lab Qualifiers Comments: 118: Analysis performed by Spectra Laboratories,LLC Lab-Sample#: 301504- Approved By L Jessica Donaldson Client Services and Project Manager 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. 130025-01 Page I of 1 1786 SE Mile Hill Drive Port Orchard,WA 98366 I t SPECTRA Laboratories-Kitsap www.spectra-lab.com "�•'•"°r'`""Nam. (360)443-7845 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County 4 6 ! Collected a^'' Mason Mont Day Year 1 m PM Type of Water System(check only one box) ❑Group A ❑Group B DOther Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# -- --- System Name: Estes Builders 4182 WA 106,Union Contact Person:Arleta Eisele/Arcadia Drilling ^�— Day Phone:360426-3395 Cell Phone: Email: arleta@arcadiadrilling.com Eve.Phone: Send results by(Print full name,address and zip code or atria) arleta@arcadladrilling.com Arcadia Drilling,Inc SAMPLE INFORMATION Sample collected by(name):Seth Specific location where sample collected: Special instructions or comments: Well Head #BNV892 Type of Sample(check only one box) 1.[I Routine Distribution Sample 2.Repeat Sample(after unsat.routine) Chlorinated:Yes❑ No❑ ❑Distribution System Chlorine Residual:Total Free_ Unsatisfactory routine lab number: 3.Source Ground Water Rule Sample HI I I Unsatisfactory routine collect date: Cl Triggered Chlorinated:Yes❑ No ID ❑Assessment Chlorine Residual:Total Free 4. Enumeration Source Water Sample IS I ❑E.coil [Fecal.&slaw,cvn,spr;19d:aterad Yes(l No 5.0 Sample Cofucled for Information Only: LAB USE ONLY DRINKING WATER RESULTS LA USE ONLY ❑Unsatisfactory Total CdiformPresent and --jL f tlsfactory ❑E,coiipresent ❑Ecoliabsent Replacement Sample Required: ❑Sample too old(>30 hours) 0 TNTC ❑,.— Bacterial Density Results:Total Coliform__._... I100ml. E.coli __..._.I100ml. Fecal Col form 1100m1, HPC /1 mi. lab ID Number Dale and Time T22ii 1oo 32 --01 APR 0 w_~ „Method Code. Date and Tore Incubated: SM 9223 6 _ APR 0 6 2022 Date Analyzed. Date APR 0 7 2022 RXPR 0 7 2022 DOH Lub.Sam Lab Use Only: 225 . 1> 46rb19W«Mon+dl.uywntedrflpile•SmiemYareily Srmtcd . .ou iv.rd car p akoloo,WI satiaua ii imaAihvapo+b4Jinp.�kr 1786 SE Mile Hill Dr. Port Orchard,WA 98366 SPECTRA Laboratories - Kitsap (360)443 7845 ...Where experience matters IOC TEST PANEL Complete or Selected Inorganics System ID No: System Group Type: Private Sample Number: 225-02401 System Name: Estes Builders Sample Location: 4182 WA 106,Union-Well Head#BNV892 County: Mason Sampler: Max Source Number(s): Sampler Phone No: Sample Purpose: Other Date Collected: 04/06/2022 12:00 Sample Composition: Single Source Date Received: 04/06/2022 16:00 Sample Type: Untreated:DW Date Reported: 4/14/2022 Send Report to: Bill to: Arcadia Drilling Arcadia Drilling PO Box 1790 Tina Parker Shelton,WA 98584 PO Box 1790 Shelton,WA 98584 DOH# Analyte Results Qual. Units SDRL PQL Trigger MCL Exceed Method Analyst Analysis MCL Date 0020 Nitrate-N ND -- mg/L 0.5 0.500 5 10 EPA 300.0 010 04/08/22 3:43 NOTES: 'Confirmation Include the original lab number,sample number,and collection date of original sample in either lab or sampler comments section. SDRL: (State Detection Reporting Limitl)The minimum reportable detection of an analyte as established by the department. Trigger Level: DOH drinking water response level.Systems with compounds detected at concentrations in excess of this level may be required to take additional samples cr monitor more frequently.Please contact your DOH drinking water regional office for further information. MCL: (Maximum Contaminant Level)If the contaminant amount exceeds the MCL,please contact your regional DOH office to determine follow-up actions. NA: (Not Analyzed)In the results column,indicates this compound was not included in the current analysis. ND: (Not Detected)In the results column,indicates this compound was analyzed and not detected at a level greater than or equal to the SDRL. <(O.00x): The compound was not detected in the sample at or above the concentration indicated(usually the lab method reporting limit). mgiL: milligrams per liter a parts per million. NTU: nephelometric turbidity units(a measure of water clarity). pmhoslcm: Micro ohms per centimeter(a measure of the ability of the water to conduct electricity).One micro ohm per centimeter is equivalent to one micro siemen per centimeter(uSlcm). No existing trigger or MCL value. 1: Secondary MCL(Established for aesthetic purposes,not health based). Lab Qualifiers Comments: 010: Analysis performed by Spectra Laboratories- Kitsap,LLC-Sample#=216787 Approved B: (.- ,6� Jessica Donaldson Laboratory Manager 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. II 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. _ 130U24-01 Page 1 of 1