HomeMy WebLinkAboutWEL2023-00010 - WEL Application, Design, Letter - 3/13/2023 A
MASON COUNTY 415 N 6TH STREET,SHELTON, ,, 98584
SHELTON: 42 T EXT967 400
i-ra.:.. BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA: 360 482 5269,EXT 400
FAX:360-427-7787
RISLEY MATTHEW D & ASHLEIGH C
2536 W TONYA RD
PHOENIX, AZ 85086
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2023-00010
11 NE RIDGETOP CT
123194250010
The 2-party water system, Ridgetop Ct#1, 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 or email at Danderson@masoncountywa.gov
Since ,
. , 7-Th
David Anderson
Mason County Environmental Health
,e H:.., Date Received:
.. , MASON COUNTY
'1' COMMUNITY SERVICES Amount Received: Received By:
�; 5 a.5 P
\,` •� Building.Planning.Environmental Health,Community Health
415 N.6i6 Street,(Bldg 8)—Shelton,WA 98584 WE L a.Cla,3- 0 0010
Shelton: 360-427-9670 x400 13c1fair:360-275-4467 x400 Elma:360-482-5269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT PHONE 96 3475
MR i i N P-v-1 Rt 5C C-:.Y (+06) a
MAILING ADDRESS-STREET,CITY,STATE,ZIP
Z•53(9 W• TAN YA RPM , PE-10E1 t1 �( , I\z 85 0%
SITE ADDRESS-STREET,CITY,STATE,ZIP
' -X N RtIDG-LETCP Cook , (3�c �- -(4, vor et 52.8
PRIMARY PARCEL NUMBER(WELL SITE)
12-3! 9-'}-2- 50010
SECONDARY PARCEL NUMBER(IF APPLICABLE)
1319 -4Z- 500Z0
WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE
�� PARCEL 2 LOT SIZE
❑ New IN Existing Well ❑ Spring 745 A 5.03 AC' S
PROPOSED WATER SYSTEM NAME(REQUIRED)Rl GC--To()) C000_ I
PROJECT DES PTI\51 ENO 186 Fool" 't- [011- I5 61AM TO 31 D
w tr J EA LzTz_
DIRECTIONS TO SITE!CONDITIONS
For\ 6 .Lr— c02� TA 1 .. OW'( 300, RICztI7 5c oq o NIL-! l i
Pie)X. (• [ VM(LE 5 l /216-0-1 orb R IY-7,G ToP c77 l s��l 0� 1.-r/
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...)
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Submittals Checklist: (these additional items will be required for approval)
Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled)
IWell 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) 4 l!p
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
❑ A ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields, tanks, buildings; indicate distance on plot plan)
(t El ❑ Are there roads within the 100 f of radiu of the water source? If so, is road private,county ta r_
TT What is distance to ROW? � � of e
{-e Q� ��`��� '" e. 5. C
❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan)
❑ ❑ Is the well cap satisfactory?
❑ ❑ ❑ Screened and vented? g //
❑ The well casing extends above level ground I concrete slab? (circle one)
❑ ❑ Is there evidence of a surface seal?
❑ ❑ Does the seal appear adequate?
❑ ❑ Is a variance necessary for well site approval?Comments Ak 1 l.�
( - / 7 '16 (p 2
( psi5 5
XPass ❑ Fail Inspector th Date -1'07--7c, 2_3
Review Step 2: Two-Party Review:
YES NO NA
El El Water Well Report with adequate pump7 test on file? f Q
TT If NO, date of Capacity Test 2(i /G(/L 3 Driller l-`IS Oi Pc GPM r`J
❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test /e//2/ ' Zf
El ❑ Received Signed, Notarized, and Recorded Notice? AFN 719 y S zr
❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
f7S1 Approved ❑ Denied ReviewerV .
Date 1j2VTO7
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', 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
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2194528 Mason County WA.
0310612023 11:48:32 AM NOTCE
eRecorded #184806 RecFee:6204.50 Pages:2
AEGIS LAND TITLE GROUP
Return To
7-5317 \al.ithrtyt. Rot
PO0G.14I1,I Az 8508(D
Grantor(s):(1) 1141FrOiVsi D. R151-PY ,(2) {L L((lt G. i,Z15l.tE Y
Grantee(s):(1)PUBLIC
Legal Description(1) Lar It��#95'141 fYtJ NW SG. t9-2-3-I
(Abbreviated form:i.e.lot,block,plat or section,township,range)
Assessor's Tax Parcel:(1) I 2. a t . -. z - D o 0
NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM
I(We)the undersigned grantor(s),certify that the water source located on the above-described
real estate under Legal Description(1)and Assessors Tax Parcel(1)situated in Mason
County,State of Washington,has been designated to serve a source of water to the following
parcels situated in Mason County,State of Washington;herein described:
Tax Parcel:(Connection 1) L Z 9 -k z- - Q I C)
Tax Parcel:(Connection 2) .- 4 z•- 0 0
The system owner is responsible for keeping this system in compliance.
The name of the water system is: (ID(1 1 P COtxp.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/ s no been granted one or more waivers from specific provisions of the
regulations. L�
Dated on this 1 ` day of L �' ``1 ,20 1-3
Si e f Gra
(2)
Page 1 of 2
This document was recorded by
Aegis Land Title Group as a
courtesy only. No liability for
the validity and/or accuracy is
assumed by Aegis Land Title Group.
State of Washington ton 4 r' 2P'- 1
County ofMeao.r N..-%;cop 0-
I,the undersigned,a Notary Public in and for the above named County and State,do hereby
certify that on this I'{tit.day of Voix .20 23 ,
ww D R; Q; pet tonally appeared before me,who is known to be
signer of the abov instrumen,and ac owledged that he(she)(they)signed it.
GIVEN under my hand and official seal the day and year last above written.
JENNICA
41"i"e warypuuttc LaYAllma otary Public in and fo the State ofWesttiRgtef drievrna
YAVAPaCOUN1Y residing atil‘P UP 5a✓
Commission8634999
ono Expires Septenter 20.2026 My commission expires:09/Z0/2U2 6
Page 2 of 2
2194528 Page 2 of 2 03/06/2023 11:48:32 AM Mason County, WA
CinE
SEPTIC DESIGN G/114IMTEMl4MCE
February 13, 2023
Re: Site Evaluation/Feasibility
To Whom It May Concern:
My name is Rod Left. I am the President of Acme Septic Design & Maintenance. I am a state licensed septic
designer as well as a Monitoring & Maintenance provider who has worked in this industry for over 30 years. I
routinely provide service to the Belfair area. My findings are based on current state and county regulations for
various On-site Sewer Systems (OSS) and my years of experience.
On Friday, February 10, 2023, I conducted a site evaluation for tax parcel ID 12319-42-50010 to determine if a
drain field could be installed on the property that would be able to handle a 4-bedroom residence. This property
is located on NE Ridge Top Ct in Belfair, Washington.
I excavated 4 soil logs staying over 200 feet away from any wet areas. I also stayed 200 feet away from any
disclosed wells. Soil logs 1-4 are categorized as Type 4 soils. The following details each soil log:
Soil Log 1: 0"-30" Light brown sandy loam with lots of pebbles
Soil Log 2: 0"-28" Light brown sandy loam with lots of pebbles
Soil Log 3: 0"-25" Light brown sandy loam with lots of pebbles
Soil Log 4: 0"-25" Light brown sandy loam with lots of pebbles
Taking into consideration the soil depths and the 2-4% slope of the proposed drain field area, I believe a
Standard Pressure system could be proposed in the area of soil logs 1-2. Approximately 270 linear feet of drain
field would be required to accommodate a 4-bedroom home. In addition, I recommend applying for a Class B
waiver in order to enable us to petition for this less expensive alternative system. Waivers are completed and
submitted by the designer and will be included in your design cost below.
The approximate cost for a 4-bedroom septic installation of this type is currently between $20,000 and $25,000.
The design cost is currently $1,850 (including the waiver mentioned above) and $810 for the Mason County
Public Health (MCPH) design application fees (including the waiver mentioned above). In addition, the MCPH will
require a Record of Construction (ROC) at a current cost of$600. A minimal fuel surcharge may be applied.
Please be aware that the MCPH determines final decisions for the approval or denial of submitted designs. This
letter is the opinion of the undersigned, and shall not be construed as an approval from the MCPH or associated
governing building department. If you have any questions, feel free to contact me.
Sincerely,
``
Rod Left rip
`
Acme Septic Design & Maintenance, President ,.• %z y�-
Info@AcmeSeptic.com
www.AcmeSeptic.com R r� . ,.
C.E 1S_A)DF: �
EXPIRES\
,, ,.�.
1786SEMleHi r r
PmlOrDr.M WA '1 SPECTRA Laboratories - Kitsap i
96366 ...Where experience sooners
L_ I COLIFORM BACTERIA ANALYSIS FORM
Dab sample Collected I Time Sample County
Collected •
m.,2' f2 ' 23 °^�
Orf War
o�
Type of Water System(deck only one box) �'Va� •
❑group A ❑Group B Other
Group A and Group B Systems-Provide from Water Fealties Inventory(WFI):
System Name:c?Okra.l I Z?j I 9,12 SOO I o
Contact Person:
Day Rom:( ) - Cell Phone:( )
Ethel.
Serb results to(Print full none,address and zip code airmail)
uc i rv� t�c ei�YL
l.
SAMPLE INFORMATION -
rSample collected by(name): 'Evvek,k\A..f .
Specific location where sample . Special instructions or comes :--j
WIC\\
Type°lan*(estate*one type of sample from types 1 through 5 below)
1.❑Routine Distribution Sample(AO') 2.❑ Repeat Sample(AIP)
Cliorinated:Yes No ;from distnbulion system after inset ravine) .
Unsatisfactory routine lab number
Chlorine Residual:Total Free
• 3.Ground Water Rule Source Sample —— —`
Unsatisfactory routine collect date:
Is I - I I
Chiannated:Yes No
❑Triggered(AV) Chlorine Residual.Total Free
❑Assessment(A/P)
4. Surface or GWI Raw Source Water Sample(Enumeration) ISI I I
❑E coil 0 Fecal Feed Yes No
LTSample Willo d tar Information Ordy
LAB USE ONLY DRINKING WATER RESULTS LAB U ONLY
❑Unsatisfactory Total Coliform Present and tisfactory
❑E.coli present 0 Eook absent
Bacterial Density Results:Total Cditorm mph j100m1.E.coli mpn/100m1.
Fecal Coliform du /100ml. HPC 11 ml.
Replacement Sample Required: 0 TNTC 0 Sample too aid
❑ Sample Volume CI Damaged Container 0
D 1R V LUL3 g a\ Lab Reirgin 0("0 2
Receipt Tip C° 4lserod Code: SM9223B or SM9222D
Dale Reported io DOH Lab Use Orgy
e
DOH Lab-Samptea
225- LAW .U Z
-004i fate(senneourn•vto neinernbini.e.fee-pfk.tort pgere.e75D417 Merry di TM
Die ricer nlrorae U.n nUeel++rdfu.geoflYelvow..
r . ri",,,,,,,,„„,,,,-,,,,,----,,....,.
WATER WELL REPORT DEPARTMENT dF NotieeoflntertNo.WE37835
ECOLOGY Unique Ecology Well ID Tag No.BNA102
Type of Work: State of Washington
La7 Constrrtrnn Site Well Name(if more than one well):
0 Decommission i.:� Original installation NO1 No. Water Right Permit/Certificate No.
Prepped Use: E4 Domestic industrial 0 Municipal Property Owner Name Ron Bums
0 Dewatering 2 Imgation CI Test Well Cl Other
Well Street Address NE RldQetoo Ct
Construction Type: Method:
•Nrw well 0 Aheraton 0 Driven 0 Jetted W('able Tool City Belfair County Mason
J lka penmg Cl Other 0 Dug Cl Mr- Cl stud-Rotas Tax Parcel No. 12319-42-50010
Dimensions: Diameter of borings in.,to 188 ft. Was a variance approved for this well? ❑Yes i No
Depth of completed well 186 ft.
If yes,abet was the variance for?
Ceestrecttesa Details: Wall - ---
Casing Liner Diameter From To Thickness Steel PVC Welded Thread
® 1 0 6 in. +2 181 1/4 in. 81 I 0 0 I ❑ Location(see instructions on page 2): O WWM or 0 EWM
❑ 1 C _m. _ _ _in• 0 I ❑ DID NW V.-%ofdie SE /;Section 19 Township 23 Range 1W
0 1 ❑ in. in. 0 1 0 ❑ 1 ❑ Latitude(Example:
❑ 1 C in. -- —in. ❑ 1 ❑ CI 1 ❑ 47.12345)_
Longitude(Example:-120.12345)
Perferatiess: 0 Yes 3 No Type of perforator aced
i No,of perforations_— Sim of perforations_in,by_in. DrUkr's Log/Construction or Decommission Procedure
Pertbraled from_ft.to_ft.below ground surfaceFornuuon:Describe by color.character,sot of material and structure,and the kind and
Et nature of the material in each layer penetrated,with et least one entry for each change of
Screens: i Yes 0 No 4 K-Packer Depth 179 R. mlirnation. Use additional sheets if necessary.
a Manufacturer's Name Abv M aclime Works
Material FromTo
Type Stainless Model No.
PI Diameter 5 in. Slot size20 in.from 181 fl.to 186 ft. Brown Gravel_ 0 30
t Diameter_ in. Slot size in.from ft,to_IL Orange Gravel Moist 30 50
g 3and/i:'Bter pack:0 Yes M No Sue of peck material_in. Light Brown Gravel 50 95
5g Materials placed from_ft.to ft. Light Brown Gravel&Sand 95 120
Gravel Dark Brown 120 165
Miriam Seal: Ill Yes ❑No To what depth.'25 it. gang&Gravel w/Water 165. 186
Material used in seal Bentonite
Did any strata contain unusable water'' Cl Yes `.No ,
t Type of water? Depth of strata
o Method of sealing strata off _--_--_--__----__--
IPump: Manufacturer's Name Type ---
H.P. Pump intake depth:_ft. Iksigtted Flow raw. rpm
-
0
8 Water Levels: Land-surface elevation above mean sea level it
Stick-up of top of well casing_ tt.abuse ground surface — \—'
Static water level ft.below top of well casing Date --
RECEIVED
Artesian pressure Ms.per square inch Date _
4` Artesian water is controlled by (cap.valve.etc.)
wail Tests: - - By WELL CONSTRUCTION AMD Lig:ENSING oFFice at a50 an Aug 27,2020
W'asapumpingtestperforntsvf7 No 81es --.;' byNiam' ------ N. ----- ,
Yield ___-gpm with ft.drawvdown after _hrs.
F- Yield _ gpm with__P.dmwdown after hrs.
YRM gpm with—ft.drawdown alter hrs.
to Recovery data tome-tero when pump is turned oil water level measured from well
g --,
top to water level)
13 1 one Water Level time W alcr t.evel Time wafer Level .______..-._.___ _-_.. _ __..
W
Date of pumping tem�-
p Bailer test 15 gpm with 1 ft.ilrnwdown after I hrs
C Air test gpm with stem set at tt.for_ hrs. - Date_ _____ i
Ancsian now gpm 1
I 'fentperiture of water_°F Was a chemical analysis made? 8 Yes ❑No Start Dale 01II20/20 Completed Date 07/15/20
•
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 intitrmation reported above are true to my best knowledge and belief.
CI Driller 0 Trainee 0 PE- ' t Name Jack Grande Drilling Company Davis Drilling
Signature 2 �,�!/ Address 340 NE Davis Farm Rd
License No. (J City.State,Zip Belfair,WA.98528
IF TRAINEE:Sponsor's License No. Contractor's
Sponsor's Signature Registration No. Date 08/26/20
ECY 050-1.20(Rev 08/19)/f you need this document in an alternate forerun,please call the Water Resources Program at 360-407-6872.
Persons with heating totes can c 7fl for Washington Relay Service. Persons with a speech disability can call R77.833-6341.
Davis Drilling
340 NE Davis Farm Rd
Belfair, WA 98528
275-5367
Test pump for: Tax Parcel #12319-42-50010
Pump: 1 h.p. sub
Well Depth: 186'
Static Level: 153'
Date: 02/01/2023
Well ID: BNA 102
Draw Down
Time Water Level Flow GPM
0 min 153' 0
5 min 154' 18
10 min 154 18
30 min 154' 18
2 hr 154' 18
4 hr 154' 18
Recovery
Time Water Level
0 min 154'
1 min 153'