HomeMy WebLinkAboutWEL2023-00010 - WEL Application, Design, Letter - 3/13/2023 MASON COUNTY 415 N 6TH STREET,SHELT967 , E 98400
SHETREE ,SHE TON, , EXT 584
t•rfi.
BELFAIR:360-275-4467, EXT 400
• Public Health & Human Services ELMA:360-482-5269, EXT400
•
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 ,
David Anderson
Mason County Environmental Health
` MASON COUNTY Date Receive` d.
COMMUNITY SERVICES Amount Received. ivedB
_t 5 2.5 Pc�
�!yl,, Building.Planning,Environmental Health,Community Health
415 N.6i6 Street,(Bldg 8)-Shelton,WA 98584 WE L a 0,,3- 0 00 I 0
Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elam:360-482-5269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPUCANT PHONE ����
10k i i i w RISC._`( (4iN� a%-
MAILING ADDRESS—STREET,CITY,STATE,ZIP
Z53( W. TANYR RoPhb 1 Pf4ogi411., Az. 850%
SITE ADDRESS—STREET,CITY,STATE,ZIP
XITx M 21.06,E-T CAP Coo (3�c-(--A- ! W 8 cf 5z8
PRIMARY PARCEL NUMBER(WELL SITE)
I Z.3 l 9--Z.— 50010
SECONDARY PARCEL NUMBER(IF APPLICABLE)
12 5 l 9—42-- 50020
WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE�
El New IN Existing po wen 1: Spring 74..5 A' � 55,03 fK RF�
PROPOSED WATER SYSTEM NAME(REQUIRED) __ /
RIOC—i TOP COURT I
PROJECT DESCj21PTlk 51 l tqC7 186 roar w t vct-t+ l5 6/611A4 To 6G 5-kt e
tW LTd A J C LOT Z.
DIRECTIONS TO SITEJ CONDITIONS
Faoc'z\ 13c1.� (Q.1 -riAt . Hwy( 300, RV-Itfr o'I SAt PILL t
SO)( (. 1 f ILE5, R(67t 04 tRtDCZGToP �� 1 7 -DT 0i1 L. -1--1
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...)
C5E--6._ tecrThf-ar,=-40 5°()2•\11()
DO E.----,_o
T
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Submittals Checklist: (these additional items will be required for approval)
01 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) WIN
This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021
Page 1 of 2
elieffimememb 1
— — 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)
❑ ❑ Are there roads within the 100 f of radiu of the water source? If so, is roadprivate,County to
What is distance to ROW? � � Y o{e �� ��U�>� e5.1. C
❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan)
❑ ❑ Is the well cap satisfactory?
❑ ❑ ❑ Screened and vented? �9 iI
❑ The well casing extends ?_t above level ground/concrete slab? (circle one)
❑ ❑ Is there evidence of a surface seal?
❑ ❑ Does the seal appear adequate?
❑ - ❑ Is a variance necessary for well site approval? l �
Comments /Vo TA& - - `i6 (< 2 r/
Ce
— 1 )2 cC515 5
XPass ❑ Fail Inspector Date -----oZ�� 2,3
Review Step 2: Two-Party Review:
YES NO NA
y ❑ ❑ Water Well Report with adequate pump7 test on file? /� )Q
If NO, date of Capacity Test 2( //0 Z3 Driller otitis a//i 7` GPM r`J
fg_ ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 'Leg//Z(;Z f
❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 7(6, I_tS Zr
❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
Approved ❑ Denied Reviewer x Date /2//ZC/ Z 5
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
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2194528 Mason County WA
03/06/2023 11:48:32 AM NOTCE
eRecorded #184806 RecFee:$204.50 Pages:2
AEGIS LAND TITLE GROUP
Return To
Mtrtz.1514r
2.536 \al.TANYA Rob
PH(9 -,t4lXl Az 8508'
Grantor(s):(1) MAril vi D. 1Z15L.PY ,(2) A91L.1&.it C. R(5L y
Grantee(s):(1)PUBLIC
Legal Description(1) (5 II 1.3.4 95-141 PIN NW 5r-:. SW 14-23-1
(Abbreviated form:i.e.lot,block,plat or section,township,range)
Assessor's Tax Parcel:(1) 1 2 I I t) - 4- Z -a D Q 1 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) 1 2- 3 1 q - �" z- -..5_C 0 I
Tax Parcel:(Connection 2)1_1 31 9.- 4 2.- 5 Q Q 2 0
The system owner is responsible for keeping this system in compliance.
The name of the water system is: R ttbC- TbP CL 2
T
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/ as no been granted one or more waivers from specific provisions of the
regulations.Dated on this I j l L�
day of 1?-6VA"5 ,20
4jra / .� '!I ..1Am.
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 Wasfringhm
County of-Meson ist cap°.
I,the undersigned,a Notary Public;be
and for the above named County and State,do hereby
certify that on this I LI k ic
day of war. ,20 2 s ,
Ri h + R: perionally appeared before me,who is known to be
signer of the abov instrumen,and ac nowledged that he(she)(they)signed it.
GIVEN under my hand and official seal the day and year last above written.
JENNICALOYD otary Public in and f State of4Neehir�gter+i'ritnn0.
�Gv NaY VA,PAI OU TY 5
YAVAVAI CAUNTY residing at�P UPS JtnlC�
lCarrtia.++on0B34989
o.+,o Expires Sepienter2o.ne My commission expires:O9I ZOI7O?6
I
II
Page 2 of 2
2194528 Page 2 of 2 03/06/2023 11:48:32 AM Mason County, WA
gcfnE
DESIGNI n'IallITErlalICE
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,
ly,
A9K
Rod Left �/1//(( ff
Acme Septic Design & Maintenance, President Y� - •
Info@AcmeSeptic.com Kti '.7.77tC.
www.AcmeSeptic.com
EXPIRES\
1786 SE Mile Hul rt
Pm Orchard WA it SPECTRA Laboratories • Kitsap
98366 j ...Where expuleaee masters
COUFORM BACTERIA ANALYSIS FORM
Date Sample Collected 1 Time Sample County
Collected
,h2j (2 ' 23 0:°A, /t-QtwSorDay Yaw
Two of Water System(chedc only one boa)
❑Group A O Group B Ot er t + (va t
Group A and Group B Systems-Provide from Water Fac7Rfes Inventory(WTI):
System Name.Pea( I i 5 t "1 i-/Z J v o a
Contact Porten:
Person:
Day Phone:( ) Cal Phone: )
Enid:
Send reelb b:(Print its name,address and by code or e.maiq
•
MPLE INFORMATION
Sample collected by(name): , 11/4A� —�
Sped&location where sample. • . Special instructions or commecomments:j\ t\`` I t
•
Type of Sample(select only one type of sample from types 1 through 5 below)
1.❑Routine Distribution Sample(ARP) 2.❑ Repeat Sample(A/P)
Chlorinated Yes_ _No (from diatnedion system after onset routine)
Unsatisfactory routine lab number
Chlorine Residual:Total___Free_
3.Ground Water Rule Source Sample
Unsatisfactory routine collect date:
S
Chlorinated:Yes No
❑Triggered(A/P) Chlorine Residual:Total Free_
0 Assessment(ARP) —
4. Surface or GWI Raw Source Water Sample(Enumeration)
CIE.coli 0 Fecal Raved Ye._No
( 31 1 1
LTA Sample Coaecled ter MtWmation only
LAB USE ONLY DRINKING WATER RESULTS LAB U ONLY
❑Unsatisfactory Total Coidomn Present and I tisfactory
❑E.coli present ❑E.cd i absent
•
Bacterial Density Results:Total Coliform mpn/100mL E.col mpry100m1.
Fecal Coliform du /100m1. HPC 11 mL
Replacement Sample Required: 0 TNTC 0 Sarre too old
❑ Sample Volume ❑Damaged Container ❑
Tfilnr3123 'R c tVi o(--02
Receipt Temp C � SM92238 or SM9222D
Date Reported to DOH Lab Use Only --
DOH Lab-Sampiea
225- LAD ib2
—SOI131Y(llu.Ltcarl. mos/Ha an fait r - 11
This.n!sew Intbbns n na i*atrwhhrgeAtYMpMr.
WATER WELL REPORT 0 DE
Type of Work: PA t?MD NT OF
Notice of Intent No.WE37835
ECQLOGY
State of Washington Unique Ecology Well ID Tag No.BNA102
f1 Construction She Well Name(if more than one well):
0 Decommission i ' Ongutal installation NOI Nu Water Right Permit/Certificate Nu.Proposed the:the: a Domestic ,Industrial 0 Municipal Property Owner Name Ron Bvers
0 Dewatering `J Inigition 9 Test Well 0 Other" _
Well Street Address NE Ridgetoo Ct
Consrrsetlo.Type: Method: --_ ---
■New well ❑Alteration ❑Driven ❑Jetted Si Cabk Tool City g6lfat County Mason
3 Lkepoung 0 Other 0 Dug 0 Air- 0\cud-Ronan Tax Parcel No. 12319-42-50010
Dimensions: Diameter of boring 6 in.,to 186 ft. Was a variance approved for this well? 0 Yes [J No
Depth of completed well 186 ft.
Construction Details: Wall if yes what was the variance for? —_--
Casing Liner Diameter From To Thickness Sled PVC Welded'Thread
L i 0 8 in. +2 181 1/4 in. N I 0 CI I C Location(see instructions on page 2): fn7 WWM or❑EWM
DID in. - - -in. ❑ 1 ❑ OIC
O 1 ❑ in. — _ in. ❑ 1 ❑ DID NW ',:'a of the SE V..;Section 19 Township 23 Range 1W
❑ 1 ❑ in. — _. _in. ❑ 1 ❑ ❑ i C Latitude(Example:47.12345)
Longitude(Example:-120.12345)
Perforations: 0 Yes §No Type of perforator used_ — —
I. No.of perforations___ Sin of pertoralions in.by ____is Driller's Leg/Construction or Decommission Procedure
Perforated from flu to ft.below ground sttr6tt l-omtatson:Describe by color,character.size of material and structure,and the kind and
L nature of the material in each layer penetrated.with at least one entry for each change of
Screens: •Yet ,1 No 111 K-Packer Depot 179 g_ information. Use additional sheets if necessary
3 Manufacturer's IName Ahoy Machine Wales Material From To
Ype Model No.
t^ Diameter 5 in. Slot stze22 in from t81 ft.to 186 ft. Brown Gravel 0 30
L
4- Diameter in. Slot size in.from i ft.to ft. Orange Gravel Moist
30 50 i
' Sand/FinerM pack:0 Yes ftto No Size of peck material_is Light Brown Gravel 50 95
Light Brown Gravel&Sand 95 1 p Materials placed from .to_ft 20
g 120 120
Gravel Dark Brown Swine, P1 Yes `I No To what depth?22 ft.
Material used in seal Bentonite Sand&Gravel w/Water 165. 186 {
Did any strata contain unusable water'' ❑Yes Q No
Type of water? Depth of strata
o Method of sealing strata off
C Pomp: Manufacturer's Name Type: -0
— --
H.P. Pump intake depth:_ft. Designed flow rase. rpm
0
3 Water Levels: land-surface elevation above mean sea level_ft.
Stick-up of top of well casing ft.above ground surface acro ---- -
e—
IStatic water level ft.below top of well casing Date
•' Artesian pressure Res per square inch Date RECEIVED
.' Anesian water is controlled by (cap,valve.etc.) _
L Well Tests: WELL CONSTRUCTION AND I LICENSING OFFICE at D NM»Aug 27,2020
L Was a pumping test performed'? 73 No .0 Yes =.::J by whom'? ` - y Yield_ gpm with_ft.drawdown after hrs. --
I"' Yield gym with_ft drawdown after hrs.
2 Yield gpm with_IL drawdown after hrs
tin Recovery data(time-zero when pump is turned on'--water level measured from well
g top to water level)
Tune Water Level Time Water level Time W atcr Level
'- -- -- --- --
u
tL Date of pumping test - --
O Bailer test 15 gm with I ft-drawdown after.' hrs.1
C Air test ,gprn with stem set at ft.for_hrs - Date ___ "- -'-
Artesian flow_win
temperature of water_"F Was a chemical analysis mate'' A Yes D No Start Nate 01120120 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 information reported above arc true to my best knowledge and belief.
4 al Driller 0 Trainee��"" 0 PE- ' t Name Jack Grande Drilling Company Davis Drilling
Signature 2 _� Address 340 NE Davis Farm Rd
License No. City.State,Zip Belfair,WA,98528
IF TRAINEE:Sponsor's License No. Contractor's
Sponsor's Signature Registration No. Dale 08/26/20
F.CY 050-1-20(Rev 011/19)lfrou need this document in an alternate fannat,please call the Water Resources Program at 360-407-6872.
Persons with hearing lass can call fl/for it as/u ngnm Relay Service. Persons with a.speech disabiliy can call R77433-6341.
Davis Drilling
340 NE Davis Farm Rd
Be!fair, 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'