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HomeMy WebLinkAboutWEL2023-00028 - WEL Application, Design, Letter - 5/9/2023 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 Barber, Michael and Eva 1420 W Cloquallum Rd SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00028 1420 W Cloquallum Rd 320303290012 The 2-party water system, Barber Water System, 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 Sincery, David Anderson Mason County Environmental Health 1411161111484- �R`�S 4,y� Date Received �� Vorir . MASON COUNTY ;w 7 a3 COMMUNITY SERVICES Amount Received: Received By: 1m' � 1 Buldmg,PlanningEnvronmental Health,ConNnunity Health•H['1YY� 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L 20 2 3 - 000 2 e Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT Michael and Eva Barber PHONE 360-628-49 MAILING ADDRESS-STREET,CITY,STATE,ZIP 1420 W Cloquallum Rd, Shelton, WA 98584 SITE ADDRESS-STREET,CITY,STATE,ZIP 1420 W Cloquallum Rd, Sheltoon, WA 98584 0 �� PRIMARY PARCEL NUMBER(WELL SITE) 320303290012 SECONDARY PARCEL NUMBER(IF APPLICABLE) 320303290011 WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE P L 2 L ❑ New 121(1?xisting CC Well 0 Spring 1.04 1. PROPOSED WATER SYSTEM NAME(REQUIRED) BARBER WATER SYSTEM PROJECT DESCRIPTION TWO-PARTY WELL DIRECTIONS TO SITE/CONDITIONS FROM DOWNTOWN SHELTON, TAKE LAKE BLV, CONTINUE TO W CLOQUALLUM RD AND TURN RIGHT AT 1420 Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius, driveways,roads,septic/sewer components and lines,easements,etc...) ATTACHED 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 • w Staff Use Only .96116:017:611:. -ate, Review Step 1: Well Site Inspection: - 5k-4° gi- 6l - rfoUb , 9/ b YES NO NA — Seph2,fiu4 K 6b — Vicori€ tc( 7 I Z S 4 ❑ ❑ 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 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? r ❑ The well casing extends l 7 above level ground I concrete slab? (circle one) [Z ❑ ❑ Is there evidence of a surface seal? (-*' LIT. 1136 7-13 ❑ 100: - in, llsr?86❑ Does the seal appear adequate? TCIG, E mT IS6 El ❑ Is a variance necessary for well site approval? J Comments Pass ❑ Fail Inspector Date 5//6 (wZ3 s rurwr.rruw v��r - Review Step 2: Two-Party Review: YES NO NA yr ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test Driller GPM 4 ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test .7/ IS./ZOZ L Y�J ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Zf'C9(t pl. ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments Approved ❑ Denied Reviewer Date 1/1/W z3 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 2196914 MASON CO WA 05/09/2023 12.25 PM NOTCE BARBER #186680 Roc Fee. $204.50 Pages. 2 Return To I Iliii IIIIII I III III011 IIIIII IOP IIII IMlI IIIII I III 11111 IIIII 101 IIII NI tL ►4-4EL Z . 3 A28 F 1(L 1 y 20 w C. 61 &ALL-u ni k 1) S 4 L.Tu w1 wA �1�AL4 Grantor(s): (1) P ICH14EL J2. 1-311R13ER , (2) E1!A , L . 0,R2r3E12 Grantee(s): (1) PUBLIC Legal Description (1) TR I O1= lJi4 3v'l LOI Z OF S? It 2 54 a5 51/149 (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 3 2 0 3 U - 3 L - `) O 0 1 2._ 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) 3 0 3 0 -, 3 L - j 0 0 I 2— Tax Parcel: (Connection 2) 3 Z. v 3 0 - � L - 0 0 I 1 The system owner is responsible for keeping this system in compliance. The name of the water system is: &4R3E:A WATER 5Y5Tt N1 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. I This system (has/ has not) been granted one or more waivers from specific provisions of the regulations. Dated on this 9 day of 16/1 11- 1.i , 2o2. 3 . Signat re of Grantor(s): (1) / i ti P re _ , (2) ;2>f,) Gr -# 4 Page 1 of 2 4 State of Washington County of Mason I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this ot day of VV1C01 , 2003 , ,kAlCOp6 3 ENc., 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`,•••<ssionF.�/� Notary Public in and for the State of Washington, residing at 5)1p W. @jack v r10TARY = My commission expires: Li- 10- '�,0 U" .."6 BLIC ' .!'UM be< .••••' Page 2 of 2 ' 4 . I Vanguard Laboratory 2635 Parkmont Lane SW Olympia,WA 98502 360.967.7010 VANGUAlt Report of Laboratory Analysis LABORATORY Collected by: American Pump and Drilling Matrix Drinking Water 360-754-7867 Laboratory ID: V220714-1 Sampling Address: Date Sampled:7/13/22 16:30 1430 Cloquallum Rd Date Received: 7/14/22 8:30 Shelton,WA 98584 Date Reported: 7/15/2022 Sample ID: 1430 Cloquallum Rd Analysis Result SDRL MCL Units DF Date Analyzed Total Coliform&E.coli by SM 9223B(IDEXX) Batch ID:V220714-I Analyst:V! # Coliform,Total Negative 1 I MPN/I00 mL 1 7/14/22 15:00 E.coli Negative I I MPN/100 mL I 7/14/22 15:00 Nitrate by EPA Method 353.2 Batch ID:V220714-I Analyst:RS Nitrate(as N) ND 0.20 10.00 mg/L 1 7/14/22 10:05 Notes: MPN:Most Probable Number ppm:parts per million ad:non-detect Reviewed by Robert Smalling,Chemist on 07/15/2022 n/a:not applicable SDRL:State Detection Reporting Limit Approved by Tori Johnson,Operations Manager on 07/15/2022 DF:Dilution Factor MCL Maximum Contaminant Level Page 1 of I Samples were recieved in acceptable condition.The result(s)in this report relate only to the portion of the sample(s)tested.All analyses were performed consistent with the Quality Assurance program of Vanguard Laboratory.Please contact the laboratory if you should have any questions about the results. 2635 Parkmont Ln SW,Suite A,Olympia WA 98502 I Office:360.967.7010 I testingta�vanguardlaboratory.com I www.vanguardlaboratory.com • WATER WELL REPORT ,INENEDEPARTMENT OF Notice of intent No. WE48258 ECOLOGY Unique Ecology Well ID Tag No.BMT 156 Type of Work: 11410 Stale of Washington Cl Construction Site Well Name(if more than one well): ❑ Decommission r=> Original installation NOI No. Watcr Right Permit/Certificate No. Proposed Use: I±1 Domestic U Industrial 0 Municipal Property Owner Name Mike and Eva Baber ❑Dewatering Ll Irrigation ❑Test Well 0 Other Well Street Address 1430 Cloauallum Road Construction Type: Method: El New well ❑Alteration ❑Driven 0 Jetted 0 Cable Tool City Shelton County Mason Deepening ❑Other 0 Dug ®Air- ❑Mud-Rotary Tax Parcel No. 320303290012 Dimensions: Diameter of boring 6 in.,to 219' t, Depth of completed wall 218-6' ft. Was a variance approved for this well? ❑Yes ElNo If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread © 1 0 6' in. +2 213' 1/4 in. ❑a 1 0 1st I ❑ Location(see instructions on page 2): 0 WWM or©EWM ❑ I ❑ in. in ❑ I ❑ ❑ I ❑ NW 'it-A of the SW A;Section 30 Township 20N Range 3W 0 I ❑ in. _ _ in. ❑ 1 ❑ ❑ 1 ❑ ❑ I ❑ in in ❑ 1 ❑ ❑ 1 ❑ Latitude(Example:47.12345)47 19366 Longitude(Example:-120.12345) 123.11567 Perforations: 0 Yes 0 No Type of perforator used perforations Size of No.of perforations in.by in. Driller's Log/Construction or Decommission Procedure Perforated from ft.to ft.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: C■1 Yes 0 No Cl K-Packer : Depth 212' n. information. Use additional sheets if necessary. Manufacturer's Name Johnson ' Material From To Type SS Tele Diameter 5 in. Slot size 12 in.from o212' p.to 218' ft. CLAY,LOAM W/GRAVEL (BRN) 0 3 Diameter in. Slot size in.from ft to ft. GRAVEL&CLAY HARD (BRN) 3 44 Sand/Filter pack:❑Yes O No Size of pack material in. CLAY,SILT,GRAVEL,SAND (BRN) 44 57 Materials piesd from ft.to ft. GRAVEL,CLAY,SILT.SAND (BRN) 57 73 Surface Seal t7 Yes ❑No To what depth?18 EL GRAVEL,SAND,CLAY TP (LT.BRN) 73 98 Material used in seal Bentonite CLAY,GRAVEL,SAND (GREY) 98 108 Did any strata contain unusable water? ❑Yes l No GRAVEL,CLAY,SAND,TP (GREY) 108 111 Type of water? Depth of strata CLAY,GRAVEL,SAND,TP (GREY) 111 119 Method of scaling strata off PEAT (DK BRN) 119 122 SILTY CLAY (GREY) (BRN) 122 133 Pump: Manufacturer's Name Type: SILTY,CLAY,SOME GRAVEL 133 148 196 ELP. Pump intake depth: ft. Designed flow rate: gpm GRAVEL,CLAY,SOME SAND TP (BRN) 148 Water Levels: Land surface elevation above mean sea level ft GRAVEL AND SAND TP W/B (BRN) 196 219 Stick-up of top of well casing ft.above ground surface Static water level 171'-1' R.below top of well casing Date 6/3/2022 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No I 1 Yes : ) by whom? Yield gpm with fl.drawdown lifter hrs. Yield gpm with ft.drawdown utter hrs. Yield gpm with ft.drawdown after hrs. Recovery data(time—zero when pump is turned off—water level measured front well top to water level) Time Water Level Time Water Level Time Water Level Date or pumping test Bailer test gpm with ft.drawdown after hrs. Air test 15 gpm with stem set at 210 ft.for 1 hrs. - Date 6/3/2022 Artesian flow gpm _ Temperature of water "F Was a chemical analysis made? ❑Yes ❑No Start Date 6-2-22 Completed Date 6-3-22 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 arc true to my best knowledge and belief. 1 Driller 0 Trainee 0 PE— . tN a Dan Carpe ter Drilling Company TIMS Well Drilling Signeiurel n Address PO Box 14996 License No.2236 City,State,Zip Tumwater,WA 98511 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No,TIMSWWD834DN Date ECY 050-1-20(Rev 11/18) 1f 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. .... . , . .. toil, 4 Property SCALE-1"=40'-0' ,, L:s\\.\\ _____. a IIIIIhhl" . �\ a. oaa r 1 • ® 0 PARcE1 : 5LO30 2.9 0tl 300' O 0 a► REM IS GROUND EL -� - 205' - i- - -- 'a 20' 0 0 0 _ WNW �i„ r 50' `��\ os i tao CIP 1 O 6 O V O --- �=-- 0 I 110' — -4 126' - //�OSCARORMA� !" / CJ / 1 k . © / O / 88 It. t a J �► _ _ Sao<� O 1 61' I t hh�RCE L;3L0�O 32� nO I I O PROPOSE.`. — O PROPOSED WELL - -----_ O PROPOSED STUBOUT CLEANOUT(IE •9J 0 -- O SEPTIC TANK(IN.EL -96 S'OUT EL - 21 8 10 feet by 20 feet well house/shed with electric and O PUMP CHAMBER(PUMP EL--93 plumbing for pressure and water treatment tanks 020'-2'PVC TIGHTLINE(SCM40) 8 Contour lines O PROPOSED VALVE BOX(IE •99 0:, O PROPOSED DRAINFTELD AREA 0 SOFT DOWNSLOPE AT TENUAT ION ZONE