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Home My WebLink AboutWEL2023-00007 - WEL Application, Design, Letter - 3/7/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 400 98 584 SHELTON:360-427-9679670 EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA 360-482-5269,EXT 400 FAX:360-427-7787 POTVIN MARK JOSEPH & MICHELLE DENISE 2617 22ND AVE SOUTH SEATTLE, WA 98144 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00007 1161 SE Somers Dr 220315000072 The 2-party water system, Well 22031-50-00072, has been reviewed and is hereby APPROVED for 2 connections. Please continue to follow best management practices with maintaining your water i 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 Sincerely, I David nderson Mason County Environmental Health Dale Received: MASON COUNTY 73 " .s COMMUNITY SERVICES Amount Received., R Received By Plam )L . E h ,�• Building, m�q,Emiron mental Community Health �, 1<11.111'IY'.�1 415 N.6°Street,(Bldg 8)—Shelton,WA 98584 W E L 7,' z j — 0 06 7- Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elm:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Mark Potvin 206-890-4615 MAILING ADDRESS—STREET,CITY,STATE,ZIP 2(e 1 � - E. A �1 �F\(A_ SITE ADDRESS—STREET,CITY,STATE,ZIP 1161 SE Somers Dr.Shelton,WA 98584 PRIMARY PARCEL NUMBER(WELL SITE) 22031-50-00072 SECONDARY PARCEL NUMBER(IF APPLICABLE) WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE ❑New 0 Existing 0 Well ❑ Spring 2.5 acres PROPOSED WATER SYSTEM NAME(REQUIRED) Well 22031-50-00072 PROJECT DESCRIPTION Addition of a new ADU to the existing well used for existing residence on site DIRECTIONS TO SITE/CONDITIONS From downtown head south on HWY 3.Turn L onto E Arcadia Ave. E Arcadia becomes SE Arcadia Rd.Turn slight right onto SE Lynch Rd. Turn L onto SE Totten Shores Dr.Turn L onto SE Somers Dr. Destination on the R"1161"on old white post @ driveway Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septiGsewer components and lines,easements,etc...) See attached site plan Submittals Checklist: (these additional items will be required for approval) Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) 0, 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: 1/17/2019 Page 1 of 2 Staff Use Only Review Step 1: Well Site Inspection: YES NO NA sp+i, TW S of Gy' aj ❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) 40 ❑ ❑ Are there roads within the 100 foot radius of the water source?If so, is roa• , ounty or State. What is distance to ROW? ff l J ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) p ❑ 0 Is the well cap satisfactory? ❑ ❑ ® Screened and vented? `, ❑ The well casing extends 5.S above level ground I oncrete slab (circle one) ❑ ❑ Is there evidence of a surface seal? `a f; 4 7 i 70f812 F] ❑ ❑ Does the seal appear adequate? 1.011; _ I r Z . U6n 7- ❑ Cl Is a variance necessary for well site approval? TGy : 11 ] Comments WI d irr orc e &act shed w��h cen �'br ", s s u((at41 Q t Z above, cPf ct. ,"1r' M is v / r floor a� Barre aa��e by y �� ! y 1,r.to no evd e c of wu L y r1?ii'usirrt� ? • I] Pass ❑ Fail Inspector A.,..-- Date �/J //0 V Review Step 2: Two-Party Review: YES NO NA ❑ Y"' ❑ Water Well Report with adequate pump test on file? /) / If NO, date of Capacity Test l?/ Z I /ZOZZ Driller A(C6G1i(4 Orci 1 1/I( GPM / 6'S ❑❑ Received Satisfactory Bacteriological Analysis? Date of test Li '(3 l43 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2t y�716 X ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments M Approved ❑ Denied Reviewer ADate C(f Z/Z'7ij 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/9''', 2018 per ESSB 6091. This form may be scanned and available for public view on the Mason County Web site. Revised: 1/17/2019 Page 2 of 2 i 2193736 MASON CO WA 02/13/2023 01 28 PM NOTCE 1111111111111111111111 R III I I I��Ilpl III Illp!III�i Ill Return To. 0 2C4,\-4 ZZ p4- fwe `2 . A .� . uo,A, et70,-ka NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I(We)the undersigned,certify that the water source located on parcel situated in Mason County.State of \1 ashington,herein described Totten Shores 73 OR Subdivision Division Lot Range Township Section And having the Tax Parcel Number of 22031 __ 50 __ 00072 Has been designated to serve a source of water to the following parcels situated in Mason County,State of Washington,herein descnbed (abbreviated legal description and tax parcel numbers(s)of property(ies)affected) Totten Shores 71-72 OR Subdivision Division Lot Range Township Section And having the Tax Parcel Number of 22031 __ 50 __ 00072 Totten Shores 73-74 OR Subdivision Division Lot Range Township Section 22031 50 00072 And having the Tax Parcel Number of — -- The system owner is responsible for keeping this system in compliance The name of the system is Well 22031-50-00072 This system is designed to provide for two services. Planning and design approvals must be obtained from the department prior to expanding beyond this number of services.Additionally, a water right, I obtained from the D:.a ••-.t of Ecology,is required if the water system exceeds exemption standards I This syste :s/ •-. not)been granted one or more waivers from specific provisions of the reg rjatlon;il ri -� S„t Signature State of Washing on ) County of Mason ) I tv7ndersigned, ota P Cere1"h11•\HAt ve na d County arid State.do hereby certify that on this day of . ,il• ��l/ personally appeared before who is known to be sane tl ' ••' :n 8/ff �t,an acknowledged that he(she)(they)signed it under my hand arIFoftic day., y1iar last above wntten i Z 's L�6 qe t; c Ir a� r.1he of Washington i ,cs,�bd>� s+!` = residing at I/L ��y gill ///,� r,",dka1`N o\s�.',�-�`_ My commission expires 7-C_ti.gil iiii/t°4l°tM1N d l- J 4 74.amier Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer: Mark Potvin Well Tag#: N/A Phone: 206-890-4615 Depth: 143.5' Well Site Address: 1161 SE Somers Drive, Shelton Pump Set: 135' Date of Test: 12/21/2022 Static 115.8' TIME GPM LEVEL RECOVERY 1 Min 5.0 120.0 TIME LEVEL 2 Min 5.0 120.5 1 Min 119.9 3 Min 7.5 121.2 2 Min 119.4 4 Min 7.5 121.5 3 Min 119.0 5 Min 7.5 121.5 4 Min 118.6 6 Min 12.0 121.5 5 Min 118.4 7 Min 12.0 123.3 6 Min 118.2 8 Min 12.0 123.6 7 Min 118.0 9 Min 12.0 123.8 8 Min 117.8 10 Min 16.5 123.8 9 Min 117.6 15 Min 16.5 124.5 10 Min 117.4 20 Min 16.5 124.5 25 Min 16.5 124.5 30 Min 16.5 124.5 35 Min 16.5 124.5 40 Min 16.5 124.5 45 Min 16.5 124.5 50 Min 16.5 124.5 55 Min 16.5 124.5 1 Hr 16.5 124.5 Ott, Thurston County Environmental Health 2000 Lakeridge Dr.SW •Olympia,WA 98502 360 867-2631 E THURSION COUNTY COLIFORM BACTERIA ANALYSIS APR 1 4 2023 Date Sample Collected Time Sample County l J 7-3CCollected RECEWED -�c Nu Ml:•Is/4 PM Month Day Year Type of Water System(check only one box) 24 Private Household ❑Group A ❑Group B ether ` FP►Q' Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Contact Person:�R k ‘337‘,/)4.4 Day Phone:(200, gqp.Li(Q‘ Cell Phone:( Send results to:(Print full name.address and zip code or email address) SAMPLE INFORMATION Sample collected by(name): P Specific location or address where sample collected: Special instructions or comments: Type of Sample(must check only one box of#1 through#4 listed below) 1. Routine Distribution Sample 2.Repeat Sample(after unsat.routine) Chlorinated:Yes No 0 Distribution System Chlorine Residual:Total_Free_ Chlorinated:Yes No 3.Raw Water Source Sample Chlorine Residual:Total_Free ❑E.coli—GWR(A/P) ❑Fecal—surface.Owl.springs(numeration) Unsatisfactory routine lab number: Filtered:Yes No ❑Assessment Monitoring(AP) Unsatisfactory routine collect date: ❑Other / I S 4.0 Sample Collected for Information Only Investigative _ Construction 1 Repairs_ _ Other _ LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and Satisfactory ❑E.coli present ❑E.coli absent o Coliform detected Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑__ Bacterial Density Results:Total Coliform ____/100m1. E.coli 1100m1. Fecal Coliform /100m1 Enterococci 1100 ml. Method Code: SM 9223E OSM 9222D Date and Time Received: 0 SM 9215E ❑Enn7terolert® L�• 'Z"1i3 Date and Time Analyzed: 4• • ` Z- v27 Dale RepoA4-13 l?y 34-1-- Sample Number(DOH number plus rive dgils) Lab Use Only: 0 8 0 -z D -ThO DON Form 0331-319(revised 011t6)C=tS � 3o1 1O j.).U. INVOICE i 15) d .11.! % . 3P47(6 DATE: 12/22/2022 DUE DATE: 01/21/2023 INVOICE# 38400-1 Arcadia Drilling Inc.Po Box 1790A1110./ Shelton, 60 98584 26-3Phone:(360)426-3395 //(C.a.,,,44•Pvizi„,:s'// 4,„41/ Email:sue@arcadiadrilling.com Wil b/ BILL TO: SERVICE TO: Mark Potvin Mark Potvin 2617 22nd Avenue South 1161 Southeast Somers Drive Seattle,WA 98144, United States Shelton,WA 98584, United States ITEM DESCRIPTION QTY PRICE PER UNIT AMOUNT TAX PUMP SERVICE CALL SERVICE CALL-FLAT RATE- 1.00 $275.00 Item $275.00 Y COVERS UP TO 1ST HOUR ONSITE-SITE VISIT ON 12/16/22 PUMP ADDTL SERVICE CALL FOR 5.50 $195.00 Item $1,072.50 Y HOURS ADDITIONAL HOURS ONSITE PUMP-1.5HP 18GPM 1.5HP 18GPM SUBMERSIBLE 1.00 $1,914.00 Item $1,914.00 Y PUMP AND MOTOR DROP PIPE- 1.25 1.25 SCH 120 PVC DROP PIPE 135.00 $11.00 Item $1,485.00 Y SUB WIRE 10/3 SUBWIRE W/GROUND 10/3 140.00 $2.82 Item $394.80 Y TANK TEE TANK TEE ASSEMBLY 1.00 $389.00 Item $389.00 Y ASSEMBLY CONTROL BOX- 1.5HP 230V CONTROL BOX 1.00 $263.00 Item $263.00 Y 1.5HP 230V 1.25'CHECK VALVE 1.25'BRASS CHECK VALVE 1.00 $113.00 Item $113.00 Y WELL SEAL WELL SEAL 1.00 $88.81 Item $88.81 Y 1' Ball VLV. NL. T-1002 1"BRASS BALL VALVE 3.00 $30.36 Item $91.08 Y FxF TANK PRESSURE TANK-H2P120 1.00 $1,809.64 Item $1,809.64 Y MISCELLANEOUS MISCELLANEOUS PARTS FOR 1.00 $300.09 Item $300.09 Y UPGRADE _ SUBTOTAL $8,195.92 TAX RATE" 8.5000% TAX $696.65 OTHER - TOTAL $8,892.57 PAID $8,892.57 11 BALANCE $0.00 0 I 1. OVERALL PLAN SCALE:1"=w.-0" (E)WELL HOUSE s -®: 100WELL RADIUS— D1dERS.DR' /1,`A , (E)GRAVEL DRIVE- SE S .. ,.. �j �� ji ' PAD 0460°. sE S°. . ` i d lb 411A-40 \'-- - • tiie..a, dry '''.''1*114CM-le-N"Erk • t4W .0 4, ;`4t,.:• - .>_....:....,...„ ' ,.... .si. r&I Fairi...0.1-1. .-to. es/ --1W.ZI,PS°.5,,,/ ,.',% ii 41147417 _ _ ---- it 1001,,.... ...46,0, \\ n,_, _----- - Ntakedg&PPA .--) \\__I± 0 „4442 iilLitli '41.. -.. ,, '' I ---.., \,,,4 i. 1; I- ra414410 ..--- ,0'.- -'1-1 I N,-:4, ."r* _ / PROPOSED AD (E) }� �;. ' A WOOD SHED T 'BE Si ® , l��; REMOVED `' TOP OF BLUFF 1 h . • }-�� „.,,m,s b h, DEMASON nCOUNTY GIS (E)RESIDENCE& 70 DECKLOT 71 LOT 72 ,.T 73 LOT 7' (E)SE 11 AND DRAIN S L gVE'� II / I 1 P14 C Y TCpCGRA ICHE�LE Pp^VIN I R . S4oFES2 MA 71-76 131' (E)SHP1EUNE tiff DELI ARONPER PARCE-SITE o. 220 ADS ERS DR MASOI COUNTY GIS 1161 5E SOpA 905" II / A 20-0 SETBACK 5HEy1 20�1 SETBACK- a� TOTTEN INLET 2047SETBACK 5L 0 ER NC ��„_.. u.'i . . ..w.WA sM-\— uM . \ v240'-0' oi