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HomeMy WebLinkAboutWEC2023-00077 - WEC Application - 7/11/2023 ""�, iL 415 N 6T"STREET, SHEL rON,WA 98584 �L-- , MASON COUNTY SHELTON: 360-427-9670, EXT.400 ( r COMMUNITY SERVICES Ili ,' L. BELFAIR: 360-275-4467, EXT.400 l,. : ELMA: 360-482-52d9, EXT.400 \_ `„:/ Building,Planning,Environmental Health,Community Health BY• ---`-- FAX: 360-427-7787 yr�::.� .� / _ CONSTRUCT A WEL r NOTICE OF INTENT TO P��j ��njGajoi9 Permit Number— Payment Information Instr ions aC� 1. Complete Part 1. Incomplete applications will be re;ected WEC Receipt Number 3- 2. Attach a plot plan and vicinity map. Ci)10 `�`?J� 0 Cash 3. Submit this completed application with appropriate :be a minimum Q� 0 Check of 24 hours in advance of initiating well construction. Refer to -f Mason County Environmental Health fee schedule for ost. 0o Date of Payment `1 I[la3 4. Mason County Public must receive notification at least 24 hours G - prior to the drilling of the well. , PART 1: Applicant I Parcel Identification f Site Address N , S�/(Ore_ Start Card# VV'�j573' I Drilling Firm V i S D r j I i 1 tur Phone 3,00-t61-1/3,c Applicant pa r) Cius-- sh— NW W (cci i (.e. Phone Mailing Address 2522 N pl'y4O( . �� J 0 City 7 u f,,isovi State \N A Zip __ -F I 0 — Parcel Number 32, 1)129 0I L/Q Directions to Site \k1 ham} _ Cj CAA-e_ Rrk(o x YtkI.\-C vvokikzAr — — Is the well site within 100 feet of salt/seawater? plies INo If yes, a variance from DOE is required. Have you applied / received (circle one) a variance? Dyes (41No NOTICE:All proposed connections to new wells are subject to water adequacy requirements at time of building permit per Mason CoJnty Title 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19th, 2018 per ESSB 6091. MI\O-- Applicant/Agent Signature PART 2: Health Department Review (Staff Use Only) YES NO TAG # Called In ___t ❑ Driller on Site? �❑ ❑AO Is the well capped and Vented? ❑` ❑ Is there evidence of a surface seal? 1-4 f 6 7: LH 371 yjz ❑ ❑ Is there a 2" annular space on all sides of the casing? /' ❑ ❑ Has the seal slumped? Cc'?) , - (Z3,07K5 ❑ ❑ Is the well flowing or is there evidence of other leakage? ❑ ❑ Is there evidence of cascading water? ❑ ❑,.,t, Is there evidence that the seal is at least 18 feet long? X ❑ Do the well site set-backs appear to be appropriate? Comments 56 �/` i (,Pass El /�Fail Inspector Date l S(w) This form may be scanned and available for public view on the Mason County Web site. Revised:2/7/2018 i A I • a i a • J • a 1 a • U 2 0 I N } f k Q • O !II rt W f • O O 4 r D i i g. -4. r y� ; II •5 Q C ! • Z '5 . a , /.! Q Lo CV Lli Z IQ 0 0 i ef . , . 71 yT •6 M a o X cb • j ,� • V? co N t t'1 co • • f • C V I 111 O d o J v • O LZ' • It> C o s � r U J. 0 .— ,t,- o N Q 2 i }. -7 f0 v M E CVcv 'm i a 0 ©0 ■■ N a L Pss- j-05iec- ?It MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 •, SHELTON:360-427-9670,EXT 400 k. BELFAIR:360-275-4467,EXT 400 r Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 WELL PERMIT: CONSTRUCTION OF NEW WELL WEC2023-00077 APPLICANT NORTHWEST LOGGING COMPANY LLC Phone: 253-722-4366 Address: 2522 N PROCTOR #15 TACOMA, WA 98406 OWNER NORTHWEST LOGGING COMPANY LLC Phone: 253-722-4366 Address: 2522 N PROCTOR#15 TACOMA, WA 98406 WELL DRILLER DAVIS DRILLING Phone: 360-801-6107 Address: 340 NE DAVIS FARM RD BELFAIR, WA 98528 DOE Start Card: WE53114 Well Tag (if avail.): Well Site within 100ft of saltwater? No DOE Variance? Site Address: 26141 NE North Shore Rd Primary Parcel Number: 323332290140 Contractor/Driller: DAVIS Date Received: 07/11/2023 Date Requested: 08/02/2023 Date Inspected: 07/25/2023 Inspected By: David Anderson Inspection Status: DONE Inspection Results: Is there a 2"annular space on all sides of the casing? N/A Is there evidence of cascading water? N/A Was the driller on site? YES Is the well flowing or is there evidence of other leakage? N/A Is there evidence that the seal is at least 18 feet long? N/A Has the seal slumped? N/A Is there evidence of a surface seal? N/A Comments/ Summary: Lat: 47.4437182 Lon: -123.0785707 Proposed well site is 56'from creek. Not all requested well construction inspections are inspected by Mason County staff. If Inspection status reads "Not Inspected", it means an inspector was not available at time of construction and therefore no actions are observed. This should not be confused as an unsatisfactory or failed permit. 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 19th, 2018 per ESSB 6091. This form may be scanned and/or available for public view on the Mason County web site and/or public portal MASON COUNTY 415 N 6TH STREET, SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 r4: BELFAIR:360-275-4467, EXT 400 Public Health & Human Services ELMA:360-482-5269, EXT 400 FAX:360-427-7787 Is the well capped and vented? N/A Is there evidence of improper well siting or sources of NO contamination? Comments/ Summary: Lat: 47.4437182 Lon: -123.0785707 Proposed well site is 56' from creek. Not all requested well construction inspections are inspected by Mason County staff. If Inspection status reads "Not Inspected", it means an inspector was not available at time of construction and therefore no actions are observed. This should not be confused as an unsatisfactory or failed permit. 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 19th, 2018 per ESSB 6091. This form may be scanned and/or available for public view on the Mason County web site and/or public portal