Loading...
HomeMy WebLinkAboutWEL2023-00042 - WEL Application, Design, Letter - 7/25/2023 415 N 6TH STREET,SHELTON,WA 98584 MASONCOUNTY SHELTON:360-427- ,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 WILLIAMS RANDALL T & DESIREE C 1570 E GRAPEVIEW LOOP RD GRAPEVIEW, WA 98546 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00042 1570 E Grapeview Loop Rd 221132400030 The 2-party water system, Well @ 1570 E Grapeview Loop Rd, 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 360-427-9670 Ext.353 or email at danderson@masoncountywa.gov Sincerely, avid Anderson Environmental Health Specialist Mason County Environmental Health • ' MASON COUNTY Date Received: It 4. 17 COMMUNITY SERVICES Amoutets Receiv • Mb Building.Pknninq Environmental Health,Community Health 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L43.0,1:q otsoist4 Shelton: 360-427-9670 x400 Belfair 360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Randall Williams 360-584-5686 MAILING ADDRESS-STREET,CITY,STATE,ZIP 1570 E Grapeview Loop Rd SITE ADDRESS-STREET,CITY,STATE,ZIP Grapeview, WA 98546 PRIMARY PARCEL NUMBER(WELL SITE) 22113-24-00030 SECONDARY PARCEL NUMBER(IF APPLICABLE) WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE ❑ New 0 Existing 2 Well ❑ Spring 4.7 ac PROPOSED WATER SYSTEM NAME(REQUIRED) Well @ 1570 E Grapeview Loop Rd PROJECT DESCRIPTION ADU project 2023 DIRECTIONS TO SITE/CONDITIONS From HWY 3 turn east on the south end of E Grapeview Loop RD 1.5 miles to 1570 E Grapeview Loop Rd. Property is on the corner of E Grapeview Loop Rd and E Stadium Beach Rd W. Site Plan: (may also be attached) (property boundaries.structures,well site w/100'radius,driveways,roads,septic/sewer components and lines. easements,etc...) Please see attached. JUL 2 62023 rn RECEIVED t T C H `sJ .JUL 2 5 2023 19- By Submittals Checklist: (these additional items will be required for approval) O Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) O Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) O Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) O 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 mew —Staff Use Only ---------Review Step 1: Well Site Inspection: YES NO NA ❑ K ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings: indicate distance on plot plan) ❑ KElAre there roads within the 100 foot radius of the water source? If so, is road private, County or State. What is distance to ROW? I, ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) 'MI ❑ ❑ Is the well cap satisfactory? i ❑ ❑ Screened and vented? ❑ The well casing extends / above level ground /concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? ❑ ❑ Does the seal appear adequate? 01 `® ❑ Is a variance necessary for well site approval? Comments L f 7 3 O Gj S i� -. c o q `/Co pf Pass ❑ Fail Inspector 7 1� Ul-„ Date 2- - Review Step 2: Two-Party Review: YES NO NA y ❑ ❑ Water Well Report with adequate pump test on file? ! I vI If NO, date of Capacity Test Zoos Driller 4Cacetti' &i1fthr� GPM I Z /If ❑ El Received Satisfactory Bacteriological Analysis? Date of test (IF 77�.3 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2 ro ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments "I Approved ❑ Denied Reviewer Date cl 7( /703 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. i Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 1-77.11=mimillimilimillimmi Thurston County Environmental Health 2000 Lakeridge Dr. SW 4 Olympia,WA 98502 Ea\ 360 867-2631 • THURS ON COUNTY varommummi COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County �.. Collected L'7 / 17/ LcZ5 /l �AM Ll—Montn Day Year : I \ CI PM 7 j4 Type of Water System(check only one box) ( Private Household ❑Group A ❑Group B ❑Other Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# System Name: 0 /S 7D g Ovt.Vaict,si i-P .'gyp Contact Person: i '0}t-c- Get•LL 1.4- fi'lS Day Phone:(AO ) ..P`/._ 5 6, b'la:' Cell Phone:( ) E-mail: iAi/IL-{.:.(l r�i l i;wil")y1,4 01,1€ye.Phone:( ) t' 11 Send results to:(Print full name,address and zip code or email address) jLC 15-7 � E (,�u1EZ4/ 44,04)' f SAMPLE INFORMATION Sample collected by(name): 7Z*t) L Gvl(-it,.4'0.3 Specific location or address where sample collected: Special instructions or comments: .-TH R-:.1.1 siN4 it Type of Sample(must check only one box of#1 through#4 listed below) 1NILRoutine Distribution Sample 2.Repeat Sample(after unsat.routine) C brinated:Yes No ❑Distribution System Chlorine Residual:Total Free Chlorinated:Yes No 3.Raw Water Source Sample Chlorine Residual:Total Free El E.coli-GWR(A/P) ❑Fecal-Surface.GWI,springs(numeration) Unsatisfactory routine lab number: Filtered:Yes No ❑Assessment Monitoring(A/P) Unsatisfactory routine collect date: ❑Other / / S 4.0 Sample Collected for Information Only Investigative Construction/Repairs Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and Satisfactory ❑E.coli present ❑E.coli absent o oliform detected Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑ Bacterial Density Results:Total Coliform /100m1. E.coli /100m1. Fecal Coliform /100m1 Enterococci /100 ml. Method Code;<SM 9223B ❑SM 9222D Date and Time Received:tkl- ❑SM 9215E ❑Enterolert0 I - j H-5 Date and Time Analyzed: -kJ- Z Date Reported:7 Sample Number(DDH number plus five dQgits)Q Lab Use Only: 0 8 0 . 2> 881 DOH o #331.319(revised 1/16) 'Zca.sVI 3i2 o52_ • 0 CL ' a) _ WATER WELL REPORT CURRENT Cl.) Notice of Intent No. WE05348 ,l„„ ,,, ,l, Original&1"copy-Ecology,2"'copy-owner,3'dcopy-driller i 1 0 1 0 G i Unique Ecology Well ID Tag No. ALJ503 N Construction/Decommission("x"in circle) .,c El Construction Water Right Permit No.EXEMPT WELL ♦I 0 Decommission ORIGINAL INSTALLATION Notice Property Owner Name ROY&JULIA BUNNELL O 4R d 3� of Intent Number • Well Street Address GRAPEVIEW LOOP ROAD/STADIUM BEACH C PROPOSED USE: Domestic ❑ Industrial . ❑ Municipal City GRAPEVIEW County MASON O ❑DeWater ❑Irrigation ❑Test Well ❑Other__ I -- Location SE 1/4-1/4 SW 1/4 Sec 13 Twn21N R2W ;M ❑ check CI TYPE OF WORK: Owner's number of well(if more than one) WWM O one E m New well ❑Reconditioned Method r['Dug ❑Bored 0 Driven (Lat/Long(s,t,rDeg Lat I,at Min/Sec El Deepened 0 Cable m Rotary El Jetted 0 it DIMENSIONS: Diameter of -__-_ inches,drilled 220 ft. Still REQUIRED) Long Deg Long Min/See C Depth of completed well 220 _ _ ___ _R a) CONSTRUCTION DETAILS --Tax Parcel No.221132400030 t Casing m Welded 6 " Diam.from 2 ft.to215____ft. .f.+ Installed: ®Liner installed " Diam.from ft.to ft. CONSTRUCTION OR DECOMMISSION PROCEDURE I.- Threaded • " Diam.from ft.to ft. --- Formation: Describe by color,character,size of material and structure,and the kind and O Perforations: El ONO nature of the material in each stratum penetrated,with at least one catty for each change of 75 • Type of perforator used information. (USE ADDITIONAL SHEETS IF NECESSARY.) RC ' SIZE ofperfs in.by in.and no.ofperfs from ft.to ft. MATERIAL FROM TO Screens:• m Yes ❑No m K-Pac Location 212 BROWN SAND 0 6 CCI -I-1 Manufacturer's Name JOHNSON BROWN SILT BOUND SAND AND GRAVEL 6 32 t13 Type SLOTTED , Model No. GRAY SILT BOUND SAND AND GRAVEL 32 70 ❑ Diam 5 Slot size.014 from 215 ft.to 220 ft t l Diam. __Slot sire from ft.to ft. GRAY SILTY CLAY,WET 70 94 S Gravel/Filterpacked:❑Yes m No ❑Size ofgravel/sand BROWN SILTY PETE 94 96 4-I Materials placed from ft.to _ft' • GRAY SILT 96 155 r • Surface Seal:©Yes ❑No 'To what depth?20 _ft. BROWN SILT 155 165 Material used in seal BENTONITE CHIPS GRAY SILT,GRAVEL,WET 165 178 • iDid any strata contain unusable water? El Yes m No BROWN SILTY SAND 178 185 as Type of water? Depth of strata BROWN SAND,GRAVEL,WET 185 212 Method of sealing strata off GRAVEL,SOME SAND,WATER 212 220 PUMP: Manufacturer's Name O Type: H.P. - Z WATER LEVELS: Land-surface elevation above mean sea level Il. O Static level 143 ft.below top of well Date 9/6/06 C) Artesian pressure lbs.per square inch Date O Artesian water is controlled by (cap,valve,etc.).----------------------- WELL TESTS: Drawdown is amount water level is lowered below static level Cr) Was a pump test trade?❑Yes is No If yes,by whom? Yield: gal./min.with • ft.drawdown after hrs. O Yield: gal./min.with ft.drawdown after hrs. 0 Yield: gal./min.with ft.drawdown after__ hrs. LIJ Recovery data(time taken as zero when pump turned off)(water level measured from well 4-• 'top to water level) y--� gg O Time Water Level Timc Water Level Time Water Level tt-1! ��C K-"n B 7 4-I li T tl,,..,@._.s y:._.II 'k .e--_, ' C --- E Date of test OCI 1 6 Cui6 LBailer test gal./min.with ft.drawdown after hrs. • CO Airtest 12 gal./min.with stem set at 210 ft.for 1 hrs. w a S(a l i 1�;1Z11� 'e 1 S11 C Q� r•� Q1 Artesian flow E.o.m. Date DeTI(iTtlt"t.flC of Et C1IJQV O Temperature of water Was a chemical analysis made? ❑Yes m No a Start Date 9/5/06 Completed Date 9/6/06 S I— WELL CONSTRUCTION CERTIFICATION: 1 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. °Driller O Engineer°Trainee Nam 'tit)E NELSO Drilling Company ARCADIA DRILLING INC. Driller/Engineer/l'rainee Signature Address PO BOX 1790 Driller or trainee License No. 1886 City,State,Zip SHELTON WA 98584 If TRAINEE, Contractor's Driller's Licensed No. __ Registration No ARCADDI098K1 Date 9/7/06 Driller's Signature - ._. -_ -- _-_ ECY 050.1.20(Rev 3/05) • Ecology is an Equal Opportunity Employer. 2199767 MASON CO WA 07/20/2023 11:18 AM NOTCE WILLIAMS 0188946 Rec Fee: $204.50 Pages 2 111111111111111111011111101111111111111111111111111111111111 Return To Randall Williams 1570 E Grapeview Loop Rd Grapeview, WA 98546 Grantors): (1) Randall Williams (2) Desiree Williams Grantee(s): (1) PUBLIC Legal Description (1) TR 3 OF SE NW S iz) -r ZI t tZ Z (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 2 2 1 1 3 _ 2 4 _ 0 0 0 3 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) 2 2 1 1 3 _ 2 4 _ 0 0 0 3 0 Tax Parcel: (Connection 2)The system owner is responsible for keeping this system in compliance. The name of the water system is: Well @ 1570 E Grapeview Loop Rd 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/ has not) been granted one or more waivers from specific provisions of the regulations. ( + Dated on this ���� day of c111.1 , 20-. Signature ntor(s): (1) , (2) Page 1 of 2 r State of Washington County of Mason ) I, the undersigned, a ptLary Public in and for the above named County and State, do hereby certify that on this lit day of J u\� , 20�3 , V NJJi� 0y4 VMr,�,e Wit i&yAS, 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. ���H t u t r t rrrrri A i l)ram"' Notary Public 1n and for the State of Washington, ?: ct`°�5-2 4b •• residing at MO-SOV\ C - * :c° ° Q ARy My commission expires: �l 1' .O 1 PuBlA •!1!umbet1'• ,F OFtWAS \ `�\ Page 2 of 2 is--,. iAm.. . 01(7 2ao7- 6Dt-ibid AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION • Owner Name e.,0\i t,!Nif1tvc, Assessor Parcel # .2-tl -- Z4—OW- Mailing Address /r -7() & braFel'J L4 O/M Specialist Name . MSC Vid$Cr--,:�r' / City, State, Zip f Mr't'�--1 WA CS� & Installer Name !,fir -141 0(A\ Site Address 5044'!'�` 6/...:; ci tmye. Designer Name 7 Please complete this checklist to the best of your knowledge. If items are unknown leave blank. • INSTALLATION CHECKLIST s System Type Pe (/'7e ? /SSC- c Pretreatment Type 7-7Ow'd Drainfield Ln. Ft.�d' 9 53/ Drainfield Sq. Ft. // g(2 Drainfield depth l -(over >5 ft. from foundation? - - ❑ N/A EYES ❑ NO >50 ft. from wells? - - ❑ a ❑ Z >50 ft. from surface water? - - CIg 0 HCleanout between building and tank? - - 0 g 0 U Tank baffles present? - - CIa 0 d 24"access risers over each compartment?- - ❑ g. ❑ W Effluent filter installed?- g 0 cn Septic tank size i?CO gal Manufacturer VW` •D-box water level and speed levelers used? - �N/AYES❑ ❑ NO O Manifold/D-box accessible from surface?- - Z ❑ ❑ Ou` mz Check valves installed? - ❑ ❑ 6Q // 2 Transport Line Size Schedule/Class Bedrooms installed (if known) ❑ 2 0 U ! 151'," r- ❑CommerciaUOther r t- I, - i >10 ft. from foundation?- ❑ N/A RYES ❑ NO 0 >100 ft. from wells?- -i�t Y 3-}- - --I,'❑ ,, 0 W >100 ft. from surface water? - �[� U❑ A ❑ a: >10 ft. from potable water lines?- ----la----- 0 km ❑ z > 5 ft. from property lines and easements?- -_� - 0 * ❑ E > 30 ft. from downgradient curtain/foundation drains? - - 0 C. 0 Observation ports present? 0 Ff ❑ XGraveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ Jf ❑ Pump tank setbacks consistant with septic tank? - ❑l alp X YES 0 NO • `1 Pump tank size ( gal Manufacturer lin/(r�-�' 1,1 Q24"access riser(s)and accessible from surface?- - ❑ k� ❑ I— Alarm or Control Panel Installed? - - ❑ 0 O. �, Control Panel equipped with Timer 1 ETM/Counter- - ❑ ❑ d Pump installed in ❑ Bucket or lg On Block or ❑ Other a' Pump Make/Model 11��it,fahl Floats or CI Transducer R. Tank draw down -2-5- in/min Pump capacity t/7 qpm Squirt Height I//ft PnntePdr 6 j 1l /�ar,ocounty ( 4ccar Daily flow set at y��-'�oc.�gpd �",f I iQ(j uoao 2a917016 Printed from Mason County DMS • AR-cc- "c►c# AS-13,�;1k — _-_. . ----` ire ' 72.1 t 3- Zt4- 400 30 1t1. APp��V JUN13101Z I RV ASO4 COUh n Eh�]ROh'MENTAL HEDEALIN \ nr DA,A�'�J�''l Ads y&dm rao Marti -Sheda dis .b., per cwe-07-I/48 1 4/7 ci,s 4., to term r..i c /...1. , 9- 4- I ♦i� • W • ♦ • . / ♦ f: / la) il/ �+ ,• \ � f t - ` ' s�T a1 P/r- ,..rV vi--:\\\ vl r--,... -- . ....:---- , \i" Noo it ..-• 0 &Sid fit/ c..)/7 ::we.r' tut" c ot,s . , an 051Z7/7-eL2 . Printed From Mason County DMS Printed from Mason County DMS • CM CD C:. (Cl CD >13 = 0 a C13 /.Y........ .... cn co (17' co co< = a ci) CD 1:3 CD X 0 c7; co (i) a. co -. o co r.) -, o_ _... *4, >.g co .*. CO II'............... .. o ••••.............. . = • •._. . 7 0 •. CO . -0 • Fir • CD X . • -o co 0 co c Yo x 3 co x • 5 0 co .... -o .63. . •. co •0 7 5. •. o : • cco • a. r..) .. .o.. ea . • • v., co co •. co -... cp • E. c..0 • • x 0 • P• • • '7 n_. . Co . co C71 . • •. X • . •0 ,...... • • CT) = . CO ET 01 . . •. •. 7 ••••••1 • -6 • •0 ... (i) CD -0 3 . . • • -c) • . .. 0 m M 0 • . CA •CD • • N..) 0 .. .. a u, * . • .. 0 co ca) . • . I if ,-- m co 6 • •. . • • , .. • : • . 0 -1:3 < T) co < = a CD SD •• • Z * D O . . •.: CD NJ r•••(1) C •: X N) 0 (/) •• ii5 — 0 :=I: ...... C.J 0 co •I=• * 0 0 XJ-0 (I, 0 CI CD Z• 0 .,..... 0 CD kJ) 0. tCD Z * CD * Cl.) CO OD 01 -4. cs) co c.0