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Home My WebLink AboutWEL2023-00020 - WEL Application, Design, Letter - 4/12/2023 igir. MASON COUNTY 415 N 6TH STREET,SHELT ,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 NORTHWEST LOGGING COMPANY 2522 N PROCTOR ST #15 TACOMA, WA 98406 RE: WATER SYSTEM PERMIT: TWO-PARTY WWL 2023-00020 26132 NE North Shore Rd 323332300020 The 2-party water system, North Shore 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, ,P David Anderson Environmental Health Specialist Mason County Environmental Health immil e .' MASON COUNTY Date Received r MMUNITY SERVICES Amo Rece?r !r r Building,Planning,Environmental Health,Community Health 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L fb b0 t 0 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE /Jo2�l 0JES7. MAILING ADDRESS-STREET, (.061 �ZkJel cott1P43/ 26 3 . l22 . 36(, Zs22- N r PP-0 c o2 S-r. 1 S -0qC s,04, WA q9'/o( SITE ADDRESS-STREET,CITY,STATE,ZIP n � 26137 VC- earth 51/01, ' r�Qi 7��U)/�, �� y8588 PRIMARY PARCEL NUMBER(WELL SITE) I-33322101 1 C i SECONDARY PARCEL NUMBS (IF APPLICABLE) 3233323000Zo ,lih,� WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE Ig1New ❑ Existing At WeII ❑ Spring S,0 ' 01 2oS 3.O 7 ACQrS PROPOSED WATER SYSTEM NAME(REQUIRED) N o 17- 1 I <lia (?El. iz.b PROJECT DESCRIPTION TW 6 PA z1-y Pa1JA-TS -TeTz- 4 y s-rEtkA-- DIRECTIONS TO SITE/CONDITIONS FRS i Iki te1-42L-n,o..r s c r1E 3CLCA14- 1 &•i)/A Lt. f J6 t>3ipsse' b of �/ fP - 5 1AY " At bet •n-o 14-60.y 'Fa- 7,2- rU - T tU c-cF-r actin /-PE IJt114 S l-c fz-D , oe.e.ocs& 1~oa .8 Mtc-ES DaRJurA'1 Wtct- Se eat-i L-Efr Ac2ccs FROM L-R24E TSL-ALA F _,J Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...) 4 c.e A-M4V--0 . . CiGq-e ( 6.0 I �6 TAPR 1 2 2023 By_ 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) 44 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 Staff Use Only Review Step 1: Well Site Inspection: , YES NO NA RA 3 'i ❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) 71 ❑ ❑ Are there roads within the 100.got radius of the water source? If so, is road riva , County or State. What is distance to ROW? 14 ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? A ❑ The well casing extends /6 above level ground / concrete slab? (circle one) [dl ❑ ❑ Is there evidence of a surface seal? igt :yi; 1.t7<I1lt 4 ta2 I ❑ ❑ Does the seal appear adequate? L __llZ"�1' U�i 2Q!Z ❑ Is a variance necessary for well site approval? � PQ g S Comments k/v l/ /00 •F�tm1 cep Kass El Fail Inspector Date -(C /wZ 3 Review Step 2: Two-Party Review: YES NO NA 7f ❑ ❑ Water Well Report with adequate pump test on file? /6(If NO, date of Capacity Test ` �z3Driller t2ti11't.' GPM 1 l/ rM ig- ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test �/ /?e' 3 ' ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 71 q99 rl7 .•.-/ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments �� vJUCPs l`l -( Q 4 P J b ii irMi'mii,n 70W d (6 t PO Ifcd vc,�r� m'Y11t"1t r /o/t C bA . �✓� �� z3 aUd g� a o�e�; v� � 0 Approved ❑ Denied Reviewer Date F742l20 03 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!nay apply to all new wells drilled after January 19'r', 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 T 1766 SE hide HII ._.._.. D' '"t1'3ct SPECTRA Laboratories - Kitsap rdra Pon Ord,Y!A..__ . ______.____. 98366 .Where experience matters . 6 iti -/-t, q , a, fzi n 'flokon �ORM BACTERIA ANALYSIS FORM Dale Sarrpleeolected Time Sample County cosseted Mores ow Year Type of Water System(check only one box) J . ❑Group A ElGto B 6Other I 11 tierk- Group A and Group B Systems-Provide from Water Faakties Inventory(WFI): !Da / System Name: 2(21y � c I M � • ` i(1,d(e Contact Person: Day Phone:( ) I Cell Phone:( ) Email: Send results to(Print till name,address sad decode seal) SAMPLE INFORMATION r Sample collected by(name): c„_ \% t f % wed: Special instructions or comments: Specie location where sa co Vise\ � Typo of Samp a(select only one type of sample from types 1 through 5 below) 1.❑Routine Distribution Sample(AR) 2.❑Repeat Sample(A/P) Chlorinated'Yes No_. (fin Est on system Aar ursa.routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample ———- lS I I I Unsatisfactory routine collect date: Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residual:Total_Free_ ❑Assessment(A/P) 4. Surface or DWI Raw Source Water Sample(Enumeration) I S I I I ❑E.cot' 0 Fecal Frtimect Yes No_,__ 5.yiSample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Cdiform Present and .tisfactory ❑E.cob present 0 Ecoli absent Bacterial Density Results:Total Cottons mpn flo0ni. E.cot mi o 11t)Orrtl FecalCoiiform du 1100mi. NPC 11 ml Replacement Sample Required: 0 TNTC 0 Sample too old 0 Sample Volume 0 Damaged Container 0 o�y tab Reference Numbs tn72ly i0 L2$s2'� ��l Receipt Temp C° Method Code: SM92238 or SM9222D Date Reponac s DOH n Lab the Only: JUN 12 "� '3 DOH Lab-Sampled � DC4.1 kern O 5 t fan).IAu 2r1VUtth nn&raw fv+u.Me04S25.521(T1)Orr1'Y.4 711i. "RNS IVA able se eared.rt...Ah.asodir#pev. Loa 3 - 0037Lf Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories -Kitsap 26276 Twelve Trees Ln NW Ste.C ...Where ecperience matters Poulsbo,WA 98370 Phone: (360)77VE1C E IV E D www.spectra-la .com AUG — 1 2023 615 W. Alder Street Spectra Labs - Kitsap, LLC (Poulsbo) received samples for Davis Drilling on Wednesday, June 21, 2023 at 1:40 pm. Unless otherwise noted, all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures. A summary of the samples received are outlined below. Sample No. Description Location Sampled 228506-01 26141 NE N Shore Rd Well Head 06/21/2023 9:00 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360) 779-5141 or email us at www.spectra-lab.com. This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 06/28/2023 Page 1 of 1 WATER WEL I. RFPnRT DEPARTMENT OF Notice of Intent No.WE52891 tLU LU V Y Unique Ecology Well ID Tag No. BPQ 165 Type of Work: State of Washington -- • _•; Construction Site Well Name(if more than one well): C Decommission => Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: r Domestic C Industrial 0 Municipal Property Owner Name NW Logging D ossatering C Irrigation C Test Well C Other — Wcll Street Address 26141 NE N Shore Rd Construction Type: Method: — !l New well ❑Alteration C Driven C Jetted `Cable Tool City Tahuva County Mason 0 Deepening C Other C Dug C Air- C Mud-Rotary Tax Parcel No. 32332290140 _ Dimensions: Diameter of btorir.g 6 in.,to 80 ft. Was a variance approved for this well? 0 Yes 0 No Depth of completed well 65 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread ,7E I ❑ 6 ia. *1 45 1/4 in. ❑ 1 G 'E l ❑ Location(see instructions on page 2): i:i W'A'M or O EWM M 1 U 6 in. 68 70 1/4 in. El 1 0 E 1 ❑ NW 1/4-'4 of the NW '4;Section 33 Townsn:p 23N Range 3W ❑ 1 ❑ in. in. C 1 G ❑ 1 C 1 ❑ in. _ in. G 1 ❑ ❑ 1 ❑ , latitude(Example:47.12345i 47.44451 ' Longitude(Example:-120.12345)-123.07920 Perforations: El Yes r No Type of perforator used —No.of perforations Size of perforations in.by in Driller's Log/Construction or Decommis,ion Procedure Perforated from ft.to ft below ground surface Formation:Describe by color,character,size of material and structure,rnd the kind and , nature of the material in each layer penetrated,with at lea one entry for each change of Screens: IF:Yes 0 No .l K-Packer t=j Depth 42 fl information. Use ad:Luorul sheets if secesaryy. Manufacturer's Name iohnson _ Material From To 1 Type stainless Model No. Diameter 5 in. Slot size 14 in.from 45 fl to 65 ft. Reddish brown conglomerate 0 38 Diameter in Slot size in.from ft to ft. Light brown sand&gravel saturated 38 65 Clay bound sand&gravel 65 80 Sandi Filter pack:G Yes 0 No Size of pack material in. -- Materials placed from ft.to ft. Surface Seal: l Yes ❑No To what depth? 18 fl. Cut drive shoe at 68'pull casing back to 45' Material used in seal bentonite 1-— Did any strata contain unusable water.' C Yes C No — Type of water? Depth of strata Method of sealing strata off Pump: Manufacturer's Name Type:H.P. Pump intake depth: ft. Designed flow rate: gpm Water Levels: Land-surface elevation above mean sea level ft Stick-up of top of well casing ft above ground surface Static water level 26.5 ft below top of well casing Date Artesian pressure_lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? C No 0 Yes by whom? — Yield gpm with_ft.drawdown after hrs. Yield gpm with ft.drawdown after_hrs. Yield gpm with_ft.drawdown after hrs. Recovery data(time=zero when pump is turned off-water level measured from well top to water level) Time Water Level 'Time a Water Level Time water Level Date of pumping test Sailer test 1 gpm with 38.5 ft.drawdown aftert_hrs.1 Air test _gprr.with stem set at ft.for_hrs. J Date Artesian flow gpm Temperature of water _°F Was a chemical analysis made? Yes C No Stan Date 6/7/23 Completed Date 7/1/2 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance wiih el Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. Driller C Trainee C PE-Print Name Emily Davis Drilling Company Davis Drilling Signature CA Address 340 NE Davis Farm Rd License No.3142 City,State,Zip Belfair,WA 98528 -- IF TRANEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.DAVISDi1100A _ Date July 2023