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Home My WebLink AboutWEL2023-00037 - WEL Application, Design, Letter - 7/7/2023 WA 98584 �4 MASON COUNTY 416N6SHELTON SHELTON ,EXT400 SHELTON:360d2]-96]0,EXT 400 BELFAIR / Public Health & Human Services A:360-275-4467, EXT 400 ELMA:360-482-5269, EXT 400 FAX 360-427-7787 SCHAEFER MICHAEL PRESTON JR & TANYA HATFIELD 760 E THORNTON RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00037 760 E Thornton Rd 221357590144 The 2-party water system, Schaefer-Glick (221357590144/221357590143), 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, David Anderson Environmental Health Specialist Mason County Environmental Health Ti Date ReceIv d /�� \ MASON COUNTY � r COMMUNITY SERVICES tourcmee/.- Reel. t\ % Buldn4 Pken1146rvI,mmentn Halm CwnrtwnryHE.Nh ) . 4q J 415 N.6'"Street.(Bldg 8)-Shelton,WA 98584 W E L ,.�(, 13 - bC� ()';)1-- Shelton: 360-4279670 x400 Beltaiv 360.275-4467 x4110 elms 360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANTTI ((CC1\\ ry1 \/h^� ^�}�(�`�--�- PHONE MAILING ADORESG . ITY�,STATE, AY-c c ``�,, r��,,..� sooa k.)-�mv /s el LQO nY.STnr�.ZFh r E Irk 12443I vC ,All t Wr1 [ O d0 —f PRIMARSETE Y etie L `innmtUV" ltd ,Sir 1I,JIN- SY5 MARRY2ARCEL N -c]ER(WELL SSITE) SECONDARY PARCEL NUMBER(IFPPLICAGO 221 AS - 7C - 10 t I--r; WATER SOURCE SOURCE TYPE PARCEL I LOT SIZE PARCEL 2 LOT SIZE New ❑Existing ,Well 0 Spring / t Iq OcY — It I atm_ PROPOSED WATER SYSTEM NAME(REQUIRED) ON , R� = ° : r; ^c , I►��,t/f,; .A., �v &c- -er - GllccC PROJECT DESCRIPTION /"l ri Uakt. 2 - f W 'T. w V`1 DIRECTIONS ^S TO SITE/CONDITIONS FIL11t11 • 11.oLtsa AV 1 Al e- is J• " . 1sM1oJ k Dr`v\V2 '�,llUU PP�harniw. oil . 2-v-a Ab kftJ} anno- tn_' S rMrLt'1Cw Gl Site Plan: (may also be attached) (� . • (property boundaries,structures,well site w1100'radius,driveways,roads, septic/sewer components and lines,easements,et ) JUL 07 2U23 LSr�I-LV1L1 JUL 1 2 2023 - RECEIVED Submittals Checklist: (these additional items will be required for approval) JSatisfactory 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) orm 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 ❑ Pc ❑ 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 fgpttradius of the water source?If so, is roe. pri ate, Cr my orStState r�/ What is distance to ROW? fY Cy ,,e -JJ ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) �07 satisfactory?❑ ❑ Is the well cap Y-' ❑ ❑ Screened and vented? It ❑ The well casing extends �� above level ground/concrete slab? (circle one) XJ ❑ ❑ Is there evidence of a surface seal? Leff: Lj?'2SA3S00 Xt. ❑ ❑ Does the seal appear adequate? Corp '122.8f911s6 ❑ . 1 ❑ Is a variance11ia� necessary for well ,siit�e.approval? (� L 1,,� �J : EPA/0 ii2_ 7 Comments fVO 41/C(/ di l( Uf Q( /r"tt UC ctl`i iwy - F( 7i/ ( f - _Ready fcr reincpec ban : cl/L/�d/ZOZ3 7 / 77 ICI Pass ❑ Fail Inspector ��71- ( O( ?(zz3_ Date F7L 77zo? Review Step 2: Two-Party Review: XS NO NA ❑ ❑ Water Well Report with adequate pumptest on file? , If NO,date of Capacity Test •Gfg// z Driller & bait ad OraIf11 GPM 10 ❑ Q Received Satisfactory Bacteriological Analysis? Date of test Qlj3r a7zi � ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2WZ.-576 ) ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments 7\pproved ❑ Denied Reviewer 4 ( Date /o/07073 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. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Vanguard Laboratory • ' 2635 Parknnm Lane SW it-if!lb- Olympia,WA 98502 360.967.7010 VANGUARD Report of Laboratory Analysis LABORATORY Collected by: Ackley Pure Service Matrix Drinking Water 360-827-2309 Laboratory ID: V230913-11 Sapling Addres Datesanpled: 993/231400 746 E Thornton Rd Date Received: 9/132316:05 Shelton,WA 98584 Date Reported:9/152023 Sample ID: 746 E Thornton Rd Analysis Result SDRL MCL Unit DF Date Analyzed Total Coltform& E.coil by SM 9223B(I DE%X) Bath ID:V2 3 0 91 3-11 Analyst:VJ Coliform Total Negative 1 1 MPIW100mL 1 9/132317:13 E.mli Negative 1 1 MPW100mL 1 9/132317:13 Notes: MPN-Mast Probable NarrAx ppm:perk per million rt1 none Reviewed by Robert Smalling,Chemist on 09/1S2023 Na:not applicable SDRL:Slat Deacoon Reporting Limit Approved by Tori Johnson,Operations Manager on 0 9/1 520 2 3 DF Dilution Factor Iu7IRS:xoll MC L.Maximum Contaninalt Level LAW raaovamn Page1 oft Sarple were rme d in aecepteble condition.The results)in this rayon relate only to the portion of the sarple(s)tested.All ataly92s were performed insistent with the Quality Assurance progran of Vanguard laboratory.Pleaaecontat the Iabaatuy if you shwM have any vita sabout the results rya SEP 2 8 2023 RECEIVED WATER WELL REPORT N"Irr:6 TILLnt An AE5146, - ECO1 _ 1'u1g11c 1'[nlvy\ \\ell 111 Idu\a HPN0.2 . .� . .. Ate Al„II N.nnc ld:1111C 1 11 I i a uc11v Irt -we > U 11nn.0 an �,. _ Rl crI< 1 lrnnii pcu.<u Vrnpr..it Ov- •ur.nr. , 1 er,n r`11.11 11111111_ (I N110 NCO. MICHAL L AND IANYA HATFIELD SCHAEI rR_—. L:_ ADD., .A.1,L..- 746E TIURNTON RO • 1 1.1 : 1111111Pa .. \ SHFI TON _ r1 MASON r i. I .. yr n. i- i51- V .. rrW:'Pr' . I r ----I," 1.. • ].. oPl v cl lII I „„wi DeDD. 6 all ..m_ I r 1 inli O. IYL1 -.. • +2 1 'i • I oc.WWI I lo.. :IrlI •r • M.l\\ I: V _ _ SE I De SE 6 DID,_4 _ 1 '- Inp 2 F _2 _ nthiLic II N.p11111, ro. .nr I IIncondL1 Dimple IJI ;•'....I1228902J L.r nr v .. • I . :a _ _ _ Rll rv1 ( 'Ial n Decommissionl lu ._. - rc l ue, .JOHNSON AIll I 1,cri it T.c STAINLLSS I _ _ ' o_- ,, , lq .., D., I.T i (BROWN CLAY LOAN.G' AVF_L I 0 J 'GRAVEL el Al' e 1 1 1 L. v A Inc,. _. SAND GRAVEL AND GRAY\ 1 _ 93 98 11398 GREEN SAND f3 93 AVEL I .urma ycr11: A„ L•4mnnem')� n GRAVEL SMALL SAND 113 160 6 rlrre u.d"n..n 56 HENTONIT C CHIP ----- - - m.,r..,n.r+.e. — GRAY SAND GRAVEL '4E3 160 180 rl iu -a.nl 11 I - __ - ._ _ --______ _.I. i •crl +. " II. 1 11 ,i II i. 1' I I vJ O6Q 1I4U29H �ma p ilr. I .qum u.J0 4 r . J r utlr +. .0 be 1 - i _SI 1 .\I o'l na _ I A .a: l v..l [. _1 —--I nl. I. ,a: !.n 1 . . + 11 A.r 1 ". l pdv 06 420C -I — - v_ u . 08/21002 (on1 I I DIc 08242023 I � o p 1 1 C INS I HI 1>.1 I I 111A 1'I.H III IC A I ION: I .,r,.1a1. 6.13“Cil IC.pe 1L.I I. .oien v III, .v:11.i1I 117 11111p1"ID 4.. 11 IP OE.'Jrtrn xcll rrm.11 da- 11.111_ 1 c.n4 The :I r"p..LT,d 4,n3.11. 11417.. 1 rvIc and:.a._ • I i. DT._ IF I A..o.ROBERT LAYMAN 1111_(nir LI AO' ANCEDDRII I ING I.LC ;Il_ , \ Ir 11530 SCHOOL I AND RD SW A :..w .,. 2588 t ID.ALoc.LiI.ROCHESTER WA 98579 II II3VIN F SI . n 7 1 ILLIO7Nn m I. . }L _gym Ii 1.rr1 Nr.ADVnNOLtlOCDL U on0911 202f 2202526 MASON CO WA v / TTRNTR HPTFIED-SCHBEFERT#191077 Rec Fee $204 SO Pages 2 II]0IIIIIIIIIIIIIIIIIIIIIIIIIIIII1111116E111111111111111!lFI1111IIII Return To ICt.n Jca_ t � —Sc-k‘^ '1 Lc c E MOO-0bn 12e SfP fk$ Sh-e khTiclet48 292023 ReCFfvFO Grantor(s): (1) m (Le SChke_- -C___, (2) Gut?, P�t� sckc&2 -r Grantee(s): (1) PUBLIC PIN Legal Description (1) LOT r{ O C S P (- P N# ZSZ 13 14 .3- 3_ 13L4 (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) _Z_2 _ I_ _3_Sj - __5_7 Q_L__ S 35 - T 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: I Tax Parcel: (Connection 1) tZ_ _1_ 3_ d_- _Z _1 - � _-1 CC o_ .�__� Tax Parcel: (Connection 2) 2_2_ 3 S_- -2 - __L O_ �__ 1_ 3_ The system owner is responsible for keeping this system in comp(igf7ce`.1- The name of the water system is: - 1- b I% \Ctc-_t.0- S11 l L(L 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/ut) been granted one or more waivers from specific provisions of the regulations. 1 Dated on this __Z2__day of 2-t42t , 20 3 Signature of Grantor(s): Page 1 of 2 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 thi ) ��'' day of _ bet, 20_3 , - jefeL ersonally appeared before me, who is known to be signer f the above instrument, and acknowledged that he (she) (they)signed it. GIVEN under my hand and official seal the day and year last above wr. n. I Notary Publi . , anc}fpr the St toe 2f ashington, TERESA L WAY residing at �� Notary Public My commission expires: y =15—_20Z _ State of Washington License Number 135501 My Commission Expires May 15, 2024 Page 2 of 2 0 In p N 89'45'52` E 330.44 (REC) 4\ v! • "1 330.4JJMEA! -FOUND 1RON BAR I W/CAP LS 8547 0. 66 N. \ \ ■ 'moo L o r �\1 o - 1 . 42 AC. 1 /r 13. 15 I r N 89'45118' E 330.32 • <,, y � � � \ / 4 ' ` N. .1\ �� I.) --CO N , b h r . 19 AC. N n 1 ! ..„,_ V �1 '•' i• J N 89'44 J2' J/330.22 I1 • 1 IA 1 /;1., / \ • 1 / - � � \ I i o / n, `„ ' C n OT — � h I-• `00 1 . 19 AC. I ' '_ - -Silt •" - 3 \ 5 43'48' ,W 3.�.10 J0, 00`, ' f 'r 3 nI LOT 4 � s 1 . 19 AC, , I1 / \ / l 3 o. CA LC) A• n•.n1/27• r jean fn fOrrl k