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HomeMy WebLinkAboutWEL2023-00037 - WEL Application, Design, Letter - 7/7/2023 584 MASON COUNTY 415N6THELTON SHELTON, EXT 400 L TH STREET, ,SHELTON,V EXT 400 F BELFAIR:360-275-4467,EXT 400 t Public Health & Human Services 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 MASON COUNTYCOW nil' R "` �( COMMUNITY SERVICES Amour ea`, Re,. rryf \ ~ - Building Ma in Emnmmenul Health Commun ly Neat S i \ 415 N.6 Street.(Bldg 8) Shelton,WA 98584 WEL .� ( 23 0. �) O 1— Shelton 360 427-9670 x400 Belfart 360-27 4467 x400 Elme.360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION MAILING AODRB-STR ' ITT ZIF � STATE.ZIP n / 1 Wes" "Sir Li SITE ADDRESS-SIRE , RV,STAT .11-• p �� I_J,_+- e- to +U1(1 • a f r7y5tti PRIMARY P"tEL NV : R(WELL SITE) 22 L - - Go L-I SECONDARY PAR EL NUMBER OF PPLICABLE) 221 _ p ( I—F WATER SOURCE SOURCE TYPE • New 0 Existing ta Well 0 Spring ' IReli� Al7 'i A.L i. — 11_A PROJECT DESCRIPTION ri / k"L ^f11 - f a 11 /yl/15 1 . ._.....L.____, .. . . _ , Site Plan: (may also be attached) (property boundaries,structures,well site w1100'radius,driveways,roads, septic/sewer components and lines,easements.etc_.) 0 70 7//Z021 N Lri. JUL 1 2 2023 - RECEIVED 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) Septic Records(additional locating requirements may apply if there is a lack of septic records on tile) Is 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 ❑ pr ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields. tanks, buildings; indicate distance on plot plan) ❑ X. ❑ Are there roads within the 100 fgptJadius of the water source?If so, is roa. pri ate, C.; my or State. What is distance to ROW? fig g• DI ;,e „J -y " r dry ❑ ❑ Does the ground slope away from the water source site?(show slope an plot plan) D ❑ Is the well cap satisfactory? VI 0 0 Screened and vented? Sit ❑ The well casing extends t-✓ above level ground/concrete slab? (circle one) g ❑ ❑ Is there evidence of a surface seal? Left y7-•ZS8 500 XI ❑ ❑ Does the seat appear adequate? wn f22•5193lY ❑ .7 ❑ Is a variance necessary /for well site approval? ` 45 • BON y O Z Comments N'0 tvV(( rid i(& al e or c`fc- L 1 eq1 : 7777( rYizx Ready fa- a(r)cveez6bn : '(4111 023 �/ p Pass Fail Inspector ,7/ ! �-( O/ y(�Z3 Date ?7Z / 770z Review Step 2: Two-Party Review: YES NO NA yce ❑ ❑ Water Well Report with adequate pump test on file? d �A If NO,date of Capacity Test .0/!iI Driller Idtc4 ca 06i'/i71Q GPM. /ii _ ❑ [] Received Satisfactory Bacteriological Analysis? Date of test 9fijia, Z ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 21.0Z-576 v ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? �C`o'mments 7\pproved ❑ Denied Reviewer ___.--- Date J6//0/70e 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 196,2018 per ESSB 6091. This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021 Page 2 of 2 Vanguard Laboratory 6`. •J 2635 Parkmont Lane SW '� Olympia,WA 98502 :• 360 967.7010 'VANGUARD Report of Laboratory Analysis LA no R,n'o Rr Collated by: Ackley Rtrp Service Matrix Drinking Water 360-827-2309 Laboratory ID: V230913-11 Sampling Addresm Date Sampled: 9/1 323 14 00 746 E Thornton Rd Date Received: 9/132316:05 Shelton,WA 98584 Date Reported: 9/152023 Salple I D: 746 E Thornton Rd Analysis Result SDRL MCL Units DF Date Analyzed Total Conform& E.coil by SM 9223E(IDEXX) Batch ID:V2 3 0 91 3-11 Analyst VJ Colifoml Total Negative 1 1 MPW100mL 1 9532317:13 E.mli Negative 1 1 MPW100mL 1 9/132317.13 Notes: MPN:Most Probable Writer can:part per mil Iion nd nondelect Reviewed by Robert Smalling,Che miston 0 9/1 520 23 Va:not applicable SDRL:State Detection Reporting Limit Approved by Tori Johnson,Operations Manager on 09/152023 DF:Diluton Factor = 17u25:2011 MC L Maximum Conraninmt Level t1.1.• i"oxncav IC° Pagel oft Sanpla were reciered in axgptable condition.The result(s)in this Port relateonly b the portion oftesarple(s)teed.All analyses were perfonned consistent with the Quality Assurance program of Vanguard Laboratory.Please cmtan the laboratory if Ka should have a yqt estias about to result. SEP 2 8 2023 RECEIVED WATER WELL REPORT c' Not...,of 1,ta't v'. AF5149. EC. 111e.d nor',: +:m N cll N.nnc 111 nlur r:.0..:. ..a1M1. I'r::p::r,$II., •n:,. :. ' L:dl:.n: :Limp,pI, hilrkit. II\vIlk, Non:fvVC.HA-1 AND TANYA HAT FIELD SCHAFFER I ....LIP- 11nr_.nIII I 1.0N.11 nrtn. V. 1 S .c; eddm, 71R E THORNTON RD 11 : :: 1•Mr ytljM: _.. . :o. . SHELTON .: : MASON "'- Ji I is VALLI♦o 2213 7 11 III. . IC, :k nn 0 - IXII 1 -i f whit lialloill10,1711‘' '•1.II "" r- •2 70 P n. • • [ I I,..Ir1I ._I • qlt V1 or I I'1AA( In n ' SE ,I At, SE ':.:m T- lamnafi:p 21 I- Au. 2 u. - _ — 1 I I: 1'Ilvomplc l ,714425821 - .___ -- ___— I oo,Fade II xampl 2:.::I -12289424 f- Driller' LagI. alruction o Uvom\narlm occamt n n pme • ! J� 0.�r: lID u.: __ I,:m ' I 4 !::I f M1:•: KMNSf.V T NY C 5 n o .:._ 1. a.:- . 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Mak al.,•>:d. :d Ill ,I Ay.n_d.}r: (lift III I. ,Ix.., I..Iva aid l aL.: • I r.c PI 1 v A',:;c ROBERT LAYMON IA II A I (o epv:.AD`.ANCED DRILL INC LLO IIu � II .11533 SCHOOL I AND RD SW :,.AtN o 2588 _ I .til.u„_[IP ROCHESi[R WA 98575 II IA\I\II'Spo:m.r I:eon,.v.. _ 1 oFF-1,E01 . yl•, ,.I, it,IIIill.lIIIIII No ADl9ANCL8041/1 U Ira :9 11L(23 R2202526 MASON CO WA NVP HRTFIED-SCHR EFERTR191©i7 Rec Fee $204 50 Pages. 2 IIIIIIIIIII IIII!IIIII IIIIIIIIIIIIIIII1IIIIIIIIIIII II111111111111111 Return To 141414.. { , "ScV01/44l E Ths frrt{on 12e1 SEP Shea-tn Lf 4S5 7 d 1p2 J REcPIVfD Grantor(s): (1) Thicku.kn1 SC kL.- __, (2) _l C-Y\jA `Oat P-1 SCKC& - r Grantee(s): (1) PUBLIC Legal Description (1) LOT ft 0C- SQ # 25712-_PIS( P 134 (Abbreviated form:i.e. lot, block, p/at or section, township, range) Assessor's Tax Parcel: (1) z-_2 _1_ _3_Sj - __1 __3 1_Q_L__ 7_ _3- S 35 - T ZI - �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: Tax Parcel: (Connection 1) Z_z_1_3_5_ - _Z _ - aGo_ .l__LI4 -y Tax Parcel: (Connection 2) _L_2- j_ 3 5_- -Z_5_ - L c_ J__ 1_ 3_ The system owner is responsible for keeping this system in come. The name of the water system is: _ -Y C-ha..e ktC_-_S1I 1 GIL 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 ft the water system exceeds exemption standards. This system (hasr4t) been granted one or more waivers from specific provisions of the regulations. 0 Dated on this f.�L_day of�3-e , 20_2-6 Signature of Grantor(s): Page 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a Nofpry Public in and for the above named County and State, do hereby certify that on thisNN`` day of _ bet, 20__3 , e� rsonally appeared before me, who is known to be signer e above instrument, and acknowledged that he (she) (they)signed it_ GIVENunder my hand and official seal the day and year lastla above/b wr n. ��-max/Wl - Notary Publi an f r the Sta�te�9f ashington, TERESA L WAY Notary gat i� Syr Notary Public My commission expires: 3-15--2/'1 .41_ I State of Washington License Number 135501 My Commission Expires May 15, 2024 Page 2 of 2 o i I - Pi • +/+! p N 99-45'52` E 330.44 (REC) \ I- •" --FOUND IRON BAR 3 '43JMEt� U `1 1V/CAP LS 8547 ., 0486 N. 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