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HomeMy WebLinkAboutWEL2023-00008 - WEL Application, Design, Letter - 3/9/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 P Public Health & Human Services ELMA:360 482 5269,EXT 400 FAX:360-427-7787 Shauna Schacher 5380 SE Arcadia Rd SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00008 5380 SE Arcadia Rd 220303190030 The 2-party water system, AAD065 (20303190030/20303190040), 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 ut\ MASON COUNTY Dale Rece,ved li. COMMUNITY SERVICES n R e nr _ Rece,vedB Building,Pbnning,Environmental Health Community Health - ,._:.,.:. ) 415 N.6'"Street,(Bldg 8)—Shelton,WA 98584 WEL 4).0 1_ )-. c100g Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT, re•- .. PHONE n:x '(\o --)CIikaCAr\a..r ?0 , 2 , (s -5 MAILING ADDRESS-STREET,CITY,STATE,ZIP r '^ �` 3 5380 3E c \ ��=w(„ n l u SITE ADDRESS-STREET,CITY,STATE.ZIP` t PRIMARY PARCEL NUMBER(WELL SITE) 21'0 SCE 3 I - goo -- 0 SECONDARY PARCEL NUMBER(IF APPLICABLE) 1 O o 2203Q WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE 0 New XExisting Well 0 Spring 1- ckfc.-5 S- a cr<3 PROPOSED WATER SYSTEM NAME(REQUIRED) k ND 065- PROJECT DESCRIPTION'` t')u SR CA,j Vel-(..4'r o,n p V. 5 Lt.o fl. .___c-.�r.,, f c v x �\ DIRECTIONS TO SITE CONDITIONS p t_-1,,A_ S nA,\ 6J on t��_`^N`�"\ VLd ,��-t- r is) h4 ClFcxre R. etQ_c\ 7 Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...) Fp T M T 11 VI @ \-_\1 1; MAR 0 9 2023 By Submittals Checklist: (these additional items will be required for approval) d Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) C��, ell Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) Cad flotice to Future Property Owners recording (record with Mason Co. Auditor. supply copy of recorded document) EI 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: RV ��\ Chi Clafl Pm Ti YES NO.__ NA Nit, Po(tyt1 I( ' pV rn ibi'LC 5 ? twit 7?' xi ❑~ ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) 0 d ❑ Are there roads within the 100 foot radius of the water source? If so, is road private, County or State. What is distance to ROW? 0 ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) Gf ( tf_i" ❑ Is the well cap satisfactory? KO- Scr d( v&if1I `(/1 (wog( X a ❑ Screened and vented? ❑ The well casing extends --y above level ground/concrete slab? (circle one) ki ❑ ❑ Is there evidence of a surface seal? X ❑ ❑ Does the seal appear adequate? ❑ ❑ Is a variance necessary for well site approval?.? // (� Comments cci1 �� ��� 7 j 1�C.e Jul\_.6".t�-NZA c 1 o t�5 (cII' - IlZ 5%(t/ Pass ❑ Fail Inspector 4j2 _ Date 3 ��, ZQ7i 3 Review Step 2: Two-Party Review: YES NO NA p ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test I/ Z Y Driller l 7 1700 G PO ZI ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 6//Y1 79ZZ 47 Cir 0 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2 t 9 ` G% ‘ 9- ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments Approved ❑ Denied Reviewer Date ?"(7o z l 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'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 :23 W ATE R WELL REPORT Start Card No. N12544 STATE OF WASHINGTON $ Water Right Permit No. AADO6S Address E1 6970 ARCADXA ROAD WA 96564- ,� l t) OWNER, Name COL3RO11, 1'1RRY e 8. (2) LOCATION OF WELL: County MASON - MI 1/4 SW 1/4 Uec 20 T 20 N., R 2W WM ,I N40 12a) STREET ADDRESS OF WELL (or nearest address) 01 6970 ARCADIA ROAD ix (10) WELL LOG (3) PROPOSED USE: nolasTIc d (4) TYPE OF WORK: Owner's Number of well Formation: Describe by color, character, size of material (If more than one) 1 and structure, and ahoy thickness of aquifers and the kind and nature of the material in each stratum penetrated, with V1 NON Method: ROTARY at least one entry for each change in formation. vt-i (5) DIMlNeIO1S: Diameter of well 6 inches FROM TOo O Drilled 139 ft. Depth of completed well 139 ft. swim cum 0 3 ORONO NAND PAN 3 17.5 (6) CONSTRUCTION DETAILS: .5 40 Casing installed: 6 Die, from +2 ft. to 139 ft. 1RA11f 9A10 CLAY C GIAVIL 140 7 11 SS WELDED " Die. from ft. to ft. GRAY CLAY 40 68 R Dia. from. ft. to ft. DLUN CLAYit 63 DRAY SAND CLAY 63 ( 93.5 WM CLAY 0 Perforations: NOo DRAY CLAY Pik DRAWL 96.5 102.5 4}. Type of perforator used 102.5 106 in. by in- �� MAY CLAN 106 115 C S,'LE of perforations RAND a =AV= DRAY CLAY perforations from ft. to ft. 115 124 Q� ft. PAC= ONA�' A NATIO 124 139 perforations from ft. to LOOSE DRAVE. WAT1A 1✓ perforations from ft. to ft. Sw O Screens: NO ti 12 Manufacturer's Name .Type Model No. fl; Diam. slot size from ft. to ft. Diem. slot size from ft. to ft. 0 Gravel packed: NO Size of gravel Gravel placed from ft. to ft. CV -C a.r Surface seal: Y18 To what depth? 20 ft. Material used in seal 12DIT06TlT1 4.4 Did any strata contain unusable water? NO ft. C Type of water? Depth of strata f-L Method of sealing strata off 03 (7) PUMP: Manufacturer's Name Type H.P. O (8( WATER LEVELS: Land-surface elevation above mean sea level ... ft. Z Static level 119 ft. below top of well Date 07/23/93 (1 Artesian Pressure lbs. per square inch Date a Artesian water controlled by Work started 07/22/93 Completed 07/23/93 (9) WELL TESTS: Drawdown is amount water level is lowered below WELL constructed and/or acceptCD responsibility for con- 0 level. struction of this well, and its compliance with all O Was d pump toga made?/ i If ref, by whom? Yield: gal./min with ft. drawdown after hrs. Washington well construction standards. Materials used 0 and the information reported above are true to my beat (� knowledge and belief. W Recovery data Q Time Water Level Time Water Level Time Water Level NAME ARCADIA Df G RILLINor corporation) (Type or print) 4.1 (Person, au ADDRESS Es 17 MALIIA E Date of test / / hrs, (SIGNED) License No. 2053 Bailer teat gal/min. ft. drawdown after 03 Air test 15 gal/min. w1 stem set at 133 ft. for 1 Date s Contractor's O. Artesian flow g p•m. Date 07/23/93 Cl Temperature of water Was a chemical analysis made? 610 Registration No. ARCADD209SE1 40 I- AI _ 5380 SE ARCADIA RD Parcel 220303190030 WEL2023-00008 From applicant Josh C.on 1/8/2024: "Please find attached photos showing a capacity test that I believe meets the second** condition." ** 2)A capacity test within a 24-hour period that produces a minimum of 1,600 gallons. o� A. , h 36, i ALlONS -Gt•IIONS 2" 1 A\ Ai meta 10 y' se ..aeo-n6-OU; n1 Matte( sb V meter 60 1-s00.,05-Nn 4: eeL.., ..I VI MI 0 Mon1416001411 5:39 McM]p:aruaryB 8:25 41,959,300 gal-41,957,600 gal= 1700 gal total allIMINIe t 1� I� I-t I-+ N N I s I-' ha N I-- F-' F-' F� I.• • . N N N N N N N N N N N N NJ NJ NJ Ni ` ▪ N F- o , ((tit. \ \ \ \ \ \ \ \ v I -, I-i I-+ V F-+ I--+ F-+ F-+ F-+ F-, J J J J V V V a 3 V V V V V V V V V V ` ▪ '�. 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JWW —V 00 00 V V 01 Cr) CI 01 01 Ql Q1 01 Q1 01 (P O D CO v '. 0 n U, T C) O a) G 0 0iv 0 0 0 0 0 0 0 0 0 0 0 0 0 0iv o a —i 000 CNo v - rn rn rn C rn rn rn O O rn o VI r+ T_ 0 F-+ F-+ 1--) I--4 F-4 I-4 I-A I-+ I-+ I-i F-+ I-A I-k I-4 I-+ F" ,3 01 01 lT 01 01 01 01 01 01 01 01 01 C11 01 01 01 p N of '1 '1 a1 O1 O1 01 O1 'a) O1 c71 '1 in 'a) '1 '1 m ✓• V 3 O u N W • Thurston County Environmental Health 2000 Lakeridge Dr.SW ,Olympia,WA 98502 TH®� 360 867-2631 COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample Collected County /I S /20 Month Day Year AU ❑PM `Y nts°em Type of Water System(check only one box) ❑ Private Household ❑Group A 0 Group B i Others *IC C{tA, (JJ Group up A and GroupSystems-Provide from Water Faciliti s Inventory(WFI): System Name: Contact Person: Al Day Phone:( rg) • a. j ipabh Cell Phone:( ( ) , f t : .� • v•.Phone:( ) Send results to:(Print full name,address and zip .de or email I address) �-i• L_,, • SAMPLE INFORMATION Sample collected by(name): ..,_l[il], •Specific location or address where sample collected: Special instructions or comments: • , Type of Sample(must check only one box of#1 through#4 listed below) 1.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine) • Chlorinated: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 WP) — — DaherUnsatisfactory routine collect date: S / / •4:11.ample Collected for Information Only • Investigative Construction/Repair VC Other LAB USE ONLY DRINKING WATER RESULTS Unsatisfactory Total Coliform Present and LAB USE ONLY ❑E.co/i present Satisfactory ❑E.coli absent o .liforrn detected teplacement Sample Required: • ❑Sample too old(>30 hours) ❑TNTC 0 acferial Density Results:Total Coliform • /100m1. E.coli /100m1. Fecal Coliform /100m1 Enterococci /100 ml. • athod Cod-; SM 9223E ❑SM 9222D ❑ Date and Time Received:t Z SM 9215E ❑Enterolert® \ e and Time Analyzed .)y 1.te L. Iple Number(DOH number plus fee dgits) Date Reported: 0 8 0 Lab Use Only: orm#331-319(revised 01/16) -)q 2 2- 2194 681 MASON CO WA 03/09/2023 10:38 PM NOTCE 111111 I 1111111111111111111111111 1114111 III III III II I I I I I I 19 e s. 2 Return To . C_L�. �370 3E ilk r-C --A_..- YZ /� (2) ' CrXiy- Grantor(s): (1) () S�,{1�fc eY �041�1'� L� Sc4� Grantee(s): (1) PUBLIC _�^ �, -� Legal Description (1)-1-5 - 'c" I —xu� z0�2o R Z bbreviated form: i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1)I Z 0 S -0 --3 \ - ot '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 ('I) 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 Z U 3 t) - 3 1 - q D 0 3 Tax Parcel: (Connection 2)1— Z. P s 0 - 3 1 Cl a 0.(47) The system owner is responsible for keeping this system in compliance. The name of the water system is: N A U euo 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. 744/4A, 2�Dated on this day of Signature of Grantor(s): (1) lept4 cCk , (2) (JO tS SL��, Page 1 of 2 r State of Washington ) County of Mason ) I, the undersigned, a otary Publi in and for the above named County and State, do hereby cer ify that on this day of 7" 1f i1 , 2S S ` 0arx,I/17a/j(,.0aelr4r personally appeared befor: e, who is known to be signer of the above instrument, and acknowledged that he (shad signed it. GIVEN under my hand and official seal the day and ear last above written. �.�`Pr1 V. T Rq/,�,% Not. Publiicc inn and fo jhe State of ashi gt C?•cc`\�5 2 1), S %. residing at 6 ( G!� 1GIf -f-40 }.a �/�/M//" �:F S O ; ▪ i• ci NOTARY N '; My commission expires: (,�/�r '.. PUBS-" v:.= V ;'.mid ,\per;'��` �i �' S //,/F(5 WAS�\\\ I I 1 ,l I Page 2 of 2 • PPOPOew E SEPTIC COMPONENTS �Terrwr+, 0 SEPTIC MOW'(HOUSE) tB SEPTIC STUBOU7(GARAOE) OAERATION SEPTIC TAN( 0 OPUP TAN( rerr Nr� f• . M O SEPTIC TRANSPORT LNE % %% / 10 4 OSEPTIC CONTROL BOX '07L i% % f 05 ©PRIMARY GRAIN FlE1O / / / % / il, OMONR G.ORIN 'CLEANOUT PORT(M,) / /VV��'''" O O GRAIN FIELD RESERVE AREA / ., " /',,,, 0 % .,. TT • .1. SCALE. I'•*40' 0 270 SO '+ +TMrrrtw 1 „rasri.rn t 1 1 1 1. 1 memo 1 rr TOT1RI/% 11ry 1 tn 1 PROPC.0 aemM C ecat) — nne .el . �C01121' 6 49' bt A 1I99 ' \ �*M MiL1 It. \ I I \ / \ \\ �V / \ 1111111,11C 1 .15,03 Wean,. u. 4.1, 4 1 '404 /101110 - ----� -- Lt)j1) •