HomeMy WebLinkAboutWEL2023-00045 - WEL Application, Design, Letter - 8/8/2023 A
MASON COUNTY 415 N 6 SH ELTON HELTO EXT 400
SH STREET
360-427-9670,TON, EXT584
It 400
BELFAIR:360-275-4467,EXT 400
Y E/ Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
RUSSELL COLLIN R
310 NE KISSIN TREE LN
TAHUYA, WA 98588
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2023-00045
310 NE Kissin Tree Ln
323342400000
The 2-party water system, New Hobas Water System (323342400000/323342400000), 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
[2ca
' MASON COUN AUG 092013 ® Rece s _ )-��
/ COMMUNITY S ;it VI:;.1. Ep "c S -
Ro(ner
41',] r Sled)-(Bldg St %Jinn WA 985b4 WEL 20 . 3 -boa`t-S
Snd 16II--. 9670r10J li lr,ir 160-27S-446'Y400 Elora.3n1-4#.<269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT PHONE
Mattson Land Consulting, LLC 253.228.7462
MAILING ADDRESS-STREET,My,STATE,ZIP
21227 88th Ave E Graham, WA 98338
SITE ADDRESS-STREET CITY,STATE.ZIP
310 NE Kissin Tree Lane Tayuha, WA 98588
PRIMARY PARCEL NUMBER WELL SITE)
32334-24-00000
NUMBER(IF APPLICABLE)
3Z33R -a -0000(2
WATER SOURCE TYPE PARCEL I LOT SIZE PARCEL 2 LOT SIZE
SOURCE ❑New 2 Existing 0 Well 0 Spring 10 acres
PROPOSED WATER SYSTEM NAME lREOURED
NewHobas Water System
PROJECT DESCRIPTION
lice existing well to provide water to 2 Single Family Dwelling Units
DIRECTIONS TO STET CONDITIONS
See attached driving directions
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100 radius,driveways,roads,septic/sewer components and lines,easements.etc_.)
See attached for site plan
_.'7 t. y ( 555
(' V
2
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ll
4o; 082023 ' all
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)
HiNotice to Future Property Owners recording (record with Mason Co. Auditor. sl/oply 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'. IO/1 3/2021
Page 1 of 2
Staff Use Only
Review Step 1: Well Site Inspection:
YES NO NA
❑ g ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields,tanks, buildings; indicate distance on plot plan)
❑ h ❑ 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? .) t'L uo 7 )t'
❑ ❑ Does the ground slope away from the water so rce site(shot slope on plot plan)
D ❑ ❑ Is the well cap satisfactory? /v./A -L ii k.-E-("A4 i( / I I rh--S-e )C f
la ❑ 0 Screened and vented? t k
❑ The well casing extends I ,( above level ground /concrete stab? (circle one)
❑ ❑ `4' Is there evidence of a surface seal?
❑ ❑ Does the seal appear adequate?
❑ ❑ Is a variance necessary for well site approval?
/ t C
Comments 1 1 1 � >SS
///////// J / 1 A -7 — ( ) 3 C� ' �)O
[pass ❑ Fail Inspector I G/e tAkt1, gfp Date /0
Review Step 2: Two-Party Review:/ "Uo /�
YES NO NA IIII Cp/1061❑ ❑ Water Well Report with adequate pump test onfile? 7 NO f t/ ,/
c� Let II to •
If NO, date of Capacity Test JQf(r/�Z7 Driller J ko/Sal / �.S/Pm/rn9 GPM�/U.
V ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test WTO/u/21?
I1 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN it??? 7 7
/igri ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
ikr Approved ❑ Denied Reviewer Date 1(777?Oli
Findings in this review reflect observed conditions as they existed on the day fthe site inapeetiorr. No claim is made. express
or implied of the future success or failure of this system. Well site approval does not coilctinee water system approval. Water
System approval i.c 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 u.vage restrictions and additional fees may apply to all new wells drilled after January 19'h, 2018 per ESSB 6091.
Revised: 10713,202i
This form may be scanned and available for public view on the Mason County Web site.
Cage 2 of 2
RECEIVED
Litt WATER WELL REPORT
CURRENT NOV 1 7 2017
origins].l"e.pr-Eeoey,x`"=npy-owne.,1^eon-Millet Notice of'Went No.WE 29364 inn wT_Pe De parlment
� �
dECOLOGY Construction/Decommission("+' in circle) Unique Ecology Well ID Tag No. ALIT 686 rat Fco4egy (SWRO)
/Q Constfucnon Water Right Permit No.
❑ Decommission ORIGINAL INSTALLATION Property Owner Name Jennifer Chavis
Notice o/Intent Number _
Q J PROPOSED use; A Dame.ri= 0 mamuial 0 Mw=ip•I Well Stied Address Risslne Tree Lane
❑ Dewne. 0 Irrigation 0 Test well 0 Other City Tahuva County Mason
in TYPE OF WORK: Ownefs number of well Of more than ore) location ND/del/d�Il4 Sex 34 Tun 23 RJ EWM 0
L MI Now well ❑ Reconditioned Method:❑ Dos ❑ Bored ❑ Dorn In. SNIRMI/45 I/4D) Or
Y ❑ Deepened E Cable 0 Roth.) 0 Jetted W,OrM
C DIMENSIONS: Diameter of well portico.dnikd 2 4_..fl. Ira Oil
Q Depth ormmpkmd wdlm fl. Tat Deg _ Ist Min/See
C CONSTRUCTION DEFAME lung Deg Long Min/Se
O Come I worded 6 " Diar,.fleet +l ft m 249 It. Tax parcel No.(Requircd) 12)3434-00000
}+ Ins
ullee 0 Liner Instilled ' Dom from_fl.to fl.D
❑ lTrtadM _ " Diam.From_1t to P.
enfe..imn.. 0 J« CONSTRUCTION OR DECOMMISSION PROCEDURE
Q Type ofryerrnramr used _ _ _ Formation:Descnbed by color_character,size ofmaleml ardnnmmre,
s� and the kind and nature of We material in each stratum penetrated with at
- Isz peri!_n.by_ and no of perk o hom_A to fl. least one entry for each change of information. (USE ADDITIONAL
Screens: i] Yes ❑ No AnK.ine Location SHEETS IF NECESSARY.)
QI Manufacturers Name Alloy Machine works MATERIAL FROM TO
L4-0 Type stainless Model No.
I— Dam 5 sla ice m from249 Ato tie fl. DR 0 5
O Dam. Slot size from ato II littlish brown till 5 45
Cravewmer pongee: 0 Yea E No Size of raveYsand_ peat 45 48
ri,K placed from a m n. Cemented sand&gravel with water 48 95
f0 Surface Seal: IN Yes 0 No To what depths 25 fl. Modish brown till 95 t 100
40 Mmerim,used in seal tie Light brown till 100 i 200
eaDid any Contain unusable water ❑ Yes U No Sand&gravel with water 200 254
0 Typo ofwetr Depth nferau
Method o t scaling strata:oft _
PP: M nnAemrer e;,ame
UM Goulds
yea Typo dolt- H.P. 1.5
1a WATER LEVELS: Land-surface
elevation Moss mean sea level fl.
C Static level 201 It below top[dwell Due
rri Amman pros lbs.per square inch Dale
t rolled by (cap,valve etc.)
CO TOMS:Drawdow n, a level n lowered below.static level
} Wasl a pump:rat modes 0 Yes amount
Mo If yes,by whom?
} Yield. ,aVmlr=with ft dmdown Oct lin.
Q I Yield. cal!min with ft drawdown abler=hrs.
Yreld.�a me taken
wnah e.pumpo,re do ins.
all weIwr''' mp,memaen waeo when pump nnnM oQ/lwtzc level measured front
C) m 'ate'Level
,(QT'�l Tyne •Watem lrvd Tine Water level Time Water Level 1
L _
OD.n.nitnr
ODUYv teal gaVmin with f drawdown after ben.
LE Amos gal/m,n with stem let at 6.for�M1n.
LLJ
t Artesian flow gP m. Date
Temperature of wamr Was a chemical analysis modes ❑ Yes Ill No Stan Dnd0/9/17 Completed Date 110/17
C
E WELL CONSTRUCTION CERTIFICATION: I constructed andlor accept responsibility for constnction of this well,and its compliance with all Washington well
construction standards. Materials used and the information reported above are tme to my best knowledge and belief.
PP El Duller CI En imxr['Trainee Name Emily Davis Dolling Company Davis Drilling
Cl. Drilln/EnginureTrainee Siqumre --(ilmv‘ _ Address 340 NE Davis Farm Rd.
v Driller or trainee license No.3143 City.Slag,zip Helfair,WA 98528
o IF TRAINEE Itdller c License No Contractors Nov.Y019
Pi Drillers Signemrn - - Registration No. DAVISDI1100A [we
t ECY 050-1-20(Rev 02-2010) To request ADA accommodation including materiels in•J aifor the visually impaired,call Ecology Water Resources Program
r or 360-407-6872. Persons with impaired hearing may cell Washington Relay Service at M. Persons with speech disability may call TTY or 8 7 7433-63 41.
ttif
NICHOLSON DRILLING INC. NOV 9
PUMP TEST RECEIVED
NAME: Collin Russell DATE I October 19,2023
SITE: 310 NE KISSIN TREE LN TIME 10:40 AM
TAHUYA WA 9B588
WELL DEPTH 2541 Feet WELL DIAMETER 6 inches
PUMP MAKE GOULDS 1-1/2 HP PUMP MODEL
TANK MAKE TANK MODEL
Time Depth Draw Rate Time Depth Draw Rale Time Depth Draw Rate
iicnw To Down gpm to Down gpm to Down gpm
Water Water Water
Static 207.2 0.0 40 217.7 10.5 18.8 660 0.0
1 211.0 3.8 45 218.1 10.9 720 0.0
2 211.8 4.6 50 218.3 11.1 780 0.0
3 212.4 5.2 60 218.9 11.7 18.8 840 0.0
4 212.8 5.6 70 219.2 12.0 900 0.0
5 213.1 5.9 18.8 80 219.8 12.8 960 0.0
6 213.3 6.1 90 219.8 12.6 1020 0.0
7 213.8 6.4 100 220.1 12.9 1080 0.0
8 213.8 6.6 120 220.1 12.9 18.8 1140 0.0
9 214.1 6.9 150 220.1 12.9 1200 0.0
10 214.2 7.0 18.8 180 220.1 12.9 1260 0.0
11 214.4 7.2 210 220.1 12.9 1320 0.0
12 214.7 7.5 240 220.1 12.9 18.8 1380 0.0
13 214.9 7.7 270 220.1 12.9 1440 0.0
14 215.0 7.8 300 220.1 12.9 1500 0.0
15 215.1 7.9 18.8 360 220.1 12.9 1560 0.0
20 215.8 8.6 420 220.1 12.9 18.8 1620 0.0
25 216.3 9.1 480 0.0 1680 0.0
30 216.9 9.7 18.8 540 0.0 1740 0.0
35 217.3 10.1 600 0.0 1800 0.0
RECOVERY
Time Depth Draw Time Depth Draw Time Depth Draw
to Dawn to Down to Down
Water Water Water
1 217.1 9.9 11 0.0 45 0.0
2 216.2 9.0 12 0.0 50 0.0
3 215.9 8.7 13 0.0 60 0.0
4 215.4 8.2 14 0.0 70 0.0
5 215.2 8.0 15 0.0 80 0.0
6 214.9 7.7 20 0.0 90 0.0
7 214.7 7.5 25 0.0 100 0.0
8 214.4 7.2 30 0.0 120 0.0
9 214.2 7.0 35 0.0 150 0.0
10 214.0 6.8 40 0.0 180 0.0
SIGNED BY:
Christopher Chi on-Pump Supervisor
i `` Thurston County I nvlronmentul Health
-y ]OJn'.ik t'dl1," r s\v 001r+��e.ia,\v.1 H150)
M,y 1e08F> 363=
COLIFORM BACTERIA ANALYSIS
r _:....I � iAv� sir.•
O? 110 1 AS 10,�.aQ o Meson
5 nI :Iy wtA
SW 8389Celle q...axi�. ,. ,;w 250 PO
r "^ OAS,"r{+y_crru114 g^4.l .4 r, ,SA -250-9399
call n (At. cwaxllp44r al.(or% v,
310 ME k,ss'n r.c LA/ Uk
Y gj&
28
SAMPLE INFORMATION
310 N£ Kss,n Stec LEW
•-+A 1985s8
L.
Rout u batnWl.: sample Repeal S,moln,ueruoul rtlwint.
I1 Ihw Whin Sour'.Sample
S
N Co If fee ricn, Iv,.P�h _.
N_r DRINKING WATER RESULTS
iu :aeon . .. A�Id s6p cap ..
Pn pheemaml Smp;e NWmmeb
f 11 ' ?, "4 IV ';
I
yet
Thurston County Environmental Health
te 2000 Lakeridge Dr. SW 4 Olympia, WA 98502
360 867-2631
THURSTON COUNTYemanunima NITRATE TEST PANEL
Report of Analysis
Gam Cnllceled: !nl NI:DI)3 3 i 0 1. / 11Z;2 3 System Group Type:iln.ar„net A B Other:
Water Spslem ID Number. _ System Name.
Lab g Sal p. a: URD — County: Mon
Sapplel a 45gg source Numhcrt ) I I fee.if l l -mhuhm
3o A/E kssrn . Lt.), 11.19.0.y. 4A — _
Sample Purpose- httk eprhoorene P30.1 F Dale R ived: tMMODvtr t / 1 h...) �1
I
- 12( It tin 'C ph e is C requirement. Dale An a lyzed:IMM DD'y)') O tc 2 I
C Confirmation a II �� 11 of c tc I e, Ir Date Repotled minalorvTYt �% 7 3
I -Investie oho)r.a ,r re9td men. . Sampler Comments
O O Other ! cd- Pe m.nl-1
Sample Composition trInk numofireebow Sample Tylx: (check one) ❑ Pre-treatment/Untreated(Raw)
® S -Sinvle Source ❑ Post-treatment(Finished)
f l B Blended iiim sillIte,in Source N tame) fad) ❑ Ilnknolw or other pp
,j C Composite( list seurccen ti„ cen tnc(.)' field) Sample Collected by: (name} 6r;enL 5eCS6 /Collie 4.0seii
I) Dktribui ion sample Phone Number. a5o - 2380
Send Report toucan inc or e-nail address): Bill to. (client mime)
colt' o,c.CoeS5Ctt n4LCart _. — Glltn 0... se1
310 doh. .5Sn Vry Lnl11-6.110.1.1ue4gS89 -
EPA REGULATED AND STATE REC.ULATEI)OR REQUIRED
DOH ANAI.YTE DATA RESULTS UNITS MRL SDRI. TRIGGER MCL EXCEEDS METHOD/
p QUALIFIER MCL? ANALYST
IX if yes)
UG20 Nvn¢N 40e� mpril 0.5 0.3 Al5 1IL0 SM4500 NO3D/Nod
THE NITRATE LEVEL IN YOUR WATER SYSTEM IS:
Ll} In Compliance' ^I0 itt!L is the maximum contaminant level allowed.
I] Our of Compl lance
[OTES
ehonfirmaton clue Me original lab number.eurrple number.and collector elate of onsoral sample in either Mb or sampler comments.mllon.
Ilk Et.QIIAIJ IIER: A smnbre or leaenu deplore.rddiiional information alx.ut tM1r result
mFIJ millicsmuper liter or pans per maWnt
%MI INIelhodRplrtingl t} I h low lowere ruerrerfiehleof on anal '
trpr
ifikukl,'Slate Detection Iltipm lion I it I he ininirmink reponnblel f'itn fmalklestalis d bk itte dp I.
TRIGGER: Doll drinking .pose level SkSiellls N% h compounds detected at vt.(on III ekeeto cifthis level nk be required to take additional.bytes or
re Oen'clink
EX(EEDS MCI-I M t !onto 11 Marked if ihds theMCI-ttder chapters 246 290.infl246291 WA(' Please contactthe
depfmmvtiz ill inkiiin kkinei iegienal office in k our. vtltdc crf ell lhr upt< ots.
Lnb(ommenb::
2199929 MASON CO WA
o Ne2a,3 n 0 4 Ur�r d0. SQ Grmr t
RrrSsel 'illiillHI�IIIINIhil@ulhVfll)i�I killh�lt
act NF Kissin I ree Lane
ie'14( 1 L A 23_333 _._.
Grantor(s) I, llolhi R RI sso!I
Granteets): rn El err: C
Legal Description !' Pin SE 11W34 23 3
an;essrlmarl a I'IrrrSlfr I 1.r 'fi'-Oeir11)0l
Assessor's Tax Parcel'. I I t 3 _ 3 3 0 0 it cc_
NOTICETO FUTURE PROPERTY OWNERS OF PRIVATE TWO.PARTV WATER SYSTEM
,.c. iirstni rained drantonsl. certify 'hot the water source located on h :Morro d :te..
.al estate under Legal Description)1) and Assessors Tax Parcel (1)situated in Mason
',minty Slate of Washington has been designated to serve a source of water to the following
oarcels situated in Mason County Stale of Washinglon herein described
tax Parcpt iConnearon 1.3 2 3 3 4 _2 4 0 0 0 0 0
r.F +'ret ICa11e00'1
e system owner is responsible for keeping this system in compliance
nrr urine of the water system is _tewHahas Wafer Syslernlc.
es— ` 1.a3 „GC c . .. :Ann - r3nd ,.cam r press
nits', ha obtainer: r am department prior to expanding beyond this number of Services
A:xlfaonapy a water nnht obtained rant the Department of Ecology is required rf the water
vatem exceeds exem pLon standards
:iris systent Lilac hos r t) been granted one or more waivers Irnm specific provisions of the
,r:4 u:asonc
r.Jeer IHS .. .lay of I I2ri
Page 1 of 2
flare of Washington
Dmuuob o' Mason
the unriersgned a Nouny Puuhc In and for the above named County and Slate do hereby
crier t! brs .ay of l .__. 20
personally appeared before me who is Known to be
sinner of the above insimntant and acknowledged that he(she)(they) signed rt
(IV( N under no hand and official seal the day and year last above wittier
onMnrM „ I Ir.. r- -1 ( I -1i Iu) �.+ t__ d�____.-__
r/ ..
o` �. (evbdF•:9.0k Notary Public in and for the State of WAshington.
V"` Id
0 o.Os.zgri i.2 residing of j,,L,.��.jyLJ
() nasty My co msson exp.tes I p �_I�. j _t; eL
nos
"fF'9a,�nm�;:�ti
Page 2 of 2
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