HomeMy WebLinkAboutWEL2023-00057 - WEL Application, Design, Letter - 10/18/2023 A . ST
TON,
WA
584
MASON COUNTY A15N6SHELTO 360-4 7-967 ,EXT 400
BELFAIR'.360-275 4467,EXT 400
Public Health & Human Services ELMA 360-482-5269, EXT 400
FAX 360-427-7781
IDDINGS FAMILY PROPERTIES LLC
PO BOX 2
MAPLE VALLEY, WA 98038
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2023-00057
617 NE Dewatto Beach Dr
323284300000
The 2-party water system, Iddings Well (323284300000/323284200040), 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
nil
"n- i Dale Received
` Mawiv s OUNTY
'$ A- COMMUNITY SERVICES f Amos eltls Rece
? Sv Build ( S In.nen mental Health.Communay H"nin •
719-Navy) :
411,N.H"St,cut (H ldr X) ShmIton.WA 98584 WEL Asa VII o t cl
Shelton: 360-427-9670 x400 HdrinT3602a5-0467 x4W Elma:160-0R2-5269 x4011 - 0 //
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT ,r _ PHONE
eli,a4 /'e 4 Tdoi/ ny5 0706 -- 39/ - 23/3
MAILING ADDRESS-
CITY.STATE,ZIP I VPOAn / 2 fir
/e z / /e y, G.I/9 SD L9
8-
SITE ADDRESS STREET.CITY,STATE,ZIP
62 /% — Air pe1J4 %eoeA ✓ r. _ T uyq1 k1 n 9eno
PRIMARY PARCEL NUMBER(WELL SITE) a' Szs2C i /v9- 0000C
SECONDARY PARCEL NUMBER OF APPLICABLE)
#,3232 $ — -Y2 — O oo slo
WATER SOURCE SOURCE TYPE PARCEL I LOT S(E PARCEL 2 LOT SIZE
0 New XExisting Well 0 Spring efr etc e es -3Vz ace eS
PROPOSED WATER SYSTEM NAME(REQUIRED) -Z-Val
i 44S I YAI///e y/
PROJECT DESCRIPTION /
flp/rnb✓e -Con et fwo --par ><y / r 1 fr'4J1r lh)afe el
S S"f an } 9 eor` J,(e Co,1t: uo45 ///araeis is:sll-ci / aJove .
DIRECTIONS TO SITE/CONDITIONS
Site Plan: (may also be attached)
(property boundaries,structures,well site w!100'radius,driveways,roads.septic/sewer components and lines, easements,etc...)
see- a 1ach_ee( rr
Ne Tk—.' • v✓Qfer� sa rn IPIe ( we// /oq arc Oil 7 ; le :
• 2 �nnry 1✓n}en 5-y5ferrt_ 1 5 recce deof 0,/%uo/r-/o/A
. -Lde,e/ nee N No " se/oI;e/sewer ro,n onerris
$
Its
Submittals Checklist: (these additional items will be required for approval)
0 Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) - o n -c; /e
Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) on -c,.fe
Notice to Future Properly Owners recording (record with Mason Co.Auditor, supply copy of recorded document)..Li,e
ISeptic Records(additional locating requirements may apply if there is a lack of septic records on file) /
Revised: ]Or 7?g
rs form may be sunned and available for public view on the Mason County Web site. 02I
Pagel of 2
Review Step 1: Well Site Inspection:
YES NO� NA
*`>"l
❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
�5 (drainfields,tanks, buildings; indicate distance on plot plan)
❑ n ❑ 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?
❑131- ❑ Does the ground slope away from the water source site?(show slope on plot plan)
IL ❑ Is the well cap satisfactory? 3 oii of l(11,^,w_e(f CM " -'novel fke�n{s (405e
❑ ❑ Screened and vented? - (py1(1/N�' I4O1C flat p tub 5 ci
�! (dj ❑ The well casing extends ( level ground/concrete slab? (circle one)
Crg
� -' ID Is there evidence of a surface se I 50Ci( flAnP Le: 49. 99Ez7ly
1"' ❑ Does the seal appear adequate? Joy� (-0n 1 -12.1.06`ocia
tau I.
❑ [ ❑ Is a variance necessary for well site approva . TO : CMsit;
Comments - MOv4 4- by /tS._.'rev- 'tea cp n- loose or ,nf'tc,w
�( - Seg ( has, stooped 11" Need 1a be resenreel l 7 ' j
/�I Pass Fail`7�Inspector Date /O/Z6/7o2
ael
/Review Step 2: Two-Party Review:
YES NO NA
cki ❑ ❑ Water Well Report with adequate pump test on file? /r- n �yyd����'
If NO, date of Capacity Test 9/Z(ZZO Zd Driller OQ MA- ✓1�/I(i'q GPM 3U
❑ El Received Satisfactory Bacteriological Analysis? Date of test 9/(6170t7
�-,r ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z Z 0350((
/ 0 ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments fill ( i (?p ((j 0464 1n we(( ivied _ 11 /C/zaz3_
\
OD Approved El Denied Reviewer ./7 1� Date {f/7/(r�2 j
( - Findings in this review reflect oh.cervedd conditions as they existed on the day of the s site inspection. No claim is made, express
or implied ofthefuture success or failure(this system. Well site approval does not constitute 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 usage restrictions and additionalfces may apply to all new wells drilled after January 19"', 2018 per ESSN 609/_
Revised: 10/132021
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
WATER WELL REPORT '.. No„,, l -, WET:ISG
hPenrwoek: ECOLOGY mU r utn 10 Tag r;r, an>n3 _. _.
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er 111 COASTRCNUA CERFTFrl AT10N ., ., mina e b:L m v,ol'ry w. rai.,mnrl 1 •e�I ;, r..e:l
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s r __o-lmdo v .Mini_ i i :mdY , A d v �bubef
(Tills IrrFm I- -Au Fmlly Dcws I'I Inc [ mpinn DBns Drilling
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ee 31n2 C.r Z . B fart/rPfib'I2±
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aLCa�zoa3-61o80 WA-109y09-3_o9WLD
At I Thurston County Environmental Health
5 „t .,, I 2000 Lakeridge Dr.SW 6 Olyrnpia,WA 98502
360867-2631 i
TItiblenntes COW-F?
COLIFORM BACTERIA ANALYSIS //tr�l
r Dale Sampr oected Time Sample Cony 1 �W T1.
Coilecled
9 15 23 to oo Fr �a 934
0v. I >Cn s uZ3
I Time or Mate System(meat only one box) Lg-F`vale Heusenolbl RECEIVED
❑Ginn A ❑Croup B ❑Oilier _
Group A and Orlon 3 Systems—Pmviia from Water Facilities Invonlory(WFI): I
saps mak eu rIle.MGCi ,(� Iz Prone f )
Deere-bone ) /y}. o Re Pnone
S ndz_ _H+ .L4 ^¢5 .._ ,
COI /_WN g85Z.$—
SAMPLE INFORMATION
Sample:Sulk by(name)'.Ee9C I 3.0L2
V S
Te beaten or address where male collected' 1 St cal instructions or COMMONS:
617 ar Braxv+6 ah` ,
1 Tip... __ ,rJsl 9Rs88 4tut3 - BAa l73
Type of Sample(must deed only one box of di thrmgh#411sletl belnw) I
L[Jithuline Distribution Samp;e ! 3.Repeat Sample(alter unsal.routine) :
Clihrfn+L:J.Yes Nu Ler ❑Dismbuten System
Chorine Residual-Toler Free re< Chlorinated.Yes_ .. No I
3 Raw Water Source Sample Chlorine R sluat Soho Fee _
❑E coi-GY!R(tips
❑Fecal—siae,onl.sor Ins mimumm) Unsatisfactory routine lab number
FIRred.Yes No —
❑Assessment Monitnng(NS) unsalslactory routine collect date-
DOlher I
Is 1 I
A.I]Sample Col'.ected for Information Only
Invesliyalrve Construction!Repairs Other_
—,
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑Unsatisfactory Total Coiiform present and I,6alisfaclory
❑Beer present 0 Emr absent No CoFiom,dclpctel
Replacement Sample Requiretl'.
❑Sample too old p30 hours) ❑TNTC ❑_ .
Bacterial Dense,/Messes Total Coliform IlOOntl. E curt 'ream''
Fecal Colfonn __ IlOOml Erlerococci -__-_n(ar mL
errnod Cede ❑S'e 9223E OSIO 9222D Dele and Time Raeeredr
❑Sal o2ISS ❑Enlerolef® 11300 q- K-23
e An;Tillie AnaO222 103e RetOne { 16ip3,
anrate one eaters,9,.a n I Lab Use any 1 n o o e) t( 6 0 I 123204-ol A
es,roar.3r 1,e"zed 0'IN
2203509 MASON CO WA
10/18/2023 12 32 PM NOTCE
LAURP P IDDINGS $191839 Roo Fa S204.SD Rag4 2
III IIII Inllll11111III!01 IHII���IIIIIII I�IIIII IIII lii
Return To
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99n13 $
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Grantor(s): (Y . (2) �t eat f
Grantee(s): (1)PUBLIC
Legal Description (1) S t✓ SC 4-X S y1� s6 - S'9
(Abbreviated form:i.e. lot, black,plat or sect' n, township, range)
Assessor's Tax Parcel: (1) 3 2 3 2 8 _ . <3- O O O 0 0
Jan Tc73 ,es
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) ,3 2 A 2 Q - - - coca 'C
Tax Parcel: (Connection 2)3 2 .3 2 e - z - O O O -r
The system owner is responsible for keeping this system in compliance.
The name of the water system is: -re/di it n s wC//
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.
Dated on this /vim day of Cc /Io/er , 20. 9.
Signature of Grantor(s):
(1) ✓adcE%-7 , (2)
) GL%,
Page 1 of 2
State of Washington
County of Mason
I, the undersigned, a Notary Public ir�k atLnd� f'or the above named County and State, do hereby
certify that on this day of wt)J�� , 2023 ,
tJ1uit A 'TM vac? 3r( .b)l personally appeared •:fo - - -,who is known to be
signer of the above rristrument, andknowledged that h (QS(the signed it.
GIVEN under my hand and official seal the day and year last •ov- • en.
Uri as vrNal- rapiabb
.
Notary Publiin�and for the State of Washington,
N�
residing at �'"Y 1'C
My commission ex ires: 623'1/47/
NOTARY PUBLIC
STATE OF WASHINGTON
JOYCE M BEVA NS
MYCOMMOB&ON DP E$
MMRCN 1S,2021
COMMISSION 0 4S e4
Page 2 of 2