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HomeMy WebLinkAboutWEL2022-00044 - WEL Application, Design, Letter - 9/15/2022 584 MASON COUNTY d16N6THELTON: , 0427-97 ,EXT 400 SHELAIR 360-2754467,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360427-7787 DAVIS DRILLING 340 NE DAVIS FARM RD BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2022-00044 XXX E Wild Grape Way 221144190010 The 2-party water system, Wild Grape 1 (221144190010/221144190020), 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 COUNTY o..R m-N: - 15 COMMUNITY SERVICES am.un�R.cM•ne. Re-11aE, dtlldlrg.PlmryFmi,mm�mYNJrhCnmmnlrylMelN 415 N.5"Strsa.(Bldg 8)-SEhas WA 985M WEL c3CGaS - Shdbn: 360427-9620 x400 BPRslr:360-275J 7x400 Eless 360�825269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION Apn1CAM Tab L a� l- 37 MARN.AURIU.— PfAV sRE RE%-STREET,CRY,STA ,LP 1 1 C PRIMAR�RIEI NUMBER IWELL`R ' _ BECOX� i HUMeE p`APP AalEl 0 WATTEERSWRCE SWRCE MF PARCe"LOT 3 //� / YE PARCELFL0r 8ME yt New ❑ Ezisfing [$Well 0 Spring I I U PROPO6E0 WATERY^YSTEI i MFYE Grp.1 PROJECT DESCRPTVMVN G 2 y w DXFECn0N8 TO$9EJ COND';: i o Site Plan: (may also be attached) (property boundanes,sauotures,well site w/i 00'radius,driveways,made,septic/sewer components and lines,easements,etc...) NO CS On these �� evctu"� VQrcels Via m_ a� r � en O 0 6 N Submittals Checklist: (these additional items will be required for approval) Satisfactory Bacteriological sample (this may be deferred if well is not yet dulled) 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) Pff 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 an 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 ❑ Q' ❑ 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 foot radius of the water source? If so,is d private, urdy or State. What is distance to ROW? 7, ty/❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) u ❑ ❑ Is the well cap satisfactory? ff'�❑ ❑ Screened and vented? ❑ The well casing extends g' above level ground/concrete slab? (circle one) pp'o�❑ ❑ Is there evidence of a surface seal? ❑❑ /n� Does the seal appear adequate? V ❑ 1] Is a variance necessary for well site approval? Comments Pass ❑ Fail Inspector Date el �70 ijsy Review Step 2: Two-Party Review: YES NO NA E ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test, 4q 1 13 I7'r Driller GPM_1 ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of lest 9 1 1 )PYy ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z76 T7,1 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments 7 �,J7 , Approved ❑ Denied Reviewer Date Z./ V (i/l� Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. Na claim is made, upress or implied of the future success or failure ofthis 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 19i° 2018 per ESSB 6091. Revised: 1 011 3/2 02 1 This form may be scanned and available for public view an the Mason County web cite. Page 2 of 2 WATER WELL REPORT 0IPAi(IMEN•OF NgiceofMeetNp. WE42M ECOLOGY (nxi.l1 1 We11;1)Teg N...ONA/09 tYFaww s:pw awril:MLup aC.psLn 34ew lNm (ir0w Um apewal0: ❑ueM®ukkke:� tLiBmi oktlana Noi w. wm,L;LN pp,piNrp,riR�m Np. 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