Loading...
HomeMy WebLinkAboutWEL2023-00064 - WEL Application, Design, Letter - 12/29/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467, EXT 400 Public Health & Human Services ELMA:360-482-5269, EXT 400 FAX:360-427-7787 ODELL CHARLES K & LAURA B 4197 MATTSON PL NE BAINBRIDGE ISLAND, WA 98110 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00064 340 E Eckert Rd 121081390013 The 2-party water system, Odell 2-Party (121081390013/121081390012), 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 I ` \ MASON COUNTY Dale Received '"' F, COMMUNITY SERVICES Amount v t ��I Received _ '�' Building Planning Environmental Health.Community Health 415 N.6th Street,(Bldg 8) Shelton,WA 98584 WE L C) — b v 4 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Charles Odell 2 © 6 - Cl `( ' -• ea-] i q MAILING ADDRESS-STREET,CITY,STATE,ZIP ` 1,'77 A-7/9 7'7 s DA) P 4- /!E 8 A/f 3a-i,D GC /s44 n.O , wA ?a'/ ID SITE ADDRESS-STREET,CITY,STATE,ZIP 340 E Eckert Rd, Grapeview, WA 98546 PRIMARY PARCEL NUMBER(WELL SITE) 121081390013 SECONDARY PARCEL NUMBER(IF APPLICABLE) 121081390012 WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE IR New 0 Existing ® Well 0 Spring 1 1 PROPOSED WATER SYSTEM NAME(REQUIRED) OdeJ / z - j ct- ti PROJECT DESCRIPTION DIRECTIONS TO SITE/CONDITIONS Site on Right 550' after stretch island bridge. Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways, roads,septic/sewer components and lines,easements,etc...) • DEC 9 2023 �tity By _ ! Eft `2\ '7)61001? 1210?) 310012-- JAN032024 RECEIVED Submittals Checklist: (these additional items will be required for approval) 1 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) I: Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) eptic 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: YES NO NA ❑ [V ❑ 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 road rivate unty or State. What is distance to ROW? "'$0 N ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) ❑ ❑ Is the well cap satisfactory? _ pa ❑ ❑ Screened and vented? Z .., tara " ❑ The well casing extends above I and I concrete slab? (circle one) !'•' El Is there evidence of a surface seal? Lai-' Li?.326 4'�f20 Van � Does the seal appear adequate?❑ �� = -Ili .83o?361 X a Po. IS 3 ❑ ❑ Is a variance necessary for well site approval? u S Comments ken St'i'rfl(//'?G'��i[�c 61, L' 40,_ 'mai_ t a /% 7 if/�.--- p( . Trill ri' S (1 a , to a f ff of I'Spe-c ✓ 7. � y Pass ❑ Fail Inspector —,, Date /// 7( ?O Z y Review Step 2: Two-Party Review: YES NO NA g ❑ ❑ Water Well Report with adequate pump teste on file? /, �y If NO, date of Capacity Test i l /f/ZOZ� Driller OCtfr 0) (d GPM Z IA0050j fp4o1) ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 Z/77/ ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z ZC/tO fir ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments &yin arov( (I Trilled C/! iv latand 1 e.(ie( 7,g/2o Y. IX Approved ❑ Denied Reviewer Date 7( (3/ ?a? t'( 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", 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 WATER WELL REPORT DEPARTMENT OF Notice of Intent No. WE54384 tt ECOLOGY Unique Ecology Well ID Tag No. 1 3P0 lc3 Type of Work: State of Washington O Construction Site Well Name(if more than one well): ❑ Decommission r y Original installation NO1 No. Water Right Permit/Certificate No. Proposed Use: RI Domestic ❑Industrial ❑Municipal Property Owner Name Charles Odell ❑Dewatering ❑Irrigation ❑Test Well ❑Other Well Street Address 340 E Eckert Rd Construction Type: Method: U New well ❑Alteration LI Driven LI Jetted LW Cable Tool City Grapeview County Mason ❑Deepening ❑Other ❑Dug ❑Air- ❑Mud-Rotary Tax Parcel No. 121081390013 Dimensions: Diameter of boring 6 in..to 110 ft. Was a variance approved for this well? ❑Yes 0 No Depth of completed well 110 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread ❑. I ❑ 6 in. +1 105 1/4 in. ❑O I ❑ I) I ❑ Location(see instructions on page 2): 0 WWM or 0 EWM ❑ 1 ❑ in. _ in. ❑ I ❑ ❑ 1 ❑ SW /-y,of the NE '/;Section 8 Township 21N Range 1W ❑ I ❑ in. in. DIO ❑ 1 ❑ 1 ❑ in. _ in. ❑ 1 ❑ ❑ 1 ❑ Latitude(Example:47.12345)47.326458 Longitude(Example:-120.12345) -122.830913 Perforations: ❑Yes ❑No Type of perforator used No.of perforations Size of perforations in.by in. Driller's Log/Construction or Decommission Procedure Perforated from fl.to ft.below ground surface Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes ❑No LC K-Packer b Depth 102.5 ft. information. Use additional sheets if necessary. Manufacturer's Name Johnson - Material From To Type stainles Model No. Diameter in. Slot size 12 in.from 105 ft.to 110 ft. Topsoil 0 10 Diameter in. Slot size in.from ft.to ti. Blue clay 10 60 Brown sand 60 84 Sand/Filter pack:❑Yes ❑No Size of pack material in. Blue clay 84 90 Materials placed from ft.to ft. Blue clay with gravel 90 95 Surface Seal: iN Yes ❑No To what depth?18 ft. Peat 95 102 Material used in seal bentonite Did any strata contain unusable water? ❑Yes ❑No Green sand&gravel 102 104 Type of water? Depth of strata Brown sand&gravel water bearing 104 110 Method of sealing strata oft' Pump: Manufacturer's Name Type:sub H.P. 3/4 Pump intake depth:80 ft. Designed flow rate: 15 gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing ft.above ground surface Static water level 40 ft.below top of well casing Date Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No ❑Yes r=> by whom? Yield gpm with ft.drawdown after hrs. Yield gpm with ft.drawdown after hrs. Yield gpm with ft.drawdown after_hrs. Recovery data(time-zero when pump is turned off-water level measured from well top to water level) Time Water Level Timc Water Level Time Water Level Date of pumping test Bailer test 20 gpm with 17 ft.drawdown after hrs. Air tcst _gpm with stem set at ft.for hrs. - Date Artesian flow gpm - Temperature of water °F Was a chemical analysis made? ❑Yes '❑No Start Date 11/1/23 Completed Date 12/2/23 WELL CONSTRUCTION CERTIFICATION: 1 constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. ▪Driller❑Trainee❑PE-Print Name Mike Davis Drilling Company Davis Drilling Signature Address 340 NE Davis Farm RD License No.0.i/79)71//n City,State,Zip Belfair,WA 98528 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.DAVISDI1100A Date DEC 2023 ECY 050-1-20(Rev 08/19)/f you need this document in an alternateJorntat.please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 Jar Washington Relay Service. Persons with a speech disability can call 877-833-6341. Davis Drilling 340 NE Davis Farm Rd Belfair, WA 98528 Test Pump for: Charles Odell Address:340 E Eckert Rd Grapeview,WA Well depth: 110' Pump size: 3/4 hp Static water level:40' Date: 12/28/23 TIME WATER LEVEL GPM 5m 58' 20 15m 60' 20 30m 60' 20 1h 60' 20 2h 60' 20 RECOVERY 1 m 47' 3m 42' 4m 41' 5m 40' ellttttttttttttttttttttit.. 26276 Twelve ' Trees Ln NW 'I Stc.0 jt SPECTRA Laboratories -Kitsap Poulsbo,WA — ...Where ex _-- 9fS3711 perknce mailer, (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County /f 2 Collected � /�� dinsi2 51 Year �- --9----.. at r I Lt/t,}U Y 1 /� Type of Water System(check only one box) ' . + ✓.9i ❑Group 0 Group B Other_Pri u b-� �1Y Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): rT`cop O4 ID# kb System Name: ,1(32 4 , (.`c r �(�i J \S ` 1 Contact Person: 7C Day Phone: Cell Phone: Emai: Eve.Phone: Send results to:(Print all name,address and cc cede or email above foe elemonle copy of results) i(S. i =1....4_44_-- SAMPLE INFORMATION Sample collected by(name): Y„v ( ( Lit Specific location where samp! ollected: instructions or comments: W L l WO`TJ 1 Type of Sample(check only one box) 1.❑Routine Distribution Sample(AIP) 2.❑ Repeat Sample(AlP) Chlorinated:Yes El No❑ (from distribution system after unsat.routine) Unsatisfactory routine lab number. 3 Chlorine Residual:Total Free 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: HI II / / Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residual:Total Free ❑Assessment(A/P) 4.Surface or GWI Raw Source Water Sample(Enumeration) S ❑ E.cot) ❑Fecal Rested Yes_No 5.)4,Sample Cofecten nor Information only. LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and X Satisfactory b D E.coli present 0 E.coabsent Bacterial Density Results:Total Coliform mpn/100m1.E.cok_____mpn/100ml. Fecal Coliform cfu/100m1. HPC___ ..cfu/1ml. Replacement Sample Required: 0 TNTC 0 Sample too old ❑ Sample Volume ❑Damaged Container ❑_ -- meR ve0 � Lab e ;N&1-- O7- Receipt Temp C': Method Code::'` p 11 e O� t 92238/ -COUNT/SM9222D Datewow to In: h I Dart["' 1 J 2U23 This ewd ealelyu �e qro DEC 2 U 2023 UL this rapcs111 W .Olen.nay he ow do romodaloti et 360-T798141 Ind daeol av,wrM p.yey. DOH Lab-Sample it 010. OMewls(OI O On!bile loon beon ead and eepN,ya O ( N warred by eta weenier)nit rwal Yet not re rrsreduted seep 1 aWrenrfew promo.0M rpereN Di SF...m t...aes. DOH ram C31.319(Aft**edl7I I1 t - 2206085 MASON CO WA Return To 12/29/2023 12.49 PM NOTCE ODELL #193041 Rec Fee $204 50 Pages 2 Charles Odell I'ifHIPIIINIIIIIIIIWIIIIIiiKIIIHII,'l1IIIIUIrIIIIIIIDIiIIIIIIIII y 191 MATT °n) Pi--- NE 3A1 NRQ-i 0 6G tst,AnjD/ W -t8) to Grantor(s): (1) Charles Odell , (2) L v r . O d l Grantoe(s): (1) PUBLIC Legal Description(1)TR 1-C OF GOVT LOT 7 LOT:3 OF SP#2315 AF#569820,S-8,T-21N,R-1W (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 12108-13-90013 I 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) 12108-13-90013 Tax Parcel: (Connection 2) 12108-13-90012 The system owner is responsible for keeping this system in compliance. The name of the water system is: rD dy ` l .2t - p.r''t N 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 /? day of DE 1. ,i3Efl , 20 2-3 . Signature of Grantor(s): Ge // (1) t . aottt , (2) { age 1 of 2 State of Washington ) County of Mason ) I,the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this j`9 day of -iOp i YX hi X", 20 , (11-ItrI.2s, Qd.Pa 1liuY A Odateersonally appeared before me,who is known to be signer of the above instrument, and acknowledged that he (she) (they)signed it. GIVEN under my hand and official seal the day and year last above written. rya. I , ( C6ht--� No ary Public Xi and for the State of Washington, residing at 4t ttiu'�::•, W4My commissiona Aires: /p . -)4 5.........-Fcr-;.„1:0..,..p.os,-*+.—,,,„„•0":44"iv4;st_.:04„16.///, 21021 ' 5 —A t 416 OC:ei.2' .;:-.. '1111 7�WASOI--S- Page 2 of 2