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HomeMy WebLinkAboutUntitled (2954)• 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 PRIME LOCATION AND SITUATIONS LLC 113 E TERRACE DR BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2024-00010 1151E MASON LAKE RD 321343100050 The 2-party water system, Prime Location Water System (321343100050/321343200010), 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 Date Received: Z {/// / / /y z,1 / reilr COMMUNITY SERVICES Amount Received: 1/ /V1(/ (//Reeceeived8y. _�_ Ci 51-t 5 / Building,Planning,Environmental Health,Community Health 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L a Oav`_ Do O Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elm:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE ?f :Iv,E t—.444;a" 4 5►la4,4.D,i,t 1.1..c► 3G0 -117 , - ')La 4 MAILING ADDRESS-STREET,CITY,STATE,ZIP 11 b ( ) tMAO•^ I.AICf.. R.0 she 1tOtA 1 WA `i.3 tie,4 SITE ADDRESS-STREET,CITY STATE,Z ' PRIM 1 1 j PARCEL tJUE Pi i.A Ice . 4 c� w/a- 9 5 /v- ►. 3 13 ,--+ -fLSJJ(, I SECONDARY PARCEL NUMBER(IF APPLICABLE) 3aL3y - ?2 - C'(/O117 WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE ❑ New AFxisting 'Well 0 Spring I ' 3 9 1 . 40 9 PROPOSED! WATER SYSTEM NAME(REQUIRED) 1, � PR'Pr, DESCRIPTION Nc PAAt4t4Ace A- I t-b"I&. 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...) C 0-4 At L t Submittals Checklist: (these additional items will be required for approval) ,1 Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) 04 Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) ail Notice to Future Property Owners recording (record with Mason Co.Auditor, supply copy of recorded document) pi 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: YES NO NA ❑ 174. ❑ 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 private, County or State. What is distance to ROW? III ❑ il§ Does the ground slope away from the water source site? (show slope on plot plan) C d 'E1 ❑ ❑ Is the well cap satisfactory? El El Screened and vented? i, ❑ The well casing extends [y) above level ground/ .oncrete sla.? (circle one) N ❑ El Is there evidence of a surface seal? l-il Z, - (/3 �❑ Ga# ' El ❑ Does the seal appear adequate? Lan ; -12 3.OS Z S p3s ❑ ®_ ❑ Is a variance necessary for well site approval? -11 ; N7/ Comments v Pass ❑ Fail Inspector , ,), „,„1 V Date — / ��� 4), Review Step 2: Two-Party Review: YES NO NA (6(gPMXrst't'il $zs ai yak 1) ❑ IX El Water Well Report with adequate pump test on file? Z /f(/ZQZ Y Driller ,4 , GPM ) If NO, date of Capacity Test � �t�� �'R� � d [ El El Received Satisfactory Bacteriological Analysis? Date of test Z(Z ZO Z f XI El ❑ Received Signed, Notarized, and Recorded Notice? AFN 22.0.763S ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments 0 Approved ❑ Denied Reviewer Date j/fV? ?Cf 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 ulcer January 19", 2018 per ESSB 6091. 4 Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 COOLWATER DRILLING, INC. 10921 HOLLY RD NW BREMERTON, WA 98312 360-830-9005 COOLWDI941QM CUSTOMER NAME DATE 2-14-24 ROB FLATH CUSTOMER ADDRESS 1161 MASON LAKE RD, SHELTON, WA TIME STATIC GPM TIME STATIC GPM 32 05 33 11 120 34 11 10 34 11 135 34 11 15 34 11 150 34 11 20 34 11 165 34 11 25 34 11 180 34 11 30 34 11 205 34 11 45 34 11 220 34 11 60 34 11 235 34 11 75 34 11 245 34 11 90 34 11 105 34 11 RECOVERY STATIC RECOVERY STATIC TIME 34 TIME 05 32 30 10 45 15 60 20 75 25 90 THIS WELL WILL SUPPLY SUFFICIENT WATER FOR TWO HOUSES. 26276 Twelve 1 Trees Ln NW Ste.0 I1 SPECTRA Laboratories - Kitsap Poulsbo,WA 98370 ...Where experience matters • (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County b2 1024 2o2'f Collected OAM M fc-So� Want Oa/ Year J NA) litLim Type of Water System(check only one boos) ❑Group A ❑Group B (aOther Z Tom' Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Contact Person: Day Phone: Cell Phone: Email: Eve.Phone: send resits to:(Print Suriname,aoks9 and zip on ebonite,lecnonlccopy �r ' DM;IS nI.1U.I i/�VtsQ,ll,.!> .' ttat - ---ifD -Mtt -HOirr► SAMPLE INFORMATION Sample cot ecte�d by�(n�ame): �v16T 1,3 tttc'"N4 Specific location where sample collected: ,/Special instructions or comments: c 22O— �S - f iaLO1 4 It40% E MnTo" it 4 ail- 1.t+c(40"1 LAA c Type of Sample(check only one box) 1.($Routine Distribution Sample(A/P) 2.❑ Repeat Sample(A/P) Chlorinated:Yes ❑ NoiA (from distribution system after onset.routine) Unsatisfactory routine lab number: Chlorine Residual:Total Free_ 3.Ground Water Rule Source Sample — S ( I I Unsatisfactory routine collect date: Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residua!:Total Free ❑Assessment(A/P) 4.Surface or GWI Raw Source Water Sample(Enumeration) I S ❑ E.cob ❑Fecal Filtered Yes No 5.❑Sample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAci USE ONLY ❑Unsatisfactory Total Coliform Present and I Sattsfactoty ❑E coti present ❑Ecot absent Bacterial Density Results:Total Coliform mpn/100m1.E.coi mpn/100ml. Fecal Coliform cfu/100m1. HPC_ cfu/1m1. Replacement Sample Required: 0 TNTC ❑Sample too old ❑ Sample Volume 0 Damaged Container ❑ D tttti /(.5 j La°23 roe _b/ Recall Temp C: Meypd 161 ; 0T COUNT/SM9222D Tao tDate In: Dam 03102� dFEB 02 Q1 �.pleas roei be ardor im.dtloh el 3ri?rNS1 n aed enScV DOH Lab-Sample 4 riPatpa`ory himmir010- t )100/ ap i ,akedbr wheatnift en, rmleredameapoSlln nw GNMI .rr� !y idt.. 001 Fam 1031319(.lacy..0el17J Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories -Kitsap 26276 Twelve Trees Ln NW Ste.C ...Where experience matters Poulsbo,WA 98370 Phone: (360)779-5141 www.spectra-lab.com Spectra Labs- Kitsap,LLC(Poulsbo)received samples for Davis Drilling on Friday,February 2, 2024 at 4:31 pm. Unless otherwise noted,all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures.A summary of the samples received are outlined below. Sample No. Description Location Sampled 236476-01 Private Exterior Water Spicket 02/02/2024 15:50 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call(360)779-5141 or email us at www.spectra-lab.com. Attachments 01) This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 02/09/2024 Page 1 of 1 EXHIBIT MAP MASON COUNTY, WASHINGTON No. BEARING DIST. L1 N 53'03'39"E 5.00' ,56. L2 S 36'S6'21"E 30.26' \ L3 N 88'13'01" W 73.50' \ L4 S 01'53'13' W 70.00' �6. L5 S 0741'12"E 4.09' �• � ,i. \ L6 N 82'18'48-E 5.00' a:? L7 S 07.41'12"E 7.23' ZiS \ L8 S 88'13'01"E 18.80' \;\ N 88.08'46' W © c' ` 159.66' O rrT-.; -- \ IQ � • ,I-- v \ ‘ N -o \ SHED " F a W-T 3 co I O I ;1 a �, ?> .a C� 3 I \�5 ... \ • a- �-r i \ u �'. o" O y0 \\ �- �' ZilZ' --1.\\---1-- - T \ „ N uT1UTY POLE \� o N h N - \ -_QS \ '7C n o Cn r 2 (PARCEL NO.) \1 r- \ aQ.,(32 1 34 3 1 00050 ) \\ `�W A + v \ 1. O. 1 L3 w II L. 1 v L6 153.43'". 89.17' 4-- \- v' r N S 8813'01"E - 242.60' L8 PARCEL NO. OA = 25' WELL & WATERLINE EASEMENT 32 134 31 00090 BO = 10' WATERLINE EASEMENT © = DRAINFIELD EASEMENT © = 10' WATERLINE EASEMENT © = 30' INGRESS & EGRESS EASEMENT Scale 1" = 80 ft \ '' 0~c�� Aspen ,0'�AG LANOS / Land Surveying .47 DANIEL B. JOHNSON at The Landing in Key Center LLC DRAV1NG NO. 8011A CKRT717CcTB NO. 28408 P.O. Box 124, Vaughn. WA 98394-0124 DRAWN BY.: PWT DATE: 12-8-2023 15510 - 92nd Street NW, Gig Harbor, WA 98329 (253) 303-0270 FAX (253) 303-0273 NOTE: THIS IS NOT A SURVEY • j ro • -c:c". .-C1 + i.•45.7- ire' —+.... ... -.... i Oro caccd - / - ,\\ •` (D LaiN a / / �� 0 oo 0// / O \ \ `. \ o oo / • \\ \p co�� 31(34 CtOC rD fD Ir 1 = I . 1 4 ~ I -- ---{-•-. I-- al !fD '� H��`� N /l w m r II lI 1 m W \a n w 1 I 0 v� rI b+' = .G / II I su _ .-r CC ' .Q I f 7 p O f =; 1 / \\ �\` i�A 164' Power �� a D a \\ N I s Cr �� 3I ower • 7 y aNasa} • �• OS aNasa} N `° ,os r9n an}asa} N f I � .i 73.51' slA ft. a v rD o (A 1 et) VI -1U O 3 , Cn N Pi 50.88" r. (1) at II ,ZSZ II NJ O •A I 2207635 MASON CO WA 02/16/2024 10:46 AM NOTCE a30q 50 Pages 2 • PRIME LOCATION & SITUATIONS LLC ii195109 Rec Fee 111111111111 I II IIIIII 111111 IIII II I II II II II I III ill III IIII Return To Prime Location & Situations LLc 113 E Terrace Dr Belfair, WA 98528 Grantor(s): (1) Prime Location & Situations LLC (2) Grantee(s): (1) R a.c h e 1 S _s Legal Description (1) PCL 2 OF BLA# 23-10 AF#2198017 S 53/96 (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 3 2 1 3 4 _ 3 1 _ 0 0 0 5 0 53f-0•1 r23 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 1 3 4 _ 3 1 _ 0 0 0 5 0 Tax Parcel: (Connection 2) 3 2 1 3 4 _ 3 2 _ 0 0 0 1 0 The system owner is responsible for keeping this system in compliance. The name of the water system is: Prime Location Water System 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 15 day of Feb 2024 Signature of Grantor(s): (1) • --(- , , (2) Page 1 of 2 I I 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!(o& day of r4 66,,, , 20 23( , i - F L.V-, persdnally appeare• before me, who is known to be signer of the above instrument, and acknowledged that • -�- 'ey) signed it. GIVEN under my hand and official seal the day a, • �—'-'T•' a itten. • Notary `:G • 'n and for the Stateat of Washington, GREGORY A RUSSELL residing at a t Olfo,0 1-e-�'S^"'�— Notary Public My commission expires: A,.S 1 °l 2 rLS State of Washington Commission# 134076 My Comm. Expires Aug 14, 2025 Page 2 of 2 9 After Recording, Return to: Aspen Land Surveying LLC PO Box 124 Vaughn, WA 98394-0124 Grantor: Prime Location and Situations LLC Grantee: Raechel Shanks,as custodian for Eban A.Shanks Grantee: Prime Location and Situations LLC Encumbered Parcel: 32134-31-00050 Benefited Parcels: 32134-31-00090,32134-31-00010&32134-32-00010 Location: NE Y.of the SW Y,Sec.34,T 21 N,R 3 W,W.M. INGRESS, EGRESS & UTILITY EASEMENT For valuable consideration,receipt of which is hereby acknowledged,the Grantor,Prime Location and Situations LLC,hereby grants and conveys to the Grantee,Raechel Shanks,as custodian for Eban A. Shanks,and unto themselves,their successors and assigns,a Well,Water and Power Easement,together with the right,privilege and authority to construct,improve,repair and maintain a Well,Waterline, Powerlines and appurtenances upon,over,under and across a parcel of land located in the Northeast Quarter of the Southwest Quarter,Section 34,Township 21 North,Range 3 West,W.M.in Mason County,Washington,described as follows: A five-foot wide Power,Water and Utility Easement,2.5-feet on either side of the following described centerline; Commencing at the Northeast corner of Resultant Parcel 1 of Mason County Boundary Line Adjustment 23-10,recorded in Book 53,Page 96,AFN 2198018,records of Mason County Auditor; thence North 88°13'0I"West along the north line of said Parcel I,a distance of 2.60 feet to a point on a 678.70-foot-radius curve to the left(radius point bearing South 76°11'26"West)and the TRIM. POINT OF BEGINNING of this description; thence along said curve 125.98 feet through a central angle of 10°38'06"; thence North 87°58'08"West, 104.66 feet to Point"X"; thence continuing North 87°58'08"West,74.59 feet,more or less,to the westerly boundary of Resultant Parcel 2 of said Boundary Line Adjustment and the terminus of this description. ALSO A five-foot wide Power,Water and Utility Easement,2.5-feet on either side of the following described centerline; Beginning at Point"X"as described above; thence North 29°00'29"West,63.32 feet to a well head; thence North 34°38'25"West, 18.27 feet to Point"Y"and the terminus of this description. ALSO A five-foot wide perimeter around the exterior of a Utility Shed described as follows; Beginning at Point"Y"as described above; thence South 51°57'11"West, 16.25 feet; thence North 38°05'03"West,26.33 feet; thence North 51°57'11"East,22.27 feet; thence South 38°05'03"East, 18.80 feet to Point"Z"; thence continuing South 38°05'03"East,7.52 feet; thence South 51°57'11"West,6.01 feet to the Point of Beginning. ALSO A ten-foot wide ingress and egress casement,five-feet on either side of the following described centerline; Beginning at Point"Z"as described above; thence North 00°33'53"East,31.26 feet,more or less,to the southern boundary of an ingress,egress easement as described in Statutory Warranty Deed,AFN 17459336,records of Mason County Auditor,and the terminus of this description. Ingress,Egress&Utility Easement—Page 2 The parcels benefited by this easement are legally described as follows: Mason County Tax Parcel No.32134-32-00010(Shanks) The Southeast Quarter of the Southeast Quarter of the Northwest Quarter of the Southwest Quarter of Section 34,Township 21 North,Range 3 West of the Willamette Meridian; EXCEPTING therefrom that portion lying within Lot 75,Plat of Rainbow Lake,as recorded in Volume 7 of Plats,Page 14,records of Mason County,Washington. Situate in the County of Mason,State of Washington. Mason County Tax Parcel No.32134-31-00090(Prime Location and Situations LLC) Resultant Parcel I of Mason County Boundary Line Adjustment 23-10,AFN 2198017,records of Mason County Auditor. Situate in the County of Mason,State of Washington. Mason County Tax Parcel No.32134-31-00010(Prime Location and Situations LLC) That portion of the Southwest Quarter of the Southwest Quarter of the Northeast Quarter of the of the Southwest Quarter of Section 34,Township 21 North,Range 3 West of the Willamette Meridian,in Mason County,Washington. EXCEPTING therefrom that portion lying East of the Easterly right-of-way line of Mason Lake Road,County Road No.52210. ALSO excepting therefrom that portion conveyed to Mason County,under Auditor's File No. 470787. Situate in the County of Mason,State of Washington. The easements described herein are for the non-exclusive use of the Grantees,their heirs,their successors and assigns,who may pass and repass over said easement and may remove brush and debris therein which in the opinion of the Grantees interferes with their use and enjoyment thereof. The covenants contained herein shall run with the land and are binding upon all subsequent owners thereof.