Loading...
HomeMy WebLinkAboutWEL2024-00020 - WEL Application, Design, Letter - 3/25/2024 (2) 415N6THETREE STREET, 4MASON COUNTY SHLTON: 7-967 ,EXT400 BELFNR:36O2754467,EXT400 Public Health & Human Services ELMA:360482-5269,EXT400 FAX 360427-7787 RONNY CLARK P.O. Box 3009 SHELTON, WA 98584 RE: WATER SYSTEM PERMIT.TWO-PARTY WEL2024-00020 1031 SE Arcadia Rd 320282200020 3/28/2024 The 2-party water system, Clarcadia Water System (3202822000201320282200010), 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. Condition: No development may occur in the areas logged under FPA# 2420872, issued by the WA Department of Natural Resources. This development moratorium is effective on the date of issuance, 03/22/2019, until the 6-year development moratorium expires on 03/22/2025. Any development or construction for this two-party well water system must be in accordance with the moratorium resulting from FPA#2420872 and RCW 76.09. If you have any questions, please contact me at 360-427-9670 Ext.353 or email at d anderson@masoncou ntywa.g ov Sincerely, e111-- David Anderson Environmental Health Specialist Mason County Environmental Health Ra MASON COUNTY COMMUNITY SERVICES -- e _ r ass rrw.,�.a.....,m�,lxaxn c.nr,,.�rvwwa. 11JA6 SII ( i., tih Onn N'A 99iW WEB .101Y - /`lr 2_0 SA 1 i 16U:D-Y6�f A[0 P 1 r rN4_ 1} "") N,n M y' 11611 i44N1 11..1�11J/���� TWO-PARTY PRIVATE WATER SYSTEM APPLICATION w µy Yp AUORE'4/�.6/'��-�y/4gr .cRY.B�rAwyTE(Zi' ' I .1-A-9a-9TREfi, '�Yz928 Z2n0002o sEcoxDAarrwcu,xueeEx Ia APPt�ceBLE) zoza O 16 "IExaoul(LE Bp111QTm ❑Ncw Existin Etr Eor eva wxn.xrnr aaE B �Well �Spring 5' 1* Y60P0n!DWATEaaYaT6Yx1EE1xEDUPEO) C(UIGadcq }I� Pnwan oeacawrpx ��g+��Sr""•r ___ DYEciaxs TD snvconongxs _ , �' Site Plan: (may also be attached) (woaeM bouManes,snucturaa,wql sloe w!tge'ratlus,ddvaways,roads,saWi✓sewer componenCs arq lines,easements,ere_) —o b 4Yur Sf� SY. v � e 00i5 ,3 rwN iKil O W4. TMk. Submittals Checklist: (these additional items will be required for approval) Satisfactory Sactedological sample(this may be deferred if well is not yet drilled) Well Log with pump test or 4-hour rapacity test performed by driller(this may be deferred if well is not yet drilled) Notice to Future Properly Owners recording(record with Mason Co.Auditor,supply copy of recorded document) Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and a niffable for Public view on the Mason County Well,site, Resis'ed: 10132021 Page 1 of 2 I - , ..._..._... --...__--- '.' Staff tisw t?:,ly ....._. .... ..--------- ..__..__.... Review Step 1: Well Site Inspection: br 5, %-ei(I - k'1�y�J�*w"rr W E41 CM// 16y3B Cpn'f Of F/YtsfG 'fJ4A�Slp/ $ 4+' yto�ls4/�.,p�w7f Gfa7f ✓ YES NO NA _�M/1 4• QYty ❑ ❑ Evidence of existing sources of con urination w m 100 Foot radius of water source? (dramfields,tanks,buildings;indicate distance on plot plan) 1A ❑ ❑ Are there roads within the 100f000l{Fedius of the water source? If so,is road deaf County or State. What is distance to ROW? ❑ ❑ Does the ground slope away from th`e water source site?(show slope on plot plan) ( j�tsl �" ❑ Is the well cap satisfactory?_ �q l[0 Oaf of Y &411 C40 �j p4w jwk ❑ ❑ Screened and vented? err, T, "M A� 0 'V'G �A/ 1,0K lbY12> ❑ The well casing extends g e above level ground/ oncrete sla (c le one) 4 f t, ❑ ❑ Is there evidence of a surface seal? (, 4; 1f 7f I a ❑ El Does the seal appear adequate? _ (i3 ��ZI t{(( Ely� El Is a variance necessary for well site approval? / /� y r� T-45 : Lin Comments AV1f1O� �/� IG � , ( f� -.—l, 1ta/ 6�lv1XPass�Fei�r Date S12j17 Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water Well Report with adequate pump test on lI ArCddres p/+'(Irh r/n tZtL7(19�7' vit 3O0M lino ��������,�y dd p 66" (1.1001 ) If NO,date of Capacity Test—%l«•'vl_ Oriuer GH 4 GPN jg4jj1 kI 1Of nA'/� ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test a1� (tyk6V) ❑ ❑ Received Signod, Notedzed,and Recorded Notice? AFN _ Zu) fr?a ❑ ❑ System appears lyadequate ettopserve 2 single-family residences based on informattiionnpprovided? Comments An Ir Approved ❑ Denied Reviewer Date Findings in Jhis review reflect absened conditions us(Bev erisled on the day aj(he site inspectlon. .Na claim is made.express -� or implied of the future success or(allure q(lhis.txr/em. Well site apprawt does not consrinrte waler.ryslem appmwl. Water Sysrem approval is a moo-part pracess. All proposed connecfiomc to new wear are subject to water adequacy requiremena at Lime ofbuilding permit perblCC 668, Water usage restrictions and addilional fees may apply m all new wells drilled affer.lanuary 19e, 2018➢er 6SSB 6091. This room maY W scanowd and available for public vi.w oa the Haeon County web site. Revised: 10;13i2021 Page 2 d 2 rue Orlsio.l ma n,d Corr.nm WATER WELL REPORT arruuum No. ....____,._.. neP.hmem Of mole®' 9KOOE Cn9Y—owner.Cary �mna a9r—omier.Corr 9'isTE OF WASIDNfYPDN (1) OWNER .(�lis-i It L• 1u,ssa-- �'mar--!Q ......_.._111a1=•+....,...r. s.w...__....__.__._.J i 2) LOCATION OF WELL.' 0 Manna .na awnw tram.ecWa or wem.moa waver �3) PROPOSED USE n000Wu W-Mo at.t ❑ uuMd9d0 (19) WELL LOG, IIry.yan ❑ xM Wdl ❑ ONo- ❑ eige tNrkn.0 a.lfmbana Nu Rood ind ndI anolun o)tM f h NN b.ae. N .eMvm pv.fmna, Nun et Nut aiu.mry for each ahano. Pf fo«webO. 3 4 TYPE OF WORK: onmerY n9mb.-m wen y/,T�,RC r m xo > of morn N�or).... . ..__.._._...__. N N.w veu 1� m.mra:nw ❑ earea ❑ D.Paa ❑ G w Orlvea ❑ , R.modalO..a❑ aatrr❑ a.ttaa ❑ /I / all 05) DIMENSIONS: niamd.r m ww ---2'rMoo.. G C nrwea�i-7-.mac Darn ae wuplsud S O W 8) CONSTRUCTION DETAILS: .� �.«� ECaring imtaued:__fc._•'m nm-A:,—ff..4-fc h. r I X Tbr.a.d❑ d agoo_ A.b......r-h Ii 41 Perforations: Yw❑ N-K -. .•• yta Type d Porormr b.m m' L 912r Of PMor.ree. _ am C —p for.tm tt®—.R b R l� Screens: Y..❑ No J' 10 WnW.etorar.N Yead N st.t.tre-.�Gmi Y � ?.` Gravel packed: Y..❑ N.X ruwt a pavoh R OnYd Pt.wa Surface seal,: voo? NO p xe�b.t dwAl la 3 wad . am..: 7ta/J xalg Na s m Mo .M, Mu aver., wu.bl_. w~ Yb'O o H xrw et w.trl_ niib Of.mus ; O aebea of w.mr yt — C '0 (9) WATER LEVELS: p wrtaa.a Pwrm. ___mow.r.r ra.n tare mn_—_--- G .vtr.n w.ur b msewlMa br_.— IC.p.vafv...b.) w (9) WELL TESTS: m.waewa a amount..ter l..tl L m..wa .tmr>.r.f wort O w...PvmP tr!moor Y.❑ No eu m..br boo. DRILLERIS STATEMENT' C wab 14M�aewa.M T well was drilled under MY luMdkHm and this r"00 is true to Ibe beat o[ my juowledge .ad belief. /J i Recov a a.0 (time Yken u r.w oh. roars brats -IrL Iw.iR ]ml .�_ _ / ` �... __/ - �__•.r ..— 11 Tau WWr I..wi xmrr. Ws1aI Ubl xbu Wm.I twgt ' IMJtun/{Nm,aOr wuwsaan IxLYr.r p.bt) L Fn.w a [Sued)........... ._.._.. _.__. ._._............. Bdter trc�l./r,{tl./mtn.wllLf._�t.anNnaa slur 4___M. (W.11 ilrfllarl Temper.tun Ox w.w_._._was'mae1t11.a.Vdb maa.l yr❑ No I.lceese N...........�-Y.?7 .... DSR.lC_.4`�._.._.__. IB.! Inrr"DmomA SHEETS IF Ng ) S a COOLWATER DRILLING, INC. 10921 HOLLY RD NW BREMERTON, WA 98312 360-830-9005 COOL WD1941 QM CUSTOMER NAME. DATE 2-9-24 l RON CL'4i CUSTOMER ADDRESS 1031 9E ARCIDA RD TIME FSTATIC GPM ; TIME STATIC GPM 05 193 14 120 1% 14 10 1% 14 135 196 14 -~ 15 196 14 150 _ 196 14 20 196 14 165 196 14 25 196 _ 14 80 196 14 30 196 14 205 --I 1% -�- 14 45 196 _ 14 22_0_ 196 _ 14 60 196 - 14 - 235 196 14_ 75 _ _196 14 245 _7 196 14 90 196 _74 105 196 14 RECOVERY STATIC RECOVERY STATIC TIMF. 19( TIME OS --- 190------ 45 - 10 15 .. _ .... .� _ -60 _ 20 - 75 25 90 1262]o fvwl � j Trgs Ln NW S.,c SPECTRA Labeamue - Kitep . PW ,WA we 98)ID s. -�_m J ' p�g_ 141 C_OUFORM BACTERIA ANALYSIS FORM G Bmnfg/eCWacrtl -T Tme Smyllc _ -.-- ... ._I J L � O� 1 y Gerxlea O+r ¢wI 115 -.1 T1Va a akbr Symem(dcen wrh are bl..) ❑Qr A ❑Gr a GwPAantlGmroB Slswns-hwM¢twn WeYrVaa.be6lmarinrylWFII IGtl � Swa.+bmre j2o� nAr I Can�Puem c<x,l r.+A.ft L -�� �"Oer—Rmle�Co b�'+_ 4aL CtlI F1mx I EmM Ere. ': Smbrtsil5 '.P^:harn.,mr.aWmsmlls«ekrewiwl=uova«1u41 SAMPLE INFORMATION 5.mpk wbcmtl b/Pom.l . I COol Vl1'i i{ , SPxakkoem w�we a.rybttLxYtl: TSpetialmWucEms wcammenb I. I _yRems.xele(tllemmhala mv) --+ i t❑AwMe UiF41bu1bn Surpe(AR 1 2 0 Raput Sampta(A?I C Wb .w:Y. 0 %:j Chbne RwWW:iaW kee 'Jr.elafa.rory routx Pb e.mW __- 3.6rourbWSxPub6ouru8amge ' $ j � V:Wbsbclory r?.�necdl id5r¢ Ch, n Yes Nc [�'•Ggaea lhRl Ct,bma Re&.t.I Fl ❑Ae%ssm ItA?I l6utlau aGWIRw8 .WwSemp4A memlwl I I i _❑ E m ❑F.M S. C Wcy--.bmYtlmO} IAS VSE ONLY ORINNNIG WATER RESULTS tAB USE CNLY J Oca ft mTanC wi P. aa.___._ I rMmn ❑ecoFpswa ❑r<oFWwxn _ I '�. BaebwiY GMFB}'RxuMa.itlalCMpann___-mwiBtrM EarbnpNIBOM. F.xlCailwrr -_-."M.t HP6 --_--a .l. RplpamaJ 9amp4 RequinC: ❑'NfC ❑SalWeboatl ❑ 9.npe Vdume ❑OenleBetlCwAarlw ❑ .- _ xer.pl'emoc wmacooe suex�e ..rood suaczo 2208943 MASON CO WA 03125/2024 01 49 Pe NOTCE IIII!1111111111911111111I1fi,IIIIIIIIIIIIIIII!Illllllllllllllltdllllllllllh! 2 Return To c A _ A'I'A c 3Gd9 _ c�rtL7ar/ L/N—Q�S1SC 0)4 Grantor(s): (t)Rga Grantee(s): (1)PUBLIC Legal Description (1jT2Z OO �(/,�I Alm 52�ZA (, (Abbreviated form:i.e. tor, block,plat or section, township, range) Assessor's Tax Parcel: (1) 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) —1a- 1 U 2 $ _ Z-Q O O 2 0 Tax Parcel: (Connection 2) 3 Z_!5! 2 Q? - 2 - O O y O The system owner is responsible for keeping this system in compliance. The name of the water system is: 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 2S day of Maw ,20 ZY. Signature rantor(s): 2) Page 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 Mcerti that on this ZSday of M a✓f.�n ,20-_Z , V1Y1w1 CsaV!4 personally appeared before me, who is known to be signer of the abbve instrument, and acknowledged that he(she)(they si ned A. GIVEN under my hand and official seal the da ar last a ����"��\STANT"��p rY Public in and rthe Statey�of"Washington, ��� Gy•��On fi'0 1''i��� fe at �Sl' fro.^ o�tiQ:�F"�o-so7�!��; � mmissronexpires:_�—/y - 7 yiV�'%OtARY n: `• C; :Oz ?� 'P eta• . e` F:V` ip•1j..... mb�1, OF IW Page 2 of 2 cc.n� Rr(E�Te� �n[i' AS �u uT' f l 5e Acr tNA leb ` SkaToa , vJA 9&V4 �;32Cyg � ZZ- oo©zo : . CO5 � G� t , n � L- /9Q, W 'O �9 M j W 1 rnE 5 T� a Printed From Mason Couw Printed from Mason County DMS