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HomeMy WebLinkAboutUntitled (2980) MASON COUNTY 415 N 6TH STREET. SHELTON,WA 98584 J 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 MARCINKO FRANK A & SUZE MARIE 5677 MINNIG LN NW SEABECK, WA 98380 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2024-00014 797 NE Blacksmith Dr 223107990663 The 2-party water system, Frog Hollow Water (223107990663/223107990661), 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, /0, David Anderson Environmental Health Specialist Mason County Environmental Health )lZV Zia 2(1 ' MASON COUNTY Date Received 3 9 / OZ® ( 7'1 COMMUNITY SERVICES A mokReceivect Received By / Building,Nanning Environmental Hcalthm�Community Health Cl 5 f\ 415 N.6th Strut,(Bldg 8) Shelton,WA 98584 WE L caw o OQ \Li Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Frank andSuze Marie Marcinko 360-801-0147 MAILING ADDRESS-STREET,CITY,STATE,ZIP 5677 Minnig LN NW, Seabeck, WA 98380 SITE ADDRESS-STREET,CITY,STATE,ZIP 797 NE Blacksmith Dr, Belfair. WA 98528 PRIMARY PARCEL NUMBER(WELL SITE) 22310-79-90663 SECONDARY PARCEL NUMBER(IF APPLICABLE) 22310-79-90661 WATER SOURCE �, SOURCE TYPE PARCEL 1 LOT SIZE ' PARCEL 2 LOT SIZE t/ 0 New 4r Existing Well ❑ Spring 1.22 acres 1.35 PROPOSED WATER SYSTEM NAME(REQUIRED) Frog Hollow Water PROJECT DESCRIPTION Newly drilled well to be shared between 2 lots in the same plat. Private access road and the cul-de-sac access and utilities easement provides the avenue for the water line connection with sleeving under any driving surfaces DIRECTIONS TO SITE/CONDITIONS West on NE Bearcreek Dewatto Rd to a left on Blacksmith Dr, follow the nice wide gravel road about a mile to the second left past NE Forge Ct, follow that driveway 100 yds to 797 Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways, roads,septic/sewer components and lines, easements,etc...) fo-J ? .5(vrve-7 4' / 4" 2 Submittals Checklist: (these additional items will be required for approval) 21 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) ® Notice to Future Property 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 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: / /� �'ete{YES NO NA ` V ri ree Svr(/ ❑ ( ❑ 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? k-1511‘ktgl ❑ ❑ Does the ground slope away from the water source/ site? (show slope on+ plot plan) 16y J - � ❑ Is the well cap satisfactory? ( 10 1 e/e 1�'tal C�dV i'1- 1(f-,- ❑ ❑ Screened and vented? _ 1/ ❑ The well casing extends `3 above level ground /concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? [ ❑ ❑ Does the seal appear adequate? ❑ ❑ Is a variance necessary for well site approval? Comments CdtieAI i - Q-n/ 3/Z N : Plc /� M ce-17 pif Pass 'ail Inspector Date 3._- 7 — 1.t( Review Step 2: Two-Party Review: YES NO NA 1600 ga t (r ❑ ❑ Water Well Report with adequate pump test on file? n. t/ If NO, date of Capacity Test �![ (V[ ZQ 13 Driller 1 JCS �/Pi� o} t GPM ZOirl g ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 10 j (ZZ' ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN_2169 23 yf ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments Approved ❑ Denied Reviewer Date ! ,' f/2 i? ( 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 E•�0 l C> Y� Notice of Intent No.WE52723 Type of Work: c_.. Unique Ecology Well ID Tag No.BPS-260 _•- ® Construction Site Well Name(if more than one well): O Decommission r=i Original installation NOI No. —. Water Right Permit/Certificate No. Proposed Use: ®Domestic 0 Industrial 0 Municipal Property Owner Name Frank&Suze Marcinko 0 Dewatenng 0 Irrigation 0 Test Well 0 Other Well Street Address 797 NE Blacksmith Dr Construction Type: Method: El Ness well 0 Alteration O Driven 0 Jelled 0 Cable Tool City Belfair County Mason ❑Deepening 0 Other 0 Dug ®Air- 0 Mud-Rotary Tax Parcel No.22310-79-90663 Dimensions: Diameter of boring 6 in..to 177 ft Was a variance approved for this well? 0 Yes CO No Depth of completed well 176 ft If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread © I 0 6 in +1.4 176 in © 1 O ❑ 1 ❑ Location(sec instructions on page 2): 0 WWM or 0 EWM ❑ I ❑ in in O I ❑ ❑ I O NW'h-%of the NE %;Section 10 Township 23N Range 2W ❑ 1 O m in DID DID O 1 D in _ _ in D 1 ❑ O 1 ❑ Latitude(Example:47.12345)47.50377 Longitude(Example:-120.12345)-122.91637 Perforations: 0 Yes 0 No Type of perforator used No.of perforations Size of perforations in by in Driller's Log/Construction or Decommission Procedure Fomration Dcsctibe by color.character.size of material and structure.and the kind and Perforated from It to ft below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes 0 No 0 K-Packer b Depth ft. information. Use additional sheets if necessary Manufacturer's Name Type Model No. Material Front To Diameter Slot size in from ft to ft. Lt Brn boulders cobbles gravel sand silt 0 3 Diameter Slot size in from ti to fi Lt gray cobbles gravel sand silty clay 3 28 Lt brown cobbles gravel sand silty clay 28 125 Sand/Filter pack:0 Yes sin No Size of pack material in Lt brown cobbles gravel sand silty clay saturated 125 134 Materials placed from ft to n Lt brown cobbles gravel sand silt some water 134 150 Surface Seat: 0 Yes ❑No To tshert depth"18 ft Lt brown gravel sand silt some water 150 165 Material used in seal BENTONITE CHIPS Lt grayish brown gravel sand silt water 165 176 Did any strata contain unusable water'' 0 Yes 0 No Type of seater' Depth of strata Lt brown gravel sand clayey silt 176 177 Method of sealing strata off _ Pump: Manufacturer's Name Type H.P. Pump intake depth: ft Designed flow rate. gpm - - Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well easing+1 ft.above ground surface --' Static water level 131 ft below top of stell casing Date 09/22/2023 -- Artesian pressure lbs per square inch Date Artesian water is controlled by (cap.valve.etc) %Veil Tests: — -- — Was a pumping test performed? I3 No 0 Yes b by whom? — Yield gpm with h drassdoscn after hrs. Yield gpm with ft drawdown after hrs Yield _gpm with_ft drawdown after Ins Recovery data(time=zero when pump is turned off- water level measured from well top to water level) — -- Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test gpm v.ith ft drawdown after Ms Air test 20 gpm with stem set at 174 ft.for 1 firs Date 09/22/2023 Artesian flow gpm --- --- Temperature of water 'F Was a chemical analysis made° 0 Yes 0 No Start Date Completed Date 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 0 Driller 0 Trainee 0 PE-Print Name Mark Wiese Drilling Compant RICHARDSON WELL DRILLING Signature .- • ,C/' �!s Address PO BOX 44427 License No.2432 City.State.Zip TACOlv1A,WA 98448 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.RICHAW'3210B Date 09/26/2023 ECY 050-120(Rev 09/18) If you treed this document in an alternate format.please call the IVater Resources Program at 360-407-6872. Persons with hearing loss can call 7 I I Jar Washington Relay Service Persons with a speech disability can call 8 7 7-833-6 3 411 RICHARDSON WELL DRILLING Aquifer Test Data Well ID# BPS-260 Owner: Frank Marcinko Site Address: 797 NE Blacksmith Dr Pumping Well Parcel#: 22310-79-90663 Pump On 06/18/23 12:30 Pump Off 06/18/23 14:10 Date Time Date Time • Reference Static Level 130.20 Feet Pump Size 1.5 HP GPM Recorded By Time Water Levels Date Clock Elapsed Time Reading In Depth To Drawdown COMMENTS Since Start Gpm Water PATRICK 6/18/2023 12:30 0:00 6 130.20 0.00 12:32 0:02 6 132.80 2.60 12:34 0:04 6 133.00 2.80 12:36 0:06 6 133.10 2.90 12:38 0:08 15 137.30 7.10 12:40 0:10 15 137.30 7.10 12:45 0:15 21.5 143.40 13.20 12:50 0:20 21.5 143.70 13.50 12:55 0:25 21.5 143.70 13.50 13:00 0:30 21.5 143.70 13.50 13:05 0:35 21.5 143.90 13.70 13:10 0:40 21.5 144.00 13.80 13:15 0:45 21.5 144.00 13.80 13:20 0:50 21.5 144.00 13.80 13:25 0:55 21.5 144.00 13.80 13:30 1:00 21.5 144.00 13.80 13:40 1:10 21.5 144.00 13.80 13:50 1:20 21.5 144.00 13.80 14:00 1:30 21.5 144.00 13.80 14:10 1:40 21.5 144.00 13.80 2ECOVERY 14:11 1:41 131.60 1.40 14:12 1:42 131.60 1.40 14:13 1:43 131.20 1.00 14:14 1:44 130.90 0.70 14:15 1:45 130.60 0.40 t . . , ---, a cM/A-TE R . AM MANAGEMENT ANIL 1111111.1 LABORATORIES 1t4C.:. 1.1111 1515 tiOth St E Tacoma,WA 98404 i - ...,i • 1111111PF . [ COLIFORM BACTERIA ANALYSIS FORM . "T--- Date Sampe Collected Time Sampe Cotinh. Corected i/q i 2._3 , 0, • : vr,In Da.. . Type of Water System(check only one box) . 0 Grow A 0 GrouD 6 CSkOdter Group A and Group 8 Systems- rou.cke from Weir Fa:. 7•es m.enzr,(WFIt• l IN F.1?.711K _14.4•I'C..414/fa _10 System Name Ccntact Person. Aaron Leeper Day Phone ,, 2$ai 5.-7., -7332 Cot Nene f ...:53 37'7-0236 Email Eve.Phone Sent rts..ts tr. ,D:-.:i. ,a're.assess as:27;cots _Richardson Well Drilling PO Bor. 44427 . _.... . 984 46 . " 7.7-77 --=.-77: 4 SAMPLE INFORMATION , Sample collected by Memel' Patr; c K ,... __ - --- -4 Speci5c locator:*Imre samplekoliacted , ar ttif,i( 7/7 I 1 - i Type of Sample(WET/onty one type ol sample,Iron.rypts I vlickign 5 ttetn.v) 1 0 Routine Distribution Sample(A/P) ' 2 0 Repeat Sample(ASP) !hot cr.t,t c..yi s,sterr stsr -ist ir.,Arnet Chionnated Yes_ lk - _ 4 Onsabstact::,•tour*lat.-.urrn;er ChlOnne Resvia:.To Free_ . . .. . .. 3 Ground Water Rule Source Sample . Unsalreacttpi re:Alm collect(sate S • Chlyinatec Yes_____No. 0 Tnggered iik P Cmonne Resioat Total__ Free D Assessment 1A..P 4 Surface or 13WI Raw Source Water Sample tErtarerao:11 S ; C)E co! 0 Feu] :...,,i,., I 5 0 Saw a Ca.nuse,fo•Information Only: ' LAB USE ONLY DRINKING WATER RESULTS LAS USE ONLY I Unsatisfactory Total Coirhorm Present and r0 0 E cob present 0 Ecok absent 1 kebsleclory I Bacterial Density Results Total Coition__ 1000 E cok_ ___ __.10Orni Fecal ColitOrm__ _ . '100mi. HPC . ii mi Replacement Sample Required: 0 TNTC C)Samoa moot 0 Sample Volume 0 Damaged Container 0 _ ___ - -_ Datellime•,•.. ii- -1/10 ork '1 •-114 Refee,,n aki-stw tAtip-1 LC)............. ..1...• ___\ i_:_- L__th .__..... Recent Temp Cr. Filetnon Cole 5 ri d?,r) i..4. Dale ed to ool, 3 oil , ...0„„ AR183k DOH Lab-Sam . 1 r------ I 089 C .t. I i i ____1 11:.it•-•-e!?t•!,?,,dt:4:e0.5;•*. 0)1,...id,.1 p.:.R.7,*,' ."•....,1*tr41,11777111.t.. ...^?1 1• 77* Return To 2204823 MASON CO WA �A I ' 11/22/2023 12 28 PM NOTCE <Q���fL MRRCINKO #192835 Rec Fee $204 50 Pages 2 5.6 77 i f/AItij L N N1✓ 1IIIIII IIIIIIII IIIIIIII1111111I 1I11111111111111IIII 1I111111EIII1 S"e t e c.4, JQ/ 4' Q83 f 0 Grantor(s): (1) / i_,1A• ` gC41;1 ' , (2) Sate Marie- // pe/hie Grantee(s); (1) PUBLIC / Legal Description (1) I T R 60 -A aft.SefsV 107 Ile 3 Of s p #.279.c ' 3c38g (Abbreviated form: i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 62 oZ- 3 ( d - 7 ? - 7 a 6 6 I NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned grantor(s), certify that the water source located on the above-described real estate under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason County, State of Washington, has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington; herein described: Tax Parcel: (Connection 1) oZ 2 3 / o _ 7 9 - 9 o B 6 3 Tax Parcel: (Connection 2) 02 aZ 3 1 0 - 7 Q - f 2 6 I The system owner is responsible for keeping this system in compliance. The name of the water system is: Fraa flew flaw (✓a--7'er This system is designed to provide for two service connections. Planning and design approvals must be obtained from the department prior to expanding beyond this number of services. Additionally, a water right, obtained from the Department of Ecology, is required if the water system exceeds exemption standards. This system (has/ has not) been granted one or more waivers from specific provisions of the regulations. J L Dated on this o`� 0 day of /►/r/R,i%° er , 20 2 S Signature of Granto s): (1) -T , (2) c�Yr‘- Page 1 of 2 State of Washington G/5 4 7-..t( ) County of 447c5 /T-s42r=a I, the undersigned, a Not. Public in nd for the above named County and State, do hereby certify that onn this , 1 :ay of , 20 ..d , fA'9N '/eAC4,$'.44, c/J8A1 ' ersonally 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 . • e written. Notary Public Nota -T•414111Wr e St. : of Washington, State of Washington • residin at ., S BETH A ALEXANDER My •mmission expires: / / .41,111 COMM,EXP JANUARY 12,2025 COMM. NO.3444 Page 2 of 2 / IWell radius for 22 •-79-90664 t I +0'el 184.83' 1nnsioorec 141 a sc‘c d �Q'oa _0, Oaa Parking& Q'0 i _Is e' \ac4'S .'C° Turnaround / • , Fa'•��0 time (4 ��. Area I qo 40\s ,‘, \ l , \ r -.........1 /30471 1 ; '1,(63' / \ i; . , ►`� / ...................... /�� '� ' �� 200 Amp Service ���,�_� Pump Conduit&Wire /( —ug Tank Sep c. 1 I/ an r Proposed New 1111• ' /F■ Water Line For The 100% il ad�us c��P we'i Adjoining Parcel# �. 69s ., Well 22310-79-90661 Reserve h.;v- ea i, House Zr X 1 / ob —ct Qoh o�e /', SL#3 .90 Q�o4S I.. .� ONO v' 5.... -.4 v.. r .4.boy,/, Q',ea�at„ QWl Downspout Drainage •�': �� �(°,7�` ' Line to daylight ,' Planned s".�,.' q', Rain Garden/ `ai \.....;:, ��°. Runoff .....' S> ,off ate,' Retention �,.. � ,cec a\ :., Area ,5 Pe el`' • oyes 111 P . --. „ee. s ` Proposed So°aa.Le` Well ea +5'el 184.46' +9' el Building Site Plan Name: Marcinko Tax Parcel: 22310-79-90963 Scale = 1" = 40' Address: 797 NE Blacksmith Or, Belfair r z N x m i O �� I N Men cc �4 k W O1 W Y w_ p __�Z; 3 - % L. a a a 2 W co n. v I ,�l% _ g --.. o n. o. co a I k I —R I —$ ---- ii I ,l Co ~ ram`:L1=*.:_.. `� �"+�H1��YVSN3=g-3N /.,� Q \ cc a / I h 1 -- co 1w /• z4 & m / o 0 \ '. e_ r� �' a I I 4: I Dce . �• i CO Z 3 m,W * i W I ' Liiz o CC IX n 2 N-EN*I )-ziv a n `W / / \\ I / `, cz W\ zO I' r , • • et \ W t , 8 �' - - - Du) a ce o a Ul. / I �• to w / \ ...... o / \ 1 8 / \ gJ II za // I •\ j J tJ CO W 0-1 1 a / - ,�\ `- '�a W0 / \ Q >vWi / ` I \ I oa as / zz / \,, \ n3 Z= !�/ i '� I� I > N CC a cn w w > �E• • 11 I I 0 Nz 1 I o ,m Z - i , / t ! I a