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HomeMy WebLinkAboutWEL2024-00018 - WEL Application, Design, Letter - 4/2/2024 WA MASON COUNTY 415NfiTHELTON.STREET,SHELT96 ,EXT 404 $H LFAIR 360-275A460,EXT 400 4 9ELFAIR'.380-2]5<467,EXT 400 Public Health & Human Services ELMA:360-482-5269.EXT 400 FAX 360427--7787 KIM DELANEY 2629 Schirm Lp Rd NW OLYMPIA, WA 98502 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2024-00018 1361 E Crestview Dr 320221290021 The 2-party water system, Cocchi-Delany(320221290022/320221290021), 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 K /Z ( 20It( MASON COUNTY COMMUNITY SERVICES _ ai8�y%amip Erv+nimwtlXrNiCmmMYHaJT 415 N.6°SxjffidgB)-Sheb9P,WA98584 WEL 2v :Z - OQO! Shelmn: 360429-9670x,UX1 Mxtn 360-295I16'IE400 Elo&:3b 82-5269 x4W TWO-PARTY PRIVATE WATER SYSTEM APPLICATION Mq 04 / KPLCRM f( m /- Iana 3410 -Z b'O - 241 O � samxa xoPam-sre ,em,sA 2 S ,im 4.o led iUw SRE aYOnEa9-EIeEEr.em'.STeIE}P 3 E. G'/CSfrJieeJ .mil" Pmxrar PanceLx 3�2Z �L"Q062'i- SEcaxoMVPxRCELxuren y77� r� Va II WP)ER SOIIR4£ ('ilA/ lYR PMCELI LOTS PMR6SLOr0 xWeve O Existing Well O Spring weoPoseo W,LrEn srarEnxNlElltlaN!NFLI Co CChc ' .E�PIGo PROIEtteeELIIFlIPfI CU/1UC/T Sin % a GcJP/ � Z LJe// aE<.�xEre.nifw 3 he/fti s. v>, All Jz. 421 C�FS�UirEJ 7�1 f�� er7 m Leif Site Plan: (may also be attached) (Preperty bounCi slrucWres,well site WI100'reds.**swap,mods,sepfiUsewe,mnporsnls and lines,easeinend,etc...) 2624 Submittals Checklist: (these additional items will be required for approval) * Satisfactory Bacteriological sample(this may be deferred rf well is not yet drilled) ® Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred 6 well is not yet drilled) L Notice to Future Property Owners recording(record with Mason Co.Auditor,supply copy of recorded document) rYrn' 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 ❑ ❑ Evidence of existing sources of contamination within 100 fool radius of water source? (drainfields,tanks,buildings; indicate distance on plot plan) ❑ Zf ❑ 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? ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) �J ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? 11 El The well casing extends above level ground/concrete slab?(circle one) ❑ ❑ Is there evidence of a surface seal? to: If'ZIND? ❑ El Does I—1'Z1.040542e Ds the seal appear adequate? 'iq9 , 6 PS�u6 ❑ V ❑ Is a variance necessary for well site approval? ,Comments I� Pass ❑ Fail Inspector Date Review Step 2: Two-Party Review: YES NO NA 2%% X t111111 b Isofrt (y ❑ ❑ Water Well Report with adequate pump test on file? 0�" If NO, date of Capacity Test I ft 1717 Driller Pig% GPM �] ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 27 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments ll 77 77��r 77[� Approved ❑ Denied Reviewer Date ''T�Z/4(/G-4 Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied ofthe future success or failure of this system. Well site approval does not comillule 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 ofbuilding permit per MCC 6.68. Water usage restrictions and additional fees may apply to all ni wells drilled after January 191*, 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 aDEPARTMENT Of Nodeeofhlmm Np.WE49889 ECOLOGY Unurye Ec pWev II)Tn No.SPS-10B rm otwum state or Washington ® cokwe:ivn Site WellN.0fvwseshea..11): ❑ Dapmmia+ioe o odp.liauoeaa Not Nn Wear RightP.WCe%J5eote No. P:4oeA1Hc ®O.�esdc ❑foieaew ❑m.pw Prop¢rty OwvttName Mi Del" ❑DaaaaaAq ❑Iviggoo. OTenwd ❑OAu WeR Seat AdNess 1361 E Croatvkw Dr CnumeNST>pe: o ®New Wes ❑Ahm 0 Dai tino llehea ❑)eem ❑Gbie Tool City 36tllm Cowry Munn ❑Da cdo{ ❑Diner ❑Pm ®Air ❑Muo-Raery Tex Feral No.32022126p020 Dluerw: Di.meurofbormpa im,m2S_a Wweveriaoaygrpvd brthia wdl7 ❑Yes ®No D�oreaopmmdwm 216.E rt C�iYDal.ae: wallVyeq whatwathe resuna foR Cut, Eiver Oismele Fe® To lLi'mev Suet F WeWd Thrstl M ❑ B o. -1.8 —m ® 1 ❑ ❑ 1 ❑ I.owriw(acimwcuow ovpege 2) 0W 4.0BWM ❑ ❑ _la — m. ❑ 1 ❑ ❑ 1 ❑ NW'/.-Yeof6.NE'/4 Serino 22 T—ft WN Ravge�e 1 ❑ ❑ _1a _ _ m ❑ ❑ ❑ ❑ ❑ I ❑ w ❑ I ❑ ❑ 1 ❑ [aENde(tkengle:47.12145)4721348 Langihde(Example:-120.12I45)-12204U82 F tin— ❑Yin OW Tyaofpataoeo, d Dr19er'sLog/Comelraedouor DeammiNw Proeraua Na ofpaforenwe_ SiaofMft:b®_m.Fry_b. 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Dine p9l11fi22 Ae:uim Poo_®m Tmpenmeafwm F Wuerhmicde®ysu mdeR f]Yn ®No ymt paq gl1212022 CampletN Dale 9'132022 WELL CONSFRUCITON CERTUIM n()N: I roosweted a of aeapt rapenmbRityfin cawrveliw oftWs WeR,toad its compliance with ell Washiogm WeR Caamdiu smdedn.Mamide wed W fipformuiov reposse0 above as tine to Wb knowledge sell belief, 0 Etilla❑Trace❑PE-Pant Nerve Mack Whw Willi^ C� RICHARDSON WELL DMWNG gib� Address PO BOX 44427 ]3awe No.2432 Cib Sb T TACOMA.WA 984/8 FTRAWEE Spowor' 13 N 2432 comae lor's S 's S' me Re®^ Nc,.RICMAW'321f Dae09M4/2022 ECY050-1-20(Rw09/I8) 7Jyw need Mis docummrdan atrasmmformar,Plasewll the Wamr Rerovrcm Pa mm36ft 0!O 872. PersmuweAhwring bsa inn all7ll jpr WashMgmn Rsiay Sen1re. Penrons wlNp rah dispbifiryron mt181)d334341. Thurston C«my Envko=enW Health 812 LMY Rd HE O)ydnpie,WA 98606 360-807-2631 as�rnsa¢+w'is-rr COLIFORMBACTERIAANALYSIS o�5anpleoldded Thms.,& O-ey .r oa .. .LLc�'nw QSfSh TNRd'RetrS>.doLdEerianyauyl� Rwyd MlblpPNp ❑0WA ❑G"B ❑obe — Gnddp A N 9ddp B 9delse-Pwid 5m�YhLu FadYGc h+•dnY lWFl): d _ byWeNme — — — CaahtlPamc B'Yq'o"K 28t) — O CapPhmc(. 'alb::. Emt LhiMro:(. ) Bea�.w�pvNu.®a,das� .r.u.y �m G 1�..+ideleaa ern» SIUMLE 9��IATRx7 sa�amLexaLylmaY Sp dkb-bmmtl5ew atoms aNnpbadaNt PWutliondarmmmeMn srdertarn 2 98_dH T1PdBoegM)m�dmkoN/op Dadl4 Tmyhtt iffit Od�w) 1.�IwNne M59Rulfon5m�tp flRappN3wpb)dYrunat.muBn) l7dotn�QYei_No� ❑D�hilxi6m Syslen (TtlnnePaAo[TeW_Rea_ Chlmsietl:Ye_tb_ 9Ra iLAarSoarte$�da tNo�eWNiN:Tale�Hae_ ❑Fool-98!(I�Nf ❑�eo'-ate.s4a+a�m�au UnsatidpWrymuBid U6nurtba Rfn1 Ya—Ma_ ❑AmsaiAWio6pnBWM P�auolefdak ❑� f L �$�kCoDxbd Mddwwbea onip . Perna_ Conffiarini/RWasa� ow— LAB USE ONLY DRDMG WATER RESULTS LAB USE ONLY 011aaW9%: TTaPICdiumPadand ©Ewlpezad ❑F�aWnt dekaNd RepPcemmt�mpla�utrW: ❑CaoaaPaad i'mr�a,I ❑TNTC ❑ �NON®1T Rants ToblfbPom�_IIOBeL Eml NOIMd id fnBonM1 /IOOeI Bdppmo�JIW N. *AW03ta 9AMM ❑5MMM Mean) LI6n..Netr rsa lalDw 3 apau��y 2208787 MASON CO WA 0313013024 D9 68 eK NOTCE KIN DELANY #195961 AM. F.. f304 6O Pa [[ 2 Return To 1111lllINN1II1110 fill III N111 le /frir, /fie/a�.1 zy29 Scbii�rlr+ /�/dd A/w Ul C rda 98502 Grantor(s): (1) 'DaO H COL Ckll , (2) Grantee(s): (1)PUBLIC Legal Description(1) /-af B a SP*3152 AF#Z/05-05D Pm n w n e- (Abbrevisted form:i.e.lot,block,pot orsection,township,range) Assessor's Tax Parcel: (1) 3 Z 0 2 2 - 1 2 O v 2 z S 22 -7'20- R3 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)�L 2- 0 Z 2- 2 - 9 v o 2 Z Tax Parcel: (Connection 2),� 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 20 day of /Ylt«ch 20 Z y Signature of Grannt�tt/or��(s): (2) Page 1 of 2 State of Washington ) County of Mason ) 1, the undersigned,a Notary Public intand for the above named County and State, do hereby certify tha(op th(g�Qay of "'U�tIC h , 20 �Adt Lt ( 1 t1C L I personally 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. `?'LL:NFN., N� ry Public State of Washington. F`* i +Q�i''�, residing at QF^tip off'�",r`0= My commission expires: NOTARY •m2 11 6 F�W A S N��C` 1 Page 2 of 2 . � | \ ( § . \ ƒ \ \ m \ \ \ \ ) � - ~�\ \ \ } z % \ _ \ k \ \ \ ~ . .... ... . .. 2 . --- - - - -- ? . . . .... _m,ACCE | § § � / ) ( § $ k < § � B j § ! § ; / | 5, ) ) ) _ / ƒ ] ° ! ) \ § 7 _ W > f R - / § ; f !! - ! -so 0 \ ( r , t - - ew 'WCD - 2 ; | | | ° ~ � � §o § : ! r m � ( ` � k