The URL can be used to link to this page

Home My WebLink AboutWEL2024-00018 - WEL Application, Design, Letter - 4/2/2024 ® MASON COUNTY 415NBTHELTON: SHELTO70EXT 400 SHELTON:3602759 ]O,EXT 400 OELFAIR:3642]Sf46],EXT 400 Public Health & Human Services ELMA 360-482-5269,EXT 400 FAX 360-42]-778] 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(3202212900221320221290021), 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 Y/Zl Z07y MASON COUNTY COMMUNITY SERVICES •. mrti,aPl.•�•se.wa,,,,.,,�:x..nnca..m��n N..lm './C1 415N 6A Sb (Bldgg)-Mellon,WA 98584 EL 1-6 �?, Sbebao: 36p4IT46mx(10 Be141c36 275M67x4 Elm 360- Q-1269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION AYq — 024 m L�/an D -280 - 2 �0 11WILINOPOOREeE-SrREEr.L1lY. 2 �5c /im /14c2 yrF xeOREEa_ETREIT.Lm'.air,TE,1P 3 E. Ciesfv e� A-• PRIMARY PIRCFI Ni ZIWI 7—.pOO�� EEC011nMY PPrI R TTT I VO zI WA 50tJRLE n Well ❑Spring Pwd.'J7aF New ❑Exs PMLELiLOraQE PROP .WATERCVBrFIIN (RNI(MlO) CJCC/7L ' vP/Gn PRaFn oFxwrpx C!J/JIl2rT •$�/� /e G G/ � L L<le// OIRELTXNISTO Laao1nV 3 zii-� AC/A, 7v crcsfuiP..) A. /�/- v- , Leff Site Plan: (may also be attached) (prop"boundana$.sauaures,well site wl1W'radius,driveways,roads,sepbr/seWer cornponenb and lines,easemen6,alc...) l� Submittals Checklist: (these additional items will be required for approval) 19 Satisfactory Bacteriological sample(this may be deferred ifwell is not yet drilled) 0 Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred 6 well is not yet drilled) Notice to Future Property Owners recording (record with Mason Co.Auditor, supply copy of recorded document) rYs^' Septic Records(addRional locating requirements may apply'd there is a lack of septic records on file) This form may be scanned arM available for public vlew 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 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 Stale. What is distance to ROW? ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? 11 ❑ The well casing extends _above level ground/concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? Gq}, V'ZINDF ❑ ❑ Does the seal appear adequate? Lon; —I M.64Of 4t1 ❑ V ❑ Is a variance necessary for well site approval? ?a9: aysm� ...Comments [� �I Pass ❑ Fail Inspector Date Review Step 2: Two-Parry Review: YES NO NA 20(A )r 10il= IW,U * (�{( ❑ ❑ Water Well Report with adequate pump test on file? pp If NO. date of Capacity Test�— Driller Ai f GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 u J ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z7 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments ? ��w�t 7 Approved ❑ Denied Reviewer Date 10/m IN Findings in this review reflect observedconcinions 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 cunstilvte 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 new wells drilled afier.lanuary 190, 2018 per FSSB 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 MDEPART.E.Tor xouce ofletevlNo.wea9969 ECOLOGY Uvp Eobgy WeBm Teg No.BP3108 Type.1 Woet State vl wmgingtan ® [o�.wnim Site Well Nemc(ifemrt lien one well): ❑ Daommissim C Ori®valuwYation NOl Na. WeteflflgM PC1101VCCNfieele No. Pnpoaae u.m BDomntle ❑lpduni.l ❑Mmkpel ProPey Owna Name qim Oelam ❑Dewemdvg ❑edpm. ❑Tat Weg ❑aher Well Steel Addrap 1361 E CreaWiaw a Cwwasesw Type: MA.d: ®Nw wA DAlm.:m DPisa Dlmee DCMmTm ❑ly SDelron Covvry Meson ❑Deapeoin ❑Gka ❑Dog SAio ❑M."a Tex Pnral No.32022125OD20 moomosoe D®naNborings ro.,a21f<ft Waeveden¢approved fa this wdlT ❑Yn ®No D9Mofcosp WR 2155ft C:WwYw➢m.i: weft IfyM,w t000@evariercew Cam{ Imn Donela F— To Thickom Slni PVCWeM Tbwxd ® 1 ❑ Q_b. .1.5 Z= �m ® 1 ❑ ❑ I ❑ I otmY(XCImhYC40M O0 poge 2): ®WWMOf❑EWM ❑ ❑ _b iv ❑ ❑ ❑ ❑ [�' Y„'Mofthe N�Y.,'Sadoo T2 TowvMiP SN Reoge 3W ❑ 1 ❑ _m — _ M ❑ I ❑ ❑ I ❑ ❑ I ❑ — m ❑ I ❑ ❑ 1 ❑ Lb°'de(Ex Im :47.12s5)4721345 fmgi We(Ex®ple:-Im.12345)-122 Daos2 feai oW— ❑Ya am Tp dpabwmfineY D kr'sLog/Coo.trurfien of MwoosrW wo N "dswe Nv.vfWm&ss_ Siavfpeknnim_m.bi_ie. Nuuw a¢IkaesiEe by oolo < ,,sum ofine:<:ul oW rooss,wd We"wl nxo:.nd wm_0.m_ftWw g000d smite nmeofenm.mril meech mya Peoewnd,wM stkan aoemyRrechobovaa Seneca ®Ya ❑No 0K-Prin b Dlp 29"e. ®Fnmsuov. Untldidvmishee¢ifoaavuy. Mnumw:w'a Naa Melerial F. To Type MoMm.. U BIDNTI bruldae cobbles grsov4 aiM aB D a DiemelasT SIwe�24—_iv.fi® 2MZA.m216de. Dlnnaa_ smtdu_io.wm _e.m_e ubro glsdA Oil 5 32 iadTesnpnl:❑Yn ON. Seedpeckouuvl_u. kf bry sane grovel sft ssroi 32 d] uB.day a BB M.mmhplxNn®_am_fl uBrmmveryd saysavrl 6B N s.efenseo: WYa DNo T.ogadryal3Lft Lt Bmwn tine deyey sane 96 119 Mamaluvwm.l SEWME Ltg soft clay 119 18a Dk ury mem mvumwmbk wvYl DYn Mm �y sandy clay 164 190 Typeofoxul Ds.fuw McNvtl MsalingrwoH GmyiersWc yavN prM clay NktaM Wpbr 1" 197 211 Gmy ravel vb1' 211 216 Rmp:Maeem:a'rxwe Type Glgy 9raval selM sgrydaY w'elx 211 216 H.P._ Pm�mpke hl.W:_ft Dn:goM6wn¢:_Wm Bn:srn GBy 210 W.W lwre4: lmdamf elendoo.Wveme®wlrvN_fl Slid-W ofmP afwesaaae*160.sbwe Pmiod su:ix $IedcwewleM 2Lsftbebwmpofwell ndve oo Damo Awsuv p:esum_Ibs.Pnsgweimd _ Arvin wawkmwvllMay (ep,vemew.) Wes Tew: wn.Pwpog wt a.meo:m? 0N. ova o gywmml YieM_gpm wM_ft Mxdowv ePa_M. YieB_gpmwM_ft dnwdmvadm_kn. y,o—so.b:_e.AewdawoeM_M. Raova)'tlsm(dove=mowhev PnW un:swd vR-was msd mwM Ewe w6 Time nkvdl rime wmlrel Time w.wl<a1 Twe waa� WkofpvnPimn Mr.rrb_® wM_ftdi.wdwmsM_M Ab rm 2gglo &,o .aa Ass,w 214ftsv],y M. DmeaWt32@1 flow_gpm Temyv.vo.vfwMx_'P Wa eMwimlevJysu made? DYn BNo SMD Dale 9/12f2022 Completed Dale W132922 WELLCONSTRUCTIONCEET6 nON: 1cwwuad evNoreaepl respomibiliry fm cavwraov ofthis welt,andi¢compliance with ell Washington well cpwauaipv smotlaNa kfaedaleseed evd the htfmmelivn repoved ob:we are aeeto my ben kmowlnige end belief. SDrilla❑Trabee❑PE-Print Name Mark Wiese DnL C RICMARDSONWELLDRIMING Sim Addrae PO BOX/aa2'f U� No.2d32 Cit,Ststo L TACOMA.WA 98da6 7 TRAQi SpqqW&Ucess,No 2432 ConlnctorY S Sgppp,o, Rsguorwurnm.PACNAWMOB We OBH42022 ECY OSPI-20(Rev W/18) {flmv naei ib donrmwrNan aGmwmfornmr,..m th.h Wara Rearms P.lt877 36o40J-dBJ3. Persorewffblmvwrg bra avn mO JllJor WaNingfon Retry Smire. Peaone wifha�dtmbiliry con ca118JJ-g33-6341. Thurston County Envimm mlal Health 412 Uly Rd NE Olympia,WA 96506 360-067-2631 annmaxvmaaaT _ COLFFORM BACTERIA ANALYSIS 0aasaap.cdad T®aasaeptr o..q xm yea g .� J_LGT_pry �f�]afn TiaadWa*&Mm(tlu3a*"beO MATab HwwM OQaQA OQep0 ❑oh OMWAaad Ga 09pmc-%Vft Gam MW FaWft hrmNYOYFI}. d _ _ _ _ _ _ S/WnNeie Cadadeeamc 0a/PAaaa: 28D _ O CalPhniel -._:d: EaroY �A�'1 1 saeamtecpbaNeaarasMri eerlatl`ay '. /M aiAl1�G� a rp" SAMPLE MR)MATON Stnp.mleka Mtaaaak Sps&babneadl�mbesapeaYrid - nslua5ememmradc /3G3 E. Cres/✓M•�Dr She tfu.a a 9$SS TYwdSamWefm td:ei oNy mw 6aal€16aaua9��t{is@tl 0ebw) i.�'ttoatim D;st�Awan SamNe t.Reaeat Sam{&IdkrvnwtraWal CMa�namd vu_m�— ❑CigribuionS)a1m C!daie Rag ,TOW—F2e_.. Chbmdad:Yea_m_ 3Raa Water$oarcesamde (]:bma Ruiiel:TONt_iw`_ ❑Ema-swn1AR! ❑Feel-tea ana�t^v+M UnsAH' art�mu5mleDmaiper. ❑AummaetM.re M(A!P) tW*"*q dmmkddit Oorbr � � S 1�T 9eayM CoMarLdierinkreidmn Oey b+ariOdiaa_ C�iRapab� oAv_ IARMEDtBY DRNNNG WATER RESULTS IASUSEONLY ❑a.se "Td/Odomps aad O6mlFv OEaalabmaA bad ftao�samph RKp Osmgmm(+»mu4 ❑TRR ❑ &o WDedy R Em( DOOA Fades Erroma.-------=0 Wtlnd(A8e MS OWSM maelaa ..rra yy u 0 a 0 .. 2208787 MASON CO WA 03IZ M24 09 Qe M1 NOTCE NIn CtlryE�tLANV 019a5a%N1 Rec Fe. I'■a$�304�q5��0tlP� �a P Return TO mwi III II�I'�I�IPI��IIIIII Iwl�unl��IIiN IIII��III a10 mii IIiI VB zo Z� I/ w U/ 4r Iva 9SSuz Grantee(s): (1) C ue CtP1 , (2) Grantee(s):(1)PUBLIC Legal Description(1) Hof 8 OF 5t"v3152 Ar#2-105'0.50 Pm n w n e. (Abbreviated form:i.e.lot,bbrk,plat or section,township,range) Assessor's Tax Parcel: (1) 3 z 0 2 Z - f 2 - 9 U 2 2 5"22 -TZO- 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) .3 z- O Z. 2 _ / 2 - 9 U 0 2. Z Tax Parcel: (Connection 2)jr Z O 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 /Yla�ch , 20 2-°L Signature of Grannt�tor((s�s): 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 certify tha(op th�5 7 Qay of fiXC h , 20 , pOTdl d ( 1 t1 GL�1 personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she)(they)signed h. GIVEN under my hand and official seal the day and year llffast above Iwritten. ^\`OU�rALLM�r��/p , 1 G�CJG'✓RGtI" v ' �. E ,.L F , Notary Public'n and f r e State of Washington, ^v�'ai� Zo QN�.°'', residing at Q��^� m' )�= My commission expires: =2: NOTARY :m: =V:' �'. m:D- n S PUBLIO N. E A; Ili3 O"1*111''0 N`' Page 2 of 2 2 -1 0 M 0 co \ ` ' o o 0 666.42' T 0 �\ § � i ^ ~�\ KN f ............ < > \ � . . \ � . ------------ ----- - ......----- --- - - - ... .. .. . . EXISTING ACCESS 866.38, X , \ )\ \ Z; ) } \ � § � � f k m- z m mz � m } /_ 0 P? >MM \\M (§ Mw> E < M z oz , > Cox m � - x > > F ■ m m 0 z T LO m z M > 0 M Z M 0 o M 0 M 0 'n