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HomeMy WebLinkAboutWEL2024-00023 - WEL Application, Design, Letter - 4/16/2024 MASON COUNTY (tt COMMUNITY SERVICES yAby Annmg,indmnaxd NNR[mmrwiry XmlM 415 N 6° Street.Bldg 8. SWM WA 98584 Shelton:(360)427-9670 set 400 a BeB 60) 4477 ext 400 O Elms:(360)482-5269 End 400 FAX )4 APPLICATION FOR WELL STE INSPECTION Permit Number Payment Information Instructions Receipt Number J-�- 1. Complete Pan 1. Incomplete applications will be rejected W . O ❑ Cash 2. Attach a detailed plot plan. 3. Clearly stake out or flag me well site. [I Cash 4. Submit application and appropriate fee to Mason County Date of Payment Public Health. Refer to Mason county Environmental Health Fee schedule for cost. PART 1:Applicant I Parcel Identification Water System Name Orchard Beach Community Site Address 312 E Orchard Beach Drive,Orepeview WA 98546 Applicant NWS for Orchard Beach Comm Group Inc Phone (360)878-WW x107 Mailing Address PO Box 123 City Pon Orchard Stab WA Zip 98366 Parcel Number 22127-50-01901 Directions to Site Hay 3,East on E Island View Rd,South on E Orchard Beach Rd, Left on E Ochard Or Parcel with Pumphouse on right�" Water Source is: YNew ❑Eldswg System Type:0,Well ❑Spring No.of Proposed Connections_ PART 2: Heahh Department Review(Staff Use Only) YES NO NA EL ❑ ❑ Evidence of u s of contamination within 100 foot radius of water sou ? o-0 (drainfil, ' tanks uildm :indicate distance on plot pan) Sri} ; O / ❑ ❑ Are there R e 100 foot radius of the water urce?If so,is roa private, unty or Stale. What is distance to ROW? (� -f O ( ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ hE. Is the well cap satisfactory? ❑ ❑ Screened and vented? The well casing extends above level ground/concrete slab?(drde one) ❑ ❑ §', Is there evidence of a surface seal? ❑ ❑ Does the east appear adequate? Is a variance necessary or well site approval? t c�.amrtwrtis S7/ /O 44c �arN�t� C1Q ��Bo ❑ Pass ❑ Fail Inspector I f, Dab 9 ,1 —2 This form maybe e n rid available for uqk view en the Mason County Web arts Fins qs Mthis raNew rMecrmwsedm dUa.rswyeilsieem NedzY?r dr are ireperxion.NO WM1n rnrM.ee�rr«Nndrddme lWrs li p r«f Mleee"4tl a 2JAppwaeWtiMtlewpeeerere pl'oaw«mnvlmnWMwlrrM nspPe'� Wrl«sYetonWaalrehol�erl Drsaa eron onmtleseAW nreeR er wart aYatcn dews msYhaWmUrR r«mrw 7:IEH FormsIDRINKING WATER FORMSIOrinking Wamr Well Site Inspection App.dmX Revised: 120/2017 414 Phadna•Manegemeo[•F.ngl-refng P.O.no.123•Port Orehar4 WA 90M•888-881-0 8•360-876-0 M April 15,2024 Jeff Wilmoth Mason County Commuaity Services jwihnoth@co.msson.waus Subject Orchard Beach Water System(ID 64031ty,Well Site Inspection Application Dear Jeff Wilmoth, The wellsite inspection application and supporting documents far a proposed new well for the Orchard Beach Community Group A water system are enclosed.The property is located in Grapeview on Orchard Beach Drive.A vicinity map is provided to aid in locating the property and the staked wellsitc.The new well will provide system redundancy and an increased well pumping rate will allow full buildout of the service area The proposed public well will be located on Mason County parcel number 22127-50-01901. The 100-foot sanitary control radius extends to eight other properties,as indicated on the attached site map.Restrictive covenants are in place For 4 of the properties.There is one property,parcel number 22127-50-01006,which contains a small cabin and septic components(tightline and septic rank).Regina Grimm,Assistant Regional Manager,Washington Department of Health,SW Regional Office,has confirmed that there is a case ter a reduced SCA based on the well log of the Orchard Beach existing well and the location(S02)and the location of the septic components approximately 80-95 feet from the proposed well location. The water system contact is Erika Aunt Her contact information is 360-250-9110 and eemalk yahoo.wm. Should you have any questions,in require further information,please feel free to contact me. Sincerely, NORTHWEST WATER SYSTEMS,INC. John Devitt iohn.d(a),nwwalersvalema.wm (360)876-0958 ext 107 Cc: filelprojects\230905 Enclosmea' Well Site Inspection Application Vicinity Map Site Map Well Log S02 Email from Region Grimm o - A v SITE NFORMATON PIDVDEU BY. NMI : C{ THE CLIEM,MASON CgRIIYGB AND ^.r - BY SIZE INBPECTDN Y I TH181S NDTA SW VEY.PROPEIITY LVF9 i AID ELEVATDN891gAA1 ARE BAS® E UPDN THE AVAIABIE INFOIMATIONANO AREAPPRD%MATE OILY. DISLRDBANCE OF EIGSTNG SURVEY MONUMENTS IB AGROSS MISDEMEANOR UNDER RCW SL01.015 li PROPOSEDWELLSITE ORCHARD BEACH ORCHARD BEACH 312 E ORDNARD BEACH DRIVE p � 230M VICINITY GRAPEWEWWASBSW —APRIL2,2021 `� NTS NORTHWEST WATER SYSTEMS,INC. wrtaaxw m.ewwsmn pgen® scA E Pso' WATER WELL REPORT 021145 S.wrwnx a lmwpY sw.w c.Fr—D.nw'.czr STATE OF wASNIMOTON ma con—v.uw.CeW waw A+Fr rw.w R.. O (1) OWNER: rr.. h WatOrSy t .rn.. he"1 Drive SheVVm W 41 (2) LOCATION OF WELL co.wr Me nn SW .9F. 79 T_21e. Z R.n (L) STREET LODDRESS OF WELL C.vmr.YY..0 3 R Damnb PROCEDURE DESCPWnON (3) PROPOSED USE: C xrro.L.. IRY El MrY.pl❑ ItDI WELL LOG ar AMISIOFEENf ❑ D.w.M TW WM ❑ OMF ❑ Fwlls Grab.M aabr. MSN✓. rs a I..NM W .aWw. r aw Ly IlAyer aM.M....M W W rr.rMllY br.A aaMi.rrr.l ate. 14) i ff OF WORK: Ix�mc..•i w�era.r 2 .nrewr N.N r'^'r" s.a To AL.nYY.M:I Nwwe1 Al M.I"W ow ❑ BerM ❑ O D.wre ❑ C.LI. M wba ❑ C R.conJMOmd❑ Ra.n❑ J.IIM ❑ .7 (5) DMENSION9: p.Mrrawal 6 EDnx.e �� I.r. Dean olYanplr.YMY�II p (6) CONSTRUCTION DETAILS: 0 Ar 201 K �SI H —' Mr.ns A.r R so 1M.xM r P.na.mn.: Y.103 O T,.•aF.lwaar w Lttl_V CsuA a..Y.nMr bN Ip ywrs.xrs Kb A' 8aerr: Y. N. u.w1..1.+r.wM Cook - Trr_ Ow r L�. 2�1 Rlo ye_�_Rrrr Dnn.IPM.t Yr x. YR.aP...l yyrFKI Yril ME) Aa rYyNi )A Oiwrrlr.W Y.tl D � __. Z Du.m wrM.rW.rrlN.ara. rr� n.6]r y 8) u.MeawMswM rt O 9 (7) PIMP: rww«Ie.nNur Perki r >1 Ugr (8) WATER Lff E O V MnM.euw. b...e Wrr.Ya� MP _. W Yp IYYI. WELL TESTS: d.w���rpeI�rgl.wyblY.rn Nwlb4w..n�Q�RY.a N w...oe+G/na.i.wly. 7 R[[u'1 .Yr.bwoel WELL CONSTRUCTOR C211MFIC11TNIN: YW:�❑ rr.w J.L-.�n4..Y..rr_i1`_u.. IemrwM Wls.Oorol r.s...Ritr lw.arrucnenalM.wN. W M Cn1ERF0 Rb Y WRMIIRIon w.11 c-.lrucll.n -MY 1— •• YMNNN YrY NF M Irr11bIW rM.rrJ.Low.n N..le mY M. 18 •• IAgy{IE.wNDYW. ' O. Rww�rmerwr .we.Ir..wwrYan N�wurM.wM d 1MwIIMbvawlMO � 97 1 ff3n 62� � v-1 Play.1111I. mMYMFIPO DYR tl.IRRI 1 md,..�Z _ n. Tom. Ar.F wtaiu "L O1S``528 A �iRbmalr 2/20/R9 lS1uv.FV ON"'4 /�A"1!� Lb.n1.Ib 1706 M.w1��M.rRbrbrnrlr�tla�Ya I1lVTCORi f.W1 D.b Feb_ .FBm rwm..lw.awr._w...a+.Isl..wr.e.Y.1 r 12 (USE AOOMMAl. SHEETS F NECESSARY) .c.m�.+Y lam aYs '�• John Devitt From: Grimm,Regina(DOH) <Regina.Grimm@DOH.WA.GOV> sent: Friday,April 5,2024 9:19 PM To: John Devitt Lydia Bower, Erika Aust&Eric Campbell Subject RE:Recap of Team Meeting 20240320 Hello John, Thank you for sending a summary of the meeting we had about Orchard Beach's Intention to drill a new well. I confine that there is an option to reduce the sanhary control area if there is justification provided. Thank you, Regina Regina N.Gdmm, P.E. Gender Pronouns:she/her Assistant Regional Manager Office of Drinking Water-Southwest Regional Office Division of Environmental Public Health Washington State Department of Health reaina arimm®doh wa aov 564-669-08571 htt^ '//wN---dohwaaov/CommunityandEnvironment/DdnkinaWater ©U O ©©0 IIWIFHEALTH From:John Devitt<john.d@nwwatersystems.com> Sent:Thursday,March 21,202412:56 PM To: Lydia Bower<lydia@nwwatersystems.com>;Grimm,Regina(DOH)<Regina.Grimm@DOH.WA.GOV>;Erika Aust& Eric Campbell<eeanda@yahoo.com> subject: Recap of Team Meeting 20240320 External Email Please see attached. Erika-I didn't have DeeDee email so please forward to her. Enjoy your day! John Devitt Northwest Water Systems,Inc. www nwwatersystems.com t