HomeMy WebLinkAboutWAT2023-001099 - WAT Application i
WAT 2a23
0, 415 N.6°Stre ^ I
MASON COUNTY Shatov,WA 98584 f
COMMUNITY SERVICES Sharon 36o a27-900,at aoo
Belfair.360-2754467,at 400 J
\. F.,d,e,F1.. .,o,Ewm,m.,dv�,4m�.,.,,,erewn Elmer 360482-5269,at 400— I
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Application for Determination of Water Adequacy {1 t
Instructions 5
1. Complete Part 1. No determination can be made until Part 1 is fully completed. 1
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application,with any required attachments for review.
4. An approved building site plan must accompany this application. 6"
i
Part 1: Applicant/Parcel Identification _ f�`�'/j��m pr1� _ ! "L
Name on Applicant Lji,+UXC71 Mt)bl(.P'J uflte: 1-,31 - 7�7
Mailing Address: t).6i5K ( F3-ltp
/ Phone: QW-4;4 '114qt,
I
Parcel Number: c5hzLkii, WA "1 3igo7- -),q- gx-l3 3
Type of Water System Reason for Application
❑ Public/Community Water System(2 or more Building permit Com 2623 - OX7�P
connections) ❑ Division of land:
Individual water source(one connection), #of Parcels? SPL
Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
If you have more than one residence connected of water system below if applicable—no
to this well, check the Public/Community Water signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System:
Water Facility Inventory(WFI)Number. (write'none'for two-party)
❑ I am the manager of this water system.The water system has been approved for_services.There
are presently connection(s)in use.This will be the connection.
❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system(Le.:recreational to full time).Please Indicate on the following line the nature of
this change:
This water system is able and willing to provide water to this(these)connection(s)without exceeding the
limits of the water system or any limits set by state and local regulation.
Print Name of Water System Manager Phone
Signature of Water System Manager Date
This form may be scanned and available for public view at www.co.mason.wa.us.
i:�rr®,�m gw,rc a d4=21
WATER WELL REPORT _=DEPARTMENT Of Notice of Intent No.WE52706
ECOLOGY U.i,.eE elegy Weil ID Tag No.BPN 040
Typeof Work: State of Washington
EN Coatmcleon Site Well Name,(if more than one well):
❑ De,.nmimion "O pieced installation NO[No, Water Right PemtiVCerdfcare No.
Program Um: ID Famine ❑Idurawl ❑murmipl Potently Own.Name EARL SMITH
❑Dewatenng O hrigaticn ❑Teat Well ❑Odm. Well Street Address 1001 KAMILCHE LANE
construeean Type: Mnhd: City SHELTON County MASON
*New well ❑Agenda. ❑Dnven ❑lened ❑Cebk Tool
❑Deepening ❑Over ❑Dug O Air- ❑Mud-rtoury Tax Parcel No. 3190744-00042
m.emlans: Diattuur classical 6 in.n.!an ft. Wasavanance approved for this well'! ❑ Year ❑No
Depat.r.nlpletd-11Sal ft.
If Y
Comtnetloo Details: Well ea,what was the variance fits!
Casing Liner Diaim4r From To Thickness Swel PVC Welded! Thread
❑. 1 ❑ 8 in, +6 94 in. O ❑ E 1 ❑ Loam..(xe insvuclicns on page 2): 17 W WM or❑EWM
❑ 1 Cl _ _ _in. ❑ ❑ ❑ ❑ SE 'b'Goflhe BE Ye;Smrim 7 Township 19N Range 3
❑ ❑ _ _m. ❑ ❑ ❑ ❑ latitude(Example:4T 12345)47.14366
Longitude(Example:-120.12345) -123.09891
Pertentlom: ❑Yes ®No Typeofperf crowd Driller',LoglConrtractloas as,Marmalade.Proedare
No,ofperfon m Sae afperfantiore_in.q_io. Formationbe:Mmnbyco r,clmectMsizeofo mlaMsmture,aMthekidad
Pa6inted horn fl.a_A below pouts aurfux re of the ma rut in each hir,pemrnd r ,with at least one entry,for each room of
gmeem: MY. ❑No 0 K-Packer '* Death 92 a 'thermal... Use additional since.if naereary.
Mannficur er's Nam 3OHN30N Material From To
Type STAINLESS Model No SANDY LOAM GREEN 0 2
Daunt r 5 in. Slot sae40 in.from Sal ft.to 99 1, 2 8
Demeter n. Slat siu_ in.from_gar—ft. SAND LOAM GRAVEL
GRAY SAND SILT 6 16
Sand!Feter pack:❑Ya f No Sae f,ark maenad_w BLUE CLAY 16 20
Martinets placed eons_A ro_ft GRAVEL CLAY BROWN 20 40
Surface Seal: DY. ❑No To what depth?19 It SAND GRAVEL 40 60
Noverialnsd in veal 318 BENTONITE BROWN CLAY GRAVEL 60 80
Did any avau ronion wnsable wnen ❑Yes SMALL GRAVEL 80 90
Typeofwamn Depthefeream SMALLGRAVEL WB 90 99
MetMd of aea0ng seam aD GRAY STIFF CLAY 99 106
Pam,: Manufrromr'a Name Type:
H.P.— Pump imice delay_A Daipud Row me:_gpm
µale,Levtlr: lard-1.11caeelewhi.c.lese min .kvel_ft.
Stark-upofwpofwellcuwg +2 ftebow pouts swfan
SUMwamrkwl 68 ft.bclown ofwellcasing Date 07=023
Armi.Inceruse_Nat.pin square lash Date
Adocan water w comalled by (cap.calveetc)
Wtll Testa:
Was a pumping tat permanced! NNo ❑Yea C by whom?
Ywrd _gym with_ft d...wn ehr_her.
Yield_®m with_ft,drawdmir after_has
Y.Id_®m with_It,dmwdown after_lers.
Ramvery dam(time-ttro care.pump u.ned off-cancer level mcam<d fins.well
telphro ellevel)
Ti Water level Time Water Level Time Water Lava
he
ofpumpingtur
Baikruat_gpm wirh_6,drswdown after_inn.
Pro. 10 gpon with atom set at 92 fl.fort r.. D+r<07a7Q=
Aneaun flow_In
Tw,wNtm<ofwaur_'F Waaeheminlanslyslseade? ❑Ya oho' Sort Dote 07/24/2023 Complmd Due 07/27/2023
WELL CONSTRUCTION CERTIFICATION: I convected and/or accept responsibility for constmction of this Well,and its compliance with all Washington wall
coasmrethen sthMards.Materials used and the intimation,reported above an,time he my best Imowldge,and belief.
Cal Driller❑Trainee❑PE-Print Nance ROBERT LAYMON Drilling Conaparay ADVANCED DRILLING LLC
Si scree Address 11530 SCHOOL LAND RD SW
License No.2588 City,Slate,Zip ROCHESTER WA 98579
IF TRAINEE'Sparran.6 License No Contractor's
Rest ton Na ADVANDL804DL Date 08/09/2023
Spoa.or's Signature -
ECY 050-1-20(Rev OVI9)/f3»u need this discontent in an alfernale formal)Please call the Water Resource.,Prograan at 360-407-6871.
Persona with hearing foss can cal/71l far Washington Relay Service Persmm with a speech disability ten call 877-833-6341.
Thurston County Environmental Health
02l011 Rd NE
OIymP
ia.WA 98508
360-6 7-2631
ALYSIS
COLIFORM BACTERIA AN
caunty
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au
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♦ Type AWabr SYdem lUh°Uk ordyoFa /�eryn�
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Provide hom Wam(Fac'atles Inventory(wF9'
IDN
SyslemNalne'.
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Day Phme:( dal Z•°V y2 3(/i Eve.Rmna'.( 1
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ISAMPLE INFORMATION
Sam*mPaDlad by lnianal q�- b'
I 1 � Spedal instmctionea mlanen
where sample mNaoled.
gpedgDboation or address 1119�LA++�
to to
Type of Sample(lrudoheck only one °I 3t R.�t SamP lamed
u�tmo..)
1. oudna 0,Wbudon Sample Databudon SYslem
. Chbtinalad:Yes ✓Now
Chbdnead'.Yes No�
Gnome Residual:Total_Frea_. Chorine Residual:Total—Faa—
g.Raw Water Sauma Sample t
❑E.col!-GWR(A/P) Unin"odory routine an number.
❑Feml—auH—oWi.ayvyx lnumas�^1
FXWed:Yes—N°— — gory mugne mlled dale'.
❑AssesanentlAonimriDgl�l Vnsati
—l�l_
pOUer
S
q.0 SempM Collected Mtormadoa Only
Invesb8ab`re Consllud'wnl NATE_ES RESULTS
LAB USE ONLY
LpB USE ONLY DRINIUNG WATER SebshMry
❑Unsatlsfacmry Total CDliloml Present and o IADmidatadad
❑E.mli absent
E mli Present
Rapla,Wd Sample Rpulred: ❑—
❑SamplebooWP30tnUm) 0TNiC
1Wld. E.mF�
1pOml.
Badmlel Danny Rinalb.Total Coldana� moo m1.
Enteromcd�
Fxal Dom,—JIDIXnI �ad''TT�"m"e
hktlmd Cade: SM 97[3N.. 0 - ry 11 J
�Sh4921580 Dare Repalad_
Ise lka anlY'.
ON end1XMAIW �ereadal
yrye Nie2wlD�
-7- 1 �^
Return Address:
2205512 �ON CO WA
James E. Hungerford HurvcEeFono 111933]9FF�o Faa s3 sa Paq—
AttomeyatLaw ������ �������� ���������� ����itIIlIt
P.O. Box 1191
Shelton, WA 98584
0
SHARED ILL VENANTS
GRANTOR:West Coast Mobile Equipmen pair,LLC
GRANTEES: William McTumal,Janet McTumal
LEGAL DESCRIPTION (a eviated): PTN SE %< SE 1/4S7, T19N, R3W (full legal
descriptions on page 1
ASSESSOR'S PARCEL -44-90041, 31907-44-90042, 3190744-90043
1,4-.
This Declara is de this �A d y of December, 2023, by the Grantor, West
Coast Mobile e 'r, LLC, a Washington limited liability company, and the
Grantees, Willi McT and Janet McTumal, husband and wife, in consideration of
mutual benefits.
EES, William McTumal and Janet McTumal are the owners in fee
simpl ollowtng parcel of real estate in Mason County, Washington.
of ort Plat No. 3142, recorded December 3, 2021, under Auditor's File
2172118 and 2172119, being a portion of the Southeast quarter of the
u ast quarter of Section 7,Township 19 North,Range 3 West, W.M.;
sessor's Parcel No. 31907-44-9004 1;
ereafter Parcel 1).
THE GRANTOR West Coast Mobile Equipment Repair, LLC, is the owner in
fee simple of the following parcels of real estate in Mason County, Washington.
Lots 2 and 3 of Short Plat No. 3142, recorded December 3, 2021, under
Auditor's File Nos. 2172118 and 2172119, being a portion of the Southeast
quarter of the Southeast quarter of Section 7,Township 19 North, Range 3 West,
W.M.;
Assessor's Parcel Nos. 31907-44-90042 and 31907-44-90043;
(hereafter Parcel 2 and Parcel 3,respectively).
Shared Well C.v..s-Page 1
COVENANTS
The GRANTOR and the GRANTEES hereby decla d establish the following
easements, covenants,conditions and restrictions:
Location of the Well and Water System4' ateir
There is a well on Parcel 2 near the cmy line between Parcel 1 and
Parcel 2,which serves Parcel I and Parcel 3. trot serve Parcel 2.
Cost of O eration Mai nance S stem
The owners of Parcel 1 and Parshare equally in all costs of operation,
maintenance, and repair of the well and�Waerystem. The cost of repairing common
distribution water lines, if any, shall be home equally by the owners of Parcel 1 and
Parcel 3. Each owner shall responsible for the installation, maintenance, repair, and
replacement of any water line p g water from the well and water system to such
owner's own particular r property.
Easements fo II and Water Line
The G or he y establishes an easement for a water line on Parcel 2 for the
benefit of P e or ater line ten(10) feet in width, lying 5 feet on each side of the
existing e, the existing location of the well Westerly to the East line of
Parcel ] r also hereby establishes an easement for access for the benefit of
Parce T n�trcle with a radius of 10 feet, with the well being at the center of the circle.
Th r Parcel 1 will have the right to use the easements for access to the well, the
tem,and the water line as needed for maintenance and repair of the water system
ater line.
The Grantor hereby also establishes an easement for a water line on Parcel 2 for
efit of Parcel 3 for a water line ten (10) feet in width, lying 5 feet on each side of
Pa
rcel existing water line, from the existing location of the well Easterly to the West line of
steel 3. The Grantor also hereby establishes an easement for access for the benefit of
Parcel 3 in a circle with a radius of 10 feet, with the well being at the center of the circle.
The owners of Parcel 3 will have the right to use the easements for access to the well,the
water system, and the water line as needed for maintenance and repair of the water system
i
and the water line.
i
i
Shared Well Covenants-Page 2
2205512 Page 2 of 4 12/14/2023 11:33:1S AM Mason County, WA
Restriction on Fumishin¢Water to Additional Parties
The owners of Parcel 1, Parcel 2 and Parcel 3 shall of fumish water from the
well and water system to any other properties or dwell' out the consent of all of
the owners of Parcel 1 and Parcel 3.
Heirs. Successors and Assigns
This Declaration shall run with the I and s I be binding on all parties having
or acquiring any right,title or interest in th e d herein or any part thereof,and
shall pass to and be for the benefit of ea weer eof.
General Provisions
This Agreement shall benefit and burden the real estate described herein and shall
run with the titles to the real to described herein. This Agreement may be amended or
terminated only by a written m signed by all of the owners of Parcel 1 and Parcel
3. In any litigation arisit Agreement, the prevailing party shall be entitled to
recover reasonable at%ni�ey� es d costs.
GRANTOR: GRANTEES:
West Co ' e pment Repair, LLC
By 1 ember illiant MrTurnal
O anet Mtmal Mc al
Shared Well Covenams-Page 3
2205512 Page 3 of 4 12/14/2023 11:33:18 AM Mason County, WA
STATE OF WASHINGTON )
as.
COUNTY OF MASON )
On this 37rr day of December, 2023, before mrs ed, a Notary Public in
and for the State of Washington, duly commission d om, personally appeared Earl
Smith to me known to be the Member of West Coas tle Equipment Repair,LLC,the
limited liability company that executed the f ent, and acknowledged the
said instrument to be the free and volunt act deed of said limited liability
company, for the uses and purposes the ti , and on oath stated that he is
authorized to execute the said instnunen .
GIV=mderd and official seal "d year last above written.
No Publi and for the S`�-te of n 1AMES E HUNGERFORD
VA�Shi iding at \\ // NOTARY PUBLIC#74094
My Commission Expires����/// STATE
TON
COMMISSION EXPIRES
OCTOBER 24, 2024
STATE OF WA$ NG )
I ) ss.
COUNTY OON )
I, the rsl e , Notary Public in and for the State of Washington, do hereby certify
that o 3�- day of December, 2023, personally appeared before me William
Mc met McTumal to me known to be the individuals described in and who
e t the within instrument, and acknowledged that they signed the same as their free
ex
act and deed, for the uses and purposes therein mentioned.
GIV under in d o mial seal the day and year last above written.
o ublic in or the State of
W ngton,residing at
My Commission Expires: ,TAMES E HUNGERFORD
NOTARY PUBLIC•74094
STATE OF WASHINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
Shared Well Cave mis-Page 4
2205512 Page 4 of 4 12/14/2023 11:33:18 AM Mason County, WA
2200480 MASON CO WA
08/07/2023 11 36 nM�09NOTCea.E
IIIIIII IIEPR� 6I IIII IIIIIII(IIIII IIII IIII IIIII IIIII IIIIIII III IIIII IIIII IIII IIII 2
R m To
Yl,
V.O,bbX lbqlt
SheLFon, W.A re5
Grantor(s): (1) Lad IALt 06t:l"h , (2)
Grantee(s): (1) PUBLIC ,�.�}-
Legal Description(1) L A 3 Of(f' -, �31'Ja
(Abbreviated form: 1 C L- �� y.e.K block plat orsection, township, range)
Assessor's Tax Parcel: (1)3� �il
9 0 - L{ q - —x
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA)
I (We), the undersigned grantor(s), hereby place this notice on record that the described real
estate situated in Mason County, State of Washington is subject to water use restrictions and
conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These
restrictions and conditions are based on location of property and/or Water Resource
Inventory Area or WRIA.
WRIA: I`f
Maximum Annual Average Gallons Per Day: tir gallons
Dated on this 7 day of Q(4 q S 4- 20 a 3.
Signature of QGrantorr((Js):
(1)' Ti'LC�l n.,_..�� . (2)
State ofWashington )
County of Mason )
Page 1 of 2
I, the undersigned, a Notary Public in and fort a above named County and State, do hereby
c dy that o this day of 20�
YO N �1� ), sonally 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 an ar la above written.
NOTARY PUBLIC Notary i ' and or the Sta of ashingto ,
STATE OFINE A. GTONCASE
JACQUAUNE A. CASE residing at
Uc. No.22016377
My Appointment Expires My commission expires:
APRIL O8,2026
Page 2 of 2