HomeMy WebLinkAboutWEL2024-00004 - WEL Application, Design, Letter - 1/17/2024 584
MASON COUNTY 415NBTHELTON:STREET,SHELTO70,EXT 400
SHELTON:360 277 670,EXT 400
BELFAIR:3fi0.275-0467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX:360427-7787
WILLIAM MCTURNAL
P O BOX 12048
OLYMPIA, WA 98501
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2024-00004
1003 W KAMILCHE LN
319074490042
The 2-party water system, West Coast Mobile (well on 319074490042 with
319074490041/319074490043), 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
MASON CO JAN 2 21014 R%N
COMMUNITY SEL Ep5r _ al�Pa
wsaoa rr��a L�nml xmlm w
415 N.6°Soat,(Bldg B)-Shelton,WA9R584 WEL .261
Shelton: 360-421A6]0 x400 BelE S:360-2]54 67 A4W Blma.3604U.5269 x40U
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
Av KIANT vxOxE
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rM OOREsa-aTREET,CRY,aTPTE.➢V A ��� _q
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srt OORE55-aTREET,C .STATE. 'I ✓MV t 0 a//�
PRIMARY VPRCE isrR ELLATE�
aELONOMYPRRCFLNUMSERIIP LPPLICPSLn —�QO/� / � 3� 0�- ��� IOON�
WATER SOURCE ....��(( SOurCETYPL r P111CF1t LOT 8PF PPRCEL 2 LOT ME
IQmew ❑Existing ell 0 Spring Z, k
PROPoSED WATEA 9YSTER XPMEIREOUIRE01 /(
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PROJECTO NPIION
MRECTCxsroSna COUSTOa �� N
c 1A Lr✓�f aTo � of icfii
site Plan: (may also be attached)
(property bdundafts,Sbudures,well site wsl00'radius,driveways,roads,septiclsewer components and lines,easements,etc...)
u,r r
0
0
d� F
W"J j
Submittals Checklist: (these additional items will be required for approval)
14 Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled)
19 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 boating 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 allies. Revised: 10/13/2021
Page 1 of 2
.............--------------------------------------------------------Staff Use Only ------------------------------------ ---
Step 1: Well Site Inspect" n:
-Iv611 kUrc& r�'lRs+-�d �lfeY,ny pz.,seUs
YES NO NA -77' 10 pr4r44G
❑ ❑ Evidence of existing sources of contamination within 100 fool radius of water source?
(drainfields,tanks, buildings; indicate distance on plot plan)
�J ❑ ❑ Are there roads within the 100 fool $$dips of the water source?If so, is road iv County or State.
What is distance to ROW?. W
❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan)
r ❑ Is the well cap satisfactory? Alt t4Nf jee(.
❑ `N ❑ Screened and vented? po,.
❑ The well casing extends t7 above level ground slab (circle one)
QQ ❑ ❑ Is there evidence of a surface seal? Le., #( '-W Yg1L
❑ El Does -W -0187M Does the seal appear adequate? !r
❑ 'm ❑ Is a variance necessary for well site approval? T4y- tr(a
Comments - Ill , Will l OPW4!t
_ opt g,V-V92 am kaj,
'r"- Pass'J�Fail Inspector Date
0
Review Step 2: Two-Party Review:
YES NO NA
ILY ❑ ❑ Water Well Report with adequate
� wv-r pump
�test
ron file? Aduf�i�d {dfN�y�'� �Zi�7Ozf l0lf�ry �or Zlvf',
If NO,date of Capacity Test cj� Driller MIN GPM
W ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test liS3Jal '�Bk1l
❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN 77 M17-
❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
)(Approved ❑ Denied Reviewer Date
Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. No claim is made,express
or implied ofthe future success or failure ofthis 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
Wafer usage restrictions and additional fees may apply to all new wells dr illed 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 =DEPARTMENT Of NohelfbeteetNo.WE52706
ECOLOGY Un gmHoogy WeDID TagNv BPNO40
Type of Wpe,; state of Wmnington
(m cm.mmdw Site Well N.(if.the ®-weU):
❑ Dec... o Ongmel immmdonNCHRt, Water Right PmmitlCerifieem No.
P pa Use 9 me ❑LWm¢MI 0M'ml':41 PMpeetycwcrhunc EAR SMITN
a Dewateen ❑hdpdov ❑Tat Wd ❑umm Wa0 Street Addmm 1001 KAMILCHE LANE
commmdo.Tyw: Memo: City SHELTON Cmmty MASON
b Neww ❑Altmtloa ❑Driven ❑lend ❑G Tool
❑Dap®, ❑omen ❑Dee mAh- ❑MW-Rowy T.paved No.31907-44-00042
DlmeWau: Oh .fbmkg6 m,m 106 @ Wmeverl®wappmvdfiefhkweOT ❑yen ONp
Depmo£mPeImdwe W A.
Comtreetlm Denim: Woo uyd,what urea the varieva fot'l
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M I ❑ 8 ee. a2 W _m. M I ❑ M I ❑ I.ocafiw(aeei.DDefiomwpege2y. ❑. VVWMor❑EWM
❑ ❑ ❑ I ❑ ❑ I ❑ BE Y'/.afthe SE Y«'Soed. 7 Towveip 19N Rmge 3
❑ I ❑ 1°' a. ❑ ❑ ❑ Lfimde(E,emple:47.12 5)47.14356
0 El — IuvgieWe(EVampk:-I20.12345)-123.09891
Ferfm.tlem: ❑Yen MN. Typ.ofpetihea,, d IlrkOu'sLg/Cov.lroNov of Decommiedov Procedvly
No,ofpafmmiom_ S®ofpaPomtiom_ieby_I Fom ;Demvbe by wbr,chuacter,she efm.mvled abucme,ad me kkdmd
Peribeeted Rom_ftb_ftbebw pomdemmm mb.e ef0m m.md in hky p. 14 wimm leeet om eeey meaeh cb,d
9ermm: MY. ON. MK-Pak Depm B2 A. mfvwrke. Usee&HeG la ffeaemy.
14mo�8ctmv'e Nme 001NSON Mate h] Fmm To
Type 8rplNLFss Model No. SANDY LOAM GREEN 0 2
Diavmter5 is fae,.4 mRom94 Km 99 @
Dime — glm� mWm_fl.m_@ SAND LOAM GRAVEL 2 6
GRAY SAND SILT 6 16
S.dlbemrweb❑yes ENO gmofpeetmam kL BLUE CLAY 16 2D
Merawle plied ROm_ftm_@ GRAVEL CLAY BROWN 20 40
smfine Sam: MY. ❑Ne Tewbmdep0719 @ SAND GRAVEL 40 60
Mamd.lemdmrcal 3'SBENTONDE BROWN CLAY GRAVEL fill 60
D'dmy Weeewmm®m.bmw+teO DYm ONO SMALL GRAVEL 80 90
lypa ofwvm? DNmofae.m
Merlwd.fealmgmam off SMALL GRAVEL WS 90 99
GRAY STIFF CLAY 99 106
PemP: MmfectenWSName Type:
RP._ Puepmmlmdam:_ft Dmig.d Rowmc_g
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$Rck-:p aflapafwetl ua'vy +2 fl.eboux @.u.d surmm
sPe,e vmlcavl 00 kt l tp.fweucawg Date 0]2]]1D23
Artmknpmmme—ma Pe Wa'e mrb Dme
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pmoVaymp(ds=zm.whmpimp u e.md off-wawlevel mmeivM fiemweR
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Taep aeOfwna_°F Wm achemivslamlyah odes Oyu ON* I Sw Oeteff242023 Completed Dore 07272M
WPT.T.CON,,,UCFION CF.RTQ'1CATTON: I opmtructed evNmaoeWt t®OceatbOiry for cona0uctiw of[tie well,and its complimcewRh ell Weehivgmv well
eeee,ft vemdmds.Materials ueei ed the infmmeGw reportd above are true m my best keowkdge and belief.
O Drilkr❑Trainee❑PE-Print Name ROBERT LAYMON Drilling Coe w ,ADVANCED DRILLING LLC
Ss�,e Add.11530 SCHOOL LAND RD SW
Licwee No.2588 C'ry,Stete Zip ROCHESTER WA 98579
W TRAPIEB'Soaoem' liPamse No Contractor's
Spoa'e S'lpmtum F ,,,,.Ne.ADVANDL804DL Dam OSRMI=
ECY 050-1-20(Re,O8119)/jyoaneed A&de—m ,In an a(remarehO ,ieleer coil the Water Reaoarcee P'Ogam at 360-407fi872..
Pemou whh hearing lov rnn mR fluor Wmhmgeou Relay Servuw. Parente wlm arpeech didahili9•can rW(877-033-6341.
�I
Arcadia Drilling Inc.
P.O.Box 1790
Shelton,WA.98584
Customer: Bill MCTumel Well Tag#: BPN040
Site Address: 1003 W Kamikhe Ln. Shelton,WA Depth: 99,
Date of Test: 2282024 Static: 61.5
TIME GPM LEVEL RECOVERY
1 Min 12 65.8 TIME LEVEL
2 Min 12 1 67 1 Min 86.2
3 Min 12 1 67.5 2 Min 83.1
4 Min 12 67.9 3 Min 62
5 Min 12 68 1 4 Min 1 61.5
6 Min 12 68.1
7 Min 12 68.15
8 Min 12 68.2
9 Min 12 68.2
10 Min 15 68.25
15 Min 15 71.8
20 Min 15 72.7
25 Min 15 72.9
30 Min 15 72.95
35 Min 15 73
40 Min 15 73
45 Min 15 73.05
50 Min 15 73.1
55 Min 15 73.15
1 Hr 15 1 73.15
1 Hr 10 Min 15 73.15
1 Hr 20 Min 15 73.15
1 Hr 30 Min 15 73.15
1 Hr 40 Min 15 73.15
1 HE 50 Min 15 73.15
2 Hr 15 1 73.15
Total
Gallons 1758
pumped
- Eflvlronmenlal
Thurston County
02 Lilly R6 ME
Olympia,WA 96506
360-667-2631. ..
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cnnslnw9onl Repa9s_- Otlwr Mpg USE ONLY
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Use oniY.
Return Address: '
2207487 MASON CO WA
James E.Hungerford 0"GERFOR6 0194976nR..VFoe $305.50 Pca s� 4
Attorney at Law I loll IIIInVII111111IIIIINt111IIIIti� illIIII oll
P.O. Box 1191
Shelton,WA 98584
SHARED WELL COVENANTS
GRANTOR: West Coast Mobile Equipment Repair,LLC
GRANTEES: William McTurnal, Janet McTurnal
LEGAL DESCRIPTION (abbreviated): PTN SE %< SE %. S7, T19N, R3W (full legal
descriptions on page 1)
ASSESSOR'S PARCELNOS.: 31907A4.90041, 31907A4-9d042, 31907-44-90043
This Declaration is made this �a'�day of December, 2023,by the Grantor, West
Coast Mobile Equipment Repair, LLC,—a Washington limited liability company, and the
Grantees, William McTumal and Janet McTutnal, husband and wife, in consideration of
mutual benefits.
THE GRANTEES, William McTumal and Janet McTumal are the owners in fee
simple of the following parcel of real estate in Mason County,Washington.
Lot 1 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 No. 31907-44-90041;
(hereafter 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. 3190744-90042 and 31907-44-90043;
(hereafter Parcel 2 and Parcel 3,respectively). Il
Shared Well Covmana-Paget LU� FPE X22024 J
�—
COVENANTS
The GRANTOR and the GRANTEES hereby declare and establish the following
easements,covenants,conditions and restrictions:
Location of the Well and Water System
There is a well on Parcel 2 near the common boundary line between Parcel 1 and
Parcel 2,which serves Parcel 1 and Parcel 3. The well does not serve Parcel I
Cost of Operation. Maintenance and Repair of Water System
The owners of Parcel 1 and Parcel 3 will share equally in all costs of operation,
maintenance, and repair of the well and water system. 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 be responsible for the installation, maintenance, repair, and
replacement of any water lines supplying water from the well and water system to such
owner's own particular dwelling and/or property.
Easements for Well Site and Water Line
The Grantor hereby establishes an easement for a water line on Parcel 2 for the
benefit of Parcel 1 for a water line ten(10) feet in width, lying 5 feet on each side of the
existing water line, from the existing location of the well Westerly to the East line of
Parcel 1. The Grantor also hereby establishes an easement for access for the benefit of
Parcel I in a circle with a radius of 10 feet, with the well being at the center of the circle.
The owners of Parcel I 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
and the water line.
The Grantor hereby also establishes an easement for a water line on Parcel 2 for
the benefit of Parcel 3 for a water line ten(10) feet in width, lying 5 feet on each side of
the existing water line, from the existing location of the well Easterly to the West line of
Parcel 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 casements for access to the well, the
water system,and the water line as needed for maintenance and repair of the water system
and the water line.
Shared Well Covenmts-Page 2
Restriction on Furnishing Water to Additional Parties
The owners of Parcel 1, Parcel 2 and Parcel 3 shall not furnish water from the
well and water system to any other properties or dwellings without the consent of all of
the owners of Parcel 1 and Parcel 3.
Heirs. Successors and Assigns
This Declaration shall ran with the land and shall be binding on all parties having
or acquiring any right,title or interest in the land described herein or any part thereof, and
shall pass to and be for the benefit of each owner thereof.
General Provisions
This Agreement shall benefit and burden the real estate described herein and shall
run with the titles to the real estate described herein. This Agreement may be amended or
terminated only by a written instrument signed by all of the owners of Parcel 1 and Parcel
3. In any litigation arising out of this Agreement, the prevailing party shall be entitled to
recover reasonable attorney's fees and costs.
GRANTOR: GRANTEES:
West Coast Mobile Equipment Repair,LLC /
By Earl Smith,Member illiam cTumal
Unct MeTimial
Shared Well Covenants-Page 3
STATE OF WASHINGTON )
ss.
COUNTY OF MASON )
On this /37TI-day of December, 2023, before me, the undersigned,a Notary Public in
and for the State of Washington,duly commissioned and sworn, personally appeared Earl
Smith to me known to be the Member of West Coast Mobile Equipment Repair,LLC,the
limited liability company that executed the foregoing instrument, and acknowledged the
said instrument to be the free and voluntary act and deed of said limited liability
company, for the uses and purposes therein mentioned, and on oath stated that he is
authorized to execute the said instrument.
GIV�underd and official seal the day and year last above written,
No Publi ' r and for the State of JAMES E HUNGERFORD
iding at NOTARY PUBLIC#74094
My Commission Expires: STATE OF WASHINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
STATE OF WASHINGTON )
ss.
COUNTY OF MASON )
I, the undersigned, a Notary Public in and for the State of Washington, do hereby certify
that on this 1'bTW day of December, 2023, personally appeared before me William
McTurnal and Janet McTumal to me known to be the individuals described in and who
executed the within instrument, and acknowledged that they signed the same as their free
and voluntary act and deed, for the uses and purposes therein mentioned.
GIVEN under in 1 d o cial seal the day and year last above written.
No blic in or the State of
W gton,residing at
My Commission Expires: JAMES E NUNGERFORD
NOTARY PUBLIC#74094
STATE OF WASHINGTON
COMMISSION EXPIRES
-0CTOBER 24, 2024
Shored Well Covenants-Page 4 ,
RetyrnAddresa: 2205512 MASON CO WA
James E.Hungerford 12114120 z3 11933 nn cm
Attorney at Law
P.O. Box 1191
Shelton, WA 98584
SHARED WELL COVENANTS
GRANTOR:West.Coast Mobile Equipment Repair,LLC .. .. .. _. ..
GRANTEES: William McTumal,Janet McTumal
LEGAL DESCRIPTION (abbreviated): PTN SE '/4 SE '/. S7, T19N, R3 W (full legal
descriptions on page 1)
ASSESSOR'S PARCEL NOS.: 31907-44-90041,31907-44-90042,31907-44-90043
This Declaration is made this /a�'�day of December, 2023, by the Grantor, West
Coast Mobile Equipment Repair, LLC, a Washington limited liability company, and the
Grantees, William McTutnal and Janet McTumal, husband and wife, in consideration of
mutual benefits.
THE GRANTEES, William McTumal and Janet McTunud are the owners in fee
simple of the following parcel of real estate in Mason County,Washington.
Lot 1 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 No.31907-44-90041;
(hereafter 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 Covenants-Page 1
COVENANTS
The GRANTOR and the GRANTEES hereby declare and establish the following
easements,covenants,conditions and restrictions: .
Location of the Well and Water System
There is a well on Parcel 2 near the common boundary line between Parcel 1 and
Parcel 2,which serves Parcel I and Parcel 3. The well does not serve Parcel 2.
Cost of Operation Maintenance and Repair of Water System
The owners of Parcel 1 and Parcel 3 will share equally in all costs of operation,
maintenance, and repair of the well and water system. The cost of repairing common
distribution water lines, if any, shall be borne equally by the owners of Parcel 1 and
Parcel 3. Each owner shall be responsible for the installation, maintenance, repair, and
replacement of any water lines supplying water from the well and water system to such
owner's own particular dwelling and/or property.
Easements for Well Site and Water Line
The Grantor hereby establishes an easement for a water line on Parcel 2 for the
benefit of Parcel 1 for a water line ten (10) feet in width, lying 5 feet on each side of the
existing water line, from the existing location of the well Westerly to the East line of
Parcel 1. The Grantor also hereby establishes an easement for access for the benefit of
Parcel I in a circle with a radius of 10 feet,with the well being at the center of the circle.
The owners of Parcel 1 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
and the water line.
The Grantor hereby also establishes an easement for a water line on Parcel 2 for
the benefit of Parcel 3 for a water line ten(10) feet in width, lying 5 feet on each side of
the existing water line, from the existing location of the well Easterly to the West line of
Parcel 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
and the water line.
Sh=d Weil Cuwnts-Page 2
Restriction on Furnishing Water to Additional Parties
The owners of Parcel 1, Parcel 2 and Parcel 3 shall not famish water from the
well and water system to any other properties or dwellings withoui%dle consent of all of
the owners of Parcel 1 and Parcel 3.
Heirs.Successors and Assigns
This Declaration shall run with the land and shall be binding on all parties having
or acquiring any right,title or interest in the land described herein or any part thereof, and
shall pass to and be for the benefit of each owner thereof.
General Provisions
This Agreement shall benefit and burden the real estate described herein and shall
run with the titles to the real estate described herein. This Agreement may be amended or
terminated only by a written instrument signed by all of the owners of Parcel 1 and Parcel
3. In any litigation arising out of this Agreement, the prevailing party shall be entitled to
recover reasonable atmmey's fees and costs.
GRANTOR: GRANTEES:
West Coast Mobilise Equipment Repair,LLC
By Earl Smith,Member illiant UcTurnal
anet McTfumal
Shared Well Cover"-Page 3
STATE OF WASHINGTON )
as.
COUNTY OF MASON )
4,
On this /37 rt day of December, 2023, before me, the undersigned, a Notary Public in
and for the State of Washington,duly commissioned and sworn,personally appeared Earl
Smith to me known to be the Member of West Coast Mobile Equipment Repair,LLC,the
limited liability company that executed the foregoing instrument, and acknowledged the
said instrument to be the free and voluntary act and deed of said limited liability
company, for the uses and purposes therein mentioned, and on oath stated that he is
authorized to execute the said instrument.
GIVEN under nd and official seal the day and year last above written.
No Publi and for the State of JAMES E HUNGERFORD
rington,r iding at NOTARY PUBLIC#74094
My Commission Expires: STATE OF WASHINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
STATE OF WASHINGTON )
as.
COUNTY OF MASON )
I,the undersigned, a Notary Public in and for the State of Washington, do hereby certify
that on this I 'b T14- day of December, 2023, personally appeared before me William
McTurnal and Janet McTumak to me known to be the individuals described in and who
executed the within instrument, and acknowledged that they signed the same as their flee
and voluntary act and deed,for the uses and purposes therein mentioned-
GIVEN under m a d o cial seal the day and year last above written.
No blic in or the State of
W gton,residing at
My Commission Expires: JAMES E HUNGERFORD
NOTARY PUBLIC#74094
STATE OF WASHINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
Shared Well Covenants-Page 4
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