HomeMy WebLinkAboutWAT2023-00188 - WAT Application - 6/28/2023 WATT- Dolt/
MASON COUNTY
COMMUNITY SERVICES
BUIIEln%Pbnnlnry EwirmmeM iHmit Community Hmith
415 N 61h Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 4 Belfain (360)275-4467 ext 400 4 Elma:(360)482-5269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
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.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Kyle & Kelly Casteel Date: 6-28-23
Mailing Address: 7338 28th Ave. SW Seattle WA 98126 Phone: 206-412-4194
Parcel Number: 22132.-11-90300
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more 0 Building permit -00 eovs- 066lnB
connections) ❑ Division of land:
p Individual water source (one connection), #of Parcels? SPL
El Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
M you have more then one residence connected of water system below if applicable—no
to this well, check the PubliclCommunity,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)
❑ 1 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 (i.e.: 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.
Signature of water System Manager Data 6-28-23
This form may be scanned and available for public view at www.co.mason.wa.us.
1:\EH Fotms\Drinking Water Revis d I/25/2018
Individual Water Well
Water well report(attached to application). Depth 13 V ft.Well capacity Test(attached to application)—W—gpm I l.f
UC) gpd.
The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a rapacity test,
a well capacity lest,which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
�I Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA htto://gis.m.mason.wa.us/olanninci 14f 6150160 22GJ
Water use or limitation recorded................................... N/AQ Yes
WellDrilled ............................................................... Date
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Date
Relationship to Applicant
Part 3: Mason County Community Services Evaluation (staff use only)
satisfactory Determination:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.66.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
iJ Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
CSD Director: Date 2 of2
WATER WELL REPORT DEPARTMENT Or Notice oflntent No.WE51686
ECOLOGY Unieuc Ecology Well ID Tag No.BPS-201
Type of Work: Stale of Washington
B Cwumtcdan Site Well Name(if more Nan ono well):
❑ Cemmnisawa q DeVed installation NOI No. Wader Right PemddCereificate No.
Pr.Pamd Us.: ID Daneaue ❑bdeddd ❑Mtmicipd Property Owner Name Kelly Casteel
❑Noesprim, ❑ladgaim ❑Tad W6I ❑pher
Well Slrcet Address 41 F Pine Tong POIM
*Now tlIf Type:t Mauo uo City Shelton County M�
C Now eards AlbNion ❑Dr. ❑heard Cable Tool
❑Deepening ❑Oder ❑Dog B Air- ❑Mud-Romy Tax Pmcel No.22132-1I-W300
Dion—sas: Diamdar.fbannfif i..,u 141—ft. Was a variance approved Rrthis well? ❑Yes IN No
M*afcanpleud writ 1388 h.
Ify
Counaedo.Doeskin Wall q whet wa<the verianm for?
C'y Lisa Dowder I. To 7lawspov Srcal PYC Welted 34tud
B 1 ❑ 6 as ate. 132.7 _in. ® 1 ❑ ❑ 1 O Location(see imbuctionf on page 2): S W WM or❑EWM
❑ 1 ❑ —�. —ia. ❑ 1 ❑ ❑ I ❑ ICE�G!/.ofthe NE'/,Section all, Township 2IN Range VW
1 ❑ _in. _in. ❑ 1 ❑ ❑ I ❑El 1 ❑ ❑ 1 ❑ ❑ 1 ❑ Lmiwde(Example:07.12315)47,27085
— _in.
Longitude(&sample:-120.12345)-122 95503
Ferbseoas: ❑Yu BNo T,,of cefasbruxtl
No.dperfadi... She dpedadiau_M.by_ Dr11Wb Logr,c moa,dndon Decommission ..keys
Perfaatd hwn_f.b_flW.,:andauda<e Famattu:De.mibe by edoe,chwvna,ds dmddd mddtruuue.mdtbe Lv'ndW
nature of the metaled i.ead:Iayerpcndnscd wild ddud mo nosy(a emit cM1nge of
Serene: BYa ON. BX-Pxka C Degh1]t.bf infatmalim. Use additional sheets ifncasvuy.
Mudadmm'.Name Material From To
Type Model No. U grayish brown glacial Ill 0 27
DeamdmlRde Slmris25 ..fan 133.5 ft.W LIMI A
mamdm_ Slotdss_M.fam _rt.u_f. U grayish brown cobbles gravel sand clayey 27
SIR-saturated 42
gaadf Utorpack:❑Ya Blip Simcfparkmduid_ia Gray small gravel a.said Gay 42 108
Material.foamed ham_e.as rt Lt grey acme gravel sand Silly Vey smurtod 108 133
gurnme Scal: SYer ❑No TowM1adegh?2Qft. Gray Some small gravel sand site water 133 138
Metonal wd in rat SPN Olfr(E CHIPS Grey day 138 141
Did my oust.eansew unuubh wale(? ❑Ya BNo
TYpeofwabr? Dythdfaeate
Method of d W ing stoke oe
Pam,: thrall.'.Na.c Type
N.P._ Aunp inW<degh:_fl. Dmipxdnowrae'._gpn
Water Levab: laodsodmr elevatim sb.vema.eu level_B.
Sdek-up of Imp ofwell wing+•13 ft.abuva errand adxa
gaidewaariewI774 It ImAwtopofwelluding Does pMMM3
Anedm proospe_iba for square inch Ume
Affsam water is controlled by (up,vdw,also)
WeIlTnb:
War a pumping not pMamd? ®No OYed b by wham?
Yield_ypm with_e.4--doera afla_hn.
yield _"with_f.dnwduwn after_ten.
yield _goo wits_f.dnwtlown Na_ten.
sder(time xro when rymphtamed oR-waxrlavel mevuM ban well
too p 10
o water level)
Time Wamr Level Tim< W.tm Level Time Water Leval
Dery ofgmpinB ern —
Bdler tat_gpm widt_fi.dnwdown.flm_hs
Abroad 10pmwithrtemedmlUft forlha. Date 02f2212029
Artooia.now—lino
Tanprmuxdwaur_°F wxarh<miraludyrirmde? Or. BNo Saw Dale 02212023 Completed Dore 02222023
WELL CONSTRUCTION CERTIFICATION: I cnmeuaW and/or adept responsibility for NmDoolion of Nis well,and its compliance with all Washington well
construction standards.Materials used and doe infommtion poisoned above are we m my bast knowledge and belief.
®Driller❑Trainee❑PE-Print Nana Mark Wtead DrillipaCconinew RICNARDSON WELL DRILLING
G i Addrcu PO BOX 44427
Li.No.2432 City Stat,Zip TACOMA,WA 118448
IF TRAINEE'Sponsors License No ContyacW's
Sandaka a sigroderars, Registration No RICNAW 7210E Dose D2242023
ECY O5PI-20(ggw 0W1g) IJyo mM hisdacumenr In an olmrwkfl mag pleax mll she Water nesources Rogma of 360.007.6872.
Personas with Fearing Idea non sall 711/or Washington Relay Service. Pereav with a speech disability can call 8 7 7-833-63 41,
RICHARDSON WELL DRILLING
Aquifer Test Data
Well ID# BPS-201 Owner: KELLY CASTEEL
Site Address: 41 FAST PINE TREE POINT
Pumping Well Parcel#: 22132-11-90300
Pump On 02112/24 1:40 Pump Off 02/12/24 2:40
Date Time Date Time
Reference Static Level 54.10 Feet Pump Size 10PIK20-80
Recorded By Time Water Levels
Dale Clock Elapsed Time Reading In Depth To Drawdown COMMENTS
Since Start G m Water
PATRICK 2/12/2024 1:40 1 0:00 2 1 54.10 0.00
1:42 1 0:02 2 1 59.30 5.20
1:44 0:04 2 60.00 5.90
1:46 0:06 2 60.20 6.10
1:48 0:08 8 1 65.50 11.40
150 0:10 6 1 72.70 18.60
1:55 0:16 8 1 80.70 26.60
2:00 0:20 U 98.40 44.30
2:05 0:25 12 116.40 1 62.30
2:10 030 12 116.90 62.80
2:15 0:35 12 119.20 65.10
2:20 0:40 10 116.70 62.60
2:25 0:45 10 116.90 62.80
2:30 0:so 10 117.50 63.40
2:35 1 0:55 10 118.00 63.90
2:40 1:00 10 118.60 64.40
-54.10
-54.10
-54.10
-54.10
-54.10
-54.10
RECOVERY 2:41 1:01 113.20 59.10
242 102 108.70 54.60
2:43 1:03 101.20 47.10
2:44 1:04 98.70 44.60
2:46 1:05 95.00 40.90
T _��/
WATER
AR MANAGEMENT
LABORATORIES I. ,.
= 1515 Mh d E•Tacnw•WAM
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LAB USE My DHINKDIGWATERRESULTS LAQ USE
pU ..d.Ycaory Trial CpNonn Pmxm.nd Bat.rrttaY
❑Eadp t OE.mAeO.enI
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089
2202506 MASON CO WA
0912212CXS,Ea023 I2 22 PM NOTCE
1 III IIIIII 11111 rm 111111 IVI I1�I�lid if IIIII Bill
Return To
l�¢iffCt UlA CISfA(P ?,
ey 221�23 (�
Grantor(s): (1) -IIL ��71e(,� . (2) kelly Custeel
Grantee(s): (1)PUBLIC
Legal Description(1) l»f of `�P I 11 oFTtz.3OUF 41.L• I
(�ATbbreviated loan: lot t block.Plat orsecffon,townsht% range)
Assessor's Tax Parcel: -;� - 1 1
S 32 - T21 - IZ2
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: 14
Maximum Annual Average Gallons Per Day: �40 gallons
Dated on this I day of •CQ r(k,b 6✓ . 20 23 .
Signature o Grantor(s):
(1) (2)
State of Washington )
Countyoffbpaaerr
Page 1 of 2
r
the undersigned, a jJ0�ary Public In and for the above named County and State, do hereby
rtify that on Misa of Goa).tiH br/ , 202?
<ctlH A&n ce,"�el' �j :,I personally appeared before me,who is known to be
gnerof the above Instrument, and acknowledged that he(she) (they) signed It.
VEN under my hand and official seal the day and year last above written.
and for
[JOHN MILTON PAVNE JR No ry Public in and for a St a of Washington,
Notary Public
te of wnhirgton residing atission L 20101410. EaPlres Feb 20. 2024 My commission expires: 0112 alley -y
e
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