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Home My WebLink AboutWEL2024-00024 - WEL Application, Design, Letter - 5/2/2024 (2) SHELT N. 584 ® MASON COUNTY 415 NBTHELTON: 60427-O70.EXT 400 SHELFAIR 3W27598]0,EXT 400 BELFAIR:350-2]5-048],EXT 400 Public Health & Human Services ELM 3W482-5289,EXT 400 FAX:360427-7787 PYLE JAMES MATTHEW 3441 E RASOR RD W BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2024-00024 100 E Elin Ln 220247590041 The 2-party water system, 100-120 E Elin Ln Water System (220247590041/220247590042), 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 S�3/�Zoz� MASON COUNTY COMMUNITY SERVICES Yid^irW^P9[^omerXYNxINCannnR/NeM './�1 `a 615 N.6^Str ,(Oft 8)-SWW,WA 9101A WEE o60 Shelton: 360427-9690 AW Mini r.360-r5446lx4W Elm36 815269 x4N) TWO-PARTY PRIVATE WATER SYSTEM APPLICATION RPPMI "M; James Pyle 360 801 1263 MLM ADVW9a-arr .cm.BTRTeu 3441 E Rasor Rd W Belfair,WA 98528 9nEnm100- Elie, n hell a _-- il%1 E Elin Ln Shelton,WA 98584 P W 1M0.Y PMCEL NV EB61(W 6L 811E1 22024-75-90041 SL NO P.LNC6 NN6EA n,1PPl1C. us 22024-75-90042 Wr.TEr =Un 9oMCeT PMCEL 118ra6E P/,RC6]Ler� O New ❑Existing Well O Spring 1.25 Acres 1.25 Ayes Pnorosm wnTu eroTMvrunanmowml 100-120 E Bin Ln Water System PKWWTC0 M*N 2 party well system serving above parcels. aw6no MMIWWNWONa After crossing bridge to Harstine Island,turn right on E.South Island Drive,at the next slop sign turn right on E Harstine Island Rd S. Property is on the right about 1.5 miles,property is about 700 feet in down E Elin Ln. Site Plan: (may also be attached) (popery toundsdes,stmd:ures,well she w/100 radue,dsve s,roads,earaa§ewer romponena and lines,eaeemerds,ac...l Sec A+laat j. MAY 02 2oA By Mq�yC�r�� Submittals Checldist: (these additional items will be required for approval) Cd Satisfactory Bacteriological sample(this may be defamed if well is not yet drilled) 8 Well Log with pump test or 4hour capacity test performed by driller(this may be deferred if well is not yet drilled) 12 Notice to Future Property Owners recording(record with Mason Co.Auditor,supply copy of recorded document) B Septic Records(additional locating requirements may apply'd there is a lack of septic records on file) This form may be conned and available for pubic view on the Munn County Web shoe. Revised: 10/13/2021 Pagel of 2 -----------------Staff Use Only ------------------------- Review Step 1: Well Site Inspection: YES NO NA ❑ ip ❑ Evidence of existing sources of contamination within 100 fool radius of water source? (drainfields,tanks,buildings;indicate distance on plot plan) ❑ ❑ Are there roads within the 100 fo-oCrddus of the water source?If w,is roe ovate my or State. What is distance to ROW? 3300 ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? ❑ The vrell casing extends_ _above level ground/concrete slab?(circle one) 'Y ❑ ❑ Is there evidence of a surface seal? J-q f: YJ.211�6 1P ❑ ❑ Does the seal appear adequate? t'w: 'f 2Z.9P4jJ ❑ 1p ❑ Is a variance necessary for well site approval? Tjy: aNM Tr I Comments LdW rtmMhM1 kim hry- Ot«w jeuV yea kwy [t'rOMAbIdW 10 ✓1//I On by fir 2ylus� A&—jp eI16N#rd 6CtM, hy&d Le on S t/20A Pass ❑ Fail Inspector Darts S/30/zo�y. Review Step 2: Two-Party Review: YES NO NA of ❑ ❑ Water Well Report with adequate pump test on file? LS6/m 414' 19001111• wS00 fol Will. ,,,eextt If NO,date of Capacity Test Driller GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test `//( &Zq ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z 7I0'177 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments((((((��''' A, Approved ❑ Denied Reviewer Date Findings in this review m lecf observed rordmons ar,they costed oo the day ofthe site inspection A'o claim is made express or implied ofthefuture success orfdlum ojthte syrtem WeB.nteapprovaldwsmtmwnmtewmersyrwmapproval. Water System approwrl u a Mw-part process. All proposed cannectiom to new wells are subject in water adequacy requirements at nine ofbuilding permit per MCC 6.68. Water wage restnctiow and aMumnal fees may apply to all new wells drilled afrerJam ary 19'" 2018 per F,SSB 6091. Revised: 10/13/2021 This farm may be scanneE and available for public view on Me Mason County Web site. Pape 2 of 2 WATER WELL REPORT :I DEPARTMENT OF NaNce nfN,.t NP. WE55663 ECOLOGY Unigm Ecol.gy WeBB)Tag No. BNM851 Type of Nork: State of Washington Lal cnnuw<tmn Site Well Name 0fttma than me Well): WELL M 1 ❑ Demmdnim o rn&M umtunon NO]No. Water RghtPvmiVCmnficam No. PrapsaA Use n Domnec kI Inman fl M..,w Property Owmr Name•TAMES PYLE ❑I mime ❑bri"wri ❑Tm Weil ❑ONm Wdl Snot AtMtcsa iW &720E ELIN UN 9 New ge eamo Type: McUd: City SHELTON Comdy MASON ®N wa f]Mmnuoo f]pivm f]letad OGbk Tml ❑Deepening ❑Dam ❑nog RAh- OMW"Romy Tu Parcel No. 2202A7590041&220247690042 Oimadane Dunasmofbodng S k,tu 361 A. DepWOlcompkwd wen wl g Was.eartmeeappavWfmthm.119 ❑Yn ION. a:eosurcnoa Daub: Wall RYea.what wasthc vmimeefM _ C irm Lircr Daoemr F. To Thielmo Sted PVC Wdded TueW it 1 ❑ 6 in. N M1_ 250 at, Ca9 ❑ ® ❑ Localim(sce inmtefina on page 2); awwl m.O W ❑ I ❑ in. ❑ ❑ ❑ ❑ NE /«'/.ofthc MV y:;SecYoe 24 Tomxkip 2DN Range 2 n I ❑ _m _ _ —_m. ❑ I ❑ ❑ ❑ ❑ 1 ❑ _m _m ❑ I ❑ ❑ ❑ IAtrWJe(Examplc47A2M5) 47.211497 Prrf saes: ❑Yes allo TMaperibnmrmd �a(Ex'"°pk:.120.12345) '122.874438 __ NP.fperfmuimly_ Sirs orpmlbrmum_my_a DrWv'st.pg/Cpmtrpetlop er Dempmmdop Praoe&ve IM dfiom_ftm_ft6cbw 9omM atufia� Parmoml)—am bymW,tiwuYn six of mmrulmdaoncme,vdtmkladaed murohhe mameal N exh latvpmmmted,wkM1y kdorcemy rmmcb ebenee of Serea: 31"n L]No ®KAdn b UepW_fl. kfomatiom Uuadditioml alree ifacwwy. arnurtttmm's Nam___ Mammal F. To Type STANLESS Mwlvl No. Diemen 6 a g 6 a Rom 3h S.m wi& CLAY&SAPID&GRAVEL BROWN 0 180 Diemem_ m SW.ut_ is R®_g m R. CLAY&SAND BLUE 180 205 Iiaedl4'9mrpmk❑Yn 9No s5:e orprt onm:l_v. PEAT BROWN 205 210 rnmiak pbd Soo_R.W ft. CLAY B SAND S GRAVEL BLUE 210 240 PEAT BROWN 240 245 Swssem ®Yes ❑No To der deph?20 fl CLAY&SAND K GRAVEL BROWN 245 275 M.tetd reel,aref Didmymmmaa oamamtikrIRE CLAY&SAND BLUE 275 345 kmbkw>aa? ❑Yn ®No Typ ofw.om Depth ofmm SAND&H2D BLUE 345 361 McRNdofemll otamoff 'Peep: Mammuiter's Nam GOULDS Type: SUB 3PH H.P. 3 Pon,imu,d.,tg_N0 ft Deu d❑or nk: 18 ,in W..Leviue lwnbsmfere eleomoo abmem em inei 8. SEck-tpofgpa caiog� fl.abovegmmtl sour Sutu wam lcmI 207 R.bebw ropofwell easing Dam 412-24 Mcsun prcsaurt__Ilp.per.gmre 0ch Deh Arteskn w.mrb eamoneahy f�.wN�.em.> _ WW T. Wna,uepin,,tmpeHomed? ❑No KYP, � bywhnm? Yak 25 gpmwia3 Adtawdpwwahe?ba. Ykk_gpm wah_A dav:dmwafler_ars. Y M_gqn wiW_ft dmwdowo eRm_M. Rttorcry dda Dint-ma wkn P'mP u Iwrctl oH-wear kvcl vmsvN fiom well mpmwwmr keep Time W.le.xl Time Wamrlessl T®e WYnfeel Da¢ofpon,ing tea Baits tnt_gpm oats .Maim,%efler hn.� Aomt Imewith wmmn_M1kr_Ivs. Dam Arm mfkw_®m T—peome of._-F Wn achasm]i—Iris mtle? CI Yn RNo Sm,Dye 2.19-24 CMnpk Dim 3-29-24 WELD.CONSTRUCTION CERTIFICATION: 1roaab W aWar erupt mponmbility for conrtimim of Nis well,am it CDMPH ce With Al Wuhmgion well catumhm omhttds/Mmrial�s used and No,infmmaion reportM above are um to my beu ImerlMge and haief ❑a Ui9a❑jai Prma Name CLAYTON PITTS Drilling Company COOLWATER DRIWNG•INC. SiRnahVe Address 10921 NW HOLLYRD Iittdu Na 2516 City,Smte,ZT BREMERTON WA9012 W TRAINEE:Slao s Lmm t No. Cpnuacwe S Spmeor'd Sppmmc Regii1mioo No.COOLWD1941QM Dam 5-1-24 ECY0572 Peev su,ft eado,led thisdall 711 far whvr Reemnm.Phmr, mltrM Rarer Rrsnrvne Prvtgrum al 360d8)-r,Y72. Permm wkh Aeorlttg lwv rnn mil l/l(or U3-634rur Relay.G•rrux•. Permns wvAaapeerAdaabifin•rnn all AJJ-A33-634I. 26276 Twelve I Troas L.NW A sw.c 11 SPECTRA Laboratories - Kitsap Poulslm,WA -Jr ...When• erieseeawr.v 98370 (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Cole"', Time Sample County 1 Coloured Oaa nee me Y. /Z ./U pa !IAte✓ Type of Water Srslsm(char,oMy one box) ❑GmupA ❑Group e e}oder Group A and Glaq B SystmR-Provide from WaterFarLaes InverMy(WFII ON Syssem Noma: _FAis /y48 Cobape : cvrLuJJtt R�tt TrC Day Phme:� t` . 5c OW Faale: Emad: I Eve.Phone: and memo b ep.b wuM Me 4 0n W e mat ar nrbl _ICI LW b/F+cj NQL r i i JL tl /�C�NAZC_Co., SAMPLE INFORMATION Sample collected by(none): c!'It r..4-nt Specific ,cmum wlwre sample mlbcbd: SmKGl imeucAcem Or cawmna: TWN of San pk(olmok only am poo 1.❑Routine Distiledem Sample WP) 2.❑ Repeal Sample(AN) Chauued.Yes ❑ No❑ (men oumbuton sv,b after wwa.umc) Unc ammong mutne ao number Chbnm Resduel'.Tom Free— S.GroIurdC Wefar Rua ScrumIs SempM Umeli+lacmry routne robe dace: II I Chlorinated'.Yes_No ❑T19Bered(MP) Chimera Res":Toter_Fme_ ❑Assessment(AR) L.Surface or GWl Raw Source Want Sample(Enumeration) s S ❑ E cab ❑Fecal curb Yrs_rid 5.ja SaTpm C a nd M moo mdan only LAB USE ONLY ORIN MG WATER RESIATS USE ONLY ❑Umatlafactory Total Cdaolm Proenl and SatiahrMry ❑Ecot prom ❑E.cob absent BacYAal Density Resuaa Toal CoMo n waalt E.pN---ffW0Dmi. Fecal Coponn CkUlCON, HPC LiW1ml. Replacement Sample Required: ❑TNTC ❑San*too dd ❑ Sample Volume ❑Damped Conamer ❑ DaWfem ReuiM: Lab Rluen Rwep Temp C: .�U SM9 TLgNUSM972T1 [Wool,: Draw =• w.anw.....ve R 0 9 W APR 1.UO2L DDH LeoSampeN .bs�cw m...�. naa.u.mv.m�..�wmebar.w.s Nam and Return Address: 2210177 MASON CO WA Jones;Pyle 0412912024 10Afi nM NOTCE Belfatr,WA 99528 $ a�� Document Titles) 1. Notice to Future Property OFvuera of Private 7Mo-PartyWater Sretmr 2. Reference Numbers)of Documents Assigned or Released ADDRIONAL REFERENCE rS ON PAGE_ Grantors) 1. ames e 1 ADDrnONALGYANTE1SONPAGE Grantees) 1.Public 2. ADDITIONAL GRAMEES ON PAGE Legal Description(abbreaia[ed form;i.e.IM,blink,pig or sMion,[ownsMg nrye,quarter/quarter) TR4 OF SURVEY 2/123LOT.1 of SP4 2815 AF i636965 ADD=NALIEGLLnONPAGE_ Assessors Property Tax Parcel/Account Numbers) 22024-75-90%1 22024-75-9DD42 ADDITIONAL PARCEL NS ON PAGE_ THE AUDITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT III THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEMW INFORMATION PROVIDED HEREIN. Return To James Pyle. 3441 E Rasor Rd W. Belfair,WA 98528 Grantor(s): (1) James Pyle Grantee(s): (1) PUBLIC Legal Description (1) TR40FSURVEY2/123LOT: I0FSP#2815AF#636965 (Abbreviated form:i.e.lot, block,plat orsection, township,range) Assessor's Tax Parcel: (1) 22024-75-90041 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)22024-75-90041 Tax Parcel: (Connection 2) 22024-75-90042 The system owner is responsible for keeping this system in compliance. The name of the water system is: 100-120 E Elin Ln Water System 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 'd the water system exceeds exemption standards. Tax Parcel owner 22024-75-90042 will remit$120 annually to Tax Parcel owner 22024-75- 90041 to cover the electrical costs for operating the well. This system (has/has been granted one or more waivers from specific provisions of the regulations. Dated on this (2- Day of April,2024 Signatureof Granter(s): �at (1) L= (2) Page 1 of 2 -See attached notarial certificate- ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On oy /a /2024 before me, Nick Bruni, Notary Public AA� (insertp name and title of the officer) personally appeared TG WV4 A P✓LCi who proved to me on the basis of satisfactory evideneb to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Q NICK BRUN' O2405 WITNESS my hand and o ial se COMM BLIC -CAUFO NOTARY CK RNIA S SAN DIEGO COUNTY � CmmisednI 'MOY 79,202G Signature (Seal) E Elin Ln 1510 E Harstine Island 300 Eledrlc.0 James Pyle Road Easement 3441 E Rasor Rd S 166 Ft Belfair WA 98528 (360) 801-1263 jimmypyle@icloud.com 166 Ft Existing Power Pole 166 Ft r700 Ft0 Underground 1 Primary 66 Ft 30 R Elecble U Road Easement ay Q 100 E Elin Ln 166 Ft « n 2202sas-sooei w+ ❑ o,,,,,Y,,,, 120 E Elin Ln 166 Ft 2202a5e0042 X� �.y 140 E Elin Ln 166 Ft 22024.754WO 22o24.7seoou 160 E Elin Ln 166 Ft 20 n Elac .0 Road Easement 0dueway 330 Ft James Pyle 3441 E Rasor Rd W Belfair, WA 98528 360 801 1263 Plot Plan 165Ft 165Ft Parcel # 22024-75-90042 Parcel # 22024-75-90041 Shelton, E n, A Shelton, E n, Ln Shelton, WA 98584 Shelton, WA 98584 4br Septic Dmin Field Reserve Drain Field Or Septic Drain Field Reserve Drain Field ILL M v CID Z CID /100 Ft 10 / --------------- 30 ft Utility/Acce Easement