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HomeMy WebLinkAboutWEL2024-00024 - WEL Application, Design, Letter - 5/2/2024 415N6 H ,SHELTON,WA88580 MASON COUNTY S HELTON:ELTON:360- ]0,EXT 400 4 BELFAIR:360-27544275446],EXT 400 Public Health & Human Services ELMA:3604B2-5268,EXT 400 FM 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 WWZoZY_ MASON COUNTY COMMUNITY SERVICES x bwh�e Plmwy Emo�uvmY X W IM1 Cwnnnlry 1 keltl� 415 N.6°Sh ,(Bid,in-Shelton WA 995M WEL 0o Shelton: 3W427-%70x4W Belfmr 36 M4467 x4W Elme.36 2-526 x4q) TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APRACNR PIpXE James Pyle 360 801 1263 IMLNO A.. m.lMa 3441 E Rasor Rtl W Belfair, WA 98528 srtEnoo100- Elio nn,Shelton, a - 100 E Elin Ln Shekon,WA 913584 Pwawv rAxc¢xusea(w¢ianEl 22024-75-90041 laorm5m e.5nc¢NUMM(s wMucnalEl 22024-75-90042 WATa1fd111LE `*Uii 1YPE Weil Sna 1 ii_¢2 ffi la New ❑Exsting r ¢ AesM1.25 Acres w..+eX ararv.wov Iw�ml 100-120 E Bin Ln Water System Paaerr ixa A N 2 party wells stem serving above parcels. crossing bridge After croming britlge to Harstine Island,turn right on E. South IelerW Drive, at the next stop 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) (propeM boundaries,structures,well site W100'roaus,8iveways,roads,sepdm le r conponerft and lines,emweids, sec. R44o_jAJ. MAY �0 2 2024 By Submittals Checklist:(Mess additional items will be required for approval) FQ 0 Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) 8 Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) 0 Notice to Future Property Owners recording(record with Mason Co.Auditor,supply copy of recorded document) 0 Septic Records(additional locating requirements may apply K there is a lack of septic records on file) This farm may be emnnd and avNlaw.far pultlie vNw on do Mason County Wab site. Revised: 10/13/2021 Page 1 of 2 ------------------------------ --_-__---------------------------Staff Use Only---------_—_— Review Step 1: Well Site Inspection: YES NO i NA ❑ 0 ❑ Evidence of exisdng sources of contamination within 100 foot radius of water source? (drainfields,tanks, buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 fNol�rgaus of the water source?If so, is ma 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 cep satisfactory? Pr ❑ ❑ Screened and vented? ❑ The well casing extends 16 above level ground/concrete slab?(circle one) 1P ❑ ❑ Is there evidence of a surface seal? I-q f: YT.211�6 V ❑ ❑ Does the seal appear adequate? LM: -I2Z.8FYjJ ❑ to ❑ Is a variance necessary for well site approval? -"q: BNM Tin Comments '* /(/MI Itr114 '�+01t1 hl5/_ o1vM.t'' Jard tvF!11 Clytll A/' Ine!(f IP/L d 1v ✓UYI on (ry Jbr 2ylus W kp/ fo G��rrl 6P.yhr, hw&d lip Orl 51/Marc Pass ❑ Fail Inspector Data S/3o�toa� Review Step 2: Two-Party Review: Yr�{E. S NO NA Ia ❑ ❑ Water Well Report with adequate pump test on file? L$g/ir1 '/E/' IFOlryrh. Nr SDO fdI {a/a�. If NO,date of Capacity Test Driller GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test `ll(O�ZOty ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z Z toll P Z ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments A^Approved ❑ Denied Reviewer Date Findings in this review reflect observed candmons as they existed on the day ofthe site inspection. No claim is made,express or implied ofthe fumre success or failure ofthis system. Well site approval does Trot conetimte water system approval Water 5}stem approval is a two-part process. All proposed connections to new wells are subject to water adequacy requirements at time ofbnili ing permit perMCC 668. Water usage resMctions and additional fees may apply to all new wells drilled aflerJanuary 19'" 2018per ESSB 6091. nhiformmnybeamnwe and available for public view en the Mason Courrty Web site. Revised: 10/13/2021 Page 2 m 2 WATER WELL REPORT .;;;: DEPARTMENT U. Noticc of mtmt No. WE55663 ECOLOGY Unique lkology Well ID Tag No. BNM851 ATypeoft tit Yto Of Wd5M1lp8Wn Communion Sit Well N.lifmort Nen one welD: WELT-pi ❑ �ebn <inpjnnl insrel6mo Not No. Wokr Right PetmiVCcrtificmc No. Pnpena U. lndotia) uMm4ctw Pmpmy Owtur Name DAMES PYLE ❑DmvImmg ❑Imgodan ❑Tatwdl ❑pYm Weil Street Add,,, 100 &120E EUN LN Cdamoe4.n Type: Mtlaad: MN.w ❑At.. ❑Dom ❑ltlmd ❑Cabk Tool City SHELTON C.,y MASON ❑Deepeomg ❑Glmn ❑Og LEAF ❑M.Mlobry Tax 1'mwl No, 220247590041&220247690042 Dimeatl� numn<r.livn<g a k..b 361 R Waavariaace appsored fv lhk ase07 ❑Y. 11No 0Mhoymmp .11 MI fl caWtlo<Dtla4: W<II if Ya.Whatwv HM woke f0ll Get., Liptt Uumetn Fmm To Thickness SNN PVCWtl lbwad ® I ❑ a in. +1 351 T m. m 1 ❑ is 1 ❑ L oadon(s.mtlmoti.on page 2): IN w'WMW❑EWM ❑ I ❑ _b, in ❑ ❑ ❑ ❑ NE NW ,:;Section 24 T..nad 20N 2 n l ❑ _m _in ❑ 1 ❑ ❑ 1 ❑ p— — ❑ ❑ _m m. ❑ ❑ ❑ 1 ❑ V°tucic(Exemplr.47.12345) 474211497 hrfpnebm: ❑Yv ®No Typcar Loogiwde(Exampk:-120.12345) -122.874436 _ brus[4 D~.La{MaMrboa pDeestttYaa l4aoeduoe No.ofperfondam_ 5wedperbmtiom_imM_is Farmmion:Dmn3e byooW,ulw m,sim of mrtavlad zhuNvl,mdthkiotlam Porfmamd 6om_ftb_ftbclow gmuM emfas venue of:t mabeul bexM1le Ym peveneb4,whM1 at bw one m%aw och change of 9mes: Ok'w ❑No 3K-Porto b Ppb_R mf ixm. ttveatltlnioial skins ifrem. ry MvuRcmmsName Maimal F. To STPN FS3 o'smenue m s,o,.6 uSmt 361 I,b 361 R CLAY&SAND&GRAVEL BROWN 0 ISO Osmsly_ d 61a:ia_ in rmm_rtm_n. CLAY&SAND BLUE 100 205 PEAT BROWN 206 210 ti•alplherpuk:❑Yv ®No 3ve oflmek wsviY_A. CLAY SAND&GRAVEL BLUE 210 240 MLviah pla<M fion_R b_ft PEAT BROWN 2/0 245 rmrn«s<a: aYv ❑1m TewMtlgM1l a2 S. CLAY&SAND&GRAVEL BROWN 245 275 Mamml m<d meal BENTONITE CLAY&SAND BLUE 275 345 No•ay mmm mwdin untabk w ❑Ym MNo Typcor. e? D dtem.y_ SAND&K2O BLUE 345 361 Matoilofsrvlingst uoR -Pomp: nfawmnurersName GOULDS Type: SUB 3PH HI Puny make deed:340 R heipped& iilm: 16 ®m W.br L<veh: I:M-aurf<In'ae;ona[oas m<.osu k«I_R Sack-,.17 pofwelloutw 1+ ffamdevf Sufic wetm kvcl M7 R.tlw bpo(well canvg Wm &I1 Amlunprcsw<__Rs.Pma9imremeh Dde Am'un wemre mmoRed by (eW,vEw.eac) W aT� Waepmrmmgbns peda:m<d1 ❑No EY.s bywhnm? VkN 25 gpmw,,t fllaw4o+m tli4 ha rmm_wet w;m_fl l.wmwn,am_ms Yrtld_gpm.ivh_R dnwLwn after_M1ry Rmbvmy dam Isimc•so whrnpunp is cwatl oR-wam lc cl nvmeM foot xR ppm wab tsct) lime WYU IeM Time Wa4tlewl I. Wdblenl dmofPumpivg'etl — 9eikr wt_gpm wiN_ft lowdown aRer_b..l Air o _gpmwilsumwtl_ftbr_mx JL. ptle Anesue Row_gpm Tmipmehue ofwua_°F wmaeh<®mlaminin mode? ❑Ya Milo 1 Snit Dik 2-1&24 Compkud Dat< &2944 WELLC0NnRUMONCERTIFICATION: Iconahucted asuVaaaept«speosibility fW conshucdm ofNia ooil,and imcamplinat wildill Waahagtcn eoU conmumien sreoderds//Metenils used aM sh<infmmaean tepmtM Ybve are tive to my bet 1mow1<dge mdbelid: 19 Iki0v❑pi Trot Name CLAYTON PITTS mtiog Companry COOLWATER DRILLING,INC. Signature - Address IM21 NW HOLLY RD Licevae No.2516 citysmmzip BREMERTON WAM12 w TRAMEL SooitorS utt No. Connector's Spouwr'S Sigmnoc Reg,,otu n No.C0OLWDI9410M Dot 5.1-24 ECY051L1-20(Re411/I8) /(srou and Wiy dsxvmmiUpn altrrnam fnmue.Phase rentltM R'aser Resnarcev Prvtgram at 340d07-6872 Penmu wieh Among bss mn mR l/I for Wavhingrw Refm•S•nw n. Perm ohaspeechdi,.WiArnnmll 8774334341. 26276Twclvc S Tres La NW sa.c SPECTRA Laboratories - Kitsap Poulsbo.WA 99370 (360)779.5141 COLIFORM BACTERIA ANALYSIS FORM Dale Sample Colwm Tone Semple County py tort 2c2 y CdMo%dom strw ltr vN /Z ./v O+u NA(err Type of Waler SysYm(derAmy om bon) ❑GmupA ❑Gm B e"ar Gmp A Gna 8Syabme-PmWde ham WM FBdB lesN"(WFI): IN Splem Name: -FAMFS PytE Collect Fenon: e+rl.w.Tl<L RR++rrC Day Prows b. +v- $D CNPhme: Emw: Ew.Phone: 5!M rtNR b:flm N core.aaenr N rp a0e w e.e rlvw tr YaMa mq M maul SAMPLE INFORMATION sample wleft!by lmme): I'll t .¢Ac speaaa k=iion where sample colt : q Kwmwcbom arcwwmna: /.a E tti "J TW«o'somb(deck wry om roc) 1.❑RouUk D4Wbutlon Sample WP) 2.0 RapeatSwpl«KIP) ChbOmW Ym ❑ Na❑ (ham dinNwronsyslw^fbr uum.muuml Unselblxlary mobs m numeer Chbrxe Residual:Told_Free_ I 3.GmW Vl W Rule Swrw Sample Umaaslacbry touWe collect dale: S I IJ _I CNotaki Yes_No_ ❑Tnggemd(A/P) CNmMR..":Toa1_F=— ❑Assessment(AP) s.Surlace or(iYa Raw Souris Want Bsmple(Erwmarelbn) ❑ E.cos ❑Feral 5.;aSam0e ullw[ br afameaon Ony NAB USE ONLY DRINKING WATER RESULTS USE ONLY ❑U.Imfta q Tobl Callon Present and S.&bmry ❑Ec.h present ❑E.roli absent Bap l Density Reauhft,TOW CaBam_fnpWIO ..E.cof mprt100n'+ Fral Goltono dW1001W. NPC C[Wiml. Replacement sample RequRad: ❑TNTC ❑Swill bo ob ❑ Sample VoYme 0Dw4WCwWw ❑ Oala'fone Pareire0. Itl Wbrmm Mxnbw R.caarempc: ��y aamd -SMB22 iC01Mil SM67rID APR 09M APR 1,02024r"" .swn:aummi`.�e WHImSwple« WO —6GC2L-- m_�....wN..m.mr.m.m. owr..muxl.`mamn Name and Return Address: MASON CO WA James Pyle 2210177DT E 3effWr, A Rd Belfaiy WA 98528 Document Title(s) 1. Notice to Fature Property Owoera of Private Two-PartrWater 2. Reference Number(s)of Documents Assigned or Released ADWrIONAL REFERENa IS ON PAGE_ Grantor(s) 1. ames Pyle 2 wDDmONALOawMPffi QIewOR Grantee(s) 1.Public 2. ADDmONAL GMMEES ON PAGE Legal Description(.IAP—I edro :i.e.I.,bi.1,Pb, ra., i,r,�.cu•N�/w=N.d T11,4 OF SURVEY 2J123 LOT:1 of SP4 2815 AF 7636965 ADOmONAL LEGAL IS ON PAGE Assessors Property Tax Parcel/Account Number(s) 22024-75-90041 22024-75-90042 AMMONAL PARCIELIS ON PAGE_ THE AU DITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEXING INFORMATION PROVIDED HEREIN. Return To James Pyle. 3441 E Rasor Rd W. Beffair,WA 98528 Grantor(s): (1) Jame Pyle Grantee($): (1) PUBLIC Legal Description (1) TR40FSURVEY2/123 LOT: IOFSPp2815AFN636965 (Abbreviated form:i.e.lot,bock plat or section, 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 if 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 (pas/has been granted one or more waivers from specific provisions of the regulations. Dated on this L Day of April,2024 Sign(attuurreee of Grantor(s):_(1) = //� (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 ,f,I (insert name and title of the officer) personally appeared TCt YV'�t-S /"1• ✓GCS who proved to me on the basis of satisfactory eviden a 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. NICK BIR WITNESS my hand and o ial se CONM.t4d05z.. NOTARY PUBLIC •CAUFORNN I SAN DIEGO COUNTY Cmm ftAUY 13.2026 + Signature (Seal) iBYcn I E Elin Ln 1510 E Harstine Isl 30 N Electrical/ James Pyle Road Easement y q 3441 E Rasor Rd S ji 166 Ft Belfair WA 98528 (360) 801-1263 { jimmypyle@icloud.com 166 Ft Existing I Power Pole 166 Ft r700 Ft0 Underground 1 Primary 66 Ft AO R EIscWcaV Road Easement umm�my 166 Ft ❑ 100 E Elin Ln 22024ase 1 ses 13d�y 120 E Elin Ln 166 Ft � 22024a54)0042 Dd..y 140 E Elin Ln 166 Ft Esel rrn 22024 7] 90043 raxi 22024aa-90o44 160 E Elin Ln 166 Ft Houee Rea 7ecMca9 Road EaeameM Daveway 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 120 E Elin E Ln Shelton, WAA Shelton, 98584 Sheltonn,, WA 98584 41)r Septic Drain Field Reserve Drain Field Or Septic Drain Field Reserve Drain Field .6-r ILL CO v I m m �1 )Ft 10ft /fi --- TI30 ft UtilEasement