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.
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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
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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
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sa.c SPECTRA Laboratories - Kitsap
Poulsbo.WA
99370
(360)779.5141 COLIFORM BACTERIA ANALYSIS FORM
Dale Sample Colwm Tone Semple County
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strw ltr vN /Z ./v O+u NA(err
Type of Waler SysYm(derAmy om bon)
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Day Prows b. +v- $D CNPhme:
Emw: Ew.Phone:
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S I IJ _I
CNotaki Yes_No_
❑Tnggemd(A/P) CNmMR..":Toa1_F=—
❑Assessment(AP)
s.Surlace or(iYa Raw Souris Want Bsmple(Erwmarelbn)
❑ E.cos ❑Feral
5.;aSam0e ullw[ br afameaon Ony
NAB USE ONLY DRINKING WATER RESULTS USE ONLY
❑U.Imfta q Tobl Callon Present and S.&bmry
❑Ec.h present ❑E.roli absent
Bap l Density Reauhft,TOW CaBam_fnpWIO ..E.cof mprt100n'+
Fral Goltono dW1001W. NPC C[Wiml.
Replacement sample RequRad: ❑TNTC ❑Swill bo ob
❑ Sample VoYme 0Dw4WCwWw ❑
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Name and Return Address: MASON CO WA
James Pyle 2210177DT E
3effWr, A Rd Belfaiy WA 98528
Document Title(s)
1. Notice to Fature Property Owoera of Private Two-PartrWater
2.
Reference Number(s)of Documents Assigned or Released
ADWrIONAL REFERENa IS ON PAGE_
Grantor(s)
1. ames Pyle
2 wDDmONALOawMPffi QIewOR
Grantee(s)
1.Public
2. ADDmONAL GMMEES ON PAGE
Legal Description(.IAP—I edro :i.e.I.,bi.1,Pb, ra., i,r,�.cu•N�/w=N.d
T11,4 OF SURVEY 2J123 LOT:1 of SP4 2815 AF 7636965
ADOmONAL LEGAL IS ON PAGE
Assessors Property Tax Parcel/Account Number(s)
22024-75-90041 22024-75-90042 AMMONAL PARCIELIS ON PAGE_
THE AU DITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE
DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEXING INFORMATION PROVIDED HEREIN.
Return To
James Pyle.
3441 E Rasor Rd W.
Beffair,WA 98528
Grantor(s): (1) Jame Pyle
Grantee($): (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