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Home My WebLink AboutWEL2024-00025 - WEL Application, Design, Letter - 5/24/2024 (2) MASON COUNTY <iSNfi SHELTON: ,SHELTO70,EXT 4W SH STREET, ,SHEL ON, EXT5S4 4 BELFAIR:36 275i 7,EXT QO Public Health & Human Services ELM, 62-5M%EXT4 O FAX:360. 27-7787 PYLE JAMES MATTHEW 3441 E RASOR RD W BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT., TWO-PARTY WEL2024-00025 140 E Elin Ln 220247590043 The 2-party water system, 140-160 E Elin Ln Water System (2202475900431220247590044), 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, ��/J� e /!" David Anderson Environmental Health Specialist Mason County Environmental Health i ® MASON COUNTY u COMMUNITY SERVICES W idrX.PIaKq EmXmm�nl xYhh Cmmnxy IktlIM1 415N.a SD ,(Bldg 8)-Sklbu,WA 985M WEL Shelwn: 360427-9670z4W lielfair:360-27 67,4 E. 3W482-5269 WW1 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION PJCPXi PHONE James Pyle 360-801-1263 EINDA - ""ATare 3441 E Rasor Rd W Belfair, WA 98528 SnE ADDRE59-Sr REST,C1W eTXTE,M 140 E Elin Ln Shelton, WA 98584 rMRYPMCEL XUEBH11W6L VIEI 22024-75-90043 HSCOXDARYPAIg6 MI20 4 75-900 22024-75-90044 wATd WVRDE UUID[TYPE ARC6rIgTe PARC61EA New 13 Existing la Well O Spring 1.27 aCfeS 1.27 acres oroemw rRDsouX®1 R�140- 160 E Elin Ln Water System PROIST DFECRVTgM DIRECTTV S TO SIIF/<ON W TANS Hwy 3 east, turn right on E Pickering Rd. Cross Harstine Island Bridge, turn right onto E Island Rd S at stop sign turn right onto E Harstine Island Rd S, 1.5 miles turn right onto E Elm Ln. Site Plan:(may also be attached) (blowy bounogim,sbudurm,wei airs vd10a radm,diveways,roach,mpGrleewer mmponeMs and lines,easemeras,el)...) See Attached Submittals Checklist: (these additional items will be required for approval) m Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) 0 Well Log with pump test or 4-hour capacity lest 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 if there is a lack of septic records on file) This form may be sammd aM avallade for pudic Wee on the Mason CoMPacg unnty Web sire. Revised: 10Y1312021 loft —_--_—�.____.__—.___.Staff Use Only Review Step 1: Well Site Inspection: YES NO NA ❑ 56 ❑ Evidence of existing sources of contamination within 100 toot radius of water source? (drainfields,tanks, buildings; indicate distance on plot plan) 141 ❑ ❑ Are there roads within the 100 foot rpolus of the water source?If so, is road ovate County or State. T" What is distance to ROW? Zfi N' ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? �CJ ❑ ❑ Screened and vented? ❑ The well casing extends above level ground/concrete slab?(circle one) ❑ ❑ ❑ Is there evidence of a surface seal? Lot: Y;.2)d 1 w5 Pu ❑ ❑ Does the seal appear adequate? LOq' ❑ V ❑ Is a variance necessary for well site approvall?n��(f�� Tl9' nt Commes recf eAI rY twJ vp .5�2 ylaz[t 0"W t'41 ffr 1Y( nity awe err Mtn. Pass ❑ Fail Inspector Date J f(// 1Z JL/ RSWew Slop 2: Two Party Review: t— YES NO NA �'( ❑ ❑ Water Well Report with adequate pump test on file? Z3 0M for 2YA MM(SSAIQt kh1 J If NO,date of Capacity Test Driller GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Dateoftest Y/Z3/Ie Z9 QryI]f ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN 1 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments ,nJ Approved ❑ Denied Reviewer Date 20 ZY. Finings in this review reflect observed conditions as they existed an the day ofthe site inspection. No claim is made, express or implied ofthe future success or failure ofthis system. We/f sue approval does not constitute water system appreent. Water System approval is a two-pats process. All proposed coneumnons to new wells are subject to water adequacy requirements at fine ofbatlding permit perdfCC 6.68. Water usage restrictions and addifiornl fees my apply mall new wells drilled afterJanuary 19e,1018 per ESSB 6091, This form may be sunned and avallable for pnAlic view on the Masan County Web sift. Revised 10//32021 Page 2 of 2 - DEPARTMENT Of W q7 WATER WELL REPORT -'� ECOLOGY iii., rh6en Wc I Ty,wrwmim s:ateof Washington viquc Ecology Wc Um Tag No. BNMl152 0 Cppmwdo i Site WeU Nerve(if.(haa.well): A2 ❑ Dttmmhti Pgiml o. lloum NO[No, Water Right Pmmi mtific9a Nw P pomd Use a o, ii W.] ❑Mamcyet pmpmty Owmr Name JAMES PYLE ❑Dewkrhg ❑Itd,. 0 Tem Well ❑phs Wdl Street Address 130 E ELIN LN A 140E ELIN LN rvew Obmmi-11 Tipee MaOad: —_.. ® wsll ❑" ❑wi.cn ❑lemd ❑cble Tool CStY SHELTON Cvmty MASON C Dmpenm,, ^(lb> ❑Dig MA CuwAa Tax Pmeel No. 22D247590043&2=47590044 Momoiiem: Dhmsterofboring fi b.b��fl Waaewd m Dcpbofcompk� u361 ILaagxovm Fa t6h wrJIT ❑Ya FI No cmno oa Dalai: w.0 BYm.what wps t6c vmivvee foR t'ffileg I.m Dinrebr From To TbrYmb S!d PYC Welded Thnd 0 ❑ 8 m at 376 250 id ■ I ❑ a I ❑ Localim I.matracYwam Pegs 2): MwwMm❑EWM ❑ 1 ❑ _R Id ❑ I ❑ ❑ I ❑ 1�W Y'/,oftlr NE % mtisp'S 24 Towmhip 20N Ravge 2 ❑ 1 ❑ —m, — - -m n I ❑ ❑ I ❑ ❑ 1 ❑ : m Laogiam(eE(xEmnapm1Pk47-.]1220.41S21M457).2/ 018m ❑ ❑ ❑ ❑ ❑Yo ®N Typofpmme6 -122.87 4159 N.ox, w _ Stre efperbauom_i6)_i UriBerS l.Ogl('emtrrmbn priNmrmWer lhuadgre Pe?amed 6m_flb_flhebw®omd m&n iwmaeom peanbe by mbr,elmmep,daafmmeid aodsvuome,and We kiedam erne a(the mMwl m z.:ch IaYxrpmeaand.wbbrt Iba:m eehY OrmEchm4 of Sneed: 9Ya ❑NO ■K4Mtm b DtgA_L hfmnmdev. Uu atlilimishev J¢xeamy. Mmabclmc's Nnm --- -- Mmcnal From To Type STANLESS MOdel No. Diemeur6 im mwme 12 i5am 370 &m 8 l R CLAY B GRAVEL SAND BROWN 0 ISO Diamm m sluaim_ i7mm_&b fl PEAT BROWN ISO 190 6eed:Flger p.ebCYc *NO S dwicmmakl m. CLAY& SAND BLUE ISO 220 Mmmkpmo,lfmm_Kb_& CLAY B GRAVEL BLUE 22D 245 CLAY SAND B GRAVEL BROWN 245 275 sudem rem: NYb OmTo whnd.gn? 20 &I d ioceel B E CLAY B SAND BLUE 275 385 DiclYnmmromsvaommhkomrt ❑Yb ENO GRAVEL H2O GREEN 385 381 Typeotwert!! Dapmefa _ Mmodofvl�mmoff 'per blamBq tram GDIdLD6 Type: SUB ". 3 _ poeyiemedaph3E0 IL Dwpd mwnae 18 gpm wear Lewh: I.m.me4¢ekwkn ebmm mmo a®led n SdOhup otmporaxprasiog 1 flebove pwmismhce Smcwm ksxl 212 fl.hebwtopo(wep OaablB Dow 4-22-P1 Amimtpremou_pv.pmqumc hrd Dow Mesieo wmmkpamolkd by (aP.calve.ml WMT.: Wmapompio6lenpmfomrd" O No A Yes b byabomt Ykk 23 ppmwah3 d.dmwdoxmaflm4 hm nmd_6Tm-1N_—k dnwdo.a aflm hs. Yield_Wm with_ft.dmvvo e6er_hm. Ra dam(Hmc=me wheo pwvp mmovi Off-os6 Inxl:wuel fmm well Ti mwmr keep Tree Wmlu.cl I. Wm 4M Tbr Wualcul Dmofpmophg rev, -___- 6arYtCn_gpmwiN_fld:a & — bit Ah m Wm whb seem sern_&ir_hm Mes® f Dm tlOw_ssm Tebpebtwx Otvm_°F WbarBemielamlysv nedet ❑Yes ®NO Shirt Dpm 4-1-24 Completed Dm 41S-24 WELL COPWRUCnONCERTMCATION: 1 wvstruc&d md/aaaryl lcsp®bi0ry farcollstmetim ofth®M7,and ibco�Bavice with all WasMngmv well cmatrpcdmstmdmdLMaterials s amthemfo® umrgertcdaboutmembbmybWknowledVavdbe8ef: ❑e Driller❑Tremce❑PE-Print Name CLAYTON PITTS pilling Company COOLWATER DRILUNGJNC. Simmbue Address 10921 NW HOLLY RD Ul.No.2516 City,Sore.Zip BREMERTON WA 98312 IF TRAME:Spwpm's Licrosc No, Covtrmlm's Spmcm'e Sigm RepjWeaeo Nm COOLW01941QM pplp 5.7-24 EEY050-1-20 11/IB) lJ,nw need Wu&wvmemiaa alremarc(rmot.yfemrcvlf dre R'afer Resuumra Prugmn ar i,Wi6N3-WF73. 'Y(K4 hC8fN PAfii*No ni RF#4A" fhMilw H»srwawAxaMe4 diwMTM'rw rxfl 8'�is�bJtlf. 26276 Twelve Tras In NW Sme " SPECTRA Laboratories Kitsap Aadrbo,WA 98370 C%O)Tt9-5141 COLIFORM BACTERIA ANALYSIS FORM IMkSw&Cdkoled TM ft" Cauny I I Colleted tly ZZ ZH ow Wt. Me T. 3 : Lo-B1 Type d wewSyen k>ecr alr ae mx) ftee A and Gmlp BSrakilc-Provide ban We*FaoT6m VWWM W4 ID# — _ — S#wNimes: Tzn NY•E Carrimpatim Day Rmpp 3CO 5. J - Joe r CeIRonto Etd Ere Pllane: _ Sae not h Far tl ma a0prs N;robs r W YY YY W e eglur W ecOr ai6TfL/�kZttlJaC[ Jf.•Tnw3e.Co t,, SAMPLE INFORMATION SarokwecoedMSnaek enoC r.�A9fP SDectbcNmrlmeeat9kculetee: TSpemlenwclotamnmlk: ��7 C TypoFSalpk chaicany am box) r.❑Routine Distribution Samoe(AIP) 2❑ RepttSenpk WTh Chbfnated Yes ❑ No❑ Veekkckry mukc kbmm�w: 'ChbNie ResltluaLTc31_Free_ 3.Ground!Water Rule Sowee Sample --- ----- Umakfecbry raditemkttt S I Chlorinated:Yee_No_ ❑Tdpgaedpw) CNoWe Rmidusk TotL—Free_ I SurimerON Rao Source Wow Solple(Enumxalm) S ❑ E el ❑Fecal moor vY ro__ 5. SYde CWM ad lnlae4m Onls IABtISEONLY ORNOIING WATER RESIXTS LAgUSEONLY ❑UMMWKar TDWCWM phe Slt6ekry ❑Ew6pment ❑E.celebead I Bacteriel0aotq Rnat:TaMCtlaR----m TBPN.EwI----IwOd. p woal Cdilolm _cfi OOrnL FPC "W. Replarement Samplk Rwiti ❑TNTC ❑Semplelcook ❑ SaRmopee VVabw ❑DentagatlCmkM ❑ PagptTanp C: Naioe OTiWII/SWt22p 4,I ,Y,.. r•.Y.s,e4,. APR 23 MI �� werraYra eavoYrer YYY APR 24 M4 Odf Wsayea M p,.� 11�YY.lYq'OYY.YINNY.µN. onn�rarrs.mm I Name and Return Address: 2211204 MASON CO WA )amta`1"' 05/2412024 11 10 AM NOTCE 3441 E Exact Rd PYLE R197914 Rec Fee $305 50 Pages 3 Belfair,WA 98525 Document Title(s) 1. Notice to Future Properly Owner of Private T%o-ParlrWater System 2. Reference Number(s)of Documents Assigned or Released ADMICNAL REFERENCE eS ON PAGE_ Grantor(s) 1. ames e a ADDmowucuwr�m4rAca Grantee(s) 1.Public 2. ADDITIONAL GRANTEES ON PAGE Legal Description(abbreviatedl :I.e.IM,block,platwsec n,eowmM1lp,nnp,Ruartx/quarter) TR 4 OF SURVEY 2/123 LOT.3 OF SPI 2815 ADDRIONAL LEGAL IS on PAGE Assessors Property Tax Parcel/Account Number(s) 22024-75-90043 22024-75-900" ADDITIONAL PARCEL KS ON PAGE_ THE AUDROIVRECORDER 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 Belfair, WA 98528 Grantor(s): (1)James Pyle Grantee(s): (1) PUBLIC Legal Description (1)TR 4 OF SURVEY 2/123 LOT: 3 OF SP#2815 (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 22024-75-90043 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) 22024-75-90043 Tax Parcel: (Connection 2) 22024-75-90044 The system owner is responsible for keeping this system in compliance. The name of the water system is: 140- 160 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. Parcel owner 22024-75-90044 agrees to pay parcel owner 22024-75-90043$120 annually to cover electrical cost of operating the well. This system has not been granted one or more waivers from specific provisions of the regulations.Dated on this 7-1 day of ^4Y 20�". Signature of Gra'ntor(r(s�)r: ' Page 1 of 2 State of Washington ) County of Mason ) I,the undersigned, a Notary Public in and for the above nampd County and State, do hereby certify that on s3L4 day of rn QLq 203 rsonally appeared before me,who is known to be signer of the aboW instrument, and acknowledged that he (she)(they) signed it. GIVEN under my hand and official seal the day and year last above written. Lj�,""k 01 D-�% M,•WF"o Notary Public in and r the Sta4 f VJgs�hin t QP ,p ox a �S's residing et `( .0 t;OTARY 'F,;••. '_ My commission expires: b b"L 21009497 i `..,¢ :• PUBLIC _ 0,MIu?5�'Pc Page 2 of 2 E Elin Ln 1510 E Harstine Is DOfl EWC~ James Pyle ""tl ESSOMM 3441 E Rasor Rd S 166 Ft Belfair WA 98528 (360) 801-1263 jimmypyle@icloud.00m 166 Ft Existing Power Pole 166 Ft AA�700 Ft� Underground Primary 166 Ft ,r 166 Ft ❑ 100 E Elin Ln 22 02 4-7 540"1 Od 120 E Elin Ln 166 Ft 22024.75800/2 D^ y 140 E Elin Ln 166 Ft 2202A-754MM wn 2202 -154MW 160 E Elin Ln 166 Ft EE et Ddvaww 330 Ft i