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HomeMy WebLinkAboutWEL2024-00035 - WEL Application, Design, Letter - 7/9/2024 ® MASON COUNTY 4,SN 6SHELTON: ,SHELTO70,EXT 400 SH STREET. .SHEL ON,W XT400 BELFAIR:360.276 67,EXT400 Public Health & Human Services ELMA:380 Z269,EXT400 FAX:360-42]-]]8] ISLAND LAKE ENTERPRISES LLC P O BOX 1473 SHELTON, WA 98584 RE: WATER SYSTEM PERMIT., TWO-PARTY WEL2024-00035 1050 E Island Lake Dr 420014190041 The 2-party water system, Two Party Well (420 01 41 9 0 0 41/42D014190444), 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, ,1ti David Anderson Environmental Health Specialist Mason County Environmental Health ;7/LZ/2vz y MASON COUNTY COMMUNITY SERVICES DINn9PW°MEnrYu,. •NWNrCmmnlry14J16 415 N.6s SI (Bldg 8)-S6elhon,WA 985M WEL Z� Z - Qpp'3S" Shelton: 360427-9670 x400 Belfair:360-2754467 A400 Elms:360482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT P1XlXE Island Lake Enterprises, LLC 360.490.7843 MAILING ADDRESS-STREET,CRY,STATE,LP PO Box 1473 SITE ADDRESS-STREET,CRY,STATE,9P ,F-��1 �^ /,' Shelton, WA 98584 lox F_ ryr Or PRIMARY PARCEL NUMBER(W ELL al EI 42001-41-90041 SECONDARY PARCEL NUMBER OF APPLICABLE) 42001-41-90444 WATER SOURCE ❑ New Gil Existing aWRCETYP Q Well ❑ Spring F PARCEL I LOT 52E PARCEL I LOT RUE .75 acres 2.22 acres PROPoSEO WATER SYSTEM XAYE(REQUIRED) Two party well PROJECT DEscRIIT Two party well for two single family dwelling units DIRECTIONS TO SmEl CON0111 $ see attached Site Plan: (may also be attached) (property boundaries,structures,well site w/l00r radius,dnve nays,roads,septiclsewer components and lines,ease ents,etc... see attached ✓U � 62�74 RF�f/VFD JUL 0 9 2024 By Submittals Checklist: (these additional items will be required for approval) ® Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) B Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) B Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) © Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form maybe scanned and available for public view on the Masan County Web site. Revised: 10/13/2021 Page 1 of 2 ---------------------___.........._________-----------------------Staff Use Only______._____________________________.___________________.____._____. Review Step 1: Well Site Inspection: YES NO NA ❑ ❑ Evidence of existing sources of contamination Within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 f t radius of the water source? If so, is road privat or State. rrr,��r What is distance to ROW? o e oun ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? 7 ❑ The well casing extends Zd above level ground I concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? tq f� 47.21do11 ❑ ❑ Does the seal appear adequate? tC " -1 Z3.170V ❑ ❑ Is a variance necessary for well site approval? 11"'U t 9PIV/z Comm/ants UO Pass ❑ Fail Inspector Date 7/1 / l7intb Review Step 2: Two-Party Review: YES NO NA 01 ❑ ❑ Water Well Report with adequate pump test on file? f fil QR/1MSS pA Syfy/rbl0 'A 1A 4oblp1%, 60Am (14[xffvl If NO,date of Capacity Test Driller GPM �] ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 5LO 10 MEl Received Signed, Notarized,and Recorded Notice? AFN Z Z)Z ❑ ❑ System appears adequate to serve2 single-family residences based on information provided? Comments !;et wARO Z ( —000 1 Z tl FO+�'rr 4 f- `I F � 0 Z t Z�f�O Approved ❑ Denied Reviewer Date `IZ07,y Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. No claim is made,express or implied ofthe future success orfailure oftbts system. Well site approval does not constitute water system approval. Water System approval is a two-part process. All proposed connections to new wells are subject to water adequacy requirements at time ofbuilding permit perMCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19a,2018 per ESSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 WATER WELL REPORT MDEPARTMENTOF Notice ofbitent No. WE38245 ECOLOGY Unique Ecology Wellm Tag No. BMS113 Type of Work State of WashlVan Ua Comwdluc Site Well Name(itmomthanamvell): ❑ Uevommu<ieo o On®ndneedhowNOl o. WMer Right PenniWestifi®u No. PropmN Ur: a Oammd< ❑fodamil ❑Mu cipd Pmpcty( w Nemc Jew&GVnthia Redtke ❑O<walninp ❑led®ean ❑Tee wall ❑Otlm Well SttM Addtm 1050 E ISUnd lake Drive ❑1 no ln rrn: M.nm: o New_will ❑M City Shelton C Masm :mrim 1i.e Dlmd D(1W Tool county ❑Ceep=ning ❑phn ❑" ■Ab- (314usRo:ary Tex Perwl No. 42 0 0141-00 0 4 0 Dluendom: Dien:emnefooeha 5 Y,e 78 A. Was a variance approved for this well? ❑Ym [9No Dvph ofwoWiend well 75 !. Crevedom oemh: wa! Ifyn,wtmtv.'asthevariencefM CMiq Liam Maunder Feem To Ilid® Setl PVC wibd Th:aN M ❑ e m. o 71 .260 be. O 1 ❑ M ❑ I.actlion(.indented.on page 2): 11WWM or❑EWM ❑ I ❑ m m. ❑ 1 ❑ ❑ I ❑ NE MWAofft SE B;Swdm 1 Township 20N Refuge 4W ❑ ❑ _sa _in ❑ 1 ❑ ❑ I ❑ Lsrimde(Example:47,12345 ❑ ❑ _ _ ❑ I ❑ ❑ I ❑ ) 47.20960 Lalgilude(Example:-120.123d5) -123.121m12 Perf<ndom: DYm GNe Tywo(pnlmmrmed No.ofµrtentiem_ Sim ofprfomime_ie by_it Dri0eh lAg/Comtruttlov or Drammbdov Pnnoobs. Pr6:med tin. so_l.helnw gourd seal Famvtw¢ bebrenlr,chuuw,eim ofnemiel andemetue,and the kind itd mwe ofth<m uniel in w<h kyo,percmld,mlh in 1.one emy fvavh ebwge of &peen: fat Ym ❑No 0 K- m . b Oeph 89 a. i:frm<dw. Ur addidoml elw=:.Ifnnneery. Itammc:ino.Ne:m Allay MeehNre Works Material F. To Type Stainless Sloltetl Model Na Oynerr 5_ Slotaiw.UxO u gem 70 Rb 7! R Brown Si Sentl entl revN,nibbles 0 3 i ionna_ Sbt.im_caam _!.b_8 Bmw,totty sand and revN loose 3 33 ganwhptmwcIu❑Yn ONO SveofprY mn.l_v. Bmvm silty sard and grawl,wet 33 51 Memdeb pled lem_6m_0. Multiwlored gnewl,mediurn to coma brown 51 Sudan SN: mYm ONp TawhrdgWl 15 ! Sam,lose,Watw 78 Mdeml and in mod B!rlon8l CMlu Ud ery vpue rmrmmwbbwmfl DYm EN. Type o(watte? bplh e(ttlra Meticd ofsed ns mem nd Pump: Mmuhamee'e Ninon Typo: HP_ Puvp iueke dvph:_d Domysel Mwmc_@m Wmefep: IwM-emhce<levedmahow mn oknl Z&I !. 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SignMure / i/ Add(ms PO Box 1790 Weaeu No.2874 I City Stele,Zip Shelton.WA fli D'TRAINEE:Societies',Unionist No. ^T Conbactne's Sllamte'p Sigeuhae Re®wetion No.ARCADD1098K1 Dste Sr1S12020 ECY05"40(Rev09118) lfpuneedlhkdmwwntinaaa[Mm lefr 4,lwsemlilhe Water Reaomcea Pmg at360407.972. Peraonswith hemhsg lwa mn w71711for Washingkrn Relay Service. Per iviihaay hdimbikiy�wlIS77d33.6341. 1786 SE Mile Flip Drive SPECTRA"s mforien-Mum, Port Ordurd,WA98366 -m.,.ww..�... w Apxha-labs.. (360)443,7845 COLIFORM BACTERIA ANALYSIS FORM Deb 6mige Cokgetl 1 cony OS 1 10 / 20 o.A r.. 02 00 0a Mawn / rypedNetr3RbaA(tlwJ;mryorebvJ —_ f ❑GWA ❑GmupB modw GUPAal Geu6B Syrlslu-ft"k«n WNerFwu-W-hymn IDS Sl l More:Cynthia Ratlky 1060 E kland Lake Or,S11aftun Caatl Pecan:Arbta EbaWArtWb DNlllnp DINT FIwe:86I426.8826 CeA .. 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A 7117R MAY 2 0 2020 2 IabbeoNr. 2b .S `� � 2212997 MASON CO WA CYNTHIA Re TKE30t1199272 Roe Fee $304.50 Page. 2 IIIIIIIIIIIIIIIIIIII1111111I11111IN III IIN 111111111111IIII1EI111111111111 Return To 6ay, 11 he�11)i V)A- �fts �l Grantor(s): (1) SS10,Cj Grantee(s): (1) PUBLIC Legal Description (1) QUA i 6-A*23-11 P�?A'M�Q PTW of 6OV-17 I A 1 5 (Abbreviated form:i.e. lot, block,plat orsection, township, range) Assessor's Tax Parcel: (1-)_q_� Sb\)TZo , R y 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) LL L - U Tax Parcel: (Connection 2) y 2 0 �J_-��-� b ��L The system owner is responsible for keeping this ��system in compliance. The name of the water system is: z TAFkN ap(I 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. This system (has/ has not) been granted one or more waivers from speck provisions of the. regulations. Dated on this �' day of J 1A(7 20 7a Signature of Grantor(s): (1) (2) n M Pagel of lu�(lf JUL 16 2�24 ay State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this S°y jay of 207 , A 2a.c(4r-k�_ personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. Notary DAVID 6COTr JENSEN Public in and for the State of Washington, Notary Pubflc residing at fi 00 W +4"<- State of Washington My commission expires: t zoa commhslon Y 23034862 My Comm.Explres Aug 16, 2027 Page 2 of 2 219893}JF� WA 888l 9 aii� iai ; 'Rig y 44 Mm Apis �� p �€ ' E k a •� m ii a g g �x o �A i5��$ a 5�'i Ii8Ra. ;5'i k5 S@ is �§� N d Zd IN jail °•maF S S i° ✓ 9/ s S' _ _, '\ ! z p k @ zz a g BBiee �b o �@� dg 5@d d � as;_ c �9 f , � �✓ y °Si gg3 'qx a _ uy+ �q� @a y S Fa+�g�dpl ,�_�Q�za� egdd@i IN �a ,5A 3 �s 8 a $� E �• �5 kpB i��C�C ° 3.�e � 9��a 9 P� .qb4. � -- 1 "'A",�:*.\ 8 �1�i� y �� bA SLgND Lal- 1 'v , 2212458 MASON CO WA 0612512024 alas Pn EBsm III0TI01[11N17o1IIinIIIIIIt�aaI&11IIII1111IIINaytl a Return Address: n PO Qyf, 1`t13 AFFIDAVIT �hCl fm rJ A- `iV5 q No..................... ..... WA R.E.EXCI JUN EX PT L T s my E EM T GRANTOR: Island Lake Enterprises, LLC GRANTEE: Island Lake Enterprises, LLC LEGAL DESCRIPTION ( iated): Resulting Parcels 4, 6, & 7 of BLA N 23-11, PTN NE Y. SE W 'I/ SW Y. S6, all in T20N, R4W (full legal descriptio 2) ASSESSOR'S PARCEL 01-41-90041,42001-41-90043,42001-41-90444 The Grantor, Is s, LLC, a Washington limited liability tympany, is the owner of e follq�p'I described real estate in the County of Mason, State of Washington: P Parcel 4 of Boundary Line Adjustment No. 23-11, as recorded June 19, 0 r Auditor's File Nos. 2198930 and 2198931, in the records of Mason nty, Washington, being a portion of the Northeast quarter of the Southeast of Section 1 and the Northwest quarter of the Southwest quarter of Section a in Township 20 North, Range 4 West,W.M.; Assessor's Parcel No. 42001-41-9004I; (hereafter"Parcel A"). Parcel B: Resulting Parcel 6 of Boundary Line Adjustment No. 23-I 1, as recorded June 29, 2023, under Auditor's File Nos. 2198930 and 2198931, in the records of Mason County, Washington, being a portion of the Northeast quarter of the Southeast quarter of Section 1 and the Northwest quarter of the Southwest quarter of Section 6,all in Townsbip 20 North,Range 4 West, W.M.; Assessor's Parcel No. 42001-41-90043; Eaaa nt-Page I of (hereafter"Parcel B"). \\ Parcel C: /^--. ' �\\V Resulting Parcel 7 of Boundary Line Adjustm Ylp! 3-1 1, as recorded Jute 29, 2023, under Auditor's File Nos. 2198930 , in the records of Mason County, Washington, being a portion of a No quarter of the Southeast quarter of Section 1 and the Northwest qu er of Southwest quarter of Section 6,all in Township 20 North, Range 4 t, Assessor's Parcel No.42001-41- (hereafter"Parcel C). WHEREAS, the Grantor dear i0litate the installation and maintenance of utility lines and septic systems elopment on the subject properties; WHEREAS, the for gnizes that neighboring properties possess adequate land area for the in on Gc systems and utilities and seeks to secure easements to access and util' such for the benefit of the subject properties; WHI is willing to accept the easements for utility access and septic mstalla I a purpose of expanding the total available land area of the subject pro a 'valent of one acre for future development; FORE, in consideration of the premises and mutual benefits, the Grantor es and declares the following easements: 1. ant for Par el A: Grantor grants a perpetual and non-exclusive easement over Parcel C for the purpose f accessing, installing,maintaining and repairing utility lines and septic systems to serve Parcel A" 2. Easement for Parcel B: The Grantor grants a perpetual and non-exclusive easement over Parcel C for the purpose of accessing, installing, maintaining and repairing utility lines and septic systems to serve Parcel B. E.aement P.,2 d4 2212458 Page 2 of 4 06/25/2024 01:55:10 PM Mason County, WA 3. Scope of Easements: The easements granted herein shall include the right of in d egress for installation, maintaining and repairing of utility lines and septic syst s, a sary,to facilitate the development and utilization of Parcel A and Parcel B 'dentia purposes. 4. Binding Effect: These easements shall run with the titles t e re to described herein, shall be binding on all parties having or acquiring right, tle or interest in the real estate described herein or any part thereof, apass "to, benefit and burden the owners thereof. i ; 5. Governing Law: These Easements shall be governed by and construed in accordance with the laws of the State of Washington IN WITNESS WHE$$()F parties hereto have executed this Easement as of the date written below. \\v Dated: S 2024. terprises, LLC .Radtke,Member is A. Radtke, Member Eacemeat-Page 3 of 4 2212458 Page 3 of 4 06/25/2024 01:55:10 PM Mason County, WA STATE OF WASHINGTON ) \\ COUNTY OF MASON ) On this Z&'jk day of J t+..e .2024, jj�� undersigned, a Notary Public in and for the State of Washington, duly cod swom, personally appeared Jerry P. Radtke and Cynthia A. Radtke tomthe Members of Island Lakc Enterprises, LL , the limited liability corn ted the foregoing instrument, and acknowledged the said inswment t -bcoluntary act and deed of said limited liability company, for the uses pv������PPPPPPestherein mentioned, and on oath stated Wat they are authorized to execute the :rf . i WITNESS my hand and official seal hereto affixed the day and year first above written. otary Public in and for the f Washington,residing at lroccd Nt 0A`iD SC0 r JEN5EN My Commission Fxp� tot t of State of WashinesMn6 48 Casmml Expi o 230716, 2 My Comm.Expins Ap6 16, 2027 D D D D DD D Euement- Page 4 or4 2212458 Page 4 of 4 06/25/2024 01:55:10 PM Mason County, WA