HomeMy WebLinkAboutWEL2024-00037 - WEL Application, Design, Letter - 7/17/2024 ® MASON COUNTY 415 N BTH STREET,360-27 4467.E 98584
SHELTON:360427-9670,EXT 400
eELFAIR:380�275d487.EXT 400
Public Health & Human Services ELM0.380i82-5259,EXT 400
FAX:380427-7787
OMDAHL MAX L &VIKKI L
2061 E CRESTVIEW DR
SHELTON, WA 98584
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2024-00037
50 E Emily Ln
320241290004
The 2-party water system, LHADMO(320241290004/320241290061), 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@masonmuntywa.gov
Sincerely,
!/�2--
David Anderson
Environmental Health Specialist
Mason County Environmental Health .
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WYbnGPIfnM4LmA,mm�nW N®IIM1.GmnY,ill'NoIIM1
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WEL )0 SS
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TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPrKANT DR-N 3 o o •- oz7
uu AoonEas-sTREEr,cm',sTATEIaP 'L �
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WTE ADDRESS-MEET,CnY.STATE'
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ANY PARCEL NUMBER I W ELL S
202 - 2- -
SECOND "PAR ELNUM/ER(IF APPLI IN
2 2 2 5T PP0.CE 1lOT 8RE PARCE iLMSSE
SOURCE mE KWell ❑Spring 23 .WPTERSOURCE
New ❑Existing
PRO En WATER STSTEM NAME IREOUIREDI
MWECT DE//SCCRIPTOR GELS
tJ6Lr_ 42,1 /t F
ORECTIONSTOSMUCONDIATaONS 1r 7^'� / �` l��)xC �/•- M/L` TV
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phl��ww'-1 �ti/ 7rl£ �/Hs�r
Site Plan: (may also be attached) r wm onenls and lines,easements,at .)
(property boundaries,strudures,wNl site wltlNl'ratlius,tlriveweY p
m�
3 79
RF�Fi�o
JUL 17 2024
\ t ,
By
Submittals Checklist: (these,additional items will be required for approval)
Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled)
f[Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled)
Ey 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)
Revised: 10/13/2021
This form may be scanned and available for public view on the Mown County Wee sits. page 1 of 2
- -
----------Staff Use only -------------------- -- --'—----
--------------
Review Step 1: Well Site Inspection:
YES NO NA
❑ rul ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
VA (drainfields,tanks, buildings; indicate distance on plot plan) /
❑ ❑ Are there roads within the 100 fo t radius of the water source?If so, is road ph , County or State.
What is distance to ROW?�— (-/
❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan)
❑ ❑ Is the well rap satisfactory?
❑ ❑ Screened and vented? �rt •t
❑ The well casing extends 2V above level ground I concrete slab? (circle one)
�pf: Y7.21L37
❑ ❑ Is there evidence of a surface seal? LOn! „I LIopl7?
❑ ❑ Does the seal appear adequate? �6d: VFW-
is a variance necessary for well site approval? ''Ad
Comments
TPass ❑ Fail Inspector Date
Review Step 2: Two-Party Review:
YES NO NA ()0 F9�F1 ar60tM1(�711)
(� ❑ Water Well Report with adequate pump test on file? I/ZS/Zaly v 7n
If NO, date of Capacity Test Z / Q Driller (D (df a 64 1 y GPM W
�'] ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Z 2
�f ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2V W6 '
❑ ❑ System appears adequate to serve 2 single-family residences based on information prolix ?
Comments 7,QN
7ON U OIy �`�
IYI Approved ❑ Denied Reviewer Date d?
rFindings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, express rh,
or implied of the future success or failure of this system. Well site approval does not constitute water system approval. Water
System approval is a two-part process.
s at time
AIIWaterosed wage r restrictions annections to d daltional fe subject
es may apply to adequacy
new wells drilledtaffer January 19i° 2018 perESSB 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 UPAMENTOI Moiceofl:ernt No VJE =2
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Typ of W-d, Stall or WifMn6140
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Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA,98584
Cuslgngr: Max Orndahl WeIl Tag#: BPF162
SM Address: 100 E Emily Lane,Shelton Depth: 86'
le Static: Flowing
Da of Test 2f12024 Pum Set: 60'
TIME GPM LEVEL RECOVERY
1 Min 8.5 1.6 TIME LEVEL
2 Min 9.5 2 1 Min 10
3 Min 8.5 2.2 2 Min 8.1
4 Min 12.5 2.2 3 Min 7.8
5 Min 12.5 3 4 Min 7.3
6 Min 12.5 4 5 Min 6.8
7 Min 12.5 4.3 6 Min 8.4
8 Min 12.5 4.6 7 Min 8
9 Min 12.5 4.7 8 Min 5.5
10 Min 15 4.8 9 Min 5.2
15 Minin 15 7.4 10 Min 4.9
20 M 15 7A
25 Min 20 9
30 Min 20 9.4
35 Min 20 10
40 Min 20 10.7
45 Min 20 11.4
50 Min 20 11.0
55 Min 20 12.2
1 HT 20 12.2
1 Hr 10 Min 20 12.2
Vanguard Labmw*
2635 Pmkmont Lane SW,Suite A
Olympia WA 98502
vvMS93FD 360-967-7010
COUPORM BACTERIA ANALYSIS FORM
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SAUWV EINFORMATION
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2213356oMASON CO WA
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Return To
MI+ K �nIJ�AFIL
yob f �. Cn Esrvt �^- DA,
S�ro�v uiq , g 8 S'b'S°
Grantor(s): (1)
.. ,, f (�MDA (2) --JANcSSf; 0 D "
Grantse(s): (1) PUBLIC ,Z �pwniSN�P 2c�N I NbE 3 kl
Legal Description (1) 5(t�(Air1M 7
(Abbreviated form: i.e. lot, block,plat or sectron, township, range)
2 0 2 5 -1-—-�-!a
U O
Z-
Assessor's Tax Parcel: (1) 3 ---.—
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:
�yv o
Tax Parcel: (Connection 1)iA Z D y_4-J_—2 1_0 O w
Tax Parcel: (Connection 2) 3 2 a y —4 --L -1----
The system owner is responsible for keeping this system in compliance.
The name of the water system is: ZHit DM
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 specific provisions of the
regulations.
Dated on this�.�day of 1�� 1�• 2ti�.
Signature o4Grant
UGt Page 1 of 2
State of Washington
County of Mason
I,the undersigned, a Notary Public in and for the above na ed County and State, do hereby
certify that on this day.toff • ��e 61 , 20 2
in •d. ; � 1 yM1�dah.Qpersonally appeared before me, who is known to be
signer of the above Instrument, and acknowledged thatthe (rhe) (they)
last Pove signed it.
GIVEN under my hand and official seal the day d�
<<tuunL�yuq,�
S99S9+ °,� �,�
l ''F e•2°•� + f'�'� N a Pu lic i nd for the State of Washington,
c °a •.T ry
residing at
My commission expires: D �Z
° SLIC m `r
''46 WASHt`Y.�"�`
ggnunuu"�
Page 2 of 2
REPAflED BY A-LI p�Y �(�� T'O T /L`t.3.`
ATE 1 Y 1 ,M I1
PROJECT ACTION NOTES PROJECT PLANNING NOTES
29
30
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32
33
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35 V
36
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41
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43
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