HomeMy WebLinkAboutWEL2024-00037 - WEL Application, Design, Letter - 7/17/2024 WA
MASON COUNTY 415N6TH LFAIR, , 275 7.EX8584
SHELTON:36 27-9670.EXT 400
BELFAIR:380-275i48],EXT 400
Public Health & Human Services ELM:360 62-5269,EXT 400
4 FM 360427-7787
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 360427-9670 Ext.353 or email at
danderson@masoncountywa.gov
Sincerely,
!/�a—
David Anderson
Environmental Health Specialist
Mason County Environmental Health _
�IS�ZoZ�
UNTY
COMMUNITY SERVICES
WNN,a Nnaq Em� Mmin —' WEL
4151,1.6n:sra (Bldg})-Shelton,WA98584
Shelton: 360427-9670 x400 aelfair 360-275a467 x400 Elmo:360482-5269 x400 —
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
%IGHE /j
APPLICANT / ) K `A- 3 v O — 'O//Z /
MAI I GADDRM-SmE¢\T.GRY,V—AIE.MP /L
V mil/
SITE AooREss-BTREFT.LITY.BTATEa ` E
ARY PARCEL NUMB ER 1E 81 4 /�L VVT1
3 ' - 2 - y000
SECONDARY�LEL NUMBER(IP APP4KABLEI�
2 2 RR �.I PARLFLILOT 9MF PARGEL]LOT 1 a��6E
WATERSOURCE -Well
[3 Spring
New OF xisting r\
PROPOSED WATER SYSTEM"ME tREGU1 EG1
PRLECr BESCRIPDTID L�CS
ELL /t- 2
aRELTMl8s TOWn"CONOIIpNS 57V•L �� L/ eff Y V �/Z m��•` /
E R!6N'fC PO /A r 70 �it�s RocGL
U&f T) 1M ji�yH�
Site Plan: (may also be attached) rents and lines.easements,a .)
(property boundaries,atrUdU sE'"ji sIb W/100'radius,dri arMays.roads,aeptiCinamr compo
t
JUL 17 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)
l#1C Well Log with pump lest or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled)
Y 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 may be scumed and available for public view on the Mason 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)
Pg ❑ ❑ Are there roads within the 100 f t radius of the water source? If so, is road!91
County or State.
What is distance to ROW? f o
❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan)
❑ ❑ Is the well cap satisfactory?
❑ ❑ Screened and vented? �7M
❑ The well casing extends `0 above level ground I concrete slab? (circle one)
4�21t3J
❑ ❑ Is there evidence ofasurface seal? toffWn! �I LI,OOIj$
E ❑ ❑ Does the seal appear adequate? -�pq: 611"Fl6L
❑ Itf ❑ Is a variance necessary for well site approval? dd
Comments
n/t 3/Zf�
Pass ❑ Date lkiFail Inspector </ /
Review Step 2: Two-Parry Review:
YES NO NA (jp ti/n
[] ❑ Water Well Report L with adequate pump test on file? (1lS/ZalY
If NO, date of Capacity Test / Driller I D wl G pt! I/ GPM Z�
❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 2 Z
t
❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 7 Z)3)M6
System appears adequate to serve 2 single-family residences based on information prgw%?
Comments f Q
Gjk� U OIy
Approved ❑ DateDenied Reviewer Nl
4
Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, express l6.
or implied ofthe future suttees or failure of this 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 of building permit per MCC 6,68.
Water usage restrictions and additional fees may apply to all new wells drilled after January 19'h, 2018 per ESSB 6091.
Revised: 10/13/2021
This form may be scanned and awllable for public New on the Kati County web eke• Page 2 of 2
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WELL CONSTRUCTION CERTIFICATION: 1 cmCDmlfd uWoreaaeDe raeueiNliy fiecawnNem ofbis eNl mtl v comDliercewN:all W W iWlaa..ell
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U.N. 2063 Ciy,Swic,Zip ERetta: WA B868p
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Arcadia Drilling Inc.
P.O. Be. 1790
Shelton,WA.98584
Customer: Max Omdahl Well Tag e: BPF162
Site Address: 100 E Emily Lane,Shelton Depth: 86'
Date of Test 2112024 Static: Flowing
Pure Set: 60'
TIME GPM LEVEL RECOVERY
1 Min 8.5 1.6 TIME LEVEL
2 Min 8.5 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 6.4
8 Min 12.5 4.6 7 Min 6
9 Min 12.5 4.7 8 Min 5.6
10 Min 15 4.8 9 Min 5.2
15 Min 15 7.4 10 Min 4.9
20 Min 15 7.4
25 Min 20 9
30 Min 20 9.4
35 Min 20 10
40 Min 20 10.1
45 Min 20 11.4
50 Min 20 11.0
55 Min 20 122
1 Hr 20 12.2
1 Hr 10 Min 20 12.2
Vanguard Labomtory
2635 parkmom Lane SW,Suite A
Olympia WA 99502
vbRYA'0 360-96T-TO10
COLIFORm BACTERIA ANALYSIS FORM
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SAWILE INFORMATIOR
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100 E Emily Lane, Shelton
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I USEONLY 010111ONOWATERREBILTS LAB USE ONLY
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285-
2213356orMASON CO WA
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Return To
ng 1+ )C �iylJ�A 1l L _
Srl ,row u A • g8S b'`f
Grantor(s): (1)
i 11lKkt MIM (2) -�Anir=5Si4 �ivlDA�sl<
Grantee(s): (1) PUBLIC
Legal Description (1) S[_C-'TroN �T
(Abbreviated form:r.e. lot block, plat or sectron, township, range)
Assessor's Tax Parcel: (1) 3 2 P 2 `f -L ! % O O O
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) --
Tax Parcel: (Connection 2)
2o � L
The system owner is responsible for keeping this system in compliance.
The name of the water system is: L:f ff 10/" /2
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
h sis required if the Water
r of services.
Additionally, a water right, obtained from the Department of Ecology,
system exceeds exemption standards.
This system (has/ has not) been granted one or more waivers from specific provisions of the
regulations. ,,I 1
Dated on this� .day of ` � , 201- .
Signature of Gr ntq, ):
UN Page 1 of 2
State of Washington j
County of Mason
I, the undersigned, a Notary Public in and for the above n�a!Ved County and State, do hereby
��os , 20"G24 -
certify that on this day f��.. �
�, 1 1 • 1 1 • a• 4\ �fs� �u<(¢(�,Qpersonally appeared before me,who is known to be
signer of the above instrument, and acknowledged that he
ast heovte written.
signedit.
GIVEN under my hand and
�o�fficciial seal the day
�e'7A1 �% N ary Pu lic i nd for the State of Washington,
AAy' i?E residing at D f�j 2
IM commission expires:
'k 0r
9
'�h'�pF WASF1\t�.��•
/11/111111/111111
Page 2 of 2
REPAREO BY A70 9-0 7-0 -rim y\]Ly FC
ATE N0.
PROJECT ACTION NOTES p"EC 1111 9NPIINL NOi[5
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30
31
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