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Home My WebLink AboutWEL2024-00038 - WEL Application, Design, Letter - 4/5/2024 MASON COUNTY COMMUNITY SERVICES araNarw,:nrm�d xdMcoi..momrMdM 415 N e Street.Bldg 8, 9 Shelton WA 985M Shelton: (360)427-9670 ext 400 G Belfair:(360)275- 467 ext 400 G Elm:(360)4825269 ext 400 FAX:(360)427-7787 APPLICATION FOR WELL SITE INSPECTION Permit Number Payment Information Instructions WEL Receipt Number 1. Complete Part 1. Incomplete applications will be rejected. 1{• 001D ❑ Cash 2. Attach a detailed plot plan. ❑ Check 3. Clearly stake out or Flag the well site. 4. Submit application and appropriate fee to Mason County Date or Payment Public Health. Refer to Mason county Environmental Health Fee schedule for cost. PART 1:Applicant J Parcel Identification Water System Name Panhandle Lake 4H Camp Site Address 370 W Panhandle Lake Rd.Shelton, WA 98584-8923 Applicant Panhandle Lake 4H Camp Phone (360)470.4870 Mailing Address 370 W Panhandle Lake Rd City Shelton State WA Trip 98584 Parcel Number 520354160000 Directions to Site From W Shelton Matlock Rd, take W Highland Rd to W Panhandle Lake Rd. Turn left onto W Panhandle Lake Rd. Water Source Is: ® New ❑Existing System Type: ® Well ❑Spring No.of Proposed Connections PART 2: Health Department Review(Staff Use Only) YES N NA ❑ IP�L`� ❑ Evidence of existing sources of contamination within 100 foot radius of water source? , aH, (tlrainfields, tanks, buildings; indicate distance on plot plan) 11 Al5 Q o 4 d l ebxky y s ❑ ❑ Are there roads within the 100 foot radius of the water source? If is road private, County or State. What is distance to ROW? ;lOF4- 1055 2 [� El El Does the ground slope away from the water source site? (s4iow slope on plot plan) ❑ ❑ g Is the well rap satisfactory? ❑ ❑ r�1 Screened and vented? W The well casing extends above level ground/concrete slab? (circle one) ❑ ❑ �} Is there evidence of a surface seat? ❑ ❑ Does the seal appear adequate? ❑ ❑ Is a variance necessary for well site approval? Com is we (( 5 �L IW Cf- f tl 61 F( Cd4d M� *'-Z& Pass ❑ Fail Inspector W 1 Date —J .Z This form rnav be scadmiltiladd available for public view on the Mason Coun Web si e. firopeclbn, cbhn is made,eXP a a" " dlti ure _. proval.Wetar system aPP.Val is a two pan process. 1 Uie water system design may lb wlxdded far review J9EH Fonse DRINKING WATER FORMS1Dnnlang Water Well Site Inspection App.docx Revised: 1/20/2017 I Planning • Management • Engineering North%est Water Systems �, P.O. Box 123• Port Orchard, WA 98366• 888-881-0958 • 360-876-0958 www.nw atersyslems.com July 16, 2024 Jeff Wilmoth jwilmoth@masoncountywa.gov Environmental Health Mason County Public Health 415N6th St Shelton WA, 98584 Subject: Panhandle Lake 4H Group B (ID#65913F), Well Site Application Dear Mr. Wilmoth, A well site inspection application and supporting documents are enclosed for the Panhandle Lake 4H Camp Group B water system. The system is currently approved as a Group 8 and is seeking approval to become a Group A TNC water system. There are two existing wells on the parcel (No. 520354160000)as part of the water system. Both of these wells have no well log and thus there is no confirmation of a 18 ft bentonite seal on either well. The wells also have septic systems and parking lots within their 100 foot Sanitary Control Areas (SCA). The camp has chosen to pursue drilling a new well away from these areas of potential contamination. The proposed well location is 265 ft east and 227 It south from the northwest comer of the parcel (No. 520354160000). The 100' SCA is located on camp owned property. A dirt road for logging is located approximately 20 feet from the well. This road is only used by logging trucks about every 5 to 7 years when logging activity on camp property occurs. "No Parking" signs will be posted along the portion of the road that is within the SCA, as well as a ditch will be installed between the road and well that will divert any runoff away from the well. The proposed well location is an improvement from the existing well locations while still allowing the well to be within the general camp vicinity. This will allow easy access to the well for maintenance. Additional documentation of the sewer component locations are provided. Should you have any questions or require further information, please feel free to contact me. i Sincerely, NORTHWEST WATER SYSTEMS, INC. Allison Whittle all isonanwwatersystems.com (360)876-0958 ext: 121 1 1 NOTES: LEGEND SITE NFORMATIONPROVIDEDBY:THECUENTAND PARCEL BOUNDARY MASON COUNTY GIS EXISTING WATER LINE THIS IS NOT A SURVEY.PROPERTY UNES AND 0 EXISTNG SEPTIC COMPONENTS ELEVATIONS SHOWN ARE BASED UPON ME AVAILABLE ---- EXISTING ROAD INFORMATION AND ARE APPROXIMATE ONLY. PAVED PARKING AREA DISTURBANCE OF EXISTING SURVEY MONUMENTS IS GRAVEL PAFtI(NG AREA OWN MISDEMEANOR UNDER WIN SB.OA.015 1 W SCA WATER LINE AND SEPTIC COMPONENT LOCATIONS SURFADEWATER PROVIDED BY THE SITE MANAGER.LOCATION IS APPROXIMATE. Wp / ROAD __ PICP D PARKIN6 LOT —_ — — — — .L. WELLI F1EV.AA' '�EIF/.Y20 SE.EI EMbTP S. _ ___ WELLY EMSTM Eusm2a _ _ PANKNDLOr EumHlou.sE .s' E%WENS�LL1 ❑ ELR.41Y_ PWPHOUSE �ExISmq LUdf• EIEVA29 ELEV.N4 _ SERVDE. E%9IN0 wnmR V EV ELAIP E%WTEq KRCNEN PANfUNMELAKE SERVICES ELEY.O15' E%6lNG 9ATx KOL6E ELw.nv YIX151ER PUMR M SERN " E%ISTINOIKI 131. TPNSM2501S'S(q ELEV NO' 49A3AC°E9 4�gMEVEEN �e GN WASNA4,Bob •' AIE°^WK1°M ...�PANHANDLE LAKE 4H REVS ION 240102 SITE MAP -'July a 1016I9 NORTHWEST WATER SYSTEMS, INC. �j WAL XX cesIDN-casuLnNG-NMUGEMENT rA'S'TKNJAL P.O.ROl(121 PCAT ORCHARDWA� 1]�1 S]80'GB