HomeMy WebLinkAboutWEL2024-00030 LYNCH RD LOT D - WEL Application, Design, Letter - 6/6/2024 ® MASON COUNTY /15N6 HLFAIR, ,SHELTON, .EXT 44
9HELTON'360427-96]O,EXT 400
BELFAIR 360-2]5-046],E%T 400
Public Health & Human Services ELMA:360 825 ,EXT400
FAX:360427-M7
SPEAR ET AL LOGAN & BRENNA
ANDREW & MARCY SPEAR
SHELTON, WA 98584
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2024-00030
XXXX SE Lynch Rd
319024190004
The 2-party water system, Lynch Rd Lot D (3190241900041319024190003), 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,
David Anderson
Environmental Health Specialist
Mason County Environmental Health
�/19� 7azy
aMASON COUNTY DAM Rx _
COMMUNPPY SERVICES
B,iIM9rY^MEmim,mislMcM.CnmmuiryXaltl,
"54S. - I
415 N.6°Sven,(Bid,8)—Shelton,WA 985M WEL'A-a 'a _ 3p
ShCiron: 360 27- M x40il Belfair.364275 4467 x" Rim:160 481-5269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APM c., MIOIIE
Logan Spear 360-239-1541
' MFLING gppRESa-aTREEi,GTY.MAIEDP
1661 W Shelton Valley Rd Shelton, We 98584
Pr1E ADMESS-SmSET.CRY.STATE,DP
xxx SE Lynch Rd Shelton, We 98584
PWMMY PARCEL NUMBER nwiL ME)
319024190004
SECIXIpARY PARCEL MUMMUS FM AMl1CABLn
319024190003
WATER BpURG9 ..ETYPF PARCEL 1 LOT WE PARCELSLOTSIZE
12 New El 0 Well ❑Spring 1.86 1.86
PNOPOSEO WATER SYSTEM NAME REQUSUEO)
Lynch Rd Lot D
M ECT DESCRFrWN
Install two party well to service a single family residence on lots C and D
MAECTNIMSTOSRE/CON WONS
US HWY101 South from Shelton to SE Lynch Rd. app.4.3 miles out Lynch to site on left side of Lynch Rd
Site Plan:(may also be attached)
(properly Wunaanes,struchlres,Well site W/1W radius,drivemys,roads,sepridseWer aRnponents and lines,easements,etc...)
See Attached
JUN 06 2024 D
Bv�
Submittals Checklist:(these additional items will be required for approval)
W Satisfactory Bactenalogical sample (this may be defamed If well is not yet drilled)
�[ Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled)
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 scanned and available for public view on the Mauss County Wab Sam Revised: 10/13/2021
Page 1 of 2
..._. _.__..Staff Use Only
Review Step 1: Well Site Inspection:
YES NO NA
❑ $J ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields,tanks, buildings; indicate distance on plot plan)
❑ Are r there roads within the 100 foot radius of the water source?If so, is road private oun or State.Qtj ❑
What is distance to ROW? (0(J�
❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan)
❑ ❑ Is the wel I cap satisfactory?
M ❑ ❑ Screened and vented?
❑ The well casing extends / above level ground/concrete slab? (circle one)
❑ ❑ Is there evidence of a surface seal? Lat., •1l I601 f
E] ❑ Does the seal appear adequate? 40Ar —1 jj•01W
❑ 4 ❑ Is a variance necessary for well site approval? T14 l ffrrIq .
Comments f141 s uajn ki'' le OLk�1 - �►15P�f� 3/t y lwt y, Su. �
rV
/ Pass ❑ Fail Inspector Date 1,3/ZOn
Review Step 2: Two-Party Review:
YES NO NA
�1J ❑ ❑ Water Well Report with adequate pump test on file?A2dd/n onlamyO/I NJG/Ml / r� ZS6<n for6BM h[6sar/gl�
If NO,date of Capacity Test aK?rM& Driller 001,111 __GPM z Z
❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Ali/Z
�$ ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN 7 2 (y Esc/ _ _
❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments > 7
EyApproved El Denied Reviewer Dala /(�11A72
Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. No claim is made,express
or implied of the future success or failure ofthis 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 a8 new wells drilled after January 19s.2018per FSSB 6091.
Revised: 10/13/2021
This form may be scanned and available for public view on the Mason County Web site.
Page 2d2
�a
JUL 1 9 2024
RECEIVED
WATER WELL REPORT =DEPARTMENT or Notice of Intent No, 10MEW75
ECOLOGY Unbm&ulg Well ID TEN No, BFi 193
T,w Work: Mersa W.W.".
❑O Cnmrmdon Site Well Neme(ifmmetlmnmm Well)
❑ Demmmissiun o Ori®ml caalbdon NO]No Water Right Pelmil/Ccnifeme No. _
Pmpmrd l'ae: ODwws6c ❑INWuI ❑Muicyrl Progeny 0.Nerve Local Smar
❑massei:g ❑ImIcah"R ❑Tint Well ❑pbr
Well Sveet AddreM SE Lynch Rd
*ilea, all Mand: City Shelton Count Mason
M Dew wet ❑other n ❑omen ❑Ah- ❑Obk Tml Y Y
❑twepmmg ❑odm ❑one G A;r- ❑Md-Epry Tax Parcel No. 3190241-90004
lamwskaw Pa,merofbawe8 n re216 A Was m a variaeappooved for this sell? ❑Ym INNo
Ikghof.wmpkwewe11215 R
C.unecdee Dwails: WWI If,,What.,,here wvc,fix?
Cuing Lion Diemen Frtm To Thickness Swl NC WeMM TMe1
p ❑ a n 9 all .25 in. 0 O N 1 ❑ Lacetiophes imbucriemsmpa 2L OWWM rcO EWM
❑ ❑ — — n. ❑ ❑ ❑ ❑ SE Y.-Y.of the SE Y.;Smtbn 2 Towrp 19N Ren9e 3W
_
❑ I ❑ —m. W
❑ ❑ ❑ ❑
❑ 1 ❑ 6tiwh(Exm O315 nple: .12 ) 4].18010N
� _ — in. ❑ ❑ ❑ ❑
LorgitWe(Example:-120.12345) .123.01428 W
Parbmd.me ❑Ya mate Type ofped'aawr wed 11r111w',LOP/Construction or Deeomadmian Praedum
No.ofpMmtbns_ Risoflvkntinu_m5Y_u Fomation 0.xriM Ey color.caannn,aiae ofmatmnl er0 suucm:e.vd the kiMa:tl
Pu6nbdfiom_6w_n.habit pwudawfiw mnneofthe mnb:iel of eacM1 kyer pnieuated whhrt lean owenq W<xn clump of
Sc— 51Yes ❑No MKP vrb D.*_L kfwmniow Use Mditiwelahmifismaim, '.
Mas.fa m.r's Nerve ANov MeeMne Wales Material Fret To
Type W4re-WfaDOed Model N.
pnma<r 5 slc a-c O10 oa 6we 211 n.w 219 R BtpM148 G IORI11 0 3
^. ar Slotsiv_inemm —fir.—S. Britain fine Undy sNlbourtl vel 3 12
Dark orgy SIX.ft 12 14
swid/Fdnr pack:❑Yn Wks Rise are"vicarial_in Blpwln A.stately NN dry 14 Is
Mwadau pima own_Rw n. Grit fine Ilt,dry 1B 20
Saelxe Real: W Yaa ON. T—beedspL? 19 ft Gray 91W clay 20 62
Mamid wedwast Bentonde Gips
Did nnysaancoonin unwabbwelell ❑Yea ONo Gla SillyM day. .1 ISMS
02 54
Typeofwnen DepM1-I— Bfo'M1 fine Tally,SMM ,armeelly on B4 ]2
MwbdefaedtMehataoR Brown fine to rakian silly warkly grEMl boas 72 91
Brown fine sarM fine to rnMium Riches.Wee s 91 104
M1mF' Mmuicw:n'.Nanm Type: Br.fires to meditern a@IEWrd aBDtl,shimp 104
x P.— Piece strike,depth_n. Desised Rsw rum'._apm ravel paid,rrmlet 125
wMec Leveb: trod+cafika —imiarocx:aaauraek.cl IN R. Grey rave day 125 136
Slbbupofilefwenmise 1_8 R.rore gmud noRee Gray fine sandy sill 136 in
Rmic .teal Ill n.below eyufwrn aeairy DUR/1fl24 Fills to mucks gray Feat,Wel.tarvii 153 203
Mnian pevwe_IN,Pal apace ask Dale
An<.ian wmerbmvmltm by Irv.wlw,m.J Cast,fine to course smed,fine to heappre, 2IX1 l
Wdl Titan: InuN1-abretl gossel,hathigaiwater 216
Wmaplmpoemeperfem.d? FNo ❑YV C bywlao?
YieM_Wm wnh_R.dnwdowoaBer_6n.
Yield_min wirr_n dnwdowe efier_hva
yield!_epm wRM1_ft E�ra-0own eRn_M.
Recovery Maoiea la.Pm^piawsal.ff wrbwl mvmaM homwen
ap wale kwD
Two Weurlewl Time Wna Lev<I Time Water L<v<I
oeuafpunginS nal �
&ikrwn_y-'ah, n.dnwibwoanm_hn.1
Amite 25 pow-osm Beal 140 n.bra M rite WW4
A vdmn Mw_,i J
Rnpenune ofwua 52 •F wu.clmnded adyskomde? OYn File Sinn Dace l925f24 CanPlated Dale S125f24
WELL CONSTRUCTION CERTIFICATION: 1 camruGN enNa aaryt rmpansibility facmawctim of Mis Well,eat iN campimmm wth ell Weshingtm aWll
consuunion atendaNs.Materials usN eat the information reported above we true to my bed kmWM9e eat belief
❑Thriller(NTrainee❑PE*N. �w Ddllin Can n Arcaia DGlin9 I..
St metreAddress PO Box 1]90
License No.3441TCry Stace Z Shellm WA 985M
IFTRAINEE.S on is U CSnlrRicas
S sa's Si remRegdmton No.ARCADDI098N1 Date fl28f24
ECY050-1- comemmmallcm irOm 1,PfmnmffeheWnrerRaoorcxsPammo1360- O?] 72 oriwkw' gmn Relaf Srrvke. Pemom wahaspeerh AsaMGrymn mll8]]d33L341.
Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA.98584
Customer: Logan Spear Well Tag#: BPF193
Site Address: SE Lynch Rd, Shelton (#3190241-90004) Depth: 216'
Date of Test: 7/2/2024 Static: 112.9
Pum Set: 180,
TIME GPM LEVEL RECOVERY
1 Min 5.7 113.8 TIME LEVEL
2 Min 57 113.8 1 Min 113.5
3 Min 5.7 113.9 2 Min 113
4 Min 5.7 113.9 3 Min 113
5 Min 15.7 114
6 Min 15.7 116
7 Min 15.7 116.3
8 Min 15.7 116.2
9 Min 15.7 116.2
10 Min 22 116.2
15 Min 22 118
20 Min 22 118
25 Min 22 118 �(/(
30 Min 22 118.1 9ppZ4
35 Min 22 118.1 RFCF/V
40 Min 22 118.1 fQ
45 Min 22 118.2
50 Min 22 118.2
55 Min 22 118.1
1 Hr 22 118.1
1 Hr 10 Min 22 118.2
14
YanpaM tau Ory
2635 Parkmont Lane SW,Suhe A
Olympia WA 99502
Trfttg6TD 360-967-7010
COLIFORM BACTERIA ANALYSIS FORM
WeSw"CokcW TYM Sampe Camp
07/02l202A om, a» MASON
WN W YM _MN
Too dWM SysW(tlaU"M bo)
❑GMFA ❑G'aga �OMa__
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AN SPEAR
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- L3M
SAMPLEINFORMATIWI
S"VM w Neo,l emerSHAD JUC 19
sp.*trees'd wagN wYactN svaoa vnpucamaccmmeMe RfC;. .
NBPF193 SE Lynch Rd,Shanon J
TyPMfegle dkJeM"O'swo tom bpM I r-'05 WON)
! ❑ROUSNObb4aa�U"JA% 2❑ gYwNaNMrWP1
CabWw Yee_No_ aewuYmsymarerwe moral
uaeeFebpbry areYm`p aenee�
CnvNaaeFkW.Tod_FM-
3.GMIUW WWr Rak 5a I fta ft �.
I I
DbWtod YM-__No_
❑Tiggm (A4) Chkme ReeEwt TOW._Frta._
❑Aateesmenl(AF)
A 5unauwdW Ram SMNe WeMaeaile(EwTmNpoa) ' Q
❑E.cM ❑Fetil F,r,a r._w__._ L�1�L
5.■Senale CaMaMbpMWkn 0.N
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑uo'a'h ryTMICCJY PrawnW �SMIFYebry
❑EpoYv ❑EnoEa
BacexW pMkyRMuN'.Tool CaldartL-_ 110aa EYW lfOMA
ReplepnmMSanFM❑"°0-a aa'pp. Vcg anm [J OdrtWen CanaYeCr
❑a eowR iftd: ❑TNI ew
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a
ea,hpaw mna! ueuw aA
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285-
2213754 MASON CO WA
0126/2024 0202 PM NOTCE
(IIIIII IIIIII III IIIIIIIIIII IIIIII IIIIIIII I'lll lull lllllll111lull lull llll llll 2
Return To M
140 1/e �ifi� 1+'t I/' /Z� ✓U� j
sl,e r Fen 111A- 9954y RF�F/�jOjs
Fa
Grantor(s): (1) LOW- 5ge r Bren& gi , (2) in" ,.r�u�OT
Grantee(s): (1) PUBLIC v K/
Legal Description (1)
(Abbreviated Porm:r.e. ott�block, plat d,section, township, range)
Assessor's Tax Parcel: J—
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) L��?'�-�' - 3
The system owner is responsible for keeping this system in compliance.
The name of the water system is: LyA 'h Q 1 Lef D
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_Z6±01 day of , 202!�-.
Signature of Grantor(s):
Page 1 of 2
State of Washington )
County of Mason )
I, the undersigned,��a�N��,,t,ary Public i anr�for the above�na��med County and State,do hereby
certify that on this j0day of `
pe onally appeared befo me, Who is kn to e
signer of the a ove instrument, a d acknowledged that he(s (they)signed it.
GIVEN under my hand and ofricial seal the day and ye r last above written.
r
Notary Public' d fo the State of a ington,
residing at
s ,.
My commission expires:
♦y,VyYW o,WNJ. -
Page 2 of 2
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