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Home My WebLink AboutWRIA and Well Report - PLN Water Resource Inventory - 8/1/2024 2213979 Mason County WA 08/01/2024 11:50:45 AM NOTCE eRecorded #200074 RecFee: $305.50 Pages: 3 EMPIRE HOME CONSTRUCTION Return To biyp/26 #0NC COWS&UCT/oN LC C Po Ll" 2 Y/ A`axO, 1,,14 90`6� Grantor(s):(1) F1MAt-IWAft 60A)}�PUC770A)uc(2) Gran6ee(s): (1)PUBLIC -row"ship IQ, Legal Description(1) EVz, nid niO nu� Ex S Ate` 'Ex f nd�G H (Abbreviated form:Le.164 block plat orsecSon,townsh4 range) Assessor's Tax Parcel:(1) ,� 5 - o�3. - 0 C�0 TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA) I(We),the undersigned grantor(s),hereby place this notice on record that the described real estate situated in Mason County,State of Washington is subject to water use restrictions and conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These restrictions and conditions are based on location of property and/or Water Resource Inventory Area or WRLk , I WRL46 Maximum Annual Average Gallons Per Day: �y gallons Dated on this 3 1 day of 0i-Y 20 Signature of Gra ): (1) (2) State of Wash'ngto County of Masan- - ) Page 1 of 2 I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this 3 I St day of •Swl tom , 20�, Loren DtkVaW mrym bev h Oh e�rsonally appeared before me,who is known to be signer of the above instrument, and ac nowledged that he (s (they) signed it. GIVEN under my hand and official seal the day a fyear last ovgwritten. Notary Public in and or 1he State of Washington, residing at LongV��GU My commission expires: D o25 b.Z NOTARY PUBLIC STATE OF WASHINGTON DEENA L DOLBEY MY COMMISSION EXPIRES OCTOBER 25, 2027 COMMISSION # 74363 Page 2 of 2 WATER WELL REPORT � DEPARTMENT OF Notice of Intent No. WE55853 call ECOLOGY Unique Ecology Well ID Tag No. BPD 950 Type of Work: 110i" State of Washington 1� Construction Site Well Name(if more than one well): ❑ Decommission => Original installation NOI No. Water Right Pennit/Certificate No. Proposed Use: G Domestic ❑Industrial ❑Municipal Property Owner Name EMPIRE HOME CONSTRUCTION ❑Dewatering ❑Irrigation ❑Test Well ❑Other Well Street Address 180 W ARTESIAN ROAD Construction Type: Method: Y New well ❑Alteration ❑Driven ❑Jetted ❑Cable Tool City SHELTON County MASON ❑Deepening ❑Other ❑Dug ❑O Air- ❑Mud-Rotary Tax Parcel No. 41905-22-00050 Dimensions: Diameter of boring 6 in.,to 365'-6" g Was a variance approved for this well? El Yes ❑No Depth ofcompleted well 367'-8" ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread ❑O ❑ 6 in. +2-2" 70' 1/4 in. O ❑ 9 ❑ I Location(see instructions on page 2): ❑WWM or❑EWM ❑ 4 1/2 in. in. ❑ ❑ ❑ ❑ NW '/4-'/4 of the NW '/:,Section 5 Township 19N Range 4W ❑ ❑ in to ❑ ❑ ❑ ❑ Latitude(Example:47.12345) 47 17098 Longitude(Example:-120.12345) 123 22150 Perforations: ❑' Yes ❑No Type of perforator used Mills Knife No.ofperforations 32 Size ofperforations 1 1/4"ip.by 1/4 in. Driller's Log/Construction or Decommission Procedure Perforated from 28/64 ft.to 32168 ft.below ground surface Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: O Yes ❑No ❑K-Packer c�> Depth ft. information. Use additional sheets if necessary. Manufacturer's Name Johnson Material From To Type PVC Model No. Diameter 4 1/2" in. Slot size 30 in.from 347' fl.to 367' ft. CLAY LOAM W/SOME GRAVEL (BRN) 0 4 Diameter_ in. Slot size in.from ft.to ft. CLAY,GRAVEL,SAND TP (BRN) 4 33 CLAY W/OCC GRAVEL (TAN) 33 47 Sand/Filter pack:El Yes ❑No Size ofpack material in. CLAY W/OCC GRAVEL AND SAND BRN 47 70 Materials placed from ft.to ft. Surface Seal: O Yes ❑No To what depth? 18 ft. BASALT (BLK) 70 367 Material used in seal Bentonite Did any strata contain unusable water? ❑Yes ❑' No Type ofwater? Depth ofstrata Method of sealing strata off Pump: Manufacturer's Name Type: H.P. Pump intake depth:_ft. Designed flow rate: gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing ft.above ground surface Static water level 5'-7" ft.below top of well casing Date 6/10/2024 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No ❑Yes by whom? Yield gprn with_ft.drawdown after hrs. Yield gpm with_ft,drawdown after hrs. Yield gpm with_ft.drawdown after_furs. Recovery data(time=zero when pump is turned off—water level measured from well top to water level) Time Water Level Time Water Level Time Water Level Date ofpumping test Bailer test gpm with_ft.drawdown after_Ins. Air test 1/4 gpm with stem set at 360' ft.for 2 hrs. Date 6/11/2024 Artesian flow gpm Temperature of water_°F Was a chemical analysis made? ❑Yes ❑No Start Date 6/6/2024 Completed Date 6/1 1/2024 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. O Driller❑Trainee❑ PE—Print Name Daniel Carpenter Drilling Company American Pump&Drilling Signature!�Y Address P.O.Box 14996 License No. 2236 City,State,Zip Tumwater,WA.98511 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.AMERIPD781JK Date ECY 050-1-20(Rev 08/19)Ifyou need this document in an alternate format,please call the Water Resources Program at 360-407-6872. Persons rvith hearing loss can call 71I for Washington Relay Service. Persons with a speech disability can call 877-833-634I.