The URL can be used to link to this page

Home My WebLink AboutWEL2024-00039 - WEL Application, Design, Letter - 8/2/2024 MASON COUNTY 415 NBTH SH ELTON: , 0427-970,EXT 0 40 STREET, SHEL ON, EXT 400 BELFAIR:360-2754467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360427-7767 Lukkasson, Rick PO Box 2166 BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2024-00039 321 NE Katchemak Ln 123212490082 The 2-party water system, Lukkason Water(123212490081/123212490082), 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, David Anderson Environmental Health Specialist Mason County Environmental Health CO UNTY OUNTY COMMUNITY I Y SERVICES eua�arr.,usEm�a,men�xwTcam..WNw, './ RII_ 3�.,'\ 415 N.6'Soco,(Bldg 8)—Shelbn,WA98584 WEL aouv � - OU J q Sheltm 36 27A670 x4W BeMir.36 275�7 x" El 3604823269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION Man (eQ - 21-Y257 MAODRE53-STREET. / 4J 1- 2eJfAilk WA yI &T POORE09-B Ru�RY,3TATT k 4 5zs PRIYMY PRRCEIF^NUM BER I W Ell ern iz 21 -24 - 9oo£s! aFr j 232.1 NDZ�e��bvF/2 NATERSOURCE SWRfETYR Nwxisting .8.11eTa� P ILMa� ❑ )"ell 0 Spring ,70 Acre .69Acr t5 PROPOSM➢ ERSY r l ' D) PROJC �•VV••fA— y C� ME CT MT03OEJC0N0IIpN3 ra ar � k Site Plan: (may also be attached) (property boundaries,stnlctures,wall site wI100'radius,driveways.roads.septa/sewer camponeMs aM lines,easements,etc...) 9U�69 S,2a � Submittals Checklist: (these additional items will be required for approval) IR Satisfactory Bacteriological sample(this maybe deferred if well is not yet drilled) Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred I 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) The form near be Manned and available for public view on the Mason County web site. Revised: 10/13/2021 Page 1 of 2 -------'----------'--------Staff Use Only---.._..-------"-'----------._..__�. Review Step t: Well Site Inspection: II YES NO NA ��j✓5(f ^-SD i f(sOCA ZI N ❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfiekls,tanks,buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 foot raiiius of the water source? If so,is me privet County or Stale. What is distance to ROW? —W ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? r�y' ❑ ❑ Screened and vented? Old yr(40 ❑ The well casing extends 4 rs above level ground/concrete slab? (circle one) �l ❑ ❑ Is there evidence of a surface seal? Lq f: 4 9.`(PISS ICJ ❑ ❑ Does the seal appear adequate? LOA: -ILL ril/P "M ❑ Is a variance necessary for well site approval? rag NPq L, Ir0 vjrvle l Comments ? 'Pass [I Fall Inspector Date Review Step 2: Two-Party Review: YES NO NA - �L fist ❑ �J ❑ r^NI Water Well Report with adequate pump test on file? 6.7 4�n K 2yo - If NO,date of Capacity Test R 11013 Driller ^ fI N/ J GPM o l� ❑ ❑ Received Satisfactory Bacteriological Analysis? Date oft st i'MI K�LS ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z 7 140 TS ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? ,Comments / �l Approved ❑ Denied Reviewer Date Findings in this review reflect observed conditions as thev existed on the day of the site inspection. No claim is made,express 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. All proposed connections to new wells are subject to water adequacy requirements at time ofbuilding permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled ajierJanuary 19v%2018 per ESSB 6091. Revised: 10//32021 This form may be scanned and available for public view an the Masan County Web fits. Page 2 of 2 P4 , 08117PA13 TOP DOG DRILLING CO. s00 DAVID BROOKS SITE:21 NE GARRAC LN BELFAIK WA. PUMP MODEL 7LS05 PUMP SETTING DEPTH 149 ft STATIC ON WIM4013 121.5 ft DATE TIME LAPSED DEPTH DRAW GPM OW1712013 DOWN 3:41 1 125 7 3:42 2 3:43 3 128 7 3:44 4 3:45 5 131 6.9 3:50 10 142 6.9 4:00 20 146 6.9 4:10 30 148 6.9 4:25 45 149 6.6 4:40 60 149 6.6 N,�k ��wsi- M276 Tvely. Seek �� SPECTRA Laboratories- Kilsap PeWebO,WA ._Wrrm emn.enm 9SSm BACTERIAA (SIS FORM (30)n9-5ut � M. Dole SWO Cretlr Time Sample COunry o7l III 2ozy umkG Om . �,: om. MkSDnI Typaofw Sjsbm(tlrA6ro9anbora PriveTe Gnwp Aeno Gray a 6WMrrla-Rwib M1Om W�FeWtlae lrmmnMllYFn: SPremt Nmr: Cmbd Pamm: GaPnra:3W821-4L57 Crl%,a: 1 2 Ear:Wbj_Z-MY.L 401. .Pharr 9Mmmle Y[M.rrY�.r...em�arrrr.A.w.nwlq Sample colt by(name). Speckb mpn"ere sample colleck6: SperiloWUSsacannri: zq N B G4,P ck Al,L BetcAr2 WA s9azv,- 'd- fwa Type oo srgle(tl.rA"am hmo. 1.Wounme olaMbson Sample(AM) 2.❑rtWW$MWb q C%nnateo.Yeso ME) aormuele.r•ynaewr....r.a•) UraSemcmrymUma W nnEr Chbtlne Resitluat Taal_Fnn_ i S.Greud war Rum See.Srple ——— ————— S UmaWOKbrynWmrrd6ele: G Chkw b :Yr_Np_ ❑Trys.e6 M Chrme RaelaN:Tamt_Fr— I.EwM erGM Rw Seur WrerlYryle(Emmrrr) ) S ) ) ) E.coo ❑Faral 5. e�{b Cole[WbwweWYrOy. ❑UrsMmmtlrYTaWCrbm P,errA eaet lldewe" ❑EmPpraml ❑E.mlebenl BererlelOrelq RemN:TOW CaMMm- ---Pw nY.Eer_awow Feel G. ch1fM3,,Y. NPC Wr1m. Repmeemeroetple Regru6: ❑TNTC ❑SmpM 9n ale ❑ Sampm Vrum 00amead Cophaar ❑ —0/ Reugl Tempel ' Rrnecea. I t MAIZEA y� e.mwe. DoYKum OY(� � II Lal �e•ee•r�M m.�e�r�YY .)1/L J Y"u y.�r•nn`n•"a�mwrr""e CIO wnnT.nF aYYYmrryaYrmmlmlYey.lm i pI Spectra Labs - Kitsap,LLC (Poulsbo) J l SPECTRA Laboratories-Kitsap 26276 Twelve Trees Ln NW Ste.C Poulsbo,WA 98370 Phone: (360)779-5141 www.spectra-lab.com Spectra Labs- Kitsap,LLC (Poulsbo)received samples for Rick Lukkasson on Thursday,July 18,2024 at 8:29 am. Unless otherwise noted,all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures.A summary of the samples received are outlined below. Sample No. Description lacatiun Sampled 242079-01 Private Well 21 NF Garrick In House Faucet 07118/2t124 7:30 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360)779-5141 or email us at www.spectra-lab.com. Attachments 01) This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.D you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not he reproduced except in full,without prior express written approval by Spectra Laboratories. 0722f2074 Page I of I 2214055 MASON CO WA 09102/2024 09,3e Bn -'- RIC�IKKlt^LWIKI11 SSSO Fn2.�p12IIm Fe�c��ppF�I��Ifpp3yyr0��4 SI11Cf`Glla��pex. 2 Return To t�tkk ,a `r?&-t3w_ 2l66 r tIVi►t'Q 04, ggsz� Grantor(s): (1) k),dyIR5 Lgkkthssod . (2) Grantee(s): (1) PUBLIC Legal Description (1) l o-rx 216b 300 ?Tu DFSE NbJ (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1)_L 2 2 -L - Z-5L-� .SJJ -1-23 - h'l 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) 12 z L- 2 L4 - 9 Q D K Z Tax Parcel: (Connection 2) _Z �-aQQg Z The system owner is responsible for keeping this system in compliance. The name of the water system is: L uJi&-maaJ W e pep 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 it the water system exceeds exemption standards. This system OoW has not) been granted one or more waivers from specific provisions of the regulations. Dated on this_J U day of jv, l y 20 A14 . Signature of Grantor(s): Page 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this 14�" day of T—Iy 20 tY M��•f•s L„kk�,,,� personally appeared before me,who is known to be signer of the above instrument, and acknowledged that he(she they)signed it. GIVEN under my hand and official seal the day and year last ve writte . Notary P blic in and for the State of Washington,ONS residing at S- 1, O irl s44 a._k U- pJL.:t,�A lf"$ lic no N My commission expires: "1 /So Ice'i HENRY02/devul 30, 202r Page 2 of 2 � To � � 4 r 6 z YY E R C F ,+ .p , m vlJ �k N j ———_____—JV'ty f3D f;D ; O a a �- $ a o 0 w b . . . . . . . -,2 % lope a !. m n'' Pit 1 j t t,OT PPROVE I MAY 14 2024 N i� MASC CCJ�TI EY,,n-5ME0 L H 10' RET � m ": w i Katchemak IN .8 85i pp P+ # � IV 0�� N O �� `�F C '2 o N CDs 3 � 9 � ' w 0 0 al � 3 E