HomeMy WebLinkAboutWAT2024-00137 - WAT Application - 3/11/2024 MASON COUNTY
COMMUNITY DEVELOPMENT
vemn nssimna cmur.sundin¢.vumdna
415 N 6-Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ex[400 O Belt 360)42�787 x14D0 O Elma:(360)482-5269 ext 400
FAX
Application for Determination of Water Adequacy
Instructions
11. Complete Part 1. No detemlination can tte made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application,with any required attachments for review.
4. Ana roved building site Ian must aocom an this application
Part 1: Applicant/ Parcel Identification
Name on Applicant: Phyllis Eickhoff Date: 3/11/24
Mailing Address: 411 Mill Rd Apt 2D, Adrian, MI Phone: 517-260-4831
Parcel Number: 22309-750-0220
Type of Water System Reason for Application
�/ 00330
❑ PubliclCommunityWoter System(2 or more ❑+ Building permit 'a(.l�
connections) ❑ Division of land:
❑p Individual water source(one connection), 4 of Parcels?_ SPL
M Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain) ❑ Replacement or Remodel(please indicate name
If you have more than one residence connected of water system below if applicable—no
to this well, check the PubliclCommunity,Wafer signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System:
Water Facility Inventory(W FI)Number:
(write"none'for two-party)
❑ 1 am the manager of this water system.The water system has been approved71inee
.There are presently connection(s)in use.This will be the❑ 1 am me manager of this system.This connection will be to upgrade or changtingconnection on this system(i.e.:recreational to full time).Please indicate on thnature
of this change:
This water system is able and willing to provide water to this(these)connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager
Date 3/11/24
This form may be scanned and available for public view at www co ma�n-IWa,i
i.
J:\EH Forms\Drip gWater
Individual Water Well
Water well report(attached to application). Depth `U
/pU Well capacity Test(attached to application) a "" " epd.
/ The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test,which provides stabilization of draw-down and recovery data, must be performed
bY a licensed contractor.
f� Satisfactory bacteriological test(attach to application).
[[[ "' Water Resource Inventory Area(WRIA)
Development within which WRIA http//ais.co.mason.wa.us/)Ianning 14015961EQ 22Q
Water use or limitation recorded................................... WA Yes t�,
Well Drilled ............................................................... Date i J cf
Individual Spring/Surface Water
0 WDOE permit(attach to application)
0 Method of disinfection
0 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Date
Relationship to Applicant
Part 3: Mason County Community Services Evaluation (staff use only)
❑ Satisfactory Determination:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable W DOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Detemiinadon of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
❑ Unsatisfactory Determination:
Applicants water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
CSD Director: Date 2 orz
Dd.lwt and P�nl cubs wnnREPORTnaDDNdm ND
.IeP.ia—Mo6L rEeRF (mar WATER WELL OT
rnrrd cmY-Dam rb T++Pr STATE OF WA9B1NO2'ON
(1) OWNER- N Roa Delost F. 0 Box,-6o2a beer- ran7r a:ar-sL� WI
_ (2) LOCATION OF WBLL: cmmv.. Maeda .___.__._.. .._ __ ..... ._.__ -SE u_.NS.4 sn-9 T.23.N..a. 2Wwat,
bona(vvd dNbwe Dom aeellw or rvpuhuan sem=r , __
.__
1D WELL LOG: 23-02-91i
('3) PROPOSED USE.. Dwmdm�(1 IvdNaxl ❑ w_-mm❑ ( )
rrtlnMv ❑ T weD ❑ ma, ❑ .rAmO tAl[N.a D1a[arlaef DY s.ram.wvkbdiM viWumr�t 11i IK mmnNN In M{
yrv.mle�wjn at 4N1 aN lry lx exp.+m�v. of fe_rawlm:.
(4) TYPE OF WORK:
n.w weu acewed:Don ❑ Dw.d ❑ ro - can &MVe1, 01
.v
Daen ❑ ab
ed D4 ElDdxa❑ -dim sand Wave]. o7.a Sit
AxondlWned❑ au4y0 Jetted O - _ ..
(5) DIMENSIONS: m.mWY of w.lr 60
Drwed 13.1 .. rt. D.DIh a.omabbd wau 13].-_- ' own gratre�5. eastd - 6Q - 103
own sand ssavel wets;_ . . .7Q3, 131
(6) CONSTRUCTION DETAILS:
Casing 1Dstafled: 6.. •• D:aD. tmm_0. .. R m..12-r'l- _ _..
wesd.dlJ _r D4m.inm J ..N.m___ n e o 1 1 ft. 1 8 _
Paduratiolm Yx❑ N4 e op 0 ticker 1 f
pe 1 tt. i_ .-...
in.
Nrmnt4ro from ._..... R m ..___ _ a. OTeen OVB .:
.»... . xronuWw nxn . ... _ n 1D _..__. .....n- tatre head
_.D
in
-
•.•
Sereem: Yn(L ND❑ 0 O 11 M 310
Mmue me�♦.,N�tmQve _sLQilas($_.....__._..._............... __
-
m�.. .6._m.r.at.020.fibbb, 126n.m.131-
Geavat peeked: vxQ Ny{7 sm Dr anver:.... -.R _•_— _�_ ._- --
cnxlW.xdtnp.._ .
Slsleee seal: Yx aw❑ 'fie. aeamt
mW1.1 wd 4 na.....tlei Ylorl . 13 -
lid ..Y .lr.b cePtun unuNb4 w+Rr1 Yx❑ Ns0 �_ .. .�__.... .-----•- - -
r
••-
mlavd Pf and".1.Da r
. r.. ..- �. —_....
17) PUMPt mmrxl..er:Nvm.__
o Ode mranDeQ�.eVal y •_•__ ___.._...- _.
(B) WATER LEVI
-!-._.R aMv.mD vl wws Data __--
nn.WDDmeun ....._ _.. .. ma.Dvr bawl.Inch
ANxIM water b Naw14tl n, ^ IOa0.valor.lal .._ •------�-' --- ' •"'-
(D) WELL TESTS: -24
was v PvmD x t m.dvf i'x❑ N.❑ N Yn.by w"nal
vvrd:_,�--pumm•wlm _..n_d.xwna— M _ vr.. WELL DEILLEWS STATEMENT'
lrvernma the best at M kDDWbdBe end elmon and Mi. Heart bit
n.m.ery n.m Nne xYm at xm whm tamiD svlmd in twalx 1xa Nicholson Drilling y
mMaared ,, _.Campar
i • I
...•ZYW W Prmtl .•.
{,me wmx tADy{ I Tw. Warn Id.rt I Tmry wyrx LDwI layrbyu• Im,yr e.rp.n
' ......... _.. .._....... . ..._._..........................
Address.....pa_Qy.....$4?S._1.29_.PAS:E._.01`°hard.r._WA...983
. ......- .._• _•- talarredl........ . . . .. .......... .............
Dyrea - :..�" � 1
aw:x r.e a__ aNsxm.wm 7 it,drawd.wv urx.._:J;-.__m.. 0519 9-...6.... ...-. 84
Arbmm sow._._._. _._ Lrawe Na......_....__. _... - Oats..
T<m0ertlla.a[wawP .- wN a rDnad.1.bid meant Yu Q Na Q
iUn ADDITIONAL aNaCra tT NLCLa&baY'
NICHOLSON DRILLING INC.
PUMP TEST
NAME: PHILLIS EICKHOFF DATE June 4,2024
SITE: 490 WE HORSESHOE DR TIME
SELFAIR WA 98328
WELL DEPTH 131 Feet WELL DIAMETER 8 inches
PUMP MAKE uKN PUMP MODEL IUKN
TANK MAKE TANK MODEL
Time Depth Draw Ral8 Time Depth Draw Rate Time Depth Drew Rate
ramw To Down gpm to Down gpm to Down gpm
Water Water Water
c 97.5 0.0 - 40 101.7 4.2 680 0.0
1 101.0 3.5 45 101.7 42 720 0.0
2 101.8 4.1 50 107.7 42 780 0.0
3 101.6 4.1 80 101.7 4.2 15.4 840 0.0
4 101.6 4.1 70 O 0 900 0.0
5 101.7 42 15.4 80 0.0 900 0.0
6 101.7 4.2 90 0.0 1020 0.0
7 101.7 4.2 100 0.0 1080 0.0
8 101.7 4.2 12.0 0.0 1140 0.0
9 101.7 4.2 150 0.0 1200 0.0
10 101.7 4.2 180 0.0 1260 0.0
11 101.7 42 210 0.0 1320 0.0
12 101.7 42 240 0.0 1380 0.0
13 101.7 4.2 270 0.0 1440 0.0
14 101.7 4.2 300 0.0 1500 0.0
15 101.7 4.2 15.4 360 0.0 1580 0.0
20 101.7 4.2 420 0.0 1620 0.0
25 101.7 4.2 480 0.0 1680 0.0
30 101.7 4.2 10.4 540 0.0 1740 0.0
35 101.7 4.2 800 0.0 1800 0.0
RECOVERY
Time Depth Draw Time Depth Draw Time Depth Draw
I. Down to Dam to Down
Water Water War
i 98.1 0.6 11 0.0 45 0.
2 97.7 0.2 12 0. 50 0.
3 97.5 0. 13 0. 60 0.
4 0.0 14 0. 70 0.
5 0.0 is 0. 80 0.0
8 0.0 20 0.0 90 0.
7 0.0 25 0.0 100 0.
8 0.0 30 0. 120 0.
g 0.0 35 0. 150 0.0
io o. ao o. 1e0 o.
SIGNED BY:
Christopher Chilton-Pump Supervisor
Spectra Labs - Kitsap,LLC (Poulsbo)
As Laboratories-Kitsap 26276 Twelve Trees Ln NW Ste.C
Poulsbo,WA 98370
Phone: (360)779-5141
www.spectra-lab.com
Spectra Labs-Kitsap,U C(Poulsbo)received samples for Coolwater Drilling on Monday, May 15,2023
at 5:33 pm.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 Location SnmPled
227123-01 Phylis Eckhoff 490 NE Horseshoe Dr 05/152023 10:00
227123-02 Phylis Eckhoff 490 NE Horse Shoe Dr 05/152023 10:00
227123-03 Phylis Eckhoff 490 NE Horse Shoe Dr 05/15202310:00
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.
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.If 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 be reproduced
except in full,without prior express written approval by Spectra Laboratories.
06262023 Page I of 1
26276 Twelve Trees La NW Ste.C
Poulsbo,WA 98370
(360)779-5141
JLSPECTRA Laboratories - Kitsap
...Where experience matters
IOC TEST PANEL
Complete or Selected Inocganits
F
ID No: System Ckoup Type: Private
Number. Olo-/2302 System Nesne: Phytia Eckboff
Iaca0on: 490 NE T.laaee Shoe Da Comply: Mason
Sampler:
NumM(s): Sampler Plane No:
Pompano: 00. Dam Collected: 05f151M 10:00
Composition: Single Source Dam Roomed: 05/15/202317:33 Type: Drinking Water Dome.—mwA: 6262023eport to:ater Drilling CoolwmerDrilling
Holly Rd NW 10921 Holly Rd NW
rton,WA 98312 Bamnmton,WA 98312
DOHA Malyle Remik QIaL Unln $DRL PDL Ttipgm MCI ) Matwd Analyst
0004 a ND — Nall 0.001 0.001 OB7 0.01 EPAZ00.8 Ma 06r0aR3000
tmi 0.001 0.mi 0016 U.015 EPA200.8 AM OBN823D.00
NOTES,
'confirmation coutle the Oil pro number,sample number,and aianden abteafboost sample in show lab or sampler ammaeb beraon.
SDRI: (Stab Delectia RepMkg LimhO the minimum relnortabbdebcaa ofaana6le as esmblished by Me depeMwnl.
Tdppw LwN: DOH binding water responseWor.Sows with compounds deeded at concentrations in excess of his bust may be minuend to take
Modems,aproper a manila more hequt,tly.Phase omtad War DOH dnnking water regional omce forfamer infameab.
WIL: (mans mar,Containment Lowd)N she eaawnnent anlant andess ram MCI,plas.ambdyWm Wasnal DOH.Soa to bdaromb foi aeame.
NA: (NO Analyzed)In be made bottom,imposes the and,and was not nodded in me anent analysis.
ND: (Not Dwentri In me results mlumn,radiates mle compound was anspzed and not deleted at a level greater than m bone!tome SDRL
<(01h): The compound was not detected in to sample at on bodies me oonce bao (up
orally pleaded me bb mehod repwan9limiC.
dial: miagne.perawmrpampermiea.
NTU: nsphel mcWNdhyunlb(emmsumofwalarderhy). One mina ohm rantimabrleequNelmtto We mwm
pmhmkm: Micro ohms pw cmtimeler le meaare dome abM'dy MNaweterto andudelec9k11y1 per
oemm pw cenammer(ushom).
No o dding egger a MCL wile.
1: Secmdary MU(Establaoed fa aesmeac pumosas,not halm based).
ARI:Analysis performed by Analytical Resources,LLC Lab-Sampleff:23130510
Page 1 of 3
227123-02
26276 Twelve Tlreea Le NW Ste.C
Poulebo,WA 98370
(360)779-5141
SPECTRA Laboratories - Kitsap
...R7aers experience eywIt!
IOC TEST PANEL
Complete or Selected Inorgani
System m No: System Cmsp Type: Private
Sample Number. olPr 03 System Nixon: Phylis Eckhoff
Sample Location: 490 NE Homes Shoe Dr Cawty: Mason
Sampler: Cfolwater
Source Number(s): Sampler Pbove No:
Sample Purpose: Other
Date cacaed: 05f152023 HIM
Sample Composition: Single Source Date Received: 05/15202317:33
Sample Type: Unheated:DW Dve Reported: 626R023
Send Report to: Bill to:
Coolwa[tt Drilling Coolwattt Drilling
10921 Holly Rd NW 10921 Holly Rd NW
Bre
Beentram WA 98312
DOH 98312
DOH Meyn Raab OA Una SORL POL Inglor LExceed
g meow Malys Mai
0015 Handrwer Ce(:03 NO — NWrCa= 10 10 — — SM 2340B AM 05/11230:00
PH 6.76 J1a S.U. — 4 — — SM 4500 HaB KS 05119017:00
shun IIAO _ %it 0.1 O10 — — SM 556DB AS OVMi0:30
BOOB Iron 0.60 — nryl 0.10 0.10 — 0.3' vEs ®A20D.7 ARI OSOB/23000
Ni
Conermaeon monde as mcmal lab number,sample numbs,end caWeass,data of aigbal sample in eNrer lab or sample,mnmenls$adim.
BDRL: (BNter Deletion Rponal lime)The minimum examine delari of an amyl,ea i steblabed by fire deportment.
TdW Lend: DOH drinlong water response leval.Systems wdN mmpounds detected at mnrenpaeons m access of Nis WM may be required to Was
addeanel samples or mums mac haquently.News conlad your DOH drinking water mgional a.M MMe,infameom.
MCL: (Msdmum ContaminantLml)BNemnNmmantemauntexceeds Ne MCL,plesxmnfadymrmmai DOHomca Mdde,minefobeupeoems.
NA: (Not Analyzetl)In Ne rasuBs cdumn,indicates Nis oanpound was not induced In are mnentanallis.
ND: (Nat Datedar)In Ne results Worm indir Nis mmpmnd was analysed and not daNCNd at a Nwl greater Nan or epual to the SDRL
<(OAexI: The compound was not detected in the samp%of a soma me memmodon lndbabod(uwdly the lab meNod repmeng limit).
mpg: magmms per aer or parts err miaon.
i nephelomems wrddiry box(a measure Dinner dairy). -
prehahm: Miaoohms per Mbmet (ameasureof Neabileyof NewowtowndutldecViaty) OnemomohmpawnbMterissawasest°onemiw
semen per centlmarer(Wm).
No¢song bigger Or MCL value not health based(.
1: Secondary MCL(Esrabltshed ex eesNroec WTos°s
ARI:Analysis performed by Analytical Resources,LLC lab-Sasnple#:23FA510
112of3
227123-03
e
26276 TYe11a
T.Le N
sae " SPECTRALaboralories- KWW
PmU ,WA
98310
(36W)r1 5141 COLIFORM BA _.ANALVSI
DBb Sanpb Cdl.cbtl C.M. d
ow nnn 5or'
Tra a w.b ar,bm 1e+NI.Mr vw tis)
Oaq Aem GmupB Spbm-Pmmb hao Web FarA6se/m,W IwFM.
so. . PH lT5 Eck o F '..
C,WPa"ar teolW PtL p. ".TA
DR 71'/ 30 00 C.e" "
Eme9: Er Ram:
8mtl neuty I,ru�..are+MrY�ar..errosl.wrae.aq
c<eAw N.LEA AL kL& 14TM4TL Co..
SMEPLE INFORMATION
Saryle wkdW by lnnm): cp. L I✓6TCa
SpedScbWmYMmaemDl"mMiatl' SpeWlFYhoNaY arcanmeub:
Nit FEE go ASGSNof
rL
Tinof%.*(dmb"ee.baa
1.❑Rome.Di.Vl S.mpk(W) 2.❑R"Fwt mPWAP1
(nY„ea.dmn.Mem wrtmueYl
CMon,mmtl:Ves ❑ N. �ege"yaay Mubm Wb bb renbec
CSbbe ReNtluel:TaeL—Free_
e.OmmlWNrRule Source S.ml. ��yyarmuam Wbd We:
oftww.Ys_Ne—
❑TM-W (W) LmpryleRwKWTobl_Fme—
❑Aoe"voml WF)
{.Su o emR Scum WMx S"m bM Emlmaebm) I e I I
5 lammm,r
tAB USE ONLY DRINKING WATER RESULTS LB USE ONLY
❑Ue..fo"TUal CWam PMM.ee �On
❑Em pP ❑Erna b
B.c .l Drolly R.. Taal Cdihmn__Ji,W1�M.Eml_^PMIDa^1.
FaW CaAbm__cSuY00ml. WC—ewtm.
R.PI"cwroel SWO-r -W: []WC ❑SaeDl.aoW
❑ Sanpkvobme ❑DameBetl Calmow ❑
R.mMi TmYC: 111.,[8 'SM"]2.18 TL01MTlsa
. ..�YM_..Yi.uo...^.:%.
5 I07 3 ,.. . n . �m.
010
py,ymYaYlY.M11
SPECTRA Laboratories—Kitsap, LLC
DRINKING WATER SAMPLE INFORMATION(WSI)FOR
INORGANIC CHEMICAL ANALYSIS
See Sampling Instractlons on back of page
1.System ID No: 2.System Name: 3.Group(drde)
P1� LL S I;ehNdfP A B ate
4.Semple Location: S.Date/rim Collected: Lab Numb:fub ux
1110 NG /+oRSe How e S 23 l�oa
6.Sample Collected By: 7.Ssnpler Phone me r. S.Sample Type:(Circle one)
Untreated (raw) Treated Unknown
9.County:(circle one) 18. Sample Purpose: I .Sample Composition IL Souses Na(sic
Kmap Cleliam Wrerscm ° Single Source —�—�
Pierce Thurston ❑ Routine Compliance ❑ Blended —�
Island King Greys Harbor ❑ Composite —�—�
Other: 40ther,lnveuigative ❑ Distribution —�--
13.Send Report To:(Print Name,Address,Zip Cade) 14.Phone No.: g�e f 3 6_
- pOAs
coo 1.&J rie QRS L�JI)4 15.Fax No.: J
/e-jZf 140L. y Ri
u..,e/ 70IJ W/1 t / L 16.Email:ceei ✓#r-vetl RLLCrY(GIA97AlAA
17.Special Instructions:
OPrimmy IOC
Analysis Olnorgunic Chemicals,IOC OK(tsap 5(N(lN,Fq Mu LT,Cood) (Sb,AN&411•C Cr,CN,F,
Requested (Group A&Bsystetas) H,ML ,G,NOeN,NON,
(Sb,A%M,BOCdXr,CN",RRa,NVk,Tl, OPieroe County IOC Ne.Turb.Pb,Cu)
Check a NO,-N,N .CFFgM.,A&90„Zu Na, (ggAs,ByBr,C0.Cr,CN,F,Ha,Ni,Se,TI,
group hrr0.ron0.turArobr,MC.) N0,N.N0YN,FgMa,Nr4 t-kPgCa) 0Other(circle
orcihh individual
individual []Nitrate only Okelrerson County(NO N,Cr) test or write in new tat
revs We. below
EPA EPA REGULATED ETA REGULATED SPATE UNREGULATED
REGULATED EPA RF.GULnTEO
Antimony(Sb) Nitrate-N(NO,-M Chloride(CO Sodium(Na) Alkalinity
Arsenio(As) NMWN(NOs-N1) Inn(Fe) Hardness Calcium(Ca)
Bmium(Be) Total Ninte/Nndfe Mmpnese(Me) Cond..,ty Pan—(Mg)
Beryllium(Be) Nickel(Ni) Silva(Ag) Turbidity Potassium(K)
C
admiumSelemum(Se) Sulfiae(SW') Color pH
Zino(Tit) Other. (list) Chlorine Rcsiduel (etrcle)
Thallium(Tt) Free smilo, Total
UNRSTATE'rED 7oml Orgmic Carbon OrthopbosPh�P
Lead(Pb ToW Diasolved Solids Sulfide(HS)
Copper(Cu) Bromme,(BrO,') Tasmin
Simple Swanton WhTs,c
Regeeuhhed By: a
Srmph Rudved Sgodun Cmdifnueud Tenpmhn oo wad";
By:
26276 Twelve Trees 1,anc,5une C A Poul bo WA 98270A f3601779-5141 ♦Fox'13601779,5159 A wsvw Scecna-lel,.com
a:\Adminiwuive\Fasms vd Temduses\TemPlus<sVSemPle Mmiegemu�aCusrcm wFl FaemeVOC Fan Rev 61052021.dw Rsvision due 0B1619
SPECTRA Laboratories—Kitsap, LLC
DRINKING WATER SAMPLE INFORMATION(WSI)FOR
INORGANIC CHEMICAL ANALYSIS
See Sampling Instructions on back of page
1.System ID No: 2.System Name: 3.Group(drele)
014 t• LT5 6 -h N 0r1' I A B ie
4.Sample Locettion: 5.Daternme collected: 40waa I Lab N o� rah adv
Y a pigdJ(S�e E a o J.5 2 /Oo L I
6.Semple Col etted By: 7.Sampler Phone umber. S.Sample Type.(Circle one)
ceoL s.+q-TEt 34a Treated Unknown
9.County:(circle one) la. Semple Purpose: 11.Sample Composition 2. Source No(a):
Kitsup Clellam Jefferson li- Single Source
�ma 7m Pierce Thurston C Routine Compliance ❑ Blended
Island King Grays Harbor ❑ Compmim
Other. PL.Other.Investigative ❑ Distributim
13.Send Report To:(Print Nsme,Address,Zip Code) 14.Phone No.: yC d 7'30—rje ll —
1d521 /�((v) Fj 15.Fax No.:
/3rferc� TO� (AJ ,6.Ema0:cos (�4-rtc1PSLtxrLE TrVl21. ti
17.Special Instructions:
Analysis OPrhnary IOC
Requested obsergank Chemicals,IOC OKitup S(NO N.Fo Me Cr,Coxd) ($b.AaayBe.Cd.CY,CTI,P,
(Group A&Bsystems) filoftsc LNorx NLh N.
pie Ar,%.jk. d.Cr.CN.F,ne,Ni,Se,T4 opieree County IOC N*Twh Pis C.)
Check a NAN,NO.-N,CFFJA. .7^Ns, (Sb.Ae,Ea,8WACr,CN,Fjfl.NW,R
group beed.eead,M1rbmbr,Pb.Cel Nlh-N.NO}N.PeJNeJJa.M1rbfACu) ❑Other(circleweieete individual
indMdual pNitrate only p3eRerson County(No.N,cry tat or write in news tat
rem bebw
below
EPA EPA REGULATED EPA REGULATED STATE UNREGULATED
REGULATED Seaada REGULATED
Antimony(Sb) Ninme-N(NON) Chloride(Cl-) Sodium(Na) Alkalinity
Arsenic(As) NiMre-N(NON) non Calcium(Ca)
Barium(Be) Total NitrucNiftite Manganese(Mn) Conductivity Magnesium(Mg)
Beryllium Be) Nickel(Ni) Silvan(As) Turbidity Potassium(K)
Cadmium(Cd) Selenium(Se) Sulfate(9044) Color p
Chromium(Cr) Thallium M) Zinc(Zn) Other. (rim) Chlorine Residual (circle)
Free and/or Total
Cyanide( ) STATE Trial Organic Carbon Orthophosphate-P
UNREGULATED PO4-P
Fluoride(F) Lead(Pis) Total Dissolved Solids Sulfide(HeS)
MacurY(Jig) CDpper(Cu) Become(Brol-) enni
Sample Sleemart Dsn rtlue:
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COOLWATER DRILLING, INC.
10921 HOLLY RD NW
BREMERTON, WA 98312
360-830-9005
COOLWD1941QM
L A well inspection was conducted at 490 NE Horse Shoe DR, Bellair Wa,on 8 May 2023. The foBowmgwas
found.
a. Pressure tank has 20 PSI in the bladder should be set at 38. Recommend replacing
tank soon.
b. The pressure switch has considerate burning on the points. Recommend replacing
immediately.
c. The control box is in good condition with no corrosion on the capacitors.
d. The pump motor windings had the following OHM readings
BLK/YL— IS Range should be between 3.0—4.0
RWYL—48 Range should be between 11.0— 13.5
These motor windings are showing considerable age of the pump. Recommend
replacing soon.
e. 'Ihe pressure gauge is reading accurate.
f. Has shut off valve before the pressure switch. If closed there will be nothing to shut
off the pump. Recommend removing the valve.
g. The plumbing is in good condition with no leaks.
h. The well head needs a new well cap. The current one is not attached and just sitting
on the well. This will lead to chlomforms and possible E-coli in the future.
Recommend a new cap immediately.
2. A bacterial sample was taken during the inspection. Results are attached with email. The
other following samples were taking Iron,Hardness,PH, Arsenic,Tandins and lead and will be
forwarded upon receipt.
//a//
Brian Trotter
Pump Installer