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HomeMy WebLinkAboutWAT2023-00374 - WAT Application - 12/28/2023 MASON COUNTY WAT COMMUNITY DEVELOPMENT 40 N B Street,Bldg 8,She-4467 e t 4 98584, Shelton:(360)427-9670 ext 441 O -Stye:t,Bld 275-44 It n Opp O Elma:(360)482-5269 99 FAX(360)427-7787 Application for Determination of Water Adequac fJ Instructions 1. Complete Part 1. No determination can be made=a2plication. 11 m late 2. Complete only the portion of Part 2 applying to thconnection utili 3. Submit completed application,with any required review. 14. Ana roved buildingsite Ian must accompany t Part 1: Applicant/ Parcel Identification Name on Applicant: ru f, , rak Date: f�t'plr��a� Mailing Address: 15 G 3Z LiR4 �,C, Phone: Parcel Number: u2 t 2_7_7G— g667) Type of Water System Reason for Application ❑ Public/Community Water System(2 or more Building permit o70%l7/— DIrlH?" connections) ❑ Division of land: ,D!k Individual water source(one connection), #of Parcels? SPL fir—Well ❑ Boundary line adjustment ❑ Spring/surface water Iex❑ Other ❑ Other(explain) (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 Water 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 tiro-party) ❑ 1 am the manager of this water system. The water system has been approved for services. There are presently connection(s)in use.This will be the connection. ❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature 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 This form may be scanned and available for public view at www.co.mason.wa.us. Pd Fu \Drmki Wam Revised 1125¢018 �/ Individual Water /Well) Iq�Water well report(attached to application). Depth` — v n, ram./11 1 Well capacity Test(attached to application) l� gpm Q 0 pd. 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. �// )p Satisfactory bacteriological test(attach to application). !!!��\ Water Resource Inventory Area (WRIA) Development within which WRIA hgp:llais.co.mason.wa.us/planning 14[:3 150167 22ED Water use or limitation recorded..... ....... ..................... N/A Vl!e��s_ —1 Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ I 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 WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040Zetermination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. ❑ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: / Environ. Health:�1 1 Date CSD Director: Date 2 nr2 WATER WELL REPORT DEPARTMENT OF Normoflntese No. 1?4E54992 ECOLOGY Unique Ecology Well ID Tug No. BFF/85 19 co(wmk: StannlwasAingron � omo-wlwn Site Well Name(itm«e Il:un one wel0. 11neeanmivion =1 Dnai:wlimmlkdoo Wo No. Wasp Right PP.rmil/L'emitKBm No. Pwpnrd Cae: N Dooraio ❑Its:seut ❑Muoin'so Properly Dwvmr Name \Amore NarmaV ❑Dewnenna ❑ImPngn ❑Ter Well ❑Other Censuses-Tyr: Mutual Well Street AM. 501 E Eagle Point Or B New well ❑Alnwtkn ❑Dr— ❑(mud D Cabk Taut City Shellson County Mason ❑Dwpmne, ❑pryer ❑Due 0 Air ❑Mid-Rosy Tux hurl No. 42122-76-90D71 Dieeemi<m: Douteterofbonoa8 m,m 380 R WwavariarKe. Don,.ruinei.edwdl 380 A. sppmvcd fsthis well? ❑Ya INN,, Cogeneration OeWa: Well "Yes,y hin was the Moore,far? miry LMr Deaver Fmm To Tbklow Steel PVC warded lanad 0 I ❑ 6 in 0 also .25 in. El 1 ❑ O 1 ❑ Locution(see imbuctitma on page 2): 11 W WM or❑EWM ❑ 1 ❑ in _ n. ❑ 1 ❑ ❑ I ❑ SE ❑ 1 ❑ %'.of the in. ❑ 1 ❑ ❑ 1 ❑ NW &;Section 22 Towmhip 2N Ran,, 4W ❑ 1 ❑ n ❑_in. ❑ 1 ❑ 1 ❑ Iwlil:de(Eaample:47,12345) 47.29541N w w PrrrsNa : ❑Yee 0 No iypeo(perkntm wed LoNflde(Eaample:-120.13345) -123.177M No.onerkmrlom sift ofperfinaimu_in by—in. Driller's Lag/CoseleucNou or Demmmhaian Praredurt waa:ved hma am R.M1vmw gmuod swoon Tm:mkn:Deaenbe by eolw,<Iwsr<r,eiss ofmue:el Ws.tor,mMrneki:dmd wnne o(Ne metwinl m weM1 IeW Pn'<aa'ed.wiJ:m kvl me gory rvead:<Iwnge a( Smem: ❑Yon ON. ❑K-Pckm b Dya_R. imams.. n. Ueead"orialeMee:fwmweY. Mmukctmer'a Nave Tills, Model No. Materiel From TO luseri Sistine seem _R,ro_R, Brown fine to molium allux) M sand, 0 Diewmw_ Slmse_ieirs. _R.ro a. routs mayi hampan 19 Sandrolrcrpeek:❑Yea Istria Sue ofpck:wlmiel_in Worst fine to na?diutl sit SaW and raYQl,kgBa 19 73 MNerialaplecNfrom_R.na R. fine to medium noosslgMMer 73 T7 Soefew&al: c Yn ❑Na To.se&,oh? 19 R. Btwn fine to mu ium a1 sots and ravel,8 M 77 0 MeranAused in xd BeMonile cm Gre fine to metltum si sand and ravel Bp 97 Did my sbauwmain wxubk xuan ❑Yp O No Dark brown fine to medium sand, raed,siRbound 97 100 Typeofwnrl IsNe a,amu Brown SnetOmediumsl son rieehlow slats 100 lie MaJnd Granules mu off Gre fine to mellumsa resel,sillMMer,mola 118 /23 Fame: Mwuaaturce's Nome Tyra. Gray and bravo silly day 123 128 NF pnmpin:aadep4:_11 Ileei®d naxtme:_®m Gray fine grarelty silly clay 128 135 Brown firm to medium sillysand and ,mic st 135 Wakupofii ; fesil:vfece elevnionuWve meanen Nvel 050 R, ono edlawltua1100 Stri, or li,,6 94 ftne 2 flf.an s, awDue 161 Amin wmer level 2aa R.below mPa(wan wa,N Dam B/321 Red and brouran medium sand and revel dltbtntler 141 1& nnwan arcssme_IW.pe.pwre ineM1 Dare G fine to matllumm regal and silt 181 181 Annion wmer is controlled by (us.vdvgemJ OISM and broom foe sand and grayal moist 164 175 Wdl Twu: Brown--a" tan alfthinder gravel and sand 175 Win a Pumping tau Perfi:mmd? ®No ❑Yes, o by wwm? molts 193 Yield_germ with—n.dwwdmvn aRw_hire Brown fine to medium sand and gravel,wet 193 2M Yield_1.with_a.dowdown anon non. Red and brown fits silly ravel and sand 203 254 Ykld sm wim_D nrawdowa as<,_lug. One fine ravel and sandy silt,dart 25t 260 Rmovary duo Dime=ttm when pump is mined o6wum ktel mew:aed 6om well Brown fine sill sand and gresel Z66 277 mptowwt<r Wines Green and grayfine revel and eats e1ft 277 2M To— me,Level Tom out.Level Time Wmm Lewl Brown Me gravel and sit sand 2 29 _ Black ravel and graysilt 291 81 297 Dark bravo fine sandy silt,evoM nature,milt 297 303 Da:fofp—Piny kv anilsoust a un wia_a."worries after—M Brow Brown n gravely si rl to medium Silly sand and ravel,nrmM 303 353 As. 13 ltbbintler 353 373 ePm wnn.mm m:n 360 R.ar 1 non. Dam 61324 Anaai.n Mon_spin Brown fine to m cium sard,caloW grainel,ander 373 380 TuNvurrusfwem 52 -F Waasebeminlamlyaismadd Lyn ©Na Start Date 529124 Completes!One 81324 WELL CONSTRUCTION CERTIFICATION: I eonstmddd and/or useepl responsibility for constowtion ofthis well,and He compliaree vvilh all Wmhimpon well cotmmclion staldads.Materiels used and the informarion reported above ere INe to my best kmWedge and belief 0 Duller❑Tretnee❑IT-Fort Name C Johnson Dedle a Come,Amodio D611129 Inc. 5 ��� Address PO Bw 1790 Licmae No. 3441T City Stain Zip Shelton WA 98584 IF TRAINEE:S ormor's Liarae No.20''$� Conlnclm's S ser's Susestrone Regisuatiao No.ARGAD01098KI Data WM4 ECY 050-IQ0(Rev 09JI /J)no turd his docunmmar an a11rueseAmed,p/eone call the Water Resources Program.1360407-6872. PersmumlthheannglomaenmR7llfor Washingmn Relay Se ,i,e. Persons wid�aapeea'h diraMh9:nn mll8)7dJ3-6301. Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA. 98584 Customer: Vince Hartney Well Tag#: BPF185 Site Address: 501 E Eagle Point Dr, Shelton Depth: 380' Date of Test: 6/7/2024 Static: 294.2 Pum set: 360' TIME GPM LEVEL RECOVERY 1 Min 4.5 1 295.8 TIME LEVEL 2 Min 4.5 1 297.1 1 in 304.5 3 Min 4.5 1 297.8 1 in 301 A 4 Min 4.5 298 3 Min 300 5 Min 10.7 298.3 4 Min 298.8 6 in 10.7 300.3 5 Min 298A 7 in 10.7 303 6 Min 297.9 8 in 10.7 304.1 7 Min 29T5 9 in 10.7 305.1 8 Min 297.3 10 Min 10.7 305.9 1 9 Min 1 297 15 Min 10.7 307.5 20 Min 10.7 308.4 25 Min 10.7 308.9 30 Min 10.7 309.1 35 Min 10.7 309.3 40 Min 10.7 309-5 45 Min 10.7 309.7 50 Min 10.7 309.9 55 Min 10.7 310 1 HrI 10.7 1 310 1 Hr 10 Min I 10.7 1 310.1 O'anguara Laboratory V 2635 ParAmont lane SW,Suite A Olympia WA 98502 VVETUAFD 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM Dm$A 'GOMpltl Tme Samae Cueq O6/07/2024 Da�exba ❑w MASON Typeol WaM SpYm Iaani mN aro Evl OGmvA ❑c s 0Daw Gmp A 1w Gmv a Syrwlm-Pr hum Ww FacAba Ww"(WFI la _ _ _ _ __ SYe N— VINCE HARTNEY conga Pe4On.Aroma Dm v Inc D"Ptare (36O )43&3395 car RM 1 Emae. Ere R. 1 ! 6N�1Yar(,Rmi 4n nne atlRO ed xW¢Yk samaR Y41tQ'�eM1!tlYp mm AM pn@bfi�J�y mn SAMPLE INFORMATION SHAD_ Seeofic brapm alne�e u^e+e rollecxa Spe�vxfixlne aavmmns 501 E Eagle Point Dr. Shelton T3ya or Sa�nola Ysebo car one Mro d ea+pe eqn hOea+ftm5n s eabrl 1 O Rdanr DelbWutlm SanyN Na'I 3.❑ RePaa 9apla NPI Cxmra�ee Y. Nc Pmm aaeAvax-eryemAwsY wni dwl 7Mal F" UmabOaW muanetW wlroer 3 Gf"wat.7ftw Somw' s.* UreawlalYry mLti�e caba aae _.— L� CMmwBlr Yw_No- 0 Trq"(Aj cAbme Resinlal TaW_._Frm_ ❑Afp9BameM(AP) < Swfc.waaliraw.r.wr e.w lEnrrlwam! � 1 ❑E :o- ❑Fetal ew.e ru_«e— J S M S.rpAe OAatlNbalraetwNor LAB u%ONLY ORNNW WATM OR LTS LAB IISE ONLY ❑Um VdAd ryTd Caawn Nm etl $f btlWtlMy ❑EnOp N ❑Etolaawt Bae1WlNaa)Raub TM Coklm"___IIOpa E.Caa +1b)0 FxN cow Itao" HPC nrw RpgwmotSmolall I : ❑TNTC Oswvww m ❑ SA+pb Vd ❑Dampen Canmmc ❑ D r�kvT 14 1 qZUZL.7.1 �"r�,Pc MMa°fAOi SM9223B tve� (roue Oa o ussamw 285-