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HomeMy WebLinkAboutWEL2024-00042 - WEL Application, Design, Letter - 9/20/2024 MASON COUNTY 415N6THELTON: 0427-O70,EXT 400 SHELTON:36042]-96]0,EXT 400 BELFAIR:360-2754457,EXT 400 Public Health & Human Services ELMA.360482-5269,EXT 400 FAX:360427-7787 DAHL PROPERTIES LLC 261 HAMILTON RD NORTH CHEHALIS, WA 98532 RE: WATER SYSTEM PERMIT., TWO-PARTY WEL2024-00042 1505 W Highland Rd 520241350050 The 2-party water system, Highland Shared 5/6 (520241350050/520241350060), 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 10161707 (( 0 MASON COUNTY AL: COMMUNITY SERVICES A wnt Ra iw 5�5 Rq dB, s,raa.w YyLmlrmmerW x..m.eo�.e�Iolwa 415 N.6^Sa (Bldg 8)-ShelWn,WA 985M WEL 202`I • 00002 Shrht 360427-9670 AW Bel .36 275d467 x400 Elma:360-082-5269 x4W TWO-PARTY PRIVATE WATER SYSTEM APPLICATION KNC W p��+l `Pro erli�s LLi 3eo-140 o3µ5 Ye11x0A O E6a-STREET.CR,,S A/ ID 21ol N. itgvv ',Ito� P-A Cl lelnAlis WF'f `I6c332 anE A00RN8_aTREEr,arr,srAm,a XXX 4,IAvd or Wf) 1100150OLt ( kot P W YMY PMCEL MIYBER I W FLL a 202 1 ( 0T<) 15(Ir V SECOROMTPMCELxUYeER(IFM QAHLE) 52o2`t oobo lot b �i ' WATERBWRCE aWRCETYPE PMCEL1Lm s� rMCEL1LM a� ❑New Existing Well ❑Spring 5. o t 9•S3A trt PaarosEo w6Tm srarEa xuts(REwssol %tO,EGT 0E5CR1 A well paEenoxa ToarEdcexomox5 Ct+v i t14o W it oy. r R o m IRID41> Site Plan: (may also be attached) (pmpeny WuWanes,structures,well site w/100'redius,ddveways,marls,septiUsewer components and lines,easements, Sce .ilach�d c0( Submittals Checklist: (these additional items will be required for approval) JLP .L U Satisfactory Bacteriological sample(this maybe deferred if well is not yet drilled) Well Lag with pump test or 4-hour capacity test performed by driller(this may be deferred Btxegls,tet-yel4tdlled_ 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) ThY fwm mM,be scanned and available for Public view on We Maen County Web SM. Revised: 10/132021 Page 1 of 2 staff use Only Review Step 1: Well Site Inspection: YES NO NA ❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfelds,tanks, buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 foot radius of the water source?If so, is road p/I atq,County or State. What is distance to ROW? — (� ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) 19I ❑ ❑ Is the well cap satisfactory? ❑ ❑ Screened and vented? I, ❑ The well casing extends 1_above level ground/concrete slab? (circle one) IA' ❑ ❑ Is there evidence of a surface seal? kQ f., j1 JPr Hr ❑ ❑ Does the seal appear adequate? UJI! _11).2J04 ❑ Is a variance necessary for well site approval? / ! QPI✓oS7 Comments I Pass ❑ Fail Inspector _. Date Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water Well Report with adequate pump test on file? A�EAA d��"lf L"�6 5'Mi0en, w 90 If NO,date of Capacity Test Driller GPM ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Zc A [� ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN Z ( J•/ ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided O 1 IA Comments NSONCnr OCT f �/ O Ir S y NYio,.. /� �✓ aMFNT [Approved ❑ Denied Reviewer Date �V/u� /TN Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied ofthe future success orfailure of this system. Well site approval does wt constitute watersyslem 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 additiow[fees may apply to all new wells drilled after January 191 i 2018 perESSE 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason county Web site. Page 2 of 2 WATER WELL REPORT JWM 0i?Ag!MENt01 Noticeofloo.No.WE55427 ECOLOGY Ueigw EeokgyweRJDTag No. RPNO57 T)pe atUmN: S;alr nl WaiFin610n ® eansmt<r o Sim We0 Name(if mae then one well): ❑ Gsommimo Ddltmal msmlmtion NOl No. Water Right PetmVCwirimte No. pispex•)Use: 0Domesdr Dhxlumtial 0Mmeipal ❑Dewdermg ❑too'.. ❑TcN W<II DOtbm PmPeM Qaata Name DAHL PROPERTIES LLC Casmmtbe TW: Mebpd: Well Soeet Am 0 W HIGHLAND RD LOT 5 a M.well ❑ARmtion ❑Iniaeu ❑teed nCkle Tool City SHELTON Comity MASON ❑Neepming ❑abv ❑ag G q ❑ 'R°ms' Tan Ppreel Net.52024-134KKX10 Dlmag,bm: 11amnmofixon,6_i n m42 k DepWafmmplm l-11 7 R Wmevm sosseu ,etlforthiswdl? ❑Ym HNp Cammae4m Demlh: Wall Ify vdhmwasthesremstcefm? Csis, Lute Dkmew F. To Thihass steel PVC Weald @mad ® 1 ❑ 4 in. 1 42 .25 m. ® 1 ❑ ® 1 ❑ Laration Isee instrwlimm on ®W WM or❑EWM ❑ i ❑ _w ❑ 1 ❑ ❑ I ❑ [fE 4.V.ofthe BE.;Section 24 Tox hip 2LN RstoV5 ❑ 1 ❑ —m ❑ 1 ❑ ❑ 1 ❑ Utimde(Eample:47.12145147.20852 Peefi dime ❑Yaw®No Typeofpeforawosd Lo iwde E le:-120.12345 -1 .25MO No.dpermntiom_ Slxsfpetforadm,_mby_m. DrOM'a LepJCmmhuefhw or Deeplmmlaama Prpeedarc Petferaeedfian_ft.m_g.bolo gmmisrbm Famtioa:R brby eobr.chamcw.�ol�mk<ulad 5rvcm¢Wtnekid and oenuc dale tmteid m mA Is"PmemeLL with at lemox emy finerb abagc d Scraaa: &Yes ON* DK-Ya<Ne b Dgtm43 A. inbmmdm.Umdditi.l,k sdoesmsvy. Manufxmme'sN.JdlNSDfJ Mverinl F. To Type STAINLESS Mdel No. BANDY LOAM BROWN 0 3 Dimrew5 Sbtsiu74in.fmm 42 n.to 4jR Dizmem Sbt slx in.ban n.m_n. BROWN CLAY GRAVEL 3 30 GRAVEL SAND WB 30 47 Smdlktl ,psek:❑Ya OM Svcnfpxkemml— Natcdebplxd @om_ftm A Sudan Seale OYcs No To sbm depth?]¢ft MateriolmW st.1 "SENTQ411L UHMP D'Wanysw amuwsab1s.1! DYo MW Tyyeofxaw!ont Depth efamm MethdafsmlingswmoR pump: ManubcmwiNmm Type. HIT_ PumpmmkedmM�_ft Daikmd Rmvmw�llpm Ware fineeb: La sclls swing I fl onaba e m d s w level_fl. 5tbk+tp ofmpofwcll<aing�t R.abmx gmmtlsurf Smk water kal�_R.bebw mporxvprmiog Date M25C>,Y274 Anmvnla<ssurt_IFx persgnart imn D,x Anabn saw u<mwlkJ by IW.vaWcat<.t Well Tests: Was a lumping tat Mfmmed! $No ❑Yes b by xbma'! Yield_,M with_fl.Nesdoxx ahr_M1m. Yield_Bpa with_A.dnwdown after M. Yield_rpm xah_fi.lawhnrtnfler_M. Ravvmy Mm(twe°ago x4.en pow b mmeJaR-wte level unnamed Jim well elpbaawkrel) r Wmerle,cl Time Wm Usd Ti— Wag ls,N Dam ol'Pungtmllat Roily tot_m+tt silt_A dmwdoxn aM_M Av mt ugrynwahatem ores jQft br2hn. WxObl14(NN gnai�n tlow_gym Tergmmnaeafmw_°F wma<Iwaimlamysu tide? Dyes ®Na I I Stan pat<O6I13I202A Cmnpkted Date Ofif1d/2024 WELL CONSTRUCTION CERun,ATLON: I eauuucld adtmxxpt eapomibiliry for<amRaniop ofthis well,ad ib compliance with a0 Wasbmgtm we0 .e.etion sarldmtk.Metmals tired ad the iaf tion tepond above are ttw to my bmt kmwledyc and belief. N Driller❑Teaime❑PE-Prim N.ROBERT LAVMON DrillingCowotty ADVANCED DRIWNGLLC Siommm r..ag. Address 11530 SCHOOL LAND RD SW Liam,No.25M Ciry.Stele.Zip ROCHESTER WA "579 W TRAD.FES L' puN cmemsr's Spo ' Simem Rc mamrt Nn ADVANDL804DL Date 06M,11 0 4 ECV050.1-2011keYMflg1 /lsnuarcNtMr dxnmavxdan alnovum/uumt.pleme•Mfrhe tfmrr gnunrcra Prvgrumm 31i0.40)fig72. lkrsnnr xyslr lx 'og lmr rmrr /7"J",H,"oh"grmt l4•kn.V°mire. /•moor xiDrm ryxrrlr A!<aA)lM'mn roll g))JJ33�dJ4/. i .M*&Ana.na.wn z.oR,n+`awn a,kIMdAyee—_Be_ y,asaewmn+pis..d�sM omSaiwcWaba ihf>Sti�V79 Cd"C' u�8dedurmiRrmiui0er. -7 '3o /A coeowwm 1n�COY� aabeReauibr F� --- ----- e Month DW Yw —IL PM 3.&ouMMMer Ruh BowI 9empk LYiuMfetlpy.uaiwlbideb: TYPeelwebSYdunldpdcG*"bw) 2 P IJ —J i A B OAr ❑T�.etl IW) ChbnnaW:Yea_MtL- 3 GMVAe Q UPBSY a ❑AmearentlAN) Chb Rmidoi:Tatl_F%T a od aXYmxane: yy0z •IB•000bD d.aBrew«Bwixewawn.wae awme p.« n) I s l 11 .L*4;mk ot'bSKwAWell S, ❑E"' ®`� FlMWY._No_ 5 — CanhdPemr. B. cuedea r«hren.Rm Dab ' l Sw.Flaw( 1 car 1 FA%1 L'.J TaW Uellogt Piaesi '- CI EdoFRawd . ::; QEYilgf . Saryb CoOeded aYR�): h BeRBb�de: ReRAbGidi rdlmn Xom� .. �.: f L�ed�c Lx� WhereS ob Sn loll dnnbw Camnind. tiy4, ------ ,NODnI, IPG := Xvl CobcteLf/ultl�;c entl Feuoell;c entl FeuceB: da.�YbWYYB: �O TNfC [].awgMYweM )ocx H�hla-A IPeI wm "D g 'o fPN r2: I.O0o D I , RregTpnp C: Wne Cods LL/VT� 5 w£u.l Pia RpaWYrOpF ldtlr-0K . ± 2216077 MASON CO WA 09/20/2024 0320 PM NOTCE OPHL PROPERTIES LLC #201001 Rec Fee. $304.50 PaSes 2 Return To Zol N .4�aw \Wok Wd Che4wliC WPt 9053�- Grantor(s): (1) AVI) VTb!payfiQc, LLC , (2) Grantee(s): (1) PUBLIC Legal Description (1) 1 a14, cs ' LLC #T; - Q_3 AF 22059 52 SW N£ S 54/l0 (Abbreviated form:i.e. lot, block,plat or section, township,range) Assessor's Tax Parcel: (1) 5 2- o 2, 4- I - S o 0 5 d S24 ,T2_o, ps5 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) S z O 2- 4-_L 4- 0 ,� 0 Tax Parcel: (Connection The system owner is responsible for keeping this system in compliance. The name of the water system is: Hs1-��Ard ri�, h ChAY'pek w F II 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 20t~ day of STO 6 C 202�1_. Signature of rPntor(s): (1) (2) 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 tow day of 20 2L , CAIV1n UAW 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 above written. REBECCA R. MEISTER NOTARY PUBLIC Notary Public in and fort the State of Washington, T O WASH STA E F IN GTON My C,am n.N 1�8�79� residing at ).LNII(('OUYyt A.\Nk My commission expires: 4 • 14 - 7D277 Page 2 of 2 L7! !• y! P 9i oI Hill , e - � § « / �=\ • , . . , *«ea,weeee | � ---- � � � . . � lzzl � . ww � � � � |$ f> § , / )�� | ■ � %\ � ! ! g ©� � | � ( | , - p � ■ � ' u5 �u