HomeMy WebLinkAboutWEC2024-00078 - WEC Application - 6/7/2024 415 N 6-STREET,SHELTON.WA 98584
MASON COUNTY SHELTON:360427-9670,EXT.400
COMMUNITY SERVICES BELFAIR:360.2754467,EKE 400
a,r�r Meer .e a.+a� r ELMA:360-482-5269,EXT.400
FAX:360427-7787
NOTICE OF INTENT TO CONSTRUCT A WELL
Permit Number Payment Information Instructions
1. Complete Part 1. Incomplete applications will be rejected
WEC Receipt Number 2. Attach a dot plan and vicinity map.
.� ❑ Cash 3. Submit this completed application with appropriate fee a minimum
❑ Check of 24 hours in advance of initienng well construction. Refer to
Mason County Environmental Health fee schedule for cost.
Dale of Payment 4. Mason County Public must receive notification at least 24 hours
prior to the drilling of the well.
PART 1:Applicant!Parcel Identification
Site Address 1130 SE Craig Rd start Card# WE56731
Drilling Firm Advanced Drilling LLC phone 360 790-7373 (Pam)
Applicant Travis Rowland phone 360 870-1287
Mailing Address 1091 SE Craig Rd
city Shelton r� C state WA Zip 98584
Parcel Number 37 �1 � ) —` U >— per ' �1
Directions to Site Hwy 101 to exit 3. Right on Craig Rd and follow parallel to freeway. i mile on right
Is the well site within 100 feet of salt I seawater? ❑Yes ®No
If yes, a variance from DOE is required.Have you applied I received(circle one)a variance? ❑Yes ®No
NOTICE:ABprcposed cornechons M new,wells are autijecr b wets adsgmlcyniqukements ar Irte 0fb0ddrg parmrt per Mason County 1"6.68
walerusage mnicfivna and additional lees may apply b aVaew wens dri aas January 19w,2018per ESS9 6091.
Applicant I Agent Signature
JUN 01 2P4
PART 2: Health Department Review(Staff Use Only)
YES NO TAG# 'gpf.l 061 Called In BYF'ifZ (e�I?'2Y
„e-- ❑ Driller on Site?
❑ 12- Is the well capped and Vented? 4 't I 1 I Z Ce o
,0— ❑ Is there evidence of a surface seal? „ t Z3 Will H`fit'
❑ Is there a 2"annular space on all sides of the casing?
❑ Has the seal slumped? Umr c3s:-n lED
❑ Ja Is the well flowing or is there evidence of other leakage?
❑ Er Is there evidence of cascading water?
J]' ❑ Is there evidence that the seal is at least 18 feet long?
Q- ❑ Do the well she set-backs appear to be appropriate?
S
Comm is ^,(00 1 '( ha `h
Pass ❑Fail Inspector Date (e.I 1$ I ZT
Thia form may be scanned and available for public view on the Mason County Web site. Revised:71712018
Mason County WA GIS Web Map
FT-
I
1 �
3 19 062 10002 0
31WS2201000 P''°N'y� 319052190002
I
ti
6I412024,8:49:16 AM 1:769
0 0,01 0.01 0.02 mi
County Boundary 0 0.01 0.02 0.0aam
No Filled
Site Address (Zoom in to 1:3,000)
Nd.NPS.NXUf1.fsmue. Rh RMVY�YL 5•.rrM'. Ev.
Tax Parcels (Zoom in to 1:30,000)
wsc•G..y vweu weew.�oroa wn
4aml:wMaxYnsw✓.iy reLnq['In'tlMssNwMfR+l.w:YORIP Tv2'VnT Vte c'C"9s.YYq mwRVll.Y+b W'YFLL W