HomeMy WebLinkAboutWEC2024-00094 - WEC Plot / Site Plans Notice of Intent to Construct a Notice Number
Water Well WE57368
usrnxlwenr or This fomr and required fees MUST BE RECEIVED by the Department
ECOLOGY of Ecology 72 HOURS BEFORE you construct a well.
1. Property:Owner
Name
SEAM SEM
Mailing Address City State Zip Code
10848 SE 228TH ST KENT WA 98031
-2.Con slung-:Finn (if applicable)
Business Name
Address City State Zip Code
Mailing
Email Address Phone Number
;3J, at[Site Location
County Name Tax Parcel Number
Mason 22221-3 0
Street Address C Statetate Zip Code
13790 E STATE ROUTE 106 BELFAIR WA 98528
Township Range Section %(within 160 acres) NW '/.-% (within 40 acres) SE
22N 2W 21
Latitude Degrees Longitude Degrees
4. Project=Details
Estimated Start Date 8/8/2024 Project Name No.of Homes 1
Well use: Domestic(Single) I Work Type: New Water Right Permit: Not Required
5.Driller Details "
Professional Name[Architect I License Number
Engineer I Surveyor] (if applicable)
Drilling Company Name Phone Number
MOERKE AND SONS PUMP AND DRILLING (360) 748-3805
Licensed Driller Name Driller License Number
CHRISTOPHER JONES 2253
Commerrts
f1:Fea Summary
Total amount due for wells with casing diameter less than 12": $200.00
Remit payment to: Department of Ecology Cashiering Unit, P.O. Box 47611, Olympia WA 98504-7611
OR Pay online at htt //appswr ecology wa gov/wellconstmction/Wells/NoticeOflntentPaymentRequestt a�
Notice Status
Date Confirmation I Cash Journal Number
Pending 8/2/2024 10:43:00 AM
Sfgtr: I",4o' Ytct rlan
f s+q�t a w so Seams_
137ct '+Isra' '4tt378/ jbF "17.02•
Fi`S7s.t ����`� l �J=ltS+ Holy
40' VJ�a Ll e• #3�9 29127" bsi
r80t$ •IC COmf/n
11 f 3at�
ro
s
\ s deb
v
*1390,
z�
tsatt g � 1
t�
sicON3 I y
`v PPuu JOY JO'N K'. 9 ,
'1 ¢ r •
Wi+10.hd 3i �•
FI
R VEp
k MASONOJAN 23 024
ti JLtNTyENyIRO
REi HEALTH
7
MENTAL HE /
t
I �R
2� Z4 1Op