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HomeMy WebLinkAboutWEL2025-00002 - WEL Application, Design, Letter - 1/9/2025 SHELTON.WA MASON COUNTY 415 Nfi SHELTON: , 0427-97 .EXT 404 BHELTON:360�27-9670,EXT 400 BELFAIR:360-2754467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360427-7787 MCGRATH GALE B 430 SE BREWER RD SHELTON, WA 98584 ' RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2025-00002 430 SE Brewer Rd 319083200000 The 2-party water system, Rocky Acres (319083200000/319083200040), 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 360427-9670 Ext.353 or email at danderson@masoncountywa.gov Sincerely, David Anderson Environmental Health Specialist Mason County Environmental Health 1/ul 107E MASON COUNTY °N CL a5 COMMUNITY SERVICES R.«4;5b R«a mlana.vs,.,nR Fmimmx�M1l x�im ca,.�„�Xr IInM 415N.6N Stro,(Bldg 8)—SWWr,WA 985M WEL D_Q,2. S- b Ua, Stollen: 360427-9570x400 Belfeic 360-2754467 x400 Enna 36 82-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPIl .T 6 PxoNE3c�o 4 (c3 MPILWL�ES�STREET.0 R 1 VA SIM AcDRESS-MEET,,JCITY,MM,W PRIMPRVPFRCELNXM9ERIwELL5nE1 i q - D0000 $ECOXOP PRRCCELXnM M(MMELSPRIM IFL00TEO ONS.MEP 11.I 8 3a P PMCELIL i$aEllwnlsnl PFRCEL aLOT bMllwnt.enl ❑New >(Fzisting XWell O Spring PROPOS TER SYSTEM X.LME eaMnl vaorecTv cRvnox 1. nw Pau,I.w.mM..rEneYnurrcP,Pdroo OIRECTNIXS TO SITEICplgTMINB WTE CODE/SFT L04TIONIETC. � ( _ � L1V-J/. I ♦ Site Plan: (may also be attached) (property boundaries,strudures.well site w/1 00'radius,driveway$,roads,sepbHsewer components and lines,water lines,property easements,etc.) 5EE -Oe(cVVA-- Required Submittals Checklist: (additional information located on the first page of this packet) Satisfactory bacteriological test from within the last year(this may be defamed if the well has not been drilled yet) Well log and/or capacity test performed by a well driller(this may be deferred if the well has not been drilled yet) F,, otice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office p Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may Be scanned and available for public view on the Mason County Web sae. Revised:12/17/2024 Page 1 of 2 --------------------- Staff Use Only --------- Review Step l: Well Site Inspection YES NO NA �. ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields,tanks, buildings; indicate distance on plot plan) /a ❑ ❑ Are there roads within the 100 foot,raQius of the water source? If so, is road 6p,County or State. What is distance to ROW? Fs t/ ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ¢] ❑ ❑ Is the well cap satisfactory? V9 ❑ ❑ Screened and vented? 0101 fl]!( ❑ The well casing extends above level ground I concrete slab?(circle one) I� ❑ ❑ Is there evidence of a surface seal? Let: 47. W10 r ❑ ❑ Does the seal appear adequate? Lon: -173.0111W ❑ ❑ Is a variance necessary for well site approval? Tag: evilig Comments Pass ❑ Fail Inspector Data f1 Z,f Review Step 2: Two-Party Review: YES N NA ❑ ❑ Water Well Report with adequate pump test on file? > �.L, If NO,date of Capacity Test Z 2 Driller 9 ) GPM S 6 �S/ rLtl W Mr) ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test t El ❑ Received Signed, Notarized,and Recorded Notice? AFN ZO ❑ ❑ System appears adequate to serve 2 single-family residences based on information I rovideE7 QjlComments yc b ?�/ 40 c. gy Approved ❑ Denied Reviewer Date Ty Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. No claim is made,express or implied ofthe future success orfadure of this system. Well site approval does not constitute water system approval Water System approval is a two-part process. All proposedconnecdons to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19'^ 2018 per ESSB 6091. seal - Revised: 12/172024 This form may be scanned and available for public view on the Mason county Web site. Page 2 of 2 MOERKE & SONS PUMP �'DRIL:LING, INC 1162 NW State Avenue, Chehalis, WA 98532 (360) 748-3805 PUMP TEST AMBER KNOTTS 9/17/2024 P.O BOX 282 TENINO, WA 98589 WELL SITE ADDRESS: 430 SE BREWER RD, SHELTON 98584 Pump Make & Model: Pump Set At: Sounder Make & Model: Make&Model: Measured in: GALLONS MINUTES GALLONS METER LEVEL TO PER MINUTE READING WATER NOTES 0 0 123213 75' 1 15 123228 76' 2 14 123242 76' 3 16 123258 76' 4 15 123273 76' 5 14 123287 76' 6 15 123302 76' 7 16 123318 76' 8 14 123332 76' 9 16 123348 76' 10 15 123363 76' 15 15.2 123439 76' 20 15.8 123518 76' 25 15.6 123596 76' 30 15.6 123674 76' 35 15.6 123752 76' 40 15.8 123831 76' 45 15.6 123909 76' 50 16.2 123990 76' 55 15.2 124066 76' SIGNATURE: SONS PUMP AND DRILLING .. » . ) ! R_� vv, Do ! ®/ 13ML � ? 7 ■ ( ! - ) El / | ( 0 ( El ! r � � ] 2220402 MASON CO WA WIN12025 03.49 PM NGTCE MCGRATH 0205319 Rec Fee $304 5e Paees 2 I II IIIIV m����Intl 11111 I111 It 111111111111111111 IN I Return To _a&t'�_ ahet.tcx.. k>A �It�50�f Grantor(s): (1) C�1(�1L�jrG L_ , (2) Grantee(s): (1) PUBLIC Legal Description (1) fN i `xl (Abbreviated form:i.e.lot block,plat or section, township,range) Assessor's Tax Parcel: KX 0 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) -3�-1.108 --,�=1=- QU----- Tax Parcel: (Connection 2)The system owner is responsible for keeping this system in compliance. The name of the water system is: t�lrXjV tA4`3 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. //rr�r�`"�, �n Dated on this�" day of L - 203_!� Signs reqq7' Grantor(s) p , (2) Page 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a Notary Public in nd for the above nam County and State, do hereby cert�that on this tN f ,p2O� �(a 61• nersonall a eared before me,who is known to be signer of the above instrument, and acknowledged that he(she they)signed ' . GIVEN under my hand and official seal the day and ye st o e wn n. „pb1«mibbi« ER SEA of is I r t to of Washington, ° ;pa NOTARY I;; � siding at 2303e426 My commission expires: PUBLIC o N •tsy��•.•.;annot!•• • aaaa •O'nxnx+•' Page 2 of 2 oek; i a ayae� e rya $ I�, 5 i 1 0 $ Pgee a eeee s a a g � Q as I I 9 a M1 O V y R I n hF Z Ili ❑ ? e fz� tilt u, B ] - ' • : Oil] �|�||| ; : , . . . .|.,• ! | )$ � , k m� � | � > < © � > i § • ! | � | . �