HomeMy WebLinkAboutWEC2024-00085 - WEC Application - 7/16/2024 f � t
415 N 6TM STREET,SHELTON,WA 985"
MASON COUNTY SHELTON:360427-9670,EXT.400
COMMUNITY SERVICES BELFPJR:360.2754467,EXT.400
ELMA:360-482-6269,FXr.400
FAX:360-427-7787
NOTICE OF INTENT TO CONSTRUCT A WELL
Pa at Irdormatlon Instructions
1. Complete Part 1.Incomplete applications will be rejected
Fy C Receipt Numbe� 2. Attach a plot plan and vicinity map.
p Cpro
ash 'l..n� 3. Submit this completed of Initationw iaonstwafeteeaTom
mi to r111 mum
Check ''vJ of 24 hours in advance of initiating well a schedule
Refer to
1 Mason County Environmental Health fee schedule for cost.
Date of Paymeot�_1_� 4. Mason County Pubkc must receive notification al least 24 hours
prior to the drilling of the well.
Permit Mundw
PART 1: Applicant I Parcel Idgntification
Vz t2M E Phillips Lake Loop Rd, Shelton Start Card III
WE57142
Site Address p
phone 360 790 7373
Driving Firm Advanced Drilling LLC
Applicant JM Matz Phone 360 789-9649
Mailing Address 98584
city Shelton State WA Zip
Parcel Number 51-QQa02)
Directions to site WA 3 to Pickering Rd Right on Phillips Lake Rd I eft on Phillips Lk L D9 Parcel on left
Is the well site within 100 feet of wit/seawater? Dyes ®No
If yes, a variance from DOE is required.Have you applied I received(circle one)a variance? ❑yes ❑No
NOTICE:AM proposed cnnnecerns to new wells are wNect to wateradequxy reQwra neras atgme of building peme Per Mason County Title 6,68..
Water usage restrictions and adc0onal fees m y appy to all new wells dn'lled after January iT,2018per ESSB 809.1_,DO,MU 7M
PA4W I VJmA fy) �9 l
Applicant lAgent Signature
PART 2: Health Department Review(Staff{�N 016 9
YES NO TAG#
�1 Calledln Ic�r•�yf farms�Z-`(
f-1 Driller on Site?
Y^J/ ❑ Is the well capped and Vented?
❑ Is there evidence of a surface seal? f n -1, _j'q q 4 Y Z"1
[� ❑ Is there a 2"annular space on all sides of the casing? 'l
❑ 12_� Has the seal slumped? — l 22 'Q V 1 Q /D
❑ Is the well flowing or is there evidence of other leakage?
❑ ,� Is there evidence of cascading water?
❑/ ❑ Is there evidence that the seal is at least 18 feet long? Nor o$5div et
C ❑ Do the well site set-backs appear to be appropriate?
Comments r Date o LZ 2H
pass ❑Fail Inspector
This loll,may be scanned and available for Public Mew on the Mason County Web slte. Revised:2l?I2g18
E, PW11;p5 Lake Loc
55 PRd� ca\t'V" 30'
° PLOT °LAIC
c1a�z—
" P.v�i= y17065'51-00403
50' neI t, ��EPcjy�sltkttpw2d
we.
"PPS°
la '
L T
t EST �J%S
2 e� Tve des @Q x# l zw 15 to
rgg `�aa° z h` A �ill'M�C1�iv1o�
}1Duse £
8 -50 X4o, —i
l �w�E.c�c-�'a'NFsr CGMl�0.GJIION�t�11V1.�
011 1
•I V`2-a��cao��'wE�=,�- DEL
I
Audio-lIauai Alarm
III 3d I 3 Cieanout
Soo Gallon Pr Trash tsak
I
K ' 1 ct O NuWata BA'R-500 ATU Tank
OS 1,000 Caton Pump Chamber
I
O6 Valve Control Boa
Q Sol;ds PweP in Basin
i
Paar4'L;„a� I
h
NOV 30 < 22
�n 3 9ASON COUNTY ENARO'NME,iTHLHE-.l: yak
RET
910349
O, G6Y6gaSAUU JOY JOHNSON
IZ,
2.bg.11