HomeMy WebLinkAboutwec2023-00112 - WEC Application - 9/26/2023 415 N 6TM STREET,SHELTON.WA 98584
MASON COUNTY SHELTON:360.427-9670,EXT.400
COMMUNITY SERVICES BELFAIR:36D-275-4467,EXT.400
ELMA:360 4825269,EXT.400
FAX:360427-M7
NOTICE OF INTENT TO CONSTRUCT A WELL
- Instructions
1. Complete Part 1.Incomplete applications will be rejected
W EC Receipt NumberA3 t{a 2. Anson a plot plan and vicinity map.
,^�� ❑ Cash 3. Submit this completed application with appropriate fee a minimum -
C7✓ � Check of 24 hours in advance of imitating well construction. Refer to
Meson County Environmental Health fee schedule for cost.
OU L^ Date of Payment Cl 4. Mason County Public must receive notification at least 24 hours
�J prior to the drilling of the well.
PART 1:Applicant I Parcel kWntMMUOn
Site Address 3q j F F.kCI4 Rp Start Card# Wes' � 3ffq
Drilling Fkm Phone z1-,r-27S- 53G7
Applicant f�:r_r a7 Phone 1 a G- 4 N 9 - 6'7W1
Mailing Address —
City :AntnA j TcLfj State Ir✓A MP I f lln
Parcel Number ��Od ,�� '" 94413
Directions to Site I5,)V)1 1 / f/k Lb 1�t4kc bA, R-� —'o'I Lr Q" Y6e Tb3f'
Gu ro�
Is the well site within 100 feet of salt/seawateR ❑Yes,*O
If yes,a variance from DOE is required.Have you applied/received(circle one)a variance? [Dyes []NO
NOTICE All propoeed tomOdfbns to new welts are subject M wateradeeuacy Wua mentaat time ofbullding permit par Mason County Title 6.M.
waterusaga reahiUioroark addconsi lees may apM'to ag raw wWa drilled after January W.2018 per ESSa6
,,(�� v515t- i 6 V1L�NP4'IIIU^Illll
Applicant enSgnature SEP 25 ^2023
PART 2: Health Department Review(Staff Use Only) --••
__ f3 r_�
YES NO TAG# Called In �tr12123 Fee lD
❑ /rY®�H+ Driller on Site? �I, 1 ffU rr��
Is the well capped and Vented? W' 4�•;Zpy`p,
Is there evidence of a surface seal? Im : _V Z Z. 1930 9 49 I
❑ ❑ Is there a 2"annular space on all sides of the casing?El ❑ Has the seal slumped? Tkjl W0 <
❑ 9 Is the well Flowing or is there evidence of other leakage?
❑ Is there evidence of cascading water? �Wq(61' i�5 &l
❑ ❑ Is there evidence that the seal is at least 18 feet long? C.(0Vf q �Q'•���
❑ ❑ Do the well site set-backs appear to be appropriate? 0 -{
comments Paw 4� h - 1 '/^/V0 vfft S
❑ Pass ❑Fall Inspector Dote �1 C RZO -2 (1
This form may be scanned and available for public view on the Mason County Web site. RCyIBLd:.'
d •
well drill
charlie Odell <odellck@gmail.com>
Mon 8/7/2023 11:09 AM
To:Mike Davis <davisdrillingt@hotmail.com> 50
Hi Mike
Our two tax lots are on Stretch Island. Parcel numbers 12108-13-90013 and 12108-13-90012. Encoosed
is a plot map as well. Please let us know what you can do.
Thanks much.
Charlie Odell
206-949-87141M-
G COR A9 I' IP (ROBERT A LIMA 587-38-19-E NORTH LINE OF OOVER'V@'VT LOT 7.
Ca T LOT 7 ON BEACH DONRER PER PREVIOUS SURVEY OF RECORD OF R.D. LOVITT
P / W/ LDPPFA TACK,-- JO• PRIVATE EASEMENT FOR IN
GP �p�� N NTT7BJ-m-.E B7a (RMECS' a L12 sr" IS � IL ITY PuIPOSES FOR TH
QR.' .__T,Y_RJAD......(AS-BUILT).........
R�100 ' "` 1�+y,L'�-_ 10 NBTSIL 22B.J7 N 'U
�+ a LOTS 4 FND 117.33 109.,02 1
1.14 AC. ---
EALKING FOR p0 a4 i
PRIVATE BEACH D _ v y_LOT 3 n ;
ACCESS FOR BENEFIT - 1.00 AC. 3 LOT < qq1�
OF LOTS 1,2a3 LW R , AL. R`
o s 1,4 a a LOT
-- __ 1.00 AC.
h a
----
'zl'p?Oa r '---'` 9 s� EAST LINE
o LEGEND: f�,� $JJ FND J/s• r� AS PEB DEED
M1�
Ow 7 P'S3 IRON BAR A PLASTIC ■ 2?
W YELLOW CAP SET FDLMD rla'
0- FOIL AS NOTED y. 3s CORNER
FENCE
■- SOIL LOO S `xr CORNER THE PROPOSED LOCATION
0- POSSIBLE HELL J 2�. f ■ /OF WELLS a ADVISORY ON Y. U5
ARE SITE ONLY.
93-9SP SHORT PLAT `�?D9. OJB / WELLSI TE AE INSPTION A '�t .
% sJ/!,.. SEPTIC SITE INED FOR N 1
FOR ie FqY MUST BE APPI,l EO FOR -
MARGARITO 8r WANDA LLAMAS fCIJ H PRMIT. BVILD(NO
IN sue.
GOVERNMENT LOT 7 W Po
SECTION 8, TOWNSHIP 21N, RANGE IW. W-N. p,
E 330 ECKERT RD. STRETCH ISLAND SCALE. 'J
GRAPEVIEW, WA. 98546 TA'pCo
i
(206)426-4043 PARCELI 12108 IJ 00010 0 50 f00 200