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HomeMy WebLinkAboutWEC2024-00024 - WEC Application - 4/20/2023 &r�-jt ,d IAt-) SC1 415 N BTM STREET,SHELTON,WA 986M MASON COUNTY SHELTON:360427-9670,EXT.40O COMMUNITY SERVICES BELFAIR:360-2754467,EXT.400 rWnv „.ye,..a,,,...as..Mcdr.i...wYHs ELMA:3604AX: 60 EKE 7-7787 FAX:360427-7787 NOTICE OF INTENT TO CONSTRUCT A WELL Perailtillumber Pawaint Cos lnformatlon Inslructions� 1. Complete Pad 1.Incomplete applications will be rejected W EC Receipt Number au•rIT 2. Attach a dot Wan and vicinity map. 1/�ryjJ Cash 3. Submit this completed application with appropriate feeaminimum off= Check of 24 hours in advance of initiating well construction. Refer to 400a Mason County Environmental Health fee schedule for cost. W"�'l 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 IdentiBcaBon _ Site Address E MossBower Lane Gmpeview WA,98546 Start Card# WE55170 Drilling Finn Grande Drilling Phone 206-510-5539 Applicant Stephen Byron Phone 360-275-7276 Mailing Address PO Box 854 Allyn City Allyn State WA Zip 98524 Parcel Number 22116-77-DO090 Directions to Site Highway 3 North-Turn Left on E Anthony Rd-Turn Left onto E MossBower Lane. Is the Well site within 100 feel of sell/seawater? []Yes ®No If yes, a variance from DOE is required. Have you applied/received(circle one)a variance? ❑Yes ❑No NOTICE:Alf proposed ronnec0ens to now welts are subject to warereder uscy rscuinvosols at How 0fbu4dr 11 permit par Mason County ty Tilt 6.6a WarerusageprWehbnrerMe ' Dial fees mayapply M aenew wells drilled~January W,2018per ESSB 6091. Appllwn gent Signature PART 2:Health Department Review(Staff Use Only) p(J'( f42,YES NO TAG# Called In -A l-'LJZ`( ri" ZI 14�2.`f o6`s� ❑ Driller on Site? s PN yJ. 3oNfr-f9W ❑ Is the well capped and Vented? bit, - Is there evidence of a surface seal? �b °134D(r ❑ Is there a 2"annular space on all sides of the casing? ❑ '[� Has the seal slumped? ❑ ® Is the well flowing or is there evidence of other leakage? ❑ Is there evidence of cascading water? 'Q®�7 Is there evidence that the seal is at least 18 feet long? P' ❑ Do the well site set-backs appear to be appropriate? Comments 1 N) Pass ❑ Fail Inspector � 1 14 4 Date ]' This form may be scanned and available for public view on Me Mason County Web site. Rcvised:2/72018 2196248 Mk§ON CO Wq A£u 2jojL,248 VOL 53 PC-,.30 a n R F Fwp inns gFc a 3 f7av a1g � BA� \.!a o AN at Ill �� , 9t 174,�\ 2 n �� f R q� � xe f �• qR b� �1. i4d V1 ka � � a oil g sj , 4 � w A 4� �a�lfio . o = V► f 5L tad$$ aasa ,. fi # i7555 All s a� all o x I,o ao 120 PLOT PION L SttVChtOGlr�it gy ron, \ � 4errtlK 2lllirll'0000.0 Mossklowfx Ln. GFsL)t1- +V E G aoarsa 5 w/8oz5 r aJ.1 Ol Audio-visual Alarm \ \ W-6 43"t„1 Sj�dj.5 O2 Cleanout Nmo -ry pa 1 s A I © 500 Gallon Pre-'hash tank �t12: 0-12` c,F5L,Lz-3Z E G co..'rse 5 pastd!52-• O4 NuWater BNR-500 ATU Tank w/s}o...di"'yy(er Type 1014 OS 1,100 Gallon Pump Chamber (5) 3x 59, plrlrnar, O6 valve Control Box P ry att drq�n��t,1d 'k'C{1 jt t itoad ® q O.G, yjlte - EasEr\E rLStrvt� bft"wlLY' APPROVED 5'< syOPE � DEC18 2023 I I t 1 In#t1 I .d V MASON COUNTYVIRONMENTAL HEALT`' DJA I l I 1 pH ""OLA JOYrJOHN50N';. s4 j t Q 4 (k) WEu 9QA I WEu Nouselop; 04 r r w� Prin �r Mason County DMS t �'� Ponied from Mason County DMS