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HomeMy WebLinkAboutWAT Application - 10/19/2006 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health _ _- - Personal Health PO BOX 1666 SHELTON,WA 9858 LOCAL(360)427-967 Application for Determination of Adequacy BELF FAX(60)427779 Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application, with attachments to the health department for review. PART 1: Applicant/Parcel Identification Name of Applicant: Washington State Patrol Date: 10/19/06 Mailing Address: 8623 Armstrongg SW Telephone: 360-596-6003 Olympia, WA 98504 Assessor's Parcel Number: 420023260010 Type of Water System Check One); Reason forApplication Check One): X Public/Community Water System (2 or more a Building permit connections)" ❑ Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. ❑ Well #of Parcels? SPL= ❑ Spring/surface water ❑ Boundary Tre adjustment ❑ Other(explain) ❑ Other(explain) " B you have more than one residence a Replacement(please indicate name of water system connected to this well,check the Public box. below if applicable—no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System Name of Water System: Washington State Patrol Academy Water Facility Inventory (WFI) Number:029935 (write "none for two party) X I am the manager of this water system.The water system�as been approved fo28 services.There are presently 37 connection(s)in use.This will be the 38 connection. ❑ I am the manager of this system. This connection will be to upfade or change the use of an existing connection on this system(ie: recreational to full time).Please indicate on the following line the nature of this change: This water system,is able and willing to provide water to this(these)connections)without exceeding the limns of the watersysten any lit i set by state and local regulation. Signature of Water System Manager Date IIPEGGys%MREDOCsWv4GEIIIWA STATEPATRODWATERAD4.DOCUpdm:April 2006 Individual Water Well ❑ Water well report(attach to application) Depth ft. ❑ Well capacity test(attach to application) gpm gpd e well driller often performs well capac es a e Ima a we Is cons me esu s from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test,awellca ify test,which provides stabilization ofdmw- down and recrove data must be ertormed a licensed contractor. ❑ Satisfactory bacteriological test(attach m appllcsllon) Individual SpringlSurface Water ❑ WDOE permit (attach to application) ❑ Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day and/or provides water at a rate of 2 gallons per minute based on the following observations. AUTHOR OF STATEMENT DATE RELATIONSHIP TO APPLCAM IN ADDITION TO PROVIDNG THE ABOVE STATELENT,THE APPLICANT VALLNEED TO M NGE AN ON-SITE INSPECTION BY THE HBILTH DEPARTMENT PRIOR TO DETERMINATION OR ADEQUACY. Departmental use only. Do not write below this line. PART 3: Health Department Evaluation (Staff Use Only) ❑ SATISFACTORY DETERMINATION: Applicant's water supply appears adequate to meet the needs of its intended use. This determination does not address adequacy of the distribution system, guarantee an adequate supply of water indefinitely into the future,or guarantee comp.4arce with all applicable WDOE water resource regulations. ❑ UNSATISFACTORY DETERMINATION: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason (a): REVIEWER'S SIGNATURE DATE IIPEGGYSSNAREDOCSWANAGWWA STATEPATR0DWA7ERAD4.DOCUpdm :April 2006 6 TNGa�lr�z f]af-]nf"]rzl-]rz rnzfrfrJ rf'atr�2f"1frx�rf�l�r k+]frx7 rzf]rnx rf� 'f7rs f7rzf7rzfa]@7 rnr lr�r rfe�rn+frs RaR:7 rf7+("r rfDl2lfrr]fralr�+ rf7+ STATE OF WASHINGTON Public Water System Operating Permit The Department of Health Office of Drinking Water issues a permit to operate WASHINGTON STATE PATROL ACADEMY WS (ID#02993 5 ) to owner: WASHINGTON STATE PATROL County. MASON WASHINGTON STATE PATROL PO Box 42626 Olympia,WA985042626 This permit is valid through Nov 2005 PERMIT CATEGORY: **** Blue **** The permit category may be modified or the permit revoked subject to water system compliance with applicable State of Washington drinking water rules and regulations and the following statements: The system operating permit color category is based on information on file with the Department at the time thi: permit was printed System lacks Department design approval and needs to bring system into compliance by getting required Department approval i1 Heatate lth DOH 331-0W(6 )Front 3� • 000/D Report Date: 11232004 y .7oud ' �r�y1191R111art911d1191rIIRIIRI@IIf9RaIR1rl91f!)RlIIRIIRIIRI(R1R9119R91RIIRIIf9119IRIIRIIZIRIIRl1!l1R111RIRdIRIRdIl91RIRlIIf9119RaIR11f91RIPdIRIIRIIR1119RaIRIIRIIraIR11RIIRlRaIl9IRIRdIralRllfalr9lRlRaIf111rdlralRli9m� STATE OF WASHINGTON Public Water System r 9 RECEIVED � Operating Permit ,. L Department of Health Division of Drinking Water issues a permit to operate NOV 14 1994 1@@ WASH1NGTUN SfA(E PATROL Af:ADLMY ( lull, 0199S 5 ) PROP. MGMT L to owner: WASHINS'ION S'IA'IL PA'IRUL UOU�TY: MASON P- r � WASHINUfUN S'f AIE: PAIROL 1p PU BOX 426L6 L L L C ULYMS'1H WA 985N4262h. 11 L -I L This permit is valid through 19 L NOV 1, 15'95 � PERMIT CATEGORY: - L #### OLUL- #y>t# The permit category may be modified or the permit revoked subject to water system compliance with applicable State of Washington L .drinking water rules and regulations and the following statements: 91 � L P 19 L L 91 L d L R L L L 91 L O L L L L � L 1 kp L L g L L L L L L L L E L ER 93 F L L JTE WAC 246-294 requires water system plan approval and issuance of anew operating permit before transfer 9 of ownership of a Public Water System. - � peH 1t16fU(IyWIFroM L L �(dLTrl�ImfardLrflgln rmrmrmrRlnrra r:nnnnnrraimrmrrarrdrmrmrramirrartarmrtartaimirairartamimmim,mtrtarmmme ryrrartamrra rmrtartartartami rra� IAa it. L,H I id l f'.U . :�•,/!iLJ'9q WATER FACILITIES INVENTORY(WFI) PHealth j Environmental Health Read Instructions on back before completing iTEN ID NO. pOOUMfY WWI P TYFE Wg1A WFI COMPLETED BY 1nlE )')35 MASON A NTNC 0 y MTpy gAlg DAY TELEPHONE DATE WASHI.NGTON STATE_ PATROL ACADEMY BIREETADORE88 B SON ITTED NEW SYSTEM NOCHMIOE RFAClIM1E W 631 DAYTON—AIRPORT RD svBTEJ xAME aWNGe UPDATE IMURS PM.Be,W APPLICABLE) 'OLD SYSTEM NAME-ENTER ONLY IF CHANGING WITH THIS WFI Clry STATE MOODE P SHELTON WA 98504-2626 I COMERS NAME DA6[FIRST) OWIWR RESIDENTIAL WA B.NUM9EN ACTIVE RESIDENTIAL 10.NUMBER ACTIVE RESIDENT WASHINGTON STATE PATROL 91],[,, . DGNNFCi1DNB POPUU1ilOM 81METADOREBB L: PO BOX 42626 P.O.BOX OFAPPLICABLE) SYSTEMS SERVING ANY NON-RESIDENTS(I.E..TRAVELERS. EMPLOYEES,STUDENTS,ETC.).COMPLETE THIS SECTION CITY BTATE ZIP CODE 11.NUMBER NON-gESIDfNMLCONNEC110N3 OLYMPIA WA 96504-2626 11 S.SYSTEM CONTACT PERSON TITLE ML ENTER AVERAGE DAILY NONAESIDENTIAI POPULATION SERVED FOR EACH MONTH.MANE ENTRY FOR EACH MONTH THOMAS A. NEFF — SECTION COMMANDER DAYTELEPNONE EVENIND TELEPHONE ,Mx 60 M 45 73 BEP 43 M DOES THE SYSTEM SERVE AT LEAST 35 OF THE SAME NONRESIDENTS FOR A OR MORE SAYS PER WEEK MR AT LEAST IN DAYS PER YEART I I HI PPRIVATE:NON�PPOFIT RESIDENTIAL W RIVATE:FOP-PROM RECREATENAL © YFB O NO LOCALOWERNMENT BUSINESS/INDUSTRIAL L� LWAL OVERNMEND/ AGRICULTURAL/COMMERCIAL WATER OIBTRICn LODGING/FOOD SERVICE M.MWTAL NUMBER 11.DNiTT11BU110N REBEIIVOIRIS) CONNECTS M f EBT V D TDTAI.WPACITY 8 STATE SCHOOL/MY CARE C4V Y FEDERAL OTHER(CHURCHE%ETC.) 6 rJJ_F GAu0x4 LIST UTILITY'S NAME FOR SOURCE. y IF SOURCE IS PURCHASED OR B R INTERTIED.UST SELLER'S ID F F� Y q (EEETI (GPM) IM.1/t INC. THE MG. FORMAT.E UN.%XXXU(I NAME IND y rt E {t ae SEC. NO. EXAMPLE:TFOWYI SEATTLE § •� g I�jI ;UL WCLI_ A L a Y CCCE I3 1/)4 4Wi sW 02 yAq >q4J PAININIUM BACTERIOLOGICAL SAMPLING ET. YB. JAN T FEB MAR APR MY JUN SCHEDULE JUL AUO 8EP OCT NOV DEC 1 1 1 1. 1 I OWED SERVICESIPER PIANB) Il MTEM 1 0000 wooNj I UST W.—MMCRITCKWATERSUPPLYWHIrcEAHEAT YES NO OW MGMT AREAS YES NO 24, EFFECTVE DATE RETRO.CHANGES SIGNATURE OF SON REVIEWER MTE WATER SIMEM DON 111t-011(Rw.SAND V A T E R V E L L R E P O R T start Card 40. 006746 MATE OF WASHINGTON Water Right ►erNlt No. • (I) MM#tNase WASHINGTON &TATE+PATROL asv....vAddress . V 631 ev........ .... ....... ................. ..... .YTOFAIRPOI RD +••SMELTON,WA�90506• (2) +LOCATION Of WELL' County. o my+WaSOM + - AV11/6 •a9W 1/4 ++See 002 T 020 N.,.a 006+W Car merest iRPORT (c. S....a ADDRESS OF WELL .....:..........1 ............A...... RO ... .....................u+.................. (3) PROPOSED USEt DOIESTIC�� a +a. a �00) WELL •LOT ........sl.................. ...... +........ .----- ..........^s+.-. ------------------------- ......----------------------------- (p TYPE Of YOUR: Owner's Nudur of Nell Iornetten: Describe by eater, character• size of Material (If Man than ene) and structure, and show thickness of sculfers and the kird NEW WELL Method: ROTARY and nature of the Materiel In each stratus penetrated, with at least orn entry far each chorale In feraaltion. (S) "it led 166 Dl seater of well B fnehae ------------------------------------------------------------ " Orll led .. ft.... Depth .. cmplet.d well ... It. MATERIAL aN01 TO ..I....S.va.ION DETAILS: LOP SOIL GRAVEL BROWN 0 3 (b) Casino :T10M DETAILS: SAMO L GRAVEL BROWN 3 SL Casino lnsblled: B " Ole. froze e1.5 ft. to 156 ft. CRAD L GRAVEL WATER CROWN 56 80 MELDED " Ole, frm ft. to ft. GRAVEL L M L CROWN WL 00 9S ^ D1a. frm 1t, to ft. SAMCOURSEL GRAVEL L GRAVEL OWN 05 IO .......................................................... SAMD L GRAVEL CLAY CROWN M 10' Perforations: XO COURSE SAND L GRAVEL CLAY 105 10 Type of perforator used SAND L GRAVEL CLAY BROWN 109 11' SIZE of perforatl am In, by In. SILTYSAND GRAY 115 13 perforstl ern frm ft. to It. HARD CLAY GRAY 136 15 perferatlons fret ft. to ft. HARD CLAY L GRAVEL GRAY ISO 15 perforatl area frm ft. to ft. WLTI-COLOR SAMD L GRAVEL WATER 156 16 .......................................................... COURSE SAMO L WATER 166 16 SeraaMa' YES Manufacturer's Ame ion2aN Type SLOTTED Model Me. Won. 7 stet site 60 frm I66 ft. to 161 ft. We tryed to pump well and ofso. 7 stet size 100 frm 161 ft. to 196 ft. could hot et the water to -••--------•---------------------------------•••••••••• Oravel pecked: Mo slxe o1 groval Clean up. (turbidity) Gravel placed frm ft. to ft. ----------------------------------••-------•""'-----"--- We then pulled the screen an surface seal: YES To whet depth? 20 ft. casein to 88' and reinstall d Mac e Materiel used In seal SENTOIITE g old any strata contain uueebte water? YES screen is now set from 78' It, 88 ' Type of water? POTABLE Depth of strata SS ft. Method of *@.Tins strata off CASED . i -III I ..............................I.. . We then developed the well w th Ti Er (7)�PUMP tMarafacturer'SNeoe for 2 hours . Type X.P. ..............vv.....uuu..+.I....a+.+uv..Oev..v.vvoo (0) WATER LEVELS! Lord-surface elevation The static water level is th sans above man see level ... 126 ft. as when the well was 166 ' (4 ' ) Static level 62 ft. below top of well Date 04/13/92 Artesian Pressure the. per sware Inch Date Artesian water controlled by he well blew 1$0 m at 68' f1tIr 2 In work started 04/11/92 a Caipleted 04/13/92 .".+..............^.................s.........................+......+......................0....................+""+....... (9) WELL TESTS: Drawdan to amount water level is lowered below VEIL CONSTRUCTOR CEATIFICATidu static level. I constructed and/or accept reaponsibtlity for can- Use a peer test Made? No If yes, by w11om? Itruetlm of this "it, SM itACCepllarso with sit Yield: gal./min with ft. drwdoen after hrs. Washington well construction standards. Materiels use and the infarmt ion rspertod Above are true to My best knowledge std belief. Recovery data IT. Voter Level Tim Voter Level If Me Voter Level NAME ARCAD IA DRILLING INC. (Pere., fires, or eerper.tion) (Type or print) ADDRESS SE 1TO WALKER PARK NO Date of test Bailer test gat/"In. ft. dra.down after hrs, nICMEDI Lt... No. 0950 Air test 275 sal/oln. w/ stm set at 166 ft. for 1 hra. Artesian flow I.P.M. Dora Contractor'. lelpersture of water Was a chMaleel enelysle soda? NO Registration No. ARCADDa167K1 Date 05/00/92 ..........+.....................................a....................................................+..+...s.au......++. Reconstuction was done on May 4 , 199 8 Plate 2 STATE OF WASHWGTC I DEPARTMENT OF ECOLO r1` PERHIT TO APPROPRIATE PUmrC WATERS OF THE STATE OF WMHINGTON ❑ and.Water �twawesr�.i w.r..aor,n,,.�axua�nwn..e�.....e..w w..�r.a w+�.. ❑g Gmund Water S"te4�a r�e,r oat rtw.�e January 8, IM G2-28364 G2-28384 P Washington State Patrol do Dennis Craig .aat.sn Tun n Way (Dilemma am 0mw 4242 Martin Weshinatcn 99504-0612 The applirau f5 punaaa to ilia Repan ofEsmunonon whkh hat been accepted ay ate applicant,hereby granted a penny to q at,,n i 'the following dncdbed pubIx"I=of toe State of Wa ,Vn ablest to rotting nghur aM to tAe(Lnitseieru aM prolnunts te1 a Anein nw PUBLIC WATERS TO BE APPROPRIATED Well ,rwaN.o•wsreaw.rew ,wo.rasrsT,s,t®o arua.rau.nn 340 Emergency uses oaenn.nrs6uareema,E _— Fire protection Emergency use Multiple domestic supply Emergency use only �iIF11Tw 0F8iG'XSIAiDaali LOCATION OF DIVERSIONIWITHDRAWA 1200 feet south and 1000 feel east of the west quarter comer of Section 2. mvS InWuruvxnvoe w.ac.awtwx NW%SWYi 2 20 4W 14 1 Mason E R ED PIATTEO PROPERTY v rcre xiws ar e,..t w.mw,w LEGAL DESCRIPTON OF PROPERTY ON WNICH WA R IS TO BE USED That part of the southwest quarter of Section 2 and of the west half of Section 11,T. 20 N., R. 4 W.W.M. described as follows: Beginning at a paint on the west 0ne of raid southwest quarter of Section 2, 1200 fee south of the northwest corner thereof; Turning thence southerly along the west line of said Sections 2 and 11 '5100 feet; thence east 1400 feet; thence north 5100 feet; then=west 1400 feet more or leas to the point o. beginning; in Mason County, Washington. That par of the north half of the southwest quarter of Section 2,T, 20 N.,R.4 W.W.,described in follows: Beginning at the northwest Comer of said southwest quarter running thence east, along the north line thereof 800 feet;thence south 800 feet;thence east 600 feet;thence south 400 feet;thence west 1400 feet;more or less IG the west line of said southwest quarter;thence northerly,along said west line, 1200 feet more or less,to the point of beginning,Containing 27.5 acres,more or less,excendin the north 60 feet thereof for County Road right of way. ALSO Alva served by the Pont of Shelton. 4 to 1 DESCRIPTION OF PROPOSED WORKS p s fiN drilled well. I _ DEVELOPMENT SCHEDULE (Started August 1, 1993 n�. August 1, 1994 nenre PROVISIONS Installation and maintenance of an access port as described in WAC 173-160-355 is required. An air fine an, gauge may be Installed in addition to the access pun. 'At such time that the Department of Ecology determines the regulation and management of the subject water is necessary and in the public interest, an approved measuring device shall be installed and maintained i accordance with RCW 90.03.360 and WAC 5OR-64-020 through-040. The Water Resources Ad of 1971 specifies certain criteria regarding utilization and management of the water of the State in the best public interest. Favorable consideration of this application has been based on suUciec vaten available,at least during portions of the year. However,it is pointed out to the applicant that this us of Water may be subject to regulation at certain times, based on the necessity to maintain water quentitic sufficient for preservation of the natural environment. The Permittee is advised that notice of proof of appropriation of water (under which the final certificate o water right is issued)should not be filed until the permanent diversion facilities have been installed,and th system is currently in use. This includes installation of a mainline system capable of delivering the recommends quantity of water to an eristing of proposed dumbution system within the area to be served,and fulfillment o ul other terms of this permit. i I Thu permit shall be .subject to cancellation should the pemtfstee fail to comply with the above kwlopmmtschedule and/ar fatim give notice m the Department of Ecology on forms provided by thatDepanmest kdmrnrMg such compliance. _ Men under my hand and she seal of this office at 04inpa, Warhingron, - - --- ' ihir 29th day of July . 19 93 Mary Rlveland, Director -at ts: Department of Ecology ENOIN OwTA e:*CMI ^ ac E �A by PERMIT .a. Na Driller's Log - : 0 _ _ 3 Top soil E gravel ; brown o z Y o � B,i o.o Q F •a• Sand E gravel , brown a z 2 z N O — U Q •� Static water level @ 42' u C J 0 N G N •U• z H Q U 54 J w Z a J ~ y 0 O .p' Sand E gravel w/ water, brown s Top "K" @ 73' z u - Casing shoe •O� N N @ 77' 80 e •o Gravel E water, brown 85 s c Bottom screen ---r1 ,�, a 87 Coarse sand E gravel , brown @ r J Y g.o Sand E gravel w/ clay, brown c 0 iU :Q 109 Coarse sand E gravel w/ clay m Sand s. gravel w/ clay, brown ( E "_ 115 10 - Silty sand, grey 9 '• N > __ 138 m = u Hard clay, grey - 150 li Hard clay 6 gravel , grey „ 156 �'•• Multi-colored sand E gravel , water test screen set 156'-166' a V o 5 166 Coarse sand E water 9 8" Johnson, stainless wirewound screen, .100", 78' - 83' ; .0601 , 83' - 88' 3 5" riser and "K" set 78' - 73' i l PUMiWELwLf1 WELL INFORMATION: TATE PATROL DRILLER:ARCADIA DRILLING INC. CMENT SE 170 WALKER PARK ROAD ` SHELTON, WA. 98584 208 426-3395 PUMP TEST INFORMATION: DATE DRILLED: 5.8-92 TEST BY: ARCADIA DRILLING INC. DEPTH: 88' SE 170 WALKER PARK ROAD SCREEN: 10' FROM 88'TO 78' SHELTON, WA. 98584 SURFACE SEAL 20' WELL LOG: ATTACHED PUMP: GRUNDFOS 3755300-5 INTAKE DEPTH: 6V DROP PIPE: 3"GAL. PUMP TEST: EL. TIME LEVEL TEIME LEVEL GPMEL.TIME LEVEL GPM 0 41.7IN. 41.9 340 420 MIN. 41.2 340 1 MIN. 42IN. 41.9 340 450 MIN. 41.9 3402 MIN. 42 MIN. 41.9 340 480 MIN. 41.9 340 3 MIN. 41.9 MIN. 41.9 340 510 MIN. 41.9 340 4 MIN. 41.9 MIN. 41.9 340 540 MIN. 41.9 340 5 MIN. 41.9 MIN. 41.9 340 570 MIN. 419 340 6 MIN. 41.9 MIN. 41.9 340 600 MIN. 42 340 7 MIN. 41.9 340 150 MIN. 41.9 340 830 MIN. 42 340 8 MIN. 41.9 340 160 MIN. 41.9 340 680 MIN. - 42 340 9 MIN. 41.9 340 170 MIN. 41.9 340 720 MIN. 42 340 10 MIN. 41.9 340 180 MIN. 41.9 340 780 MIN. 42 340 15 MIN. 41.9 340 190 MIN. 41.9 340 840 MIN. 1 421 340 1 20 MIN. 41.9 340 200 MIN. 41.9 340 900 MIN. 421 340 25 MIN. 41.9 340 210 MIN. I 960 MIN. 421 340 30 MIN. 41.9 340 220 MIN. 1 41.91 340 1020 MIN. 42 340 35 MIN. 41.9 340 230 MIN. 41.9 340 1080 MIN. 42 340 40 MIN. 41.9 340 240 MIN. 41.9 340 1140 MIN. 042 340 t AMIN. 41.9 IN. 41.9 340 270 MIN. 41.9 340 1200 MIN. 42 340 41.9 340 300 MIN. 41.9 340 1280 MIN. 42 340 41.9 341 330 MIN. 41.9 340 1320 MIN. 42 340 41.9 340 360 MIN. 41.9 340 1380 MIN. 42 340 41.9 340 390 MIN. 41.9 340 1440 MIN. 42 340 41.9 340 390 MIN. 41.9 3401440 MIN. PUMP OFF Y DATA:LEVEL EL.TIME LEVEL EL TIME LEVEL 1 MIN. 1 41.916 MIN. 41.7 15 MIN. 41.7 2.MIN 1 41.8 7 MIN. 41.7 20 MIN. 41.7 3 MIN. 41.718 MIN. 41.7 25 MIN. 41.7 4 MIN. 41.7 9 MIN. 41.7 30 MIN 41.7 5 MIN. 41.7 10 MIN. 1 41.7 60 MIN. 1 41.7 Plate 3 9 #£CE y22 © JUL 26Z0 \ { MASON m ' 0 § k « eg"D & § \ } a i / COS § Ir � . , . . . . ¢ %~ \ ^ j 2 . 0- \ \ 2 g | � \ 13 ƒ zw \ \ | . . / } 3 $ / / \ § w . 3 \ . . . : . . .