HomeMy WebLinkAboutWEL2023-00057 - WEL Application - 11/7/2023 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:36a 27-9670,EXT 408
MASON COUNTY BELFAIR 3662764467,EXT 400
ELMA 360482-5269,EXT 400
40 Public Health & Human Services FAx:36P 27-7787
10/30/2023
IDDINGS FAMILY PROPERTIES LLC
PO BOX 2
MAPLE VALLEY, WA 98038
RE: WATER SYSTEM PERMIT., TWO-PARTY
WEL2023.00057
617 NE Dewatto Beach Dr
323284300000
The above mentioned permit has been reviewed by Environmental Health and found additional
information is required.
-Insufficient surface seal: Per WAC 173-160-231, after the permanent casing has been set in final
position, the annular space shall be filled to land surface with bentonite or neat cement grout or neat
cement. Leaving voids for future installation of equipment such as a pitless adapter is prohibited.
Please contact a licensed well driller to have the surface seal evaluated, and the permeant well
_ casing sealed to land level. Please submit before and after pictures of the surface seal OR contact
Environmental Health for a reinspection.
-Three out of four well cap mount bolts are loose. Tighten the three loose mount bolts to ensure a
proper sanitary seal and submit before and after pictures of the mount bolts OR contact
Environmental Health for a reinspection.
-Well cap is unsatisfactory: Open conduit hole in well cap. Contact a licensed well driller to have your
well cap evaluated and properly sealed. Please request a reinspection OR send pictures of the well
head once it has been properly sealed.
If you have any questions, please contact me at 360-427-9670 Ext.353 or email at
danderson@masoncountywa.gov
Sincerely,
David Anderson
Environmental Health Specialist
Mason County Environmental Health
415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY $HELTON 3 -275-9670,EXT 400
BELTON:364 27-9677,EXT 400
40 482-5269,EXT 400MA'.360-
Public Health & Human Services EL FM:360427-7787
IDDINGS FAMILY PROPERTIES LLC
PO BOX 2
MAPLE VALLEY, WA 98038
RE: WATER SYSTEM PERMIT. TWO-PARTY
WEL2023.00057
617 NE Dewatto Beach Or
323284300000
The 2-party water system, Iddings Well(323284300000/323284200040), 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 360-427-9670 Ext.353 or email at
da nde rso n @masonco u ntywa.gov
Sincerely,
David Anderson
Environmental Health Specialist
Mason County Environmental Health
415 N 6TH STREET,SHELTON,WA 98584
SHELTON:36042M670,EXT 400
MASON COUNTY BELFAIR:360-275-4467,EXT 400
ELMA:360482-5269,EXT 400
Public Health & Human Services FAX:360427-7787
IDDINGS FAMILY PROPERTIES LLC
PO BOX 2
MAPLE VALLEY, WA 9B038
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2023-00057
617 NE Dewatto Beach Dr
323284300000
The 2-party water system, Iddinys Well (323284300 ctices with
000�23284200040)' has been reviewed and is
hereby APPROVED for 2 connections. Please continue to follow best management pra
free of maintaining
contamin contaminants. and st rmwater management taro around the water sou er analysis, ' keeping wellhead area
If you have any questions, please contact me at 360-427-9670 Ext.353 or email at
danderson@masoncountywa.gov
Sincerely,
David Anderson
Environmental Health Specialist
Mason County Environmental Health
S
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TWO.pARTy PRIVATE WATER SYSTEM APPLICATION
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Site Plan: (may also be attached) ray sepM1ywxer m,,,poiwMa aria lures,easements.elc...1
(property b9�x%daries,sbucaa.,nal site.1100 radius.dnrewai's•
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Submittals Checklist:(these additional items wit be required for approval)
gecleriological sample(this may be deferred t well is not yet drilled) '- o n
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Satisfactory )
Wei Notice
a to with pump lest m owners rapacity test performed by n (this may u defelrored PY of well
tdocumlent) C
Notice to Future Property Owners recording(resod with Mason Co.Go Audilo4 supply ec
Septic Records(additional locating requirements may apply y there is a lack of septic records an file)
Revised: 10; 3/20?1
is form may be waned and availableview
for public on Me Hawn Cuamv Web sae. Page l of 2
•. "_..-- Staff Use Only Redrew Stop Step 1: 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)
❑ ❑ Are there roads within the 100 foot radius of the water source? if so, is road private,County or State.
Whale;distance to ROW?
❑ ❑ Does the ground slope away from the water source site?(show slope on plot 1(t pion)
- ❑ Is the well cap salisfactory? 3 ov}Jof y (� dap A/�'����W/l0 f��
rt11 ❑ ❑ Screened and vented? — C(/n P�4" koj(i frl of P4?4e
r` level ground/concrete slab? circle one)
`I 01 ❑ The well casing extends
0rl J� ❑ Is there cadence of a surfaces 1.— (S1M0 Lot 47•"'
(' ❑ ft
arsdequale. � � c-0n: -I2J.U6YUy�
Does the seal apex ? {c1,t I,
Q [ ❑ Is a variance necessary for well site approve T�z BAIA 1}!
Comments bn I fS � .MR - O
ts, Ma
`/ �'----- Date toll6/7,0?.j
pQ Pass Pail Inspre�scttor'�._ __ —._--- -- -
1 �s r'�
Review Stop 2: Two•Party Revlaw:
YES NO NA
Rf' ❑ ❑ Water Well Report with adequate pump test on file?
'ry ) 070 Driller 0 1/1 GPM
If NO,date of Capacity Test L
❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Z
❑ ❑ Received Signed. Notarized.and Recorded Notice? APN 7 7 94M G
FYI ❑ ❑ S//ystemm appears adequate to serve 2 single-iaamily residences based on•information provided?/
Comments oLI 1 f _. . 1� __.. _. Ne
Dale
4S'f Approved ❑ Denied Reviewer __.
�T Pindi,g.,inthisreviewreflmtobservedc»ndirim-lortheyedrYedonthedayofIhe.riteiru'per'tion. Noclaimismade.exprcee
or implied of the future.mccees ar fatlore ofthis system. Well site appmeof does rtot ronsdlWe aeter.geuenc nppmsnl. Water
SwTem approval is a two-part process.
All pmpased connedirxic at new wells am subject to water adequacy requirements at time ofbuildmlipermit per MCC 6.68.
Water stage restrictions and additional fees miry apple rn all new wells drilled after Junuan'19'" 2018 per ESSB 6091.
Revised' IM3f2021
This farttt may Ce srannes and avaeable for public Wew ae the Mason county Vleb Aft• page 2 of 2
I'nnted film tklu `e CO'W Sy
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2000 Lakeridge Dr.SW d Olympia,MA 98502
360867-2631
TIIUXFRIN W W1V I - -
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2203509r�Fp MASON CO WA
Return To
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r�✓.��Js JF4-3y Idee�oeef'es ,l.(Cr(p) , our-e .ode :vc S
Grantor(s): (1)
Grantee(s):(1)PUBLIC < _ s,� _ s9
Legal Description(1) `� br .Str '� X s for sec6 , fownsrdp.range)
(Abbreviated form:I.e.bf,�bl/aek,Dls a O O O O
Assessor's Tax Parcel: (1) 3:Z ;Z 3 2 �"-L`3 _----
f
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 l)J-.2,—,I- ?—V--- -� O
OO
Tax Parcel: (Connection 2)3 .Z �zld---Y—z --o—0 0
The system owner is responsible for keeping this system in compliance.
The name of the water system is:_..mod d r nQ 's i /e
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(hasl has not) been granted one or more waivers from specific provisions of the
regulations.
Dated on this_Le day of Qe ✓06 eL , 20,U.
Signature%Grantor(s):
Page 1 of 2
f•ril f m Aieaso�Cara rs4£.
state of Washington )
County of Mason 1
1,the undersigned,a Notary Public in and for the above named County and State, do hereby
ify that on this 0' day of 20 23 .
personally appeared for , who is known to be
signer of the above ' strument, and dnowledged that heatV(the signed it.
GIVEN under my hand and official seal the day and year last sbovq,4ritten.
(ArVA yY
Notary4Publi&ldor the State of Washington,
residing at
My commission er hres:
NOTARY PUBLIC
STATE Of WASH NOION
JOKX IA BEVANS
my OOII11,118 NF7tAES
VAi 12.2W
OO11,1111,1168101,11 I I3754
Pape 2 of 2
Printed r roni Mason County DIM
r<r_tar mu6cn c'swnty �M