The URL can be used to link to this page

Home My WebLink AboutWEL2023-00057 - WEL Application, Design, Letter - 10/30/2023 415 N 6TH STREET,SHELTON,WA 985" MASON COUNTY SHELTON:36 27546]9.EXT 400 BELTON 366 27-9870,EXT 400 ELMA:360 82-5269,EXT 400 40 Public Health & Human Services FAX 360 42T-7787 10/30/2023 IDDINGS FAMILY PROPERTIES LLC P0 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 O MASON COUNTY SHELTN 36027-94 4 70 EXT 00 BELI 360-27546T.EXT 00 Public Health & Human Services Er 360 82-5269,EXT 400 4 FAX 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 (3232843000001323284200040), 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 360427-9670 Ext.353 or email at danderson@masoncountywa.gov Sincerely, David Anderson Environmental Health Specialist Mason County Environmental Health 415 N 6TH STREET,SHELTON,WA 985B4 MASON COUNTY SHELTON 36827]4467,EXT 400 BELFAIR� MA.36"82-5467,EXT 400 ELMA'.360-083-5269,[%T 100 Public Health & Human Services FM W042)-]787 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 2-party water system, Iddings Well (323284300000/329284200040), 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 danderson@masoncountywa.gov Sincerely, �n �J David Anderson Environmental Health Specialist Mason County Environmental Health drit d From Mason County DM Prmhw from 34t m county tams M AhuN ti-OUNTY COMMUNITY SERVICES _ ^� l 0.iJrLMnnhgfnomn+,i illldMCwnnmryer.M1F ' 51 m (aWFxI-JI •lio0.WA9x5xa WEL ,ZpZ3 b00 sMl.n: W"29 9670.400 110ilur.NAQ75�7.," Elms:WWKI-5269 .4* TWO-PARTY PRIVATE WATER SYSTEM APPLICATION accre a...fa.eoaeaa-sriiw c..v.ay.r a. $Da� S'4 o ,ge y 2 - �t a erz bw.ese-acaear.urv.s..e.m & - n'E AeWa 'am r.xt.,..a,sefmru 9,., eccoep.Nv v.acaa xuawea l...ouo.attl v a.am ace v.xca xam ace W.taceoUFM saervre ❑ New xixtinp )(Well ❑Spring {. G 3 2 QU e5 vwras.a w..ea srs.su a..waaauweal �C7✓O', /! S 6/ vaorec,veaeam.rox n •� a e n S 5 e or ¢ oa tet[ OW[c 0.1ownew. Site Plan:(may also be attached) mmwrunre tine roes,easemeab.etc...l (property d daries,stn 4+r.s,viva sits M10e'radius,driveways.rolls.sePrrlceaer .W 5 pe 4i'r7-4 C l -e-of it/o7k=• P/17"-er SaMllo'e 14 w�// /a, Ar if OR -F, le . 2 Pan{y )✓nll.f. Sys sfe. irreo�Jed a-Ae•^e cane " NO 'c/sewer Co.x�ogEA�S Submittals Checklist: (these additional items will be required for approval) r I Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) - o M } B Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred it well is not yet drilled)0.7 Notice to Future Property Owners recording(record with Mason Co.Auditor, supply copy of recorded document).-do,e Septic Records(additional locating requirements may apply if there is a lack of septic records on file) Al,h312t Tkis fo.m may be scanned and available for public view on Me Mason County Wab site. Re,'ised: 1 W 021 Page L of 2 Y + {8 §-•nn It 14a`+Ct M U .t/i,irlle;i. staff Use Only Review Step 1: Well Site Inspection: YES NO NA ❑ ❑ Evidence of existing sources of contamination within too foot radius of water source? (c min0elds,tanks, buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 foot radius of the water source?If an is road private,County or State. What is distance to ROW? ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ Is the well cap satisfaclory%- 3 oUf of y 'e11 C4P MdAlfr OI's 1`O e M ❑ Screened and vented? — C(//10�9 WC, 46f Ptu 7 s^♦' ❑ The well casing extends level grountl!concrete slab?(circle one) Is there evidence of a surface I LGt ❑ Does the seal appear adequate? Ittit Q [ ❑ Is a variance necessary for well site approve T�: Qf✓A If, Comments - MOyl1-f' Mtn a l�'� AR 5 IF Pass Fail InspectorDate I /L.D I j�9 C:l WT I%AC:_ _ Reviser Step 2: Two-Party Review: YES NO NA Ili ❑ ❑ Water Well Report with adequate pump test on file? 7^r NUN �0 Driller D I ilf GPM 36 If Received of Capacity Test L ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of teal � Z ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN 1?om 4 k71 ❑ El System appears adequate to serve 2 single-family residences based on infor/mation provided?? fill�� r ( _. .� /n4f�__ 1U lae�� ka '1 Z6/ zOZ3 Approved ❑ Denied Reviewer _. Date E is review mflo t observed conditions as they evaledon the day of the.site inspeerion. Noclaimismade.expreen the(umre sues'ese nr,(ailure offhis ryrtrmWell Bile approval does not eonsdmre asternyvtem app")ML Water Sslem appoval is u to part pror'ess.conne lions al new avlls are subject to aatrr adeyuaryrequiremlima of building permit per ML'C 6.68ge restriction and additional fees may ripply fu all new we/Is drilled yfter./unvan'!9'",10l8 per ESSB 609f. Reviwd: 10113l2021 Thistaml ma't em sunned and available roe public view an the Mason County Web see, page 2 of 2 F'"rir.".ad 1r +rn sila,o t M likT�y9ti LJ WATERWELLREPORT 't=<a-r.tn-:.:' naxrerinrrn!Nc.WEae,fw ECOLOGY L'+:W<rml.,Wn:lu T,M, T. a..rk n un S1;<'d<Il3anw ufrmxallwn aw xt111. C f.nun..arn _� J<:MIWwKO OrlxxlwYllrys\LIiY_ _ ___ 6a4+NIQO ifr'nM1f<m(tab Vp ___, .,�. ' frTla<J I'v C Uuwx. IMvwl :af�•w MrpnlM1 C'xMl\vK buMS �JeWblb flr:iulmn �lnlxvl' r1x.r_—.. ....ill Kcn Arttl ddCm)NSM:B Pd ___ ____ fonbwn:m PY: NrOLL firy Ta!xrya 4W.NIt Un?n -� __._. .. [\s.rl' annmi+ -pnn: JUae .ia Hrtallltl ]Ya21SAc00IX10..,___ .-� .._.... . u:.a—a:1x..,�„rN,w�.._.m e�T'�—_ _-._ ._� 11�x,..analwr a!Ilvtl.re f,x rxla•rn> �7 v<: .... rr w 4ep:n nlrongMrr2.nl rd 4 _—_ ..—� _ : f:wr.an..Ikbw: -.. x.x !fam.nuw xav�e aanarc:frx• i 3° ti_ 2 i lawa mrrurr er Y< LtVKN ' _E\•?: m _ - I. 3Euor x✓m< SW To J 4 1�—Walk Igtl: Ur< I� — f n. aFf e•m ' � '9aWlM pacrm mrgt9TMW: C ]r j I x J MY! aE�rT+� n I r, c. �— M1 I cIAY]cane orox�Sale L Srinn �9C ... i JTM r.F1� .ry: nal� . )/,:y rppyero vE6gam S a.e Sed.L\.. 10 aM agel'U' F. _j— I r _ 'lulu• .. -- .�--r— . J.-n!wn s Parr _,m= ' uFe. awrolHlp - uA ' ur..r v.^I'r•Y:ognlbnrJ •r. 1.':n .4 ryx1.v' I __ ____ ... L �•• Anv!•'.Y! twx Kann uJ nnr Ua.e le.a: '"""�� _ I — W 411 ItIN1T0.CLYl11]<LPIIYIL\t!lA <d''d I - yfnxlNec rk evl f. :.ealmu.xgW:Ne Nnmel...nrd.aNru mrunxum�rl•`nel ynna x.nwn iTlllan,..'IN:nm_ ^E ITnl Namr'-^IilY lArs q.Ln<nWNE DM 1.1111 3142 S'�1°"_...!-.•— _ f.rt..4vn lq BeWx WA?1526 IFLlyV\ PII Cnn;:x a¢rn.e\n __.-_._____._-_ Cmba:,.rra —. aurw:Arm�n pavlSCl'10�+ alc SUN_= It _ ,I � Y.. I1 IIM M1nAaw ayry .. ML rxn..:F.� 1 aan +l / T�•,�nn 'r'NrH nnr t "IN,y++rA: wl0' 'S"laan r° lei fµrom Mason County DMS PrinixA from Mason County 6MS BL1�,1Oo23-o1oSo_`_ Y+fA�T�d3'O�a'�D ^2 Thurston County Environmental Health 1 � 2000 Lakeridge Dr,5W 0 0lympia,WA 98502 j 360867-2631 TIINN`TNCOII�'IYI _ _ COLIFORM BACTERIA ANALYSIS —� EECEIVED Clleen! Time Sample ! C.,I T1 23 M /� 3crrra� I — tryeal Wale:BYalma(tlixkanlr one Coal �'l�nM rkuaMdtl i p emaPA ❑GawO ❑anal_—_—. I GrwVAanC GvuaB Sysbms-Pmviia fmn Warn:F��xi""litle''s_ ��M1xan1M'1'HfO: ON Syakm Nam:: Ije11 On IF �PyCL i)ep Phan' � q _ Q Ce�IPhonrt c.mr'a @uV:y a•i W Phone'.( 1 —.I SW nsuh k:IRMMn�. ap AaaxrANAeesl i SAMPLE INFORMATION a _— s o.cdedod j a�9�� 10f�++ I S;bW,mcatun ar aatlmaewhere sanpk colecNG. e 'allmeVucfoasa mllr¢Itls i 617 ae AeaAaP+b �.b i wX41 ao: &+a 1.75 TyNDfUnWe(maal tlwckody ono boa otrt yllagh Na XtM bekw) j j t.6a'arou4ne dsbibulion Ample 12RapeN aampla(alkrlm»LlouWel I ' CCbnnaka:Yez_No ✓' �I ❑GNnbul'mn sYfLem ',. ✓I Chknn*W Yea_No_..... ChM'ne ResiWat.Toml_Fns_J ?Raw WNx Aurta 6amPk '! Chbnne Reidml:TOL'L_Free._-� I ❑fed-Yau:a.cwlsrci5rwnwnvnl I UIna161x1urylWUne laC numCer ❑AasesemeM W. N WP) w amt...Y lauw wlkal ame'. Oahm ' _.J—r- - I Ii.O AmPk td«md ror mrorm.tkrconq �I bvaealgatirc_ CanMmcam/Ryve=a^0f— _I LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑UnasaahcbN TdalCdilam Preunl and aM ' ❑E:aa Mzem ❑E.cd'ab»nt No c.Udlomdcaak! Rapkwnmt AmpW Pe imtl: ❑Samak eodtl Pia Mml ❑TNTL I EacNral DeneiryReeulls:Tolel CCliolm_—n00m1 E�--`tWm'_ ppBM EnbraKrstl__11W mL Uep Catle ❑WE236 13SM9221D DaR nk tinw w.Fina: ❑sne02l58 ❑F„kl IISOC `I—L51 ORPaM TIlhndneG Uri`FIDwup It 2D21i r��pmixru„rcrayY�m � I lTUse dar — —1'r��ljl�rvert0�. I.1,;�iraln hTssarn wOutlxy O&?`.� 2203509 MASON CO WA 10181M23 12 32 r HMTCf I�pl�l�l�f�lfl�llAINVRp1111111��1sU vr0.. 2 Return TO /—ar-t r- et fr . •ro�►�i i29 S Po go z Mare ✓alf-041 F/�9So38 'X'Sr%I S 'Af . /)r Grantor(s): (rJ (z) Grantee(s): (1)PUBLIC Legal Description (1) .5►✓ sar e-x s ys6 - s9 /Abbravieled fbrm:i.e.lot,block,plistorsectibn, fownahip, range) Assessor's Tax Parcel: (1).3 A 3 2 9 -//-3 - 0 0 0 0 0 ag 7--Z? ,ems NOTICE TO FUTURE PROPERTY OWNERS OF PRI l 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 O V Tax Parcel: (Connection 2)3 2 2 - 2 - O D O -jV O The system owner is responsible for keeping this system in compliance. The name of Me water system is: -Z-ddr"nns Wet/ 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 /(J' day of 0e �e e� , 20.. Signature oAGrentor(il Page 1 of 2 Printed From Mason C )(. my ) NA fh'@F9Y-o tr,P1.x'�4m k State of Washington ) County of Mason ) I,the undersigned, a Notary Public i and for the above'named County and State, do hereby that on this day of who is known to be 11 -l�c��er4 by �(•{K personally appeared for ged that h sh the signed it. signerottheabove ' slrument, arxl dcnowled GIVEN under my hand and official seal the day and year last ov an. Q� aS m� Notary Publi in and for the State of Washington, residing at My commission en sires =� NOT PU9UC STAtE OF WASffIN610N W DO7Ee MNi(.111a,Ye?J fJ0�N118&ON•lVe� Page 2 of 2 Printed From Mason Cour,.t)' ?"WS grin ed f om Meade l.3»=^.t'}°DIMS