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Home My WebLink AboutWEL2025-00004 - WEL Application, Design, Letter - 7/12/2025 MASON COUNTY 415 N BTH STREET, 0427-9 7 ,E 98800 SHELTON:360-2759A70,EXT 400 BELFAIR:360-275-0467,EXT 400 Public Health & Human Services ELMA:860482-5268,EXT 400 FAX:360427-7787 MCTURNAL WILLIAM B & JANET F PO BOX 12048 OLYMPIA, WA 98508 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2025-00004 1057 E Crestview Or 320227790011 The 2-party water system, MCTURNAL 2 PARTY(320227790011/320227790022), 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, a- David Anderson Environmental Health Specialist Mason County Environmental Health -2/'19j0eE0Zr Se I 0 MASON COUNTY [01 A COMMUNITY SERVICES PnlRrdw° O Rvvly By: aaingpWnFgFnvvmmenulHnlllt Cwrvrvnrt/WYN '., 415 N.6°Street,(Bldg B)-Shekon,WA98584 WEL ZOZS-(j coo `� Shekon: 360427-9670 x400 BeMin 360-2954467 x400 Elma'.360482-5269 x4m TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONc -(' `TAPICi '- K1.1LC- O 2L'o' MAIL ADDS 53-9TREET.Cm'.STATe Lp D Y� OGYru vt GI/I aflSDb $ITA RE55-5 EEi.CfrYCfePfvi'ew'a,- Shc/fon Wit gz 1--T pppLEL HUMBEX(WELLL]II[VQI uU 20 22 -'?-V- 9d D'Z.i SECONDARY MC)LO RIIFAPPPLICABLEI - foozz y WATER SOURCE Z BDURCETYPE PARCELtLOTSQE PARLEL3LOT 8¢E ew El Existing ell ❑Spring Z, S Z J 1ROP0EEOWATER SYSiEN XANE IIiEDUIRED) PROJECT 77TIOX omEciwxs ro snncoNDMNS Avl�� Ti `wD She Plan: (may also be attached) . (property boundaries,structures,Mir site w1100'radius,ddwA ays,roads,sepOtlsemr components and lines,easemerm,etc...) Submittals Checklist: (these additional items will be required for approval) Ig Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) Notice to Future Property Owners recording (record with Mason Co.Auditor, supply copy of recorded document) It Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and available for public view on the Mason county Web site. Revised: 10/13/2021 Page 1 of 2 ------_--- —Staff Use Only------- Review Step 1: Well Site Inspection: ` 1*116 YES NO NA }p1�' ❑ ❑ 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. What is distance to ROW? ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) ❑ ❑ Is the well cap satisfactory? dWGR1 ❑ ❑ Screened and vented? t� ❑ p The well casing extends t O above level ground/concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? L04: 17,21291 ❑ ❑ Does the seal appear adequate? LOh; -123.01490 ❑ j ❑ Is a variance necessary for well site approval? 1 Q0 Q 06?- Comments J Pass ❑ Fail Inspector Date Review Step 2: Two-Party Review: YES NO NA � ��""� t0 t(tO2yrr( dl4101f/ 2W 4? Ip1 ❑ ❑ Water Well Report with adequate pump test on file?A�rwcrcv Df((Ihf 0^ I>FX340 r If NO, date of Capacity Test Driller GPM g] ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test AlL ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z z (9 1L ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments �J Approved ❑ Denied Reviewer Date ZLl ]/CQ l4 Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. No claim is made,express or implied ofthe future success or failure ofthis system. Well site approval does not constitute water system approval. Water System approval is a two-part process. All proposed connections to new wells are subject to water adequacy requirements at time ofbuilding permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled offer January 19"h,2018 per ESSB 6091, Revised: 10/132021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 RECEIVED OCT 2 4 2024 WATER WELL REPORT DEPARrMENI Of Noll.oflammNo. WE57287 WA State Department ECOLOGY Ungwr ology WHI IU Tag No. SPI of EDGIo,aY (SWRO) TNKnf,YxrX: \,il<N wt.MnglM ® tmw�:•imn Sim Well Nnnm lit nmrc Ilan one welll� ❑ Mci 'r' a m o gipial iNlklinn NM No. Wp<r Right PemllUL'edifca<No. Foramina Vic: 111 paw ❑hni:wrkl =Municipal Propwy Owner Namc BILL MCTURNAL ❑D—tvii:M ❑hripko ❑Tar Wcn =lklmr WclI SVat Add. O E CRESTVIEW DRIVE CrrmeeHoe T)pe: Mrpmd: CitySHELTON Corm MASON IN N<x well ❑AMabn _Umen ❑terra O C"Tml ly ❑DarmninH OOacr =uw R Ak- ❑btod-Ackay Tax Prod Nm 32022-77-90011 mmeeako.: Dkrm<.ofbminA 0 m.m IN A. Wasavarierce eppm ed ore IRAs wdlt OYa 9]Nkk DapibofrnnPklN w<II I66 am. f xrwu—Nat moth. WWIIf yea.whet was the verierce toll tromp Liver Ilcar Fmm To Timor— Sacco M Wali Thaaa R 1 7 8 to tt ta8 25 b. A 1 ❑ El 1 ❑ Luamiuvlikotmkuali"Nora aw2l: t7WWMor CIEWM ❑ 1 ❑ _ ❑ 1 ❑ ❑ 1 ❑ NE viva Nlhr NE %;Srrhon 20 Township 27N Raw 3 O 1 7 to. to 7 1 ❑ ❑ 1 ❑ 7 Iathvde(Exawb:47.I2M5)47.21285 ❑ 1 7 _ — — —in. 1 ❑ ❑ I ❑ LongilNelExampk:420.123431 -123.03504 Peafaeorhm: ❑Ym 31No typaapmknkrwd MMer's tmXtrmtructbn or Decommbbe Procedure N.ofperhalbm_ S. fl"'+6wmicas in.by_im. Fm�lkm l%s�iFeM<rb•cM1nraner.:in nlr:ulerialoM•rnco<a arullM kinJna NrfonNd Nrm_A.w�A.bekw gmuN awfxe nnmeMWe nNNrhl b<a1b>er pamrrvlN.x'irM1 al ka•I nm'onUY liv<ab cM1anye of ti<reeu: RYw ❑No RK-PackerO D"Ilt L ieEnrrnioa UC WhirW+M1eaaifruaeaamy. woolacneer-a N<m< JgINSfIN MYe+iel Pmro To TYpr STAINLESS MNeI No. UwoNrer6 k. ska•to 1S w.hmn hwt h. BROWN CLAY LOAM 0 1 Okmnn_ in. Sbau<_ in.frown a —1. BROWN CLAY 3 12 BROWN CLAY GRAVEL 12 30 sam"llcr pack:❑Yo, MNo lirtorpackrsoil_im BROWN CLAY 30 80 Mxwriob Places frwr_h.w_h GRAY CLAY Bo 120 Srfice Seal: Ryes ONo To chat depw! 19 A. GRAY CLAY AND GRAVEL 120 140 Mocralmrdin.ra 31SSENTONREGIIP GRAVEL SAND WB 140 150 Did any nnla cnnmin orvnabk xxNC �Ym ®No T)Pcofwu¢R Dopabofatroa Mnka of xalintlawmoR Pomp: Mmmfnmomta Nxnm Type: IJT_ i•U:np make Jagb:_A. I)olBard Dow tme:_ltpm WehvLrvrk: InnJ.nwlia<kwriwaMwrre wb[I_A. Mkk.ur ofk wellamin5 ♦1 O.akrW Nmaa avf Arlie w:rmrkwl,cj 120 A.helm Wpufxellrmin8 0.k 1h01k021 An<aunrycwxre_IM.ParywrtircA tMN Annkn wafer is evowlM by leap wbe.er.l WID Iola: %V a pnrnpum ka perlunrra? a No O Va : by shoo^ Ywid_mm x#b_A.drawdmm aAer_M1n Y.W_qrm wJL_11..Inn4rx'n anv_kx Yvld_Nrm wdb_f1.JnwMn n alto_hr Rnvwry Jun Ipnw-zmo wmn m:mp is nmwrl oR-wmok al mmrmJ fail 'Io wcaolaml Talk W.Laccl Time warm Lewl Time Wmcr Lnel ILmnfm�mri:N Ru Saikr an_Nrm do-0..dnadwnahr_ho, 1BO12D21 Avlem 21 Nenwitba<mraa 149 Lilac M1w Dar Arco-No,_ypor Tempcoo.or._°F wm.clmrkLwipk ware' ❑Yea ®No Sw Dob 09/2712024 C'omplAN Date 1010IM4 WELLC'ONSTRUMONCERTIFICATION: IcmalmdN anA/nr ncmp resrynaibiliryf awWmvlim of lhiowslh eM ib rrmplinlrce with ellWvhinglm wdl consWclipn nmvdmrk.Mnloids aced ord the ivfolamlioo repoHN obese art live Ix my bear IaowlNw nN Mlkf. :1 Drillm O Tnhlcc C PE-Print No.ROBERT LAYMON Drilling C'ontPany ADVANCED DRILLING LLC 3'Bmm �i Address 11530 SCHOOL LAND RD SW Lt.No.2688 city.stab Zip ROCHESTER WA 98519 IF TRAINEES mm'a LNe No. C'nnbw:mr'r Spo Signora Rcu'aralim No.ADVANDL804DL Dom 10101I2024 £CY 060-I-M IRvM19)I/ici.n.llhb doccwrnN in nn rdreron<•frmnrw,plmue cWl ahr Barr Rroonmx Rvy;rnm of 3M-407-M7:. /'owmi karaftinarvm mll)1/Ar IY hinym Rcla9Ao14m. l'ervrm xwh m.gweek brmMhN.,W1R)7aYdd.pl41. Thurston County Environmental Health 412 Lilly Rd NE•Olympia,WA 98506 nmamoxcounrrx 360867-2631 COLIFORM BACTERIA,ANALYSIS Dab Smrpbcdbdad TitreSwtgk wordy to 17/ ILA COExbd owu tRA61W wxn on v� 003E Ow Typeaf WmrSyalwn(dwdani Eat) ❑ pdab NaueehoU ❑GmupA RawB ❑oh Gm li A ad Gmtm B Sydame-Provide from Wabx FaoMim Invinlmy(WFQ: IDR _ 1 Syebm Name: !L (t/ziirL Contad Pence: t Dareonir 0 ) E Cei R-wo 22 E-mi: I F. nnn �-turaatrf C+Etf,O.LIM SAMPLE INFORMATION Swrpb wlbcbd by(nwne): Spm3rp baaEm aadtlteaxhan aanmb mL'ecled: Spagalinanoxmmmnmen¢: A}�qi. C0.1-6 jt ro; e( / GYG$`YI ,zcw-j/Gpi Qe: R� fa+. YSDY •li^aT 9empb Imum dwdonN otr box AY1 mmgh W Ndetl babes) 1.❑Routine D'mtrlbu9on Semple 1.Rapem Sampb leNmutwet rmMm) Chbrinmd Yea_No ❑OistMuaon System Chbnne ReNdual.Total_Fine_ ChbdnebL'.Yes Nc �.RawlYebr Sourte Semph Chbdne Resiluai:Tolal_Fina_ ❑E net`-GWR(Am) ❑Fecal-wuu.cw.enn.w Una,renoorym Welabtwmbae No*Yea—No ❑Asaeasmem hbnipuirm lAm) Umatiefiainnxhwwbcldele: panne l�— s 40 Sempb Colleabd for Iofmmetbn Only N� ^', Imnibijatie_ Q:Wn Wbn/Repaia� Obwr._ LAB USE ONLY DRINIONG WATER RESULTS LAB USE ONLY ❑UnuWxcory Tolal Cofbm Berm and ry ❑Eoo§,xm l ❑Ecciabemd No Iifomdmobl IbPYmrnml SemPb IEe4oiad: ❑Sampbbodd(130Euun) ❑TNTC ❑ BwMdd DanBOR—b:ToblCdiban nOOml. Em9 nODd. Feral Coliban MM Enblaocrd nODM. Eb9md Cod9: 9Y23B 08M MM OVY W Tara ❑91,192156 ❑EnMderl6 �0-21'Y+ 080E WawdlimNWymtl: Dew �'La Bvrµxurb inner IEaaaaO labW °yCURI - ct,� q�- o� 3323fit� Thurston County Environmental Health 412 Lilly Rd NE•Olympia,WA 98506 _ 360867-2631 COLIFORM BACTERIA ANALYSIS Deb Smpb bNeeled Tmesan* i zy catieaad lam pm .ea -!01JZ-0w Type at Waler Syaem(do*only am bux) ❑ PINae HcomhPM ❑GmupA I9GmupB ❑o1w E4oupA WW Gmup B Spiuma-RovideSom Weler Faclifin irvmby(W% Sysbm Nam: (✓�/� Dwe.a Pump: Dry Ph..( ) CeePba:( Enid: L seapyle pmmu .m.e amnpmm«.nvx.mmvl ydiq/ SAMPLE INFORMATION Sanplembcledby(naee): / Nky� Q,y,rYL Speeibbcetion ,,V D 3 aaresampb tobaea: Spaded lnslnxbmswamrmnl: zo2'e' ��Y77j4I/ 0p ,4.dJCtwjTo" , QYPrGG lK.3GaE.Y'Yrr!!7 Typ.of"k(nnm mymabmolefriagh9/bledbeba) 1.0 Rmbn.Ubblb.Ow SuVb 2R.paNSeerpl.leMmeebroelbq Chlo"bul:Yee_No_ ❑Dwb .Syron ChbM1le Residual:Toll_Fee_ Chbmrid:Yee_ 2Rea Weer Source Semple CNaie Residua:Tall Fm Cl E.mli-GWR(AP) ❑Peal-sorts..wm,aay0ameaml Umabfwjnry muting lab number: Fiftmd Yee_No_ ❑Aeeeeement AbniW,(AN) (AeaWxlry routine meeatlW: ❑Other I 1 5 1.❑Semple COlNcbd I.lnlamedon only / ,,.. braeigaina_ Canes /RepnnI ✓ .6III,�..//4- /( LAB USE ONLY OWNKING WATER RESULTS LAp USE ONLY ❑Umu. ebmy Toll DoMam Premnt end ❑EWPmmt 0E.mb'e6omt GxSwmtleledetl R.plec.man Semplell"01 d: ❑samplemoaapm hoanl ❑TNTC ❑ Ba:leda DenaN Remtis:ToW CaWom I100m1. E. 1100m1. Faced Calilam 11M EnlmcawJ IIW md. Mahod Coda: SM p123B ❑smilz D )as Tme ftcu—_ SMSY1hB ❑Enlamle* 0';7,74 BbZ Obatl Tm MelymE'. Wl 23 er�ONre�e. ninenlW�rJ99N laaiJbecd: 332 - 'l Return /To 1Al_ 217322 MASON CO WA �p R TURN Q02 7 RR.RF.: $0 .a0 Pa 2 I( l�i � /�LyWOo� WA 04F)b Grantoe(s): (1) 1jidbAW 121' v . (2) (Ja4� F 14(�it,JiLL Grantee(s): (1) PUBLIC _ Legal Description(1) d :i t�LT lj (Abbreviated mt:i.e. lot block,plat or section, township, range) Assessor's Tax Parcel: (1) �. .-&-�-L-J-�-�-�--�— Se-C- 2,2 'P20t' 3 NOTICE TO FUTURE PROPERTY OWN RS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned grantor(s), certify th t the water source located on the above-described real estate under Legal Description(1)an Assessors Tax Parcel (1)situated in Mason County, State of Washington, has been de ignated to serve a source of water to the following parcels situated in Mason County, State of ashington; herein described: Tax Parcel: (Connedionl) Zr) �-� -�1LU ! L Tax Parcel: (Connection 2) 2 0 6t e-1 �? The system owner is responsible for keepin this sy m in co, The name of the water system is: C- This system is designed to provide for two ervice connections. Planning an design approvals must be obtained from the department prio to expanding beyond this number of services. Additionally, a water right, obtained from th Department of Ecology, is required if the water system exceeds exemption standards. This system (has/ Q no been granted on i or more waivers from specific provisions of the regulations. Dated on this Altay of 1204 Signature G for (1) (2) i Page 1 of 2 State of Washington ) County of Mason I,the undersigned, a Np(ery Publ' in n for the above na ed County and State, do hereby certify at on ' t�_da of , 20 , L rsonaily appeared before me,who is known to be signer of the above instrument, and ackn wledged that he(she) (they)signed d. GIVEN under my hand and official seal th day and ye FF st a e writt ;NTY,YO,N.p1�� ;C��P��ggER SF�r.,� Q;1Zs`ON•F<;P;• s No Publi and f the State of W shington, pOTARY ^�•: residing at ° 23038426 = 49 My commission expires: Page 2 of 2 �g�.s-z �'�-a^-- � �. w N o N � a a .. o i . � e � i � Ci i- � � G i NJ � 4 � � � Q � � .� � ^? � i A !� �' . � � �� Y� 't � i A ,S / � £�` I �. � � a� � � `c$^ A M� `� b '� I N :D f t+�� _ i ./� � i S �� 1e � ` i �� ZS:.�ff/ I I � > . A ■ , ¥ . « � ` \ t \ § | � / � � � \ � ■ § � � K �