The URL can be used to link to this page

Home My WebLink AboutWEL2024-00049 - WEL Application, Design, Letter - 2/2/2025 LTON, WA MASON COUNTY 415N6 SHELTON: ,BHE7-967 ,EXT 404 BHELTON:380A27-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:3604825269,EXT 400 FAX:360427-7787 RAYMOND MCCORMICK 3725 CHICO WAY NW BREMERTON, WA 98312 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2024-00049 371 E Sullivan St 122205039003 The 2-party water system, MCCORMICK#2 (1222050390031122205039004), 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, e David Anderson Environmental Health Specialist Mason County Environmental Health z /15/a0zs ® MASON COUNTY Dslo R.�I"°° a l COMMUNITY SERVICES �" RaaIW ay 415 N�6 Str (Bldg 9)-SWIM,WA 995M wEL y Shelton 31ie42]46]0 x400 Belfeir 36e-2]544fi]x400 Elm,'.360-092-5]49 x4lp TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT I PXOXE 7 �L MAIINa $En MCEO AHRDDYZAPREAVaR PaCA -ERLsC TER L E1R EFmT.CIarTV A.STETA.l S—. NV R....SITEIP XVMBEe lF1M ABIE W T $WRCE BWRCl M! PA0.0 ILOT E PMC LOT SaE 34New ❑Existing Well ❑Spring PROPosE WATER avaTlu MUFIRwuIREm PROJECTOEECIaPllall Srn pEIECTIOXB TO 8nn Cg101TM)X8 t0 r ( pp Site Plan:(may also be attached) (property boundaries,simclures,well site w/100'radius.driveways,roads,seplirlsewer components and lines,easements,etc... *0 s 0 Submittals Checklist: (these additional items will be required for approval) L7 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) Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This 17 ay be scanned and available for public view an the Mason county Web site. Revised: 10/13/2021 On .Sewer, rb -evyc Page laf2 -- ---.--- —Staff Use Only--------------—---------------------------—......... ---.-- Review Step 1: Well Site Inspection: -Avifr/NGbovws vw✓1 foo` oFwli,6vF9/rtkrwWrS' tiWaY. YES Nq NA ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainflelds,tanks, buildings; indicate distance on plot plan) ?91 ❑ ❑ Are there roads within the 100 f�o pra.dius of the water source? vi If so, is road va , ounty or State. What is distance to ROW?� ❑ ❑ Does the ground slope away from the Water source site?(show slope on plot plan) 6 ❑ ❑ Is the well cap satisfactory? �y ❑ ❑ Screened and vented? ❑ The Well casing extends above level ground/concrete slab? (circle one) 19 ❑ ❑ Is there evidence of a surface seal? Lat! ` 7 • M14 ��[.jj ❑ ❑ Does the seal appear adequate? 1411, —(ZZ.VZf Zy I]g r ❑ Is a variance necessary for well site approval? T49! B 7f PF/ Comments w422nS'-00009 :f►P,af(/W(4h Guf- �Z� ! 7� 1)7 Pass ❑ Fail Inspector Date (Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water Well Report with adequate pump test on file?All'Cl 'a Oy'tf11l an y/f/M4 wl So6YA (v/lOtrMClBoeyer� If NO, date of Capacity Test 4CC?'(70l4 Driller tyradle rf(* GPM ld•6 6pa fw`Iwo ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Z /t344fer(' ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN ❑ ❑ System appears adequate to serve 2 single-family residences based on information pro eqp y 1' Comments O L 1�J'1'Cn. �b�V, O 1�7 .cpproved ❑ Denied Reviewer Date 7��0 p j FNrq<H41)7/ (`Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied of the furore success or failure of this system. Well site approval does not constitute water system approval Water System approval is a two-purl process. All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19s,2018 per FSSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason county Web site. Page 2 of 2 *ok WATER WELL REPORT io.EPAATM[Nl Of Naice pnllmm Na. V.E 9 RFCF�O�16 ECOLOGY Unglr Utt lD.11 ID T,No BPF17 TypeN Wort slit'of WiWgtm p camwill saw Well Nam[(ifmme than arc uelD: ❑ unmm:wmill r'+ Oapwlimallvlim NOl Na. Water Right PalmiffCitl N. Prvpvved Uvn 1N Pmaak ❑Irma l ❑Mu:icipl Pal lY Dw1rs Name le Catwitgal LLC ❑0. mdy ❑Imiplam ❑Tea well ❑0ia Well S.Mdma 371 E SDIMan St ('vmM1ucevv TYY' Meal Y INNvw well ❑Ahenlion ❑.— Olerml OciLTaal Ol AlNn courtMason ❑pmp.oiw 000ml ❑D, Gw. ❑liwal Tax Parcel No. 1222050-390D3 mamm'm: wmehrorMWcae6 ro1150 rt th.. mu'Pravedfmsew111 El y. ,'1.1mmplekdwvN 1W ia• fi. Canleucrie Dian : WWI 1r}a•wlwt w5lhe vanelrefM Catty rim D amela Tmm T. ativ8lm Stall PVC Weldni Thled p I ❑ a m. a 155 .26 in. p 1 ❑ M 1 ❑ luretian(xeinandmallia pagc2p pWWMar❑FWM ❑ 1 ❑ _ a ❑ 1 ❑ ❑ ❑ Ny4 g-'videm NE R;Saltum 20 Ta N:ip 22N Range 1W ❑ 1 ❑ —— — — e. ❑ 1 ❑ ❑ I ❑ Ide(Eple:q.12315) 4].39]aa N ❑ 1 ❑ i. ❑ 1 ❑ ❑ 1 ❑ mim mn Lon,tuda(Example:-120.12N5) .122.MM W PaOrarivm: ❑Ya MNv Type'fperfmW'rIW Mile,Log/Comtrurtion or D¢Pmmiaioo HP[edurt No..rperfualim_ Simofpnirmiom_wby_e. Fmrtawto ea[WbeMmb.Amann.:Im urmuai:tlaM muclw.WNv 4iMaM PerhmW ban_fl.m_n.Lbbwpmtlalvfin mmm oftie nmenvl inezM1layer m:mmld,will al lean wevroy fa vzn troop'yr Banal: DYea ❑No OK-Pz4r ' nepls IM a iefA. ww.. llu vWilbml themi(mmsery. nl...r rove'.rvmm AaoVMe[A' Warka Met From To Type VWe-YRaooed MWel Na, Gray LIIIIOUId san 1% IaVGI D 19 Oiv:mer 5 SM sim 010 m five' n.m 1so A Oimnaer_ Akl eix_:.flmm fl.ro_fl. Gray fine silty sand,dry 111 33 &Own fine ravel art N, sWw1 M a6 SaoNFinr peLOYm WillaS¢eofpaimWlkl_in. [Union fine to medYJn ram!art sand.walatti, 0 55 W —IllplvaEnom_f.la_R wart SeL: my. ON. Tawbaldapd3LA B.Ifirol ne silty Sand,dr, stalls 55 5] 67 hlvariWac,j is" Banal YY Brown fine ail 6aM.t 5] M DidmmmW.mWwwlll abhwaw0 Ova ONo BmWnfinefiil saM.wel 80 86 Type atwmer' OMnoP'llWa Brown fide ravWlands sand.8-12 GPM 68 109 Melhacafamliyaw'N BrOWafinefii sand. ,loose IN 1W Brown fire W alathm send,moat IM 1W ft, Mam:fialer's Nara Tye: Brawn fine to medilm gralsvnd,havM .WSH 152 151 Op Pumpim.4e al P. Dervatl amv M:_po MWIi-Cdored line lolRdMll raV6l,arow'I sa1M 157 w.a.l.amM: lath-:vMeelevym vW.<man xa krel NO n. heat/Wat t60 Sietupofm d-11mlma 19 a WwpvWt:rire Slmiowalakr<I 51 n,pJ .Pofwdlwiq map N9fI owti— prta:x_In..pamamizh De. Me.im mmtiS ccMrolkEby (alp.'al ze.l Well l'eatl: N'azvpumpin0mal ps6lmd?Utica OYub bywlmm? YNd_mNa.ah_itllmWvwntiffil Ykld—Ppmwilh_h.damia maha_na. Y.m_almawiro_ft mdmm,timmi _nm. mpm.Ydma0ime'zemwhn puryvmme:loR w.m[k.<Inaaaved fmmwell mplowalvla'ell Time Wa¢rl<.<I Tinw W.t<nl Time Waller level malep[pu:rpiyl Wwa Ihlhnea_mmwim�ftd120 ft.tier_ala. ,urea 30 Pan wen uemelW 120 A.ir1 Im. am ar9lz4 maim now_mm Rmpea.lue orwua sz •( wveewllieal®lymmde' ovn oNa S.pale/IB24 camplaN DWe alRlza WELL CONSTRUCTION CERTIFICATION: I[onWmcred enlVaaaept respwaidliry fa cmminim nflhis wall,nM iu mmplielKe Will all Wmhinlym well wwW, ,WM shmaill Mataiols used caul the information repeated Will are am to my beta knoWmlSe aml Mid ❑Dnikr IS Tmmee❑PE-Print Name rim,,Johnson Ixillina C.,,ArOada Nlil19 I=. 5' Mdrm PO BOa 1]W Bums Nu.WIT Cal SMm,Zip Sh M,WA 98W 6 MAINEE Soli Lk.No 53 Commaor's Spun S loom Reawarla n No.ARC0WODI096K1 Date 4024 ECY 0500.1Q0(Rev M/I8) 16mu creed rpiddornwm Llnn aOemmeforumr.plena mlf the N'arrr Rewurcea Pragmm ar)d0 40).ae]T. Pal with heal lasama Oil]I Ifar Wiaha8rmr May.S'rrckr. Permmhuha.rp¢chdimNliR'cmtm11877433b341. Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584j0 Customer: Ray ,� Site Address: 371 Sullivan en Street,Allyn Depth: #' 680.175 F��FO 1 Date of Test: 4/17/2024 Static: 50, Pum Set: 120' TIME GPM LEVEL RECOVERY 1 Min 3.2 50.9 TIME LEVEL 2 Min 3.2 51 1 Min 50.5 3 Min 3.2 51 2 Min 50.2 4 Min 3.2 51 5 Min 13.3 51 6 Min 13.3 52.3 7 Min 13.3 53.1 8 Min 13.3 53 9 Min 13.3 53.2 10 Min 17.8 53.2 15 Min 20.6 54 A 20 Min 20.6 55 25 Min 206 55 30 Min 20.6 55 35 Min 206 55 40 Min 20.6 55 45 Min 20.6 55 50 Min 20.6 55 55 Min 206 55 1 Hr 20.6 55 1 Hr 10 Min 20.6 55 1 Hr 20 Min 20.6 55 anguard I am a Nrn T`T` 2635 P"mwtt Lane SW.Suite A I • ` Olympia WA 99502 v.gyo6�D I 3W961.7010 COUFORM BACTERIA ANALYSIS FORM :, Dar Sarign Ceaacba T-- inre swnge Carry 0 411 7120 2 4 . ■w MASON Abe Lal ♦P ■M � rroertww sYErmlwa mry ow lan; Grw�FA eWa Gm BSVv -Pmvle Warr Farra■W."WFl) syswnr.s+k RAY MCCORMICK -- Dav� �xa taMa7a5 ;.�vlkm.t ) EmA E'w Raw( 1 BaMMRa p'hFi Nanaro kam:to�Cmk vemr: •'+b■Y�'+t�M'eaV o•+n 44�)P"�®akNNr<M tan SAAWLE NVORAAATM t 'srpncdk'traq;w�e) SHAD Somrc dawn u'em smmak maenad �9Ra01nso-ucwvn ntmvne�e� j#BPF 175 371 Sullivan Sl.A1110]t— TrweW9npaSaarw mM wr 4Ta ds�kkwn7Vaa1Na9�s Eebq �__ 1 Qaeuwr%Vbuan S."k fxp) z Q Rwwg kM(AM �nMndk: �(5 _. ___ ",asrva•.m+vR"Y!a r.a wu,n. t;rsatbl�+ay roulan kf nVmYr �nleniw 3mrea' Tau' „ f+w _... ... ._..___.. 3 Grvurl WaM Wde Sputp Sunpn U,nareM.aM1 rwonzcalbia aak` B Q Try"lA.9) SW Re ❑0.9La1ment(PR) 1 < SwW orfA■Rak9emp#hrr SaWiEn�nkknani s ' ❑[.m: Q Feat �..e- w ... 5 ..;.,nce::n;avnn=ateero.ash. _ _ UB USE ONLY DRINKING WATER RESULTS LAB LtSE ONLY 1 ❑uwMrrorry robe GMmvm ckxn•aM ' NSNOW" ' CEna nmem ❑Ervxawn 9acOrtr 9r■MRMab.Tcr�Gdamn______'Haa# Em1 nOp# cxBCawwm nD" tPC n rtt 14#rc■wna9aw■RmrAW: ❑TNTC OsmWrom ❑ Smae vd,me ❑or wcm ❑ "an*e'e?acewe s 1rowiar SM9223B t:M P9m+LUb OIa1 -lA'An'Yv " 'LM®5yj4` 285- 22183337MASON CO WA iiiiiiuiiiiiliiuiiiiiiuiuiiiiiiiiiilfiiiiiiu�iil6 Return To Nf-ormidi 37 25 Mico KZLr A*) &-Cpvr7&A,, F/t 4 Grantor(s): (1)Bgi4 Wq_zim _&�2) Grantee(s): (1) PUBLIC Legal Description (1) >C I I k n f�K'• 3' Lo' 3 (A reviated Iormr i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) - 5 O -6 cf O U ,3 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 1)1 ; 0 -3Q- 3 9 O O 3 Tax Parcel: (Connection 2) 1 7• a ;x, o - 5 Q- 3 9 0 o 4 The system owner is responsible for keeping this system in,rompliance. The name of the water system is: El ceps Yv)ILK. off. 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(has/has not) been granted one or more waivers from specific provisions of the regulations. Dated on this 3� ay of QjaVf_jbjiae jr20 j4 Signature n � (s): (1) ( (2) Page 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a No ry Public and to the above n ed County and State, do hereby c 'ty that on fF)'s yof , 0 , ersonally appeared before me,who is known to be signer of the above instrument, and acknowledged that he (s f) (they) sig ad it. GIVEN under my hand and official seal the day and last ov ritt ,gER �`'.• �gB10H•F}e'y''•. of ry tic i nd fc) he tate of Washington, NOTARY V;; S €siding at 23038426 My commission expires: E Nam:, PUBLIC I -,:A Uinl30T... Page 2 of 2 I HELL 50� 100' i WATER LIE SEMR LINE /\ ` GRINDER PUMP 0e 9-15 D 2 BATH 1 / 4�F J � T OVERHAN iG � � W 51 TE PLAN I. . oW"3R M,OORMIOK OONSTRUOTION LLO 3125 GHIG AAY NW BREMERTON,AA 98312-137I PARGFI NR4XR -12220-50-3°1063 THIS SITE PLAN 15 DRAWN BA5ED ON DATA SUPPLIED BY OLIENT AND WITHOUT BENEFIT OF SURVEY OR TOPOGRAPHY