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Home My WebLink AboutWEL2024-00049 - WEL Application, Design, Letter - 7/3/2025 ........._..... .... ....._ . LTON,WA 584 MASON COUNTY d15N6THELTON: ,SHE7-967 ,EXr 400 SHELTON:360-2754670,EXT 400 BELFAIR:360.275-4467,E%T 400 Public Health & Human Services ELM:36 2-5269,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 ill'WZ02s on.R.uW MASON COUNTY II COMMUNITY SERVICES R m,. RCMw a wAelnsvNnngEnm,u,,,.,n�N.m,camnx.,nvx..0 415 N.6i°Sheet,(Bldg 8)—SM1elton,WA 99584 WEL Shelton: 3 27-9670 x4W Belfair:360.2754461 x40o Elmo:360-481-52fi9 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION RwuLAur PNONE -)-4711 MAnwa E9S T ELCm`.E ATE.3P EITE LRESE-SIeFE L,TY,STRTE,LP— 1 MARY PMCEL NU l eE al j ,l Z cnNwU YPMLELNUNBEa IIF.1PPL CaaLE l0 - -Oxog W T 9aURCE dOURLI TYP! P/,RCE 1LOT E PARc LOTEQE YNew ❑Existing Wwell I] Spring vnovo5 wnTER avaTEla xAM`-e�'��aREWREOI L/ PROJECT nESLRIPINIX Srn omEcTwasrosTnc 'hocaa tO \ Qry Site Plan: (may also be attached) (property boundanes,structures,well site w/100'radius,driveways,roads,septidsewer components and Imes,easements,etc...) *oG .Q �S O Submittals Checklist: (these additional items will be required for approval) L7 Satisfactory Bacteriological sample(this may be deferred ttwell is not yet drilled) J�M Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) W Notice to Future Property Owners recording(record with Mason Co.Auditor,supply copy of recorded document) IX Septic Records(additional locating requirements may apply if there is a lack of septic records on file) Thls may bye�sorned and available for 1public �view/won the Mason county Web one. Revised: 10113/2 0 2 1 Or 1 -5V WN l rfV 1 j(T Y(I Page lof 3' . ------- Staff Use Only------------------------ Review Step 1: Well Site Inspection: -)he 1 /N/r 4wo %-^vl too, 4 wQ,ivF yr*Avi -*so?3" 4w4y. YES N 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 fo radius of the water source?If so, is road viva ounty or State. What is distance to ROW? ] ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) p9 ❑ ❑ Is the well cap satisfactory? V11 ❑ ❑ Screened and vented? ❑ The well casing extends��above level ground/concrete slab? (circle one) 19 ❑ ❑ Is there evidence of a surface seal? Lai; 47 . W14 ® ❑ ❑ Does the seal appear adequate? W R i —( t 2• YZp Zy ❑ Is a variance necessary for well site �approval? ' yr TQ9! g PF17S Comments W4_TZnJ -00009 't' &(Ce ml/f IyJ Pass ❑ Fail Inspector Date Z f Z�lDIs Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water Well Report with adequate pump test on file?MWrro py IN1 On 4M/2024 wl 10 Q1A{whaM(tgbe)et) If NO, date of Capacity Test "!ItKIOW Driller btsk OftltMZGPM 2V-6rWA f W(friary ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 51IM210 Z (13g4fm(/ ,,,wwwrrr ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2 Z F Al ❑ ❑ System appears adequate to serve 2 single-family residences based on information pro elll� 1.A Comments r 0 1C� � V, N0�bt6 Fry N '4Q CJ1 ,approved ❑ Denied Reviewer Date Q C Fyrq<y�� (�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 future success orfailure of this 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 after January 19'4, 2018 per ESSB 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 RF��ryF?Op6 WATER WELL REPORT DEPARTMENT Of Notice or lowest,NO V09 ECOLOGY Upgm@Ok0'WeIIIDLg No BPF1 iryeof Wwk: Stall el WaWnBran � roremn+�w: Sitt Well Norclifnwre lM1m and utlD: ❑ Ikemrm:ietiea , DipmlwaOenm NOl No. Waster Right PmmiMenifWalc No Pmewed Uee: BE Dams. ❑Itlmnel ❑mwi,i Prppeny ORTef Nemic MConnick/`.wlwadnn I i C a vmmg ❑Imgvmn ❑Tot Well ❑QM, Well SIIM Addles 371 E wham,St CoparpsaaoTpe: ak.: Alt 1—well OAYerepri ❑.— ❑1mW ❑CeW Tact City e Cpper. Mea ❑Deepeuiy ❑Oder-- ❑Dag ®'t"" pM'rd_Rnvy Tax Pmed No. 1222PS0-39003 Pmeminm: Itiemevrarhmi:M6 k.m tBO a Wmamiatceagrpvd fir lks well? OYes [ENO Ixgnarw:relmaw.n 16D n. TamRuellen D".1 well Firm,xhu wm llx wrurca for? Cavini Mrae Dume¢r Fees, T. TM1k1r:m Seel R'C WpNM Tkoi p ❑ 6 in a 1ley .25 OF O 1 ❑ 0 ❑ FOOIDA Dee imhrcties On page 2)'. [1WWM a❑F.WM ❑ 1 ❑ _, n ❑ 1 ❑ ❑ ❑ NW NE V-:Sation 20 TmmehP 22N Nei 1W ❑ 1 ❑ _n. ❑ ❑ ❑ ❑ tantude(Example 47.12345) 47.W744N ❑ ❑ _ _ _ n. ❑ ❑ ❑ ❑ Lan6iude(Exampe'.-123.12N5) -122.82956 W Perfonaov: pYM MNo Typeefperfomorvtl DdIkrY Log/ComWtlioe or Deromaikie.Procedure Na. Xprfereobo_ SixofK?wkisin—i _^ Fmwekm.L�+cdM by mbr.zLvxea.ux ormuaulaNnrrrmaed Ne 4iedW Rrfwied 5un_Am_8.bebw 8ro'nkl e:rhx b:mfimp tle mnreriel:n exM1 kyx pertmrM.wiAm k+k wn moyfexAnlmrye of Scrtee: 9Vea ❑Na OKpvher U' oNa 154 L in mrian the adlirurwl tlrm ifrvnvry. Klanufvcnax's Name Ae.y MapMrm VJohs Maksial Fmm To rye Ym11e-w FoRgd h1old Ne G airypoundean lame! 0 19 0—, 5 SM a've Ote e.fm:v t55 &b 1W A. Dimeue_ slm ape_in sam e.m_e. Grey fine si saM,rhY /9 33 61mW1 fire atfel and gmy flifty smvJ n 46 ynyFaxreeelpYe[ 61 Na Size ofpxk mvYriel_in &O.M by lO nledilM rauM all eWN. 96 55 Memiak pk®d hom_e.m_a' Bme,n fire aly S.M.some Malk M 57 Svkre Sed: OYea ❑No To wlm depth? 18 h &Mnlfine sell,d u 67 Kmv;atwedlnml Elle,wifted'i wmeepilmesiftymi wet 67 66 ENOWnUtl eery Wnemmin wmebk x'aa1' ❑Yes ONo 011 Typeof.0 Depth cram EN.fine ity el mi si s. D.6-120PM 66 1w Mopsofseali:rg[mmoe &own fine ' odic .lead IM 130 &pWn fire to tnMlMn sell.moist 130 152 Poop: Mm::mnwer[Name Tym. Brown finem metlimn ravel aeM.NeeM .Wet 152 157 lip— R:m,mekedeprF:_fl. Ikaigrcd!love nm._ipe Mllltl-C*mw firC IT medhnl gDepol,dWn merem, 157 W+m trek: L[M-rwfuek['erontls<mr+ aea keel 6o IF hebujn ,meet 160 Sli[k-up ofbp o(well mmp 18 fl.ebon pounJ 0.s:vp Suric wem level 51 Rbdaw aaa m:ng m 4zH/Y4 Anesunpmnne_Ih+xrpux.,,h meh IMe� Mnw wa¢rRummlkd M' lu':p.v+lw,mcl WNTesm WMelmrWinpmtpeRnmmd?�No ❑Ye r pywlbm^ YieW_Am:.,,h_ft dmdownefier_III YieW_gpnr wkt,—IF esvoi—naan F. Ye1J_gq:r woh_fe Jnwdnx:ufler_his Reamer}de.(I.---wl¢n mi,Is mined eR-wvn kxl:e:mnrM homed!! Tire rvva keel! Weler l<vel Time Welm Level Time W.level oveofpamp op _ Mites. e:mwiW—a.MxdowoIm 1 1. . Air Wn hp p Iirhpemwa 120 fl.ku 1 M1n. Dev </92d nnesian Mw—®:r' J Tempmanee afwvv 51 •F W'eaecMmicdahrp r:ude4 ❑Yin ENO Stan Due g2l24 Cwnplmed DARE 9IRr29 WELL CONSTRUCTION CERTIFICATION: I conslauded ride xecpt respondbilily Or caomructia ufthis xell,arW its complkrve ODD el!Weshioglon sell commnian, Mwds.Matenak used ell the inf limn repotted afmve ere am to my by hnouimlae and belief ❑Urilkr B Trainee❑PE-Rent Name Johann ,111m,Compomy Naga Orin9 N1 S e Addem PO BOK 1790 Llceae Np.3441T C1 Suite,Zip Shepan WA NW IFTRAINF.ES is Lkmde No. 53 COntrsmpr's Spa S Reg strmkn No ARCADDIO96K1 Oak MWP4 ECY Di0.1-20(Rev DOM 8) /ff p nese'OF,dmunvns III an nlrenwrefr:min.➢!dam mll the R'afer Remarrn Pro8mm m 35 07.6872. ➢erAM,with hearing loss mnrull 711/r06ashingmn hek Iientrr. Pln..ilhaspeerhdimlrililYrmrm11877433fi341. y 2v Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98 Customer: Ray McCormick l Wi Tag#: BPF175 Site Address: 371 Sullivan Street,Allyn Depth: 160, F� 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 1 2 Min 1 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 54.4 20 Min 20.6 55 25 Min 20.6 55 30 Min 20.6 55 35 Min 20.6 55 40 Min 20.6 55 45 Min 20.6 55 50 Min 20.6 55 55 Min 20.6 55 1 Hr 20.6 55 1 Hr 10 Min 1 20.6 1 55 1 Fir 20 Min 1 20.6 1 55 V angaanr I.alxmno* 2635 Parkmont Lute SW.Suite A 01Nmpia WA 98502 Y�!!!a6FD i 360-967.7010 f , CaiFORM encraaA ANALYSIS FORM Da S.VM CnlALldtl..._�__ irte SwnNd CNM1Y 04717/2024 MASON ow- , , - - ryprpwwr5ysaml�anh a+ml ❑GWA ❑Grays IS oIW--- Gm A.Gm B Syxana-pDwVp M1ain Wi Fc Imenbry WFI) foF -- sr-1— RAY MCCORMICK {-Dl,P W )A)AM33395 CAApn i . Emai A- � Es.Nlwnf I S/b91MF I`r'S:xnm sfrrs:aq npmAx.rol� j n.ua+-m..,-e,p n.+ +n�:,r•^®w�aoAD�u+p a++ SAMPLE INFORMATION j � :ro ; SHAD soFelpc ngMn onwexamge e�oNet4a 1� =pe®imsccmm a.mvM1me� #BPF175 371 Sullivan SC Allyn __-- typal NgMSaMatanry nrgrodarmeaDmrypc 1 rAw)N)5 nxb+;. ❑aO11NM IwdaWAaA aaaWA lA91 2 o Roped Stai,6 AN) _ � ..,..,eA.•M, CLMnBIM YiS. 'b_ � 4'LSdtIIN+Jry TIMG�MYIIXV CM1wn reRnrda'TotuT Fme_ ].aeounG polo,a1pA 4pu,tt SampY I J-s,2txmti ru4m CtlF+.Mt :M1bRIabE YO_NC._.� ❑irggerM lAAI %;nbwe lla TOW_Fk_ ❑A9xR4'MDI IRA) t aphapraMRawsD wswswi*b Emme ! OFcai OF.r -... w._.. s ■5.avru �:<..• ,,ane..�,xo.Pay. LA0 USE CNLY DR#1NING WATER RESULTS W USE ONLY Cl ' MINN*" C Erniwewaa ❑E.mlaawn BcMnu ltwpharun.Taal CONvm_.._. ._:Ia fcpti noun Rapaewlpq&nFY RgWItl. C'Nic O:-a�emem ❑ Sartcevaune ❑axnym C.mmuw• xr'+a 9we.x __ .xaweeA ranor _11-24 —9 __... - r'` SM9223B 285- 2218333 MASON CO WA H -0 11312030 116 AM NOTCE IIIIIII IIIIIIIIIIIIII IIII III IIIII IIIIIII III IIIII IIIII IIII IIII r Return To 37 2S 9kico XZLrAW &-Cnvr7Dti , UWJ Grantor(s): (1) mm,,i m'CPtml ) Grentee(s): (1) PUBLIC Legal Description (1) K'39 Lod 3 (A reviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 5 O -c3 O 0 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 Tax Parcel: (Connection 2) I a s z. 3 9 12 O `I' The system owner is responsible for keeping this system in_¢ompliance. The name of the water system is: Hilc-p1-m ILK.. c� 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. 4 Dated on this 3?y''`day of OMIPAAInir2014 Signature pf-B n (s): (1) ( . (2) Page 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a Notpry PC�Yublir. ' and to the above n ed County and State, do hereby fythatontf♦'s yof , 0 , ersonally appeared before me, who is known to be signer of the above instrument, and acknowledged that he(s ) (they)sig ped it. GIVEN under my hand and official seal the day and lag ove riff •`O BERM eC 0 ry tic i and f he late of Washington, �5 Ee•, NOTARY 9R. ' siding at 23036426 m a My commission expires: PUBLIC I ww�WAS1'A.o• m Page 2 of 2 u so l 1oo 7 - WATE R L4 \' 5EMR LINE 110,p� GRINDER PUMP NEA OEM / 3-6ED, 75 6ATH DIRVEIAA} � T 51TE PLAN . . 1" : 20'_0" I. oNER MCGORMICK oaWTRU'TION LLO 5725 CH1W WAY NW BREMERTON,WA AM2-1521 PARCEL HJMMR 1=0-5039005 THIS SITE PLAN IS DRAWN BASED ON DATA SUPPLIED BY CLIENT AND WITHOUT BENEFIT OF SURVEY OR TOPOGRAPHY