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HomeMy WebLinkAboutWEC2023-00103 - WEC2022-00078 - WEC Application - 9/11/2023 MASON COUNTY 15 N BTM STREET,SHELTON.WA 98584 COMMUNITY SERVICES $EP Z�23 SHELTDR:360.42T-4467,EJCT.400 BE ELMA:3"2-5289,ENT.400 _ ELMA:300-4 AX:3 0 ENT.7-7787 BY:_ - , --" PAx:3Bo-an-neT +n(„)TQ NOTICE OF INTENT TO CONSTRUCT A WELL Ir Permit Number LJ S \ Inaweflone 1. Complete Part 1.Incomplete applications will be rejected W EC Receipt Number 2. Attach a plot plan and vicinity map. L ❑ Cash 3. Submit this completed application with appropriate fee a minimum $ Check of 24 hours in advance of initialing well construction. Refer to Mason County Environmental Hearth fee schedule for coal. I Date of Payment "4 1 3 4. Mason County Public must receive notification at least 24 tours V prior to the drilling of the well. PART 1: Applicant/Parcel Identification Site Address 7 11 S!4 y I/t/rtr r�f f�D Start Card# Drilling Firm Phone(JaL nn -7im'G Applicant muy(nx}. Phone Meting Address Q v I' +Z y Ira city �el{nlr� sea !A& Lp B S ZR Parcel Number 32—tit, 75 — OU Directions to Site Fo f,, t — ShrHa t-& 1 rig U1, JS Pf] I'V Sflla l S o h Is the well site within 100 feet of salt f seawater? ❑Yes Cgtlo If yes,a variance from DOE is required. Have you applied/received(circle one)a variance? ❑Yes NrNo NOTICE:Anprvpaaee wnreokv ,ro new wens are sub ed to is,aeequal rag in mi N lime of bilging Mani!Par Mason County TN.6.6a water usegllel restrivion/e/eriesWnbnal fees may apply to aft new walla aMlee anar ,January l9m,2018 per Ess6 61 Applicant/Agent Signature PART 2:Health Department Review(Staff Use Only) YES NO TAG If Called In %u23 fat 9I8�Z3 ❑ ❑ Driller on Site? ❑ ❑ Is the well capped and Vented? ❑ ❑ Is there evidence of a surface seal? ❑ ❑ Is there a 2"annular space on all sides of the casing? ❑ ❑ Has the seal slumped? ❑ ❑ Is the well flowing or is there evidence of other leakage? ❑ ❑ Is there evidence of cascading water? ❑ ❑ Is there evidence that the seal is at least 18 feet long? ❑ ❑ Do the well site set-backs appear to be appropriate? • /f' Comments ❑ Pass ❑ Fail Inspector Date This form may be canned and available for public view on the Mason County Web site. Reviwd:2/7/2019 Mason County WA GIS Web Map Q f, �Y 9/412023, 3:34:42 PM 1:1,533 0 0.01 0.03 0.05 rtn 13 County Boundary 1 1 o o. o.oa o. km No Filled ' Site Address (Zoom in to 1:3,000) Soulm:EM,HERE,WmM.lnl . M�IINN. COT..CEBCO.IIBG3. M FNO.NPB.KKGN.GaOBr.IGN NWs NL QOrenm 9uw/.EM Tax Parcels (Zoom in to 1:30,000) wal WU VNO Ap�f Bn drAp .FsuEM.NENE. MINREIAEW P. Y .EA SM� Woo i2d W� fro Pes`g. wau 1 ApProXe�uttly I tao• ko � 'oo' POND �ppy Lp� M b *J ®Mbp( �`� �l\P \ �2 .LSi �0o, Y 0 N D ll L7 9 N`9 I0 \ O H6R M 'XkpO, � MAR I 0 2021 ?ri ' mr,A © MASON COUNTY ENVIRONMENTAL HEALTH 5n nd" I M Jew PrC55urL draly,F a IcQ Rev. 6 ed w it� O Audio-visual Alarm r e esery WOW I0 W © cleanout © 1200 Gallon SePtic Tank 2-Compartment with Effluent Futer O4 1100'Gan m Pump Chamber , Q=Tes�C Kola '.s 15 o z5 So .,5 ,eo j,� �� $ *s�L o-Loo•' (xLSIVGMs. '?1n-C E S IMNI WON 6was JOY JONNSON'. LTCP7J�S yIt f NVA" vmfts t / Printed m Mason County DMS Printed from Mason County DMS