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HomeMy WebLinkAboutWEL2025-00010 - WEL Application, Design, Letter - 3/20/2025 415 N 6TH STREET,SHELTON,WA 985M MASON COUNTY SHELTON:3604 ,EXT 400 BELFAIR:3fi0-2754467275-0467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360427-7787 Amy Hardie 698 SE MILL CREEK RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2025-00010 698 SE Mill Creek Rd 320294300060 The 2-party water system, Hardie/Ogg (320294300060/320294300100), 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, 41/2 David Anderson Environmental Health Specialist Mason County Environmental Health PZI/dolt MASON COUNTY ;-720Z6 COMMUNITY SERVICES NV RWtlM NM9EmMmmentl xWlhCm�xnlNwM Wrr ' d15N.6&6tn ,(Bldg 8)-Shebon,WA 985R4 WEL Q025 - ODU/O Sbcitml: 360A2]-9610 xd00 Belfair 360-275J 7 x400 EIme:360-d82-5269 x4W TWO-PARTY PRIVATE WATER SYSTEM APPLICATION u^u1 PHONE^1 o - r - CIS �+RPPt1LPM �� 'V 51{^/ (�1 yi �^ MYtEHGAOGRE¢¢- M."n' al,t111V�yf�`/� ��E('1N S `E�-\y E%q- CC"SSTA t WEAOdi -SJ�IjpU EETE}l ` 1 0( l—J PRIMARYPPA(R-RCEL HAMMER FnEI ooeo ta Sao - SECONDARY ARCELNUMBEP IB,L,MPNI4RYIF,,,,M0NBMIEPMCEL) Q T v cEL,LOT Sff Imin,in) PARCELZ LOT ❑New Rl Existing 4�Lwcll ❑Spriag 13P I ,S$' Zi• �/'Jam' PROPoSEO TERSYSr\ELIMAME EOUIREOI. PROJECT (a0.aIN^vhE ¢N'MiIN .exa¢Igenmltllon • 1 DIRE BTO&iEl CO11O IWTE fA I.00/, IETC. dy` (fly_^ MG bean a-0. S S Site Plan: (may also be attached) ays road¢ septiGsewer components and lines,water lines,prop¢ny easements,etc.) (Wopertyl,oundedes,structure¢.well site w/1B0'retlius,dnvew see, a�c,Ne�1 Required Submittals Checklist: (additional information located on the first page of this packet) t{I Satisfactory bacteriological test from within the last year(this may be deferred if the well has not been drilled yet) Well log and/or rapacity test performed by a well driller(this may be deferred if the well has not been drilled yet) $ Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office 7T�Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and made available for public viewing on the Mason county Website. Revised:01/10/2025 Page 1 of 2 Staff Use Only ---- Review Step 1: Well S,Iite-�Inspection: YES NO 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 1 foot radio;of the water source? If so, is road vat County or State. What is distance to ROW? L ❑ ❑ Does the ground slope away from the water source site? sh�olw slope�onn�plloot�plan) ��..�, EX f❑ Is the well cap satsfactory? t 3OJT v I 0 r ergo lnowr'm f y-, fin""" ❑ Screened and vented? yIs ❑ The well casing extends_ above level ground/concrete slab?(circle one) 1<`J ❑ ❑ Is there evidence of a surface seal? Let: if If❑ ElDoes the seal appear adequate? Lon:-124. 0 300 u ❑ g� ❑ Is a variance necessary for well site approval? Tag: $a Comments 3 / f= Wfr fthbili ( e (ZD(Z6ZS ' 6ci IC ►o[ik1^ a✓�1r/ on X1T Dui Pass ❑ Fail Inspector Date Review Step 2: Two-Party Review: E NO NA If/0 CW/ ❑ ❑ Water Well Report with adequate pump test on file? 13 6rfiLdd' ZY0 r7wM (TIN Hof) If NO, date of Capacity Test Driller GPM I�{ ❑ ❑ Received Satisfactory Bacteriological Analysis? Dale of test 0❑ ,"{ ❑ El Signed, Notarized,and Recorded Notice? AFN Z2Z s El System appears adequate to serve 2 single-family residences based on i4hrmafipnprovided? a , Comments SON M P C�ryF yy v�J 1KApproved ❑ Denied Reviewer Date L" 6 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 orfadure ofthis system. Well site approval does cot constitute water system approval. Wafer System approval is a two-part process. All proposed connections to new wells are subject to water adequacy requirements at time ofbudding permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 191",2018 per ESSB 6091. Revised: 12/172024 Thisform may he scanned and available for public view on the Mason County Web site. Page 2 of 2 Water Well Report For An Existing Well Your well moat be property(•epee prior to submitting oh tam b,.s fon'ru , RFC m F/pF Astsdsks(')Indle-re required heeds.Mall Cgpitted dd i WA pgaed 10 O Q aVaeTater or WA state Department of Ecology PO Box 4Te00,Okymple. ECOLOGY fm Mwn eM Use this taml N an anginal water wall Repod was newt RNE or Is misalnp trem aoo `aced L933 'Unique Ernbgy well lD Teg Num •Currant Use, ber: Ooew+te. 'Water Right,QYee Ili yes.Attach a copy) pgosewase Olndwemel OMen!tlpN �No Obpe,aa OTeel wen OOM tr •property owner Nametf S F�. penetrations r ^Nel Street Address!�d •Couty: weDen!hofored _ Q-Rlakmwn) •CiIY-JYC1/_i n construction peblle •Site W eII ID'. es s No OUnkrww -`Types OpVD ®Steel OConaeta Liner 'Tax parcel Numbac R 2 9 'Date Well Constructed. aO^� 'Location(Township.Range.Section) imPOrmnt The l ®tie OUnk!wwn f�edaeWra—k!.by A,An accurate location olgyour wall as vef%can Ee found on your r -*;ericmtlons__hare—Rio—R. Section.Towns hl Ran e,and'/•. our county ' tax parcel legal description or through Y sc... assessor's ofr!Ce. 'Cn []Unknown 21./ I$aa-ie.=Steil QWC 110a!er— R TownaNpa.$— Re 3=[]EW'A-OWWM C urrre �p . Sbl Sim k from—R.b-_ Section a oidl Se. 114 pnve PFlaer peck I� pUnkmwr! CO Is: � r•a:s raced ham—R.ro—R. a� ��-1 Q aaMce Sea! Sp QVea h known,to what depth J_R ❑Mc ❑Unknown Meleriets iced If krwwe: QeenloMle t5lCemenl e D D109y GwR(1 pump 19Mar25 09yes OW Undress, LatitudelLongitude Type 4�at s'bP� Norse power— (Decimal Degrees recorded to 5 decimal places) Water"Vale Latitude(Example 47.12345) Candsurface elevation above mean sea level�R. x Igl7'2 cCasing sik;k-u �above below land surface q Static g stlDvel}jZ_R.trebw top OI as, Da,e measured' LongRutle Exam le 118.12345) Artesian pressure�_Ibs.per square in.Data measured:_ �S k3- Well head has cap? 18Yes ONO Shut off valve?Q1ye5 QNo Additional Information(N available,please attach) 4157 sts: QLocetion marked on topographic map Lwn is amount water level Is lowered below static level. ®Location marked on air photo ump test made?(gyas(attach copy)ONO Unknown galmin.with _It drawdown after� firs. I]Consu tant well report -Certification: The information reported above is true to the best of my knowledge and belief. `S oConsufpng Firm C]Driller E]Engineer Property Owner Company: Number. Address of person completing this, re:ned:3 C . state Zi :(0/20161 To mired ADA accommodation urcluding elsidulx In a lnnnal fur the vaualty impaited:all Psg 07' Pemm with impural IaMawomy all Washisyue Usy sensv4»74 Thurston County Environmental Health 412 Lilly Rd NE S OlymDia,WA 98506 - 360867-2631 xuas a m COUFORM BACTERIA ANALYSIS ora Samb Cab�d Tare GM* aen ar T3padwad Spdaldndaddois6m`) %Nbnblbad10ld 00a0A ❑C+a43 OOW cmWAad raaV S Sfadwnd'pmrdnhm Waba Fair Ynadary lydFlY sob,Numa. Cmbdpnwo: Dry Phew. ) SRS*—S waluw.l 1 E-". G, 0 �tlisJmb u �adyvPym�dev adbol 1 t� ��/-A 0,9rrak 1.COON SAMPLE INFORMATION s.iro�a mbdnd 6llnmk .C,G.CG Spwkbbra9maadbam cob*dd M*ud ' n*Ww b'. SYK�� a^t T7Pd dVAA ft" laultlerAaM'aw Cmd 2.� aadw) ,.oRaea.w.urme..pb CW,k,ftd:yw_Nu_ ❑oid "Sro a^ CM Reabik Taw_ Fm— Chla a :Yea_No_ 1Rwwabr8waaa CNoma Rsdak Tad__Free E.mr-671R W% �Feml-90o.GMnYi�eaal udd,,bry reube lab ne1b0r raaemya_,e— ----- ❑Amwnmt Mmbm(AP) US V bckn ub,,, ldl*: 130dw 5 l.s Sarob Codwbd fa danna9m 0M' ynadBky— CarebA IPAPy — Opw LAB USE ONLY ORJNNING WATER RESULTS LAB USE ONLY 00mod bry Tod Ca -M Presto aM CjR dabded ❑E.CWV-W ❑Eoda6wA Ra 6MMASaapb R"W"d, ❑Smplabodd(,306 ) ❑TNTC ❑ ' 8.l w sliyRwdb:Tad CaRnm n00id. F0 n00ai Fad CoR"" Mw" Enbi000id n00 m1. SM97L38 nd coda OSNSZao Aw P'baaTwReswd ❑SN92,5B ❑Endabi6 �7 Oaff9 ob.arseA�kra,a 0i1B .t . n a n T / I 2222995IIIIIINEE14ASON CO WA Name and Return Address: 1v98 SE Cr. VA Document Tltk(s) i I. --yw o Paces W cxZ'r r SSE � 'R� vC� 2. Reference Numbers(s)of Downie, ' or Released Anon foNL REFERENCF R'S ON PAGE_ Grantor(s) 1.� 2 ADDITIONAL GRANTORS ON PAGE Grantee(s)r i 2 r, _ __AOOFrIONAL GRANTEES ON PAGE_ �J DlstTiptlon(ahEreWared form:Le.bl bkxk plRLor section.Lo+mshq,ranRR yuartH(Rwnetl 2.) \.�•. —T F- (O Ot- C1.A� �. S�C-L_ OY �L�y# A IDTITIONAAL EL GALE oN PAGr_ I ag- ao 3 �) Assesaoes Property Tax parceVAtcaEm Numbers) c):DcAQ Q ADDITIONAL PARCEL eS ON PAGE THE AUDITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE IND"ING INFORMATION PROVIDED HEREIN. 2 An o mt for the true and purpose of m vcYing.///-7 from Dwell to the property of IR'—eC� O� {�m� ( _wait 3aoa9 - 43- 00140 (ahmer name,parcel N,2w ofsubdi r number adincem to hualD. Said easement shall be five(5)feet in width and shall extend on,over,across,and underneath said strip of land from designated well site to shared property 1'osa.�lgnew permeneat type of building shall be allowed to be constructed upon the water line comment ezcepfain, the operanm of me well and wares-system. Maintenance and Repair of Pipelines All pipelines in the water system shall be inamtamed so that there will be on leakage or seepage,or other defects which may cause emtamuription of the,water,or injury,or damage to persons or property.Cost of repairing or maintaining common distribution pipelines;shall be born equally by both panics.Each parry in this agreement shall be responsible for the maintenance,repair,and replacement of pipe supplying water from the common water distribution piping to theirown particular dwelling and property.Water pipelines shall not be installed within 10 feet of a septic rank or sewage disposal dram field lines. Prohibited Practiees The parties herein,their heirs,mr,cssors and/or assigns,will nor construct any potential samce Ofcomminution, rrainuin of sutler no be constructed or mainamad upon the said land and within too feet of the well herein described,so bong as the same is operated to famish water for two-party domestic use.Any pomtial source of contamination may include but is not limited to: septic under and drainhelds,sewer lines,underground storage tanks, feed station andlor grazing mimals pins where mamsre can me,mulme,enclexures for maintaining fowl or animal manure,liq)rid or dry chemical storage,herbicides,insecticides,hazardous waste or garbage of any kind.New ��dV�UFh_ues ardor hares shall meet required setbacks and not harbor any potential source of codaminatim.The will not cross cmmees any portion or segment of the water system with my other water%curet or waste water arwsl outlet without prior written approval of the fhl[6adGounry Health District md/m ether s\�opriate govemmenal agencygovemmenal agency. ovisions for Con[Lpation of Water SerWce the putts agree to tvarntaut a cooMuous Dow of wares t«n the well and wets sys/cm,hareem described in accordance with water supply requirements of the State of Washingto; (WaSOa County. Indic event that the quality or quantity of water from the well becomes msatisacmry the pares shall develop a new sauce of water. Each undivided interest andor party shall share equally in the Cost of developing the new source of water and installing the necessary equipment associated with the new source. 2 Party Shared Well Users Agreement 2 of 4 r u t, 2222995 Page 3 of 5 03/20/2025 03:04:37 PM Mason County, WA Q Z=k O 1,the undersigned,a Notary Public in and for the a aunty and State,do hereby certify that set this \1'� day of 11 MLC.IJ• .20 b��me s�T_. n .--- ;'to me(mown to be the individuals)described in aand who lxecured the x hin instrumen4 and u mowledga that he(she)(they)signed and sealed the same as freeslid voluntary,act end deed, lo, \t\tltn turttltt ein mentioned. GIVEN order my hand and official seal the dae uses and y nand year I"above written. �/. i.,nlailen 1tYd/H - ry;o e�O soar ; ttotarY c.in and m the of Washington• mg m:M k50N C OmM Mission wires: 0911b t 1i1 ay, OF V'10`"0 ) / Ef!�"" Property$medf Signed: Print Name: t Ge.Nov nnnnuuHa I,16e �g�ied,al4dary Public in and for the shove named County and State,do hereby certify that on this 1 yof 201 ,rally appeared before me _ to me known to be the individual(s)described in it who the within insoumenl,and acknowlcdge that he(she)(they)signed and scaled the same ss free d voltn ' act and deed,for the uses and purposes therein mentioned. my hard and official seal the day and year last above written. p••EtH I IM CCU q, _.._. WotuY tic in and the State of Waahingmtu oap1 Y �. My Commission Expires: z ice. �BU4 •O� 40i"Oil OF1111110 `\vv 2 Party Shared Well Users Agreement 4 of 4 r,�t• e 2222995 Page 5 of 5 03/20/2025 03:04:37 PM Mason County, WA 1 1 510poo l �-Qpti-c�NEtGNWA - — V ELL APfRox'350 r , p .•�. vim. "COSE y' PAUTA JCY JOHNriON '. Y t � 41 / O Cleanout • — O2 1,2(H1 Gallon Septic Teak 2-Compartment with Effluent Filter ��tC�® D-Box with speed-levelers !/ end cover to surface B 18 2025 MASONCOUN Y ENVIRONMENTAL HEALTH DJA 335 TEST Y0 SCJgLE 1 3C) - A SAND k (ZOOTS O 15 30 45 60 * 1 : 0 -✓o"" LoK sk2: D-34 R ° LOHfY4 SAND t °cTS PL07- Punts J M kk�(ZDIE _ w�'� -rI^'� II�DIJSiST�NT TI LL '1�RC-ECa32o29-43-Do �oC Yo�KE-rs --1D0 SE MILL C,REF K RD Sh -roN u)f� �L0s94 3 e�� t MASON COUNTY GENERAL SERVICES DEPARTMENT P.Q BOX IN • 42l WEST OEDAR • SHELTON,WA SUM PHONE(2 )<2T-R8T0 RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM OWNER ^ O' J,t ADDRESS S F 6 M;I1 C11 P THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. Dny ZIP w A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER J -W WITH PROPER MAINTENANCE AND CAREFUL USE OF LEGAL ' 1 1 WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- S E 1 r W �2 S w 5� 1q-2u-3 VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE FIELD X LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO- U6A9- -dd0b O SIZE FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR 5//7/ qD TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND Q,,pA 14-4 'e1 THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. CLEAN- SIZE SEPTIC TANK (S) �.Z L'�/ C-9II ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS- DRAINFIELD p FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH ,p0 ;• MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA SQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE ,Ay., CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS TILL ❑ CORRUGATED Id RIGID CEMENT RECORD WHEN HE COMES. DEPTH DEPTH HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE ROCK Low TOTAL DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS CU. YDS. ��/ PIPE DEPTH RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, SPACE RESERVED FOR REPLACEMENT DISTRIBUTION FIELD: SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. MONTH 30 1 SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO 10 b'1 THE SEPTIC TANK AS THEY WOULD INTERFERE WITH IJ yp CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE f �� TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT EQUAL TO ONE HALF INCH OF RAIN PER DAY. FOOTING DRAINAGE, DOWNSPOUTS AND WATER SOFTENER RECHARGE WATER SHOULD NOT BE CON- NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE DRAINFIELD AREA. THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE NORMAL USE OF BOWL CLEANERS OR CLEANING COM- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. - /t 7 / Cr o \ THIS I AN IMPORTANT DOCUMENT OA��/ o F INSTALLER KEEE P IT WITH DEED OR OTHER ESSENTIAL PAPERS. owre SIGMA OR � �lov�lk house, �� s�t;G \ \\�\dr�iNF�i �� �©o Yhi1\ Gner�k �d �� �N�\ P�ho��. � o � a-a c-��e� � S �,°t°` VN�U �a Cre,2k � �-, c��a rei Nb� - -� �. , �n�11 c�k ��d