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HomeMy WebLinkAboutWEL2025-00017 - WEL Application - 3/17/2025 MASON COUNTY 415NfiSHSTREET, 0427-97 ,E98584 3H STREE ,SHEL-ON,W 98584 400 BELFAIR:360-275-0 67,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360427-7787 FRAHM CODY & BRITTNEY 872 EAST DANIELS RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2025-00017 872 E Daniels Rd 320112290014 The 2-party water system, 870 + 872 2 Party Well (320112290014/320112290013), 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, David Anderson Environmental Health Specialist Mason County Environmental Health D MAR 0 3 2025 ® MASON CO y 03 -03 025 COMMUNITY S CES NmnI RW.Nm: R mm h BIiM4 v4mq Emnmmenal Nm9h Camnunlry XeI F 415 N.6'SeeeL(eMY 8)-Steel.,WA 985M WEL 20Z5 - OCO l7 Shaken: 3 2'i-9610 x400 aelbir 360.27S 16]x400 Elms:360d82-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION ARPuc maN[ l 0 q' MYIlNG1BBRB88 BEREER.LYEY.eTRTE 1P`� �� W �� EITEQo40B0.EBZ9-9TRFET,OEY,aiPTEl1Y O L G i - S H0L_TCit'V Wk C105vq AUYNY PYICFL NIIYBER(WELL BIrF] -L 1 � '�7— c)I SECONDARYPp MNUMBERIlr1Rr1LYLe WRTERBOURCE 9OULLETYI4 PAa"4LN Sa£ PARCEL 2 urr ❑NewExisdng Well ❑Spring [� 4 P0.0PME0 W1TER SYSTEM XMMtREOURED) 9_70 d' BIZ Z Vkyv W 61.,E PRQUCT OESCRVrMIN to uti 2v M.cnoNSTONnCOXamo.. S r be v L4A4 .E I —Sf E $ Stbv1 \05K. Site Plan: (may also be attached) (property Doondades,sauctures,well site w/100 radius,driveways,m s,septidsewer components and lines,easements,atc...) � S O Submittals Checklist: (these additional items will be required for approval) It Satisfactory Bacteriological sample(this may be deferred if well is not yet drilled) VI Well Log with pump test or 4-hour capacity test performed by driller(this may be defamed if well is not yet drilled) V.blotice to Future Property Owners recording(record with Mason Co.Auditor,supply copy of recorded document) Iff Septic Records(additional locating requirements may apply if there is a lack of septic records on file) n1s;form may be scanned and available for public view on the Mason county Web site. Revised: 10/13/2021 Page 1 of 3 Staff Use Only----------- Review Step 1: Well Site Inspection: 'ftoe 11 IM YES NO NA RV I- �J ❑ ❑ Evidence of existing sources of contamination within 1i10 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? 16 ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cep satisfactory? IVY ❑ ❑ Screened and vented? (� r ❑ The well casing extends Z l above level ground/concrete slab? (circle one) ❑ ❑ Is there evidence of a surface seal? toff•, 4?.24 W ? ❑ ❑ Does the seal appear adequate? ta: • 111.00f Z LLJ Y ❑ Is a variance necessary for well site approval? T43 ?MSIX.L-- Comments PoN (c -w w4r , loco kd � w I Flabvl �ruS nkl� by heMeownlr i Ana W4, (Yrslx� Pass ❑ Fail Inspector . _._ _ Date Review Stop 2: Two-Party Review: YES NO NA ❑ ❑ Water Wall Report with adequate pump test on file? b PO(dl On 9(r0044 4/ ZO Ct02'I f«(OIM') If NO,date of Capacity Test Driller GPM (1707fi1)I ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test Ze ❑ ❑ Received Signed, Notarized,and Recorded Notice? AFN ?7-7_S 19 ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided ©�c Comments A?Ce(I(t°C( rP sd 3 &ZV7a1C *%* ' *P,?c -.__� ,/ 0; n'. ®.Approved ElDenied Reviewer Date 3I?V_?o2_S / _Findings in this review reflect observed conditions as they existed on the day ofthe site inspection. Me claim is made,express or implied ofthe 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 ofbuikling permit perMCC 6.68, Water usage restrictions andadditional fees may apply to all new wells drilled after January/91� 2018 per ESSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on thm Mason County Web site. Page 2 of 2 REGE1VED WATER WELL REPORT DEPARIMENI of Naiw oflawd No. WE3%78 ECOLOGY Dagw Ecology Wel DTagNo.Sfe5,2s �et.N it:.� il![ t TryeofWak sueeaw,,Noton m Site bvell NemelifelmetFmorc idly am mk ❑ DnmWxim b 6yin1vaWiwoa N0l Nx 1Vetea Right PelmiUCedlafam No. hepmN tlu: 9Demvtlo ❑tedmaio ❑Mankiwl Pmpeq Gxam Nerve Bdllnm B Cody Frahm ❑Dorett:me 0h4Ica ❑Taf well ❑tNhI Well SNM Addmas eM E Dmlkle Nd Caapbawip TyK: NeIYeN �NerweO OAIInWIoe ❑0iun Oland OCpNe TeW CRY SlllPpl Cpn!)'Maaan ❑unpe:wg ❑obm. OD, DAin 01MRahey Tu Pe No. Ml i-22A 14 a:Iulm:MINcrafteriy 6 m..233 e. WmavedancaepprovW for t1is.117 O Y. IMNo IAybafwrylnawN 238 a peuna: wa Ifym,..fiat xaa the vniuco foP Cmi g tion Uieeelee Fmm To TYdeva Steel PVC We "II1 N I ❑ e in. 0 a .4 Lio. o ❑ m ❑ wcaioa tool iadmaipmm was zy aWWltfm❑EWM ❑ I ❑ m. ❑ I ❑ ❑ ❑ NW �Y.oflhe.NVV V.3rnim 11 ltxiullp 20t! Rmpe3W ❑ 1 ❑ p. — — —_n ❑ ❑ O I O ❑IiwdelEaemde.47.12A5)4T 241145 ❑ 1 ❑ _b. — — —m ❑ I ❑ ❑ I ❑ « Longitodc(B ple:-120.12MS) -12&032809 kS hdpnem+: ❑Yn GNo TtRafwrhrlaW orPoeraoealComtraol4e aroerommuloe Rocedan LNaperfiamkaw� Sieaofp<rkndom_i6J-6 Ppmwioa'.Deembeby mlm.clmxur.dttofvnlaialaW.mems,mlOe YiNaa Rrfiwled6an_Ab_R.bebx'gmNwriw :olweoflle wlaulma<h 4yaPnelwNQ wihalnmonemrybreach<YaMM Y 3- a,ee ❑Ha WKElwrrD,62= L nbmvlwn Uu oaNnowlrhnLLdottetury. ■ sfm krnaen Name ANov Machine Wwlp MeluW _ - Fah To T, StalNnae Sloped model Na - - - W..5_ Simrhv.me k eom 233 R.m M 0. Bmwn sill Send 8 ava mbblaoi 0 4 IT.nwar_ SInw_m Sam _a.n_0. Brown silty send 8 yeva boas 4 31 y baenae,.vnwo Ym ®Na sinofpekmaMiY_ia C sill sondfl revel 31 35 amid:vinaSam_Rm_a. Ora Wit 35 36 SuAKe hat: OYw ON. TawW&W IS a B.sill sand& ravel 38 72 nh:nhluudmn.l Benlanlle Chioa Ore sft 72 91 INa mysm canminmmbl<xanri ❑rn ONe Gmy silly sand.. _ 91 02 T39eawmert oegharslm Gla -my eley 92 119 nkadotanlvgmmoF Gray sity sonde 9m,I1 119 149 (itay sifty cloy 149 171 m Pwa:MaauGmin's Nwm TW. B.eg seM 8 revel 1T 1 103 II — PrvapieeoIdWlh:_fl Dagrdemwn:_Nm 65 Grey Altysantl3 gra.1 1BJ 218 xau.Inxu Imdawbwelnatimabnauaaettalwd 210 0. B.sW sand&AhWA,wet 218 229 slsY-up aeyufa<u udy 1_5 0.ebo+e Domdauen Black ravel,metlhhn re amM IOoaw NRMf 229 230 ♦ Stohcwahfkrd IV e.bdmempaewellmim Dee BH02020 Ave—, ue_b.Kr*V' ioelo Dab Ahsim wvinn..Wby (W,,+ahq..) WO Tnb: 33 WmapmpI,B P: :mea>KNo OYn b bywlmaR YieM_I.mid_9dmrdonw.ikl=lux Yiem_ppm wilb_Abndowu after Ne Yield_ppn.milh_AdnwdmweM_M. Rao<'e:Ydualri^a-aemwtrapuopammdaf-a'alnlnH mestuMliomadl 9a Thas lnrl) lime Wmw Lmsl The Wam4M T. WanrLrd 8 W DW^fP°°gimpm Wib¢n_¢pmwip_O.8aw8rxn.Yr_hw Ahw 20 awuw:Wmmmin 210 0.6r 1 b. Dam 8/1eV2020 Anesim eor_Raa Rmpewrvwofwelu_'F Wneehulml—oo,mIlsMy. ON. Swd Doe W2M Comphom Dery &10l1020 WELL CONSTRUCTION CERTIFICNOON: I mmlWaeduWor e[ttplaesportvbility for cwNmctun oflhvxell,pM ilscamp4arae with eB WmhingNl xell aamtmmdmsWderdx h3amdels hood aW the infamalim teponcd eboveamtme IomyhadbroxlMgemdhelief 0 Whu❑Trunee O YE—hint Name pp Ddlling Canwm'Amadla Ming klw S®pima i. Addrw PO B.I no Lke.No.2574 C(Iy.3b10.49 Shsltft WA98W IFTRAB spo ,Lemma Nw� rr Conlncl Spwmha'mwlme R<aiAnhon No,ARCA )MMK1 Dem81142020 ECV 050.1i0(Rev09/IA) {fJ^ewrNfAfrdonurxmmaeenwre�ornwr,pkwe mil dw if'wrr Rnwnm P.ogma arJ60JOJ-dBJJ. PwmumRh MmfiwAW rart Ml JI l/ar WasMngaw&bJ'ser+aa. Perewm sviW vsyeecA dlmBNry mil rd/BJJ-03Y6311. l ' Arcadia Drilling Inc. P.O.Box 1790 Shelton,WA.98584 Customer: Brittney&Cody Frahm Well Tag#:SMS126 Phone: 360-970-3248 Depth: 238' Well Site Address: 872 E Danish; Rd,Shelton Pump Set: 220' Date of Test:Bit 2120 Static: 183' TIME GPM LEVEL 1 Min 6 183.4 2 Min 6 183.6 3 Min 6 183.5 4 Min 6 183.5 5 Min 6 183.5 6 Min 6 183.5 7 Min 6 183.5 8 Min 6 183.5 9 Min 6 183.6 10 Min 10 183.5 15 Min 10 183.8 20 Min 10 183.8 25 Min 10 183.8 30 Min 10 183.8 35 Min 10 183.8 40 Min 10 183.8 45 Min 10 183.8 50 Min 10 183.8 55 Min 10 183.8 i HT 10 183.8 Total c a+ices wmpe6 �u c�a��ors V1JV1 �S -060(-1 Thurston County Environmental Health 412 Ully Rd NE#Olympia,WA 9R606 360867-2631 -W— COLIFORM BACTERIA ANALYSIS Deb Smyle Cobc40 Tm Sargb Caunb' cnxemu G3k317.i7 o�A�my MA-S'w MN M Y. L:01^" Typedwawsybm(ab .*—be4 ❑ Pmmb N.*e W Gmup Ard C+oW B SYNms-Pmi�M1om'Nabr FadlNas Invs�y lYlFl): MAR R 61015 ON SyaNm Nam: RECEIVED Canted Poem: Day Num:l I Cell . (!q EmdLG]= b(FlaM1/�pema.aJFw�nDmtle semi aEeo) �"n"Dy T'QAYi L V6.C'wv SAMPLE INFORMATION SwVa wiN by(nam): r� r41 be .eaameeFemeanpbelleda0: SperJeliminbUam aomtnmb: sH&c*ANiwA' 9651iq Type m SURte(mud dsM mM ot+bm m»11nmNn•a bY0 babel t[3 Roubm DNWbuW,Sumpb 2.Repeal Um*laMrunntromW) Cblotemmd:Yea_No_ ❑DmObAon System OWm Restl al:Totel_F — Chbnneled.Yes_No_ S Rua Winer Bourn Sentpb CNorne ResiEuat.T.W_Fme_ ❑E m5-GWR(AR) []Feed-..W.sealneer3ml Umetisl moos bb mutba: M Yw_Ro_ ____— _ ❑AmemreMMonlb"(Afl UnaeEMesel- WkrlEsb'. OD9mr S A. Sempb Caleobtl brbMmaeon Ony mmppetlw_ Canehuuclionl Repan— otlim_ LASUSEONLY DRINKINOWATERRESULTS LAS USE ONLY ❑Unedwdkd 'TotAlCdifomt Pmeenl.tM BMW,-" cakndebdetl ❑EmS pe•rnt ❑Emlebemt Replsement 8empie ReOubeE:. ❑Sample boaN h39 boon) ❑TNTC O Becbtiel DemRy Reeulla To�Ca4iam___�f0or1L Emf IIODnI. Fael CaBmm It00ml Eal.111l 1100m1. MdhWCpee: W922M OSM9222D wneem.Feaaa:t)75S' W92158 ❑Eft=0 pWaETn+Mt/raA: � oW Repeiad'S� SaAYemeemmmmerpie e�1 IabILOrF/. 0 8 0 A 9 R'J V 2223116 MASON CO WA 0312412e25 01.40 PM I.CrCE GRPHN tI0]]2fi Rec Fee 1304 50 Payes 2 Return To FP f 01 p OEM g�E nQNIP-L-S VD 59eti-m ., wA 9 4 MAR142 5 By Grantor(s): (1) &174 FYM*mm , (2)Z7_l7T'/V �j 'FfLA-r(wi Grantee(s): (1)PUBLIC Legal Description (1) La-r y ^ r $9��k Zlnil{ 1�'rn/ w V�� A/i) Al W (Abbreviated/orm:i.e. bf, block,plat or section, township, range) Assessor's Tax Parcel: (1) NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned grentor(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) I Tax Parcel: (Connection g0 O —La The system owner is responsible for keeping this system in compliance. The name of the water system is: E77 0 qr_ M Z_pa!" 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 (has6Enb been granted one or more waivers from specific provisions of the regulations. Dated on this 20 71 day of APIU11 , 20 ZT.- Signaturg.<p Grantor(s (1) (2) Page 1 of 2 State of Washington ) County of Mason ) 1, the undersigned, a Nqtary Public in and for the above named County and State, do hereby certify that on this 20 day of HAQ.Q.A-1 , 20L5— , !AA---jW Fdpil4j personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he(she) (they)signed it. GIVEN under my hand and official seal the da dye last above written. O�paCEU1�r111"'I i otaryPublic j and for a State of Washington, a Q.uoF,�T to L'; residing a NpTAay t• c My commission expires: tc -ofi- ;°o 03.-0 Urn OFrrnASkNpL����` Page 2 of 2 f�ou Se /eo' N O Audio-Visual Alarm ® © Clesaout © 1200 Gallon Septic Tank 2-Compartment with Effluent Filter 4 4 1 Gallon Pump Chant wvk— 974 f: Daniels Rd OS Valve Control Box _Shelton WA 98584 XJDl Pr�y D.F. Tce,,,v�e5 Resevd¢ rn beiuleeIj N © r to tJ' APPROVED a OCT 15 2021 d JJY JO MASON COJSTYENjIRONMENTAIHEALTH PAVIA +�NSON�'. e ��cer+sEpo�s� !>s REt s q- 2z- 2l 322' - 5tak 0 'S0 CID 9L t2c