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Home My WebLink AboutWRIA Title Notification - PLN Water Resource Inventory - 5/2/2025 2224858 MASON CO WA 05/02/2025 02:05 PM NOTCE KEN SCHERZ #209220 Rec Fee: $304.50 Pages. 2 Return To K iz-&) c,— S c )4£ iz-Z 7o 5��v s c-�r— A/.E y Grantor(s): (1) Ft Ac I G- -5 L_ H &R Grantee(s): (1).PUBLIC Legal Description (1) Pi I LL C R �-f- K t-b)'3 of SP4'2�ts?�f 1'R� P-JAI -r g 5-1- 3- (Abbreviated form:i.e.lot, block, plat or section,township, range) Assessor's Tax Parcel: (1)3 'Z 0Z - Q - Q TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA) I (We), the undersigned grantor(s), hereby place this notice on record that the described real estate situated in Mason County, State of Washington is subject to water use restrictions and conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These restrictions and conditions are based on location of property and/or Water Resource Inventory Area or WRIA. WRIA: Maximum Annual Average Gallons Per Day: °� '1 gallons Dated on this day of Z , 20 "L-5. Signature of Grantor s): 1 (1) (2) A State of Was ington ) County of Mason ) Page 1 of 2 I, the undersigned, a�lotary Public in and for the above named County and State, do hereby ertify that on this d day of M G , 20 ar), , Z ersonally appeared before me, who is known to be signer o e above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. A i 'I j No ary R blic}}inand for he Sta e of Washington, l residing at -//A C& -�j A My commission expires: r {�-7 CRYSTAL WILDER NOTARY PUBLIC#23017901 STATE OF WASHINGTON MY COMMISSION EXPIRES 05-18-27 Page 2 of 2 WATER.WELL "PORT CURRENT Qriglnal&i"tow-Fegav,V topy-owner 3"'c0or-driller Notice of I f3ttent No. wingsdl EALOGY anstructXDe>r4>it►mfssinn(.fit"i�t circl2) Unique Ecology Well ID Tag No. BKD 747 0 6Onstmc4on Water Right Permit No. ❑ Decommission ORIGINA4INSTALLATION ]Notice o Intent Number Property Owner Name xraigsel,e,� ------____. PROPonb Liss., 0 Domestic ❑ Indnxtrw ❑ Municipal Well Street Address 365 SE Snider Rd ❑ Dewater ❑ hri ation ❑ Test well ❑ Other__ City ,S.belton County 'Masgrr TYPE OF WORIC Owner's number of well(if more then one)---- 0 Nt*well ❑ Reconditioned Method:❑ Dug ❑ Bored ❑ Driven location Nwl,14-1/4 SE1I4 See 24 Twn ZQL4 R Oar' MV O ❑.Dixpe6�d ❑ Cable ® Rosary ❑ Jetted (s,t,r Still REQUIRED) or bAVrSNStO IS: Diantetecofwell 6 hichts,drilled 222 ft. of balJolftai Rfl. 2 ft. + v'srltLCTLONDKrAIJ C_.- _.. Lat/Long Lat De Lat.Mi>a/See _ r*+u►E welded b^ Mane from+1 IL to 2191. I De Lon IvlinlSec _ ieddeUed: ❑1,incriaitalled__ 14h.from `ft,to op,:8. g g— P t3 Threaded Diam.From ft.to _ft. Tax Parcel No.(Required)" =-so-"543 Perramtkwi! ❑ Yes 0 No ofperforata,used C0?WMUCTION o9 DECOy1lt3ISSION PRQCLt)(1RE SIM df rfs___,_➢n.by.......in.and db.ofkerrs frdm _�to---fL Fatpsaeion IJgswbe by color,.rlmraeta,s�?o of material and stractgR,a7Jd the ldud ones Scrmw E] Yes Z No Q x-t'ac" 1:�6tibu` =tum of the matertat in each strntum penetrated,with at toast one entry for feels cbang6 biaziitTacftrtee`sName ofWormatida, (i1SB AD01770NAL St-EFTS IF NECESSAPt) 'I�Pb 1it0.. MATERIAL t)1 ... Tb . To soil,rocks 6 1 Dw0- __ 1i L*4— 1&+�rl--K zio.._.tl, p piam. Sictsiat from It to ft, Clay,silt,"sand,gravel brown/svft t 12 a velil3ttergoSked: l� .�(alp Sizcofglt}etW4.,,_ is�uinals , odf from_._.It:to�.._,.�1- eiax st'4[,saltd, 1 _. soft 12 19 S>Xrl6eee 1� Xt9� Lt Np To wl>at dgih?ifs.. VW Clay,gray/soft - l1till usedaI Bent4rLN1 ... Sand,sift,gray/Soft $3 39 t 'F4y1s eantnin unosatile w ? 0 Ya 0 Na Sand,coarse,some gravel 'hyperfwute;'l _ Depth be strata — gray/soft 39 44 of'stialing strata ON . Clay,gray/soft 44 61 qI P )vfa ai f'&*qg, NLk Sand,silt,gray/soft 61 6$ 1r -----'H1'. . --- --- Clay,wood.gmylhard 65 93 WATEA L8$i1 u;food surFaete tvsti9n above mcmt>►ft level!R. Gravel,some sand,some silt StaticA"I 778&wow tap o[wen DW gray/soft 93 lo$' Attosian pretstur;lbs.per sgraro inch Date —. Sand,silt,gray/soft I05 L21 -causiao watv`s atrolledby (cap,`eve,etc.) S and,sift,bro%NWsoft 127 I35 Sand,f ne,silt,Nvet Lb YES7S:I7 wdo�+ai;.apoimtwattrlevelisl9weredbelowstaticIpeel gr$y/soft 13S . L73 -etas a:P!tu!P;testmade? 17 Yes 14 N0 lfym by whom? Clay;graytsott 173 ?ll iatd _ 1/tdin.with Wit.diaWdown of f hrs: Yeid,_ at.lti%4-%Wtit fL-d�dbMMitter`-_]irs: �iraY$t,.soltsesand,somesilt* Ytcld a Jmlu.w7tlf _ ,mat► �a:t r _.#as gray/salt Wb ''21IREC - iY�i?rR'�r�rtatirktrJ'df�•Ctr?H'henpuu7r'ttvntt?'rij);)lrwat4rTrvclmegruradfmm - aieNrep raworlr ,me sadi i> Tune wafir`L"T 'nmc Waler Level :Ai r,it lmin.3vittrgtem•setat Attfsimi DOW ,¢p•ih Date: _ eratiiris:ol,rri2t>ti_____R/as a chetnical analysi3 tttade? ❑ Ya ® No _. ... _... _. i WELL CONSTRUCTION CERTIFICATION: Iebnstrudedand/oraccept StaADatC 2/lg018 Cop Uteri aft Zq6ZU zp4ppMilail�.for.eoristjuCtiprl oflhis well,and its epmpliance,with all Washington well cbnstnlatidii standgtd5..Matetials used arid the information re gated above are tmr to my best Im awlcdge and belief. RDrWer1D.En0WetrC1 Trainee Name Min0chrisjoneg Drilling Compon Moerkt 8t Solis Pump and fi�iiUing' v ��,, I7iitletlEn>Lirteet/Tninec 5igrteturc �L- J -Addregs 11b2NW State Ave Driller or traiifeb Lieensc No:2Z33 Citsr.State,Zip Chelia6s WA; 98332 'iP TgAINEI.M1ler'sl kzmpNo: Contractor's F�i 1isi tthititC- Ret=istration No. MOERKMRN5 ��r-.V1640A. s n ECI'05'0-1':20(Rev 011010) To'requett ADA accommadwfon including materials In a forntat for fire visually impaired,rill Eenlo$y Water Resources l'togr&W :a1,.0-1(07.$7I,PMo/Vir#impaired lfegri!tg mpy-11 Washington Relay Reruiee at 712. Persons with sioeech disability maycafl 7TYa1$7.7433y634z. 415 N.6h Street MASON COUNTY Shelton,WA 98584 SheltoPublic Health & Human Services Belfan:360-427-4467,Ext.400 Belfair:360-275-4467,Ext.400 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application with any required attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: )YkA,I(, SC -Z Date: 7 - Z I? — Z 3— Mailing Address:13 ZO S j f VF-fVr GY 4.AU(i Phone: Z 5"3 -35"3 ` 9 G 3 5' Parcel Number: 3 Z. O 2 5-f6 - 9 43 g y Type of Water System Reason for Application ❑ Public/Community Water System (2 or more Building permit connections) ❑ Division of land: C' Individual water source (one connection), #of Parcels? SPL t2^ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel (please indicate name If you have more than one residence connected of water system below if applicable—no to this well, check the Pubtic/Community Water signature required) System box. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory (WFI) Number: (write"none"for two-party) ❑ 1 am the manager of this water system. The water system has been approved for services. There are presently connection(s) in use. This will be the connection. ❑ 1 am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Print Name of Water System Manager Phone Signature of Water System Manager Date This form may be scanned and available for public view at www.masoncountywa.gov J:\EH Forms\Drinking Water Revised 05/08/2024 Page 1 of2 Group B Water Systems C� Satisfactory bacteriological test within last year(attach to application). Individual Water Well ZWater Well report(attached to application). Depth Z t q ft. IS Well capacity Test(attached to application) / O O gpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from I these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. ❑ Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) ❑ Satisfactory Determination: This determination does not address adequacy of the distribution system,guarantee an adequate supply of water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. ❑ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: Environ. Health: Date This form may be scanned and available for public view at www.masoncountywa.gov Pane 2 of 2 ,Kr(?A:k g Scy\ex z Vanguard Laboratory 2635 Parkmont Lane SW Olympia,WA 98502 3 60.967.7010 VANG (UAR]D Report of Laboratory Analysis LABORATORY Collected bv- Moerke and Sons Matrix Drinking Water 360-748-3805 Laboratory ID: V250416-16 Sampling Address: Date Sampled: 4/16/25 13:40 365 Snider Rd SE Date Received: 4/16/25 14:45 Shelton,WA 98584 Date Reported:4/18/20?5 Sample ID: 365 Snider Rd SE Analysis Result SDRL MCL Units DF Date Analyzed Total Coliform&E.coli by SM 9223B(IDEXX) Batch IDN250416-16 Analyst:AF Colifbrm,Total Negative I 1 MPN/100 mL 1 4116/25 15:13 E.coli Negative I I NWN/100 mL l 4/16/25 15:13 Nitrate by Hach Method 10206 Batch ID:V250416-16 Analyst:KS Nitrate(as N) ND 0.50 10.00 mgiL 1 4/16125 16:51 Notes: MPN:Most Probable Number ppm:parts per million nd:non-detect Reviewed by Dustin Newman,Laboratory Director on 04/18/2025 nia:not applicable SDRL:State Detection Reporting Limit Approved by Tori Johnson,Operations Manager on 04/18/2025 DF:Dilution Factor 17025:2017 MCL:Maximum Contaminant Level ecce:nrrrn ianQan70RY Samples were received in acceptable condition.The result(s)in this report relate only to the portion of the sample(s)tested.All analyms,were performed consistent with the Quality Assurance program of Vanguard Laboratory.Please contact the laboratory if you should have any questions about the results.