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HomeMy WebLinkAboutWEL2025-00027 - WEL Application, Design, Letter - 5/2/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 at '. BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 DOUG WILLIS 701 E DANA DR SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00027 3070 E Harstine Island Rd S 220257600020 The 2-party water system, Sweetwater(220257600020/220257600020), 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, David Anderson Environmental Health Specialist Mason County Environmental Health APPROVED MAY 0 7 2025 MASON COUNTY ENVIRONMENTAL HEALTH DJA r o _ /a, 4 \\ MASON COUNTY Date Received: - a - as f :� COMMUNITY SERVICES Amount Received: Received B : ) Building,Planning,Environmental Health.Community Health C_ /�+/'� 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 W E L aO W�7 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE '� bu ' w� LL�S 2 S 3 23v - 48S ' MAILING ADDRESS-STREET,CITY,STATE,ZIP 7 01 IF::. DNA DR r 54-1Et-1r31Q WA gg6 ' SITE ADDRESS-STREET,CITY,STATE,ZIP a07o F_ . 14A25T: E -ZSLANL AO. Se_3u77I PRIMARY PARCEL NUMBER(WELL SITE) „2. 2c3 . 5-'74o00Zo SECONDARY PARCEL NUMBER(IF APPLICABLE) WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE 0 New IA Existing ".Well ❑ Spring 6—Ae.Re S IV—Ai PROPOSED WATER SYSTEM NAME(REQUIRED) rt SIINJE6LT WATEt2-. PROJECT DESCRIPTION vuE E-S Si;,-)j W ELL Tu SuP/)Ly / Hd�tE PLu s / Ad u v� SA me es)R�EG , l -771uo New Aeo4u AA-Z 771li c AIEu, pfte v:atis SSul iJ g ) Two /14wES off Srrr. , .44E s 70 /271.4a ouvfbvses. DIRECTIONS TO SITE/CONDITIONS �7- CORWerk otr= E. I4M . t!4E 1 LAI.rO dp/�r ,SoLATN , V AAAD A6, SoLt7iJ i / 4eszli1 Alfa', Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways, roads,septic/sewer components and lines,easements,etc...) S/2r AT Ateg D, i4S0 \ \*I\C's 10 I. 00 4. y. , . 0. Submittals Checklist: (these additional items will be required for approval) Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) Septic Records (additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021 Page 1 of 2 Staff Use Only --- ----- '' Review Step 1: Well Site Inspection: s. - k44'a,is Z i YES NO NA P ❑ ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks,buildings;indicate distance on plot plan) f ❑ ❑ Are there roads within a 100-foot radius of the water source? /�y'' Is the road County,or State?(circle one) Distance to the road(s) ' _,04 ❑44:❑ Does th ground slope away from the water source site? YJ� :.`"2 ❑ Satisfactory well cap? Pet %le soya the 0- (40 4 IP'if" i ❑ Well cap screened and vented? %.. l • ❑ The well casing extends [ O above level ground/concrete slab?(circle one) 1 ❑ ❑ Evidence of a surface seal? Lat: /x mow pi ❑ ❑ Adequate surface seal? Lon: -IZ 2,$'#r?20 ❑ ❑ ❑ Variance necessary for well site approval? Tag: 8 i'.1GL 1 Comments: Pleciv✓t l I (Or 4 4- S-OP qs ki, r ('7,' o .?� 1-9 �4� u/ 5 " 2 / 0 ss ail Inspector Date f i [ 707 S/7/t)T5 Review Step 2: Two-Party Review: YES NO NA 1'-' ❑ ❑ Water well report(well log)with a concurrent capacity test? 0 0 Nonconcurrent/separate capacity test? //�� 1 i f Capacity test information: Date 7/26 lG6 15 Driller Cad ect 9f Mt" GPM I Z Duration(minutes) 7c? Total Gal if ?C p 0 ❑ Satisfactory bacteriological analysis? Date of test Z I Z S I l a Z) ❑ 0 Signed,notarized,and recorded notice to future property owners?AFN a Z `V A 7 ❑ ❑ The system appears adequate to serve two connections based on the information provided? Ac Comments: 'hgs0y ��y _ OI' CO • l( Approved ❑ Denied Reviewer - Date / d S Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, xIF, , or implied of the future success or failure of this system. Well site approval does not constitute water system approval '' All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19', 2018 per ESSB 6091. Revised:02/04/2025 This form may be scanned and made available for public viewing on the Mason County website. Paget of2 101 DEPARTMENT OF ECOLOGY State of Washington Well Construction & Licensing Home Laws & Rules v Map Search Text Search Forms Site Info Contact Well Team About Ecology Well Report Viewer 0 Back to Search Results q New IY Find on Map Search A DATA AND IMAGE ARE "AS IS" WITH NO WARRANTY Download Well Report as PDF Water Well Report For An Existing Well MOYo:rr well rust be property tagged prior to submitting this form. Aster,aka(1 Ind,cat*required fields RAM rrtrnplotod Original torn to ECOLOGY WA S'e'r Deps'a-.sn, f rr ng, w�w:x alc(n,(I uL .WA oa5(f-7G 'r Use this form if an original Water We'I Report was never flied or is missing from Lcology records •G,•rent the 'tart:.Fr. 'bt''-* ttC C4r.laih'ul L Arurktdae ❑tNt,sa,e• newly Nat Ip lay hurt �3 RK I ort . :•.) L't.si v.►li Coax: 'wa!er itch' n'rec 11 WS.Stash a copy) Dig, tr Dreensiats 1'tcourty Owner tNe•ro ,, _o Oa M)r Ili,a_- ._ ika orer of trot 4: m rst own of frs!nOMtcti Wtti �R (.:ttx-wn3 'WGA,rteet Aht'e s r r-7a f.. 14$ f.Jf sit,•d,t `, -.. Cc tsU actfonOetaIIs .t3aV,: w.• *courtly -•atst.0..1 Si/Yns LINO fUn&nesn 'SR.W., I') _t .A,— •Trt■Dereol Ni ter 12,GZ .i. 74-eX-?k- j.Q .�'':•�1 c_a 'Chem it nl ca.structd 19go _ X vn.7vel .1 rent,.n(Township.Rev*.Section) • .,.r,'r:c4:•faltro+c . h.,,, a to___•__r. Al ac;utata k+crdnn of y^+n wvi IS vary Important Tho `�'rtrnn. I cnrttalhtq Rassgr Ana%.V.r to ttte term 1 on yow : . iv., u»tnoon MI( Ca.cut WO MvrteM c• lnrurrp!+ ytrx GoaltY At•A;,W>,c1oce .p. lip.. IJ`:. .;meet fare' U.:7e- ,.T-.f4. Slp1 goo *my . s, Tcwnr!'.;+i,VU JJ Ramp.1Naii ObW1t4 or QQ'rhr`itlfl/ •1•a.eCFr,ter Fact Secton -i .W. iN 1:4 fa_1i4 6 • ,r'.,-;;r ._.R IC t' (:Omn.en% _..Lj. 1 e•!_ •Is A V f;/ I2C l 1 .' ce tear - T e . •rsno,vn.Isat's?de >,_.ft -- RECEIVED -- 23 't;rW s usR,.r,,v,N.. —DeptW of Ecology SRO ", .. G.� r,t - --4 A p r 2 5 ---- - �4 -.'. lnknowr• -- ,,e- Horse Poo*,„(/.4.a.rrN�• Latitude•Long:rude -- — riaesrLe)aWs (Decimal Degrees reccrdea to 6 decimal plates) Z ,a..t-v:Ufa:!Mew.-A,stove mean sea lever ft. 1-r'..1^(:._..••,..'d47 ')�1:,; ...3 Ili; ,!^k-u0........ boiOw lend�uffs a ;4 - .+. 7 /?7,ei ' '' — I ;•r.:I.+.. 4J.t ft Deem lop of eating t}stameast.•c3 I cn,.;.A.(Fram^an 118 12345 .t.-cswr.Mrssve bi pee square r Pa!r measure-s - j/=2 . ; S''1 r ��� guar __ ... v, a+t.. ,Vr..I„ej Cat uc' a;I*es Osio slim ol•valve?Dirt U Weil Pests: Additional Information(If avattab4 please attach, W 7ea4,07wn rt amount wa'i:Kitt rt b rrcd betas•.'i' 'WV L]Lor.a'Jn marked of lupos sah'r r1,37 'S :.as I C.•+p teat made?area wrath copy)rl`., c.:.hl retsn f O(te a rntaked Uri n Gh('W V.:I:!t! .Wilimet 1,LlI/1. R d.tn e.sr Sled./ h: fCQftsu"_a II?.rre worm/ Copyright © Washington State Department of Ecology Privacy Notice I Site Map I Accessibility I Contact the Web Team • Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer: Doug Willis Well Tag#: Unknown Site Address: 3070 E Harstine Island Rd S,Shelton Depth: 232' Date of Test: 3/26/24 Static: 207.1 Pump Set: Unknown TIME GPM LEVEL RECOVERY 1 Min 5 208 TIME LEVEL 2 Min 5 209.3 1 Min 209 3 Min 12 209.7 2 Min 207.1 4 Min 12 202.2 3 Min 207.1 5 Min 12 213.4 6 Min 12 213.8 7 Min 12 213.9 8 Min 12 213.9 9 Min 12 213.9 10 Min 12 213.9 15 Min 12 213.6 20 Min 12 213.6 25 Min 12 213.6 30 Min 12 213.6 35 Min 12 213.7 40 Min 12 213.8 45 Min 12 213.9 50 Min 12 214 55 Min 12 214 1 Hr 12 214 1 Hr 10 Min 12 214.1 Total Gallons Pumped: 826 Thurston County Environmental Health '1-, 412 Lilly Rd NE t Olympia,WA 98506 360 867-2631 narcc COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County / 2 V/ 2 5 a► j1 Mont Day Yew _o,w MAS " ft : Type of Water System(check only one box) 1 Private Household ❑Group A 0 Group B 0 Other _ Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Contact Person: 7u 6, i,,J,',Jr'S Day Phone:(2,3) 230 - y 8•84r •Cell Phone:( ) E-mail:lk 4 C.:r ►1.1,j s e (;,i+1),r(r e,Cu• Eve.Phone:( ) Send results to:(Print hall name,address and zip code or email address) ii G j'4;LL 5 G G MAl'[ , CLI...,1 SAMPLE INFORMATION Sample collected by(name): _..1�Cr=/L A!//i S Spea1ic location or address where sample collected: Special instructions or comments: -30 7o E. 1 gri► ILA,4 Type of Sample(must check only one box of#1 through#4 listed below) 1.)ig Routine Distribution Sample 2.Repeat Sample(after unsat.routine) Chlorinated:Yes _No. ?( ❑Distribution System Chlorine Residual:Total _ Free_ Chlorinated:Yes__-_No 3.Raw Water Source Sample Chlorine Residual:Total__Free- _- .gi E.coli—GWR(A/P) '®Fecal—Surface.Gwr sn'in (numeration) Unsatisfactory routine lab number: Filtered:Yes No - ❑Assessment Monitoring(A/P) Unsatisfactory routine collect date: ❑Other S 4.0 Sample Collected for Information Only /3t y; .V f iiliK4r/ Investigative_ _ Construction I Repairs_ Other 7( / LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and Satisfactor y ❑Ecotipresent 0 E.coliabsent No liformdetected - Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑__ __ Bacterial Density Results:Total Coliform 1100m1. E.coli__�/100m1. Fecal Cofiform _/100m1 Enterococci__ /100 ml. Method Code V SM 92238 ❑SM 92220 Date and Time Rtosived ❑SM 92158 ❑Enterolea ,Z.-1.9 & ()bow Date and Time Analyzed: 2 _ZC Date Reporter •2_(0. Zti)<e)- Surpte timber(OSH number eke rive deb)) Lab Use Ontg.;I v j't•G 0.- Return To 2224839 MASON CO WA 05/02/2025 09.14 AM NOTCE 3)O u V / lJi S WILLIS *209194 Rao Fee: $304 50 Pa es: 2 111131 Mill l III 11 ml Illi lRII���!1111 III Ili!it II 70 / e. DANA Da. SNt«,si WA 2g c sV Grantor(s): (1) _10 U Wi Ili 6 , (2) Grantor(s): (I) PUBLIC Legal Description (I)^T R 2. O F S u 12V 2°$ (Abbreviated form: i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (I) 2 O Z 5 7 40 U co Z O S25 _ T2o _ R� NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned gantor(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) 20 Z 5 76. 000 20 Tax Parcel: (Connection 2) „2. O :.'5 7 a 000 . O The system owner is responsible for keeping this system in compliance. The name of the water system is: s W E \/`JA"rE 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. Dated on this day of MA/ , 20 Z 5-. Signature of Grantor(s): (1) �� , (2)— Page 1 of 2 State of Washington County of Mason I,the undersigned, aNtary tary Public in and or the above named County and State,do hereby certify that on this day of , 20/5 , l�.t S V t1TiS personally appeared before me,who is known to be signer of t�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. /^� JANIL(V(Deu `\\����SA����ii����� Notary Publi n and fort State of Was gton, e(,P•''ysioii''w'9f_''% residing at maim �'l 15 20 A,; . My commission expires: v NOTARY to r; B L40 Sc1 n h• O 41/2 � :,y' 'ode 1�•' � ,//11 �tWASITY���\� Page 2 of 2 !60 . 5 ALE ti - 1 , N 3'30 h }7owEe. 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