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Home My WebLink AboutWAT2025-00087 - WAT Application - 4/28/2025 WAT 2025 - 00087 MASON COUNTY 415N. Street eill4k Shelton,WA 98584 Shelton:360-427-9670,Ext.400 Public Health & Human Services 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 4/28/28 Name of Applicant: Wilfonq, Joseph Date: Mailing Address: 3200 galvin rd Phone: 512-633-6857 Parcel Number: 320112400000 Type of Water System Reason for Application 0 Public/Community Water System (2 or more ® Building permit connections) 0 Division of land: i Individual water source (one connection), #of Parcels? SPL ❑ Well 0 Boundary line adjustment ❑ Spring/surface water 0 Other(explain) 0 Other(explain) 0 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 Public/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) O I 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. ❑ I 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 I oft Group B Water Systems ❑ Satisfactory bacteriological test within last year (attach to application). Individual Water Well El Water well report (attached to application). Depth 147 ft. El Well Well capacity Test (attached to application) 40 gpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from 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. El Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water ❑ WDOE permit (attach to application) O Method of disinfection ❑ I 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) X 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: sIVOINvEnviron. Health: > °S Date 5/8/25 This form may be scanned and available for public view at www.masoncountywa.gov Page 2 of 2 WATER WELL REPORT DEPAR7MEN1 OF Notice of intent No.WE58646 ileS ECOLOGY Unique Ecology Well ID Tag No.BPS-167 Type of Work: State of Washington Construction Site Well Name(if more than one well): ❑ Decommission Original installation NO1 No Water Right Permit/Certificate No Proposed Use: ®Domestic ❑industrial 0 Municipal Property Owner Name Joseph Wilfonq ❑Dewatering 0 Irrigation ❑Test Well 0 Other Well Street Address 700 E Daniels Rd Construction Type: Method: City Shelton County Mason 21 New well ❑Alteration D Driven 0 Jetted 0 Cable Tool 0 Deepening 0 Other D Dug ®Air- 0 Mud-Rotary Tax Parcel No.32011-24-00000 Dimensions: Diameter of boring 6 in.,to 149 ft. Was a variance approved for this well? ❑Yes E No Depth of completed well 147 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread ® I ❑ 6 in +1_6 147 in. El I 0 0 I 0 Location(see instructions on page 2): ®WWM or❑EWM ❑ I ❑ in in ❑ i ❑ ❑ I ❑ SE'/r-'h of the NW'%;Section 11 Township 20N Range 3W ❑ I ❑ in in ❑ I ❑ ❑ I ❑0 I El in in ❑ i ❑ ❑ 1 ❑ Latitude(Example:47.L2345)47.23906 Longitude(Example:-120.12345)-123.02605 Perforations: 0 Yes ®No Type of perforator used Driller's Log/Construction or Decommission Procedure No of perforations_ Size of perforations in.by in' Formation:Describe by color,character,size of material and structure,and the kind and Perforated from_ft.to ft.below ground surface nature of the material in each layer penetrated,with at least ore entry for each change of Screens: 0 Yes E No ❑K-Packer '— Depth ft. information Use additional sheets if necessary. Manufacturer's Name Material From To Tytu Model No. Lt brown cobbles gravel sand clay 0 24 Diameter Slot size in.from ft to ft. Diameter Slot size in.from ft.to ft. Lt gray gravel silty clayey sand 24 67 Dk gray silt w/very fine sand 67 85 Sand/Filter pack:D Yes ®No Size of pack material_in Gray gravel silty clayey sand—saturated 85 133 Materials placed from ft.to ft Lt gray gravel sand silt water 133 147 Surface Seal: El Yes ❑No To what depth?18 ft. Gray gravel sand clay 147 149 Material used in seal 13ENTONITE CHIPS Did any strata contain unusable water? ❑Yes E No Type of water? Depth of strata — — Method of sealing strata off — Pump: Manufacturer's Name Type: H.P Pump intake depth: ft. Designed flow rate: gpm Water Levels: Land-surface elevation above mean sea level ft Stick-up of top of well casing+1.6 ft.above ground surface Static water level 86 ft below top of well casing Date 03/12/2025 ' Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap.valve,etc) Weal Tests: Was a pumping test performed? No 0 Yes by whom? Yield gpm wish ft drawdown after hrs. Yield gpm with ft drawdown after hrs Yield gpm with_ft drawdown after hrs Recovery data(time=zero when pump is turned off-water level measured from well top to water level) Time Water Level Time Water Level Tune Water Level Date of pumping test _ Bailer test gpm with_it.drawdown after hrs Air test 40 gpm with stem set at 145 ft for 1 hrs. Date 03/12/2025 Artesian flow gpm j Temperature of water °F Was a chemical analysis made? ❑Yes ®No Start Date 03/11/2025 Completed Date 03/12/2025 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. ®Driller 0 Trainee 0 PE—Print Name Mark Wiese Drilling Company RICHARDSON WELL DRILLING Signature '-� (-----24 Address PO BOX 44427 License No.2432 City,State,Zip TACOMA,WA 98448 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.RICHAW 32108 Date 03/14/2025 ECY 050-1-20(Rev 09/18) If you need this document in an alternate format.please call the Water Resources Program at 360-407-6872. i Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. a RICHARDSON WELL DRILLING Aquifer Test Data Well ID# BPS167 Owner Joseph Wilfong Site Address: 700 E Daniels Rd Pumping Well Parcel#: 320112400000 Pump On 03/21/25 14:00 Pump Off 03/21/25 15:00 Date Time Date Time Reference Static Level 83.70 Feet Pump Size 30pik30-80 Recorded By Time Water Levels Date Clock Elapsed Time Reading In Depth To Drawdown COMMENTS Since Start Gpm Water Dylan 3/21/2025 14:00 0:00 7.5 83.70 0.00 14:02 0:02 7.5 84.60 0.90 14:04 0:04 7.5 86.70 3.00 14:06 0:06 7.5 86.70 3.00 14:08 0:08 7.5 86.70 3.00 14:10 0:10 17.5 87.20 3.50 14:15 0:15 17.5 87.50 3.80 14:20 0:20 17.5 87.50 3.80 14:25 0:25 23 88.10 4.40 14:30 0:30 23 88.60 4.90 14:35 0:35 66.5 89.40 5.70 14:40 0:40 66.5 90.70 7.00 14:45 0:45 66.5 92.40 8.70 14:50 0:50 66.5 96.20 12.50 14:55 0:55 66.5 99.30 15.60 15:00 1:00 66.5 101.10 17.40 RECOVERY 15:01 1:01 89.00 5.30 15:02 1:02 86.30 2.60 15:03 1:03 85.40 1 70 15:04 1:04 84.30 0.60 15:05 1:05 83.90 0.20 Analytical Report Allare Work Order: 2504278 Date Reported: 4/16/2025 CLIENT: Richardson Well Drilling Project: Joseph Wilfong Lab ID: 2504278-001 Collection Date: 4/8/2025 2:30:00 PM Client Sample ID: Joseph Wilfong Matrix: Drinking Water Analyses Result RL MCL Qual Units OF Date Analyzed Total Coliform &E.coli by SM 9223B(IDEXXI Batch ID: R98890 Analyst: JH Cdiform,Total ND 1.0 1.0 MPN/100mL 1 4/9/2025 1:37:40 PM E.cdi ND 1.0 1.0 MPN/100mL 1 4/9/2025 1:37:40 PM Original Page 4 of 5 :WATER ,;Ij sot h st. E. MANAGEMENT iacnma. WA 98404 LABORATORIES I`( ,2") ' ' 3121 Nitrate/Nitrite Report of Analysis Date Collected: 03-21-2025 System Group Type (circle one) A B Other Water System ID Number N/A System Name Joseph Wilfong Lab Number/Sample Number 089/01680 County: Mason Sample Location 700 E Daniels Rd E, wellhead Source Number(s): (list all sources if blended or composited) Sample Purpose. (check appropriate box) Date Received: 03-22-2025 ® RC -Routine/Compliance(satisfies monitoring requirements) Date Analyzed. 03-22-2025 • C-Confirmation(confirmation of chemical result)' Date Reported. 03-28-20258- I - Investigative (does not satisfy monitoring requirements) Supervisor Initials. a- , • O -Other(specify -does not satisfy monitoring requirements) Sample Composition: (check appropriate box) Sample Type: (check one) ® Pre-treatment/Untreated(Raw) • S -Single Source 0 Post-treatment(Finished) B - Blended(list source numbers in"Source Number"field) 0 Unknown or Other C-Composite(list source numbers in"Source Number"field) Sample Collected by:Dylan D- Distribution Sample Phone Number.253-537-7332 Send Report& Bill to: Richardson Well Drilling Comments' PO Box 44427 Tacoma WA 98448 ANALYTICAL RESULTS DOH# ANALYTE DATA RESULTS SDRL TRIGGER MCL UNITS EXCEEDS METHOD/ QUALIFIER MCL') INITIALS 0020 Nitrate as N -- <0.20 _ 0 5 _ 5.0 10.0 mglL _ No 300.0/CP NOTES: Confirmation: Include the original lab number, sample number. and collection date of original sample in either comment section. --No exisiting value ANALYTE: The name of an analyte being tested for DATA QUALIFIER:A symbol or letter to denote addtional information about the result. DOH#: Department assigned analyte number EXCEED MCL: (Maximum Contamination Level): Marked if the contaminant amount exceeds the MCL under chapters 246-290 and 246-291 WAC. Please contact the departments drinking water regional office in your area to determine follow-up actions. METHOD/INITIALS:Analytical method used / Initials of the analyst that performed the analysis. mg/L: milligrams per liter or parts per million RESULT: The laboratory reported result SDRL: (State Detection Reporting Limit) The minimum reportable detection of an analyte as established by the Department of Health TRIGGER:The departments drinking water response level. Systems with contaminants detected at concentrations in excess of this level may be required to take additional samples or monitor more frequently. Please contact the departments drinking water regional office in your area for further information LAB COMMENTS: