HomeMy WebLinkAboutWAT2025-00079 - WAT Application - 5/5/2025 \\VAT 2025"- 000 l
(MIT
; ,:: 415 N.6h Street
MASON COUNTY Shelton.WA 985R4
COMMUNITY SERVICES Shelton:60 a27.9670.Ext.ann
Rellnir:360-275-4467. Ext.400
1 >i-_= � l ttulldngAla nnbgEnvummrnlel Health ClxnnwniryHealth
\ Llma:i60-4tt2-5269.Ex!.400
'-- •JI11Y;1%
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: K.; LL.C-(3/5-Phone:Date: �i p / L'
MailingAddress: 15 t ti' f\�t �p O `cO1 1 17 0
Parcel Number: g 6 ' 130 I i0 _— � Pq I37flt -t ( (,J-4 /p
Type of Water System Reason for Application Sys
❑ Public/Community Water System (2 or more IN Building permit
connections) 0 Division of land:
'K Individual water source (one connection), #of Parcels? SPL
IP Well 0 Boundary line adjustment
0 Spring/surface water 0 Other (explain)
O 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)
0 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,co.mason.wa.us.
J:IEti Funnsl Drinking\Pater Revised 4127,2021
Individual Water Well
Water well report(attached to application). Depth 0 ft. v
`�1 Well capacity Test (attached to application) gpm .'0 0 gpd.
11f 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.
Satisfactory bacteriological test (attach to application).
¶ .> (tt I' :!� 04 .A.1!0 Wit, .I!,OA iw a t. , i►Of�!�*-•_A •
.
—..._ •
Water Resource Inventory Area (WRIA)
Development within which WRIA htto://gis.co.mason.wa.us/planninq 14_ 15 16 22!
Water use or limitation recorded N/A Yes
Well Drilled Date
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)
*LSatisfactory 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.
L Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its Intended use for the following
reason(s).
Reviewer'seS7'Signatures: >
Environ. Health: RINizitivlovil Dat ',�
�
i
This form may be scanned and available for public view at www.co,mason.wa,us.
, ['age2uf2
• Po Box 1790
Shelton,WA,98584
•
Arcadia DullingInc.
May 2, 2025
To Whom it May Concern,
This letter is regarding a pump test we were hired to perform for Garrick Leoppard.
The well ID is BMS150,drilled by Arcadia Drilling in 2020.
The well casing extends from above land surface to 39 feet and an open hole in
sandstone from 39' to 200'. At the time we drilled the well it was delivering just
over 1/2gpm. The static water level came up to 23 feet in 2020. That is exactly what
the water level is currently as can be seen from the pump test performed 4/23/2025.
Sandstone open hole wells static movement can be much different when compared
to a fully cased well in a consolidated water bearing formation.
I understand and agree with the health department's intention and desire to confirm
and ensure that a household they approve does have enough water to sustain a
family, which I understand is calculated at 400 gallons per day.
There are 1440 minutes in a day. Our pump test was performed in 720 minutes to
remove 400 gallons, When we returned after 24 hours, the static water level had not
returned to 23.3', although it was close- it was 32.8'.This is not uncommon for a
well of this type to recover in the lower portion of the well at a quicker rate than the
last upper portion. Even though the static water level did not return to the pre-test
level, this does not mean this well does not make 400 gallons per day. If left for a
couple days it would return to the 23' static water level, I say this since the well was
unused for one week prior to the beginning of our test.
The Owner has installed a 2000 gallon storage system for instantaneous demand and
I believe this easily meets the minimum standards and intention of the department. I
would like you to consider all aspects of the well dynamics in your decision for the
use of this water well system.
Sincerely,
Jason
General Manager
Arcadia Drilling Inc.
• R
Arcadia Drilling Inc. 1
P.O. Box 1790
Shelton,WA.98684
Customer: Garrick Leoppard Well Tag#: BMS150
Site Address: 1370 W Maple Glen Dr, Elma Depth: 200'
Date of Test: 4/23/2025 Static: 28'
Pump Set: 190'
TIME OPM LEVEL RECOVERY
1 Min 5 23.3 TIME LEVEL
2 Min 5 36.2 1 Min 188.1
3 Min 6 39.9 2 Min 187.95
4 Min 5 43.3 3 Min 187.8
5 Min 5 46.7 4 Min 187.6
6 Min 5 49.9 5 Min 187.4 _
7 Min 5 52.9 _ 6 Min 187.3
8Min 5 56.1 7Min 187.1
9 Min 5 59.5 _ 8 Min 186.9
10 Min 5 62.4 9 Min 186.7
15 Min 5 77.2 10 Min 186.5
20 Min 4.6 92 16 Min 185.7
25 Min 4.3 106.6 20 Min 184.9
30 Min 4.2 118.8 25 Min 184
35 Min 4.2 133.3 30 Min 183.2
40 Min 1.6 145.5
45 Min 1.5 149.9 24hr Static Check 32.8'
50 Min 1.5 153.3
55 Min 1.5 168.8
1 Hr 0.6 163.3
1 Hr 10 Min 0.6 165.3
1 Hr20MIn 0.6 167.4
1 Hr 30 Min 0.6 169.3
1 Hr 40 Min 0.6 171.3 _
1 Hr 50 Min 0.6 173.6
2 Hr 0.6 175.9
2 Hr 10 Min 0.6 178.1
2 Hr 20 min 0.2 180.3
2 Hr 30 Min 0.4 179.6
2 Hr 40 Min 0.25 180.8
2 Hr 50 Min 0.25 181
3Hr 0.25 181.1
3Hr 10 Min 0.25 181.25
3 hr 20 Mln 0.25 181.3
3 hr 30 Min 0.25 181.5
3Hr 40 Min 0,25 181.7 •
3Hr50min 0.25 181.9
4 Hr 0.25 182.1
4 Hr 10 Min 0.26 182.3
4 hr 20 Min 0.26 _ 182.6
4 hr 30 Mln 0.25 182.6
4 Hr 40 Min 0.25 183.1
4 Hr 50 min 0.26 183.4
5 Hr 0.25 183.6
5 Hr 10 Min 0.25 183.8
6 hr 20 Min 0.26 184.1
6 hr 30 MIn _ 0.26 , 184.4
Arcadia Drilling Inc.
P.O.Box 1790
Shelton,WA.98584
5 Hr 40 Min 0.25 184.7
5 Hr 60 min 0.25 185
6 Hr 0.25 185.3
6 Hr 10 Min 0.26 185.6
6 hr 20 Min 0.25 186
6 hr 30 Min 0.25 186.4
6Hr40 Min_ 0.25 186.7
6 Hr 50 min 0.25 187.1
7 Hr 0.25 187.4
7Hr10 Min- 0.25 187.7
7 hr 20 Min 0.25 188.1
7 hr 30 Min 0.25 188.4
7 Hr 40 Min 0,26 188.8
7 Hr 50 min 0,25 189.2
8 Hr 0,25 189,6
8 Hr 10 Mln 0.25 190
8 hr 20 Min 0.21 190.4
8 hr 30 Min 0.21 190,7
8 Hr 40 Min 0.21 190.7
8 Hr 50 min 0.21 190.7
9 Hr 0.21 190.7
9 Hr 10 Min 0.21 - 190.7
9 hr 20 Min 0.21 190.7
9 hr 30 Min 0.21 190.7
9 Hr 40 Min 0.21 190.6
9 Hr 50 min 0.21 190.3
10 Hr 0.21 189.9
10 Hr 10 Min 0.21 189.9
10 hr 20 Min 0.21 189.8
10 hr 30 Min 0.21 189.8
10Hr40Min 0.21 189.8
10 Hr 50 min 0.21 189.6
11 Hr 0.21 189.6
11 Hr 10 Min 0.21 189.6
11 hr 20 Min 0.21 189.6
11 hr 30 Min 0.21 189.6
11 Hr 40 Min 0,21 • 189.6
11 Hr 50 min 0.21 189.6
12Hr 0.21 ▪ 189.6
TOTAL GALLONS PUMPED 401.6
I
i
WATER WELL REPORT tw. DEPARTMENT 0T Notice ofin lent No. WE40833
ECOLOGY Unique Ecology Well!DTag No. BM8160
Type or Works State of Washington
RI Ceuwuottoa Silo Well Name(if morc that one well);
O Decormilulon r=. Original Installation N01No. Water Right Permit/Certifkete No.
Proposed Uses ifi Domestic ❑Industrial ❑Municipal Property Owner Name Garrick Le000ard
0 ma-wring O Irrigation ❑Test Well 0 Other
Well Street Address 1370 W Satsop Maple G1olt Dr
Construe tloeTyper aletbodr
D New well O Alteration O Driven ❑!cued ❑Cable Tool City Erma County Mason
❑Deepening O Other - O Wg m Air• ❑Ivrud•Rotary Tox Parcel No. 81930-78.00110
Dimensions:Dismeterorbortog 8 in,to 200 R Was a variance approved for this well? 0 Yes 1 No
Depth o rcompltted well 200 a.
Cons outdoes Debar' Wall It-yes,what was the variance for/
Caring Liner Diameter From To Thickness Steel PVC Welded Thread
Q I 0 8 in 0 3L.. .025 In 01 I D F) I 0 Locollon(seo instructions on page 2): Q WWM or 0 BWM
❑ 1 O 4' In j9_ 2QQ_ in. ❑ 1 Q ❑ 1 ❑ SW,y,.yt of the 8W Yr;Section 30 ,Township 19N,Range 8W
❑ 1 ❑ In. _ ^ in. ❑ 1 ❑ U I ❑
Cl 1 ❑ In, _ _to ❑ i ❑ ❑ I 0 Lat(ludo(Exempla 47.12345) 47.098072
Pertbra ttomt ]Yet ❑No Type of peewee(used Grinder
Longitude(Example:•120.12345) -123.481883
No.of per rotations,60 Sheofperfontioru 1/4 in by 2 !n D►Iller's Log/Co nstruetlonorDecommLsslonProcedure
Perforated Itor IQ_R.to 200 O.below grand saga Formation:Describe by color,character,rim ormaterial and struxtwe,and the kind and
wire oft the nuterul ineoch Ewa penetrated,oath at least ooe erery roctaclt change of
Screens, O Yea II No ❑K•Packer b Depth fl. information Use addnroml sheets if neoessaty,
Manuesetwer's Now Material From To
Type Model No.
Diameter_ Slot she In from _R to iL Brown silly sand&gravel,cobbles 0 6
Diameter Slot she infrom fLto & Brown sfly sand&gravel,loose 6 31 ,
Ssad/FOter parks Cl Yes B No Ste.ofpaeek material_in Drown silty day 31 34
hlatcriels placed from_ __fLto_ft. Gray sandstone 34 89
Gray sandstone,weak 89 94
Surface Seat, IIIYts O No To what depth?20 R
Material used in seal Benlonitp China
Gray sandstone 94 13t
Did say strata contain crumble water? ❑Yes ID No Gray sandstone,pea gravel,water 131 132
Typo awoke? Depth orients - Gray sandstone 132 147
Method°faatlng stratus IT Gray sandstone,hard 147 200
Pumps ManufknaeraName Typo:_
ItP. Pump Intake depth! ,EL Designed Oow rate: gpnt
Water Lenin Land•stsfan sleratlon abort mean sea krrtl I50 R.
Stick•up ortop ofwell easing 1T6 IL above ground strike
Sudo wart level 43 IL below top orvvetea►iag Data 10/1/2020
Artesian pressure_era.per agtmm tech Data
Artesian water b eontrolkd by (tap,valve,etc.)
Well Thu: r— — — —
1Vas a pumpins test perbrmed? ID No Q Yes b by whom?
Yield gpm with_f.dmedotrn a au_hrs.
Yield ppmwith R.drrwdownOrr tin.
Yield-ppm with ft,drewdosm OQn hrs.
Recovery data(date e.zero when pump is turned off-water level measured from welt
top to valet level) •
Tim. Water Level Time Wales level Time WaletLevel
Dela ofpunrping test
flatter lest,_gun with_fL dnwdown aver_tars.}
Air tell 1 _spat with stem set,l_R for iva Date
Artesian flow =pm
Temperature ofwater F Was a chemical analysis mada4 Cl Yes D No Start Data 9/30/2020 Completed Deto 1 0/1 120 2 0
1YEL[e CONSTRUCTION CERTIFICATION. [constructed ond/or accept responsibility for construction of this well,and its compliance with oIl Washington well
construction standards.Materiels used and the information reported above aro true to my best knowledge and better.
O Driller 0 Trainee CI PE-Print h Koopp Drifting Company Arcadia Drilling Inc
StRnature Address PO Box 1790
License No.2874 /iff_` ' City,State.Zip Shelton,WA 98584
iF TRAINEE:Sponsor's License No. Contractor's
Sponsor's Signaturo Registration Na ARCADD1098K1 Date
ECY 050-1-20(Rev 09/18) if you need this document in at alternate format,please call:he{rater Resowz s Program at)60-4074872.
Persons with tearing loss can call 711 for IVashington Relay Service. Pessolu with a speech disc billy am call 877-833. )41,
1616 BOTH STREE I E ,---\
TACOMA,WA 98404
(253)531-3121
WATER BACTERIOLOGICAL ANALYSIS
S4t,NPLE CaliC11(k1 READ INSTRIK:1MS ON OAC(Of I'ALOEMIDh)Cld'Y
II Instrucllone are not followed,sample will be rejected.
DATE COLLECTED T1 OLLECTrp COUNTY NAMEM
!r MOtal-! {DAY 2 AR
Lt 0 Am ZPut M I r�t^�
T . .
YPE OF SYSTEM IF PUBUC SYSTEM,COMPLETE: I' , (s
❑PUBUC CIRCLE GROUP
o�—�I I.D.No.
o IYIDUAL A 8
1y
(so: ony 1 roeldonco) : 1
NAME OF SYSTEM
-0�tGx� LEPPw
. LOCATION WHERE S/.,WtE COLLECTED TELEPHONE NO. f
��(to,Mahon lap O school,firo elation.rou lah) DAY (3(y1j },T -339r
�.J „, M0� EVENING( )
SAMPLE tE BY ) SYSTEM OWNER/MDR:(Name)
SOURCE TYPE❑GROUND WATER UNDER SURFACE INFLUENCE
• ❑SURFACE WE orFI SPRING []PURCHASED or IDCINTERTIE BIINATION
HER
SEND REPORT TO:(Print Full Name,Address and Zip Codo)
cM G t 1: Gr(Al 6-(4 d iikc ri \Z rri A LC1(Yi
WAS NGTON
TYPE OF SAMPLE(check only one In this column)
❑ ROUTINE . ❑ Ct0Pftnetd(i) eldt.t_.Total_Free)
DRINK}NG Y19+TER .
chock treatment Q Fl7Mred
of '❑ Untreated or Other.
' ❑ REPEAT SAMPLE .
Prevfou9 cdllomt presence Lab o
0 Previous colWorm presence Dale_ -/:..
8°u"• 8l C, I I
ARAN SOURCE WATER Total Cotlform
NEW CONSTRUCTION or REPAIRS BFocal Conform
THER(Sneclfy)--
REk,�KSS /(
. LABORATORY RESULTS(FOR LAB use ONLY)
METHOD USED
MF MPN PA MMO CP-O
2410 2600 I 2610 2720 2730
TOTAL COUFORM. /100 ml F.COU /100 ml
FECAL COUFORM /100 ml HETFRO�4�TROPHIC /Per ml
ANOTHER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE: TEST UN8URABLE BECAUSE:
❑Sam loo old • ❑Confluent growth
❑Wong oontelner • ❑INTO
O Incomplete form 0 Ttubld culture
❑ 0 Excess debris •
DRINKING WATER SAMPLE RESULTS
— ❑UNSATISFACTORY,ColiTorms present -SATISFACTORY.
Colilorma absent
REPEAT DE.Coll proaenl ❑E.Coll absont
SAMPLES
REQUIRED ['Fecal present El Focal absent ,
t>Lti HE VERSE SIDE or RI(GEN COPY TOR LXPLI\NAFION 01 ItESULFS
LAB NO, DATE,TIME RECEIVED RECEIVED BY
089:0 ! ?16- 1 -1044 31oo 1 �� . . .. .
DATE D ROUT P / T.