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HomeMy WebLinkAboutWEL2025-00030 - WEL Application, Design, Letter - 6/6/2025 MASON COUNTY Public Health & Human Services 6-17-25 Steve Jesse Matlock Grange 61 W Beeville Rd Matlock, WA 98560 RE: WEL2025-00030 Group A Well Site Inspection for the Matlock Grange on 6-12-25 The well for this potential water system is situated in the southwest corner of the property owned by Matlock Grange. It is approximately 65 feet from the county road to the east and 100 feet from the septic system and Grange building to the north. Given the lot's small size, anticipated usage, and available parking, there are concerns about vehicles being parked within 100 feet of the wellhead. The wellhead is currently not adequately ventilated. It should be fitted with a downward- facing screened vent.For tips,see DOH 331-232 Simple Fixes for Wellhead Openings. Jeff Wilmoth Mason County Environmental Health 3604279670 ex 543 MASON COUNTY PUBLIC HEALTH,COMMUNITY&ENVIRONMENTAL HEALTH 415 6TH ST.,SHELTON,WA 98584 SHELTON:(360)427-9670 X400*BELFAIR:(360)275-4467 X400 .4%;;iii, ',.... MASON COUNTYlECIEEW1 -_-, Nu I P COMMUNITY SERVICES JUN 0 6 2025 J \��%Ih _. `t. E.uYding Flaming Em1lonmental Health,Community Health A2-' ' 1 ,• 415 N 6"Street,Bldg 8, By . Shelton WA 98564 Shelton:(360)427-9670 ext 400 •I• Belfair:(360)275-4467 ext 400 •'r Elma:(360)482-5269 ext 400 FAX:(360)427-7787 APPLICATION FOR WELL SITE INSPECTION Permit Number Payment Information Instructions WEL Receipt Number 2026-- 1. Complete Part 1. Incomplete applications will be rejected. 20 21* O Cash 0 Z 4 04 2. Attach a detailed plot plan. {� Check 3. Clearly stake out or flag the well site. 000 30 4. Submit application and appropriate fee to Mason County Date of Payment No•06- 2 Public Health.Refer to Mason county Environmental Health Fee schedule for cost. PART 1:Applicant!Parcel Identification Water System Name Matlock Grange Site Address 61 W Beeville Rd, Matlock WA 98560 Applicant Steve Jesse Phone 360.876.0958 x110 Mailing Address 61 W Beeville Rd _ _ City Matlock State WA Zip 98560 -- Parcel Number 620112200060 Directions to Site From Shelton take W Shelton-Matlock Rd 17 miles,turn right onto W Beeville Rd. Drive approximately 0.1 miles and turn left.The Grange is the only building on the left side of W Beeville Rd. Water Source is: ❑ New ® Existing System Type: ®Well ❑ Spring No.of Proposed Connections 1 PART 2: Health Department Review(Staff Use Only) YES i NA 0 ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields,tanks,buildings; indicate distance on plot plan) ❑ ❑ Are there roads within the 100 f of adiu�,.pf t water urce? If so, is road private, County or State. / What is distance to ROW? �� -I'O e IAA& (" ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan) ❑ ❑ Is the well cap satisfactory? ❑ ilk ❑ Screened and vented? 0 The well casing extends .1 above level ground/concrete slab? (circle one) [gi 0 ❑ Is there evidence of a surface seal? FP ❑ ❑ Does the seal appear adequate? O 0 p Is a variance necessary for well site approval? /' Comments (05 t'a eAte. RI( Afo lleAY 1(6, Pass ❑ Fail inspector I ,4�; Date 6) .... `' This form ma be scann- e a U� 'liable for 1 ublic v ew on the Mason Coun Web site.__ :li;-#4,l iliemi,,:r;t: ,,,:te .,. ...'e`11111i.o1., i, 1 (..li ilr 1'ItI^(ilayl�°e1111: .i l::.11'.i!..:'i( I.1 (>,1-11n !:1111Ii1 i,lil":11�iliil Illtll(`#:;,. ,,'1J , 1° . 4i iiilll Kiihillb +-il.1e1 VI . 1 II 1 ( `: '1,1 ,.q1.1i V1(.. r'i(I i i l(';in,I)e)lel!'I, ''A')'1(.; :e4.11"(t"I1,qie !111 c. 1,._,e I,I e ",. - ;:jD f i..l.,e(.9611l 0_il! i . :,,V n,�l,eei/.11(1 IIiL.,,,V {,.,tan I iel1: ),. :Ili::, ,11 Lt 0 .,I.'.: .i11: ..,i:lt^.:.i,.li::1l I „ rii,I.I : :.U: ulilt,Sici• 1•i,:e,, J:\EH FormsDDRINKING WATER FORMS\Drinking Water Well Site Inspection App.docx Revised: 1/20/2017 ,,, , f, , ,, Nws 5Planning•Management•Engineering 4 iNorthwest Water Systems P.O.Box 123•Port Orchard,WA 98366.888-881-0958.360-876-0958 1 June 5, 2025 Jeff Wi[moth Environmental Health Mason County Public Health JWilmoth(a,masoncountywa.gov Subject:Matlock Grange Group A TNC(ID#Pending),Well Site Inspection Application Dear Jeff Wihnoth, Enclosed are the well site inspection application and supporting documents for the proposed Matlock Grange Group A TNC water system.The well for the water system is located at 61 W Beeville Rd,Matlock,WA 98560, Mason County on tax parcel number (TPN)620112200060.The well is existing and currently serves the Matlock Grange . building. A previous well site inspection application was completed under WEL94-0045. We are submitting a new well site inspection application due to the number of years since Mason County has reviewed the well site. The wells 100 ft sanitary control area(SCA)overlaps onto TPN 620110000000 and 620112200010.The parcels are owned by Green Diamond Resource Company.The owners of Matlock Grange have been making continued attempts to contact Green Diamond Resource Company to sign restrictive covenants. The well is located inside of a locked pumphouse. Please contact the system representative Steve Jesse at 253.951.3958 to schedule a site visit.The well log for the existing well is enclosed. Should you have any questions or require more information,please feel free to call. Sincerely, NORTHWEST WATER SYSTEMS,INC. itOli Raleigh Haneline raleighna,nwwatersystems.com (360) 876-0958 ext: 110 6/5/2025 Page 2 Enclosures: Mason County Application for Well Site Inspection Site Map Well Log 1994 Well Site Inspection Application . I 1 4-(- + 4- + 4- + 4- 4. + ; f/ ) 2 + + ! 4- 4- ! »77 + 4- + + ! 4. + � \) k \ ! ! f \ + + + ! + + + + ! I. . ; )k ) + + + + + 4- + § § §A ; + + « < c c + i t% 2 + + ! )f + + + § d-o § + + + 4- + + ) #\ , , + + a4- + + 4. 1tn.c + c6 + + ! £ i/. 2 + f + < « + r" § !p ] + ( + F + ff4- 4- > ! , + + + \ ; 2 + + + + + > </ \ ` _` c ` c ` + ` \ a o j ! 4- + % E / 2 ` f ‘ / ) 7 2 d --\4.1# /\(a / / *`§ \�> [A6 - 0 / \ 1 $ N �/ / : — ) w ! II el,2; \ * 11 1,2 ri k G. | i | | k | | i3 ;k 1t § X ) rn @ ; § 2,\\ | / §|,,\f_m iti � IP, $ 1(,) «/ ,$ -- ) p — q --� - - — -- - -- - -- — I WATRR WELL REPORT Start Card No. 052425 Unique Woll I.D. K AMP269 -1::1-‘5 ..-;12-#. STAIR OF WASHIHGTON Water Right Permit No. 41..$ ....3c.'a = .a.,.c=aamwr."=:.==aa..aa.•m=.Tm...__-a...-= - __-Y...= 3 +.=aT.....=ca...... Sow (1) ONNBR: Name 1tATL.OcK ORANGE Addreaa N 280 2AHHATZEL BEACH S.D. ancvD , WA 98984- Q mmnna 3o mmwr.==om.w-n=a=m.mmr== _ __.......n=== ===.madmr ..nm.mmc===ww..nn-- -==wwn..r=rm..nva..wn==am..ma==3ya....mm3 ava.u. (1) 42) LOCATION OF WELL) County MASON . NW 1/4 EN 1/4 Sac 11 T 20 )., R 06 WE CC (2a) STR=ET ADDRESS OF WELL (or nearest address) MATLOCK, REELTON =n_a...YIIL=aa..c-_--.r..C==ar..C==a= = aa...m= ==.r.=_...`1...MM02..r...33.a...C3 _ --a..,mnn=a omwmmY===3.w..Qm.=Ca. Q) (3) PROPOSED USE) DOMESTIC m== rr - yn_' ... (10) WELL LOG au rr.vv=mw.wvm==..r.a====ter. ..n33=m am.mm.=r==a.. (1) TYPR OP WORK; Owflar'e NUmber of t+e2Z poraationt Dencribo by color, charaator, size of material N (I£ morn than one) and structure, and show thickneno of aquifers and the kind tNKN NELL Method: ROTARY and nature of the matorial in each stratum penetrated, with ,er m.mmmmmm,.w•,n=== n.mm..m.mn=m= =. .....n =a...mm.==e... at leant one entry for oath change in formation. _ (5) DIMBNsIONS: Diameter of well 6 inches O Drilled 220 ft. Depth of completed well 220 ft. MATERIAL PROM TO ..mam..,n=.....===aw..........4*. .....m..m....m3..m.m--- DROWN Slum HARD Put 0 4 O (6) CONSTRUCTION DETAILS! MINX-COLOR DROWN CRNE(7RD GRAVEL 4- 11 Cooing inetalledt 6 • Die. from +1 ft. to 220 ft. GRAY HARDPAN 11 13 (13 MELDED CASINO . Dia. from ft. to- ft. BLACK GRAVEL ORGANICS 13 16- E " Dia. from ft. to ft. BROfh? MULTI-COLOR O83WP3ITRD GRAVEL 16 25 DRAY .SAND HARP PAN ORGANICS 25 29 � Perforations: No VERY HU1RD SLAM( C811IDiT= GRAVh7, 29 103 C Typo of perforator used GRAY SAND CLAY 103 107 -- sl0E of perforations in. by in. DLACK ODOMID GRAVEL HARD 107 133 d) perforations from fk. to ft. GRAY SALE) CLAY 133 135 perforations from ft. to ft. HARD BLACK CEHE TGD GRAVEL 135 214 4.4 perforations from ft. to ft. UOIB'I DUCE. GRAVES.WATER 214 211 L. O kOIST PACKED OPAVEL, d WATER 216 220 Screenci NO _ Manufacturer's Dame 113 Type Nodal No. Diem. slot sire from ft. to ft. I (13 ,).r Diam. clot sign from ft. to ft. lif CZ Gravel packed: MO Silo of gravel � CD Gravel placed frca ft. to ft. +•' Surface seal: YES To what depth? 18 ft. 11 Material used in Deal BRLLTON7.'CE C Did any strata contain unuoable water? Ho Type of water? Depth of strata ft. L. lathed of nnaling ntrate oft CASED - wmam. td _ .. ==.r.=em.e....=3,.....n== - - (7) PtnaPt Manufacturer's Hama Tyre H.P. I- ......m.m...=aa.. n==a=w..m=== ........ ........mm= O (8) WATER LEVELS! Land-surface elevation Z above mean sea level ... Et. (/) Static level 202 ft. below top of well Date 07/21/94 a Arteoian Preonure .lbo. per nquare inch Date O Artesian water controlled by ID Mork started 07/20/S4w`y .n- mMCo:,pleted 07 21/S4a.r....- - g (9) WELL T0HTSi'prawdown io amount watery level rismlowered below WELL CONSTRUCTOR CERTIPICATIOH; static level. I eonntructed end/or accept knoponaibilitr for eon- sWno a pump teat made? No " If yen, by whom? etruction of this Noll, end ita compliance with all U Yield' gal./min with ft. drawdown after hrs. Wnahington well construction otandardo. Materials uned and the information reported above re true to my beat W a knowledge and belief. QPecovery data 4.1 Time Water Level Time water Level Time water Level NAME ARCADIA DRTLLINO INC. C (Person, firm, or corporation) (Type or print) Q) ADDma SE 170 WALKER PARTS RD ''g Date of teat / / ro Boiler toot gal/min. ft. drawdown otter hro. (SIGNED) Licence No. 2053 Q_ Air toot 6.5-7 gal/min. w/ atom sot at 215 ft. for 1 hr.. f Q) Artesian flow g,p.m. Date Contractor's Q Temperature of Water Won a chemical analyoio made? NO Registration No. ARCADDI090K1 Date 09/l3 D9 ^) .m-=33.m.=- c v==a=..a ==nvvoawwa IT cv=9•mm.r.==mmv,n c==av ..=.=...O. na...a.r...nc==w.nvm. • r• I MASON COUNTY DEPARTMENT of HEALTH SERVICES ` Mason County Bldg.Ill 426 W.Cedar P.C.)42 Box7-%7 16660 Sh•etton.r.W27all ngton 98584 (206 Be4?os5.4467 Seattle:464-6968.Other 1-800-662-5628 environmental health personal health water quality $35.00 fee due with application Please make check payable to: • Mason County Treasurer �{ APPLICATION FOR WELL SITE INSPECTION L V! ' J Q15 Name of Proposed Water System /- 4 r G /c-- !�/>/l/ a L Name of Applicant Metz r iA A '4 A'1 v i/ Address of Applicant 0 ///1 #k> -T r L f C h J 2 4 e it Ta 4; w' iq S 7�s 8.y (7-3 Phone Number of Applicant �-- 7 •9S1 3 I5� ,c��� .C+tv€- / Y New or Existing Well? 4 i Parcel Number of Proposed Location L02011 27 (e90 Legal Description of Proposed Location I K1L&I J) Section - Townsp Range Maximum Number of Services of Proposed System / _ Well Driller water Right Application Number (required for wells pumping over 5,000 gal/day and for commercial wells) Precise Directions to Proposed Well Site Location 7-k 'f AJ t i c f/7 /4 T /c4 4 7 ,? l e- )(- s 7- E 2 'z g� `2.rd iJe Co n s 4 2- /II Sv�'� 7 i o . 4. piJtr L 1010.3 ..is 1-1/4 csc'. weR w;t( 44.4 J "KS+td Ai UGCS. / LL tt4041,,A. J LL j 6*et.. kK ©4- �pt^^ cr a4,1'.Qi ��Tq+,1.� -h w,�Cti o s 14- C.eylg„/✓ w��l "4"(4 +o c t I/ i 0N4 1. 0_4,11 tt5to,-2 tutll {t s414 QvJ ►v.`/wei ; 66v,(orc. 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