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HomeMy WebLinkAboutWEL2024-00040 - WEL Application, Design, Letter - 8/6/2024 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 01,1 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 Melissa Mae Byerly 3321 NE OLD BELFAIR HWY BELFAIR, WA 98528 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2024-00040 3321 NE Old Belfair Hwy 123094200220 The 2-party water system, Byerly Water System (123094200220/123094200070), 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 7((0( Z?Z5 z ,L''i, Dale Received. ,( MASON COUNTY f a 5 Li g, COMMUNITY SERVICES Am Received: Received By ', .. Building Planning Environmental Health.Community Health 415 N.6ih Street,(Bldg 8)—Shelton,WA 98584 W E L p2U p_LI . o J Q u Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION AP C/14 /c A & `We �''%'��!/.```���`{y��^'�(_'� PHONE/LJ, ,0 » q O$ ' S I / o AILING ADDRESS-STREET,CITY,STATE,ZIW 321 ,NE 00) X-Ph ,1-cu Rio ./3 Y, V\IA ggC2 " •SITE ADDRESS-STREET, ITY,ST�EOZIP PRImARY//PARCEL ��NUMBE,R((WELL SITE)/ O An SECONDARY PARCEL NUMBER(IF APPLICABLE �cRi�V��'� I vo'1ail er 2025-dO031 WATER SOURCE - SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT ❑ New f f Existing l Well © Spring O!Q ' A -65 1. 04 PROPOSEDJ(yATER SYSTEM NAMEII (R OUIRED) / in PROD CT DDI'EESS I II N� YVV/li^rXv'.11' • . 7ip - ri io�.k, iv-al ..Cr,Y & i-t.o14.ci h, Cse u�d.ar t�1 o►,r� DIRECTIONSSITEke 0 ND(TION�e' 'le , ?2-I ME D 13etu9 +-hwy• Site Plan: (may also be attached) (property boundaries. structures,well site w/100'radius.driveways,roads,septic/sewer components and lines, easements,etc...) 5U, Submittals Checklist: (these additional items will be required for approval) lf1 Smiatisfactory Bacteriological sample (this may be deferred if well is not yet drilled) E$r Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) V Notice to Future Property Owners recording (record with Mason Cc. Auditor, supply copy of recorded document) L '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: YES NO NA ❑ ] ❑ 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 foot radius of the water source? If so, is road private, County or State. What is distance to ROW? ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) En ❑ ❑ Is the well cap satisfactory? ❑ tA ❑ Screened and vented? ❑ The well casing extends l0 above level ground ieoncrete sla ? (circle one) ❑ ❑ Is there evidence of a surface seal? CMci LU f ' `(?' Y't ge ❑ Does the seal appear adequate? L M -4Z7. 4;C S ❑ ❑ Is a variance necessary for well site approval? I A 5 KK(I C Comments lI ^ (C� 1)154u(I c-It Cl /ZO Z c � y XPass ❑ Fail Inspector02 Date S730/Z07 5` Review Step 2: Two-Party Review: YES NO NA _ ❑ ❑ Water Well Report with adequate pump test on file? (LC 1_,] Z, go yat ioui If NO. date of Capacity Test .1_(//2O1L( Driller Ou'5 OM IlY)J GPM 12 It ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test ?/ZIu17o( 71 ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 72116 2 7 1?-ff ❑ ❑ System appears adequate to serve 2 single-family residences based or infotm2, o ded? Comments Iv'gi�(/�' WO Z 0 Z S 0003 I JUL ��{`' "'1ASONC��N G9 2025 ryFNVIRQN MAN?(_i Approved ❑ Denied Reviewer Date ,l(r70 'H�A(n, Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, express or implied of the future success or failure of this system. Well site approval does not constitute water system approval. Water System approval is a two-part process. 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`h, 2018 per ESSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Department of Ecology WATER ELL REPORT Application No, Second Copy—Owner's Copy ,_ Third Copy—Driller's Copy 4e, / .. _ STATEAF WASIIINGTON �J Permit No. .... _..__-._-......... (1) OWNER: Name___.C,/Qzz 4�,._........ : Address... i_/e-Li.. � (.__.Z&I........_ dWarGO.)L. (2) LOCATION OF WELL: county.._...,a . ��1' _ Lt. Bearing and distance from section or subdivision corner --L-s_ L (3) PROPOSED USE: Domestic t Industrial ❑ Municipal❑ (10) WELL LOG: I ! Irrigation ❑ Test Well 0 Other ❑ Formation-Describe by color,character,size of material and structure,and - show thickness of aquifers and the kind and nature of the*taterial in each stratum penetrated, with at least one entry for each change of formation. - (4) TYPE OF WORK: Owner's number of well Of more than one).... .......... ?1SATEf{IAI, FROM TO is New well Method: Dug ❑ Bored ❑ Deepened Cable pS, Driven 0 Z7 / 44// 1,9 ,,a,..._Recondition Ele2 Rotary❑ Jetted 0 rr )4 41— C�,a,e/ ��L s DIMENSIONS: /� ys1"6/"'t r �. - ( ) Diameter of wall _— 5�__. inches. A/"�, 2.ait/t LC�d k- . 37 5-6 ) Drilled___.�2_.ft. Depth of completed well_..... l St (6) CONSTRUCTION DETAILS: a Casing installed:___�" Dram. from__42__ ft. to .,..i _ft, Threaded ❑ " Dlam. from _____ ft.to ____ft. 5 Welded " Dtam, from ______ ft..to ______ ft. = Perforations: yes❑ No pr. D Type of perforator used_--_____.__._ ._.___.._...._.._..___—.___--.,..._._.... SIZE of perforations _— hi. by --_— in. l ___ perforations from ____.__.._ft.to _._._. ft. _____ perforations from ft.to _____.._...... ft. 3 perforations from_____._.__ ft. to ___.__ ft. , a Screens: yes 0 Negi J a Manufacturer's Name- _ QTppe _. . _ _ _ Model No__.__ _ Dim._ Slot size ___ from ______ ft.to._..._ft. U Diem. _..._._..._.Slot size_—.___from............_ft.to._ ft. I 3 Gravel packed: Yea❑ Na' Size of gravel:._._._.___._—._ Ps Gravel placed from__._._.,_____._ft.to....__..___ .....ft 1 a Surface seal: yes ❑ No 14 To what depth? ......____.__ ft. 1 Material used in seal_.,......,.._••__.____._.._._._.—_._..._._--__ a - - a Did any strata contain unusable water? Yes 0 No 0 V i Type of water?—__Depth of strata-_. Method of sealing strata R __._...-- ._..___._._.__. 1 ) (Z) PUMP: Manufacturer's Name- q Type: ___ .-- --HP.-_._.—__ U ) (8) WATER LEVELS: Land-surface elevation 3 above mean sea level.... ____._._ft. _ Static level ...._____ Q_—St.below top or well Date...._._._____.__ I 7171 Artesian pressure.__.___._—. lbs.per square inch Date Artesian water is controlled by-•-•-•--•----.,_.,____.___.._.__ 5 (Cap, valve. etc.) , i (9) WELL TESTS: Drawdown is amount water Ievel is lowered below static level Work i:tartcd_. . 19_ .Z/Complotcd_.._..1 _..19._ze) ▪ Was a pump test made? Yes❑ No❑ If yes, by whom?..._ __......._.... ) Yield: gal./min, with ft. drawdown after hrs. WELL DRILLER'S STATEMENT: ,. u " :; This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. Recovery data (time taken as zero when pump turned oft) (water Ievei r measured from well top to water level) NAME w e e /� ,/./.� a Time Water Levci Time Water Lentil Time Water Lever ( j/ �/ _��,,,,,,,�!!!!/// • L Person,firm, or corporation) (Type'or'print) u Address... . ..�..</.....,._-_--.4C 2- ,l...Cl. ,_ -▪ Date of test . »_ ._-.__ [Signed] ▪ Bailer test_1__..gal,/min.with__ _...ft. drawdown after..._...___..._hrs, Artesian Sow._.,._- __—.... _. (Well Driller) —g.p.m. Date..___._._._._—_....—_.. Temperature of water____.._....Was a chemical analysis made? Yes 0 No❑ License No w Date , 19 (USE ADDITIONAL SI EETS IF NECESSARY) S.F.No.73S6—OS--(Rev.4-71). .p 5 'Davie Pumps, Inc. 340 W(Dada'Farm lid deLfair,`Wa 98528 (360)801-6107 Project Melissa Byerly 3321 NE oBH Capacity Test TAG:NA Date 5/4/2024 Pump 3/4hp sub Well Depth unknown - probe unable to pass 44' Static Water Level 29.3 Draw Down Recovery Time Water Level GPM 0 34' 0 min 29.3' 0 1 min 30.5' 5 min 33.1' 12 2 29.7' 10 min 33.9' 12 3 29.5' 15 min 34' 12 4 29.4' 30 min 34' 12 5 29.4' 1 hr 34' 12 10 29.4' 2 hr 34' 12 20 29.3' 3 hr 34' 12 30 4 hr 34' 12 40 45 Capacity Notes: 26276 Twelve Trees Ln NW Ste.0 it SPECTRA Laboratories -Kitsap Poulsbo,WA ----- '• — - 98370 ...Whin*variance sistaters (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County 0-r / p l / 2)2-Li Collected 1/AY/� r� Month Day Year . 0 l 1 1 oLso Type of Water System(check only one box) 0 Group A ❑Group B laOther-AMYC'.k V 6,-k Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# '1 System Name: �j2\ t ti`c. 0 \ c3 Contact Person: Day Phone Cell Phone: Email:` „}6-?u nines rt.(?a.n��,niCe i•Phone: Send results to:(Prim Ira nave,address and zip code or anal above for elearealc copy of resins) Ta)ghecti SAMPLE INFORMATION Sample acted by(name): • \ G.w Specific location where sample collected: Special instructions or comments: Type of Sample(check only one box) 1.❑Routine Distribution Sample()VP) 2.❑ Repeat Sample(A/P) Chlorinated:Yes ❑ No❑ (from distribution system after unsat routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample —— — Unsatisfactory routine collect date: S I Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residual:Total_Free_ ❑Assessment(AlP) 4.Surface or GWI Raw Source Water Sample(Enumeration) I ( ❑ E.coil ❑Fecal Fite red Yes No Si Sample Collected for Information Only. LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Cofrform Present and t4 Satisfactory ❑E.coli present ❑E.coli absent Bacterial Density Results:Total Coition mpn/100m1.E.coll mpN100m1. FecalColiform cful100m1. HPC cfullml. Replacement Sample Required: ❑TNTC ❑Sample too old ❑ Sample Volume 0 Damaged Container 0 DatelVune Received: \\\\� lab Reference Number - -1..\\*\\.,\Cik\-CA Receipt Temp C': � Method Code SM9 l pT-CWN17 SM9222D auStsedd ea ° 0 21014JUL 0 3 2024 .'° ,,, de d0w^bY clografDOH Lab-Sample# � lbweab Malt are dams rased Ira the smrple(6) 010- ) raarod In 01 tehdrelorr.nde report e;w rcs ee r�roeuad e:ttpl in k4 vitroLLptlor ertprw wean e{>prvrrlbl3pWn labdrrrteiee. °CV Famile: 319(Mede Oann r-_.__.____ __—_�—Y _.__.____.. _. _ ...._ _ 2212627 MASON CO WA 06,29/2024 12 05 PM AGREE OAVIS PUMPS #198985 Roc Fee $306 50 Pages 4 I II 1t II III Ill III I IIVi 1111111 I II ICI�IIN�IIR MII I��! Return To: Davis Pumps Enc. 340 NE Davis Farm Rd Betfair, VVa 98528 K.) i Declaration of Wad �s nt Byerly*far S ,ystem Private2 Party . 1 . I I «! . . s i t • S .1 101: ' • V: . M k . ' I. ' :t I 1. The well and osier system being situated on:V Pared*1230942-00220 Legal Description: ' \� 'IR22OFNWSE* ` Range:1W,lbwnsh1F:.23N, • SEV.of the NW% ' J 3321 NE OLD RELit R BELFAIR WA 985289612 \\ Gran ot(s):Janice Bye Owner oF•. .17 Panel*1230.9-42-00220 1-e1/1d Desci 1ptiott:, • 1R220P NW SE' Baer:`1W,Township:23N,Section:9 (/ SE Y.oi'd e'NW'/. \ 3321 NE OLD BELFAIR HW14 BELFAIR WA 985289612 sy Melissa Mee Byeriy �1 Owns of 1 \ `� Pared#12309-42-00070 Legal Desertion: TR7OFNWSE,S53/57 R.anger. 1W,Township:23N,Section:9 SEY.of the NW%. 3331 NE OLD BELFAIR HWY,BELFAIR WA 985289612 Has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington;herein described: Parcel# 12309-42-00220 Legal Description: TR22OFNWSE* Range:1 W,Tbwnship:23N,Section:9 SE Y.of the NW Y. 3321 NE OLD BELFAIR HWY,BELFAIR WA 985289612 Parcel#12309-42-00070 Legal Description: TR 7 OF NW SE,S 53/57 Range:1W,Township:23N,Section:9 SEY.oftheNWY. 3331 NE OLD BELFAIR HWY,BELFAIR WA 985289612 OWNERSHIP Ok WELL AND WATERWORKS It is agreed by the parties that each of said parties shall be and is hereby granted an undivided one-half interest in and to the use of the well and water system. Each Party shall be entitled to receive a supply of water for one residential dwelling and shall furnish a reasonable supply of potable and healthful water for domestic purposes. COST OF MAINTENANCE OF WATER SYSTEM Each party hereto covenants and agrees that they chall equally chare the maintenance and operational costs of the well and water system. NOTICE TO FUTURE PROPERTY OWNERS The water system is designed to provide for two services. Additional planning and design approval must be obtained from the local health jurisdiction prior to expanding beyond this number of services. Design flow standards account for domestic use and watering of a typical lawn and/or garden space only. The design assumes that all residences will be equipped with ultra low flow plumbing fixtures and that all users will keep conservation in grind whenever the system is used. Additionally,a water right,obtained from the Department of Ecology,is required if the water system exceeds exemption standards.This system has not applied for or been granted any waivers from specific provisions of the regulations. EASEMENT OF WELL SITE AND PUMPDOUSE There chall be an easement for the purpose of maintaining and repairing the well and components to complete and maintain a properly functioning water system and appurtenance thereto,within 100 feet of the well site in any direction of both properties listed. Said easement shall allow the installation,maintenance or repair of the well, water system,pump house,pumps,water storage reservoirs,pressure tanks,waterline,utility lines and/or anything necessary to the operation of the water system. MAINTENANCE AND REPAIR OF DISTRIBUTION LINES All pipelines in the water system shall be maintained so that there will be no leakage of seepage,or other defects which may cause contamination of the water,or injury,or damage to persons or property. Cost of repairing or maintaining common distribution pipelines shall be borne equally by both parties. Each party in this agreement shall be responsible for the installation,maintenance,repair,and replacement of pipe supplying water from the common water distribution piping to their own particular dwelling and property. Easement shall be granted on both lots to repair,replace or maintain the waterline as needed for distribution purposes. Water pipelines shall not be installed within 10 feet of a septic tank or within 10 feet of sewage disposal drainfield lines. PROHIBITED PRACTICES The parties herein,their heirs,successors and/or assigns,will not construct,maintain or suffer to be constructed or maintained upon the said land and within 100 feet of the well herein described,so long as the same is operated to furnish water for public consumption,any of the following:septic tanks and drainfields,sewer lines,underground storage tanks,county or state roads,railroad tracks,vehicles,structures,barns,feeding stations,grazing animals, enclosures for maintaining fowl or animal manure,liquid or dry chemical storage,herbicides,insecticides, hazardous waste or garbage of any kind. The parties herein,their heirs,successors and/or assigns are required to keep the water supplied from said well free from impurities which might be injurious to the public health.It is the purpose of these grants and covenants to prevent certain practices hereinafter enumerated in the use of said grantor(s)land which might contaminate said water supply. Exlubit A NOW,THEREFORE,the grantor(s)agree(s)and covenant(s)that said grantor(s),his(her)(their)heirs, successors and assigns will not construct,maintain,or suffer to be constructed or maintained upon the said land of the grantors)and within fifty(50)feet of the well herein described,so long as the same is operated to furnish water for public consumption,ANY POTENTIAL SOURCE OF CONTAMINATION INCLUDING BUT NOT LIMITED TO:cesspools,sewers,privies,septic tanks,drainfelds,manure piles,fenced pasture,garbage of any kind or description,any enclosure or structures for the keeping or storage of non biodegradable fertilizers,liquid or dry chemicals,herbicides or insecticides as well as any enclosures or structures for the keeping or maintenance of fowl or animals such as barns,chicken houses,rabbit hutches,pigpens,livestock sheds,and further agree(s)not to use, apply,dispose or suffer to be used,applied or disposed,non biodegradable fertilizers,any liquid or dry chemicals, herbicides or insecticides within the above described protective radius.These covenants shall run with the land and shall be binding on all parties having or acquiring any right,title,or interest in the land described herein or any part thereof,and shall insure to the benefit of each owner thereof. WATER SYSTEM MANAGER The owner of Parcel#1230942-00070 Legal Description:TR 7 OF NW SE,S 53/57 Range:1W,Township:23N, Section:9 SE%of the NW%,3331 NE OLD BELFAIR HWY,BELFAIR WA 985289612 is the designated"Manager"of the system.The manager shall be responsible for arranging submission of all necessary water samples as required in the Washington Administrative Code,and Mason County Rules and Regulations and handling emergencies such as system shutdown and repair. The Manager shall provide his/her name,address and telephone number to the Health Officer and shall serve as a contact person to the Health Officer The manager shall organize and maintain the water system records and notify the Health Officer and all parties,service connections and lots that are included in this agreement,of the water quality tests that are required by WAC 246-291 and Mason County Rules and Regulation. Water system records shall be available for review and inspection by all parties in this agreement and the Health Officer. DEERS.SUCCESSORS AND ASSIGNS These covenants and agreements shall run with the land and shall be binding on all parties having or acquiring any right,title,or interest in this land described herein or any part hereof,and it shall pass to and be for the benefit of each owner thereof. ENFORCEMENT OF A E •MENT ON NON-CONFORM NG PARTIES AND PROPER S The parties hereto agree to establish the right to make reasonable regulations for the operation of the system,such as termination of services if bills arc not paid within 45 days of the due date,additional charges for disconnection, reconnection,etc. Parties not conforming with the provisions of this agreement shall be subject to interest charges of 18%per annum together with all collection fees. .�• iL1._4 c.Jt 7// Janice Water System Or ( Date P 7 (alit Melissa Mae Byerly rater System Owner Date State of Washington,{j /County of Y(4. 0 to I,the undersigned,a Notary Public in and for the named above County and State, do,hereby certify that on this (j day of i)J: . ,2024,personally appeared before me n�cj2-rf4 l;c,SC044,to t1) to me known to be the individual described on and who executed the within instrument,and acknowredge that he(she)(they)signed and sealed the same as free and voluntary act and deed,for the users and purposes herein mentioned. GIVEN under my hand and official seal the day and year last above written. '���� ( . --tD.�tiL•62 � �• O•0 Nssion F17-20?Q :� Notary Public in and for the State of Washington, y _�,o • cox, OiARY .m s residing at V r+4 ©;1 c1t r, P Q• u• • My commission expires:in-(`j_?�1A : =2' Cr �,• ° u8L1C `a ti '�i91• eNumbe�• �V�• ����/7-OFJWAsvv,.��� ON-SITE SEWAGE SYSTEM SURVEY /1"' LOWER HOOD CANAL CLEAN WATER DISTRICT `r PROJECT: LHC AREA: #5 UNION DATE: To 41' G, 0141 y OWNER INFORMATION : TITLE: MRS, MS (circle one). FIRST NAME: (/Avbt LAST NAME: 13Y4RL ADDRESS:/ '.t= 33A! o/d g► ic- gk CITY: &tfet 10- STATE: Wts�7• ZIP: 9e ve OWNER'S PHONE: 01 7 S- 1 3 I OCCUPANT'S PHONE: S' 'E • SITE INFORMATION (Mark SAME if same as above) PARCEL # 0. 309 •_--- La ---- 00 e2 a D OCCUPANT'S TITLE: MR, MRS, MS (circle one) FIRST NAME: 5/174 i- LAST NAME: ADDRESS: CITY: STATE: ZIP: NUMBER OF RESIDENTS: X WELL DEPTH J-8 i RESIDENCE TYPE: f ( F - Full Time Residence; S - Seasonal Residence; R - Recreational Residence; C - Commercial; I - Industrial; M - Multi-family Residence; V - Vacant ) ON-SITE SEWAGE SYSTEM TYPE: L Enter all that apply. ( S - Standard tank and drainfield; P - Pressure Distribution; F - Sand Filter; M - Mound; T - Deep Trench; H - Out House; O - Other; U - Unknown INSTALLATION DATE 1) YEAR LAST PUMPED: Meg Enter Year or U- Unknown GENERAL LOCATION OF SYSTEM: 5 F - Front Yard; B - Back Yard; S - Side Yard; A - Adjacent Lot; U - Unknown PERMISSION FOR ACCESS TO INSPECT THE ON-SITE SYSTEM (Y/N ) tfi (NOTE: Mason County Health Code provides right of entry provisions. However, our policy is to gain permission to access on-site systems. Your cooperation is appreciated and saves valuable time and money for Mason Cou Applicable codes pertaining to this matter will be provided for you upon request.) SIGNATURE DATE 77)L'I' G i /9 9`f Comments: CDO YOU WANT TO RECEIVE INFORMATION ABOUT WATER CONSERVATION? (Y/N) Revised June 8, 1994 (31FI raj at ORria forts— it) d 13 tFLrct14 • _ te 04 Ka frioo6c-- boo.. e 5 eifi-;c Thi,K 61;41?42€ / Skoo 0 • Lower Hood Canal Field Inspection Form Address: 1V 3 3 A.1 (Jc 1 f, • Owner/Renter: (l cam- B, e (i Permission to Insp ) J Date: S 3 o- 9`( Inspection and Dye Test Information Inspector Initials: G°� /DS Inspection Dates: 1 1: Level 1 C: 5 `30 %`l Level 2: Visual Site Inspection Data: Setback between septic tank and surface water: cc, ft SurfaceWaterType (Marine itch, Curtain Drain, Other): Setback between septic tank and well: ft Co ,', Uio7 Setback between drainfield and surface water: (.Co ' ft Surface Water Type (Marine,(film', Ditch, Curtain Drain, Other): Setback between drainfield and well: ft Reserve drainfield area gin) (French, curtain, roof foundation) (y/n) Bedrooms 2 Interceptor drains (F Other(I nrgeOn-sites,Complaints,other): ' Septic System Status and Priority System Cotions: F ication: Cc S S D — Damage to dzamfield SHW — Indications of seasonal high water F = Faded WP — Water seeking plants over drainfield L = Limited(one condition) LG — Dense, lush teas over drainfield PF = Pre-failure (two conditions) SD — Slowly draining plumbing fixtures - S = (uncertain conditions) PM = Indicaulaos of poor system maintenance HW — Indications of high water usage Failure Type: Failure Priority: D = Damage to Drainfield 1: Illness or injury related. B = Broken Influent/Effluent Pipe 2: Visual Dye, open or surfacing sewage entering H = High Water Table surface water,outhouses or cesspools with G = Greywater Discharge <3ft vertical separation from SHW. S = Surface Water Intrusion 3: Surfacing, seeping effluent not entering surface 0 = Other water. 4: Other unacceptable installations,intermittently Other Type: failing systems not entering surface water, effluent over tank baffles- 5: primarily aesthetics(odor). • Observations: ..... .�wss uua [16- • • Dye Packet Results Background Series 1 Retrieval Series 2 Retrieval Series 3 Retrievals_ Site M ' Date Date Results Dw Date Results Date Date R.soli Date Data Result Placed Retrieve Placed Rttsievs Placed Retrieve Placed Retrieve r Bacteriological Water Sample Results Rite # Date Results • Mason County WA GIS Web Map • • OLD BELFAIbHWY 7/30/2024, 3:29:34 PM 1:382 0 0 0.01 0.01 mi County Boundary 0.01 0.02Ikm No Filled • Site Address (Zoom in to 1:3,000) Esn, HERE. Gamin, (c) OpenStreetMap contributors and the GIS user community,Source. Esri,Maxar. Earthstar Geographies.and the GIS User Tax Parcels (Zoom in to 1:30,000) Community Mason County WA GIS Web Map Application Mason County disclaims accuracy,reliability,or timeliness of website info,not liable for losses from reliance on it.https//www masoncountywa gov/disclaimer.php 011.1.0111,1 us IMI f 3117oz.0°��. z .�, i4 A W.i q1W i °)i °C° QI1fl1UPUhP3i1DI Z i�02a nm°O7At1RICRC2 Z.e Iei i al(>>0a0R < 3 Z�T�aa$ 0r 2A/ZJi e i oeo�pi izvc �;:oo;Zo i y N �`- . ,,i-4. 1% °n'zii°°i',V)))ciiiii/ a•C i- ;d�. . pI>COFOQtolzrZ00eEiu ( m :•;"�. ... c,� . Ie0°izD". P:c1r" i . 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