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HomeMy WebLinkAboutWEL2025-00021 - WEL Application, Design, Letter - 8/18/2025 MASON COUNTY 415N6SHELTO :360-4 L967 ,EXT400 SH STREE ,SHT SHELTON. EXT 400 BELFAIR.360-275-4467, EXT 400 Public Health & Human Services ELMA.360-482-5269, EXT 400 FAX'.360-427-7787 08/18/2025 WASSON ET AL WESLEY S 1572 SE LYNCH RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00021 1572 SE Lynch Rd 319094200050 The 2-party water system, Wasson Temen Existing (319094200050/319094200050), 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 Environme }health • 406 7 • 4�: _� c A MASON COUNTY Date Received 1. COMMUNITY SERVICES �S m cu re.eay� ?J1/ Wilding,Plrnnly,EnWmmenLP Halth Community Health v X`V��.l 415 h'.6"Street(.aldgR)- WA9/1584 WEL t,A40a5 , cci°a Sheiks: :60-427-9590 xdnU lidrhr 360-275-4407 x400 El ma 360-042-5369 I eAW TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APyLICP PHONE fo1ele'feavk)-111E 5 eesL tkv11s��50INf 'b�'o SSI - iliLACe 53z-�5s213 MAILING ADDRESS-STREET.cm,sTAT .ZIP s--a AtVMI_ VV `k 63 1RESZ �E. — � H SITE ADDRESS-STREET,CITY.STATE. PRIMARY PARCEL NUMBER(WELL SITE) 3 iCt Opt — kt-000Sv SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) WA RR NOVICE SOURCE TYPE PARCEL I LOT SIzElmin t acre) PARCEL 2 LOT SIZE(min l acre) ❑ Nevy CKExisting g Well 0 Spring 4 , I a PROPOSED WATER SYSTEM NAME I REQUIRED). (,V P4 G'N laMARN ' }{fl XF alL5T 11J Cf PROJECT DESCRIP11ON(eg. detached ADU,new single-family residence existing connection,etc.) �� LOAC;i ae , r.,,z1w6Hw e-JeL2,r vUtw q�vt ovz r 1 SL.g A O L€_ 'tMC&- cJ4CQ v(l.) 2✓Ay- lout- will tt3v"� 1O nvawK +' St S DIRECTIONS TO SITE I CONDITIONS r GATE CODE I KEY LOCATIO I ETC. F ea^ lo% {ova. 1� Qa SEA co l 5 ^n;Lc Ia1�212t3tc( tit p -dyz'S lki4tt APi tl. Pafilfu &. CLA I\e,- Dia(cru Li) lu_ z o,t tt.Jtj- Site Plan: (may also bejltached)p (property boundaries,structures,well site wit On'radius,driveways,roads,septic/sewer components and lines,water lines,property easements,etc.) CO Eral 1.‘ J • i tyic Required Submittals Checklist: (additional information located on the first page of this packet) E10 atisfactq bacteriological test from within the last year (this may be deferred if the well has not been drilled yet) (Vell log and/or capacity test performed bye well drilla(this may be deferred if the well has not been drilled yet) Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditors Office A3" ephc Recoidsjadditional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and made available for public viewing on the Mason County website. Revised:0 /10/2025 Page 1 of 2 -- — _--- Staff Use Only --- —_____ .—___._____.____ Review Step 1: Well Site Inspection:alma �C I1 read Caf4MWdK4 try Mceel:A enf thvf/M{s -Tyy�,,S,,a``m�ofte atop A 0 YES NO NA •lny�. "' fO @ray cil ❑ ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks, buildings;indicate distance on plot plan) ❑ ❑ Are there roads within a 100-foot radius of the water source? Is the road Private,County,or State?(circle one) Distance to the road(s) 11 ❑ El Does the ground slope away from the water source site? ,...1 ❑ Satisfactory well cap? 0/0 ES/I- 6 1tEl ❑ Well cap screened and vented? / ❑ The well casing extends J __ above Icve groun concrete slab?(circle one) [(] ❑ ❑ Evidence of a surface seal? Lat'. 4a 19/i$ 'i] ❑ ❑ Adequate surface seal? Lon:-1223.o606 ❑ 20 IllVariance necessary for well site approval? Tag: ft Q t i(� Y y Comments: `lA, e.l t MI (4/f . MA� COMM.4fgko(. #0 vet( iso. NO ter 0u ass elerail Inspector Date jlj /lo7r Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water well report(well log)with a concurrent capacity test? ❑ ❑ 71 Nonconcurrentiseparate capacity tteest??,/ p z n CoCapacity testte information: Date 779 I 13 Driller PICSe �1//l�i C GPM /o Duration(minutes) 120 7/eTotal7Gal 166 0 4 ❑ ❑ Satisfactory bacteriological analysis? Date of test J/ l/LO 72 7 ,y. ` El Signed,notarize&and recorded notice to future f/ZZ e property owners?AFN J Y1 , , Al ❑ ❑ The system appears adequate to serve two connections based on the information,provided?//r fg Comments: 7 -ills Approved ❑ Denied Reviewer �� Date Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied ofthefurure 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. Page 2 of 2 ----------'"- ." ------ - —.--.-------___ elle Original and MIA BMW with Department of Too108Y WATER WELL REPORT Application No. ........ ....• . .• SicclygdgrY mgrei.r:gx STATE OF WASEDIaTor4 Y---_ (i) OWNER: Neale. Addree• Pc2,..827....74e: Ss 4/• 1- ...; (2) LOCATION OF WELL: num A To./ bent ?-si me 9 T /1.5.-N.. n3Qw.m. 0 a Bearing wad distance_ -°-------from Wien or subdivlsMo corner 70o.Arnei C a) CY (3) PROPOSED USE: reswetw )1( lasustrud ti issweiso ci (10) WELL LOG: DeScrthe by cuter.Monicker le of material sftwwww.r:g _al Irrigation 0 Test Well 0 Other C 12:crwaatianr memorgtrystondafromainvatlion# naLlor erctepoirci=ontoll #0.441,,,,,,, 3 (4) TYPE OF WORK: reon ntnutatfig r"............ ..._................ idA . MOM TO ft/ New well mit Idatbod Due 0 Bereft 0 1EDeaPetalf 0 Cable C3 Minn 0 ------ 0 c BeccmdlftrolocRotary(3 Jetted CI . Ala o (5) DIMENSIONS: —i--- ._ cs Driller,. It Depth of completed well It _ :CI CONSTRUCTION DETAIL& Casing installed: 4 - Diem. from _.0. et. to ida rt. O Tinseded 0Dma - ft to rt iF r, .ilinfilnlialligplartal c vuad from ft to n .algailinglil C Perforations: Yet 0 NOW .....egret/-.014,1rZrinfili gial 4 ea Type of perforator used_...............-........ ....-..........................-...... ao WTI of perforations pertormions ft.to _ W. ft --.--- — W .. . _ perforations from tt to ft -------- C ft. CO ft Screens: ire 0 No X CO O TYPe- C Otani Mot size . from -C we >I ------------ EMS."' plant Yes C No X Size of ran& C ----------- Gravel placed Mao..-- -ft 1 g7 -- L." fg Surface Melt Teg 0( Nig To what depth? --113--- It. ------- IlLehteial wied in 111111-.ainif&Cr Dal any strati contain unusaft Water? YOB li 140 0 --.---------- 1- Type of water? 0 Method al online 2 - V/ (7) PUMP: es is . _ ID O TYln: 175 (S) WATER LEVELS: troiranr:,:lrigt... im Static level ......Jr....-.....It.below top of won Date" .2r.t- Mil O Mas — O Artesian water a mouthed by vaa-e5----- ______________ LU 4-: (9) WELL TESTS: Dr...down is ammuenter level is lowered below 4WD level elfallir!MA" gr O Was a pump teat made? Yee El No 0 If yes,by whom _ Yield: Wil./min.with ft.dreardovin after hrs. WELL 1:1111 ER'S STATEMENT: C This well was drilled under my jurisdiction and this report is a' .. " •• true to the bee of my knowledge and belief. CO "nee" learnt=tt,=rwlhevel.:11PturiP “imed Cjf) (water level a N Vg",„Oa 7/ Alva 2c, 0. Tine Water Level Time Wares Level rime Water Level ..... ............................ tairaon, • ...........—..........--...-..1.............................-...... 17.7.7111-.11-..11".1 Palatal-a-41A..x..atdoisam......_.c.hetho.h,..00 0.1 -C I— Date of tan - iSigned9Lerkeetea Bailor test30......_ NJ .with-../2.-it.anweown after_....91......iws. :w D ri Artesian Dow g pm Date Temperature of # jwater-............Was a ennead analysis made,Yes 0 No 0--- Li ta Cen No aii a anii874Date..„Zhamf./019.74". 003 I elecne/f Wre (US/ADDITIONAL MEM IF NECJIMARY1 a wINO ,II , • Thurston County Environmental Health 412 Lilly Rd NE • Olympia,WA 98506 360 867-2631 THORSiUN caUN ry L. COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County Collected Et AM L ❑P,r Type of Water System(check only one box) ❑ Private Household ❑Group A ❑Group B Group A and Group B Systems—Provide from Water Facilities Inventory MFII: " - IDS System Name: Contact Person Day Phone ) Cell Phone:( ) ItePhone ( Sec rasa'S to:(Par'lull name,address and zip coda or email address i SAMPLE INFORMATION Sample collected by(name)'. Specific location or address where sample collected'. Special instructions or comments Type of Sample(must check only one box of SI through p4 listed below) t.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine) Chlorinated-Yes No ❑Distnbution System Chlorine Residual Total__Free Chlorinated:Yes No _ 3.Raw Water Source Sample Chlorine Residual Total Free ❑E.cols—GWR(NP) Fecal—srl e Gaol,sr.as lnanealml Unsatisfactory routine lab number Fillomd Yes No ❑Assessment MOntoring(A/P) Unsatisfactory routine csllect date: ❑Other 15 4.L]Sample Collected for Information Only Investigative _ Construction I Repairs ^_ Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Colifom Present and CJ Satisfactory ❑Ecoll present ❑E cols absent No Colitom detected Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑ — Bacterial Density Res.ts:Total Colform _. (100ml. Ecoll jIDOml. Fecal Coliform t100m1 Enterococci 1100 mI. Method Code:❑'SM 9223B ❑SM 92220 Date and Tme Recebod. ,. ❑SM 9215E ❑Enterolertb 1 Date and Time Analyzed Date Reverted Sample L Oa'number pasha drab` Lab Use onry: 0 8 0 OOB mFn>v'a's rev sad wan 2223745 MASON CO WA 04WPSSONITEME025 Ng#2©8250 PM MRecEFee 5304.50 Pages 2 Return To IIIIIIIIIIIII hill IIIIIII II IIIPII Il lllihil IIII!I IIII II Wet, C�M / L&q . Te i I l-y,sr-t4 sit-ELmPJ , wA `f859* Grantor(s): (1)to1/4)P6cOVI wQr) A?\), S-, (2) Veure n - EtAet'1 Grantee(s): (1) PUBLIC r Legal Description (1) PCL 2_ o 4 U 9'6-75 Sek_F Iq N t'sl (Abbreviated form:or i.e. lot,,{block, plat�orr�section, township, range) Assessor's Tax Parcel: (1) ] 9 T1 9 - �I- Z - Y'" 0 5t' C3 NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM 1 (We) the undersigned grantor(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:9 Tax Parcel: (Connection 1) j 6 9 - - <l $ 0 5 0 Tax Parcel: (Connection 2) 3 C( 0 I - k 2- - u, x" 6- 4 The system owner is responsible for keeping this system in compliance. The name of the water system is: W 6SSor` I SW*1 L'K xS T t r"(c 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. QOh Dated on this V — day of f\ycn , 20a 9 Signature of grant r(s): I r (1) Lv - /l/"',-._- , (2) vW-^l'-, _ SAAAP--�- WESL y bllsssenl '1-- r-e I . � .. �I Page 1 of 2 State of Washington County of Mason I, the undersigned, a,Nottary Public in and for the above named County and State, do hereby certify that on this L7°a ' day of Act"t\ 20 at-7 we.. leyy WG.Stun cwI. µ fir VI Terntn personally appeared before me, Oho is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written.�.`GUHN4th Notary Public in and for the State of Wdshington, �,E�,... engC4 rr� residing at 9�Q'&OA l l({ q(1 p c �a'n�NF h�'QA, _ N =+r.cra ma's m % My commission expires: °Flaa ag o r ?a m: p �24021853"i f. .a i OE uc 'ttrh ItrwNrN Page 2 of 2 A WAs son) /TEI'VIEIU 7E,StOENC-E t 1572 5E Lysck Rs) sFwl4oN ) WA 99581) ��a f Parcel: 3 Hai- u)- 0005o P� { WIE I I earl TC l c4fe : / 4 - / _. / j la" 2401 c _--cr. — -I- 0 w‘tr �\ °mob r ti4 axes/"i I,eon /v / / 0/ • O / / / glad ' /SSA et ��tt y� Oa i ., 0 Mi64 I q er i G -M. OP pInnt"\ b�...�l'..l I2 / LJul To 5 e?4,c TaNI( " sa r 1Jel! 'F'O Drain FtttD `;1115 Weil To (Abuse, - At0' • fief;se- To tatM -au- i tGotrN To Prntaseb a..lo1.µy 4p' ®Res OOOOOG .11 HAIM P. 0 A5,83 a i _ m )i e , 1 I i E S I il { t j ' t 1 g: _ I I1'�I\I 8a I. I III i _ _ lL 1 ; g� € # T. t3 Ti i1. S , e s - s; e ' ki a i s gp�=aia 3[ 111111 € gill � j6E § ; 5 alh z. 110 8g4ee #; s � nBE # 9 # 3 f a s 3e E i 1 1.3 1 10�sf 1_4i ' 4 ;; e@j ill .9.#e E 1 3 i 111:1 41 of I I - -