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HomeMy WebLinkAboutWEL2025-00036 - WEL Application, Design, Letter - 6/30/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 J SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 08/27/2025 KING DAVID W& LISA D PO BOX 1404 ALLYN, WA 98524 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00036 171 E Nelson Rd 122294400030 The 2-party water system, KINGNEW\HELL (122294400030/122294400030), 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 I 1 MASON COUNTY 0� - o - z©z.5 { COMMUNITY SERVICES Amount Received Received By. , Building,Planning Environmental Health,Community Health tl 540 415 N.6th Street,(Bldg 8)—Shelton,WA 98584 WE L 2oz J - O OC)3cp Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elm:360-482-5269 x400 . TWO-PARTY PRIVATE WATER SYSTEM APPLICATION `` /` PHONE 2S 3u APPLICANT— a`,I 1 — L`sR �( `w lS \l 5-MAILING ADDRESS-STREa,CITY.STE 'Olv \ Nn ' EC E DW E1oQ \ \ IA � � S 1\ SITE ADDRESS-STREET,CITY. SON iRc 1 \ w� Bs2-• it JUN 3`) 2025 PRIMARY P ICELNUMBER(WELLSITE) 00 3 C) , . SECONDARY PARCELNU ER(SAME ASIPRIMARY IFGATED ON SAME PARCEL) Dy ,/ Z _ (I -WO/ WATER SOURCE ,TO i• .. '• PARCEL I LOT SIZE(min I acre) PARCEL 2 LOT SIZE(min I acre) X New Existing )(Well Spring 1 65 PROPOSED WATER SYSTEM NAME(REQUIRED). Kk N G N k ` ,� --. PROJECT DESCRIPTION(e.g,detached ADU,new dnglefamib residence,existing connection,etc.) D ctos \t 1\00 DIRECTIONS TO SITE/CONDITIONS I GATE CODE/KEYLCATION/ETC. ` I v r N O PIN N, a t�� G Go v v4.`i,�,Loot�M. 10(t4L°NINON P r\\Vio' )(\of\\k -t0ce. R. F\cAckAvd. ON..q , 173-Ili N.5'4l3t Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,water lines,property easements,etc.) Required ........L)--) '6)-. icr Cal e Submittals Checklist: (additional information located on the first page of this packet) 'LEI Satisfactory bacteriological test from within the last year V Well report with well tag number,well tag secured to well casing,and capacity test showing 800 gal per day 'Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office iISeptic Records(additional locating requirements may apply if there is a lack of septic records on file) s form may be scanned and made available for public viewing on the Mason County website. Revised:01//2025 Page 1 of 2 r Staff Use Only ------ _ _ • Review Step 1: Well Site Inspection: �t&4. A''G ,71724 D C� co)6 • :iicø,M: ap ,;4 t1M l V.CZ( C I/'"'` O 0 E idence of exis dig sources of contamination within a 100-foot radius of the water source?(drainfields, nks,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) ❑ ❑ Does the ground slope away from the water source site? • ❑ ❑ Satisfactory well cap? O 0 Well cap screened and vented? li ❑ The well casing extends ') O above level ground/concrete slab?t(circle one) , g ❑ 0 Evidence of a surface seal? Lat: `l •3 9R ❑ El Adequate surface seal? Lon: — t 2 .• 7,,C. I6.fi ❑ pc. 0 Variance necessary for well site approval? Tag: G 4 i✓ l©v Comments: '- 5.6r 9da kd 9(A la tit &alit retalwirItf kid st/T/775` r,Pass ❑ Fail Inspector W ,`4,49 Date 7 -2 ` ("2 Review Step 2: Two-Party Review: YES N NAYrd.' " c9 0 Water well report(well log)with a concurrent capacity test? (f Ce l pp tt( vi'`fl�l' yl21b/70Z S• Pe P►m ,,6 p ❑ Nonconcurrent/separate capacity test? 7 7 /�N Capacity test information:Date 5( J ! L0ZLler 4rcc1c,4'q Oa(f( y GPM I 2_ Duration(minutes) 70 Total Gal '3 Lf fv1/le 'V m M 1h. ❑ ❑ Satisfactory bacteriological analysis? Date of test 6! Z(( l 75— ' � iff El El Signed,notarized,and recorded notice to future property owners?AFN Z V V ` 35 40/ ❑ ❑ The system appears adequate to serve two connections based on the information provided? �44 46 Comments: 0 4 F ii, kk?..) Approved El Denied Reviewer Date 51/7 e4� 44 F/1/7 Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,expresi.9AY or implied of the future 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 19th, 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 WATER WELL REPORT �� DEPARTMENT OF Notice of Intent No. WE59160 ECOLOGY Unique Ecology Well lD Tag No BQC100 Type of Work State of Washington O Construction Site Well Name(if more than one well): 0 Decommission => Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: ❑O Domestic 0 Industrial ❑Municipal Property Owner Name David King 0 Dewatering 0 Irrigation ❑Test Well 0 Other Well Street Address 173 E Nelson Rd Construction Type: Method: IC New well 0 Alteration 0 Driven ❑Jetted 0 Cable Tool City Allyn County Mason ❑Deepening 0 Other 0 Dug 0 Air- 0 Mud-Rotary Tax Parcel No. 12229-44-00030 Dimensions: Diameter of boring 6 in.,to 56 ft. Was a variance approved for this well? 0 Yes 0 No Depth of completed well 56 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter Front To Thickness Steel PVC Welded Thread p I ❑ 6 in. 0 52 .25 in. 13 I ❑ O I ❑ Location(see instructions on page 2): 13 WWM or❑EWM DID in. _ _ _in. ❑ I ❑ ❑ 1 ❑ SE Y.-Y.of the SE '/;Section 29 Township 22N Range 1W ❑ I ❑ in. — — —in. ❑ I 0 0 I El DID in. in. ❑ I ❑ ❑ I ❑ Latitude(Example:47.12345) 47.36160 N _ _ Longitude(Example:-120.12345) -122.82637 W Perforations: 0 Ycs O No Type of perforator used No.of perforations Size of perforations in.by in. Driller's Log/Construction or Decommission Procedure Formation:Describe by color,character,size of material and structure,and the kind and Perforated from ft to ft below ground surface nature of material in each layer penetrated,with at least one entry for each change of Screens: ©Yes ❑No 81 K-Packer c=> Depth 50 ft. information. Use additional sheets if necessary. Manufacturers Name Alloy Machine Works Material From To Type Stainless slotted Model No. Diameter 5" Slot size.018 in.front 51 ft.to 56 ft. Brown clay,round fine to medium sand&gravel 0 31 Diameter_ Slot size in.from _ft.to_ft. Brown fine to medium sand,water 31 52 Brown medium sand,few gravels,water 52 56 Sand/Filter pack:0 Yes No Size of pack material in. Materials placed front ft.to fl. Surface Seal: O Ycs 0 No To what depth? 18 ft. Material used in seal Bentonite chips Did any strata contain unusable water? 0 Yes O 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 54 ft. Stick-up of top of well casing 15 ft.above grotmd surface Static water level 20 ft.below top of well casing Date 4/29/25 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? O No ❑Yes t-- by whom? Yield gpm with_fl.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 Timc Water Level Time Water level Date of pumping test Raikr test_gpm with_ft drawdown after_hrs. Air test 15 gpm with stein set at 40 ft.for 1.5 hrs. - Date 4/29/25 Artesian flow gpm _ Temperance of water 50 °F \Vas a chemical analysis made? ❑Yes ©No Start Date 4/29/25 Completed Date 4/29/25 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. 0 Driller 0 Trainee O PF. Print Name J s nson Drilling Company Arcadia Drilling Inc. Signature e..4,--L" -'w✓— Address PO Box 1790 License No. 3479T City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No.2874 Contractor's Sponsor's Signature - l Registration No.ARCADDI098K1 Date 4/29/25 ECY 050-1-20(Rev 09/18) If you need this document in an alternate formal,please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 for Washington Relay Sendce. Persons with a speech disability can call 877-833-6341. Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA. 98584 Customer: David King Well Tag#: BQC100 Site Address: 173 E Nelson Rd, Allyn Depth: 56' Date of Test: 5/23/25 Static: 20.7' Pump Set: 40' TIME GPM LEVEL RECOVERY 1 Min 4.2 22.9 TIME LEVEL 2 Min 4.2 24.1 1 Min 29.5 3 Min 4.2 24.9 2 Min 25.9 4 Min 4.2 25.3 3 Min 24.1 5 Min 8.3 25.5 4 Min 23.2 6 Min 8.3 27.3 5 Min 22.6 7 Min 8.3 28.5 6 Min 22.2 8 Min 8.3 29 7 Min 21.9 9 Min 8.3 29.3 8 Min 21.8 10 Min 12 29.6 9 Min 21.6 15 Min 12 34.8 10 Min 21.6 20 Min 12 35.2 25 Min 12 35.35 30 Min 12 35.5 35 Min 12 35.6 40 Min 12 35.7 45 Min 12 35.7 50 Min 12 35.7 55 Min 12 35.75 1 Hr 12 35.8 1 Hr 10 Min 12 35.9 Total Gallons Pumped: 778.3 Gallons 4 i 4 4 I a) Collected 06/19/2025 ❑Au Mason PU Weep on Y..Type of Water System(drede only one box) 0 Group A ❑Group 8 ®Other Group A and Group B Systems-Provide from Water Fadlrbes Inventory(WFI): ID# -- —System Name David King Contact Person Arcadia Drilling.Inc Day Phone:(360 )426-3395 Cell Ph ( ) Email Eve Phone( ) Seed mutts b(Pnnt full name address and z P code m emali arlelaaarcadeoril^c corn AND Iern arcadssen,fg bom SAMPLE INFORMATION Sample cofected by(name) Max Specific location where sample colectea Special instructions or commen : BQC100 173 E Nelson Rd.Allyn Counts please Type of Sample(select only one type of sample from types 1 through 5 below) 1 ❑Routine Distribution Sample(AIP) 2❑ Repeat Sample(NP) Chlorinated Yes No (trap drstnbuton system after unsay rouire) Unsatisfactory routine lab number Chlonne Residual Total _Free 3 Ground Water Rule Source Sample Unsatisfactory routine collect date S II I —Chlorinated.Yes No_ ❑Triggered(AP) Chlonne Residral.Total.__- Free__ ❑Assessment(NP) 4. Surface or GWI Raw Source Water Sample(Enumeration) ISI ❑E.coli ❑Fecal Fasea Yeti No 5 gig Sa.Ne Coccetuo tor Information Only. LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Colrform Present and ®Satisfactory ❑E col+present ❑E coi absent Bacterial Density Results Total Gold= <1.0 /100ml.Eco/<1.0 fl00ni. Fecal Coliform n/a it00mt tiPC Na It Replacement Sample Required: 0 TNTC ❑Sanpb too old ❑ Sample Volume ❑Damaged Container ❑ D _ Lab Reremnce Number QUIZ:2 LttD`OO ASpta20...V5 Recect Temp C Method Coco SM9223B 4.0 Dare Reoosed t^DC:'+ lab Use Day Q6/21/25 285-62015 l .-ir efn.)•C ..ne�f�.e,a,+..e n.o.e.mam...r.e..`.xo<►7e ratnr;lrcorrn r rrn ii K Cee.Disbar.we rarer..pm as"ea pnAwry+..r I 2227354 MASON CO WA 06t30/202S 11 30 AM NOTCE DAVID. LISP KING 4211277 Rec Fee S304 50 Pages 2 1 IIIIIII IIIIII III llli IIIIII IIIIII III!H1111I11 I110 Mil iII 111111 IIII Iill • Return To c► c� 4L S 14in9 Al tuvn , w A q 4 Grantor(s): (l) D PW k(\ \t G' ,(2) L.15 A\SVIG Grantee(s): (1) PUBLIC Legal Description(1)—11k3 0� G• r 6W \cz 5 S S'k2 (Abbreviated form: i.e. lot, block.plat or section, township.range) Assessor's Tax Parcel: (1) 2-2� - " O00 0 5' L1T2 21 NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (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: Tax Parcel: (Connection 1) \�-�2-�r �� Tax Parcel: (Connection 2) k C)O O The system owner is responsible for keeping this system in compliance. The name of the water system is: KNCTIQ EW Vg `^ 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. Dated on this —� day of -\)1J1: Signature of Grantor(s): (1) > ,(2) ' Page 1 of 2 • • State of Washington County of Mason I,the undersigned Notary Public inand for the above named County and State,do hereby certify that on this : � day of -./l/Lf , 20 Z S , I _V/CI !—I S.a - 12,:/7 personally appeared before me,who is known to be signer of the above instrument, and aowledged that he (she) ey) igned it. GIVEN under my hand and official seal the day and y r last above written. CVO 0 aLt )• VERONICA R COLBURN NOTARY PUBLICMu1T otary Public in and for the State of Washington, STATE OFWASHMIOTON residing at-7701 tJ a COMMISSION EXPIRES My commission expires: 8 ' 2 da) b AUGUST 22, 2028 Page 2 of 2 „ i. I>rrttl� i\a..\r\2Sti lqE y •� N g �� N � \fit -�0 / � � 2- '�o c�- ,' .�,\.' ram,N TA r-”, e. \ QcksT\A- ,„, ___ , p.RefieSED 4 BEDROOM ' \ A PRIMARY AND RESERVE AREAS ... \ \ FOLLOW CONTOURS OF SLOPE l=-f� \ ,44 \ _ [EN \ \\ . %� EXISTING TANI<AND �� ���% 01 DRAINFIELD TO BE PUMPED 1- 07i'l .\\- AUG 8 2025 `� �,�\�' 2\',... AND ABANDONED AT TIME �� aRECEIVED \, \' \ OF INSTALLATION ���C>���- ��r_ 2.5`�3%50 i1 EXISTING \ . .' MAINTAIN 50'+ FROM WELL DRIVEWAY \ a� • IN•NEin1 TO TRANSPORT LINE D `f c` k �.rp�, `; \ INSTALL N 1 / SCH. 40 \ EW4"/3034 TRANSPORTS `\\\ �\ _.,„.\ SEWER LINES FROM EXISTING RETURN LINES \ \l 1. i•-"• HOME AND FUTURE ADU EXISTING/ PROPOSED t `\ rQ ' .�►\\ ; toywt \'A c.r.;-.-WATERLINELOCATION j I\ \ =' UNKNOWN, MAINTAIN 1 \\ \ e°x d wATEt1,l 1Q 10'+ FROM SEPTIC \ '\ \ COMPONENTS AND ' ' �- -- `�`�� �5 XI IG LINES. DOUBLE- SLEEVE �/�o `\�\- \ �E EXISTING V_ • "--\ CROSSINGS 10' EA. SIDE. WELL / / .----\-_`�J� `\ ` I EXISTING P�,ota 5�.� EXISTING \� \\ w \\ I GARAGE ° 1 SHARED WELL \ �� � i =i1 ��� ,�-��^I�, _.- \ \� EXISTING 70 .. \ w \\ HOME o lira 35�4/' !" \ fa TAN I<S // Af�.O ` ``�\\ MAINTAIN 50 �-~ // ) .-- \N fFfi,t� Syr \ TO SHORELINE �;i \ •��_� *.. .- AC 1,6 . '.) :, i ,,_ �a w.t�r \ ,.:,1 - r. Ronsttaos r is`' — ' /V�p 1 fir: yase EXNIfiE3 o vv ,..,f, /i!,7 \N AS5UILT/INSTALL SIGNOFF FEE WILL V`\� ' CASE YI'f�Ur ��Q1 "`'` 3E CHARGED AT TIME OF INSTALLATION • CASE t I 1. �l�l�l]A 4., �.- :rGU HEALTH R DIGGING INC, PCUSTOM# A 0 OG TEST HOLE I: TEST HOLE 2: TEST HOLE 3: [ONEE SEPTIC DESIGNS 0-30 ca GSL 0-30 GSL 30+TILL 30+TILL 30+TILL _E MASON BENSON RD. ADDRESS: 173 E NELSON RD ROOTS-30 CRAPEVIEW,WA 98546 DESIGNER: ROBERT FL PAYSSE ROOTS 30 ROOTS•30 OFFICE-360-426-1803 FAX-360-427-2353 DIECUIMER THI818 NOT SURVEY.REFFRCuree PI AYR ne e.,........