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HomeMy WebLinkAboutWEL2025-00099 - WEL Application, Design, Letter - 9/29/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 09/29/2025 ENGER MELVIN D 8391 E STATE ROUTE 3 SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00099 1170 E Bertlesen Rd 220072250020 The 2-party water system, Enger 1170 (220072250020/220072250020), 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 Sincerel , David Anderson Environmental Health Specialist Mason County Environmental Health ►- MASON COUNTY Date Received: Og r _ ^ � ill '� ) COMMUNITY SERVICES Amount Received: �^ ReceivedOP � t ' Building..Planning,Environmental Health Community Health l � 0 ^� v 415 N.6d'Street,(Bldg 8)—Shelton,WA 98584 W E L aQ25- c (DOq 9 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION PHONE r� APPLICANT ST� ' (� F j µQ 1 v ti `j\jt'�p''�'{VJ�{LLt7 1--. \\ MAILING ADDRESS-STREET,CITY,. ATE,ZIP $act l E S R 3 1 1 t��; AUG 21 2025 SITE.ADDRESS-STREET,CITY,STATE,71P ti S►t ep�i.. vJA q%V8 3 1 ,. PRIMARY PARCEL NUMBER(WELT.SITE) 22oO`i • 2Z, — SOOZb f11By y,,, - SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) ZZCO? • at • Y'Ob20 1 -WATER SOURCE SOURCE TYPE PARCEL I LOT SIZE(min I sere) PARCEL 2 LOT SIZE(min I sere) i►/lffew Existing ✓Well Spring I7 is— ec_f^Q.. 17. ' 4W- PROPOSED WATER SYSTEM NAME(REQUIRED). CljLtE to i I to PROJECT DESCRIPTION(e.g.,detached ADU,oew single-6mlly residence,existing connection,etc.) . 1 e.A J r-1 P(1F 10.14)4... P Ab v ( U$4 S to r d G b,f tS-I %....t ce_1.e1,A./t-C.a2• DIRECTIONS TO SITE!CONDITIONS I GATE CODE/KEY LOCATION I ETC. CrbJja. SLA4.14,0..... 4.64y 3 4-0 E Ag 4.e4c. ec!. L -L. as r4cis t.n 4. C o,p-k j . Task a,-3 caF P„r..it► f J a OP roof.. 1/Z .Atli. , P.t s IVAVK/'• ems- t2 S s.6.,, 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.) S►e. Required Submittals Checklist: (additional information located on the first page of this packet) 16 Satisfactory bacteriological test from within the last year Cit 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 Septic Records(additional 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:01//2025 Page 1 of 2 Staff Use Only Review Step 1: Well Site Inspection: YES NO N/O 0 I 0 Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks,buildings;indicate distance on plot plan) 17,1 0 0 Are there roads within a 100-foot radius of the water source? J� t Is the road County,or State?(circle one) Distance to the road(s) `v go 0 ❑ Does the gro Is d slope away from the water source site? ] ❑ ❑ Satisfactory well cap? fal ❑ 0 Well cap screened and vented? 1 , 0 The well casing extends i ( above level un concrete slab?(circle one) rrl ❑ ❑ Well tag attached to well casing? Lat: '?•2 y l38 ga ❑ ❑ Evidence of an adequate surface seal? Lon:-I t 1.Y816,1 ❑ lel 0 Variance necessary for well site approval? Tag. a Q Cf 6Y Comments: tt6 Pass ❑ Fail Inspector6„....—, Date l/Z)f' ' Review Step 2: Two-Party Review: YES NO NA i(r(GV7S i% q ����((�l �] ❑ ❑ Water well report(well log):Date Completed Driller ` ❑ 0 0 Satisfactory capacity test showing a minimum of( 800 GPD with full recovery to static level wi n 24 hours? Capacity test information:Date ?`Z Z! ZO 7 Driller/Pump InstallerI (.Ulf 1)#/t' GPM S 1/ Duration(minutes) 70 Total Gal ?)0 Recovery Time(minutes)to Static -1110 pd Satisfactory bacteriological analysis? Date 7l Zj/Zo U �sting Lab � (/adtakac ey o(YefEl CIlg.C regr ❑ 0 Signed,notarized,and recorded notice to future property owners?AFN 2Z? I � 7 0 0 Thesystem appears adequate to serve two connectionsbased the infonnnationrovide on pd. PPeR® �/ S VF Comments: , l2vNe� f ' �/ 26 zoZ ti1gs0Nc � FP29 1 IX Approved CI Denied Reviewer Date L A`yFg1 ., 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 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:07/23/2025 Tids form may be scanned and made available for public viewing on the Mason County webaite. Page 2 of 2 WATER WELL REPORT _Brig DEPARTMENT OF NoticeoflntentNo. WE59900 ECOLOGY Unique Ecology Well ID Tag No. BQC169 Type of Work: 1W State of Washington O Construction Site Well Name(if more than one well): ❑ Decommission r=- , Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: ❑a Domestic 0 Industrial 0 Municipal Property Owner Name Mel Enger 0 Desvatering 0 Irrigation ❑Test Well 0 Other Well Street Address 1170 E Bertelsen Rd Construction Type: Method: E New well 0 Alteration 0 Driven Cl Jetted 0 Cable Tool City Shelton County Mason 0 Deepening ❑Other 0 Dug O Air- 0 Mud-Rotary Tax Parcel No. 22007-22-50020 Dimensions: Diameter of boring 6 in.,to 85 ft. Was a variance approved for this well? 0 Yes 0 No Depth of completed well 84 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread p I ❑ 6 in. 0 73 .25 in. © I 0 0 I 0 Location(see instructions on page 2): ©WWM or 0 EWM ❑ 1 0 in. _ in. ❑ I 0 0 1 0 NW '/.-'/,of the NW V.;Section 2 Township 20N Range 2W ❑ I ❑ in. in. ❑ 1 ❑ ❑ I ❑ ❑ I 0 in. in. ❑ I ❑ ❑ 1 ❑ Latitude(Example:47.12345) 47.24130 N Longitude(Example:-120.12345) -122.98745 W Perforations: 0 Yes O No Type of perforator used Driller's Log/Construction or Decommission Procedure No.of perforations Size of perforations_in.by_in. Formation:Describe by color,character,size of material and structure,and the kind and Perforated from 11.to IL below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: O Yes 0 No OK-Packer b Depth 18 ft. information. Use additional sheets if necessary. Manufacturer's Name Alloy Machine Works Material From To Type Stainless slotted Model No. Brown sand,gravel,silt 0 29 Diameter 5' Slot size.014 in.from 73 fl.to 78 fl. Diameter 5" Slot size.000 in.from 78 ft-to 84 ft. Brown sand,gravel,silty clay 29 52 Brown sand,gravel,wet 52 61 Sand/Filter pack 0 Yes O No Size of pack material in. Brown silt,sand and gravel,water 61 70 Materials placed from ft.to_ft. Brown sand,gravel,water 70 78 Surface Seal: O Yes 0 No To what depth, 72 ft. Brown sand,tight,less water 78 84 Material used in seal Bentonite chips Brown clay 84 85 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 256 ft Stick-up of top of well casing 1.5 ft.above ground surface Static water level 35 ft.below top of well casing Date 7/9/25 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No ❑Yes c__> by whom? Yield gpm with ft.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 Time Water Level Time Water Level Date of pumping test Baiter test gpm with ft drawdown after_hrs. Air test 10 gpm with stem set at 60 ft.for 1.5 hrs .- Date 7/9/25 Artesian flow gpm Temperature of water 50 °F Was a chemical analysis made? 0 Yes E3 No Start Date 7/9/25 Completed Date 7/9/25 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 Drilling Company Arcadia Drilling Inc. 0 Driller�Trai E—Prin e James Johnson g P Y n9 Signature --">--- _ Address PO Box 1790 License . 3479T City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No.2874 Contractor's Sponsor's Signature Registration No.ARCADDI098K1 Date 7/9/25 ECY 050-1.20(Rev 09/18) If you need this document to an alternate formal,please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. Arcadia Drilling Inc. P.O. Box 1790 Shelton, WA. 98584 Customer: Mel Enger Well Tag#: BQC169 Site Address: 1170 E Bertelsen Rd, Shelton Depth: 84' Date of Test: 7/22/25 Static: 35.6' Pump Set: 60' TIME GPM LEVEL RECOVERY 1 Min 6.5 38.8 TIME LEVEL 2 Min 6.5 41 1 Min 47.8 3 Min 6.5 42.2 2 Min 43.2 4 Min 6.5 43.1 3 Min 41.8 5 Min 8.8 43.6 4 Min 39.6 6 Min 8.8 45.6 5 Min 38 7 Min 8.8 46.5 6 Min 37.3 8 Min 8.8 47.3 7 Min 37.7 9 Min 8.8 47.8 8 Min 37.5 10 Min 11 48.1 9 Min 37.2 15 Min 11 52.2 10 Min 37.1 • 20 Min 11 53.1 25 Min 11 53.5 30 Min 11 53.65 35 Min 11 53.9 40 Min 11 53.95 45 Min 11 54 50 Min 11 54.05 55 Min 11 54.1 1 Hr 11 54.1 1 Hr 10 Min 11 54.25 _ Vanguard Laboratory 2635 Parkmont Lane SW, Suite A Olympia WA 98502 v.xoaear, 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County Collected Mason 07/22/2025 3 45 ❑AN •PAI oaun Day Yea Type of Water System(check only one box) ❑Group A ❑Group B l Other Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# _System Name: Mel Enger Contact Person:Arcadia Drilling,Inc Day Phone:(360 )426-3395 Cell Phone:( ) Email: Eve.Phone:( ) Send results to'(Prnt full name,address and zip code ore-mat) arleta@arcadfadnning corn AND jeanaarcadiadri4m9.com SAMPLE INFORMATION Sample collected by(name): 1170 E Bertelsen Rd Specific location where sample collected: Special instructions or comments BQC169-1170 E Bertelesen Rd,Shelton Type of Sample(select only one type of sample from types 1 through 5 below) 1.0 Routine Distribution Sample(ALP) 2 0 Repeat Sample(AJP) Chlorinated:Yes No_ (fromdistribution system after unsal routine) Unsatisfactory routine lab number Chlorine Residual Total_Free — — 3 Ground Water Rule Source Sample Unsatisfactory routine collect date. ISI Chlorinated Yes No ❑Triggered(ArP) Chorine Residual:Total__Free ❑Assessment (A/P) 4 Surface or GWI Raw Source Water Sample(Enumeration) ISI I I ❑E.coli ❑Fecal FAxed Yes No 5.(]Same Collec�d for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and X)Satisfactory ❑E.coli present ❑E.coF absent Bacterial Density Results.Total Coliform I100m1. E.coli__ _ 1100ml. Fecal Coliform_ /100m1. HPC /1 ml. Replacement Sample Required: ❑TNTC 0 Sample too old ❑ Sample Volume 0 Damaged Container 0 Da! "T�me R ved lax Reference Number � 5. lip on Receipt Temp • McNCA Code: 4.a S1n-P'2-t e) Date Reported to DOH Lab Use Only DOH Lab-Samples 285- 72322 DON F•r'031119 teNar.sell)•1 rw:wed lus c!CMaem e n AWN..treat ad 300 525 0121 CrDCI17r.ar 7!•) *es r0 see POwNma Is mind*Vow.0m n OTn0mr0+.e1( 2231274 MASON CO WA 09/26/2025 02 40 PM NOTCE ENGER, MELVIN 0214489 Rec Fee $304.50 Pages 2 INIl�IU0I II nil IIII IIII N 1Nll II 11118111 IIII P Return To &yes SQ �3gl E SR. 3 � r� S 6 tio1 E 6y Grantor(s): (I) 1At1v;n A_SQr —, (2) Grantee(s):(I)PUBLIC Legal Description(I) i—Ot 2 of 4.S 'd (S-tlS. hF a' zit-srrt, ?Ty, d ow see 7 4 s tf 5 (Abbreviated Pm:i.e. lot,block.plat or section,township.range) Mg-so/es Tax Parcel:(I) Z? 00 7- 7 7 - SO02.0 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) Z 2 0 0 7 ' Z Z. - S'0 O 2 0 —_ Tax Parcel:(Connection 2) 2 2 O b 7 - Z2 - S O O ZO The system owner is responsible for keeping this system in compliance. The name of the water system is: ,ri.a � (V7 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 I $ day of ,2015_. Signature of Grantor(s): (I) ,(2) Page I of 2 1 State of Washington County of Mason I, the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this $ day of SJA , 20 2 S , �pope personally appeared before me,who 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. ,•r�p�w,L ,,,,,, 'Q(`C..K scy _!fel.,- Notary Public in and for t e State of Washington, •.1- •t, residing at ROAM CAVn4 I • NOTARY os o: s My commission expires: 2 4 T3 to 21 t c, PUBLIC -7?•.• at° t o •• a Page 2 of 2 k II I a i V 1 m " w o e i ili g Qoto e g U y N8 n FI p C u 4 V a z M h Jy P. r 0 V $ ` �� Y Z' § : i Q M W Z �+mH� • ^' i J M $ • F. TA" i Cr Nye Z swno ,,\ R g w 1' �3 Y 1 Y. J 1, ■ Q c Vi ® p it GC 6 Z Suz O 'h ►z ► Fes. Ca O .a 0 V I i WC Q , <ZnIC1.; NM t1 , N rZ V. It.11, Uv.v \ M� IOV p \ oa T. WWI 0 J Q :i —k,--- Itl, , _...,t .c'...P v. 4 Zn N ri o � ' ` _ ---- fnurrx� N N _ acy a / r— ----I / r I v a I _ I Q +� / / L i M W 1— — I_ g � Lam / J � ° " t o`h . "1: ^ _ N T : . 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