HomeMy WebLinkAboutWEL2025-00100 - 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
Johnston, Brittney
21 E Wrangler Ridge Rd.
Union, WA 98598
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL 2025-00100
21 E Wrangler Ridge Rd
321053490010
The 2-party water system, Johnston Ridge Water Supply, 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
MASON COUNTY Date Received: 94 / W
-F4177 COMMUNITY SERVICES Amount Received 6,t Received BY
Building Planning Environmental Health,Community Health , 'SGd Onl/i-e
415 N.6th Street,(Bldg 8)—Shelton,WA 98584 WEL Z#z$-Od 0
Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400
(
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT /1��' j Oh PHONE 3 ^ / f6,3 ^ 6 /r
fifici
MAILI AttDi al,`STREET, ITY, TE,ZIP 'el le R-d (flan/ Lii9 9t c9S
SITE ADDRESS-STREET,CITY.STATE,ZIP
Same.
PRIMARY PAR*ICEELLNUMBER
(W(WE LSITE)
SECONDARY PARCEL NUMBER(S ME AS Y I LOCATED ON SAME PARCEL)
W AE Z l ' w Y Y - f JO I 0 SOURCE TYPE PARCEL I LOT SUE(no minimum) PARCEL 2 LOT SUE(no minimum)
C. New 7xisting )(Well Spring 9. 90 ..
PROPOSED WATER SYSTEM N (REQUIRED). !_
'lfoh*it r t ( aa& ti kc Sc,
PROJECT DESCRIPTION(e.g..detached ADU,new'tingle-ramJy residence,eziati oon a)
SCcot id cone i .t fa-_`
DIRECTIONS TO SITE/CONDITIONS/GATE CODE/KEY LOCATION/ETC.
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,water lines,prope . - sements,etc.)
SFp ..t.
'p o,r ea,
i`FO
Required Submittals Checklist:(additional information located on the first page of this packet)
X Satisfactory bacteriological test from within the last year
tia Well report with well tag number,well tag secured to well casing,and capacity test showing 800 gal per day
I.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 are no septic records on file)
This form may be scanned and made available for public viewing on the Mason County website. Revised:07/23/2025
Page I of2
--- ------------------ Staff Use Only -----------------
Review Step 1: Well Site Inspection:
YES N N/O
❑ ❑ 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)
to ❑ ❑ Does the ground slope away from the water source site?
El ❑ Satisfactory well cap?
X ❑ ❑ Well cap screened and vented?
❑ The well casing extends I above leve grou • concrete slab?(circle one)
4 0 0 Well tag attached to well casing?
Lat: yi 336.?
0 0 Evidence of an adequate surface seal? Lon: —1t=.0 4fJ
❑ yl ❑ Variance necessary for well site approval? Tag: ALA/013
Comments:
Pass ❑ Fail Inspector 12 Date 7/Ifi?e?S°.
Review Step 2: Two-Party Review:
YES NO NA y(I7/ Y'F Ik'6?d&Q
1I1❑ ❑ Water well report(well log):Date Completed Driller n'l •
❑ ❑ Satisfactory capacity test showing a/minimuum of 800 GPD with full recovery to static level wit n 24 hours?
Capacity test information: Date 7(3()W`/ Driller/Pump Installer Il' alj MI.
.
GPM I Duration(minutes) 60 Total Gal t ORD Recovery Time(minutes)to Static T(~
X ❑ ❑ Satisfactory bacteriological analysis? Date $(Z6(ZO ZSTesting Lab 1 k I I, Al 6
Y] 0 0 Signed,notarized,and recorded notice to future property owners?AFN 2 ZZ 1 /i
❑ ❑ The system appears adequate to serve two connections based on the in,fpnlation prQ d?
a
Comments: oNC0�NryFN 9 20?S
y4)�
/ Approved El Denied Reviewer Date ly
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
This form may be scanned and made available for public viewing on the Mason County website.
Page 2 of 2
1011 WATER WELL REPORT `sF,o 442
u co 2o0co -owner, 3ro copy-driller CURRENT
Original&1 copy Ecology, copy <2 n
h t i t�ii t'1 Notice of Intent No.W23728I • J' O
Construction/Decommission('x"in circle) 1 a
Q Construction `( / Unique Ecology Well ID Tag No. ALN013 F/ _ S
Ei Decommission ORIGINAL INSTALLATION Water Right Permit No. EXEMPT WELL
Notice of Intent Number Property Owner Name SCOTT EICHHORN
, PROPOSED USE: ❑x Domestic ❑ Industrial ❑Municipal
0 DeWater 0 Irrigation ❑Test Well ❑Other Well Street Address MCREAVEY ROAD
TYPE OF WORK:Owner's number of well(Ifmore than one) City SHELTON County MASON
x❑ New well ❑Reconditioned Method: ❑Dug ❑Bared 0 Driven
U Deepened (]Cable ❑Roomy ❑ Jetted Locations_1/4-1/4 SW 1/4 See 5 Twn21N R 3W EWM 0 Check
or
DIMENSIONS:Diameter of well 6 inches,drilled 374 ft. (s,t,r Still REQUIRED) or
❑. One
Depth of completed well 374 R.
CONSTRUCTION DETAILS Lat/Long Lat Deg _ Lat Min/Sec
> OWelded .
Casing 6 ' Diam from + R.1.5 fl to 374 ft.
Long Deg long Min/Sec
Installed: CI Liner installed Diem.from fl.to ft
❑Threaded " Diem.From fl.to ft. Tax Parcel No.(Required) 321053490010
Perforations: ❑Yes ❑x No I I P9OCEDDRE
Type of perforator used Formation:Describe by color,character,size of material and structure,and the kind and
SIZE of in.by in.and no.of perfs from ft.to R. nature of the material in each stratum penetrated,with at least one entry for each change
Peifs of information. (USE ADDITIONAL SHEETS IF NECESSARY.)
Screens: Oyes :No ❑K-Pee Location _ _ MATERIAL FROM TO
Manufacturer's Name SILTY SAND AND GRAVEL 0 3
Type Model No. SILT BOUND SAND AND GRAVEL 3 210
Diam. Slot size from ft.to ft' BROWN SILT AND GRAVEL 210 230
Diam. Slot size from ft.to ft.
GRAVEL,SILT,WET 230 290
Gravel/Filter packed: 0 Yes 0No Size of grzveUsand GRAY CLAY 290 310
Materials placed from R.to ft.
GRAY CLAY AND GRAVEL 1310 317
Surface Seal: Yes 0 No To whet depth? 20 R' BROWN SILTY CLAY,SOME GRAVEL 317 330
Material used in seal BEN"IONITE CHIPS BROWN SILTY SAND,GRAVEL,WET 330 350
Did any strata contain unusable water? ❑Yes 0 No GRAVEL,SOME SAND,WATER 350 360
Type of water? Depth of strata _BROWN SILT BOUND SAND,GRAVEL,WITH 360
Method of sealing strata off SEAPAGE I 370 _
PUMP:Manufacturers Name GRAVEL,WATER BEARING 370 374
Type: H.P. _
WATER LEVELS:Land-surface elevation above mean sea level ft. -___
Static level 271 R.below top of well Date _4/17/07
Artesian pressure lbs.per square inch Date —
Artesian water is controlled by (cap,valve,etc.)
WELL TESTS:Drawdown Is amount water level is lowered below static level
Was a pump test made? 0 Yes ❑x No If yes,by whom?
Yield: gal./min.with ft.drawdown after hrs.
Yield: gal/min.with ft.drawdown after hrs.
Yield: gal./min.with ft.drawdown after hrs.
-
Recovery data(time taken as zero when pump turned off)(water level measured from well 0}w.,,,4 �J�
-
top to water level) ill 1�• r 1�g'�': I
Time Water Level Time Water Level Time Water Level
6...
- i�A�"'t fii
- — V�4tshirgcon State
Date of test
Bailer Test 20 gal./min.with 20 ft.drawdown after 5 hrs. Lepartlrl f'lll t }
o Ecology
Airiest gal./min.with stem set at ft.for hrs.
Artesian flow gp.m. Date
y ❑ Q No Start Date2/15/07 Completed Date 4/17/07
Temperature of water Was a chemical analysis s model Yes -�
WELL CONSTRUCTION CERTIFICATION: 1 constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well
construction standards.Materials use.1 and the information reported above are true to my best knowledge and belief.
[]Driller0 Engineer❑Trainee Name(Print) MARK H.NELS Drilling Company ARCADIA DRILLING INC.
Driller/Engineer/Trainee Signature � A / J' Address PO BOX 1790
Driller or trainee License No. 1992 City,State,Zip SHELTON , WA , 98584
fIF TRAINEE:Driller's License No: Contractor's
IDriller's Signature: Registration No. ARCADDI098K1 Date 4/17/07
ECY 050-1-20(Rev 4/07) Ecology is an Equal Opportunity Employer
Arcadia Drilling Inc.
P.O. Box 1790
Shelton, WA. 98584
Customer: Brittney Johnston Well Tag #: ALN013
Site Address: 21 E Wrangler Ridge Rd, Union Depth: 374'
Date of Test: 7/3/25 Static: 340'
Pump Set: 279.8'
TIME GPM LEVEL RECOVERY
1 Min 18 286.6 TIME LEVEL
2 Min 18 291.9 1 Min 290.4
3 Min 18 296.3 2 Min 285.5
4 Min 18 296.7 3 Min 282.9
5 Min 18 297 4 Min 281.5
6 Min 18 297.3 5 Min 280.8
7 Min 18 297.6 6 Min 280.4
8 Min 18 297.8 7 Min 280.2
9 Min 18 297.8 8 Min 280
10 Min 18 297.8 9 Min 279.9
15 Min 18 298 10 Min 279.9
20 Min 18 298.1 11 Min 279.8
25 Min 18 298.2 12 Min 279.8
30 Min 18 298.2
35 Min 18 298.3
40 Min 18 298.3
45 Min _ 18 298.3
50 Min 18 298.3
55 Min 18 298.3
1 Hr 18 298.3
Total Gallons Pumped: 1080
Thurston County Environmental Health
if' 412 Lilly Rd NE to Olympia,WA 98506
360 867-2631
THURSTON COUNTY
COLIFORM BACTERIA ANALYSIS
Date Sample Collected Time Sample County
Collected
06 1237 26- \ \ ‘5 f•ioA
Month Day Year
Type of Water System(check only one box) Private Household
0 Group A 0 Group B 0 Other
Group A and Group B Systems-Provide from Water Facilities Inventory(WFI):
ID# _
System Name: , 1
Contact Person::\i k ,j av-,s 1 yV!'1
Day Phone:( ) 5timt Cell Phone:O(au� (,,�3O(g
E-maiLCa��th �O���h'�%\
Eve.Phone:.{..--�..\"
Send results to:(Print(till name,address zi a2de or email ad r s)
cat_v_ r___o'-l_a_C O t'Y,A�� ,Co Y r
SAMPLE INFORMATION
I .
Sample collected by(name): ;)�lle„.Y Q`,1n 5 fr
Specific location or address where sample collected: Special instructions or comments:
00 C WYtkh \tir v-0� R�4.
u c
Wpr Type of Sample(must check only one box of#1 through#4 listed below)
1.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine)
Chlorinated:Yes No 0 Distribution System
Chlorine Residual:Total Free_ Chlorinated:Yes No
3.Raw Water Source Sample Chlorine Residual:Total Free
❑E.coli-GWR(AfP)
❑Fecal-Solace,OWL springs(numeration) Unsatisfactory routine lab number:
Filtered:Yes No
— ___ -
❑Assessment Monitoring(AIP) Unsatisfactory routine collect date:
DOther 1 I
S \
..Sample Collected for Information Only 0-party W t.1,
Investigative Construction I Repairs Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
0 Unsatisfactory Total Coliform Present and SatisfactoryNo. oliform detected
❑E.coli present 0 E.coli absent
Replacement Sample Required:
❑Sample too old(>30 hours) ❑TNTC 0
Bacterial Density Results:Total Coliform _l100m1. E.coli /100m1. I
Fecal Coliform /100m1 Enterococci 1100 ml.
Method Code:ISLSM 9223B ❑SM 9222D Date and ihe Recei
L
�/ C
❑SM 9215B 0 Enterolert0 V /5
Date and Time Analyzed: ' ).to -25 Date Reported:t6 Z1.y-5V(
Sample Number(DOH number plus five digits) Lab Use Only:
l
0 8 0 .L.4- G1 c,,
%
L °ate' - oot (-)v 2227936 MASON CO WA
07l1412026 12 26 P11 NOTCF
11.114. I
BR ITT TIINE`'`I JOHNSTON Y2��777 `Ryec F . f`304 50 Payers 2
i HIM Ili�i� 1 UUUI����111111�`��IIU IIIII I���h U
Return To
SEPp4L 'L5
0
Grantor(s): (1)2,CyWnfilbhvystin ,(2)
Grantee(s): (1) PUBLIC c,,
Legal Description(1) t7� i ( {,� Qr S 3x Ors i► 7�L • (f l
(Abbreviated%rm:i.e. lot, block,p at or section,townshige)
Assessor's Tax Parcel: (1) -3 2.1(J5 — ". 1-1 — q i() (D
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) )21 Q 5 ~ 3 41 - q U° 10
Tax Parcel: (Connection 2) 3 Z ) 05- - 34i - q 0010
I I The system owner is responsible fo eeping this system in compliance.
the water system is. ` Me( �U y
The name of y � � �� 1
IThis 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 1"1 day of 9 ,20 3C.
I
Signature of tor(
(1)_ _ (2)
Page l of 2
04
ai
•
State of Washington
= County of Mason
I,the undersignedha Notary Public in• ic for the above namedCounty and State,do hereby certify
that on this day ofpersonlly
eared before me,wo
signer of t above instrument,and acknowledged thatahe(she)() hey)signedh t,is known to be
GIVEN under my hand and official seal the day and year last above written.
... tttttt agabki b)(-/I3
S.:Qsy oMF <<s�, Notary Public }'n a Won,for h talc f
;�4 NCTARy N'; 's residing at ��/Jp yl
Mycommission expires: 1,, l�
21009497 p �� � a —f
N•. PUBLIC J
WAS
,
Page 2 of 2
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