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HomeMy WebLinkAboutWEL2025-00102 - WEL Application, Design, Letter - 9/24/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 J L BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 09/24/2025 DEWEY NANCY 1830 E BROCKDALE RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00102 XX SE Dusty Ln 319027590033 The 2-party water system, The Rosemary (319027590033/319027590021), 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 2, MASON COUNTY Date Received: 081 - 9 a5 r r COMMUNITY SERVICES Amount Received: 5100 Received By. cle� p Building,Filming,Environmental Health Community Health v`�- 415 N.6`"Street,(Bldg 8)-Shelton,WA 98584 W E L P 09,6- o C 102 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION I APPLICANT Nall f/ PHONE(% 9o- 3�3 MAILING,ADDRESS-STREET,CITY,STATE. I )30 E- -rockca e iA NICEM ,Lrli SITE ADDRESS-STRF.F.T,CITY.STATE,ZIP �� 33 S� / n_ PRIMARY PARCEI.NUMBER(WELL SITE) l' AUG 2 9-2025 ip) 3I qo2 -7S - g0033 SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) 31 qoz— .15 — 9 0021 By .NM -- WATER SOURCE SOURCE TYPE PARCEL LOT SIZE(no • • •• - - •' • ' New Existing 1 W Well . Spring l„(2,2 a.ureS -. .1..,$2 ct.:.reS PROPOSED WATER SYSTEM NAME.(REQUIRED). The. eOsGP-,0.r-// PROJECT DESCRIPTION(e.g.,detached ADU,new single-family residence,existing connection.etc.) New CorskrucK or DIRECTIONS TO SITE/CONDITIONS/GATE CODE I KEY LOCATION/ETC. Hwy tot ti Lefton Lyv,ol-►, Lect-otn 11'h;t(i Rd y Qj-,t en 71 usfi/ Ln, LeFt"on eriY e ec)) 15' ? t pehj on 661,i- 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.) ee oick Neck 1()Iot" plcor) Required Submittals Checklist: (additional information located on the first page of this packet) Satisfactory bacteriological test from within the last year 113 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 N;tfe 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 1 of 2 Staff Use Only Review Step 1: Well Site Inspection: YES N/O O 0 Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks,buildings;indicate distance on plot plan) ❑ , 0 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) X ❑ ElDoes the ground slope away from the water source site? � ❑ ❑ S• atisfactory well cap? XI 0 0 W• ell cap screened and vented? t. 0 The well casing extends (6 above level t and/,•ncrete slab?(circle one) le 0 0 Well tag attached to well casing? Lat: 4a•10/6 ❑ Jr 0 Evidence of an adequate surface seal? Lon: •1Z1.0t5f11 ❑ 0 0 Variance necessary for well site approval? Tag. ggm 5'3 Comments: .- 141f Agf /.q/ til to tetv OK' % Op? ToOviI lfe45 Qa'd fD X 'assfail Inspector Date./ IJIr __ Review Step 2: Two-Party Review: YES NO NA ff j /jl� ('- (�,.,1LrgW0/111 1 144 ❑ ❑ Water well report(well log):Date Completed '�l/�( w Z/ Driller w tom/ ❑ 0 Satisfactory capacity test showing a minimum of 800 GPD with full recovery' to static level withi 24 hours? Capacity test information:Date ii"i L��� Driller/Pump Installer`W i" k(/mi GPM i 7 Duration(minutes) 10 J Total Gal I q( 51- Recovery Time(minutes)to Static S- O 0 0 Satisfactory bacteriological analysis? Date 7(76 k/3—Testing Lab (i.( irk bib- ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN Z Z 300 14 0 0 The system appears adequate to serve two connections based on the information provided? Comments: Approved ❑ Denied Reviewer ,2 - Date ! '(V w 7j 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 WATER WELL REPORT DEPARTMENT OF Notice of Intent No. WE59626 ECOLOGY Unique Ecology Well ID Tag No. BNM813 Type of Work: State of Washington l Construction Site Well Name(if more than one well): WELL#1 ❑ Decommission c i Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: ❑a Domestic Li Industrial ❑Municipal Property Owner Name DEWHILL HOMES LLC ❑Dewatering ❑Irrigation ❑Test Well 0 Other Well Street Address DUSTY LN Construction Type: Method: New well ❑Alteration 0 Driven LI Jetted LI Cable Tool City SHELTON County MASON ❑Deepening ❑Other 0 Dug 0 Air- ❑Mud-Rotary Tax Parcel No. 319027590033 Dimensions: Diameter of boring 6 in..to 180 ft. Was a variance approved for this well? ❑Yes ❑No Depth of completed well 180 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread p I ❑ 6 in. +1 170 .250 in. c I ❑ O I 0 Location(see instructions on page 2): O WWM or❑EWM ❑ I ❑ in. _ _ in. ❑ 1 ❑ ❑ 1 0 NE '/a-Ya of the NE 'Vs;Section 2 Township 19N Range 3 ❑ 1 ❑ in. _ in. ❑ 1 ❑ ❑ 1 O ❑ I ❑ in. _ _ in. ❑ I Latitude(Example:47.12345) 47.16914 Longitude(Example:-120.12345) -123.01593 Perforations: ❑Yes ❑a No Type of perforator used No.of perforations Size of perforations in by in. Driller's Imp/Construction or Decommission Procedure Perforated from_ft.to ft.below ground surface Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: Yes LI No (!a K-Packer ° Depth ft. information. Use additional sheets if necessary. Manufacturer's Name Material From To Type STANLESS Model No. Diameter 6 in. Slot size 10 in.from 170 ft.to 180 ft. CLAY&SAND BLUE 0 95 Diameter in. Slot size in.from ft.to A. CLAY&GRAVEL W/WOOD BLUE 95 100 Sand/Filter pack:U Yes Et No Size of pack material_in CLAY&GRAVEL BLUE 100 115 _ CLAY&GRAVEL WOOD BLUE 115 130 Materials placed from ft.to fl. CLAY&GRAVEL BLUE 130 160 Surface Seal: Ill Yes ❑No To what depth? 20 ft. GRAVEL H2O BLUE 160 180 Material used in seal BENTONITE Did any strata contain unusable water? 7 Yes [No Type of water? Depth of strata Method of sealing strata off Pump: Manufacturer's Name GOULDS Type: SUB II.P. 1 l Pump intake depth:160 ft Designed flow rate: 18 gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing 1 ft.above ground surface Static water level 122 ft.below top of well casing Date 8-4-25 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No C[Yes C> by whom? Yield 19 gpm with 14 ft.drawdown after 4 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 Bailer test gpm with_ft.drawdown after_hrs. Air test_gpm with stem set at_ft.for hrs. — Date Artesian flow gpm _ Temperature of water °F Was a chemical analysis made? Ll Yes No Start Date 7-21-25 Completed Date 7-30-25 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. I]Driller 0 Trainee 0 PE—Print Name MADI TROTTER Drilling Company COOLWATER DRILLING,INC. Signature Address 10921 NW HOLLY RD License No. 3367 City,State,Zip BREMERTON WA 98312 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.COOLWD1941QM Date 8-2-25 ECY 050-1-20(Rev 11/18) If you need this document in an alternate format,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. COOLWATER DRILLING, INC. 10921 HOLLY RD NW BREMERTON, WA 98312 360-830-9005 46, *di.s ) <2 COOLWDI941QM iP4-0 4. Fo CUSTOMER NAME DATE 8-4-25 DEWQHILL HOMES LLC CUSTOMER ADDRESS 319027590033 TIME STATIC GPM TIME STATIC GPM 122 05 133 19 120 136 19 10 136 19 135 136 19 15 136 19 150 136 19 20 136 19 165 136 19 i 25 136 19 180 136 19 30 136 19 205 136 19 45 136 19 220 136 19 60 136 19 235 136 19 75 136 19 245 136 19 90 136 19 105 136 19 RECOVERY STATIC RECOVERY STATIC TIME 136 TIME 05 122 30 10 45 15 60 20 75 25 90 Assimmismulolatolut- 26276 Twelve Trees La NW Ste•C 41 SPECTRA Laboratories - Kitsap Poutsbo,WA , ...Where ever-kw'.natters 98370 (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County Collected l Day ?� O O GAM d d 5As0r' Mail D Type of Water System(check only one box) 0 Group A ❑Group B [}other Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): IDS 1 System Name: duS� L/J Contact Person: Cool t v A 1 t it 6 R L'L 1-Lr o'( Day Phone: 34 6 $3 0-. 5'O O Y Cell Phone: Email: Eve.Phone: Send reels to:(Print too name.address end rip code or email above for electronic copy of results) toot4iA-rct.7stZtL (-' /449rA4 ate �•¢.,L SAMPLE INFORMATION Sample collected by(name): Goo(-Loh if Specific location where sample collected: Special instructions orcomments: Quszy Lr' Type of Sample(check only one box) 1.0 Routine Distribution Sample(AIP) 2.❑ Repeat Sample(A/P) Chlorinated:Yes ID No 0 (from distribution system after inset.routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: ISI I I I I Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residual:Total_Free_ ❑Assessment(A/P) 4.Surface or GM Raw Source Water Sample(Enumeration) I S I I I ❑ E.coil 0 Fecal Filtered Yes No 5.[fmpe Collected too Information Only Private Reaidance U Cambia Rep** LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and pu Satisfactory El E.coli present ❑E.col/absent ✓ Bacterial Density Results:Total Colifonn mpn/100m1.E.cobi mpn/100nN. Fecal Co liform cfull00ml. HPC cfu/1ml. Replacement Sample Required: 0 TNTC 0 Sample too old ❑ Sample Volume ❑Damaged Container ❑ ° ps is !3 -0 Lab Receipt Temp C': Method Cod ��OT-COUNTI SM9222D Date In: bateOur:EIS � iHfnDdnhhsued elluea(Npweworfarawe,n 1�11WU! 6 0Ue• drecipient 00aaW.Aryuawprigadrinrra caw MlYYr /Si r 2025 • need red? u wiliac/d.I re NW 00-7aSill usndw p1 fna.Desna noY/OM sweet ImYdaPly r 3e0-Try$1e 1 r/ld darioy 9is teDat vaMy. DOH Lab-Sample# These/��f(OI These mores aisle e aoy the e lo rx tested Me MsanpNs)n 010- `"I// `r/ na0cd by he bEvato y.This rectal w not be reaodund fso n!!.11amas Drier wets verities amoral by Swan Iabeetr . DOH Fain ea31-319 Wee**daily) • , 2230049 MASON CO WA 08/2912025 11:21 AM NOTCE 11111III 111II111111111�11 II11i111II I111111I Sul11111111 2 Return To v� II/1 (AI (r),.(Ax,9 AUG?92025 t 0,t1.3 0 focicciaL kat REcE/'E° Grantor(s): (I) Na V �'v eti •(2) ` i&r 1M 'Pew� `� J Grantee(s): (1)PUBLIC Legal Description (1) I r SP S8 3 1 r I of- .S t' sg 502 P 3 (Abbreviated form:i.e.lot,block,plat or section,township,range) Assessor's Tax Parcel: (i) 31 9 t)L- 75` i 00 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: 2 (kveti ) Tax Parcel:(Connection 1) 3 ( g C n Z - i J - cl D O 3 3 1 Tax Parcel:(Connection 2) 3 Q 0 Z — 7 c - Ct 00 Z The system owner is responsible for keeping this system in compliance. The name of the water system is: 1 f.te_ 2SeXy\ This system is designed to p,'ovide 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 Zci day of K115 OS T ,20 Signature of Grantor(s): (1) ffa4/1ACIA/7 ,(2)— Page 1 of 2 State of Washington County of Mason i,the undersigned,a Notary Public in and for the above named Cony and State,do hereby certify _ that on his _ Ah'day of St ,20 a, t_( ✓ personally appeared before me,who is known to be 1 signer of the�bove instru ent,and acknowledged that he(she)(they)signed it. GIVEN under my hand and official seal the day and year last above written. (::::=3/ Notary Public and for the State /of Washington, TAM Notary L HERRING residing at L5r`e/ft✓1 t[V& I4' y�©h Notary Public ( / (7 / �1q State of Washington My commission expires:v� . / /`Ji Commission#41438 My Comm. Expires Jan 17.2029 Page 2 of 2 'fire ICC6EPIFIRN- 33 - , 9,,z.teoseD- • 2G6. 86 :.... -f- .. .j MIIIMIIIIP 4.1115''' I 4 1 1pi 1 1 D(�tvu.� ,! yk kIll‘ Q it Ti,.EIt J \ \\ iL__. il ..4 00 I 4- I ti _. C —r ° � e- 30—;r ® °® ° K5)3° x40 3 F1 rWa-a I ()(7 u)1 114 g-g6"6 ) z i GO' .E.1.15i lt.iCr r JA-r- R...L i. s z. 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