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Home My WebLink AboutWAT2025-00165 - WAT Application - 9/26/2025 WAT 2025-00165 415 N.611'Street helton,WA 98584 MASON COUNTY S Shelton:360heltoE 504 COMMUNITY SERVICES Belfair:360-275-4467,Ext.400 ,ty Elm:360-422-5269,Ext.400 Budding.Planning Errvuoninentnl Health,Community kieaMh �ta. Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application, with any required attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel IdentificationLtI 7 _ Name on Applicant:-{Q r Y( M q/15koY Ma-- Date: k( 2S 1232i Mailing Address: Mg"� ,�, U 1(J fkt adtlA Phone: S t4+.i- 0 -A W Parcel Number. 3.2_,02,2_,Lia 3 Z0 Type of Water System Reason for Application 0 Public/Community Water System (2 or more Building permit connections) 0 Division of land: Individual water source (one connection), #of Parcels? SPL air Well 0 Boundary line adjustment 0 Spring/surface water ❑ Other(explain) ❑ Other(explain) 0 Replacement or Remodel (please indicate name If you have more than one residence connected of water system below if applicable-no to this well, check the Public/Community Water signature required) System box. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory(WFI)Number: (write"none"for two-party) ❑ I am the manager of this water system.The water system has been approved for services. There are presently connection(s) in use.This will be the connection. ❑ I am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date This form may be scanned and available for public view at www.co.mason.wa.us. Revised 4/4/2018 J:1EH Forms/Drinking Water Individual Water Well Water well report(attached to application). Depth a ft. Lti' Well capacity Test(attached to application) (iJn qpm >400 qpd. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test,which provides stabilization of draw-down and recovery data,must be performed by a licensed contractor. Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://ais.co.mason.wa.us/planning 14 15 16 22_ Water use or limitation recorded N/A Yes Well Drilled Date Individual Spring/Surface Water O WDOE permit(attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source can provide at least 800 gallons per day;and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant • • Part 3: Mason County Community Services Evaluation (staff use only) 2 Satisfactory Determination: This determination does not address adequacy of the distribution system,guarantee an adequate supply of water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,title 6,Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. J Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: c (/. p5(l - 9/26/25 Environ. Health: Date This form may be scanned and available for public view at www.co.rmasomwa.us. Page 2 oft astir tlt..° .- :.. WATER WELL REPORT (4,111 DEPARTMENT OL Notice of Intent No. WE40656 DLL 2 n 2iLi) ' ECOLOGY Unique Ecology Well ID Tag No BMS019 • Type of Work: igg State of washington WA State [? pa j)j l) J Construction Site Well Name(if more than one well): _) Dccmnunission r . Original aulatluiat t01 No. Water Right Pcrnlit/Cettiftcate No. o Ec®lL y (SWRO) Proposed Use: "!l Domestic 0 Industrial 0 Municipal Property Owner Name Logan Spear ❑Dewotcrirmg 0[rogation C_t Test Well 0 Other — Well Street Address SE Old Arcadia Rd Construction Type: Method: New well 0 Alteration 0 Driven 0 Jetted 0 Cable Tool City Shelton County Mason 0 Deepening Cl Other ❑Dug Gl Air- ❑Mud-Rotary Tax Parcel No. 32022-46-00320 Dimensions: Diameter of boring 6 in.,to 203 ft. Was a variance approved for this well? 0 Yes C No peculiar completed well 203 ft. Contraction Details: Watt — If yes,what!Ws the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread WWM or❑EWM p i El in. 0 197 .025 in. [ 1 ❑ h I El Location(see instructions on page 2): ❑ I 0 in. _ _ in. ❑ { ❑ ❑ i ❑ SE '/.-'lr of the SW ''/r;Section 22 Township 20N Range 3W ❑ 1 0 in. _ in 0 1 0 010 _ • 1 n in. M. ❑ 1 ❑ 010 Latitude(Example.47.12345) 47.2001516 Longitude(Example:-120.12345) -123.0462571 Perforations: 0 Yes NoType ofperforator used Driller's Log/Construction or Decommission Procedure No.of perforations Size of Ixrfsntauons__ tn.my in. Fomenion'Describe by color,character,size of material and,mkture.and the kiwi and Perforated lino —ft.to_ft.below ground surface nature of the material in each layer penetrated.with at least one entry for each change of V Screens: Yes ❑No IS-Packer '' ) Depth 180 ft. information. Use additional sheets if necessary. Manufacturer's Name Alloy Machine Works Material From To 2 Type Wire Wrapped Model No. Brown gravelly fine sand some silt,tight,dry 0 24 R Diameter 5 Slot size.010 in flour 196 ft.ID 201 R- 24 24 Diameter Slot sine in.front ft.to ft. Brown medium to coarse sand,tight,moist _ Brown gravelly fine sand,siltboutld,tight,dry 29 41 SurnUFiltcr pack:G Yes L No Size of pack material--;". Brown gravelly medium sand,active,wet 41 78 I Materials placed from _ft.to_ft Brown silt,tight, 78 93 Surface Seal: W1 Yes 0 No To what depth? 19 ft. Gray silty clay,,dry dry 93 111 o Material used in seal Bentonite Chips Black sharp medium sandy gravel,tight,dry 111 127 Did any strata contain unussable water? Q Yes F7 No Black medium sandy gravel,gray silly clay 127 • L type of water? Depth of strata_ 169 o binding,tight,dry o Method of scaling strata off., Black medium to coarse sandy gravel,light, 169 c 194 a Pump: Manufacturer's Name Type. — Wee.S a Itp, Pump intake dgnh: ft. Designed flow rate: get"' Black fine sand,active,water 194 202 o Gray clay,stiff,dry 202 203 3 Water Levels: Land-surface elevation above mean sea level 191 fl C Stick-up of trip of well casing- 1.5 ft above ground surface Static water fcvel 146 ft,below lop of well casing Dade 10/27/20 — Artesian pressure lbs per square inch Date - '- Artesian water is controlled by (cap.valve,etc.) - c - i- Well Tests: Was a ptunping test perfomned? 0]No 0 Yes u ) by whom? _ Yield gpm with fl.drawdown after Ins. Yield gpm with ft.dnaw'dowo after lira Z Yield gpm with_____fL drawdown after_hrs. _.—..._.. __ a Recovery data(time zero when pump is tined off•water level nxastaed from well o top to water level) — t7 Tax Water level Trine Water tenet Time Wales level •C — V ____ L t)atc of pumping test o nailer test gpm with ft.drawdowa alter_bra. Air test 20 gpm with stem set at 180 ft.for 1 his. - Date 10/27/20 Artesian llow_gpm Temperature of water 51 "F Was a chemical analysis made? 0 Yes 17 No Start Date 10/26/2020 Completed Date 10/27/2020 L �. WELL CONSTRUCTION CERTW1CA110N !constructed andior accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the infonnation reported above are true to my best knowledge and belief. .c 'Driller 0 Trainee 0 PE Pt- nt Name Roger Phythian Drilling Company Arcadia Drilling Inc. 5ignSignature �' - l / Address PO Box 1790 License No. 2053 City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No. Contractor's censor's Signature ____ Registration No.ARCADDI098K1 Date 10128/2020 ase call the r s ram at ECY O50so r Ow with g If loss cat,call 711 for Washington Relay Service.0 need this document in an alternate a Pero s with a speech disability ova call 877.833- 3 i�72. Persons hearing Vw t nuns Inc. 340 W('cwie Tarm�d ?3eyair,'Wa 98528 (360)801-6107 Project Capacity Test TAG: BMS019 433 SE OLD ARCADIA RD, Shelton WA Date 9/26/25 Pump 18cs20 Well Depth 197' Static Water Level 145.1 Draw Down Recovery Time Water Level GPM 0 159.8' 0 min 145.1 0 1 min 151.2' 5 min 158.5' 24 2 148.7' 10 min 159.6' 24 3 147.5' 15 min 159.7' 24 4 147.0 30 min 159.8' 24 5 146.7 1 hr 159.8' 24 10 146.0' 2 hr 159.8' 24 20 145.4' 30 145.4' 40 Capacity Notes: Pump cycling on arrival at capacity test -very small leak detected in system - unknown location Filtration recommended- sulfur smell detected on capacity Vanguard Laboratory •? 2635 Parkmont Lane SW '.•,:m•' Olympia,WA 98502 360.967.7010 VANGUAlt ,b. Report of Laboratory Analysis LABORATORY Collected by: Davis Pump Inc Matrix Drinking Water 360-329-2699 Laboratory ID: V250808-14 Sampling Address: Date Sampled: 8/8/25 13:20 433 SE Old Arcadia Rd Date Received: 8/8/25 14:30 Shelton,WA 98584 Date Reported: 8/11/2025 Sample ID: 433 SE Old Arcadia Rd Analysis Result SDRL MCL Units DF Date Analyzed Total Coliform&E.coli by SM 9223B(IDEXX) Batch ID:V250808-14 Analyst:IT Coliform,Total Negative 1 1 MPN/100 mL 1 8/8/25 16:29 E.coli Negative 1 1 MPN/100 mL 1 8/8/25 16:29 Notes: MPN:Most Probable Number ppm:parts per million nd:non-detect Reviewed by Dustin Newman,Laboratory Director on 08/11/2025 n/a:not applicable SDRL:State Detection Reporting Limit Approved by Tori Johnson,Operations Manager on 08/11/2025 DF:Dilution Factor 17625:2•17 MCL:Maximum Contaminant Level i�i,! aCe�rrsn Liknotworty Samples were received in acceptable condition.The result(s)in this report relate only to the portion of the sample(s)tested.All analyses were performed consistent with the Quality Assurance program of Vanguard Laboratory.Please contact the laboratory if you should have any questions about the results. 2635 Parkmont Ln SW,Suite A,Olympia WA 98502 I Office:360.967.7010 I testing@vanguardlaboratory.com www.vanguardlaboratory.com 1 of 1