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HomeMy WebLinkAboutWEL2025-00096 - WEL Application, Design, Letter - 10/15/2025 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 10/15/2025 DEWEY NANCY 1830 E BROCKDALE RD SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00096 XX SE Dusty Ln 319027590031 The 2-party water system, The Olympic (319027590031/319027590032), 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 Y _ /4 ' -, MASON COUNTY °�° 0 1 - c),9 - a o). COMMUNITY SERVICES Amount Received: Received By: citutz Building.Planning Environmental Health Community Heath $ (d) _ 415N.6'"Street.(Bldg 8)-Shelton,WA98584 r•EL .Q'b - O Shelton: 360-427-9670 x400 Belfair.360-275-4467 x400 Blma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT //� PHONE MAILING ADDRESS N r/tAi TA� 3 C.O'910 '13 5 3 �3o STREET.. $,mdc , (Zd 5k .I-4-0r WI)F) G gSg`i ,,\`( SITE ADDRESS—STREET.CITY.STATE.ZIP (,\, . \ PRIMARY PARCEL NUMB (WELL SITE) �C\ 31go2-15-9vo3�. ,``\\ V v' SECONDARY PARCEL NIISIBER(SAME S PRIMARY LOCATED ON SAME PARCEL) K'ATER SOURCE l/, /�t (`)Z 3 SOURCE TYPE / PARCEL I LOT SIZE(min I acre) PARCEL 2 LOT SIZE(min 1 sere) New Existing Well Spring Vel G It.acts, PROPOSED WATER SYSTEM NAME(REQUI FDI. Vti—k4ell T 0( {tUZE —� PROJECT DFSC ION(e. .detached ADU,env rao�Yy�ir• ,existing' commies,etc.) lirC w " .%NvAr 5075`e 'Qes\\aorce DUI2920.75 DIRECTIONS TO SITE/CONDITIONS/GATE CODE/KEY LOCATION/ETC. t-J l o( ' Turn ore6 Ly h AA - 1 By ‘)N-1 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.) le6/ ag6 s� +,� T r = Well I0ceI-io+� WI 31 - LET 32 5�� an up 01 0-DoseIlnuse 2 o' v o �` , 0, sle,c+c>, r V3 30 rz c er.�v -1- V v 31902-1c- Soo31 3141o2-15-goo32_ , Required Submittals Checklist:(additional information located on the first page of this packet) get Satisfactory bacteriological test from within the last year .' 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 of2 Staff Use Only ----------- ------------------_--_ Review Step 1: Well Site Inspection: Mt,€6 Co YES NO N/O lej ❑ 0 Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks,buildings; indicate distance on plot plan) ❑ 1t-' ❑ 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) jg 0 ❑ Does the ground slope away from the water source site? ❑ ❑ Satisfactory well cap? ❑ ❑ Well cap screened and vented?ElThe well casing extends 16 i above level ground/concrete slab?(circle one) 51' 004. ❑ Well tag attached to well casing? Lat: k 4./7015 100 ❑ Evidence of an adequate surface seal? Lon:-1?T.bl! p ❑ ElVariance necessary for well site approval? Tag: eiv s but Comments: Uf mit alfralot tevl. OW fpif ieSs c a 19 " 6 /d 113/lflS: ti d ctif ec r mil( ci4 e lu Sv w (eve'L Li( ass Fa Inspector Date V I/207J` ? i1 - NO ( l S Review Step 2: Two-Party Review: YES NO NA j,/� /, / 1 ❑ ❑ Water well report(well log):Date Completed illpog- Driller t ' n'll( isiC- ❑ ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static level wit in 24 hours? Capacity test information: Date f OO/W ZS _Driller/Pump InstallerC00llJqfr Olin / • GPMZ/O Duration(minutes) /0 c Total Gal 2(V 0 Recovery Time(minutes)to Static J vi ❑ 0 Satisfactory bacteriological analysis? Date 8751456 Testing Lab Vccffqt4b5 kite), -), 0 ❑ Signed,notarized,and recorded notice to future property owners?AFN 1?]?.56 6S' ❑ ❑ The system appears adequate to serve two connections based on the information provided? Comments: Approved 0 Denied Reviewer Date to ( /5 /Z92c 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. 4 Revised:07/23/2025 This form may be scanned and made available for public viewing on the Mason County website. Page 2 of 2 G'*104 DEPARTMENT OF Notice of Intent No. WE60253 5e0e • WATER WELL REPORT ECOLOGY Unique Ecology Well ID Tag No. BNM814 . Y Type of Work: State of Washington O Construction Site Well Name(if more than one well): #2 WELL O Decommission t=tr Original installation NOI No. Water Right Permit/Certificate No. Proposed Use: A Domestic ❑Industrial ❑Municipal Property Owner Name DEWHILL HOMES J Dewatcring ❑Irrigation ❑Test Well ❑Other Well Street Address DUSTY LN Construction Type: Method: U New well ❑Alteration ❑Driven ❑Jetted ❑Cable Tool City SHELTON County MASON Cl Deepening LI Other ❑Dug M Air- ❑Mud-Rotas Tax Parcel No. 319027590031 Dimensions: Diameter of boring 6 in.,to 170 ft. Was a variance approved for this well? 0 Yes O No Depth of completed well 170 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. +1 160 .250 in. O I ❑ O 1 0 Location(sec instructions on page 2): O WWM or 0 EWM ❑ I 0 in. — — in. ❑ I ❑ ❑ I ❑ NE %-%<of the NE 'Va;Section 2 Township 19N Range 3 ❑ 1 ❑ in. _ in. ❑ I ❑ DID ❑ 1 ❑ in. _ in. ❑ I Latitude(Example:47.12345) 47.17014 Longitude(Example:-120.12345) -123.01642 Perforations: ❑Yes ❑a No Type of perforator used No.of perforations Size of perforations in by in. Driller's Log/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 Screens: O Yes 0 No nature of the material in each layer penetrated,with at least one entry for each change of l�K-Packer b 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 160 ft.to 170 ft. CLAY&GRAVEL BROWN 0 55 Diameter in. Slot size in.from ft to ii CLAY&GRAVEL BLUE 55 65 CLAY&GRAVEL BROWN 65 80 I Sand/Filter pack:❑Yes Ill No Size of pack material in. CLAY&GRAVEL BLUE 80 115 Materials placed from_ft.to ft. CLAY GREEN 115 138 Surface Seal: A Yes ❑No To what depth? 20 ft. CLAY&GRAVEL BLUE 138 158 Material used in seal BENTONITE Did any strata contain unusable water? LiYes O No SAND&GRAVEL H2O BLUE 158 170 I Type of water? Depth of strata Method of sealing strata off 4 Pump: Manufacturer's Name GOULDS Type: SUB H.P. 1 1111ti Pump intake depth: 104 ft. Designed flow rate: 185 gpm Water Levels: Land-surface elevation above mean sea level ft. 4 Stick-up of top of well casing 1 ft.above ground surface Static water level 127 ft below top of well casing Date 8-20-25 Artesian pressure_lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? 0 No I3 Yes t=> by whom? Yield 20 gpm with 1 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_firs. Air test gpm with stem set at_ft.for_hrs. - Date Artesian flow gpm _ Temperature of water "F Was a chemical analysis made? 0 Yes O No Start Date 8-4-25 Completed Date 8-18-25 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 0 PE-Print Name MADI TROTTER Drilling Company COOLWATER DRILLING,INC. Signature ��I 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 2-21-25 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. I COOLWATER DRILLING, INC. 10921 HOLLY RD NW BREMERTON, WA 98312 360-830-9005 1 COOLWDI941QM RFcFj 9j0�s �Fo CUSTOMER NAME DATE 8-20-25 DEWHILL HOMES LLC #2 CUSTOMER ADDRESS 319027590031 TIME STATIC GPM TIME STATIC GPM 127 05 128 20 120 128 20 i 10 128 20 135 128 20 15 128 20 150 128 20 20 128 20 165 128 20 25 128 20 180 128 20 30 128 20 205 128 20 45 128 20 220 128 20 60 128 20 235 128 20 75 128 20 245 128 20 90 128 20 105 128 20 RECOVERY STATIC RECOVERY STATIC TIME 128 TIME 05 127 30 10 45 15 60 20 75 25 90 26276 Twelve Trees Ln NW �I Ste.0 1 SPECTRA Laboratories-Kitsap Poulsbo,WA -- ...Where eajerisece Ratters 98370 (360)779-5141 COUFORM BACTERIA ANALYSIS FORM Date Sample Colected Time Sample County 442, Collected PM Type of Water System(check only one box) -� RF04s �O�✓ ❑Group A ❑Group B r ‹to Group A and Group B Systems-Provide from Water Fa hies Inventory(WFI): ID# System Name: i\„ w k„. 1 1 FidtM.,i 40%2. _ Confect Person: '( t.a At lr L c/('s e> - Day Phone: 360 — ?-30 "14:04'' Cell Phone: - Email: Eve.Phone: Send mules b:(Print roe name.address aaddp cod or uRva above for electronic copy of mutts) SAMPLE INFORMATION Sample collected by(rlame)CL pc /.e Specific location where sample col cted: Special instructions or comments: cif-/ 1...." Z . Type of Sample(check only one box) 1.❑Routine Distribution Sample(ANP) , Repeat Sample(A/P) Chlorinated:Yes El No El (from distribution system after ursat.routine) Unsatisfactory routine lab number: Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: S / / Chlorinated:Yes No ❑Triggered(A/P) Chlorine Residual:Total Free_ ❑Assessment(ANP) 4•Surface or GWI Raw Source Water Sample(Enumeration) I I I i.Cob 0 Fecal Friend Yes_No 5. Collected for Information Only. Li Private Reddens Li Construction/Rewire _ikLAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and fi�Satisfactory 0 E.coli present 0 E.coli absent ✓ I Bacterial Density Results:Total Cotiform mpn1100m1.E.coli mpnllOOml. FecalCciform cfu1100m1. HPC cfu/tml. Replacement Sample Required: 0 TNTC ❑Sample too old ❑ Sample Volume ❑Damaged Container 0 Reference Nurntor Deli P ted: _____pi 1 Lab ZJ"( 1) d1 Receipt Temp CC'': Method Code:41:4 7;1,7) DT-COUNr/SM9222D AUGatteIry Date CuL TH.o is mead -use or me pow a co`i°""b AG ? 5 L 6 �� '1 odI,d&erd .... 1mp7i)"Veraoeaerr l W4R YeaOed nddera a uwdaue4 t yar here nand fro npul n srm,DYea rnMyey.eMrr iirrdsYf/a yd1779d1e7 ertl dntray Ns'report orderly. DOH Lab-Sample# `/'�� !xJ These rMUYMae M7 bar Ilan tested end Merpls(s)se 010• f v 0 1 roMd byt»YDOYay.Ten roost seal rot terpro6uad e ll re ale vital pro Horns written approval tH seeds kaxreedM 00H Fad m31419(peen 06r171 4 2228685 MASON CO WA 07/29/2025 03:24 PM NOTCE DEWEY *212384 Rec Fee: $304.50 Pages: 2 IIIIIII IIIIII III IIII IIIIIII IIIIII IIII IIII IIIII IIIII IIIIIII III IIIII illll IIII IIII Return To M b1ci V / $3 O C 13 vockda..fe )24 9? °5 FO Grantor(s): (1) I v cal(Ai DJa 1 t.)44/\ , (2) 1V ci r (4 1 VetkJ Grantee(s): (1)PUBLIC Legal Description(1) a 7-S I 9 12 3 (Abbreviated form:i.e.lot,block,plat or section,township,range) Assessor's Tax Parcel:(1) 3 1 I 0 2- 1 S -9 0 0 31 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) 3( q02. - 9 003 Z Tax Parcel: (Connection 2) 31 ei 0 2-7 S -q DO 3' (teGli ) The system owner is responsible for keeping this system in compliance. I The name of the water system is: e 01 raf 1 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 7 day of Zq ,20 2-6- Signature of Grantor(s): (1) inaA0 , (2) Page I of 2 WINIONNIONIMINImiffisMINININmir State of Washington County of Mason I,the undersigned,a Notary Public in and or the above named County and State,do hereby certify that,°°,V/.�vli:1 this 't day of ( / v1 2t r)4: pdsonally appeared before me,who is known to be signer of the above instrumint,and acknowledged that he(she)(they)signed it. GIVEN under my hand and official seal the day and year last above written. Cia(liA Notary Publicjrt and or the a of Washington, TAMota L HERRING 74c / �vo `� � Notary Public residingat t / / 1'1 State of Washington My commission expires:chid / p l Commission it 41438 My Comm. Expires Jan 17, 2029 Page 2 of 2 ` w CO3 ' xSO• PRttvl V ?•F T RP,/cif Kseq' o .6. ITh tg5 q1 �F6 ER.�E �ET►UEI;►J i SCALE, 1 ; 41) o is 40 (09 So . P I� 04 I fa, D E z ikt L L t4-0( 1 co4 / PRRLE-#31'902-15—4:fro3 i / S . DDsTy K0 (4)3' x so' Pft-trmaatj / t-ESt-raN .)WA 98s84 D. F. -cfaatsu-Es e q ' o_C wrrr+ RC oE p sT }ot-e 6 E1-0)5-64 1 : 2S" LONti tvt v sivi D TC MrIrC"Lt1•1G 2' p -32„ Lof+t- SR145)) d d.1® ' ext.). 32-g'pu A RH P L S)1.1.0e4t CS) 0 an to tie (NI ' 4 : too, 4RDfeSPb ��m —^ M•• • _ i --; ' . ~ . 0Audio-Visual Alarm PRI,PDSED 4 oaae �� '1 --*____3 / 02 Cleanout 20 FV'fV fi © 500 Gallon Pre-Trash tank I1� 5DP 0NuWater BNR-500 ATti Tank 1,000 Gallon Pump Chamber t'•,1 V,..kl‘ FRO 00: 20 — — — "— -- — O Valve Control Box W i.t- 2 - vA�r . W ELL. '30' p.ASE E13T 5tHA-A.E D 31902 1S i 3z I SS. 3/ , Y 3o s EASTI{ PiZ \ _____ {kP?Roy !fi w PtT 542. t.. INE ,d ...N. `Ef ,_.. l . 510.3.9 '". PAULA JOY 10HNSON••. � rrt` -t4 iI L 1. , wkrwsR F%3 a0 -y 90031 2-13.2$ k At 3 1 zc, ic----10 t•---Ilf-- -- 7-12-ti 7 _T-Ti 1 . tiq tfl osi 1 • ‘,..,„ ,A , ___ 1 4 . D,-. . .0.0.,PI:do in 1, fi& k s�' .. t c, r- PAULA JOY JOHNSON `' . Q-' • , L' siGN a 1 N d ORtv�ksA... Jri `?® c� _ 2%-ZS IF U) II 1 ie �51 7 �°'' 4-4A tab .Viows _______ ______L ---? , T � tele 5�•6pt t "�� 1 or}O to,,-,, t:NISI ..vov. 2t.(a.68 kg.' eteRW c, eILL C >3 3 , xi FAiM 2 D-F- SCALE.• I u 40` THE Nctk --S @ ` B G. 'p1..0T PLA-t.i D IL- k-- -EC M- S KeE ?Pril( °3t 2- - 90032 O Audio-Visual Alarm e-L ON (1) "(e 5 t O Cleanout e500 Gallon Pre-Trash tank - �O 4- - s-c- Lt.-F 0 NuWater BNR-500 ATU Tank 3` " Low SAND 'T'o '2 G 01,000 Gallon Pump Chamber spasD A-o v)�Z- w-a4,..awt�-s-Ne-or. /L 2,'� L D P.M O Valve Control Box Pc�O) AZo0 2-' 3 eptO II