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HomeMy WebLinkAboutWAT2025-00184 WATER ADEQUACY - WAT Application - 10/27/2025 WAT 2025-00184 4?�J` , MASON COUNTY (1101"F COMMUNITY SERVICES \r;) nova,/ Building.Planning.Environmental Health,Community Health 415 N 6t Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 Belfair: (360)275-4467 ext 400 •3 Elma: (360)482-5269 ext 400 FAX(360)427-7787 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 Identification Name on Applicant: liz seabright Date: 09/12/2025 Mailing Address: Phone: Parcel Number 320024390010 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more ® Building permit BLD2025-01102 connections) ❑ Division of land: X Individual water source (one connection), #of Parcels? SPL X Well 0 Spring/surface water 0 Boundary line adjustment 0 Other(explain) 0 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) 0 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. J:\EH Forms\Drinking Water ltev1ed 1'25'2018 Individual Water Well El Water well report(attached to application). Depth_74 ft. El Well capacity Test(attached to application) 30 gpm >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. l Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa.us/planning 14 15_16_22_ Water use or limitation recorded N/A Yes Well Drilled Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) O 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) x 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. 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: R5 10/27/2025 Environ. Health: Date 2 of 2 CSD Director: Date WATER WELL REPORT t..� DEPARTMENT OF NoticeoflntentNo. WE60457 ECOLOGY Unique Ecology Well ID Tag No. BRR 167 Type of Work: State of Washington El Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NOI No Water Right Permit/Certificate No. Proposed Use: ®Domestic 0 Industrial 0 Municipal Property Owner Name Elizabeth Seabright 0 Dewatering 0 Irrigation 0 Test Well 0 Other Well Street Address 360 E Bayview Dr Construction Type: Method: CityShelton County Mason ENew well 0 Alteration 0 Driven 0 Jetted 0 Cable Tool 0 Deepening 0 Other 0 Dug '9 Air- 0 Mud-Rotary Tax Parcel No. 32002-43-90010 Dimensions: Diameter of boring 6 in.,to 79 ft. Was a variance approved for this well? 0 Yes E No Depth of completed well 76 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread g I 0 6 in. +1 76 .25 in. O I 0 0 I C Location(see instructions on page 2): O WWM or 0 EWM ❑ I ❑ in. _ _ in. ❑ I ❑ OIL SW Vs-%of the SE ''A;Section 20 Township 20N Range 03 ❑ I ❑ in in. ❑ I ❑ OIE❑ I ❑ in. in. ❑ I ❑ ❑ I C Latitude(Example:47.12345) 47.24523 _ Longitude(Example:-120.12345) -123.02076 Perforations: 0 Yes ❑O 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 nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes ❑O No 0 K-Packer b Depth ft information. Use additional sheets if necessary. Manufacturer's Name Material From To Type Model No. Diameter_ in. Slot size_ in.from ft.to_ft. Top soil 0 1 Diameter_ in. Slot size_ in.from_ft.to_ft. Silt,some day,some gravel,brown/hard 1 8 Sand,silt,gravel,mostly fine sand,and silt Sand/Filter pack:0 Yes El No Size of pack material_in. brown/soft 8 32 Materials placed from_ft.to ft. Sand,gravel,silt,medium gravel,brown/hard 32 62 Surface Seal: t Yes D No To what depth? 16 ft. Sand,silt,brown/soft 62 66 Material used in seal Bentonite Granular Did any strata contain unusable water, 0 Yes El No Sand,gravel,silt,coarse gravel,brown/soft,wb 66 77 Type of water', Depth of strata Clay,silt,sand,some gravel,brown/hard 77 79 Method of sealing strata off Pump: Manufacturer's Name N/A Type: H.P._ Pump intake depth:_ft. Designed flow rate 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 40 ft below top of well casing Date 7/29/2025 Artesian pressure_lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? r' No 0 Yes b 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 Bailer test_gpm with_ft.drawdown after_hrs. Air test 30 gpm with stem set at 74 ft.for I hrs. Date 7/29/2025 Artesian flow_gpm Temperature of water_°F Was a chemical analysis made? 0 Yes O No Stan Date 7/29/2025 Completed Date 7/29/2025 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 arc true to my best knowledge and belief. IR Driller 0 Trainee 0 PE—Print Name Chris Jones Drilling Company Moerke&Sons Pump and Drilling Signature ( & ; " - L_ Address 1162 NW State Avenue License No. 2253 Cy. Zip City,State, Chehalis,WA 98532 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No. MOERKSP072N5 Date 7/29/2025 ECY 050-1-20(Rev 11/18) if you need this document in 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. Oar MOERKE & SONS PUMP & DRILLING, INC 1162 NW State Avenue, Chehalis, WA 98532 (360) 748-3805 PUMP TEST ELIZABETH SEABRIGHT 10/9/2025 WELL SITE ADDRESS: 360 EAST BAYVIEW DR, SHELTON Pump Make & Model: Pump Set At: Sounder Make & Model: Make & Model: Measured in: GALLONS MINUTES GALLONS METER LEVEL TO PER MINUTE READING WATER NOTES 4 0 0 143149 42' BEGAN DRAW DOWN 1 17 143166 46' 4 2 12 143178 47' 3 13 143191 47.5' 4 15 143206 4737' ill 5 14 143220 47.10' 6 13 143233 48.1' 7 15 143248 48.6' 8 13 143261 48.9' 9 14 143275 49' 10 14 143289 49.5' 15 13.8 143358 50.3' 20 14 143428 51' 25 13.2 143494 47.5' 30 13 143550 47.10' 400 GALLONS RECOVERED MORE THEN 80% RECOVERY 'I 0 47' 1 45' 2 42' SIGNATURE: — MP AND DRILLING 4 4 I Vanguard Laboratory 2635 Parlcmont Lane SW,Suite A Olympia WA 98502 WAINA(en, 360-967-7010 GN021/F04 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County 0 1 1 9 J 2C Collected o AM M 11A4CLOV\'' Wolk Day Yea Type of Water System(check only one box) L ❑Group A 0 Group B erOther 'i Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): loll System Name:'L 2 k ..,,. �r�_1L1r-,-- Contact PersonS6q,1\ G ke r'(i Day Phone:Rao ) /14g ;3* )( Cell Phone:( ) Emal: Eve.Phone:( ) Send results to:(Print full paw,address and zip code ore•mal) AucAr-t Qoys -___ _ l l a_ti.v, a'it' _ _._ _._......-._.....--- SAMPLE INFORMATION Sample collected by(name) sae. Specific Uon where sample collecjed: Special instructions or comm Iv/ "' !ro," vict fp�O�tol I. 1)ei Heit)ents: Type of Sample(select only one type of sample from types i through 5 below) 1.❑Routine Distribution Sample(A1P) 2.❑ Repeat Sample(AMP) Chlorinated:Yes No (ham disc ibullon system after unfit.routine) Unsatisfactory routine lab number: Chlorine Residual:Total_Free— 3.Ground WaterI Rule Source Sample Unsatisfactory routine collect date: IS I I __--I—J Chlorinated:Yes No Cl Triggered(NP) Chlorine Residual:Total_Free___ ❑Assessment (NP) 4. Surface or GWI Raw Source Water Sample(Enumeration) I I ❑E,toll Cl Fecal feeree Yes_No 670 Sample Collected for Information Only: LAB USE ONLY DRINKING WATgR RESULTS LAB USE ONLY ❑Unsatisfactory Total Collfonn Present and ®Satisfactory i 0 E.coli present 0 E.coli absent 1 { Bacterial Density Results:Total Cdifolm 1100m1.E.coli 1100m1. Fecal Coliform 1100m1. HPC /1 ml. Replacement Sample Required: 0 TNTC 0 Sample too old I ❑ Sample Volume 0 Damaged Container 0 Datetli o Recelved: Lab Reference Number 2a�25 \u�1 va 9)aw-\-1 'I+ Receipt amp C: Method Code: { Srnoti23\6 ° Date RoportedtoDON09/03/25 Lab Use Only: DOH Lab-Sample/ 285-%i2 \ b 00r1 farttrit-319 legato Caeln-gm eeers publalanIna+digerati"feast all COOS239127fTDDMY rs!714 r Vanguard Laboratory • 2635 Parkmont Lane SW,Suite A Olympia WA 98502 360-967-7010 VANGUARD 1.APOKATOOX Nitrate/Nitrite Analysis Report Date Collected:(MM/DD/TY)0.112( System Group T pe:(Circle one.) A T B Other. Water System ID Number: System Name: L; l +L * � Lab Number/Sample Number: ,2_$5/% 2 R t y M County: a, n, +/I Sam le Location3( aY f ©f y e Source Number(s) (List all sources if blended orcomposited.) tiVACA. A. Sample Purpose(check appropriate box) Date Received: (MM/DD/YY) o $/'L 9 /a k ❑ RC—Routine/Compliance(Satisfies monitoring requirements.) Date Analyzed: (MM/DD/YY) 0 ,J1.2_ 0 Date Reported: (MM/DD/YY) 0 9/ 0 3/2 5 ❑ C—Confirmation(confirmation of chemical result.)' • Mr I—Investigative(Does not satisfy monitoring requirements.) COMMENTS:Va.SO`629'15 ❑ O—Other (Specify—does not satisfy monitoring requirements.) Sample Composition(Check appropriate box.) Sample Type(Check one.) 4Pre-treatment/Untreated(Raw) ArS—Single Source ❑Post-treatment(Finished) ❑ B—Blended(List source numbers in"Source Numbers"field.) El Unknown o Other ❑ C—Composite(List source numbers in'Source Numbers"field.) Sample Collecteddb/y (name) ❑ D—Distribution Sample Phone Number: 1 Send Report to: Bill to:(Client name.) Oti — Analytical Results Data Exceeds MCL? Method/ DOH II Contaminant Qualifier Results MRL SDRL Trigger MCL Units (X if Yes) Initials 0020 Nitrate-N 0.854 0.5 0.5 5.0 10.0 mg/L^ Hach 10206 NOTES *Confirmation:Include the original lab number,sample number,end collection date of original sample in either comment section. --No trigger value for combined nitrate plus nitrite. Data Qualifier:A symbol or letter to denote additional information about the result. • DOH#:Department assigned contaminant number. Exceeds MCL(Maximum Contaminant Level):Marked if the contaminant amount exceeds the MCL under chapters 246-290 and 246- 291 WAC. If you have questions about this result,please contact the department's drinking water regional office in your area. METHOD/INITIALS:Analytical method used/Initials of the analyst that performed the analysis. mg/L:milligrams per liter or parts per million. MRL(Method Reporting Limit):The lowest quantifiable concentration of a contaminant. SDRL(State Detection Reporting Limit):The minimum reportable detection of a contaminant as established by the department. Trigger:The department's drinking water response level.Systems with contaminants detected at concentrations at or above this level may be required to take additional samples or monitor more frequently. LAB COMMENTS Revised December 2021