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HomeMy WebLinkAboutWEL2025-00105 - WEL Application, Design, Letter - 1/26/2026 A : 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 01/26/2026 TYRIAN CHARLES G & SANDRA J 8090 DANIEL PLACE NW SILVERDALE, WA 98383 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00105 10451 E State Route 106 322255100023 The 2-party water system, Two-Party Well (SFR +ADU): Tynan (322255100023/322255100023), 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 r MASON COUNTY Date Received: cc II ��. ~( COMMUNITY SERVICES Ammon 1 Received By Building.Planning.Environmental Health Community Health 415 N.6°Street,(Bldg 8)—Shelton,WA 98584 WEL a(45- O( \C Shelton: 360-427-9670 x400 Belfair.360-275-4467 x400 Ehna:360-482-5269 x400 uw�w C wwu .Ttrr.,h.9TASIM.MINRAMP....11WRIB IPAOKOM.,lWmnmus a 94.14u 1 a u;MOaarr 2t mFMM INUMGMIT.V.V A`101 w.W. ..ar AarMu.....O1IMP0W 0.49MI n I.AP i.nue.+tA¢u r 49.�ua 50.41k,MAmm uw.A TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE CNR2L,ES -"-.511A/PRl1 �.�/1qN c: ) c2/ MAILING ADDRESS-STREET,CITY,STATE,1P 809 cE Mil SiLvF ,y 104. % : . F ©[fj \7{ I SITE ADDRESS-STREET,CITY,STATE,ZIP 04-.67 , .S� ,4w ,/,d, 44n//aN, ki)r4, 9 52 i P PARCEL NUMBER(WELL SITE) 1 L5 32 z7 -. 7 -- DDd 23 SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) R" �- 3zZ2.5' -- 57/ -- ODAZ4-- By WATER SOURCE SOURCE TYFI_ PARCEL l LOT 11(ns mii®) PARCEL 2 LOT SPIE(w mmhnum) New XExisting XWell Spring 0 t. . ' o PROPOSED WATER SYSTEM NAME(REQUIRED). v V 1 iziAN PROJECT DESCRIPTION(eeg,detached_ADU new single-familyresidence,existing connection,we)) • G ..L/��2 1L.�✓S�� ,cyDk DIRECTIONS TO SITE/CONDITIONS/GATE CODE I KEY LOCATION/ETC. 14./L4E5 kfies-r C,9_4 vl 7 olt) / oic/ ,NAV 10 a./ D A2/LE5 F5T' / 'M 42 J,E.e.32oo,&... ,Z VN s,V /IJIJ/ J 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.) 4"�/4C/-1F:P required Submittals Checklist: (additional information located on the first page of this packet) IV 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 lFr Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office y' 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 Insp ctien: 1 d kl YES NO N/O 7i0ric f j/w 78 D AC( 11 b id pevy. [ ❑ ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, [[ tanks,buildings;indicate distance on plot plan) A ❑ ❑ Are there roads withi 1 . 100-foot radius of the water source? Is the road Private, rdr!!► ,or State?(circle one) Distance to the road(s) J v tiej ❑ ❑ Does the ground slope away from the water source site? X ❑ ❑ Satisfactory well cap? ❑ fll ❑ Well cap screened and vente ? .1 ElThe well casing extends II above lev groan concrete slab?(circle one) A ❑ ❑ Well tag attached to well casing? Lat: trf.)in? in ❑ ❑ Evidence of an adequate surface seal? Lon:.-17.1.0(2606) ❑ } ❑ Variance necessary for well site approval? Tag: 3pS V2y Comments: Pass ❑ Fail Inspector Date 77-Z.j/—?0--i—r— Review Step 2: Two-Party Review: -* 'e4( Cr/115/4/c6bn date urik,,o,iil. Wafe+` WM I O. YES NO NA Dtl Warr, U l( prO vilZ(ed ./I 61 Wile. DI ❑ ❑ Water well report(well log):Date Completedrt 4%200 Driller '" 2k,(Sc f 1�y. ❑ ❑ Satisfactory capacity test showing a minimum of 800((PD with full recovery to static level within 4 hours? ;er lA\ ' / Capacity PO)15. _Driller/Pump Installer IV it(401 S&i Dn ti, GPM l�, 7 Duration(minutes) 60 Total Gal 11?y Recovery Time(minutes)to Static I /61 ❑ ❑ Satisfactory bacteriological analysis? Date r/ZOOS Testing Lab a _00/46 ' yf ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN 27.3 .16,48.(,. , O�� X ❑ ❑ The system appears adequate to serve two connections based on the information 47451, rovided? .SAN , D ,9,1��,,, -6 j,' Comments- geCOrd ( 19 —Arai. 36s 'unit* -OO ' -fc cog i fFN ?t .21 .444,_.: . I � � •� �ry sit Approved Denied Reviewer pPP ❑ Date - -'/Z6/?n 6 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 19t,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 i'WI .-.ia. Water Well Report For An Existing Well Your well must be properly tagged prior to submitting this form. Asterisks(*)indicate required fields. Mail completed original form to: DEPARTMENT OF WA State Department of Ecology, PO Box 47600, Olympia,WA 98504-7600 ECOLOGY State of Washington Use this form if an original Water Well Report was never flied or is missing from Ecology records. *Current Use `Unique Ecology Well ID Tag Number: BPS424 ©Domestic [Industrial ['Municipal ODewater [Irrigation ❑Test Well DOther. 'Water Right:['Yes(if yes,attach a copy) ONo *Property Owner Name: CHARLIE TYRIAN Dimensions Diameter of well 6 in. *Well Street Address: 10451 E STATE HWY 106 Depth of completed well 54.7 ft.(if known) *City: UNION *County: MASON Construction Details Liner installed: Oyes ®No ['Unknown 'Site Well ID: ≥_ Type:❑PVC ®Steel ❑Concrete Liner "Tax Parcel Number: 32225-51-00023 o ❑Unknown ['Other: LO. 'Date Well Constructed: UNK Perforations d ❑Yes ONo ®Unknown 'Location(Township,Range,Section) • Size of perforations in.by in. to An accurate location of your well is very important. Tho c Number of perforations from ft,to n• Section,Township,Range,and'/.,'/4 can be found on your O Screens tax parcel legal description or through your county c Oyes ONo ®Unknown assessor's office. "+-o. Typo:❑Stainless Steel ❑PVC ❑Other. E c Diameter Slot Size from ft.to ft. Township 22N Range 3W ❑EWM or❑NUM v°- GraveUFiiterPack Section 25 NE 1/4-1/4 SE 1/4 •`- Eyes Qlo QUnknown o• Materials placed from ft.to ft. Comments: -o c Surface Seal c Oyes If known,to what depth ft. RECEIVED $ ONo used If no Dept of Ecology SWRO d Materials used if known: } ❑Bentonite ❑Cement 28August25 T c Pump • ®Yes ❑No ❑UnknownI. Latitude/Longitude 3 Type GRUNDFOS SQE Horse Power 1.5 (Decimal Degrees recorded to 5 decimal places) O Water Levels 18 ft. Latitude(Example 47.12345) Z Land-surface elevation above mean sea level47.36307 in Casing stick-up 2' above/below land surface 0 Static Level 15.3 ft.below top of casing Date measured:4/8/2` Longitude(Example 118.12345) Artesian pressure lbs.per square In.Date measured: 123.00609 o Well head has cap? Oyes ONo Shut off valve?©Yes DNO o0 Additional information (if available,please attach) w Well Tests: DLocation marked on topographic map `o Drawdown is amount water level Is lowered below static level. o ❑Location marked on air photo 4- Was a pump test made?®Yes(attach copy)['No 0 Unknown EYield: 39.4 gal/min.with 4.3 ft.drawdown after 1 hrs. ❑Consultant well report r L tv 'Certification:The information reported above is true to the best of my knowledge and belief. a of ['Consulting Firm ['Driller - ['Engineer OProperty Owner I. - Name:ALAN MYETTE Company:NICHOLSON DRILLING INC License Number_____ Address of person completing this form: PO BOX 123 Signature: Date Signed: et z_i(2 5T _ City, State,Zip:PORTORCHARD WA 98367 ECY 070-557(09/2016)To request ADA accommodation including materials in a format for the visually impaired,call Ecology Water Resources Program 360-407- 6872.Person with impaired hearing may call Washington Relay Services at 711. Persons with speech disability may call TTY at 877-833-6341 The Department of Ecology does NOT warranty the Data and/or information on this well report. 3 Z g r- m C "' NJ 4.3 CCTT001O 1 A CO N -+ Ot0 CO V OC)tA W N -+ O (1,2 D T+ � r T O CD COOO V COO) Ch A W N -� 111 , .. 03 O'O rat -+ N N -a. _s a ...a a .+ 1 .r -a -a �.a OMari! 0 Cn m g 7a CD O O co Ito CD o tD tD CD CD CO !DPP CD v) m W � -< C0OO to CD CD CD tO CD CO CD CD CO CD CD CD CD -) -1 C,, �� 0 O 0 Q XC11 6) og � l� 0000000000 5 * 4:. 4. . 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H P 000,00 bob oo 00000000000000000oob N o to zi v n) 3 m ____ib ,+r si T",•\1F.'r Iii,01,Z,;.7'R•�•.X' '" .w3.ra`(;• ..,t 26276Ttvelve tic rk �;Et r•sex':1crtt+[`{_.ti11 v �'v, .,s,F,. 1�. .«t ' �` �, ,_ 4 i . r it rc41 Trees LnNW {a���';��r�e;��;e:�,a ���=' r.•iLir'����N a�r��r. €� Stc•C 1 ;SREC4?R - z i:91,0artr��TC1tsap ' Poulabo,WA rq'"'°'.?",1"( r. .r• r"*".t..-7—:.i .4' :31Theie1'rs'iricnre=iters �t�_ 98370 71, r1s'�"�:��'.k�.-_�` , Jr (360)779-5141 jY;COLt•FORNIaBACT_ER!_AkAI+IAL•1LSIS"FORM.4{ Dale Sample Collected Time Sample x County Collected tdjAR Dar Year : 45. PM OtstLSe✓ ....,. Typo of Water System(check only one box) ❑Group A 0 Group B ( Other_ Group A and Group B Systems—Provide from Water FeciG ties Inventory(WFI): ID# I OLS1 E tT System Name: S _ �f\Qi4 C. ,Q r\: , v3Y lOk.uxa`tart Contact Person: N CHOLSON DRILLING Day Phone:(3601)876_4421 f Cell Phone; Email: I—Eve.Phone: • Send results to:(Pdni fo31=te,oidrav ad tip coda a emanaboro for ttochonlc copy of nnults}— OFFICF NICHOI SONDRII LING@GMAJL.COM CCHILTON.NICHOLSONDRILLING(d)GMAIL.COM ;; ,'f`S ct' e"..ha80F7g471 ORMATIOt T4 ' `-,70A;: 'f Sample collected by(name): /"{' I )61A4 Specific location where sample collected: Special lnshuctions.or comments: xr:is .,.u:ra{.rt:--.....�.,_ ,_„t. TY. rT_.ype ofrSatnplo,(cheplc.only,:ona.buk) , > -{;7.i'" ...I Yn7, ^':;.A„rf; 1.❑Rouilne Dlstr(button Sample(A/P) 2.❑ Repeat Sample(ARP) Chlorinated:Yes 0 No 0 (tom disebu'on system after unsat ror11ne) Unsatisfactory routing lab number.Chlorine Residual:Total Free ,_ t 3.Grou n d Water Rule Source Sample Unsatlsfectory routers collect date: S 1 I Chlorinated:Yes No ❑Triggered(AP) Chlorine Residual:Total Free ❑Assessment(A1P) 4.Surface or GWI Raw Source Water Sample(Enumeration) I I I l' E.coil 0 Fecal rmemd You No I 5. Sample Collected for InfoationOnty: pttTL�p[ t(�, ( t r Information 4 AB U5E OWN,LTY a5TiT1KING i ':E A R RYES'IJ114%•1 t'7 ..PT :) ElUnsatlsfactoi Total Cotlform Present and ,, ' Satisfactory Ej E,coi presdnt ❑•E.co6 absent -.•e 11^• Neil..cz . Bacterial Density Results:Total Colifbim.- •mpnlliDlpi.rtwcort • >."mpnlifoml. l Fecal Coiifonn clu/100ral. HPC_ -__cfullmf. - Replacement Sample Required: 0 TNTC ❑Sample too old ❑ Sample Volume O Damaged Container 0 DaleiTimeReceived: Lab RaferermaNumber i Receipt Temp C': ,,,. Method Code: -,''"-^^yy CSMR238 t QT•COtINT1 SM92220 lti ra1nhsnam.yb,ra Ls*tl Nepami a=wry U —1 Dale fie / Dale Out p wlvn Ut2 odds:no:I n}ua,ceprbq act&at. rotu M by 8/Z-i /2‘ e�1/2$l2e trarlad leetimtgvmAatt mllUt tv rrxlredNhrtrn acricaav,,ra.ea�y.. astnTod1fexon0.5nisd 1. DOH Lab-Sonia qr ,`m tr (r�1 /h) j Ran=gamma city nUn Ltmatolidane 9pcarapkit)a 010. V 0I `� ".4444 noL a pweb. b. tcrori Ns taaniaab.as er I ioO ohs,tpbr ogress Ingo cpprowoopemaloto os i aerI fare 2111,319(cacao earfr) Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories - Kitsap 26276 Twelve Trees Ln NW Ste.C Where experience matters Poulsbo,WA 98370 Phone: (360)779-5141 www.spectra-lab.com Spectra Labs- Kitsap,LLC(Poulsbo)received samples for Nicholson Drilling Inc. on Wednesday,August 27,2025 at 1:00 pm. Unless otherwise noted, all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures.A summary of the samples received are outlined below. Sample No. Description Location Sampled 255050-01 Tyrian,Charlie 10451 E St Hwy Wellhead 08/26/2025 14:45 106 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360)779-5141 or email us at www.spectra-lab.com. Attachments 01) This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 09/02/2025 Page 1 of 1 2232168 MASON CO WA 10/16/2025 01:31 PM NOTCE ec 0 Name and Retureztizt„n Address: EI1I 0fillfl''II1I"i'IO!I I !III itlI1 IlII III11ff��l III11i! III • 8a g£, 7;? ilte) h)4 %8 � ,q447 RFc Z 6 2026. /1,4.0 Document Document Title(s) 1. AiIreteft 2. Reference Numbers(s)of Docu_ments-Assigned or Released Z23o577f ADDITIONAL REFERENCE WS ON PAGE Grantor(s) 1. 2• ADDITIONAL GRANTORS ON PAGE Grantee(s) 1. / \� ADDITIONAL GRANTEES ON PAGE /((i `:� N — It�gai De -iption (abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) M /7 V4— r,.`e ADDITIONAL LEGAL IS ON PAGE Assessor's Property Tax Parcel/Account Number(s) 2 / GOO Z3 ADDITIONAL PARCEL#'S ON PAGE THE AUDITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEXING INFORMATION PROVIDED HEREIN. 2230525 79oT�MASON CO WA TYRIAN 4213918 Rec Fee- 5304 50 Pages 2 Rrl,i?7? TO 1M 111 III VI III I I llI II II II IIIii I I lHH I I IIII II[III .\ 80 To,DANi 7',gcg. A/ / . ..4 YF_ ..0 4L.F, h/fl `BS 3P3 q 0 Grantor(s): (I) ,4R1 (2) :Sf KJRiti 79/PJ / Grantee(s): (I)PUBLIC \_-� Legal Description(I)13?fkic i4 ,E M' -1k I7 ' $/4/$ _,- _ (Ahhrrviated form:i.e. lot,block.plat or section, township.range) Assessor's Tat Parcel: (1) _ 3.; ::;;' 51 -- ()DO X3 5Zs--7 z2-7. --...3.---NN".//' -,.3 NN,,// \ \ NOTICE TO FUTURE,,PROPFAITY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigns i'�'tor(s),Ze ify that the water source located on the above-described real estate under Legal Descri on(1)1id Assessors Tax Parcel(I)situated in Mason County, State of Washington, has beets. signate'd to serve a source of water to the following parcels situated in Mason County, State/of Wakitingtolr;herein described: s Tax Parcel- Conp�ection 1-) 3Z25— 57 ~' OoD,� "fax Pia,c4:(C Lion 2) / - , zz. - _5/ - L Z-3 The sys_e r wner is responsible or Keeping is system in compliance. �t N \ .-1)7 / - /fi/v / — n R11 oFt)te water system is: '� J �tis syst is designed to provide for two service connections. Planning and design approvals must be tibta`irsed'1rom the department prior to expanding beyond this number of services. ionally,a water right, obtained from the Department of Ecology,is required if the water system \ exceeds exemption standards. 'his system h. h)s.ryml5'been granted one or more waivers from specific provisions of the regulations. NN, Dated on this JO day of ,20 Z Signature of Grantor(s): t I ) __,C.ja-4-6 -- • •(2)____2773 le"14 .'"fr-,1P-"e"'------ Page I of 2 2232168 Page 2 of 3 10/16/2025 01:31:21 PM Mason County, WA State of Washington ) County of Mason ) c\ I, the undersigned, a Notary Public in and for the above named-6unty and State, do hereby certify that r 1.0 day of om! Y 20? -; , t�MAU `rVi�1� Ily appead Qdfore me, who is known to be signer of the above instrruument, and acknowledged that'ke.(he) (they) signed it. GIVEN under my hand and official seal the day and.y - -fiat above written. CINTHIA AVERY t Notary Public 7- otaty-Public in and for the State of s ington, State of Washington � License Number 23007421 rest i g at '6(1 � My Commission Expires D mmission expires: S11 17,2:1 March 011. , 2027 State of Washington County of Mason I,Steve Duenkel,for Mason County,do hereby certify that this instrument is a true and correct copy of the original as the same now appears on file and of record in the Auditor's Office. In testimony whereof,I have hereunto set my hand and affixed L� seal this G��>J(Y A LJ 7 0 1 h day off C�€K 20 m \. . Steve Duenkel C`if/V.)1J \ o Mason County Auditor Wv' 5� j s i ' c9UNty Page 2 of 2 2Atria 0:R23 0% i4JiVI WA Miumricgotrttyy,W►A . • • tpP Uf SLOPE I N h ID nPP INNWAT,ia • M1^� q._.... I TLW..1.5.SLGRC +SIrA PARCELa ._•., 'f:..s:+Mrlib . , /,r SEZE PA^:Eta 4 Jt::•S1M/lt • . •PROPOSED Y + \ SETBACK PROM 'PROPosED I' RETAINING WALL RETYIIND WALL • • .........:. .* .._ �. .../ -asr uG PRIVAtE / SIw.3LE PARTY 'Pr f N'tSy,3 T-.,co aa.La::. "� I. • o7. t atrARnactr cONCP.ETE _ 'Y PO,I0LONG TANI-•SEE '"1" — tE41tr--:at: + nanr•!.ha:i!? I I r--:?;,f:,.Ya`""" 'I 1 ,i1—# 'PROPOSED 1...... • a .. i I REPLACEMENT RVI I 'PQO In �`.,rY•P s GARAGEAMORKSHOP/ L'ua+.si TEncK SIDE •I STORAGE 40'X 40'■ •I zr ' I600SQFT t YAiER LINE 1 ir— :. ED ter,Y WET. I ,r•`y.•.•..•,..•• sTRJE'URE.O'a!! PERIM,.SLGZQ2 n},4 I i I , • [ns+rR-:�+na 'PROPOSED EWE wP1.sEtaACK I PROPOSED FLAUNT ' 1 e-II 1 ; Y'ROP0aE0 ENT L • _ 1 1t LLL I ENGIN°.TEMPOSARY -^.4__�- __ eaoS10N COHERED L ak * 75 ti "11 —..._.._.L1ft:E.//AY iNtE I - ono ci4-AJaL . ' ' : j E}CIsrrAJG I 7 L 1 1-7,-0 u.5 E Z 10451 N 1-frwy IO G TWA-N(714 STATE PARK ---- ii-l>. V4� / • ' ad ��o 3 1 d cox. 5 , i ',1,1tiLti Sot f ,20oT�1c O o/\ / 7� „1 1 \ CP LE l"= .30' t1 � 0` moo` (00 PLOT 'pL OW1JER• DALLAS ALA -tg pa .EL 4.3a)„.16 5i DooA3