Loading...
HomeMy WebLinkAboutWEL2026-00007 - WEL Application, Design, Letter - 3/23/2026 M . 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 03/23/2026 Bentz, Nolan 4221 West Everett Avenue Spokane, WA 99205 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00007 490 E Pinedirosa Rd 321207500070 The 2-party water system, Two-Party Well: 490 Water (well site: 321207500070 to SFR: 321207500070 + ADU: 321207500070), 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 VIM j:;:•rta 1• l%i. MASON COUNTY Date Received: 131C-)(O /�� /�°^ " " COMMUNITY SERVICES 11 I/ Q)- Amount Received:rr-� Received'^^ By: 7� �j�{)�C(J/��_ Building,Planning,Environmental Health,Community Health it 70 E►'�'1 g-I L G D r'g _ t 415N.6'h Street,(Bldg 8)—Shelton,WA98584 VVEL Zo2„ ,_ DO O O-7 Shelton:360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 V I TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Nolan Jeffrey Bentz 509-999-2475 n (`' ; ----_ MAILING ADDRESS-STREET,CITY,STATE,ZIP ig gig a 1 VI r • 4221 W Everett Ave, Spokane, WA 99205 11 iiit,./+ ffi SITE ADDRESS-STREET,CITY,STATE,ZIP MAO o 490 E Pinedirosa Rd, Union, WA, 99205 f1 6 1i)/ a PRIMARY PARCEL NUMBER( L SITE) ^ �� 321Lu-/'5 0070 (well $$'fg) By SECONDARY PARCEL NUMBER(SAME AS PRIMARY I LOCATED ON SAM EPARCEL) ��4 311719 if 000 -r 3 2f�0 is OCo o (5F1( RP --j WATER SOURCE SOURCE TYPE PARCEL I LOT SIZE(no mini m) PARCEL 2 LOT SIZE(no minimum) O New n Existing n Well n Spring 5 Acre PROPOSED WATER SYSTEM NAME(REQUIRED). 490 Water PROJECT DESCRIPTION(eis.,detached ADU,new single-family residence,existing connection,etc.) Two-party private water system for 3bd 2bth SFR and 1 bd 1 bth DETACHED ADU DIRECTIONS TO SITE/CONDITIONS/GATE CODE/KEY LOCATION/ETC. Gate opens, up driveway, head south through trees at south end of clearing and follow central trail. Required Submittals/Requirements Checklist: ❑ Original water well report(well log)or DoE water well report for an existing well. El Well tag secured to the well casing. is Capacity test showing 800 GPD with drawdown and recovery to static level information. 11 Bacteriological test(Bac-t)results: current(within 12 months)and satisfactory. - ID Septic Records(additional locating requirements may apply if no septic records are on file). El Applicable utility easement documents. 11 Notice to Future Property Owners of a Private Two-Party Water System, Water Use Agreement, and Access Easement(s)recorded with the Mason County Auditor's Office. *Note: May be recorded after the permit has been preapproved. I own the proposed two-party water well and have the right to grant access for a second connection. I attest that the well currently has no more than one connection. Nolan J Bentz / 03/06/2026__ Print: Sign: Date: - This form may be scanned and made available for public viewing on the Mason County website Pg 2 Last Updated: 1/7/2026 Please include the following site features for each parcel served by the proposed two-party well: p Parcel numbers(s) ❑ Property lines/boundaries El Applicable easements with the Auditor's File Number(AFN) ❑✓ Roads and driveways El Well location with a 100 ft radius around it ❑ Structures *Water wells shall not be located in garages,barns, storage buildings,or dwellings(WAC 173-160-171) El Water lines for existing and proposed connections ❑✓ Septic and sewer components(tanks, primary and reserve drainfields,transport lines) ❑ Barns,chicken coops, barns, manure piles,dog kennels,commercial gardens,compost piles ❑ Chemical Storage within 100 ft ❑ Landfills(existing or former)within 1000 ft Site Drawing See U Q , / 5(11(6P(017 B4 e. . �Ro dqteseti 3/zc'zol6 —. --....„ __, , _______ FARCE_132.2O75OCC7C =ARC£L#32 1207500080 L _ �- O �_ ~ - r : r l ' t .Ir _ l- ~� �� _' PROP05[O$ — B[OROOhA 5[R 50X77 /// • a.r+ PRDP05[D I .../ / BCDROOM ADU 2 6X40 / - ( ....... ...../ / / i ' `''1 / i ,--/ f ../..' / V ..".... ./.9..".......1, / ../... F.:,., c / X,,. , / / 1 L ' / i SITE PLAN CO / This form may be scanned and made available for public viewing on the Mason County website Pg 3 Last Updated: 1/7/2026 Vp l'e 51\f-c rvaii l,,/,t 1 txf64( ioCq ( c7 7 3Z (10Fsada70 U' Z > . a38 t,J- z a g w -1......,„,, - - -165-'I NEp 0 iRO , - /? .C1=-- - / /69.+/:'----- kO V. y —�"��� l PARCEL#32 I 207500070 PARCEL#321207500080_- rid ---/ ' It- • /,i® / / // _--- // $ ---------- I VI 1 - _________ ' PROPOSED 3 \ II BEDROOM SFR O 50X77 / ' I - _ - I mar: 1 -\ . A ^ 42'+/- ub, ry PROPOSED I / H m L, l \ — BEDROOM ADU / W / N. / 26X40 i ,, m - • _ \ 127'+/- / \\ -- / / / / o ! t •.... / / // / // DRAIN \ // / /- - ' -i FIELD -- - // F� / / /'- / A / / R5RV / / "aS 7. SITE PLAN ^ // rewc.*. THE PROPERTY LINES IN THIS MAP """"` ARE APPROXIMATE AND ARE NOT "` INTENDED TO BE USED AS SURVEY. 5,111; C-I - • * 3Z(2o7-Soov11 3Z( zo -sCCO?O ....# ..., ..,,40kopp: ft,40),4i,z,.., labitlikoliii" lipt• 1111611:' Fp ila • h4 It** .hpt, _ a �1! ^ •r V4 `/'\ - Ni?II Location , iMi $ - ' w 400. s r . .- i� .� - , �iliiii • .r 4 y. - • l' I:47:-.° . . . * .' • . 4,404,145 44111:**':-# - . .4 t it;t P'"I*I •::IP ''I a ' ---- Staff Use Only -- --------- Review Step 1: Well Site Inspection: YES NO N/O ❑ CZ ❑ Sources of contamination within 100 ft of the well?(septic components,chemicals,livestock,etc.) ❑ I1 ❑ Roads located within 100 ft of the water source?Private/County/State Distance to road(s) p ❑ ❑ Ground slopes away from the well? J1 ❑ ❑ Well located outside of garages,barns,storage buildings,and dwellings,with at least 5 ft of separation? /X ❑ ❑ Satisfactory metal or plastic well cap that is mechanically secured or welded to the casing? ❑ ❑ Access ports and openings sealed/screened to prevent contamination;pressure gauge installed for artesian wells? V ❑ ❑ Adequate surface seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. ❑ ❑ The well casing extends Z Z above level g o� d/concrete slab. Lat: Y G /7-2? l 120 ❑ ❑ DoE well tag attached to the well casing? Lon: "12J•'97'577 ❑ ❑ Variance necessary for well site approval? Tag: AEG Q6o Comments:p Pass CIFail Inspector Date iiii/?°2-‘ Review Step 2: Two-Party Review: YES NO NA �/QQ El El /Water well report(well log): Date Completed 05 1?‘l f I Driller AI t b lid"PL O CI Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static level within 24 hours? Capacity test information: Date 0((IL(1014 Driller/Pump Installer /I/C4o,'{ Iq'i(1 .1/16_. GPM IGr-(3 Duration(minutes) Go Total Gal SO I. 5— Recovery Time(minutes)to Static 3 ❑ ❑ Water system capable of supplying at least 30g((PSI to each ^connection?PSI ft.Y y, [O ❑ ❑ Satisfactory bacteriological analysis? Date Z 31101) Testing Lab VG 1p/O rpf lab G( /mflt?z, Wf Ell ❑ LI Signed,notarized,and recorded notice to future property owners?AFN ZZ 3 y?z3 ❑ ❑ ] Signed,notarized,and recorded water use agreement?AFN ❑ ❑ co Signed,notarized,and recorded access easement(s)?AFN_. ❑ El The system appears adequate to serve two connections based on the information provided? P .._ 3/2o /7o Z6 1. 'R.eeetv'ed. updated 5E - pm P Comments: i1/'e(( (0C,f( � �O1rCe'( 321707-C a010, "14R Approved El Denied Reviewer Date (234,504/ E �MENTqC y./4,T/-/ Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim`is made.express or iriiplied 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 19th,2018 per ESSB 6091. This form may be scanned and made available for public viewing on the Mason County website •-- Pg 4 Last Updated: 1/7/2026 r- WATER WELL REPORT Start Card No. W101347 Unique Well I.D. t A5C960 STATE OF WASHINGTON Water Right Permit No. . _ I1) OWNER: Name ADAMS, LAUREN Address PO BOX 1047 BELFAIR, WA 98528- (2) LOCATION OF WELL: County MASON - N8 1/4 NW 1/4 Sec 20 T 21N N.. R 3W WM (2a) STREET ADDRESS OF WELL (or nearest address) PINEDAROSA ROAD, UNION 3 (3) PROPOSED USE: DOMESTIC (10) WELL LOG (4) TYPE OF WORK: Owner's Number of well Formation: Describe by color, character, size of material (If more than one) and structure, and show thickness of aquifers and the kind NEW WELL Method: ROTARY and nature of the material in each stratum penetrated, with at least one entry for each change in formation. (5) DIMENSIONS: Diameter of well 6 inches Drilled 101 ft. Depth of completed well 100 ft. MATERIAL FROM I TO _____... PACKED COURSE SAND GRAVEL D 117 (6) CONSTRUCTION DETAILS: PACKED GRAVEL COURSE SAND BROWN CLAY 17 j 51 Casing installed: 6 " Dia. from +1 ft. to 100.8 ft. BROWN COURSE SAND GRAVEL • 51 78 WELDED CASING " Dia. from ft. to ft. WET COURSE SAND SOME GRAVEL 78 91 " Dia. from Et. to ft, BROWN COURSE SAND GRAVEL & WATER 91 101 Perforations: NO Type of perforator used SIZE of perforations in. by in. perforations from ft. to ft. perforations from ft. to ft. perforations from ft. to ft. _ Screens: NO Manufacturer's Name . Type Model No. . Diam. slot size from ft. to ft. f=-- tO Diam. slot size from ft. to ft. OD Gravel packed: NO Size of gravel = 171 Gravel placed from ft. to ft. -C I Surface seal: YES To what depth? 2D ft. N.305 ' 05b -. Material used in seal BENTONITE • Did any strata contain unusable water? NO Type of water? Depth of strata ft. < < . Method of sealing strata off ` a ____.____. .__._..._ � Co (7) PUMP: Manufacturer's Name ... Type H.P. IS) WATER LEVELS: Land-surface elevation above mean sea level ... ft. Static level 70 ft. below top of well Date 05/26/98 Artesian Pressure lbs. per square inch Date Artesian water controlled by Work started 05/26/98 Completed 05/26/98 (9) WELL TESTS: Drawdown is amount water level is lowered below WELL CONSTRUCTOR CERTIFICATION: static level. I constructed and/or accept responsibility for con- Was a pump test made? NO If yes, by whom? struction of this well, and its compliance with all Yield: gal./min with ft. drawdown after hrs. Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. Recovery data Time Water Level Time Water Level Time Water Level NAME ARCADIA DRILLING INC. (Person, firm, or corporation) (Type or print) ADDRESS SE 17 ALK Date of teat / / Bailer test gal/min. ft. drawdown after hrs. [SIGNED) License No. 2053 Air test 40 gal/min. w/ stem set at 95 ft. for 1 hrs. Artesian flow g.p.m. Date Contractor's Temperature of water Was a chemical analysis made? NO Registration No. ARCADDIO9BK1 Date 05/26/99 Arcadia Drilling Inc. P.O. Box 1790 Shelton, WA. 98584 Customer: Nolan Bentz Well Tag #: AEC960 Site Address: 490 E Pinedirosa Rd, Union Depth: 100' Date of Test: 1/22/26 Static: 78.3' Pump Set: Unknown TIME GPM LEVEL RECOVERY 1 Min 11.5 79.8 TIME LEVEL 2 Min 11.5 80 1 Min 78.8 3 Min 11.5 80.2 2 Min 78.4 4 Min 11.5 80 _ 3 Min 78.3 5 Min 11.5 79.8 6 Min 11.5 79.8 7 Min 11.5 79.8 8 Min 11.5 79.8 9 Min 11.5 79.8 10 Min 11.5 79.8 15 Min 11.5 79.8 20 Min 11.5 79.8 25 Min 13 79.8 30 Min 13 79.9 35 Min 13 79.9 40 Min 13 79.9 45 Min 13 79.9 50 Min 13 79.9 55 Min 13 80 1 Hr 13 80 Total Gallons Pumped: 807.5 Gallons Vanguard Laboratory 2635 Parkmont Lane SW Olympia,WA 98502 360.967.7010 vAN UAI D Report of Laboratory Analysis LABORATORY Collected by: Ackley Pump Service Matrix Drinking Water 360-508-6393 Laboratory ID: V250923-10 Sampling Address: Date Sampled: 9/23/25 13:15 18308 Old Hwy 99 SW Date Received: 9/1/35 14:30 Rochester,WA 98579 Date Reported: 9/25/2025 Sample ID: 18308 Old Hwy 99 SW Analysis Result SDRL MCL Units DF Date Analyzed Total Coliform&E.coli by SM 9223B(IDEXX) Batch ID:V250923-10 Analyst:CB Coliform,Total Negative 1 1 MPN/100 mL 1 9/23/25 18:12 E.coli Negative 1 1 MPN/100 mL 1 9/23/25 18:12 Nitrate by Hach Method 10206 Batch ID:V250923-10 Analyst:CB Nitrate(as N) ND 0.50 10.00 mg/L 1 9/23/25 17:09 Notes: MPN:Most Probable Number ppm:parts per million nd:non-detect Reviewed by Dustin Newman,Laboratory Director on 09/25/2025 n/a:not applicable SDRL:State Detection Reporting Limit Approved by Tori Johnson,Operations Manager on 09/25/2025 DF:Dilution Factor en 17025:2017 MCL:Maximum Contaminant Level sze Ai 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(Office:360.967.7010 I testing@vanguardlaboratory.com www.vanguardlaboratory.com 1 of 1 Return To 2237923 MASON CO WA NO` � 4" E11Z1#219 12.40 Re PM F e: $E ` lu` BENTZ #219887 Rec Fee: $e04.50 Pages: 2 - W Nye111111IIIIIII1111111IIIIIIIIi11IIII1111111111IIIIII S P oNao( e 1 W k w)._o S Mq � 2 R 2026 /1,4.0 Grantor(s): (1) Nolan and Hannah Bentz (2) Nancy Bentz /1,FO Grantee(s):(1)PUBLIC ++ ''�� ��,�, Legal Description(1) 1\1 _ �.�VI t a . Z D' Jan ye 3 (Abbreviated fonn:i.e. lot,block.plat or section,township,range) Assessor's Tax Parcel:(1) 32120-75-00070 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) 32120-75-00070 Tax Parcel: (Connection 2) 32120-75-00070 The system owner is responsible for keeping this system in compliance. The name of the water system is: 490 Water 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 6th day of March 20 26 Signature of Grantor(s): 1 � n (1) { Gti' ' (2) l iAZ,C Page 1 of 2 State of Washington County of Mason I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify 0,1 that on this 6 t" day of a f h ,20 _24 • ,tic/an w?.t Hay!n„J, &i t2- ccrki 1rn'Orsonally appeared before me,who is known to be signer of the above instrument,and acknowledged that he(she)(they)signed it. GIVEN under my hand and official seal the day and year last above written 4 Notary Public and for the State of Washington, residing at sr/OK`C..-�c C: -`-k NIKOLAY BASHMACHNIKOV My commission expires: /v(a 21(• 2v 2-CC Notary Public I State of Washington Commission#21021654 My Comm. Expires May 24, 2029 Page 2 of 2 P 3.--2 S. / Rd-- i p 2S SO S la i 1V.-----7--3..0 ���-1 APPROVED �.- PROVE D 4 , ,`b.� Rd U . SEP 16F 2024 MASON C0i1NTY EI V1R0NM q tH R , r j . tV-4r' A o _ � ,_., _ ,,,_., ,,.,.,_,,. A....,.._,,t_, -3," ,,,,,,- ,,, i , , , ,,„ ' x 557 \--'-'11-"-i''''' S et). in O Audio-Visual Alarm (.1). S -v,. v..^e_. S•oo•n •,�40 O Cleanout Q © O 1200 Gallon Septic Tank 34 2 Compartment with Effluent Palter 44 3.:;400 Gallon Pump Chamber ate ,_ `,,./ Valve Control Box v. *. \\V • . ~ictL PAULA or JOHNSON '.tLS . zO-Z* Printed From Mason County DMS \I Printed from Mason County DMS