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HomeMy WebLinkAboutWEL2026-00006 - WEL Application, Design, Letter - 3/30/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,27-967 WA E 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 03/30/2026 Jeffrey & Patricia Hokenson 130 E Lantern Loop SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00006 520 E Cottonwood Dr 221283100000 The 2-party water system, Two-Party Well (SFR+ SFR): Hokenson Timber Well (221283100000/221283100000), 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 i - MASON COUNTY Date Received: n I COMMUNITY SERVICES AmountReceived: Received By Building,Planning,Environmental Health,Community Health ,6 7`) 415 N.6t"Street,(Bldg 8)—Shelton,WA 98584 WE L coo - Shelton:360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT ' PHO e: k so 310 9 MAILING ADDRESS-S ET,CITY,STATE,ZIP SITE ADDRESS-STREET,CITY,STATE,ZIP 5 .20 E. Cb o © 1)r. ' ' WA. 18 PRIMARY PARCEL NUMBER(WELL SITE) .L. ; -CeV2 3 ! - O O O' o SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) ,22. /.28 -- 3 I - o©ooO WATER SOURCE SOURCE TYPE PARCEL I LOT SIZE(no minimum) JPAJ�P) iNew Existing Well Spring PROPOSED ATER SYSTEM NAME(REQUIRED). /�Oke'rLOJ1 77 ,- w€ij LI/I L PROJECT DESCRIPTION(e.g.,detached ADU,new single-famd residence,existing connection,etc) • L G( frr » lz 1 c d DIRECTIONS TO SITE/ ONDI'o rTIONS/GATE CODE/KEY LOCATION/ETC Ceat t €d(:y-: /1 Q 7 ? Required Submittals/Requirements Checklist: ❑ Original water well report(well log)or DoE water well report for an existing well. ❑ Well tag secured to the well casing. �4( capacity test showing 800 GPD with drawdown and recovery to static level information. ❑ Bacteriological test(Bac-t)results: current(within 12 months)and satisfactory. ❑ Septic Records(additional locating requirements may apply if no septic records are on file). q Pp Y � P � ❑ Applicable utility easement documents. ❑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. Print: �1(�' l�e O 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: ❑ Parcel numbers(s) ❑ Property lines/boundaries ❑ Applicable easements with the Auditor's File Number(AFN) ❑ Roads and driveways ❑ 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) ❑ 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 rawing fD&'.c4 . CUzq I LZ Clil i e� S i�e S i p r l N t' !-Foos e. r a Q toO-G- ��Tc ? tl��Ys7 ExiiT This form may be scanned and made available for public viewing on the Mason County we site Pg 3 Last Updated: 1/7/2026 -------- - --- Staff Use Only Review Step 1: Well Site Inspection: YES NO N/O ❑ ® ❑ Sources of contamination within 100 ft of the well?(septic components,chemicals,livestock,etc.) ❑ 91 ❑ Roads located within 100 ft of the water source?Private/County/State Distance to road(s) ❑ ❑ Ground slopes away from the well? ❑ ❑ Well located outside of garages,barns,storage buildings,and dwellings,with at least 5 ft of separation? ❑ ❑ 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? El El ❑ Adequate surface seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. ❑ ❑ The well casing extends 2n1 r above level ro d/concrete slab. Lat: K�.2'gl8't [A ❑ ❑ DoE well tag attached to the well casing? Lon: (22- ? ❑ [4 ❑ Variance necessary for well site approval? Tag. (3 Q(Z 6 Comments: [ I Pass ❑ Fail Inspector Date 3/1`/?QL C Review Step 2: Two-Party Review: YES NO NA [� ❑ ❑ Water well report(well log):Date Completed 2f/0f Z.'16 Driller ff9CC4 OI Inc.. 7-' Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static level within 24 hours? Capacity test information: Date 2.(/ 'f Driller/Pump Installer u, £'4f,Y► GPM 6'lb Duration(minutes) f� Total Gal (5(C( Recovery Time(minutes)to tatic 1 Z ❑ ❑ Water system capable of supplying at least 30 PSI to each connection?PSI act❑ ElSatisfactory bacteriological analysis? Date 2(' f Z Z≤ Testing Lab ar/0! Lab O( /g . ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN Z2. ❑ ❑ EI Signed,notarized,and recorded water use agreement?AFN ❑( ❑ Signed,notarized,and recorded access easement(s)?AFN l l ❑ ❑ The system appears adequate to serve two connections based on the information provided? f� ^ ei 2- rl Z v Comments: I 46'O4/,1 Approved ❑ Denied Reviewer Date 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 futui e 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`11,2018 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 WATER WELL REPORT r.; DEPARTMENT o= Notice of Intent No. WE61801 ii E C O LOGY Unique Ecology Well ID Tag No. BRG677 Type of Wort:: State of Washington i l Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NO!No. Water Right Permit/Certificate No. Proposed Use: (E Domestic O Industrial ❑Municipal Property Owner Name Jeff HokenSon O Dewatering Cl Irrigation O Test Well ❑Other Well Street Address 520 E Cottonwood Dr Construction Type: Method: 2D New well ❑Alteration O Driven O Jetted ❑Cable Tool City Grapeyiew County Mason O Deepening O Other O Dug i Air- ❑Mud-Rotary Tax Parcel No. 22128-31-00000 Dimensions: Diameterofboring 6 in.,to 156 ft. Was a variance approved for this well? ❑Yes [l No Depth of completed well 155 ft. Construction Details: Walt If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread C ( ❑ 5 in. 0 151 .25 in. C { O F I O Location(see instructions on page 2): L2 WWM or O EWM ❑ { ❑ in. _ in. ❑ ( O O I O NE y,-AA of the SW V;Section 28 Township 21 N Range 2W ❑ { ❑ in. _ in. O { O O { O O ( ❑ in. _ in. ❑ { ❑ ❑ { ❑ Latitude(Example:47.12345) 47.27917 N Longitude(Example:-120.12345) -122.94130 Perforations: O Yes 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: Yes O No R K-Packer U Depth 149 ft. information. Use additional sheets if necessary. Manufacturer's Name Alloy Machine Works Material From To Type Stainless slotted Model No. Diameter 5" Slot size.030 in.from 150 ft.to 155 ft. Reddish brown silty sand,gravel 0 2 Diameter Slot size in,from _ft.to ft. Brown siltbound sand,gravel 2 25 Brown claybound fine sand 25 48 Sand/Filter pack:O Yes No Size of pack material in. Brown claybound fine sand,few gravels 48 61 Materials placed from_ft.to ft. Brown silty medium sand with gravel 61 90 Surface Seal: Yes O No To what depth? 18 ft. Brown silty fine sand,few gravels 90 102 Material used in seal Bentonite Chips Did any strata contain unusable water? O Yes il No Gray claybound sand,gravel 102 110 Type of water? Depth of strata Brown silty sand,gravel,loose,wet 110 141 Method of sealing strata off Black gravel,sand,water 141 156 Pump: Manufacturer's Name Type: H.P. Pump intake depth:_ft. Designed flow rate: gpm Water Levels: Land-surface elevation above mean sea level 245 R Stick-up of top of well casing 1.5 ft.above ground surface Static water level 90 ft.below top of well casing Date 2/10/26 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? r7 No O 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 \Vater 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 120 ft.for 1 hrs. Date 2/10126 Artesian flow gpm Temperature of water 50 °F Was a chemical analysis made? ❑Yes No Start Date 2/9/26 Completed Date 2/10/26 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. ❑Driller C TrAi�e❑PE—Prjn ame James Johnson Drilling Company Arcadia Drilling Inc. Signature t Address PO Box 1790 License lo. 3479T City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No.287 Contractor's Sponsor's Signature / /p ' Registration No.ARCADDI098K1 Date 2/10/26 G TV ECY 050-1-20(Rev 09/18) 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. Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer:Jeff Hokenson Well Tag#: BRG677 Site Address: 520 E Cottonwood Dr,Grapeview Depth: 155' Date of Test: 2/18/26 Static: 91.5' Pump Set: 140' TIME GPM LEVEL RECOVERY 1 Min 6 92 TIME LEVEL 2 Min 6 92 1 Min 91.5' 3 Min 6 92 4 Min 6 92 5 Min 14 92 6 Min 14 93.5 7 Min 14 93.5 8 Min 14 93.5 9 Min 14 93.5 10 Min 20 93.9 15 Min 20 94.7 20 Min 20 94.7 25 Min 20 94.7 30 Min 20 94.7 35 Min 20 94.7 40 Min 20 94.7 45 Min 20 94.7 50 Min 20 94.7 55 Min 20 94.7 1 Hr 20 94.7 1 Hr 10 Min 20 94.7 Total Gallons Pumped: 1514 Gallons Vanguard Laboratory 2635 Parkmont Lane SW,Suite A Olympia WA 98502 =arxovrD 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County Collected 02/18/2026 IIIAM Mason D D D Wool Day Year C3 PM Type of Water System(check only one box) ❑Group A ❑Group B l Other Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Jeff Hokenson Contact Person:Arcadia Drilling,Inc Day Phone:(360 )426-3395 Cell Phone:( ) Email: Eve.Phone:( ) Send results to:(Print full name,address and zip code or e-mail) arleta@arcadiadrilling.comANDjenn@arcadiadrilling.com SAMPLE INFORMATION Sample collected by(name):Max Specific location where sample collected: Special instructions or comments: BRG677-520 E Cottonwood Dr,Grapeview Counts pleas e Type of Sample(select only one type of sample from types 1 through 5 below) 1.❑Routine Distribution Sample(NP) 2.❑ Repeat Sample(AIP) Chlorinated:Yes No (from distribution system after unsaL routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: S I I Chlorinated:Yes No ❑Triggered(AIP) Chlorine Residual:Total_Free_ ❑Assessment(AIP) 4. Surface or GWI Raw Source Water Sample(Enumeration) I S ❑E.coli O Fecal Fnered Yes_No 5.0 Sample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS. LAB USE ONLY ❑Unsatisfactory Total Colifonn Present and j Satisfactory ❑Ecoli present O Ecof absent Bacterial Density Results:Total Colifonn <1.0 I100ml. Ecoli <1.0 1100ml. Fecal Colifonn I100ml. HPC /1 ml. Replacement Sample Required: ❑TNTC ❑Sample too old ❑ Sample Volume O Damaged Container ❑ Date/rmi R ry ' ^ Lab Refe ence Nuulbe 8- !-1 Receipt Tem C':Z Method Code:S M9223 B Date Reported to DOH 2/23/2026 Lab Use Only: DOH Lab•Sample# 285-O2- -2._1 DOH Fam 7431-319 l,wcw,0a'tr)•nyw'readd des puakason in on alSma'ne ram3;.3 e0w525 0127 froDRryc r 711) TR3 a ara3aCo mwww dd wagrnlo-sJigraar. Return Ton /� 2238454 MASON CO WA J .'eN /� 1_4k"son HOKENSONO3/27/20 #2203236 02:40 Re NFeCE HOKENSON Rec Fee: $304.50 Pages: 2 / 3o II III II II I I III I IIIII II II IIII I II IIIII III I IIII I III IIIII IIIII I I IIII Grantor(s): (1)s F/ "£y f' I KP�tI&0!j , (2) /6011_i C.s`t� JT M ke-,t c 1 Grantee(s):(1)PUBLIC Legal Description(1) 2 -S C- .` .Z (Abbreviated form:i.e. lot, Mock,plat or section, township,range) Assessor's Tax Parcel: (1) . .21_ 3 /_D0000 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) a 1 -2 8 _ 3 / _ OOOoO Tax Parcel: (Connection 2) ��( Z S 31 OO OO C) The system owner is responsible for keeping this system in compliance. /tl 1 The name of the water system is: O lç �S o r1 / I,i L� !N e/ 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/ha§ ot)been grante one o more waivers from specific provisions of the regulations. Dated on this I day of , 20� . Signature of Grantor(s): 1 (1) 1" , (2) LJ Page 1 of 2 State of Washington County of Mason I,the undersigned 4 otary Public in an or the çtbove named County and State, do hereby certify th ,pii4Jiis day Qf , 202, rsonally appeared before me,who is known to be signer of the above instrument, and acknowledged that he(she) (t ey) sign GIVEN under my hand and official seal the day and year I a o e writt f °" Ekey �' otary Pub is in nd lb the State of Washington, o`� �yOTARY �N� residing at,U 23038426 = My commission expires: iO717/ c9L7 €` PUBOG . u►uom,uo Page 2 of 2 r.. fJfl p APPROVED `, t JAN 272026 USON COUNTY ENVIRONMENTAL HEAL ' RET /7 I Ti ! I 4 \ t Printed From Masoh County ® 3 Printed from Mason County DMS (i ________________________________ APPROVED �- JAN 27 2026 •�� MASON COUNTY ENVIRONMENTAL HEALTH / . RED' ° ii A L _ X \ t0�tt4� 4i Pr'Mted ��, ��� � �� County ®MS. LASED DE&fGN s.1e� , ..aunty DMS