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HomeMy WebLinkAboutWEL2026-00009 - WEL Application, Design, Letter - 3/31/2026 MASON COUNTY 415 N 6TH STREET,SHEL-967 ,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 03/31/2026 VAN ACKEREN CHRISTOPHER EDWARD 60 SE SELLS DR SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00009 300 SE Wells wood Way 319021400000 The 2-party water system, Two-Party Well (SFR+ Future Connection): Wells Creek Well (319021400000/319021400000), 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 Sincere David Anderson Environmental Health Specialist Mason County Environmental Health MASON COUNTY Date Received: COMMUNITY SERVICES Amount Received: �/ lReceived By. Building,Planning,Environmental Health,Community Health 5� 415 N.6`h Street,(Bldg 8)—Shelton,WA 98584 WE L x.02 k - 0000 0l Shelton:360-427-9670 x400 Belfair.360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT I PHONE Christopher E Van Ackeren 5419130950 W, / 11111 MAILING ADDRESS-STREET,CITY,STATE,ZIP 60 Southeast Sells Drive SITE ADDRESS-STREET,CITY,STATE,ZIP �.r L0ZU PRIMARY PARCEL NUMBER(WELL SITE) 319021400000 By SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) 3- ka. )2 t2 WATER SOURCE I SOURCETYPE PARCEL 1 LOT SIZE(no minimum) I PARCEL 2 LOT SIZE(no minimum) 0 New Existing a Well Spring 20 acre PROPOSED WATER SYSTEM NAME(REQUIRED). Wells Creek Well PROJECT DESCRIPTION(eg,detached ADU,new single-family residence,existing connection,etc.) New Single Family Residence ¢ U C DIRECTIONS TO SITE/CONDITIONS/GATE CODE I KEY LOCATION/ETC. 4y j)q n'°ll G Ca(( 3/$(u11G Turn North onto SE Wellsood Way off of Lynch Road at .25 miles east of Milepost 4 Required Submittals/Requirements Checklist: - El Original water well report(well log)or DoE water well report for an existing well. ❑'' Well tag secured to the well casing. El Capacity test showing 800 GPD with drawdown and recovery to static level information. El 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). ❑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 second connection.I attest that the well currently has no more than one connection. Print. Sign Christopher E Van Ackeren 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: 0 Parcel numbers(s) El Property lines/boundaries ❑ Applicable easements with the Auditor's File Number(AFN) El Roads and driveways 0 Well location with a 100 ft radius around it El Structures*Water wells shall not be located in garages,barns,storage buildings,or dwellings(WAC 173-160-171) Q Water lines for existing and proposed connections Q 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 / / _ O TI /1 ' ,// /r / �/ add \\ ` Shed 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.) ❑ ❑ 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? ❑ ❑ Adequate surface seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. ❑ ❑ The well casing extends______above level ground/concrete slab. Lat: 7 L 1 1a'( 4 227 "D ❑ O DoE well tag attached to the well casing? q"` Lon: .. 1'3, 0 t 5 ®7 Tag: ❑ ❑ Variance necessary for well site approval? Comments: 1 Pass El Fail Inspector (2Date ? ,� i Review Step 2: Two-Party Review: YES NO NA ® ❑ ❑ Water well report(well log):Date Completed /t/1 15` Zd 2 s Driller aftci7g Orl ❑ ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recov to static level within 24 hours? Capacity test information:Date l a Z Driller/Pump Installer C I ✓(l G-+ GPM Duration(minutes) d Total Gal Recovery Time(minutes)to Static ❑ ❑ Water system capable of supplying at least 30 PSI to each connection?PSI 3 LO / [P ❑ ❑ Satisfactory bacteriological analysis? Date ?&$Testing Labi1a4,9V41ilof t ' i• Xl ❑ 0 Signed,notarized,and recorded notice to future property owners?AFN 22 '10$ ❑ ❑ Signed,notarized,and recorded water use agreement?AFN G ❑ ❑ [Y Signed,notarized,and recorded access easement (s)?AFN 0 ❑ The system appears adequate to serve two connections based on the information providgd R 3 , Z ( 6 ce - f 4Soly� Comments: j t1A ' /V L Approved ❑ Denied Reviewer Date 3(3'f / O'24 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 perMCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19`h,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 ��if �G�ik! DEPARTMENT OF Notice of Intent No. WE60574 ECOLOGY Unique Ecology Well ID Tag No. BQC126 Type of Work: State of Washington O Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NO!No. Water Right Permit/Certificate No. Proposed Use: l i Domestic O Industrial O Municipal Property Owner Name Christopher Van Ackeren ❑Dewatering O irrigation O Test Well O Other Well Street Address Wellswood Way Construction Type: Method: ❑New well O Alteration ❑Driven O Jetted O Cable Tool City Shelton County Mason O Deepening O Other ❑Dug ❑O Air- O Mud-Rotary Tax Parcel No. 31902-14-00000 Dimensions: Diameter of boring 6 in.,to 158 ft. Was a variance approved for this well? ❑Yes I]No Depth ofcompleted well 157 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread 1i I O 6 in. 0 154 .25 in. O I ❑ l I O Location(see instructions on page 2): E9 WWM or❑EWM O I O in. — — ,__in. O I O O I O SE %-%of the NE '/;Section 2 Township 19N Range 3W ❑ I O in. — — _in. ❑ I ❑ O I ❑ ❑ I ❑ in — — in. ❑ I ❑ ❑ I ❑ Latitude(Example:47.12345) 47.16430 N Longitude(Example:-120.12345) -123.01509W Perforations: O Yes 19 No Type ofperforator used No.ofperforations- Size of perforations_in.by in. Drillers 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: lH Yes O No Ill K-Packer b Depth J.!.L.ft. information. Use additional sheets if necessary. Manufacturer's Name Alloy Machine Works Material From To Type Wire-wrapped Model No. Diameter 5" Slot size.010 in.from 152 ft.to 157 ft. Brown silty sand,dry 0 4 Diameter Slot size-in.from _ft.to ft. Light brown sandy clay,sticky 4 22 Light brown fine gravelly sand,clay binder 22 28 Sand/Filter pack:O Yes O No Size of pack material-in. Brown fine sand and gravel,clay bound,dense 28 35 Materials placed from-ft.to ft. Brown fine to large sand and gravel,loose,moist 35 53 Surface Seal: l 1 Yes O No To what depth? 18 ft. Gfa boulder 53 54 Material used in seal Bentonite chips Did.any strata contain unusable water? ❑Yes lJ No Gray fine to large silty sandy ravel 54 62 Type of water? Depth of strata Gray fine to large round gravel,silt bound,dense 62 95 Method of sealing strata of£ Gray fine to coarse silty sand,tannins,wet 95 121 Gray fine to medium silty sand,some gravel, 121 Pump: Manufacturer's Name Type: woodchipS,tannins,wet 144 H.P. Pump intake depth:_ft. Designed flow rate: gpm Gray fine to large sand and gravel,heaving,water 144 158 Water Levels: Land-surface elevation above mean sea level 65 R. Stick-up of top of well casing_15 ft.above ground surface Static water level 50 ft.below top of well casing Date 8/13125 Artesian piessnre lbs.per square inch Date } Artesian water is controlled by (cap,valve,etc.) Well Tests: q9 Was a pumping test performed? ltJ 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 Water Level Time Water Level Time \Vater Level Date of pumping test Bailer test—gpm with_ft.drawdown after_hrs. Air test 35 gpm with stem set at 80 ft.for 1 Itrs. Date 8/13/25 Artesian flow gpm Temperature of water 51 °F Was a chemical analysis made? O Yes No Start Date 8/13125 Completed Date 8/13/25 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. l Driller 0 Trainee❑PE—Print blame Cory Johnson Drilling Company Arcadia Drilling Inc. Signature Address PO Box 1790 License No. 3441 City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's Lice se No. Contractor's Sponsor's Signature Registration No.ARCADD1098K1 Date 8/13/25 ECY 050-1-20(Rev 09/l8) If you need this document in at alerrtare format please call the Waler Resources Program at 360-407-6872. Persons st ith hearing loss can call 721 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. L Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer:Christopher Van Ackeren Well Tag#: BQC126 Site Address:300 SE Wellswood Way,Shelton Depth: 157' Date of Test:9110/25 Static:47.8' Pump Set: 140' TIME GPM LEVEL RECOVERY 1 Min 5 48 TIME LEVEL 2 Min 5 48.3 1 Min 51 3 Min 5 48.5 2 Min 50 4 Min 5 48.5 3 Min 49.4 5 Min 5 48.5 4 Min 48 6 Min 5 48.5 5 Min 47.8 7 Min 5 48.5 8 Min 5 48.5 9 Min 5 48.5 10 Min 20 48.5 15 Min 20 50 20 Min 20 51.2 25 Min 20 51.8 30 Min 20 51.8 35 Min 20 51.9 40 Min 20 51.9 45 Min 20 52 50 Min 20 52 55 Min 20 52 1 Hr 20 52 1 Hr 10 Min 20 52 1 Hr 20 Min 20 52 Vanguard Laboratory 2635 Parkmont Larie SW,Suite A Olympia WA 98502 adAHfl D 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County Collected Mason 09/10/2025 1 z o e ❑AM Month Day Year - -❑'PM 'Type of Water System(check only one box) ❑Group A ❑Group B (]Other Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Christopher Van Ackeren 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) adeta@arcadiadrilling.com ANDjenn@arcadiadrilling.com - SAMPLE INFORMATION Sample collected by(name):Max Specific location where sample collected: Special instructions or comments: SOC126-300SE Wellswood Way,Shelton Counts please Type of Sample(select only one type of sample from types 1 through 5 below) - 1.❑Routine Distribution Sample(AIP) 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 ————— I Unsatisfactory routine collect date: S I I Chlorinated:Yes Nc ❑Triggered(AIP) Chlorine Residual:Total—Free_ ❑Assessment(AIP) 4. Surface or GWI Raw Source Water Sample(Enumeration) ' S ❑E coil ❑Fecal is ed Yes_No 5.(]Sample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Colifonn Present and J Satisfactory ❑E.coi present ❑E.coli absent i Bacterial Density Results:Total Colifonn <1.0 /100ml. Ecoli <1.0 /100ml. Fecal Colifonn /100ml. , HPC /1 ml. Replacement Sample Required: D TNTC ❑Sample too old ❑ Sample Volume ❑Damaged Container ❑ Date7Time eceived: Lab Reference Number ja -L Receipt Temp C°: Method Code: L Date Reported.to DOH Lab Use Only: DOH Lab-Sample# 285-g1O2k OOH Far 5301.318(ereeore O&17)-0 you real uda pdLm5on in m a..erelve lcn,r.A call 00.5250127(TOUM G�'711) Iii,and onea plb5aAm ee eveletle of aw,ddaxa pw drnJdngna!e,. IS 1 2238405 MASON CO WA 03/27/2026 10:23 AM NOTCE VAN ACKEREN, CHRIS 31220294 Rec Fee: $304 50 Pages. 2 Return To 1111111 Illill Ili OIl 1111111 11 111 IIII Illf 110 Ilil 111111!11 IIII 11111 IllI Ill Chris E Van Ackeren 60 SE Sells DR Shelton WA 98584 Grantor(s): (1) /3 4cwz ._ (2) Grantee(s):(1)PUBLIC s p - T 1 q ` tR3 Legal Description(1) S '4 L t.)l< Sc'C .S 7/I6? (Abbreviatedform:i.e.lot,block,plat ors ction,township,range) Assessor's Tax Parcel: (1) 3190 /i 0 2c () 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) 319021400000 Tax Parcel: (Connection 2) `10101 0 QO Op The system owner is responsible for keeping this system in compliance. The name of the water system is: Wells Creek Well 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 /Z �� day off/f,3*- ,202. Signature of Gr Page 1 of 2 State of Washington County of Mason I,the undersigned,a Nary Public in and for the above named County and State,do hereby certify that on this ja day of jj ,20 2- P- rsonally 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. ONNF� ��� ��nh 7{-- """`r+rr, otary Publi in d,f pr the State of Washin ton, o �t� iii residing at ✓15c9- ,� /L.1 ° 'pA �; My commission expires: I_—/'(' 7 %O24006315 H% /''i , Page 2 of 2 2238405 Page 2 of 2 03/27/2026 10:23:06 AM Mason County, WA fl4;:1- , -— & p -o ( . i4 fd .^ N d t QAA car?oOO rfi! /m� Hold DEC 222025 Pril fit. Mason/02-u my DM COUNTY EN\'I1ONIMENTAL HEALTH Printed f onh Mason C;≤ ty DMS DA.