Loading...
HomeMy WebLinkAboutWEL2026-00013-TWO PARTY WATER SYSTEM - WEL Application, Design, Letter - 4/13/2026 4A MASON 415 N.6TH STREET,SHELTON,WA 98584 COUNTY SHELTON:360=427-9670,EXT 400 BELFAIR:360-275-4467,EXT400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 04/30/2026 Arnold, Jessicca 800 W Wynwood Dr Shelton, WA 98584 RE: WATER SYSTEM PERMIT. TWO-PARTY WEL2026-00013 810 W Wynwood Dr 420257500270 The 2-party water system, Two-Party Well(SFR+SFR): K& L Farms (4202575002701420257500260), 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 MASON COUNTY DaleaeceTvect; Oq 1r 0Pa COMMUNITY SERVICES AmountR ReoelvedBy: Su0dng.PlanningEmlranmenbIHealth,CommunityHealth 1�h 7, C L 41SN.6"Strect;(B1dg8)—Shelton,WA98584 Y1PEL Shelton:360.427-9670'x400 Belfair.360-275.4467x400 Elm:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICA..Nr PHOYE Jessicca-and Tyler Arnold 06 498 6227 MAILING ADDRESS-STREET,CITY,STATE,ZIP 800 W Wynwood Dr Shelton,WA 98584 SITEADDRESS-STREET,CITY,STATE,ZIP ` 207_6 810 W Wynwood Dr Shelton,WA 98584 11 PRLIrARYPARCEL NUMBER(WELL Sr1E) 420257500270 By SEC ONDARYPARCELNUMDER(SAMEASPRIIIARYIFLOCATEDO, 420257500260 WATER SOURCE SOURCE TYPE PARCr.1.1LOTSIZE(nominimum) PARCEL 2LOTSIZE(nomin)mum) New W Existing. Well Spring � �tf PROPOSED WATER SYSTEM NAME(REQUIRED). K&L Farms PROJECT,DESCRIPTION(t..,ddadun ADU,nets singto-fmnBy,,csdmce,editing connecdon,ttc) 2.party well 1 MREC1IONSTOSITEICONDITIONSIGATECODE/KEY-LOCATION!LTC ter Way towards W Delaware st.0.4 miles continue onto lake Blvd.9 miles,continue.onto w cloquallum rd..3 miles,turn fight on wwynwood dr..7 miles tum left and turn left 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. Capacity test showing 800 GPD with drawdown and recovery to static level information. Bacteriological test(Bac-t)results:current(within 12 months)and satisfactory. 09,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 UseAgreement,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. Jessicca Arnold 4113/26 Print:. Sign:. Date: 4113126 form maybe scanned and made avail le.for public viewing on the Mason County zvebsite Pg 2 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? 0 ❑ 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 foi••artesian wells? ❑ ❑ Adequate surface.seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. tr ❑ O The well casing extends t 6 above leve group /'concrete slab. q7 t?.fl o tat: ❑ DoE well tag attached to the well casing?. 1on: ./17 -('L6,6 Z0 ❑ ❑ Variance necessary for well nte approval? ` ag. �1•t3. Comments: rt v U App .by e u mo&flt d (77- Pass Fail Inspector Date L// /7 Review Step 2: Two-Party Review: YES NO NA. ❑ ❑ / f Water tvell.reporf(well log):Date Completed t1t!(O5/ 6 Driller ØrI 8r°�t{ ® ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static.level within 4#hours? Capacity test information:Date Driller/Pump installer { VII f if"t�9il' GPM Duration(minutes) 3& Total Gal_________Recovery Time(minutes)to Static 9S ❑ ❑ Water system capable of supplying at least 30 PSI to each connection?PSI. [i ❑ ❑ Satisfactory bacteriological analysis? Date Testing Lab 1"' F ❑ ❑ Signed,notarized,and recorded notice to fit u e property owner ?AFN 1 ] ❑ ❑ Signed,notarized,and recorded water use agreement?AFN ] ❑ ❑ Signed,notarized,and recorded access casement(s)?AFN z2 3 fM � Y 1 El O The system appears adequate to serve two connections�+ based on the information provided?I'Zo76z xeJe,1( cT tComments: r ► Approved ❑ Denied Reviewer Date Findings in this review reflect observed conditi is as they existed on the day of the site ihspection. No claim is made.express or implied of the fertita e success orfailrrre 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 tine of building permitperMCC 6.68. IWTater usage restrictions and additioirnl fees may:apjil y to all new wells drilled-alter•Jamrai3,19`',2018 per ESSR 6091. This form may be scanned and made available for public viewing on the Mason County websit'e Pg 4 Last Updated: 1/7/2026 WATER WELL REPORT c.URRENT IVotiq a of Intent No:W2o7948 o,,ieis.s ak i"�ovn-tea.x"'err- ,�•� Unique Ecology Well ID'I'agNa.ALL339 mmleson(``x"lnclrcle) Con o s ruction eoo Water Stight'Permit NO:Elcsi i! WeLL M.C.Construction propem,.ptarnGrNameK ARNOLD Decoinmissioti ORIGINAL 1NS7'ALLrlT1ONNorice elo W,,WYNWOOD DRIVB of intent Nimber Welt Street Address D Qiodu tci1 ❑Moulds City'sI4ELTON Gounty'MASON, tYn1 pRoNOSLD.us ®, Q Test WeU Q Other 2Q1` 4W ❑e ude ❑DaWasu i]Inib}don CI Location SWI/4-1/4 0 l(4 Sea'�Twa R ,, TEoswoxw as> otwaicifuid10)�------ LatMi /Sec aloft Method: a+a: {I Dotad 13 thiveo i t/Lang.(s,t,r . Lot 1]Eg Ne�v well O Rnoottditi Way Q Jefted . Sh11 REQUIRED) Lang Dsg Lotlg MitJSec vaepid DlhiLi'1SIONSs Dt�geterorwd)6 icehes,ddiled _R Dept!TMI ptdad wdi 343. 0- Tax Parcel No.4 50U270 CONSt7t0C)Wd DETAILS - 6 Dsrz<:F +2� tt to 338 n CUN$CRUL 1 lON OR DECOMMISSION PROCEDURE j s [(lmetitWptled Dntn front -ilto iL FoidiiQoo � � y tith s Iaatoaembat each cheu8c°I of the mo1s11 each mpenctiled.pEto ofp es o �� BAD AI.SlII3RI'S intbtnteboa Typeafpertosusod g VEL[ON NECESSARY. u4y; m tndaaofpel& ,_.,p r SILTY SAND-C 1, 6 ti SILT BOUND BROWN GRAVEL 6 65 s w JOHNSON Tc . 72 Mode No. BROWN FINE MEDIUM SAND 65gLpTiB ' xig Rto 343 a: Disat S Slattxao n�o °'�-------ft ro-- h• BROWN SILTY SANDY GRAVEL tlx 86 S►os ruc ° BROWN SILT,ORAVEL. 76: ----- 118 Yes No Siuoflgav Gsttvd J tines pttO eUttnd'__� GREEN SILT.SOME GRAVEL 112 f to 1}8 155`: Maria1cpiood&°°t• BROWN SILTY CLAY.GRAVEL Towh�tdepttft?0<—�—R .155 168 gurf sesrsli mYes ,CIS' GRAY SILTY-CLAY.GRAVEL 194 aialis�edinsul,89"NMECI11PS 168. Yes ®Nb DROWN SILTY CLAY,GRAVBL. 194 274 Did,iw of trnra eofa>ittmussGt4 Q GRAY STICKY CLAY` 335 lyryo oiyi stall. > ctante. GREEN STICKY CLAY 274' 343 I.iaLod ottratingoir BLACK PEA ORAVEL,SOMB SAND>V4/ATf?I 335 PUMP :1 bwI ctacet'.aName H P. 7Yixi•: � WATER 1EYF.tS:lam° elevation above aian sea lent Stmlolevel tI below lopoRvrdl: Date ICfI -- �a pQ,mome huh Dau — -:.P �F�.+�k '."Yl�laCCiRhC�lod I ja .£.�'>xd � 5. ater rbrel errmuzad f+oq casrrot+hrtsp,CP{?� 96)N ZlplowdWr1flel) Wetutevel Time Waterrevd Tote Water Level late D to of loss hsa Bailertcst.: $ilJmt'9-.with-----�•.draWdo � Ai{tw 2(l�SDlsntu.with stem set:;330' R`fot 1 his: Aitesilia flow A Pan Dam snado?QYes ONo 3/06 T u root`wilet Wwatobe°dalsusiysis nn5 Completed 1113v ttslb1lity for twnslnliIon of this well,end its compliance with all WELL 'coon CERTIFICATION:Materials I constructed andlor information relw�rt$above are true to my best knowledge and belief. n W41'q construction 1vlateriaLs ARCADIA DRILL 1NGiNC. . Washington ELSON Dri►ting Coate+ O Dniler EIEoeaoea.OTlanee N. Address PO BOX 1790 DnTler/E>tgiiieei(rotinee Siglmltre pay;srou ZiP;SIiEI.TON WA 985.84 ihillcraK.tt>aee+sliattsoNo.:18S6 _ —• ��ARCAUDI098K1 Data': .': 1rTiFA1N6& , 0)"P1'�Lieeesid Na: pcllter'f*ioataro Eaologg is ai Fqual t7pportunitY Eonptoy�� �^ �pS0-t-20(Rav 3Rt5) z E'rir�i d from ,ason C L my •i IO Glt iuinping Testi €t Cone #lon Shut Weil Ta "No 'DOB Source ID: Water S stcnU4ante. v ` Welt Names l tl CG TypeofTest: Conducted'B : Date: (/ atatie Water LvoJ ns inetzsuretE"f tm rercnco. cant: COUflt 4 ,V t bscrvaon 4'Volis • fV Well B1 vatioai NISL, DWauce f'Qlisczrvatofl well r °frto ails ecl w©li !): it!''/t Flute since umpitnl; e ltie to Pumping laeg Wtcte�s Drawdown Rate fQ) e ' ritn, Level ci ft tlra m'= Comrizent ,2Jgr e k , c ' a _____— _ — ° o � . December 2 Q Thurston County Environmental Health 412 Lilly Rd NE 6 Olympia,WA 98506 360 867-2631 GOIiFORM BACTERIA ANALYSIS cwo SampbCI[d• 1t'r 1`J tj C om 1.38�r Csr Yt ' I: Typo orWVater Syslem(cW only one lox) 0 Pd ate taus }i OGpA OGMWB t 1y;_. 4t Group A sr4 Grotp 8$ysii<rris»Prov}do from Water Fa es}nvanlory C1YFq: rem tra APR 2 7026 CcnW Per n; OdyPtfOn9:( } C�"�A Gt'tt4Rs: L�d` S&M utW.(PfrJ . m�drp c-od**�cf,.€r iJ 2dd`M- ) 1 , r91 & •c"V ' S .lfaal "..``S%t1' SAMPLE INFORMATION Samp�OWCted.by(*me): c c lu6oe,oa�wadd�ess wh�aro s.�rnp>i cc csG�is. Spgaal ln$buet0'cr oorrfn�nt a Typo of Sample(gnus chotJc only one box ol#1 through#41 b 'r) 1.O Roul no Oletributton Samplo ₹.Rep*at Sample(alter unto! outb o). Ch'lor?ated;Yee Uo 0 Oi Jributen System Chbrine Resxlual.Taut_Free— ChMtated.Yes h'o_ 3.Raw Water Source Sample Chino Re tat Tolaa, Fred_..,.,,_, CIE.c+ —GWR(NP1 p Fecal—s a—%1 s f t—+ l UnsaWattt'y toufne lab fxsmber; O Assossn'ent tlnr rInQ(Al') Unn2 iblaCt6r!rears coda. [)other l,.__.,.,_.el s empte Colleeled for information Only twig h'a CmauucQm tRrpais�..� 4tt r G t LAB USE ONLY DRINKING WATER RESULTS LA USE ONLY O Unsatiafagiory ToSal Cota'drrn Ptesont and Satkafaetoty (jF— 5present D E09atsent ltoColGanitd d d Replacement SampleRequlted: O Sert of ('39 hours) ❑'TNTC O r 1100ml. E.c�.; ...__._jl0Ootrd• 8ac.t<tpl 08nsgy ftesu!ts:Tole)Gorei Fecal Ce larm... __.__jt0Amd En(erasooc3. ..w,J10 rci rTie-OW Code:, Shl92?38 OSM 92220 tags a Trr xee la t ©8M921515 O Ent*rawrt' t't tf pda and rimoA a'r o _�. tt _ •'J4 C- Sa�ctcratto tearrz frk�sw�gbJ ta,us4tsar. 0 8 0 � a 223799®A6REE MA ON CO WA 03117!2©26 10:31 AH 111MI1 il11J1NIICfl Nin11 111111l�111 11HI!! Pagaa: Name and Return Address: . cS51lln i4, /J IJ Wk/Jr / ;- COVERPAGE THE RECORDER WILL RELY SOLELY ON THE JNFonMATIc a VID 0 THIS COVERPAGE FOR INDEXING PURPOSES. THE STAFF WILL NOT READ THE DOCUMENT OR VERIF HE AcCLRCY'OR COMPLETENESS OF THE INFORMATION. PROVIDED:HEREIN. '�_� Document Title(s) f Reference Numbs rs(s). acunt tsAssigned or Released ((' ) ADDITIONAL REFERENCE IYS ON PAGE Grantor(s) ' 1 I4I11)P3'JA - �/� ~'rte`• 2 , {' ADDITIONAL GRANTORS ON PAGE Gtantes�� . . r L o ADDITIONAL GRANTEES ON PAGE i.ig-i Description(abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) VOL S o t 2 ` ~ LNAUEGAL I ON PAGE____ A Assessor's Property Tax Parcel/Account Number(s). !2O G—515 w co SE top, G ADD►TIONALPARCEL II'S ON PAGE,�� 3 -SHARED WELL uSE:AGItEEMENT•-810&800 W Wynwood DR,Shelton WA- SHARED WELL USE A MEN'T - - This Agreement is made on this I.3 dayof_1A 20.E between; Owner of the Well Property: ,ZN .: Property Address: 810 W Wynwood Dr Shelton,WA 98584 Parcel Number: 420257500270 (( ç "Well Owner") Owner of the Receiving Property: Property.Address: 800 W W twood Dr Shelton,WA 98584 NN 7 Parcel Number: 4202575td¢ 6 ("Receiving Property fd ne )'' Both properties ar at ason County,Washington. 1. Purpose `` The purpo o is kreement is to allow the Receiving Property at 800 W Wynwood Dr too3hnticz estic water from the existing well located on the Well Property at 810 WW w4 dDr. t'Welt I entification and Location water well subject to this Agreement is located at 810 W Wynwood Dr, Shelton WA. K he ell is identified by Well Tag Number ALL339 issued by the Washington State. department of Ecology. 3.Permission to Use Well The Well Owner.grants permission for the Receiving Property Owner to connect to and receive water from the well for normal residential domestic use. 1/4 2237990 Paget of 5 03/17/202610:31:24 AM Mason County, WA -SHARED WELL USE AGREEMENT—811&800 W T!t'nwood DR,Shelton 1414 4.Maintenance Responsibility The Receiving Property Owner agrees to assume respo slbIIitflor all costs related to the,well,itself including pump repair or replacer r , w�casing or wellhead repairs, electrical components onents supplyingthe well pump .�a�t lane from the well to the receiving p �., property,water testing, and any other mainte ncet eary to maintain operation of the well. (' e Each property owner is responsible,foro pressure tank,pressure switch, and internal plumbing located on their respecpjdperties. "The Well Owner shall have no financial responsibility for maintenance or repair of the well. •4A. Backflow Prevention The Receiving Prapert� ? shall maintain a suitable backflow prevention device on the water line at ro to ensure that water or pressure does not flow back toward the Well perty she Well Owner shall have no responsibility for the installation, i .or operation of this backflow device. 5:Elect -itj ' osts The W 3 , wnner shall provide electrical power used to operate the well pump. If the tAl eletermines that water usage from the Receiving Property results in above- rage ectricity consumption associated with operation of the well,.the Well Owner �mae est reasonable reimbursement from the Receiving Property Owner.The ç-- tèrpimation of above-average usage and associated cost shall be reasonably C determined by the Well Owner. 4 6.Access The Receiving Property Owner shall have reasonable access to the Well Property for purposes of maintaining or repairing the well and water line.Any disturbed areas shall be restored. 2/4 2237990 Page 3 of 6 03/17/202610:3.1:24 AM Mason County,WA SHARED WELL USE AGREEMENT 810&800 W%Ynwood DR,Shelton WA .. E 7.Temporary Water Shutoff for Repairs /7) The Well.Owner reserves the right to temporary ys I(off water service to the Receiving Property when necessary.for repairs or main it ?e' ich shutoff shall not exceed seven consecutive days except where additlonatte ,a easonably required to complete necessary repairs, Reasonable notice we when practical. 8.Temporary Nature of Agreement The parties acknowledge that the Receiving Property owner intends to install a separate tae g ! P �3' well in the future.When a ne ll i bstalled and the property at 800 W Wynwood.Dr is permanently disconnect a re - well located at 810 W Wynwood Dr,this p tiY rnh� Agreement may be ter rin y written agreement of both parties. 9. Running With e Lan This Agreem blnvith:the land and apply to current and future owners of both properties 'l; i ated in writing. 10. G�fe glow gire n ent shall be governed by the laws of the State of Washington, 3/4 2237990 Page 4 of 5 03/17/202610:31:24.AM Mason County, WA -SHARED WELL USE AGREEMENT—810&800 W Wynwood DR,Shelton WA- Well Owner(Parcel 420257500270) •� Property: 810 W Wyriwood Dr Signature: Date: Name: 1U rw t Signature: Date: . Receiving Properly Owner(Parcel 0257500260 P ty � � ) Property: 800 W Wynwood\ Name: r Signature: Date: 1'Y ? . , Name: r lJ Signatu . :: r. Date:< aryA . knowledgment �-of Tashington oiy of �t`J 0n this day of l 202, before me personally appeared c►tAc� ln✓roc nr ( and ¶u m r t unc1 , \ Ki cc b vi6 (known to me to be the persons who executeAl this instrument, Notary Public Signature:(iv4iMA Printed Name: l 1 •�� �•'�9 '�<%'% -My Commission Expires: ='1 ' 1. AUBUC �ii9j�••Numbe��'••' �'tw� 414 2237990 Page 5 of 6 03/17/2026 10:31:24 AM Mason County,WA � r ,h'Rnrac.Jr % S 75V Tv gg I MgJtc c --a � I I �{. �,,. „ is'c�rr�v per, 1 j -•. ,�fcti �i I a. f E lti� sr✓Tt} 1.�+F7 F6�� �� �� � € ,pt,1� y�.?+y ( �h-•'v� Srn gr c] j�'j f 1 , ► ?oLSr Lei rams 1 l V �1TC�:cl L £J �X ff X .w� � .rE ve�6rz�lts_ 3 // Ir ARNOLD Mason Counly Parcel:420257500260 �'; Scale: � . f March 6,2022 .� YY /� d tr � ,� \` d f ,/ /\ / / / 7/) / J \\ ( ///,//; 7;/ . X; 7 / ( - : J r°' 1'J } J ( yr .._ 1071' `y 2W t!' ���' I ,..tear.._....��_., r• / \( ( ')K / \S\ \\ \ \ , - / /\; /S\ 1026 t \ r `• t F,a4 / / (�{� ,..,���e, ,�.� f ,, \#'S CiFiAIlIfS1i1lilL3�AYJ.Yi�ill r"• ( ! f ,rr'""ji thriving t iructirirt ,from Shelton Tdbwflflix. [ ? H ead cautheest oar S Prot ear Way SiYiaw s• . , CI.�6B �i' ta`ArurciWDol ware Si �� • tm � �`� a. Corttipi ,arty? aka Blvd " ,/1,y .a 145 ,/ Tum l igfi t aajto W_Wynwoa c 07r i 170 7urrt left 1 oe�rdmate Street Front �'*��` `` t0 Latitude RAIRM ', ongitude 12a 127.