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Home My WebLink AboutWAT2025-00243 - WAT Application - 7/8/2026 WAT 2025-00243 MASON COUNTY 415 N.6a'Street Shelton,WA 98584 Shelton:360-427-9670,Ext.400 public Health $ Human Services Belfair:360-275-4467,Ext.400 Application for Determination of Water Adequacy Instructions 1. Complete Part 1°. No determination`can be,made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. -3. Submit'completed application with any required attachments for review.. 4. An.approved building site plan must accompany:this application. Part 1: Applicant/ Parcel Identification Name of Applicant: REESE ET VIR KATHRYN Date: 7/8/2026 Mailing Address: PO BOX 1790 Phone: 208-410-7237 Parcel Number: 319142400020 Type of Water System Reason for Application ❑ Public/Community Water System(2 or more l Building permit BLD2025-01328 connections) O Division of land: l@ Individual water source(one connection), #of Parcels? SPL IX Well O Boundary line adjustment O Spring/surface water O Other(explain) ❑ Other(explain) O Replacement or Remodel(please indicate name If you have more than one residence connected of water system below if applicable—no to this well, check the Public/Community Water signature required) System box. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory(WFI) Number: (write"none"for two-party) ❑ I am the manager of this water system. The water system has been approved for services.There are presently connection(s) in use.This will be the connection. ❑ I am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Print Name of Water System Manager Phone Signature of Water System Manager Date This form may be scanned and available for public view at www.masoncountywa.gov J:\EH Forms\Drinking Water Revised 05/08/2024 Page 1 of 2 I-- Group B Water Systems ❑ Satisfactory bacteriological test within last year(attach to application). Individual Water Well l Water well report(attached to application). Depth 159 ft. ll Well capacity Test(attached to application) 11-25 qpm >400 gpd The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. I Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) Satisfactory Determination: This determination does not address adequacy of the distribution system,guarantee an adequate supply of water indefinitely in the future,or guarantee compliance,with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Determination of Adequacy for Building Permits:are'satisfied. Additional Growth Management requirements may apply..Chapter 36.70A RCW. U_ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following r, reason(s). :_. Reviewer's Signatures Envi 7/8/2026 ron. Health . Date This form may be scanned and available for public view at www.masoncountywa.gov Page 2 of 2 WATER WELL REPORT 0E'A?'.MEN. G- NoticeoflntentNo. WE58706 Unique Ecology Well ID Tag No. BQC134 Type of Rork' state of Washingtoe Site Well Name(if more than one Well): N Construction O Decommission b Original installation NOl No. Water Right Permit/Certificate No. Proposed Use: [Domestic O Industrial U Municipal Property Owner Name Kathryn Reese .❑Dewatering O irrigation O Test Well O Other Well Street Address 897 SE Dahman Rd Construction Type: Alethod: City Shelton County Mason E New well ❑Alteration !-Driven O Jetted O Cable Tool O Deepening ❑Other r,�Dug (9 Air- ❑1i1 td-Rotary Tax Parcel No. 31914-24-00020 Dimensions: Diameter of boring 6 in.,to 160 ft. Was a variance approved for this well? ❑Yes []No Depth of completed well 159.5 R. If yes,what was the variance for? Construction Details:. Mall Casing Liner Diameter From To Thickness Steel PVC Welded Thread [ii ;yl or❑EW I�t C I ❑ 6 in. 0 154.5 .25 in. C ( ❑ 1 ❑ Location(see instivctions on pace ): (~ ❑ in. — 'in. O i ❑ ❑ ( ❑ NW ''14-1 of the NE '/,;Section 14 Township 19N Range 3W I ❑ m' 1 ❑ ❑ ❑ ❑ Latitude(Example:47,12345) 47.13605 N I ❑ in. in. O I ❑ Longitude•(E•xample:-120.12345) -123.02232 W Perforations: O Yes Co No Type of perforator used. Driller's Log/Construction or Decommission Procedure No.of perforations_ Size ofperforations_in,by_,in. Formation:Describe by color,character',size of material and structure,and the kind and Perforated from_ft.to_ft.below ground surface nature of the material in each layer penetrated,with at least oneentryfar each change of Screens: 0 Yes O No R K-Packer Depth 153.5 ft. information. Use additional sheets ifnecessary. Manufacnurer's Name Alloy Machine Works Material From To Typc Stainless slotted Model No' Brown silty fine sand and gravel,611 0 7 Diameter 5_ Slotsize.020 in.from 154,5 ft.to 159:$ ft. 7 9 Diameter_ Slot size-in.from _ft,to ft. Brown fine gravelly sand,siltbound Brown fine sand,siltbound,fine round gravel,dry 9 21 Sand/Filter pack:O Yes No Size of pack material`in. Gray sity fine sand and gravel,dry 21 31 Materials placed from-ft.to_ft. Lo 31 32 Surface Seal: K Yes O No To what depth? 18 ft.. Gray silty fine sand and gravel,dry,or aniees 32 36 Material used in seal Bentonite chips Gray fine silty ravel,saturated 36 40 Did any strata contain unusable water? O Yes E7 No Gray sandy silt,some gravel 40 50 Type ofwatec? Depth of strata 50 59 Gray clay,moderate Method of sealing strataoff 59 72 Gray silty round gravel,loose Pumps,Manufacturer's Name Type: Brownish gray silts fine to medium sand and 72 H.P._ Pump intake depth ft. Designed Dow rate:_gpm gravel,loose 81 Water Levels: Land-surface elevation above mean sea level J9 .6 ft. Gray fine to medium silt.sand and gravel,loose, 81 Stick-up.oftop.ofwell casing 3 ft.above ground surface moist 100 Static water level 94 ft.below top of well casing Date 6!23126 Gray sill.y sand,moist 100 115 Artesian pressure_lbs.per square inch Date ;Artesian water is controlled by (cap,valve.etc.) Gray brownish clay,organics 115 143 Gray fine to medium sand,fine to coarse multi- 143 Well Tests: colored gravel,loose,heaving,water hearing 160 Was a.pumping test performed? O No O Yes by whom? Yield_gpm with_ft.drawdown after_hrs. Yield_gpm with-ft.drawdown after hrs. -_ Yield_gpm with-8.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 `,later Level Date of pumping test Bailertest_gpmwith_ft.drawdown.after_hrs. Air test 40 gpm with stem set at 140 fl.for 1 hrs. Date 6/23/26 Artesian Dow-gym Temperature of water 51 °F Was a chemical analysis made? O Yes No Start Date 6/22/26 Completed Date 6123/26. 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. M Driller G Trainee O PE—Print Name Cory Johnson Drilling Company Arcadia Drilling Inc. Signature i Address PO Box 1790 License No. 3441 City,State,Zip Shelton,WA 98584 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.ARCADDl098K1 Date 6123/26 ECY 050-1-20(Rev 09/18) Ifyott need this document in an alienate formal,please call the Water Resources Program at 360.407.6872. Persons n•ith hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6311. Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer: Kathryn Reese Well Tag#: BQC134 Site Address: 897 SE Dahman Rd,Shelton Depth: 159.5' Date of Test: 6/25126 Static: 93' Pump Set: 140' TIME GPM LEVEL RECOVERY 1 Min 11 93.3 TIME LEVEL 2 Min 11 93.3 1 Min 93 3 Min 11 93.3 4 Min 11 93.4 5 Min 18 93.4 6 Min 18 93.6 7 Min 18 93.5 8 Min 18 93.5 9 Min 18 93.5 10 Min 25 93.5 15 Min 25 93.7 20 Min 25 93.7 25 Min 25 93.7 30 Min 25 93.8 35 Min 25 93.8 40 Min 25 93.9 45 Min 25 93.8 50 Min 25 93.8 55 Min 25 93.8 1 Hr 25 93.8 1 Hr 10 Min 25 93.8 Total Gallons Pumped: 1634 Gallons Vanguard Laboratory 263$-Pa lkmdnt Lane SW;Suite,A Olympia*A 98502 360-96'-7019 c,c ruAxaex COLIFORM BACTERIA ANALYSIS FORM DateSample Collected Time`Sampie County Collected Mason 06/25/2026 3 s DAM Month Day Year Type of Water Systern.(check only doe box) 0 Group A ❑Group B 9 Other Group A and Group B.Systems.-Provide•from Water Facilities Inventory(WFI): ID# _— System Name: Kathryn Reese Contact Person:Arcadia Drilling,Inc Day Phone:(360 )426-3395 Cell Phone:( Email` Eve.Phone:( } Send rest ttsyto.(Print full name,,address'and zip cede ore-mail) arteta@orcadladrliliflgcom AND jeno@arcadiCdriltflO com w, SAMPLE INFORMATION Sample collected by(natrie):Shad Specific location where sample collected: Special instiudtions or comments: BQC134 87 SE Dahman Rd,Shelton Counts please Type of,Sample(select Doty one;type,of sample hom.types I through 5 below) 1.❑Routine Distribution Sample(AIP) 2.0 Repeat Sample(AIP)' Chlorinated:Yes No (from distribution system after unsat routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free.._ 3.Ground Water Rule Source.Sample Unsatisfactory routine collect date: s 1 I Chlorinated:Yes No ❑Triggered(AIP) Chlorine Residual:Total_Free_ ❑Assessment(AIP) 4. Surfilaor GWI Raw Source Water Sample(Enumeration) ❑E.colt ❑Fecal Filtered Yes_No- 5.IN Sample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Colfonn•Present and Satisfactory O Ecoliipresent ❑.E.coliabsent Badterial Density Results:Total`Goliform <1.O /looml. Ecoli<1.O 1looml., Focal Coliform I00ml. HPC i1 ml. Replacement Sample;Required' ❑TNTC ❑Sample too old ❑ Safnple;V.Olunle" ❑Damaged Container ❑. Date/Time Received:6/26/2026 `Lab Reference Number X12 . Receipt-Temp,C': MetirodCpde: SM9223B Date Reported to DON Lab Use Only: Lab-SampledDOH 285- :lL i c i 008 Fama3a1319 t54ecm tern•Yyoy naed OI,pub4c4x'n mTofrse@ve 0urw:c A99.5=5A127 iron Y 7!1) Ttsercic tpttass asaalab4a xtriwN.�an,W84�'Erir3dTJNdteG