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HomeMy WebLinkAboutWAT2026-00187 - WAT Application - 9/1/2026 WAT 2026-00187 a _ 415 N.61"Street MASON COUNTY Shelton. WA 98584 COMMUNITY SERVICES Shelton:360 427 9670.Ext.400 Belfair:360-275-4467.Ext.400 Building,Planning,Environmental Health,Community Health Finia: 360-482-5269,Ext.400 ,r a� 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 on Applicant: Nau Family Construction LLC Date: 08/13/2026 Mailing Address: PO Box 1418; Eatonville, WA 98328 Phone: 253-375-4964 Parcel Number: 220297590054 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more l Building permit BLD2026-00789 connections) 0 Division of land: Individual water source (one connection), #of Parcels? SPL k Well 0 Boundary line adjustment 0 Spring/surface water 0 ❑ Other (explain) Other(explain) 0 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. 0 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. Signature of Water System Manager Date This form may be scanned and available for public view at www.co.mason.wa.us. J:AEH Forms\Drinking Water Revised 4/4/2018 Individual Water Well ID Water well report (attached to application). Depth 250 ft. © Well capacity Test (attached to application) 20 gpm >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. © Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa.us/planning 14_ 15 16 22_ Water use or limitation recorded................................... N/A_____N/A Yes WellDrilled ............................................................... Date 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) N 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. ❑ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: T` rY� 5 9/1/2026 Environ. Health: Date This form may be scanned and available for public view at www.co.mason.wa.us. Page 2 of 2 WATER WELL REPORT 'z-PA;7�'l"v- C° Notice of Intent No. WE63492 ECOLOGY Unique Ecology Well ID Tag No. BQC 141 Type of work: State of t ashington J Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NOf No. Water Right Permit/Certificate No. Proposed Use: ?Domestic ❑Industrial ❑Municipal Property Owner Name Anita Nau Dewatering ❑Irrigation ❑Test Well ❑Other Well Street Address 6641 SE Arcadia Rd Construction Type: Method: i New well ❑Alteration ❑Driven ❑Jetted ❑Cable Tool City Shelton County Mason ❑Deepening ❑Other ❑Dug D Air- U Mud-Rotary Tax Parcel No. 22029-75-90054 Dimensions: Diameter ofboring 6 in.,to 253 ft. Was a variance approved for this well? ❑ Yes 1E No Depth ofcompleted well 250 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread O I ❑ 6 in. 0 245 .25 in. C O 9 ; ❑ Location(see instructions on page 2): ❑■WWM or❑EWM ❑ ❑ in. _ _ in. ❑ J ❑ O ❑ NW '/,-'/,of the NE '/;Section 29 Township 28N Range 2W 7 C1 in. in. ❑ I ❑ ❑ ❑ ❑ O in. ` _ in. ❑ ❑ ❑ 1 ❑ Latitude(Example:47.12345) 47.19742 Longitude(Example:-120.12345) -122.95878 Perforations: ❑Yes i]No Type ofperforator used No of perforations_ Size of perforations_in.by in. Driller's Log/Construction or Decommission Procedure Perforated from R.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: i Yes ❑No I K-Packer b Depth 243 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.012 in.from 245 ft.to 250 ft. Brown fine silty sand,some gravel 0 3 Diameter Slot size-in.from _ft.to ft. Brown Sandy silt,dry 3 6 Brown clayey sandy silt 6 11 Sand/Filter pack:❑Yes 1 No Size of pack material in. Materials placed from_ft.to_ft. Brown silt sand cla 11 18 Bluish gray clay,soft 18 35 Surface Seal: Yes 0 No To what depth? 1. ft. Brown sandy clay,wet 35 42 Material used in seal Bentonite chips Did any strata contain unusable water? ❑Yes 1 No Brown Sandy silt,loose,some ravel 42 47 Type of water? Depth of strata Brown fine to medium gravelly sand,loose,wet 47 71 Method of sealing strata off Gray sandy silt,wet 71 75 Gray silty clay,dense 75 117 Pump: 4[anufacturer'sName Type: Gray claybound gravel 117 122 H.P. Pump intake depth:_ft. Designed flow rate:,gym Gray siltbound gravel,hard 122 143 Water Levels: Land-surface elevation above mean sea level 206 ft. Gray silt,very dense 143 161 Stick-up of top of well casing 1.5 ft.above ground surface Gray clayey silt,moderate 161 191 Static water level 197 ft.below top of well casing Date 7/28/26 Artesian pressure_lbs.per square inch Date Brownish gray sandy gravelly silt,dense 191 216 Artesian water is controlled by (cap,valve.etc.) Fine to medium gravelly gray sand,wet,loose 216 221 Gray fine to medium gravelly sand,very dense, 221 \1ell Tests: Was a pumping test performed? i7 No ❑Yes c� by whom? wet 235 Yield_gpm with_ft.drawdown after_hrs. Fine to large multicolored round gravel,loose, 235 Yield gpm with_ft.drawdown after_hrs. water bearing 250 Yield_gpm with_ft.drawdown after,,,,,,,,,,,,,,hrs. Gray silty fine to coarse sand,some gravel, 250 Recovery data(time=zero when pump is turned off—water level measured from well less water 253 top to water level) Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test gpm with ft.drawdown after_his. Air test 20 gpm with stem set at 235 ft.for 1_hrs. Date 7/28/26 Artesian flow gpm Temperature of water 51 °F Was a chemical analysis made? ❑Yes 7 No Start Date 7/24/26 Completed Date 7/28/26 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. L7 Driller❑Trainee❑PE—Pit Name 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 Lo.No. Contractor's Sponsor's Signature Registration No.ARCADD1098K1 Date 7/28/26 ECY 050-1-20(Rev 09/18) Ifyou need this document in wt alternate format.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. } 1 0 ti e u roll n s Legend Passes ✓ Fais EPA Sd Fails EPA Secondary Environment Testing Fttenti ate Guideline Attention CLIENT SAMPLE ID: 6641 SE Arcadia Rd SAMPLE ID#: 110-14767-1 CLIENT JOB#: OTHER SAMPLE INFO: SAMPLED BY: COLLECTION DATE/TIME: 08/05/26 09:59 MEDIA TYPE: Colilert-18 Test Description Results Units Pass/ DQ RL DF Limit Analyst Date&Time Date&Time (SM 9223B) Fail Flag /Lab Prepared Analyzed Coliform.Total ABSENT NONE ,/ H 1 Present MH-WAS 08/06/26 18:00 Escherichia coli ABSENT NONE ,/ H 1 Present MH-WAS 08/06/26 18:00 Test Description Results Units Pass/ DQ RL DF Limit Analyst Date&Time Date&Time (EPA 300.0) Fail Flag /Lab Prepared Analyzed Nitrate as N 2.2 mg/L ,/ 0.10 1 10 AH-WAS 08/06/26 17:35 Job ID:110-14767-1 Authorized By:Karen Crowell,Client Service Manager Phone:(360)757-1400 Page 2 of 6 8/13/2026