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WAI2023-00040 - WAI Health Waiver - 11/28/2023
MASON COUNTY COMMUNITY SERVICES Building Planning.Envkonmental Health Community Health 415 N 6a'Street, Bldg 8.Shelton WA 98584. Shelton:(360)427-9670 ext 400 4 Bellair:(36 0) 2 5-4477exte 400 4 Elms: (360)482-5269 ext 400 FAX 87 Application for WalverlAppeal Amount Paid: _________ Receipt Number: s Instructions 2.No determination can be made until these pads are fully completed 1. Complete Parts 1 and . 2. Fees may be billed for waivers and appeals,based on the Environments!Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1.Applicant/Parcel Identification IS _73y.y-25-o cr// Name of Applicant .4./S siit42r Telephone 360-f7G-° s�t'i Mailing Address of Applicant D/ vx Cy 'Srr o cL.f state zip 9 -36 4 12EIga Tax Parcel No. 2 LA ± - 2. i12- o f` fl Site Address�, (3?/ ESl2 3 �l l � uJA ?&C8-9 _ Subdivision Name and Lot W 2 of US o -0G S iS/ S /Z 3z PART 2: Nature of WaiverlAppeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer,Pumper.O&M Specialists) ❑ Separation O Food Sanitation Requirements Group B Water System Regulations ❑ Building Permit Review Policies Water Adequacy Re uirements ❑ Location.WAC 246-272A-0210 ❑ Enforcement Timeli fi0 R D ❑ Holding Tank WAC 246-272A-0240 ❑ Departmental Dete rl LS o Mason County Onsite Standards ❑ Other MAY 02 2023• Description of Waiver/Appeal(include'/ justification,additional material may attec eJieJ Date: 02_3 Applicant Signal :- Iteviaed 1202017 Page 1 of2 J:1EH Foma\Waiver-Appeal Mason County Local PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) n Appeal n Waiver n None required n Class A n Class B n Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/ Standard revision) 3. Nature of Appeal: 4. Hearing Official: O Board of Health C. 0 Health Officer ❑ Pollution Control hearing Board �' Public Health Director O Certified Contractor Review Board ❑ Environmental Health Manager 5. Mitigating Factors: 6. I have received this waiver/appeal request. It is complete and mitigation - .� u9 required by the state and local policy has been submitted. Staff Signature: C W r y / 1- �g Z3 Date: PART 4: Determi ation of the Hearing Official The hearing official has determined that approval of this request will not adversely affect public health and is hereby granted.This decision is based on the following findings and conditions: ❑ The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied.This decision is based on the following findings and conditions: Hearingcial Signature: Date: 1:\EH Forms\Waivcr-Appeal Mason County Local Revised 120/201] Page 2 oft 7! § §k( § § § k) ! , §7 . ni ) \ § §§!§E \ '3' /J! % H-§ ( | % E _ | . p � ` \ /, > § CD ` E !7 | § , t)\)k , ■ ( • ..am m II; q e P / 4 . . , z ; @ { » y\) » » < d " !IJ /' ° adg ) \ "{ ( ( | |) ) ` , | . ,! , ! § `• , ! � () || , \ 2 - „ z ` ( ' § §� ) ° \ J U Planning • Management• Engineering P.O. Box 123• Port Orchard,WA 98366•888-881-0958• 360-876-0958 www.nwwatersystems.com July 27,2023 Mason County Health Department Jeff Wilmoth jwilmoth(a�masoncountywa.gov Subject: Sunset Ridge Events Group B (ID Pending),Mason County;Variance Request Dear Jeff Wilmoth, The Sunset Ridge Events is a proposed Group B water system between Shelton and Allyn in Mason County,that will serve a wedding venue and two existing single-family residential houses on tax parcel numbers (TPNs)22129-24-50020 and 22129-24-50030.A Group B design will be submitted after this variance request is approved. The water system is looking to pursue utilizing the existing private well,well tag number ACA-503,and convert to a Group B. The well was drilled and intended as a private water source and bas operated as such for the two single-family residential houses.Due to this,there are several existing structures and components within the 100' sanitary control area(SCA)including a driveway,parking for one of the houses, a groveled carport,and an existing garage/shop with a concrete floor.None of the septic components are located within the SCA. Furthermore,the well is located approximately 1,000 feet of a former landfill site within an existing auto wrecking yard. A landfill is not allowed within 1,000 feet of a Group B well. It appears that the actual location of the landfill was approximately 1,010 feet from the wellhead. However,the exact extent and location of the former landfill,which has now been covered is unknown.Thus,to provide an extra measure of caution the purpose of this variance request is to evaluate the existing components as potential sources of contamination,analyze characteristics of the well,hydrogeology of the area,mitigation strategies,and addressing the landfill that could possibly be within 1,000' of the well.Given the well construction,geology,topography,and proposed use,the proposed well is not considered to present any potential hazard to public health;therefore,a variance is requested in order to allow for approval of the well location. Introduction and Background The existing well and site features are shown on the attached site plan.The owners live in the house on the well property.They do not own the adjacent property that contains the second existing single-family home served by the well,however,that property is not within the 100' SCA,thus not a concern. The topography of the area is such that the well head is at a higher elevation than all other ground in the immediate vicinity of the well,and regionally slopes away from the well downwards to the north. Table I below lists features and approximate distances that currently exist within the 100' SCA: Table 1 —Potential Sources of Contamination within 100 SCA Site Feature Approximate Distance to Well feet) Cement Driveway/Parking 85 Gravel Drivewa /Parkit 50 ShopIGarae 15 Gravel Carport 60 Table 2 below lists the following feature and approximate distance that exist within the 1000' travel vicinity: Table 2—Potential Sources of Contamination within 1000' Travel Vicinity Site Feature Approximate Distance to Well(feet Wrecking Yard 650 Landfill 990-1,030 The well logs for the existing well and vicinity wells are attached.Hydrogeology for this location is described in more detail later in this report. Proposed Sources of Potential Contamination Shop/Garage and Carport The existing shop/garage and carport are used to store vehicles and other household items.The physical buildings and structures do not pose a threat of contamination.The shop/garage building has a foundation and concrete slab.The carport has a gravel floor. However,should a Group B well be approved,the owners have confirmed that no chemicals, gasoline,paint,etc.,would be stored within the shop/garage or carport,nor would any vehicles be stored in the shop/garage or carport. Even if a parked vehicle was within the 100' SCA for any length of time,and vehicle fluid were to spill,the fluid would flow away from the wellhead due to the topography.The soil would readily absorb almost all spills associated with a vehicle fluid,or household chemical since such spills are small typically being mostly bound to soil particles within approximately 2 feet of penetration of the ground. Driveway/Parking The existing driveway and parking do not pose any direct threat of contamination to the well. The existing residential driveway will only be used to access the house.The wedding venue will be accessed from the same entrance;however,veered off to the right of the shop/garage.The access is partially inside the 100' SCA.Though,it is only to traverse to the wedding venue parking further below.The driveway and parking for the residential home ranges between 50 and 85 feet away from the well head.There are graveled and cemented driveways and parking areas. Similar to that of the shop/garage and carport,if a parked vehicle was to leak a small amount of vehicle fluid,the fluid would flow away from the wellhead and be primarily absorbed and by the soil. Transient driving and parking of maintained vehicles within the SCA does not pose a significant threat of contamination. Storage or long-term parking of vehicles not being regularly used will be prohibited within the SCA. Wrecking Yard The Wrecking Yard is located outside the 600-ft time of travel radius. It would therefore,not normally be considered close enough to be a direct concern for a Group B water system. The wrecking yard is not under any known compliance actions with Mason County or other regulatory agencies. It is assumed all vehicles are stored properly and that all fluids that could leak from vehicles and become potential sources of contamination have been drained and properly stored/sold/disposed. Vehicle fluid leaks tend to be relatively small volumes when they do occur on an individual basis and would not provide a large enough volume to contaminate a well over 600 feet away. Therefore,the wrecking yard would have to be grossly negligent or purposefully disposing of vehicle fluids in large volumes for contamination to reach a well over 600 feet off site. There are no reports or evidence of such negligence. Landfill The landfill was permitted as a woody debris landfill;however, subsequent inspections identified creosote timbers, asphalt roofing,tires,other construction debris,and a small amount of household garbage. The majority of the non-woody debris was collected and removed;however, some tires were known to have remained,and other contaminants may have not been fully identified and/or could have leached hazardous compounds into the soil before being removed. Fortunately, it appears the majority of the potential contamination load was removed. Items such as tires,asphalt shingles and creosote timbers,if they were able to leach contaminants into the soil and groundwater would primarily be identified through testing of volatile organic chemicals (VOC's). The woody debris as it decomposes could leach nitrate into the groundwater;however, this would only occur towards the very end of the decomposition process as the carbon to nitrogen ratio of wood is high,and any release nitrates would be immediately taken up by microbes as they were breaking down the cellulose and lignin that make up wood. If a large quantity of wood were to reach the final stages of decomposition all at once,nitrates could be released;however,considering the variable moisture and oxygen availability,this is highly unlikely. Well Construction and Hydrogeology The well is located west of the shop/garage with a paved driveway around it.The well log is enclosed and shows the well as being 140 feet deep with a 19-foot bentonite surface seal.The upper layer is"brown till"from zero to 8 feet,followed by a"hardpan" yer from nd" 8 feetom to 15 5 to feet.Continuing,the next layers are"sand gravel" from 15 feet to 75,and 101 feet.Below is"brown sand gravel with water"from 101 feet to 140 feet.The well is screened from 130 to 140 feet. Geology consists primarily of"hardpan"and"sand gravel". The static water level noted on the well log is 100 feet,which is below the till and hardpan restrictive layers.Even still,the bentonite surface seal overlaps with the 15 feet of restrictive till and hardpan layers,thus providing an effective barrier that protects the well from surface contamination reaching the aquifer. Well logs in the surrounding areas of this property were evaluated. Evidence of till and hardpan restrictive layers were found to be present throughout the region,indicating the restrictive layer extends past the wrecking yard and neighboring properties. Most well logs included more extensive restrictive formations that listed in the subject well. Therefore,the protected nature of the aquifer is regional and not just at the subject well. Though the Sunset Ridge Events property is higher in elevation than the wrecking yard and landfill property,they are both near the top of a ridge,with elevations sloping downwards toward Deer Creek that then flows to Oakland Bay.Thus,indicating the direction of groundwater flow between the proposed well and wrecking yard is parallel with the well southwest of the wrecking yard and groundwater generally travelling in a northwesterly direction. Thus,if any contamination from the wrecking yard were to reach the aquifer,it appears as though it would be transported away from the wellhead. Mitigation The well is equipped with a 19-foot bentonite surface seal that overlaps the restrictive layers for a total of 15 feet Additionally,the well casing extends above grade and is surrounded by a rock retaining wall built by the owners. This wall physically protects the well from potential vehicular impact. Additionally,the wellhead is at a higher elevation than the surrounding area. The area immediately surrounding the well is relatively flat,draining to the Northwest. The home and garage are to the NE and SW of the well. Therefore,potential contamination would generally drain away from the wellhead. The wrecking yard is approximately 650' and the edge of the landfill is approximately 990-1,030 feet from the well head. Topographic maps indicate both the wrecking yard and landfill are at a lower elevation than the well.Thus,there is no concern of contaminants flowing at or near the surface to the wellhead. In consideration of the proximity of the landfill that is located near the edge of the 1,000 ft limit,an initial volatile organic chemical(VOC)sample was taken and analyzed. All parameters were found to be non-detect,as expected. The landfill is located in a ravine that drains north,away from the well and aquifer. Therefore, any potential contamination that were to leach from the landfill would first be indicates carried that edoh via surface water and shallow perched aquifers. The presence of hardpan till contamination from the landfill would be carried north before travelling vertically downward toward the aquifer. Therefore,the topography and hydrogeology of the site provides significant mitigation. Besides an initial VOC test,it is recommended the well be tested for coliform bacteria annually and nitrates every three years. Because most of the VOC contaminant load has been removed from the landfill,and because potential remaining tires are disbursed and buried sprinkled throughout the fill dirt used to cap the landfill,they are relatively stable and would only release contaminants very slowly. It is therefore not reasonable to suspect further VOC contamination at the travel north along the gully in whhichithe landfill was created. Testing the well annually for would coliform bacteria and every three years for nitrates will provide a much greater degree of protection for public health than a well not located in an area with the above described potential sources of contamination and no on-going monitoring. As part of the Group B approval process,the owners of the well parcel must sign a covenant legally protecting the area within the SCA from further activities whichand present the te tializel to contaminate the well.Any storage of chemicals within the shop/garage carport secondary containment capable of holding 150%of stored chemical volume or be relocated outside of the 100' SCA. In addition, storage or parking of vehicles not regularly used will be prohibited. The owners recognize as part of signing this covenant that long-term parking at the shop/garage and carport are not permitted.The declaration of covenant is attached to this correspondence and includes these specifics. Conclusions h dro eolo is formations,and The above analysis demonstrates that the existing topography, Y g g existing and proposed mitigations in place protect the existing source from the potential sources of contamination. Sincerely, NORTHWEST WATER SYSTEMS,INC. Request Submitted By: rSTHE Wkk r 7 I m 'air ..O !<'D RRr71sT'�"!\:`a d ..\'AL ty Todd Krause,P.E. Enclosures: Declaration of Covenant Well Log Vicinity Well Logs Septic Design Vicinity Map Well Radii Map Site Map \ \\ k~ �; _ § § ! .«!t j � ) | | | - § � � # QCJ z L13 (\ OZ 30, i • `WATER 1515 80th St. E. . MANAGEMENT Tacoma,WA 98404 _______LABORATORIES_INC. (253)531-3121 Volatile Organic Compounds Report of Analysis Date Collected: 06-07-2023 System Group Type:(circle one) A B Other Water System ID Number. N/A System Name: Sunset Ridge/Well Tag# ALA503 Lab Number/Sample Number:089/03400 County: Mason Sample Location: Pumphouse Outside Hosebib Source Number(s):(list all sources if blended or composited) Sample Purpose: (check appropriate box) Date Received: 06-08-2023 o RC-Routine/Compliance(satisfies monitoring requirements) Date Analyzed: 06-13-2023 C-Confirmation(confirmation of chemical result)* Date Reported: 06-26-2023 I-Investigative(does not satisfy monitoring requirements) Supervisor Initials: o O-Other(specify-does not satisfy monitoring requirements) Sample Composition: (check appropriate box) Sample Type: (check one) ®Pre-treatment/Untreated(Raw) o fl Post-treatment(Finished) S-Single Source Unknown or Other B-Blended(list source numbers in"Source Number"field) C-Composite(list source numbers in"Source Number"field) Sample Collected by:JLD o D-Distribution Sample Phone Number:360-876-0958 Send Report&Bill to: Northwest Water Systems, Inc Comments: New Group B PO Box 123, Port Orchard WA 98366 ANALYTICAL RESULTS DOH# ANALYTE DATA RESULTSRESULTS SORL TRIGGER MCI. UNITS EXCEEDS C METHOD! QUALIFIER M INITIALS NO 0.5 .5 2 p9 0 524. L 0045 Vinyl chlorideND 0.5 0.5 p9/L No 5 L 0 ,1- Trichroethylena ND 0. .5 00 pg/ No 54.27L 00 7 nc achl aria ND .5 0.5 pg/L o 524.2/ L 04 Arbon tetrachloride -- N 0 5 pg/ No 5 4. 0049 enzene NO 0.5 5 p o 0050 1,2 Dichloroethane N 0.5 0.5 p o 4. / L 0051 nchloroeMylene - 5 0 5 N9 0 . 05 Ara-0ichlorobenzene — Nb 5 pg/ 0 4.2/RL 00 Ic 0romethane - no 0.5 0.5 N .5 0 Ng L No 4.2/RL 05 trans-1, ichloroelh aria — NO 03 pg/L No 524.2/RL O6 cis-1, : oroet ene - ND .5 p No 524.2/RL 00 12- is laropropane — ND 0.5 1 pg/L No 524.2/RL 0066 Toluene — pg/L No 524.2/RL 0067 1,12 rich oroethane — ND pgl No 524.2/RL 0088 Tetrachbroethylene — Nb D 0. .5 1 pg/L No 524.2/RL 0071 onochloro enzene - Fib O. .5 0 pg/L No 524.2/RI. 0073 Ethylbeniene — NO 10 p L No 524.2/ L 0 Styrene - NO p L No 524.2/RL 0084 rtho- ichlorobenzene ND 0. .5 p / No 524.2/RL0095 1,2,4-1 ncniomounzene — ND p No 524.2/RL 01 0 otal lanes ND 0. .5 pg/L — 524.2/ L 0074 m1p yl lens(M L or Tolap -- - - 524.2/RL Chloro 0075 ne(M or total) — ND 0.5 - _ /L - 5 4. L 027 h oro rm •DOH# ANALYTE DATA RESULTS SDRL TRIGGER MCL UNITS EXCEEDS METHOD! QUALIFIER ND 0.5 — — P — 524.2/RI 28 oic loromelhane — N —_ pg - 524.2/RL 29 ibro romoc oromethane N _- p _ 5 4.2 L 0030 Brorno rm — — _ 0 pg/L No 5 4.21 L 1 Total n alomet ones -- _ pgI _ 524.21RL 053 Chloromethane — ND _ 119/I24.2/RL 0054 ramome ane — ND D 5 0.5 _ pg/L 52 .2/ L 0058 1,1 Dichloroethane — _ pg/L _ 524.2/ L 0072 1,1,1, - e achloroethaIt — ND 05 0.5 0. — pg/L — 0078 Brorrtobenzene — ND 0.5 0 0.5 — pg/L 4. L 07 1 ,3 rich oropropane 0.5 0 _ pgL 0081 horo[oluene — ND 4. 008 riohoro uoromethane — ND .5 0. — pg� _ L 05 0059 trimet 0058 romomemane — N pg D 0. 0. — p9/L — 4. L rime y enzene — _ _ 0091 1 4 nme ylbenzene — D 0' '5 _ uc/L 524. 92 Sec- uo enzene — .5 pg/L 5 L 0093 p- Butylbpyttoluene — 0. p9 Ng1L 5 4.2/ L 4 n- u nzene - ND .5 - pg _ 4. / L 0098 Naphtha one - ND 0.5 5 - pg/ _ 24. L 104 IChlorolo uoromet ane - 0 _ pg/L _ 4. L 154 I loropropene - _ 524.2/ 0 h orcet _ane - ND 0.5 0.5 Pg/L - 4.2/ L RL 059 lc oroPropane - 0. .5 - pg/ 524.2/ L 0 1,1 IUt oroProPene - N .5 0. - pgL - .2/ 064 Dibromomethane - ND pg/L RI 5 0.5 _ pg/L 24.2/RL 0070 1, - IchbroND .5 _ pg/L _ .2l 0080 1,1,2,2 eVaChloroehlofoemane - D 0. _ pg/I _ 524.2/R L 082 - horow uene - ND - p9 - L 0083 m- ichlorobenzene NO .5 - P9 - 4. 7 sopropylbenzene - pgL _ 5214.2IRL OB n-Propylbenzefle - .5 _ pg _ 4.21RL p tart-Butyl nzene - N - 24. L p9 ezachlorobute lane - D _ pgL _ 524. N .5 0.5 - pg/L L 098 1, rlr enzene - 0. pg/L - 524.2/RL 0427 ED (screening) ND 5 0.5 _ pg L 0428 (screening) ND o. 0. _ ! - 24.2/RL NIA TBE LabNumber/SaraleNumbec 089/03400 Volatile Organic Compounds(cent) LAB COMMENTS *Conarmation:lndude the original lab number,sample number,and collection date of original sample in either comment section. Analysis for EDB and DBCP is screening only.Detections of EDB and DBCP are confirmed using the fumigant last panel. —No exisiting value. pglt:miaogrmns per liter or parts per billion. ANALYTE:The name of an analyle being tested tar. DATA OUALIFIERA symbol or letter to denote addhonal Information about the result. DOH#:Depsrtment assigned analyte number. EXCEED MCL•(Mazimum Contamination Level):Marked if the contaminant amount exceeds the MCL under chapters 246-290 and 246-291 WAC.Please contact the departments drinking water regional office in your area to determine follow-up actions. MErHOD/INITIALS:MalYticel method used./Initials of the analyst that performed the analysis. RESULT:The laboratory reported result. SDRL:(State Detection Reporting Limit):The minimum reportable detection of an analyte as established by the Department of Health at TRIGGe maye tlea to drinking samples or monitor more frequently.Please coned the departments drinking water trations In excess of this level may be regional office in your area for further ipfmaalwn- Planning • Management• Engineering P.O. Box 123 •Port Orchard,WA 98366• 888-881-0958•360-876-0958 www.nwwatersy ste ms.corn March 30,2023 Mason County Health Department Jeff Wilmoth jwilmoth@masoncountywa.gov Subject: Sunset Ridge Events Group B (ID Pending), Mason County; Variance Request Dear Jeff Wilmoth, The Sunset Ridge Events is a proposed Group B water system between Shelton and Allyn in Mason County,that will serve a wedding venue and two existing single-family residential houses on tax parcel numbers(TPNs)22129-24-50020 and 22129-24-50030. A Group B design will be submitted after this variance request is approved. The water system is looking to pursue utilizing the existing private well,well tag number ACA-503,and convert to a Group B. The well was drilled and intended as a private water source and has operated as such for the two single-family residential houses.Due to this,there are several existing structures and components within the 100' sanitary control area(SCA) including a driveway, parking for the house,a gravel carport, and an existing garage/shop.None of the septic components are located within the SCA. Furthermore,the well is located within 1,000' of an auto wrecking yard that Mason County considers to be a landfill.A landfill is not allowed within 1,000' of a Group B well. Thus,the purpose of this variance request is to evaluate the existing components as potential sources of contamination,characteristics of the well,hydrogeology of the area, mitigation strategies, and addressing the landfill within 1,000' of the well.Given the well construction, geology, topography,and proposed use,the proposed well is not considered to present any potential hazard to public health;therefore, a variance is requested in order to allow for approval of the well location. Introduction and Background The existing well and site features are shown on the attached site plan. The owners live in the house on the well property. They do not own the adjacent property that contains the second existing single-family home served by the private well,however,that property is not within the 100' SCA,thus not a concern. The topography of the parcel area shows that the well head is at a higher elevation and the slopes are directed away. Furthermore,the elevation continues to slope downwards and away from the well head. Table I below lists features and approximate distances that currently exist within the I00' SCA: Table I—Potential Sources of Contamination within 100 SCA ture Approximate Distance to Well feet i&im /Parkin g5arkin 501560 Table 2 below lists the following feature and approximate distance that exist within the 1000' travel vicinity: Table 2—Potential Sources of Contamination within 1000'Travel Vicinity Site Feature Approximate Distance to Well(feet) Wrecking Yard/Landfill 650 The well logs for the existing well and vicinity wells are attached. Hydrogeology for this location is described in more detail further in this report. Proposed Sources of Potential Contamination within the SCA Shop/Garage and Carport The existing shop/garage and carport are used to store vehicles and other household storage items. The physical buildings and structures do not pose a threat of contamination. The shop/garage building has a foundation and concrete slab. The carport has gravel grounding. However, should a Group B well be approved,the owners have confirmed that no chemicals, gasoline, paint,etc.,would be stored within the shop/garage or carport, nor would any vehicles need to be and would not be parked or stored in the shop/garage or carport. Though, if a parked vehicle was within the 100' SCA for any length of time, and vehicle fluid were to spill,the fluid would flow away from the wellhead towards soil due to the topography. The soil would readily absorb and neutralize most chemicals within approximately 2' of penetration. Driveway/Parking The existing driveway and parking do not pose any direct threat of contamination to the well. The existing residential driveway will only be used to access the house. The wedding venue will be accessed from the same entrance;however, veered off to the right of the shop/garage. The access is partially inside the 100' SCA. Though, it is only to traverse to the wedding venue parking further below. The driveway and parking for the residential home ranges between 50 and 85 feet away from the well head.There are groveled and cemented driveways and parking areas. Similar to that of the shop/garage and carport, if a parked vehicle was to leak a small amount of vehicle fluid,the fluid would flow away from the wellhead towards soil and would be readily absorbed and neutralized. Transient driving and parking of maintained vehicles within the SCA does not pose a significant threat of contamination. Storage or long-term parking of vehicles not being regularly used will be prohibited within the SCA. Well Construction and Hydrogeology The well is located outside of the shop/garage with a paved driveway around it. The well log is enclosed and shows the well as being 140 feet deep with a 19-foot bentonite surface seal. The upper layer is"brown till"from zero to 8 feet, followed by the"hardpan" layer from 8 feet to 15 feet.Continuing,the next layers are"sand gravel" from 15 feet to 75, and"sand"from 75 feet to 101 feet. Below is"brown sand gravel with water"from 101 feet to 140 feet. The well is screened from 130 to 140 feet. Geology consists primarily of"hardpan"and"sand gravel". The static water level noted on the well log is 100 feet,which is below the till and hardpan restrictive layers. Even still,the bentonite surface seal overlaps with the 15 feet of restrictive till and hardpan layers,thus providing an effective barrier and prevents any surface contamination from reaching the aquifer. Well logs in the surrounding areas of this property were evaluated. Evidence of till and hardpan restrictive layers were found to be present throughout the region, indicating the restrictive layer extends past the wrecking yard and neighboring properties. Most well logs included more extensive restrictive formations than listed in the subject well.Therefore,the protected nature of the aquifer is regional and not just at the subject well. Though the Sunset Ridge Events property is higher elevation than the wrecking yard landfill property,they are both near the top of a ridge,with the elevations sloping downwards toward Deer Creek that then flows to Oakland Bay. Thus, indicating the direction of groundwater flow relative to the Sunset Ridge Events well and wrecking yard is parallel, with the well southwest of the wrecking yard and groundwater generally travelling in a northwesterly direction. Therefore, if any contamination from the wrecking yard were to reach the aquifer, it appears as though it would be transported away from the wellhead. Mitigation The well is equipped with the 19-foot bentonite surface seal that overlaps the restrictive layers for a total of 15 feet. Additionally,the well casing extends above grade and is surrounded by a rock retaining wall built by the owners.This wall physically protects the well from potential vehicular impact.Additionally,the wellhead is at a higher elevation than the surrounding area. The area immediately surrounding the well is relatively flat, draining to the Northwest.The home and garage are to the Southwest and Northeast of the well respectively.Therefore, potential contamination would generally drain away from the wellhead. The wrecking yard landfill is 650' from the wellhead and the topography shows that the landfill is at a lower elevation.Thus,the concern of contaminants flowing to the wellhead are low. Due to the proximity of the landfill that is located within the 1000' vicinity, an initial volatile organic chemical (VOC)sample is recommended to be taken. As part of the Group B approval process,the owners of the well parcel must sign a covenant legally protecting the area within the SCA from further activities which present the potential to contaminate the well. Any storage of chemicals within the shop/garage and carport shall utilize secondary containment capable of holding 150%of stored chemical volume or be relocated outside of the 100' SCA.In addition,storage or parking of vehicles not regularly used will be prohibited. The owners recognize as part of signing this covenant that long-term parking at the shop/garage and carport are not permitted. The declaration of covenant is attached to this correspondence and include these specifics. In addition,bollards are recommended to be installed to provide physical protection from cars parking in the area. Conclusions The above analysis demonstrates that the existing topography, hydrogeologic formations,and existing and proposed mitigations in place protect the existing source from the potential sources of contamination. Sincerely, NORTHWEST WATER SYSTEMS, INC. Request Submitted By: �pTTHPk, I. Dr(72[OCIJtPi�rp(� yc tJ " Christine Abubo under Todd Krause,P.E. Z k i3tvo Et C TONAL E ' odd Krause,P.E. Enclosures: Declaration of Covenant Well Log Vicinity Well Logs Septic Design Vicinity Map Well Radii Map Site Map Return to; DECLARATION OF COVENANT FOR PUBLIC WATER SUPPLIES Know all men by those present that I(we)the undersigned owner(s)in fee simple of the land described herein,hereby declare this covenant and place same on record. I(we),the grantor(s)herein,am(arc)the owner(s)in fee simple of(an interest in)the following real estate situated in: The SE'h of the NW'h,Section 29,Township 21 N.Range 02W.,W.M.in the County of Mason,in the State of Washington.More specifically, LOT 2 OF LLS 006-06 S 15/56 S 32232;TPN 22129-2&50020. on which the grantor(s)owns and operates a well and water works supplying water for public use located on said real estate,to wit: The SE%ofthe NW%,Section 29,Township 21N,Range 02W.,W.M.in the County of Mason,in the State or Washington.More specifically, LOT 2 OF LLS 006-06 S 15/56 S 32232;TPN 22129-24-50020. Well located as follows:Starting at South East corner ofsaid parcel,thence 195 feet North following the most Eastern property line,thence 115 feet due West,more or less. and grantor(s)is(are)required to keep the water supplied from said well free from impurities which might be injurious to the public health. It is the purpose of These grants and covenants to prevent certain practices hereinafter enumerated in the use of said grantor(s) land which might contaminate said water supply. Exhibit A NOW,THEREFORE,the grantor(s)agree(s)and covenant(s)that said grantor(s),his(her)(Their)heirs, successors and assigns will not construct,maintain,or suffer to be constructed or maintained upon the said land of the grantor(s)and within 100(one-hundred)feet ofthe well herein described,so long as the same is operated to furnish water for public consumption,ANY POTENTIAL SOURCE OF CONTAMINATION INCLUDING BUT NOT LIMITED TO: dwellings,outbuildings,cesspools,sewers,privies,septic tanks, dminfields,manure piles,fenced pasture,garbage of any kind or description,any enclosure or structures for the keeping or storage of nonbiodegradible fertilizers,liquid or dry chemicals,herbicides or insecticides as well as any enclosures or structures for the keeping or maintenance of fowl or animals such as barns,chicken houses,rabbit hutches,pigpens,livestock sheds,and further agree(s)not to use,apply,dispose or suffer to be used,applied or disposed,nonbiodegradible fertilizers,any liquid or dry chemicals herbicides or insecticides within the above described protective radius.There are existing buildings and structures within the 100'SCA that include a shop/garage,carport,and concrete and gravel driveways/parking.Any storage or chemicals within the shop/garage and carport shall utilize secondary containment capable of holding 150%of stared chemical volume or be relocated outside ofthe SCA.Additionally,the storage of vehicles not regularly driven within the SCA is prohibited. Exhibit B NOW THEREFORE,the grantors)agree(s)and covenant(s)that grantor(s)public water system shall be limited to withdrawal ofpublic grouadwaters for any and all of the following purposes;stock-watering purposes,or for the watering ofa lawn or of a noncommercial garden not exceeding one-half acre in area,or for single or group domestic uses in an amount not exceeding five thousand gallons a day,or for an industrial purpose in an amount not exceeding five thousand gallons a day. These covenants shall run with the land and shall be binding on all panics having or acquiring any right,title,or interest in the land described herein or any part thereof,and shall insure to the benefit of each owner thereof. WITNESS by my(our)hand on this day day of 20 (Seal) (Scat) Grantor(s) State of Washington County of 1,the undersigned,a Notary Public in and for the above named County and state,do hereby certify that on this_day of 20 ,personally appeared before me to me known to be the individual(s)—described in and who executed the within instrument,and acknowledge that(s)he(they) signed and sealed the same as his(her)(their)free and voluntary act and decd,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. NOTARY PUBLIC in and for the State of Washington Residing at Fib Drgnp wan Nt.d InWX D.amnem of Ecology WATER WELL REPORT GFIIouE wEuiae c 52 S.mM Coq-QM,e'.Copy STATE OF WASHINGTON Third Coq-Odes Copy 155p3 Weer Rlpnt FARM Nb O (1) OWNER: Name / I4drw ,p ,J - w (g) LOCATION OF WELL:County S 1M g 1M Sec_ IT_aLju 2 WM d' (Ze) STREET ADDRESS OF�TTWELL:(or nearest address) TAX PARCEL No.: ') Z/A9 Z 4Qi}af/J0 Cl (3) PROPOSED USE: fiDanestic 0 Industal 0 Mwiicpl (10) WELL LOG or DECOMMISSIONING PROCEDURE DESCRIPTION N 0 Ingelbn ❑ Tap WWI 0 OtherFamean:Deecrte q colon cnaraner,so of material and alrutur ..and OBYIMx Vie end and nature oI tie metenel In eas,strum peneusted,wH11 at least (4) TYPE OF WORK: OI afe rmabei d"I In r than ore) oe entry or each change of bbrmeyon.lndcete eN waMr enrounlered New Well M.thod: CDeepened Du Clots MATERIAL FROM TO 0 ❑ RxoSyoed ❑ Cable 0DMNI C 0 Dxpnmis on 0 Rotary ❑ Jan d y (5) DIMENSIONS: Diameer o wall � �a. t f G ,ties Eoreisa- 0 Iael Depb ol dmapteted wW /y0 rt / (a) CONSTRUCTION DETAILS e Cnbo lolled: Welled _____• Dbm.bpn 'a • _ 7. unerinsteuad Diem.Irani______ft so x ❑Threaded Dlam.11dn aa__n L/ PMfoniM.: OMM NNo 6 0 Type d lisdowr used TF a C SIZE d penanyoa sly M. R ,,.A.,.rs,...lmm_______I.to II. IO So nane: ❑) A'WP.a 1pglim / ? RECE R Ma 1acNre, Name .I a.m. Slot slae lr.m_ ]O R.lo / R DI C SbISpe ?n from ?z n.to______R A Gnnbflbr IISf11 lot a, pacsd: OYa �No ❑&W olBrw.Wand a or Materal.hpdtmm eb ell ty Mateam used !is ❑No t Th wnM T R MateNriy oa.d I,seal ) O Old arty strew mnteb unusable web(! ONM No Z Typo of waIM ____________________________ø.Ø.øiebut Method d s.ebg abut pE 0 (7) PUMP: MenufacWrefa Name- TWo: r H.P. 1 pl (I) WATER LEVELS: LOM- uncca ebaaon apoa mee,_r see ynl�!.Q- �3 �. p Static lnel /dj- lbs.p r bpolwN DDateata - . ? Work smred D9. cam lad O -Artesian P'wura la.per seen rich Data f.1 Artesian waler Is convoeed by W (Cep, .k etc.) WELL CONSTRUCTION CERTIFICATION: (9) WELL TESTS: Drewdown b w, unI water MrsM is IowNed below pays bvN I co ctw tad and/or accept ngtons,siliy lot cans4ucton of This wa0,sod its yr Was a plane made? ❑Ws R(No If).e.by MWn? - dampens wiM aII WAsNno:m well cone.uctbn standards. MMeab Used C Yowl: lmb.wbh 3______R draw.bwn after 2 M. sod the lnbrmalion report.d eb0v axe �Iwo tt//nany hest amMedyo and SUS& • mid:_getAnln.with_____________t&awdown alter hit Type or Print Name Oe V / 4R?'uaerloa No. mid:______pJmin.with f.drawderm after hn. (Lbereed albftEngloeeN L Remnry ate(tame taken as ma Mw p,xnp burned Olf)(water measured Imm - aAM Ade lop b water l) Tub..Name Lane.No. Tee Walter Lank Tin,. Water Level Time Water Leel Dulling CamDMyam. y y t 44, LSJ (signed) (_� d CI ) F- Dale of rep — ___ �j— Actress Le 9.�..F r� eaaA�/+K r ' /Ss.�. Baler lest GSJIT n.Mi R dnwdoml afterynn. Consolers AWaat N1min. e ft do"Aln att,_hn. Rpbbayo NO.RAwAR/ba2Aflom q// Artesian lbw °a m. Date IUSE ADDITIONAL SHEETS IF NEGESSANY) Tempenbredwrier Was adwrJcel erlayeb tares? Dyes No Ecology Is an Eewl Oppmtumy and Af nnadsa Adyon empbyar.For apSal FCY fE0.t.E01I 1/OS) B4Eelnmodpbn needs.1.9nw the WaterResourcesPtogmm at(3rd ,7. 66 .The TOO number 3(360)407-60. U, O 1% I liii I 4 .y. 1 ` G z ; ti. yiI E ? N V' __ F � zo y 2 t O << a ..1 Y N t 4 34 N ❑n h NAW ,1 i/aW ..0�1 VICINITY WELL LOG#1 piN Dnprrl and RNN 1:ooy weh WATER WELL REPORT a N.-.. 082525 D.p.nm.nl nr EcempY '•n!• m m ,-Dylan Croy, STATE OF WASHINGTON .D IW—IawMa I:cgY WYr RpM PpmlTlb. (1) OWNER: Name_West oar Auro Wrecking __ Mdra„ E 60 AnthOG. Rd Grape,iew WA O (2) LOCATION OF WELL: eopmY MRRon ._ J WI, NE flee 29. r. 21NR i wN. (2a) STREET ADDDRESS OF WELL for"egret eddree.) E_60 Anthony Rd Grapeview WA 98546_ __ O (3) PROPOSED USE; 'S Domenic Induelnel Ii Municipal❑ (10) WELL LOG Or ABANDONMENT PROCEDURE DESCRIPTION bipelipn Ten Wall LI Other C -' -- DOW,IaFannon: Dove•no color, chamfer. a a d m Mel wE e01.01. sad .low IR INn....ci aquifers and Ilie kind sad nature OI M•melY1N in oM Nr•lum pw ev.I.d. (4) TYPE OF WORK:awa.ft aunt..al well with w Naar one.ot a.oM pNNbe of lela.nbn. (it more lb..,on.) --___ epV«lu rapt I f0 Abandoned Newwell A Method: Dug Bad ❑ -_ -- ------ -t— - G OeeQMM Cable I$ DdyM II ___ _Reconditioned I RotaryM Jett 0 5 C ale _ .2 (5) DIMENSIONS: Diameter of well 6 - Inches. -- - — ----- A Drilled_155—fen. Depthol completed wall 165 R- iardpan 5 50 (6) CONSTRUCTION DETAILS: -- "'- - ' avel—. _ 507117Q 1,O. CaMng b•Llled: 6—• a.n.aa.�_nr._�6�n. .—r._ C webM Ei _—_-..___ —_-_ ndede Dam,apt nb n. 70 125 d ranged f"'. _______• d.m.Han IL b n. — P.11.1dba•: v«L��al ypravel_wjth Wat£F. - -.- _12.9 165__ Qtype or aavala used SIZE a10•avniMa Ie.pat K C p•rKKalbna aan It-to n. peaaatinalmm Rb «. _.Ct perforation. 'oat F «.l0 M1 Y--� Q SCnMa: YeaIIL NO ap NaMacfureSN.me__jlOUBtOn rrpe_stpp1a1a1inless qq//,Y ����//�Y Mapy Np 1��[q w T Nam.m e .ia�i, _two., L lLa.le._yfL_ft. _ . _ C DINa. BIalNn X « ro A ` Grant pa d: YsLi sIX plapypl 2A araWlpla .d*oa ItW n. sulfate seal: Yea® HOIJ VOM,ldgt9 18 - H NNM.mwelnaeN_ RRtrnritP - O Did any cOnlrn unu.W nN l•w ) vea❑ NO ._ - _ z iypeaol& Da1lNalma_— _ N wnaea•oagrinnan G (7) PUMP: wnatanw«awme __ Ups. -- Ha. _ CO 18 WATER LEVELS: L.nd"`"""�'""1°" O aeorna n .aue.l_ n. .__.____- —_— _ - {) Static Niel 125 N.below IOpm wa Dnr ----- __ _ II p art.w.,...un th.per nrzn Oat...... _... W .n•.IawnnacMn...d by _ rc.p.•.»e.n 3/,/[5{ —t O In . Work nanM_]lI?+__, a cdn Nr.e. ,19—. (S) WELL TESTS: Dr•wdf I. Nr lewd Nlor.r.dbelow NaM N.M Wee..... el meat Yn.LJ No J' rye..pv Siam? WELL CONSTRUCTOR CERTIFICATION: Yield:_ palrma.van __n enwaown anN b. I i1.pcofa Bence actual reaponeplon el construction...nVac OI Lai•well. C and ila compliance he i ell WaMmplort well above ..true .enures. L — ,� —�- ..-- • Materials used and IM inlormaliOn reported eEow an INe ID any Heel -- --- -' e ,- knowledge and belief. Ig Rrta.ry dal.1urns 1Hnnp ZNownMpVmplumld nrll fret..lnN mNwlad wwell fop to wlN level) O w.,x,aa me W.Is,1,ve. Wal.rLnsl Q NAME_ ..Ravu_Faun,M per aExepn M G Hdp IlYif M KILT t — __— — Apdreen—Belfair WA 98528 . ._ _._ - OaleoHol_ XNINNu0ew. �1' ll ., .. (SignMl EiemreNo.—_1.884.— � d . lm�� aa .M 1 NI- Conn 'e IwE onLLEm _ aN.0 _.—._-oLIIN..MNM..raf n.Nw hr. Peoin l�SDI110DA__ ww�OS- —, Ig_l ema:an Npw__ --apn DN. No. .. rnmper.Nr.dlwa..___Wa..rm..bN.nal.aem.ar Ye.D NoEk (USE ADDITIONAL SHELLS IF NECESSARY) O Eoom r-b Imen .e»1 .wed VICINITY WELL LOG k2 r1k Orbinal aM Flay amY v:N WATER WELL REPORT Departmenta(roamer AVVl:ullpn No. .._. ..- -. Thud Copy-Dowers.oppy Thud py—Onnert[nor aTA1E OF NAg�i01pN ..stall xo. .. . (1) OWNER: Nam./A4_.-Le ..[ .. .. wda.Fe ,A!4.FpRA'Laiek4k,_.. . . Oa (2) LOCATION OF WELL: canner 411¢f*e✓_......_.. _ ............. �_e..S.......0 se ....TdLN.. R� d eeenry and dktance term section or vubdlvibipn r ._ _.._C�in-- (3) PROPOSED USE: Don e.tk k Inmww O MUMcipal o (10) WELL LOG: Irrintlon D tares Other ❑ ronnatl -Decnbs by color.an ettw o/material sod rtaean d Thaw thickness of awlrn and the kind aid ratan of IM moferial tie each w�wr'a number of well Imsum penetrated. lh at kart one navy Jar inch <Mnp of IoNtbn. iD l4) TYPE OF WORK: It man than ono.... ..............._...._.....___ wRaNAL FROM To New well Method; Dina p aond ❑ /st C Deepened ❑ cable ❑ Driven 0 ---�e-�� ! _.. .— _____ a — -- O Reconditioned C Rotary@ yanad a GQ__S4dr -_—. C (5) DIMENSISNS: Diameter of well ... .....6 mans C a�.r nines . r.eC...-tt Depth of completed wdl.' ._...A r a E (6) CONSTRUCTION DETAILS: 6/G a—s-I st;� Gr 6- OO Casing installed: " mom. Inn, ._-....__. R. b ......_..__ n. f;____ (.e ' _�. O _ Perfontioas: Y.❑ N a f a 't O n Typ —..................................................... .._ 4_J,of perforatorti tat/ tar O /gr O -.._...._ . perbntleru Rpm.....__..__.._ R.b __.__...___. R. _.•_ patontlons a an_.__..._...._.. n.to .__..___R. -1-__- 2 ....._......._.. prmratlone foam __._......_.._. n.b_..._..._.._n. __________ A Screens: In❑ No% O Mannfutprera Nam a_.._...__. .._._........._._..._....__.._..___.. —_ W 1Yp--...__........_.._._______...__.... Melri Ne.--_.____.... _iiiiiiiiIiiiiwII aLi mom................. sW new _........_.... from .. ............ R.a._...__R. �' -_ a.r Gavel packed: vn❑ Not site at ` Gnvei non,--._.__..................R.b _...._ ...._.n. --- -_-. Surface seal: V F Nap Tor t d pl r .11.......... 1L _ Makrt.i lined In teal......_....it ... . ..19.:/ ..�a_.. . _,..._ Did contain - 0 d any ets contain unuxble woks? Va 0 N.O Type of water?.........._.. y Z ............................. Depth of swa Method W sealing strata oft..................... ............... O '7) PUMP: M&ZW�rt Name...... rn (6) WATELEVELS: aeove nrfan Mnauea - . _— rr�'rR.2 Skue keel --------------------- --------------ft.. . .lbelow top re well ONe.1,�4C..Z.:.. O AM1Nan Drwun __..ater.............UN. per square inch Dab............_.............._ V 'Ae1Wan water is tmtmned by ......_. —___- .. O (9) WELL TESTS: Dratmown k amoum weer kwl la -- - No o f yes. by`y level CAmpk ....... kEsiZ� ..._ C Wa s Vum tat maeef VeyPf No p If Yn,ny whom S4t_........ d seta: MamW.With /i ft.drawdpwn alley ha WELL DRILLER'S STATEMENT. — — This well was drill under my Jurisdiction and this report is true to at f my owl edge a belief. /y�r 1'�eddaa a Recovery dais IUme taken M Mb when pomp turned oft) (water level s/u�� !/l/ t�.�///I ✓p measured from well top to water level) O T. Waf LepetI TI Water fa I I tune Water LapM NAME. . .... ... .. ._.__ ....- {�). .... .Ilan or aorprNlenl 1'1Tp oe prlM) .. .... ..... ................... €pp//JJ ............ Med.S WJmW w.N .._..._n Mwdowp after...........ma. (Well ••_....._...p Atteda flow...............................................pa aria Date............... . ®� Y w/a/D— !, Temmperatan of water........_.W.a.thereat aalym madar Tap Ne C License No.. -.. ...Y ..._...................Date-............._...._...._.. . 19........ (USE AnnmoNAL nn m L NECESSARY) sov bor-1O VICINITY WELL LOG#3 No oaimal am Fen copy with Sma am Ne.Q.1_Q_fa�10 3 ap.mnaa Ot Ewa,y WATER WELL REPORT WwouCwELUI.D., A'B6i 559 fl Co therm copnd y-Dills. r STATE OF WASHINGTON wit.,mph,permM Na. Y 0 (1) OWNER: w.m xvi aJ3r a V 11(2) LOCATION OF WELL: Lmaar II< iN$a¢ T,4LN.,RWAI (2e) STREESAODRFSSQFWEULwr mm..I Opp (3) PROPOSED USE: 0 c Irqunrial Ll Munopal ❑ (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION U Nelson The Was U One 0 fwn,em:0c bymbr.aurovnr.:aeMmaem cob aITldU am show Me ns0'eq wt r/I Wpm YN by rynw of IMYYI In aetl„Yain p.n.lIM .Mm hYtl an enM t.acX L (4) TYPE OF WORK: Ownerr`mn ahoro wee aegaa eb v. e. II s m �( WI[ML awls, ro C NMnmmE f NewwSD.ep.O 0 MmaEca DDucU Eciedil D*eO p DaalNeeE ❑ ulab❑ DMen❑ 4 ±'tj Efl a ReCOmImed❑ Aaay AweE❑ ttr V_ ( y 0 (5) DIMENSIONS: aemwrbreu Iro.e. -sC' _ ; m OMMd jq0 Ieoi. N9N a Wmperl well n. CZ' C i (6) CONSTRUCTION DETAILS: 5 - wCeaigheYNE: �' olano rmn �Lb� ,.-X. • '% C W raised 5 • ofinArom Lb R LThreaded ❑ Meth.frwnAb X. — PSRMIaN: YM❑ Ne p T,ho0hamrawvn4 SIZEaperlaaaane ti y b. _.— C pabraWmfrom _tie R R r.rinrM r.Iom tie X. 'Sa prbramnf Fan hb A W Screen; Ya, Np❑ Maumtar's NYm 5/al— 5 - 11 •SF « TYP MwMNO. _... T Dam._Sbrmaa X.b h _.. Dwn._Seeus from tie A O,wlppMeE: Wa❑ N0 Saeolpaaa oma.plmMlmn Ab n. /•^ Swt.o WI: Yp Towe,EgW?_ e I— we urea ra a.a 3 O Na D Z tpw otwN.? oepnamw ' — Mamgta eem of eaaaga O 9 (7) PULP: Meml wa Name = t Oft (8) WATER LEVELS: UndeaisV1rr wmerwe ei c eud_. .re� M. npl�. sw Don hpmrMl IOW (!}(a V pns pawn M psi Square inch on / r WELL CONSTRUCTOR CERTIFICATION: W wrouan wean.cwxa.OM _ I oarou.ee anar«accts refpon IIfty for mrsm,ctl0n of .is was,and as w nF�. r— otmoience with all Washington wall TOnmupion varea Ms.MatmMe used and �) E.Inrorma on repmea move uva a my best xrb.Ndge w ears_ ^I` WELL TESTS: Dawbwnloamoun wear law, .rmbebw�Yaa e C Was epa9lwtmme9lb❑ No� M1Yf.by Men9 NAME Y I,I11�( dC YMi: Ywlmin.Mm h4re+aw+nle M. 1rtnN". I Ts</�?raaT .. ` AEOwe / r/.J � c` W aq MMI YMn iaam—,warpawaroM(asev ewaMYmlwN (Sire p r oaa LCa1 nnso No.eu /7 This Wee LnS Tee Waat,M Tane Wee Lets COaredor. L __________tin to Jm (USE ADDITIONAL SHEETS IF NECE SARY) D.Ia N. aye as after M. aiMl- fW.rmb.MnfNmwM Aht lee. Ecology is an Equal Opportunity and Affirmative Aclion employer.For spe- Ana:an paw gent Dew one aceommodanon mows.correct the Water Resources Program at(206) T•mperawre ofwWr_ .th miLa enalrW mesa? W.❑ No 407-6600.The TOO number is(206)407.6006. ELY e'AI 30IWWI"I •0r VICINITY WELL LOG#4 F'I'Gain°I and Fin' R WELL REPORT Start WoGfloo oepenmomascagy _-- Secpr4Copy'OwneesCOPY STATE OF WASHINGTON Unique WELL ID.e ACF52J Thad Copy-GMel.COPY Water RNN Pelrlla No. (1)OWNER: Nam.John Moran AAbwe 542 FIr,Shelton.WA 8S584 0 (2)LOCATION OF Well: co my Mason ig lase° 29 T. 21N N.A 2W wit. Q' (2a)STREET ADDRESS OF WELL(aee.mdamw.) E.8510S1fMRte8She6Dn,WA Parc.lH22129.24-00010 d (3)PROPOSED USE: T Domwnc Indu.M.l n Mnkipel ❑ (III WELL LOGaABANOONIENTPROCEDURE DESCRWTION: wwn _ vom.m= reeX . .e wa ..ra sea*bra.of De DeWeler Teat Well OMer ❑ as-s and me kind an°MnSth.m*'SI In each s° apa+osM,with mleseane M rch cM eW kmeY°n (4)TYPE OF WORK oem r comb. d II — _ N (N me Nano ) _.. _.._ IMTRRIAI ... NR�t TO _ .etr AWndoned = Ne.'en J aeNoc i. em a� opeoll 0 2 Deeveraa J Lm1 wan❑ Rardpar f_. _ -- 2 8 __ C R adm n.a] Rory ! Jelbt❑ 9arld&Gravel 6 18 - (5)DIMENSIONS: Damewdw.n 8 iplae Brown Clay _ 18 21 Q Doled 150 bd. DpN amma.ber 750 a. Pea Gravel 21 58.: __ ._ ,and _ __- fl 1N N (B)CONSTRUCTION DETAILS: Gravel _ 143 150 E casllglnsWled: S" - Oiem.aan 1} Rb 150 R _-- -- wdded nl ' Diam.hom _ Rb __ ft _ __.. a _. - ,� liner lnmlbel_ — • plem.M1arn Rb Thrwded - Perrnratlon. Y wwi — a-r Tpe dwmorc uwd.e _- ` SQC.Ipabnnaa _ kby k Q __- parlonaene Rem M1 petSa.afn __. _ ft.b R p domaemban M1b R --... . .— -- Scraena Y.L7 Ne¢c] ____ . —` MebleebreM1 Nenw _ _ _ Q D... _ ale a. No Diem. gNt ee._ R.ten b R 0. m. _ yl eb._ Rcm _ _ T.b L _ __ ._ Gravel paebd: Vat Nc❑R LbSJaal GrawlpbcMRom kb - R Sdrrace teal: Vat GL Ng L1 TOMddt?16 R Mvbrbl used lnteal BeR1WHe _ ID Didany e° w eb nbin unu wal eetle e/! Ye°❑ No© _ � _ T Tmeuw.bri—_—_. DeMiola _ F a4Ermatnknga ebof _ _ -- 0 (7)PUMP: tAerbbwwre Name _ . __ - _.LY_ Z Tpe: X.P. - _ -- (8)WATER LEVELS: .Ien ft. glenswnm 7/9/96__ ,Is. cemplet.e 7/8196 ,1a _— a 4becl 67 ft.bYowtgaw.a Gab 7110X16 WELL CONSTRUCTOR CERTIFICATION: Adrolan prawurc -..-_ Ib.pawwm bdr Dw Imnm arid/°r accept gtonw ibnnybrcon.ba ml of dsthmx 11 aMed DI AhdanwbNYeaadled W-_ -.— mmgb�anN.uw.wnmm nMl eenwun .n.bards. MaedaN seed O /- ________ and the xeolmamn Iwo fled eb.w era hue b my ben imw.wgeand ballet ti (9)WELL TESTS:Dre'aaww b n aab:W.I f Wet.Paaba made?Yw� Sal ee,bYnllerrd NAME Corbie Chance Dr luny LV FN+`CW. lIM.qt OJRORAIM]N) (TYPE qe 01�Nfi Yelt ____ edlmin.non Rdrwdewnabr St Q - -- Address 1411 Kanner RD N OI m IR WA 98502 — C ._ - (Signed) Q, -r tC tame la 2117 sc dr mary .lalRebnraw°wMn pab m a6(w al ladanla meweraa A m E from—b°bwbr* ConbeNYe -_ Tina Wd Lba Tim° WebrlreY Tina WYa LeM Rpbemm N CORBEDOSSBJ Oeb ,1R gi --- - - (USE ADDITIONAL SHEETS IF NECESSARY) w Iabaud _ Wwt aalimin.with __ n.erawdaam after M.. Ecology is an Equal Opppnviy and AMmaeve Action anpbyer, For ANaat 16 _.- IPlJmin,wAF abnr sat at 140- n for 2_ Ina ep. attanmodalion needs,contact be Water Rewwce°Program M MS dee Rea ... —__.- epm. Date (!W)C7- . The TDO number b(3W)407-BOOB Tape n,Mvabr_ Was a ohemkal analyw made? Yw1 No iN VICINITY WELL LOG 85 WATER WELL REPORT _ DEPARTMENT01 Notice of lateen No. WE49905 ECOLOGY Unique Ecology WeII ID Tag No BNV906 Type of Work: Sues of WmMngtan Li comm". Site Well Name(ifmore lhminrle leelD. ❑ Oecorwirdon o On®rel inhierion NOI Na. Water Right PermitCer ificale No. Prepared Use: anemone O ldamna O htwieipa Peopeny(Toner Name Daiàd ShoeinSrre O DewaEeiw O Irriprbe O Teo Wen O ghee Well Street Address 8393 E Stale Rolle 3 Ceunue iniTYpe: Meaod: City Shelton County Mason a New well O Allemioe ❑Driven ❑Jetted ❑Cade Tool ❑Oeeperw:g O Dor ❑o:e m Air- ❑Mud'Rmary Tax Parcel No. 22129-24.50010 Dimensions: Diaaaxnofmring8 in,to 177 n. Was a variance approved for ibis wll? OYes Oa No Dept ofwopkted well 177 fl. caruB LieerDnru: wen If yes,what was the variance far? Ceing Liner Okamla From 77 T.025 i Steel00 Welded Thrall pW'WM or❑EWM 0 1 ❑ 6 in a 1— .025 in. 0 1 0 0 1 O luutiaA-uof teucNNN at,pe¢2): ❑ 1 ❑ _in. _ — _ n. O I O D I ❑ 3E Y.-&of the MN R;Seclim 29 Toemship 2109 Revise 99'/ ❑ I ❑ _ _ _ _in. ❑ I ❑ ❑ I ❑ Lailade(Eumple:47.12345) 47.281017 ❑ ❑ n _ — _n. ❑ ❑ ❑ 1 ❑ Longitude(EaamPle'. 120.12345) -122865979 Perfon edow: DY No Type ofpechrolu Used Driller'.Log/Comdurfion or Decommission Prrcedun N..of1rowm — sen."rhrnim_irely_o2) Fwnlon:Describe by cold,clvactr.eiu of slids:nKauq ad the kind an Perknred from R.m_R beMw vial no6ee mnae oflhe mates)in each layer percaaled,with at less1 one envy for each chaise of Scream: ❑Yes No ❑K-Peckb Depth_R akrwtim. Urt addienwl aheeo ifinenmy wwanemer'aNwe Material From To Type Model No. Broom sg sand and Ovel 0 13 Diameter,__, Slat siu_o,.from _fl.to a. Brawn medium to coarse sand,gravel,loose 13 33 Diameter SMssix—M6aw _fl.to a. 07 Brawn shy sand and revel,moist 33 Merrd :ore S No Sie.nfpaa wnnnl_in Brpoal medium said,some gravel 47 103 aende placed Gam_R rat_n. Brown medium sand,pea gravel,wet 103 127 Swrface Seal: O Yes ❑No Towawdepw? 19 R Brown Ohre to medium sand,slit water 127 136 Did any o Material used in ma Bemo 'wae,?te O Yes UNo Brown fit,,wet 136 152 nnew miRunwabk wale,? Black shat revel 152 158 TyNofwael Deplbofarau 156 170 MAdoruRlraemmort Ora s tla some revel MWBmIoraO noel,vet.medium gray sand werer 170 177 Pane: Mmufetua'v Name Type: Pap ioWa depth'_ft. Deipel Dow now_gpm Water(eons: Ledw6Ne ekwim ibove mean wlevnl,≥L R. Stick-up afup ofwellceina 1 a.above pawdow4ce Slak water level 96 R.below op of well seine Dale 211&23 Anainn prestue_the pin apart inch owe_ Aeteiso water is controlled by h'W.vale c.) Well Two: Was a Wnipna teal perh:ned?11 Na OYeC by wko" Yield_apm with_R.dnwdown veer_w. Yield—gym will:—I Awdwe after in. Yield_We with_a.dnwdawn after_lax Recovery data Rine=rim when poop ie hated off-wale Noel mean"fine well tap IC wwerlevene Time Wntn Level Time Water Level Tare Wvlo Level Dam afpnmpw test Bailer en apwwih_fl dnwdwn aria_an Air Jew 20 M nwith stem into 160 a, r 1 kv. Date 211823 Arian flow_9pm Tempmw of weer 49 •F Was a he trial wlyais liar ❑Yin BNo Stan Date 211&23 Completed Dote 2)/823 WELL CONSTRUCTION CERTIFICATION: I canstuetd an /c accept rmpoosibilily for corWnlctim ofihis well,and its cmnpliarwe with all Washingum xall conaruction standards.Materials used and the information reported above me true to my best knowledge and belief. 0 Driller 0 Trainee O PE-Prins NaT Josh Kaepp OTilling Coinny Arcadia Drillirq Inc Si ua Address PO Box 1190 City.State Zip Shelton,WA 98584 L N 2874 Contractor's IF TRAINEE'S 's LiwuNo. S nsa's Si twe Re isuation No.ARCADDI098K1 pate 2118(23 ECY050-1-20(Rev 009/18) 1/You need this daerwientin an altenueefanmr.glean roll the Water Resources Prngrnnr or 36(1-407-6872. Persom widh hewing Ion coal call 111 for W'ashingmn Relay Senin. Persons with a speech rdsbilily can m11817-833-6341. PIONEER DIGGING, INC. PARCEL#: 22129-24-00000 SOIL Loos: 360-426-1803 CUSTOMER: MEL ENGER SLI-o22"cis sLz-o2a•'ms s13 o24"emus Bob Pgnx(Dvigm) DRAWING: PLOT PLAN 22^+c.T. NaP ' e(DIdIu) SCALE: 1 eoo_To22" eoois To24" rsJoi 24'• "=200' 4f ' 7" — �1�--- 552'-4" ___________ is yA I 411 p3? e4ar I I I I I FL PLO I I I PlPN2 / \ c ��c nted drorn Mo.n ()oa'nt DM y. E%CRC PIONEER DIGGING.INC. PARCEL#: 221 29-2400000 SOIL LOGS: SLI O22•'GLS SL2t 24"tug $L3 O24 [ub� �60-4261®09 DRAWING: PLOT 22"+GT 24"+G.T 24••4 G.T. bob Pgm(De4rc�1 DRAWING: PLOT PLAN noorsro 22^ novas To u• nem 24'• Na Paym(Drdlo) SCALE: 1"_100' 141/6 I -*p.b.1k� I I I ( r VRAWEU7: b-4O'6' (4505F) _ I W/50' AffN.ZONE \ ^•B (' EXl5f. \ Q7, Vii D I // W LOCATtION 7055I I 111LPIN ' N I .L _ I I L-�AV pkIVfWAY c /h i O, im', 4q , fIL" .,C)MS Cs — / \ ) — | ! f - � \ �< . } � . . . \ . \ - 2 \ :