The URL can be used to link to this page

Home My WebLink AboutWAT Application - 1/19/2023 WAT t119", 415 N.6`h Street MASON COUNTY Shelton,WA 98584 151 9I COMMUNITY SERVICES Shelton:360-427-9670,Ext 400 li `yf'y Belfair:360-275 1467,Ext.400 Building,Planning Environmental Health,CommunityHealth Elma:360-482-5269,Ext 400 493Z-JV 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: VAS cieiy EL) I C.-E. Date: - Icl - 2.3 Mailing Address: 11810 (✓ -FLte. eciI Phone: 5O'j 61-15 ' '13J4 Parcel Number: 3-23216 - 75 - 1 O 1 3 I Shetir— LO A 9`a 3e 4 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more Building permit 13 i�)2DZ -. 00070 connections) - 0 Division of land: Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) El (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) Acl' 4 i v() 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"non-" •r two-party) ❑ I am the manager of this water system.The water system has •-en approved for services. There are presently connection(s) in use.This will b- e connection. ❑ I am the manager of this system.This connect.• ill be to upgrade or change the use of an existing connection on this system (i.e.: recreation- • full time). Please indicate on the following line the nature of this change: This water system is able and ing to provide water to this (these)connection(s)without exceeding the limits of the water syste • any limits set by state and local regulation. Print Name of VV__a - System Manager Phone Signature of Water System Manager Date This form may be scanned and available for public view at www.co.mason.wa.us. J:\EH Forms\Drinking Water Revised 4/27/2021 Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) gpm 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 V-15 16 22 Water use or limitation recorded .. N/A Yes Well Drilled 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) ❑ 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: Environ. Health: " /� � Date This form may be scanned and available for public view at www.co.mason.wa.us. Pan 2 of 2 cro AAA Septic LLC L V aOa-zo r -7O PO Box 1460 S� 360-427-6110 Shelton, WA 98584 R 7.C 1!IV 3 2023 —PROPERTY INFORMATION t eet Location:1280 SE Fireweed Rd 6.15 W. Alder St Shelton N�^Alai To ANN M EGERTON Tax ID:320267590181 ��V`M1 1� PO BOX 1205 R S Use: SHELTON.WA \, 98584 f� GENERAL SYSTEM TYPE:Conventional (Pressurized) ON ID:320267590181 County Area:Oakland Bay MRA F°A r- ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT ` Fo1c I lave He,e Inspected:03/16/2023 - Inspection Type:ROUTINE - Correction Status:No corrections needed Company: Work Performed By: Submitted 03/17/2023 by: AAA Septic LLC Alisha Wulf Alisha Wulf COMMENTS& GENERAL INSPECTION NOTES No Deficiencies Noted GENERAL SITE& SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected Components accessible for service: YES All required service performed(if no-specify omitted inspection items in notes): YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(structures/impervious surfaces) NO All riser lids securely fastened upon departure: YES Electrical repairs needed. If YES describe in comments: NO Root intrusion on any components. If YES describe in comments: NO Settling problems observed. If YES describe in comments: NO The house/structure was vacant or used Infrequently,assessment of the drainfield was not possible. NO ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment This component was: Fully Inspected Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Compartment 1 Scum accumulation(Inches,if other specify): 2 Compartment 1 Sludge accumulation(Inches,if other specify): 4 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 4 Pum.in.recommended: NO TANK Pump Tank This component was: Fully Inspected Compartment 1 Scum accumulation(Inches.if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 Pum•in•recommended: NO •ump:Effluent Pump This component was: Fully Inspected Controls functioning: YES Tested.allons.er minute flow: Panel:Alarm-High Water This component was: Fully Inspected Alarm mechanism functionin.as intended: YES Drain field(disposal):Pressure This component was: Fully Inspected Lateral lines flushed: YES Average squirt height(if performed)(feet,if other specify): Ponding present?If YES explain in comments: NO ReportiD: 1163725 View inspection reports online at www.onlinerme.com Page 1 of 2