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Home My WebLink AboutWAT Application - 9/20/2023 • MASON COUNTY WAT COMMUNITY DEVELOPMENT rmvanuisWme Cam,,BuMMPmnni r 415 N 61°Street,Bldg 8,Shetion WA 98584, Shellon:(360)427-9670 ext 400 4 Belfair:(360)275-4467 ext 400 4 Elm:(360)482-5269 ext 400 FAX(360)427-7787 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: Dave & Pat Larson Date: q-;b '2y, Mailing Address: 14244-55th Ave. So Phone: 206-799-7892 Parcel Number: 12105-52-00106 Type of Water System Reason for Application O Public/Community Water System(2 or mare t7 Building permit ��( 202,3 connections) ❑ Division of land: ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) Replacement r Remode lease indicete name If you have mom than one residence connected of water system 1 applicable.—no to this well, check the Public/Communily,Water signature required) -. x5W rh wL 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: I (wo W r Water Facility Inventory(WFI)Number: (write"none'for two-party) ❑ 1 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. ❑ 1 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. 1:TH F.\Dew ,Wu1, lkmi I125a018 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=15=16=22= Water use or limitation recorded................................... N/Aj�Yes_= Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 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) L 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 W DOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.66.040-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 mason(s). Reviewer's Signatures: Environ. Heafth: � �Ft Date CSD Director: Date 2.172 9121/23 s WALKER PARK RD 4o fi 11MMJ.XUNIEq .. FN`�1 _ .•N .: DRIVE r2ggM— � OSCAR RIA 1S' SCALE-1"=30'-O" J 30' SHED 2 DRM SEEPAGE PR i 3GAL.SEPRCTAN FCLEAN SHED PRESSU TESTWA-GRAVTTYSEEP EPIT E%ISTINO WELL PITD MR=10" PTTDE BELOW FLOW LINE=SFT EFFE E AREA=100FT2 PER TON RATE(PER 526 TABLE I)= IPoINCH=85M PER BEDROOM MINIMU DRAINFIELDSEE=170MFOR2 DROOM DRAWFI D MEETS MINIMUM SIZE REOUIREM S FOR 2 BOW RESIDENCE JIM HUNTER& ASSOC. cIX qA Oq P.O.BOX 16Z OLT,WA 98507 LOCAL 753-1226 ANNg161CUATESEMO.I<OM INSTALL Imn 197M RECORD DRAWING sRE ADD 5/LEGAL 1 BE WALKER PARK RD OWNER- DEREKFOLEV ALDATE- W1123 TPr 520215100025 SITE q