HomeMy WebLinkAboutWAT2024-00263 - WAT Application - 6/24/2024 WAT -
415 N.Be Sneet
MASON COUNTY SW ,WA98584
0 COMMUNITY SERVICES Shelim:360-427-9670,ExL 400
Eelfair 360.2754467,Ext.400
mr,u.srm,.,mssm,mm.m,i xmm co,.�,.mv�enm Elms:360482-5269,En.400
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is funv comoleted.
2. Complete orgy the portion of Pan 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
Nameon Applicant P.ILNARD MfAWM Aate:
Mailing Address: EQ &Y 67 Phone: (fe[) 490—9✓.057-4
Parcel Number:
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more Building permit BLDOO94'-007(OI
connections) ❑ Division of land:
Ilt Individual water source(one connection), #of Pamels? SPL
0 Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel (please indicate name
N 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)
❑ 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)connediori 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 avallable for public view at www.co.mason.wa.us.
I:tEH Fmmrl DdAing Water Revised 4/ Ml9
Individual Water Well
C& Water well report (attached to application). Depth
z;Z 23 JAWO Z4,
I� Well capacity Test(attached to application) 1 . V gpm gpd. 118147211.
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 drew-down and recovery data, must be performed
by a licensed contractor. Z '
DI Satisfactory bacteriological test(attach to application). 31/j�( rl
Water Resource Inventory Area (WRIA)
Development vn RIA C0.mason.wa.us/Dlannino 14_15_16_22_ p/
Water use or limitation recorded................................... NIA_Yes_ 1`�
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 determmatioa does not address adequacy of the distribution system.guarantee an adequate supply of
water indefinitely in ere future,or guarantee comptance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Deternina5on of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may epg(y Chapter
36.70A RCW. A
f11 Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use�the following
reason(s). ✓U /` /�
Reviewer's Signatures: NCn 0910 �,
Environ. Health: Date_JL %GN�FNr
ThIs floc may be scanned and available for public view at�alaa.ffi Ya• HFq(Ty
Yuge l of 2
WATER WELL REPORT _UM DEPAatMEWT Of Naa a'haw.Nw hy�552w
ECOLOGY L,,EMmy Wa BI In Na. WF169
TZRorwoA Lbee o(wnMnglon
IN C.n Site Well Nsm<(ifmort than ol.Wel]):
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type MWalli.
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Medwdpfvaky rousts Brown fine silt and Sand 95 107
T� Brown fine grew and sand,Wet 107 1m
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S:tie ,Wer level 95 R.Felm top Wild unro On. 3 /14
ArmoePmsav_as pal queer inch DWe Brown gninol and slit,fine sand 142 176
Area v:meeedb gy,wwe,e..) Dean besa6 176 10
waTbrc and saxk seN 197 223
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Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA.98584
Customer. Richard Manning Well Tag#: BPF169
Site Address: 440 SE Bloomfield Road,Shelton Depth: 223'
Date of Test: 3/13/2024 Static: 46.9'
Pump Set: 160,
TIME GPM LEVEL RECOVERY
1 Min 6 48.5 TIME LEVEL
2 Min 6 49.6 1 Min ill
3 Min 6 51A 2 Min 109.5
4 Min 6 52.2 3 Min 108.9
5 Min 6 53.9 4 Min 107.1
6 Min 6 55.2 5 Min 106.1
7 Min 6 56.8 6 Min 105.9
8 Min 6 57.9 7 Min 105
9 Min 6 58.9 8 Min 104.1
10 Min 6 60 9 Min 103.5
15 Min 6 64.6 10 Min 102.9
20 Min 6 68.6
25 Min 6 72
30 Min 6 74.1
35 Min 76 8
Y m. 6:..:' 8.9
45 Min AIA 78.9
50 Min 4.6 78.9
55 Min 4.6 78.9
1 Hr 4.6 79
1 Hr 10 Min 4.6 79
1 Hr 20 Min 46 79
1 Hr 30 Min 46 79
1 Hr 40 Min 4.6 79 '
s 1 Hr 50 Min 4.6 79
2 Hr 4.6 79
2 Hr 10 Min 46 79
F 2 Hr 20 Min 406 79
2 Hr 30 Min 4.6 79
2 Hr 40 Min 4.6 79
2 Hr 50 Min 4.6 79 <,
3 Hr 4.6 79
3 Hr 70 Min 4,6 79
F 3Hr20Min 46 79
3 Hr 30 Min 4.6 79
3 Hr 40 Min 4.6 79
u 3W50.Min, 4.6 79
4 Hr 4.6 1.12 -.
vanpam LaWMV)rY
2635 Parkmom Lane SW, Suite .A .
Ohmipia WA 98502 i
vt l."D 360-96'7010
COLIFORM BACTERIA ANALYSIS FORM
D�U10e WWed Tmc$a-,* „any
03/132024 . 2e ❑w MASON
LLFN Ny YN —��
Type olWaRr575wm(awa arNr m"bm)
❑Gm A ❑GWB ®der
Group A alW Group B SysWrs-Prwi a from WaRr Fac*%s Inver"(WFI):
SPW N— RICHARD MANNING
Control Perron:Ar dia Dulling,Inc
Day Ph" (360 )4M3395 AMPnaw:I I
Emed Ere.PMne( )
Stag rmRav lftM Mm aiaen aW nq rode 4, -,
MerewcaTieenmrpmm Mvolenn®xmmaOM`mp mm
SAMPLE INFORMATION
sample cdtxreo by(n")'MAX {����.y�.�-------
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NBPF1694 0$E Bloom%ld,Shelton
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Vmat9*Vp mutme lab number,
CtJpme ResWual'TOW_Frae_
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0 TWAmd IkV) CNa ResidO Tob_—Free_
❑Assessment(A('r)
4. Surfm or DWI Raw Souris Wamr Semple(Enum moon)
S
❑E mN ❑Feel
S. sT»Cm'Va!"Jb ArtennYlm Only:
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑tlnsa5ebcmry Tm CoNxm Praentand Satisfacmry
❑EroWVx ❑EwNat e+!
Backrul Density Rmb Tool C9lMerr2 J10dM. EroN' ItOpN.
Fe ll Cor , 11051 N. HPC It mL
Repbcmma Sampb Ra96W: ❑TNTC ❑uenN bold
❑ SaWla V.Ium ❑Danwgm Contimr ❑
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