The URL can be used to link to this page

Home My WebLink AboutWAT2022-00315 - WAT Application - 8/19/2022 i WAT 2,OZ2. - 0a3I5 • MASON COUNTY 'I. `J COMMUNITY SERVICES 4 q, yt9YJ��/ Building,Planning,Environmental Health,Community Health 2 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 Belfair: (360)275-4467 ext 400 Elma: (360)482-5269 ext 400 740 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: JOE AND JENNIFER SNYDER Date: j Mailing Address:Address: 2870 E.MASON LAKE DR.W.,GRAPEVIEW,WA 98546 Phone: 253-670-8572 Parcel Number: 22105-52-00046 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more Building permit connections) ❑ Division of land: IXf Individual water source (one connection), #of Parcels? SPL CS Well 0 Boundary line adjustment ❑ Spring/surface water ❑ Other (explain) ❑ Other(explain) ❑ 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. ?AO, c on�tci vr) �.2 Z- o5Z Part 2: Water Connection Information -� - iY) � v lr(j Complete the section appropriate for the type of water connection being evaluated: 6 1 2022 Public Water System •5 �V AtdOr Str Name of Water System: Water Facility Inventory(WFI) Number: (write"none" for two-party) 0 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. ❑ 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`EH Forms\Drinking Water Revised I/25/2018 i Individual Water Well Water well report (attached to application). Depth N>n� ft. Well capacity Test (attached to application) I! .,I(< gpm pd. 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). 16. 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 Yes Well Drilled Date 1AVV IWY1- C covech—aYl 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 \I IZ CSD Director: Date 2 O s 1 Duckworth Pump and Well Services - Flow Test Owner Snyder,Joe 2870 E.Mason Lake Dr. W. Home Phone: Grapeview WA 98546 Work Phone: Well Location: 2870 E. Mason Lake Dr. W. Cell Phone: City at Well Site: Grapeview Fax: Legal Description: County Mason Q of the Q, Sec. T. R. WM Unique ID Well Depth: ?? Well Diam: 6 Casing Type:Welded Metal Well Use Domestic,Two Party Comp!. Depth Technician: Mat Date 09/28/2022 Drawdown: Time Depth GPM Recovery: Time Depth Static:: 24.0 -1-_ , II :00 ? 28. 0: 24.0 Start: ' 11 :05 25.0 :05 27.2 " :10 24.5 :10 27.6:15 27.7 :15 24.1 11 :20 :20 27.8 :20 :25 27.8 -__ � II r :30 .., 27.9 , :35 11 II :30 27.9 -- :40.A :40 { j 11 N "- j :45 _ :45 r -----:50 -- .__- .. 28.0 R :50 { R :55 I, II 1:00 28.0 ;.. . 1 1 t �: 1:15 1:15 " " _..- 1:30 1:30 " I.1:45 1:45 " R _-_—�— -i 2:00 1 " " —1 2:00 3.. 2:15 I -- 2 2:15 ! " II - :30- - -.... II Of i 2:30 ..._-._.._..--- - 2:45 28.0 II 300 ..__ fi _ - 3:00 28.1 1 -- i 3.30 3:15 I ,. • + L 4:00 3:30 II I I 4:30 , 3:45 II — — 5:00 -1 4:00 28.1 J 11 4:15 - --- 4 i 6:00 7:00 • 8 f9 .1..-. .. .___________I 10:30 Pump: Submersible HP: 112 Series: 10 Drop Pipe: Length Size v. Pitless Restr. Wire: Length Gage Printed From Mason Cou ��y MS Printed from Mason County DIM . SPECTRA Laboratories° 2221 Ross Way-Tacoma WA 98421 (253)272-4850 www.spe•tra-lab.com Spectra# 3 0 3 7 3 ` Q' COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County • I Li Z.Z. Coliectedt CAM MonthDay Year q_,_. J b 'PM rnAso►- Type of Water System(check only one box) ❑Group A 0 Group B /Private Well Group A and Group 8 Systems-Provide from Water Facilities Inventory(WFI): ID9 System Name QB,Well Address if Private: Contact Person: s nay DR., Phone:(ZS3) (off Email Address: 3r5v okr a ct tMco.e-M Spectra Client Name:(Full name.Malting Address and Zip Code) se44 — ;�- __ • 28�o SAMPLE INFORMATION Sample collected by(name): 3E SNy 0e02.. Specific Iocalic,sample collected(well,bath): Special Instructions or comments: 1Ct Ttl h`� C-iflu1K. TEST PUBLIC SYSTEMS FILL OUT SHADED AREA(must thick only one box of Si-5) 1.❑ Routine Distribution Sample 2.Repeal Sample(NP) Chlorinated.Yes_ NO (from distribution system after onset routine) Chlorine Residual Total Free Unsatisfactory routine lab number 3.Ground Water Rule Source Sample _ _ _ISII I I Unsatisfactory routine collect date: /_ 0 Triggered(A/P) Chlorinated Yes No ❑ Assesment(NP) Chlorine Residual Total Free____ 4.❑ Swim or GWI Raw Source Water Sample(Enumeraton) S 0 E.col, ❑Fecal Filtered Yes__ No 5.0 Sample Collected for Information Only LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and t tisfactory ❑E.cull present 0 F.coil absent / Replacement Sample Required: ❑Sample too old(>30 hours) 0 TNTC ❑Sample Volume 0 Improper Container 0 Turbid Culture 0 Bacterial Density Results:Plate Count —_ . /rnl. E.coli /100ml. Total Coliform ___._/100m1. Fecal Colitorm ,_- /100m1. Method Coo5ti . c93 Date and Time Received: ,1� �d%p 4�ts122 15 << • Date Reported: c ILO `a , Temp.3 u w,/ Rend by: c Sample fumb r a ear plustwa e;a4st Paid: — , _ -- Printed From Mason County DNiS. 118- Printed from Mason County DMS 2193246 MASON CO WA 01/27/2023 03:36 PM NOTCE SNYDER #183858 Rec Fee: $204.50 Pages: 2 IliDil IIIII I I III IIIIIII III 11111 II III I IIIII IIIIIII I I I III IIII IIII Return To Joseph and Jennifer Snyder 822 24th Ave NW Gig Harbor, WA 98335 Grantor(s): (1) Joseph Snyder , (2) Jennifer Snyder Grantee(s): (1) PUBLIC Legal Description (1) Mason Lake Estates #3 Tr 46 (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1)2 2 1 0 5 _ 5 2 _ 0 0 0 4 6 TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA (WRIA) I (We), the undersigned grantor(s), hereby place this notice on record that the described real estate situated in Mason County, State of Washington is subject to water use restrictions and conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These restrictions and conditions are based on location of property and/or Water Resource Inventory Area or WRIA. WRIA: 14 • Maximum Annual Average Gallons Per Day: 950 gallons (Applies to new ADU only) Dated on this 23 day of January , 20 23 Signature of Grantor(s): / (1) , (2) /1 Sta o ashington ) County of Mason ) Page 1 of 2 n the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this 2-3 day of Jan vca-Ykl , 20 Z 3 , Joe So LAc1 ex- Si),Act e.—personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. ' J ``��►►k11l11�/p,�� Notary Public in and for the State of Washington, apN PU40 residing at Ca Wk w� NOTARY s My commission expires: q /`f /2_Y( a.•� Pueuc • • p1111111 • Page 2 of 2