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Home My WebLink AboutWAT Application - 7/8/2023 WAT MASON COUNTY COMMUNITY DEVELOPMENT • ..4 ►..' Permit Assistance Center,Building,Planning 415 N 6u,Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 Belfair. (360)275-4467 ext 400 •:• Elma: (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:J p eEy Date: '7 f Z023 Mailing Address: 9 5 e CrFS hw)j Phone: (4.2 gj2o( - 3S2Ci frrrcz wA Gl6 t' P Parcel Number. ?j22 2if ' y Type of Water System Reason for Application ❑ Public/Community Water System (2 or more Building permit connections) 0 Division of land: individual water source (one connection), #of Parcels? SPL C3.. Well 0 Boundary line adjustment 0 Spring/surface water ❑ Other(explain) 0 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. 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) ❑ 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 1/25/2018 Individual Water Well /J 0 RECORD foUkt, 0 Water well report(attached to application). Depth ft. �N DO(fl. Sl Zr 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. 'El Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa.uslplanninq 140151710 16 22= Water use or limitation recorded N/A ,] Yes 11 Well Drilled Date 1./A.XI l0/!)N 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) -1 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: Applicants 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 2 of CSD Director Date Lab Number: 229136 Project: 10891 NE North Shore Final Report Inbox J Spectra Laboratories- Kitsap 9:24 AM (4 hours ago) to me Please see the attached analysis results for above referenced project. If you have any questions about your report, please contact us at the phone number below or you may respond to this email. Please review your data and contact us with any questions. Thank you for your business. Have a great day! Thank you, Jessica Donaldson Client Services and Project Manager Spectra Laboratories- Kitsap Port Orchard has permanently closed for business. Spectra Laboratories- Kitsap Port Orchard Sample Restrictions: Currently we are unable to accept Nitrate Samples after 4pm on Fridays. Spectra Laboratories- Kitsap Poulsbo Sample Restrictions: We are unable to accept Bacteriological Samples after 3:00 pm on Fridays. Please note Turn Around Times: Sodium, Hardness, Mercurey, and Iron- 20 days Metals- 30 Days Bacteria- 3 Days Nitrates- 5 Days Organics- 20 Days Radiologicals- 20 Days General Inorganics- 10 Days Please be sure to check with the lab on RUSH Capabilities. Thank you for using Spectra Laboratories. We want to provide the best experience possible! To help us, please take a moment to leave your feedback. Thank you. https://g.page/r/CQAiJa21g111 EAg/review SPECTRA Laboratories- Kitsap Jessica D(a�spectra-lab.corn www.spectra-lab.com Port Orchard 1786 SE Mile Hill Dr Port Orchard, WA 98366 Phone: (360) 443-7845 Poulsbo 26276 Twelve Trees Lane #C Poulsbo, WA 98370 Phone: 360-779-5141 The information contained in this electronic mail transmission is intended by SPECTRA Laboratories-Kitsap, LLC for the use of the named individual or entity to which it is directed and may contain information that is confidential or privileged. If you have received this electronic mail transmission in error, please delete it from your system without copying or forwarding it, and notify the sender of the error by reply e-mail or calling the the laboratory at (360) 443-7845 so that the sender's address records can be corrected. I 1 Davis Pumps, Inc. 340 911E`Ocwia farm lid. 13e1fair,`Wa 98528 (360)801-6107 Project Capacity Test TAG: NA Date 7/7/2023 Pump 3/4 hp 10SQE07 Well Depth 107.4' Static Water Level 32.2' Draw Down Recovery Time Water Level GPM Time Water Lever 0 min 32.2' 0 0 56.5' 5 min 41.2' 9.12 1 min 50.4' 10 min 44.3' 9.06 2 46.5' 15 min 49.4' 9.15 3 43.6' 30 min 52.1' 9.35 4 41.8' 1 hr 53.4' 9.6 5 40.4' 2 hr 55.5' 9.98 10 37.5' 3 hr 55.9' 9.71 15 36.6' 4 hr 56.2' 9.5 20 36.1' NA NA NA 30 35.5 NA NA NA 40 35.15 NA NA NA 50 34.95 NA NA NA 60 34.8 Vat&Runps, Inc. 340 9V£Vavia Tartu lid ?i3eLfair,14/a 98528 (360)801-6107 NA NA NA 65 34.75 Capacity Notes: Well static water level is affected by tidal fluctuation. Start of the test tide was in, and at the end of the recovery period tide was out.