HomeMy WebLinkAboutWAT Application - 11/6/2023 ENVIRONMENTAL I
WAT
MASON COUPIaLT
COMMUNITY DEVELOPMENT CI i
Permit Assistance Cerra.Building,Planning
415 N 6-Street,Bog 8, Shefton WA 98584, 'C
Sheaon: (360)427-9670 ext 400 O Selfair. (360)275-4467 ext 400 4- Elms:(360)d1�2.1�&N, f-D
FAX(360)427-7787
Application for Determination of Water AdequacVOV - 6 2023
Instructions ti W. Alder Street
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: Date:
Mailing Address: n1"r ix- W Phone: (41S) uoi-xjAzi
ce,wgt c{g taq
Paroet Number.
Type of Water System so Reason for Application /
❑ Public/Community Water System (2 or more U,Building permit�jLPZR3-0133*
connections) ❑ Division of land:
Individual water source(one connection), #of Parcels? SPL
M Well ❑ Boundary line adjustment
0 Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
If you have more then 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)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.
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Individual Water Well
N0 RECORD fiouko
❑ Water well report(attached to application). Depth ft. ON 7DpC. Slag
Well capacity Test(attached to application) apm apd.
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-//ais.m.mason.wa.us/plannina ,,,,JJJJ14=I1�100 �22
Water use or limitation recorded................................... N/AJ�Yes=
Well Drilled ............................................................... Datel lJ t t/7li)N
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 WO gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Data
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 6.6e.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).
yam, �Retviewer's Signatures:
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Environ. Health: �t,�WVV�/ �t t' ` Date Z 1
CSD Director. V Date 2of2
Vadiftm% , Inc.
3409V£Davie Tarm Did
tl4air,'Wa 98528
(360)80I-6107
Project
Capacity Test TAG: NA
Date 7/7/2023
Pump %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,V 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
qNANA NA NA 40 35.15
NA NA NA 50 34.95
NA NA NA 60 34.8
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.
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