HomeMy WebLinkAboutWAT2024-00014 - WAT Application - 6/16/2023 WAT 0
415 N.61a Street
MASON COUNTY Shdtoa,WA 98584
COMMUNITY SERVICES Sbehw:360427-9670,Ext.400
aelfaie 360-275- 67,at.400
a.am,e.vwNuy,emi�.,..a x»lu�c�., 4. Elms:360482-5269,Eat.400
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: Sam Mwgn,Agent for Lennar Nonhy 91,Inc Date: Wl W023
Mailing Address: 334556th Ave S Unit 1-8 FWgral Way,WA M03 Phone: 1253)ZW-1322
Parcel Number: M2D 51-00WS -Fen FmraEwes
Type of Water System Reason for App��licaathtionn)'� nn��
® Public/Community Water System (2 or more W Building permit �LV a Va1'l`v W3Q
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parmisv SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water
❑ Other(explain) ❑ Other(explain)
❑ Replacement or Remodel(please indicate name
if you have morn 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: e. air tW tJ ed-Ca' h y%' .+ A i
Water Facility Inventory(WFI)Number: $'3
(write"none'for two-party)
154 1 am the manager of this water system.The water system has been approved for N/OS services.
There are presently 75y connection(s)in use. This will be the 755 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 y set by state lm I regulation.
Signature of Water System Manager l Date
This form may be scanned and available for public view at w1NW.co.masoa.wa.us.
1:1EN Fm e,Drinking Warm Rerisei U4R018
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpro gpd.
The well driller often performs well capacity tests at the time the well is convicted. 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 htto:/lais.co.mason.wa.us/planning 14_ 15_t6_22_
Water use or limitation recorded................................... N/A Yes
Well Drilled ............................................................... Dale
Individual Spring/Surface Water
❑ W DOE 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)
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 regulators.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Detemminafion of
Adequacy for BuiMing Permits are smisfied. Additonal Growth Management requirements may apply. Chapter
36.70A RCW.
1 Unsatisfactory Determination:
Applicants water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
r�Reviewer's Signatures:
Environ. HeaRh: '6 vv I Date
This form may be scanned and available for public view at www.co.mason.wa.us.
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