HomeMy WebLinkAboutWAT2024-00015 - WAT Application - 4/25/2023 WAT ILL4
415 N.61h Streit
MASON COUNTY Shebmt,WA 98584
0 COMMUNITY SERVICES Shclue:360427-9670 Ent.400
aelfaic 360-2754467:Ext.400
eur4eavr�`v.r..9000weya.enR camm�.�na..ia Else:360482-5269,Ext.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 Mahn,Agent for Lennar Northwest,Inc Date: 4@812023
Mailing Address: 33455 6th Ave S.Unit 1-a Federal Way,WA Mors Phone: f2531294-1322
Parcel Number: 1232MI-00045 FIr RM M as"9 O' MU ILICi W7 i"�'S
Type of Water System Rdbson for AppllZlatI.n oo pp
® Public/Community Water System(2 or more 50 Building permit '60 -;l0A'4-QQQ 4.0
connections) ❑ Division of land:
❑ Individual water source(one connection), p of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ex
❑ ❑ Other lain Other(explain) (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 PubliaXommunity Wafer signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
— J Public Water System
Name of Water System:_ �?Il iY. 4)'P . -Z:r"Aj c'T X/
Water Facility Inventory(WFI)Number: 0625-D
(write"none"for two-party)
�'I am the manager of this water system.The water system has been approved aved for / services.
There are presently 96A connections)in use.This will be the_ Q,IL-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 an the following line the nature
of this change:
This water system is able and willing to provide wate to this(these)connection(s)without exceeding
the limits of the water system or a limit set by state a I I gulation.
Signature of Water System Manager Date 6'J-q/,2'0.23
This form may be scanned and available for public view at www.00.mason.wam
19FH Forma\Drinking Water Rev d 4/4/3019
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ 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 wall 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 hlte://ois.ce.mason.wa.us/olanning 14 15 16 22
Water use or limitation recorded................................... N/A Yes
WellDrilled ............................................................... Date
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 800 gallons per day;andfor
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 on
Satisfactory Determination:
This detem ination 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-Determinafion of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
fl 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: f
Environ. Health: Date y I- V f
This form may be scanned and available for public view at www.ro.mascn.wa.us.
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