HomeMy WebLinkAboutWAT2024-00008 - WAT Application - 5/15/2023 WAT 2Oa4 _-_a
415 N.6i°Street
MASON COUNTY Sheltm,WA 98584
0 COMMUNITY SERVICES Shelton:360427-9670.Eat 400
acHair:360s15�167,Ext.400
EIroa:360462-5269,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 Martin,Agent for Lennar Northwesoats: 5/15/23
Mailing Address:
33455 6th Ave S,Untt LB Phone:
Federal Way,WA 99003 253-294-1322
Parcel Number: 1932&51-0005 aBl me 3el{�iv.5fa{3.r-�
Type of Water System Reason for Application m�f
IN Public/Community Water System (2 or more ® Building permit
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ 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 PublidCommunity Wafer 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: * I-
Water Facility Inventory(WFI) Number: 09SSC� (wife'none'for two-party)
I am the manager of this water system.The water system has been approved for UD2 services.There
/ are presently 5n connection(s)in use.This will be the a.T 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(Le.: recreational to full lime). 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.
Print Name of Water System Mane r YJay Phone 31a0 .21S- 3sOC
Signature of Water System Manager Date S 3 I 2 y0
This form may be scanned and available for public view at www co mason wa us.
I:`EH Fmma\Drinking Water Re.isd4Q7P021
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) qpm gpd.
The well duller 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 ff the water well report does not have a capacity lest,
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,//qis.co.masm.wa.usiplanning 14_15_1622
Water use or limitation recorded................................... N/A_Yes_
Well Drilled ............................................................... Date
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 on/
saatisfactory Determination:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
ter 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-Deternination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
i 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
This form may be scannj and available for public view at www.co.mason.waus.
rage 2.12