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HomeMy WebLinkAboutWAT2023-00271 - WAT Application - 9/20/2023 WAT MASON COUNTY COMMUNITY DEVELOPMENT r rnft aiiaancerlleen BulldinLNanninr 415 N 6"Street, Bldg 8,Shelton WA 98594, Shelton: (360)427-9670 ext 400 4 Belfair: (360)275-4467 ext 400 4 Elms: (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: John & Michelle Wieman Date: 9/20/2023 Mailing Address: 106 Goldenrod Street Port OrchoPhone. 253-360-4975 Parcel Number 32212-76-00090 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more O Building permit hJIA connections) ❑ Division of land: 0 Individual water source(one connection), #of Parcels? SPL r❑ 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 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 9/20/2023 This form may be scanned and available for public view atvvvrv;.co.mason.wa.us. HFH Fm \Drinking WaM Rcv,wd 125I26111 Individual Water Well El Water well report(attached to application). Depth 87.4' ft. El Well rapacity Test(attached to application) 30 gpm Z AND 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 htt¢//ais.co.mason.wa.us/planning 14__=154if� 0 22 Water use or limitation recorded................................... N/A P I YesQ Well Drilled ............................................................... Date UNK 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; 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 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). ..lr� Reviewer's Signatures: Environ. Heafth: - r ' I � Date Ca'lD, .✓l '�'IL11' �' 1� bR,L1'WfU 5,11 0 I11" 2of2 YWt ow n Nicholson Drilling, Inc. 1(360)876-4421 t�PO BOX 11p23 TOR Free 1(800)894.1421 Private Watejr Siiool4 U'es an -Fa: 1(360)876-5601 System Design For. John and Michelle Wieman Well site: 1060 Tahu a River RD, Tahu a Located at property address or legal description Second party property address or legal descnpbon This design is for (check one) a single family residence: 2 parry domestic: Sinai pump: Pump rate 30 gpm. If less than the required daily production of 400 gallons per day(gpd)for a single-family residence or Boo gpd for a two-party supply,the booster pump and storage section must be completed. Required pump head: Waft Head (S.W.L. + Drawdown 8 440 Pump Selected. Attach um curvettable System Elevation 1000 Type. (e.g. Goulds) Grundfos Headlosses 048 Horsepower 1.00 Residual(30 psi) 69.30 Model Number 16sic-10 Total 167.18 Depth of pump setting 100, Booster pump: If the capacity of the water supply is less than the required daily production of 400 gpd for a single family residence or 800 pgd for a two party private supply, complete this section as well as the storage reservoir section: Required Pump Head: Booster pump rate Pump Selected: Attarchipump curve/table System Elevation Type: Goulds) Heatllosses Horsepower Residual(30 psi) F1 Model Number Total Storage Reservoir: Must be completed if a booster pump is required. • Single-family residence'. 400 gallons unless otherwise documented. Attach manufacture's specifications. • Two-party private: 800 gallons unless otherwise documented. Attach manufacture's specifications. Pressure tank sizing: Selected tank size 81 gallons. Reservoirtanksize I gallons. One gallon of working storage per one gpm pump capacity,eg.,a 5 gpm pump will require 5 gallons of working for usable storage which computes to a 19-gallons(total volume) pressure tank. When a booster pump is required size the pressure tank according to the booster pump, not the well pump. Distribution Services rpe pipe Pipe Peak Flow Xeadloss per 100 ft. Heatlloas In System 1 VC 1-114 105 5-GPM 0.46 D.48 PVC 5+GPM Completed Date. August 17, 2023 1786 S6 Mik HW Ddw SPSCL'BA LYbo wrl o-KIwF Port Omh.,d,WA 98i _.a..w....�, wwwa beam (3 443-7845 COLIFORM BACTERIA ANALYSIS FORM Me a.mN CJN�3Una 6 11s/ ((� an I `GAS O r TypedYAbapYm(detli odyaro bm) ❑6mWA ❑40Pa (byA.itlt#oupB By�oa-PMAIe Yon WekrFrHahwiny MPR BpwlNia:— � h Cahn PnYen: M (36016764421 Cw AUJ: Ew.PYois 9.n(aYt[Plp77l7Tny�vKtlYw JYYYw ..Jl .IGH�k$ONDRILMLING®©MgILC_4Ji4-. - - SAMPLE WORNAMON a�9DwtawhhJm°t�/'^ 8pd@bmim./wnwryNmMiM Spetln YNuam�wmmwile TYFYdRYDN.( a1/ou t.Cl ft**DMYbJb"w C aftn:Yw ❑- No❑ OAsalYe�ryNielbrmai muNJl aMMMRWPUYY Tdn_ Ra_ awnYYusywm lYsmlaclvy wh Nb iwrder. 13 Y Bouu qwM WDerRUNSagN _____ � $ '( � I unabfewyiYglwwbnaerc ❑Away ObFp—AyNUY— TOK- R"- 1.Everinn9wwrn.µ �E "FasF• fir.❑ w,� �--W 6$.MnYfsmn MYnwY.iaJA QNw fta y7bwc4m FnanYnY Ny �G001 n �Em/alwl RgYawdaxnW pWna: - ❑5M*Wo P,3D v4 ❑TNTC ❑ atnJYa.r�ReW:TYMCaE4e ----_Ji9 .Eul n9NM1 Foul mmw mL wllol CAt �i P�I�n00iY unANrnA JUN 17 202P °i'^ (JN 17 2M Mile Hill Dr. Pon Pmt Orcha1786 rd,WA 96366 SPECTRA Laboratories - Kitsap (360)4437645 ...Where experience matters 10C TE9F PANEL / Complete or Selected Itiorgadcs syaen,B3 No: SY—GraR77W: Privaa Simple Number: 2254=3 System Name: Warms sample location: Well Bead County: Mean sampler: T(m Sousa NombW(a): 1 sampler Phase No: ----_— Sample Pmpae: 1-wosUiue. Dsne Collecub MOM 1330 Swale Corrliasiuon: Single samm Date Received: 06116=211:30 Sample Type: untreated:[YW Dam Reported: wig= Sun]RePat a: - - - .. .Bill e: .. _ Ncpolacn Drilling tax. NictioLm adDi g lac. PO Box 123 PO Bon L23 Pat Orchard,WA 99366 PanOrehatd:WA 98366 DOH 0 Analy0: RBB1Ra Duel. Uri6 SDRL PDL Tdppar MCL Exceed! hkCw4 MrablMl AneyW _ MCL Dab 0001 Nbeb-N ND — rryM1 0.5 CIA) 6 10.0 'S.Eesy(1ReapaM) Mr m17/711217 0000kerk 1.30 — MOL 0.1 0.1 — O3s YES- EPA200.7 OBI 07711R2Q00 ODIO Manganese 0.021 — rlgM1 0.01 0.0007 — 000' EPA 200h OBI OI11M20:00 0021 Chloswe ND — MWL 2 0.1 — w EPA300.0 010 Q70MI LIT 0016 Caasstity, 90.1 — OBem 70 1A — ]m SM 2610B 010 ON307215:15 BOiFA Ito I tlan Iridiba NeoriPYellab numMr.mmpY numMr,eM mlYdbn deudpapnal aunpYYNmer YO arsamplermmrenYagbll. MIa: ($YY Oeumbn Seorenq lYd�TM mnimum reprYbN dcattbndmanayunaWNWW CytlYdaperbrem. TdtprLent DCglainW,,wamrmmonm Ynl.System>wm mmpaMatleYMdalcdxmNdbm YaxcW dtlAeNM mryMnqulrabb Ms (Mtl ulaam Ws modlormore oxsIaM.Puammnlad}ds MCL, plgntarreymaloMmbr XH oft YCL: (Merhnum GonYmirent Level aNa WnYnanantarmuntexraeds Vn MCL,pYam mnYgymra9idul DOH aMm YMYmiia loeowuP adgna. Na: (NotMmyutl)Y me rewlYcoWmn,IMaaue NY mmaontlwm mlmdeadYba oaaaemlyae. l J: Tmiass amwm YpNouMdl Iwncs aw na aMdd Ynpecmur emCrmYlninof n. .,ua Nailvo.mr ampawu nNdw eamenalyte1a lnntltlnuated(ov6,h tttwe Mb nMrmMWE NBan aqe Wmn. eial.M: mWmarcmngy $0ftL ual.le rmaane dawYra.mrl pnamlcm: Alrry Mmsper miNmeta(e mmsdeolme ebiay otmewemrm mMwaecaiMlane mlvoonm parmnamererYequrveunimone nano an per rantlmemr(uekm). No exidbnq 1A99ard value. 1'. Semntlary MCL(EsudIA Ma er aeMAeec Wmmm.not Malty bmetl). Laboudlim Comm": 010:Analysis performed by Spectra Labmatmics-Mtsap,LLC-Sample 8=218572 094.Analysis subcontracted in Emmim Eaton Analytical(WADOH8094) 132022-03 Page 1 of 2