HomeMy WebLinkAboutWAT2023-00279 - WAT Application - 10/9/2023 MASON COUNTY WATp
COMMUNITY DEVELOPMENT R E C E I V E D
415 N s°'Sam.Mg S.awl WA 911584, I 9 LJJ3
Sheeon:(3em 427-9e70 end 4m o Betlalr:(350)275 7ast 40) O Bre:(3f10)41M 9ad4W
FAx(360)427-77a7
Application for Detemination of Water AdequsLyV,
Instructions
1. Complete Pert t. No determination can b,made and Part 1 is tali permdetnd.
2. Complete Doty the portion of Pad 2 applying to the type of water connecion utiliretl.
3. Submtt completed application,wi ,any renuired attachments for review.
4. M apMved Wilding site Plan must accompany this applestion,.
1ENTAL
Part 1: Applicant'Parcel identification HEALTH
Name on Applicant: Jennifer Chancellor,Alan Schweroata:
Mailing Address: 1959 Galante Dr SW,Tu hwater Poore:
Parcel Number. 42008-78-90074
Type of Water System Reason for Application a '] /�
ElPudidcommuniy Water Systern(2 rmare 0 Buildingparmd pro a0oL3- 6 ( a,11
core. one) ❑ Dimon of land:
❑ Individual water source(one connection), ttof Perwlai SPL
D Well ❑ Boundary fine adjustment
❑ Springlsudam water ❑ Otlrer'explain)
❑ Other(axpWin)
❑ Replacement or F (please indite renter
If you have more Man one residence connected water eystem below low if i(applible-ro
to Nis wear,check the Puhlir/Cornmudy Waf sier sigrelure repaired)
System box.
Part 2: Water Connection Informatlon
Complete Me section appropriate for the Type of water correction being evaluated
Public Water System
Name of Wmer System: �a I J
Water Facility Imddary,(WD)Number"
(wde 31one'for two-party)
❑ 1 am dw manager of this water system.The water system has been approved for servie
The.are presently connecends)in use.This will W the connection
I am the manager d this syslam.Thin connection will be to upgrade or charge the use of an edsting
connection on this system(i.e,reaearonal to ful time).Please indicate on the following line the nature
' dthis change: wore cannemm
This water system is able and willing to provide water to this(these)connection(.)without s roaetlirg
the frmits of the water system or any limits r�d7 by agreeand local regulation.
SignmuredWder System Manm.r_ x> / M"h�'A� Deter 1¢INVOKS
This tone may b,scanned and available for Public view at www.co.maso
1 rEH FmmA D,v.,wb I(cri.sN I'2ra015
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 well capacity test, which provides stabilization of draw-down and recovery data, must be performed
by a licensed contactor.
❑ Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA htlo Rgis.co.mason.wgims/glanning 14= 15[= 16Q 22[--]
Water use or limitation recorded................................... N/AJ=_Vest
Well Drilled ............................................................... 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;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:
is 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.
fl Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meat the needs of its intended use for the following
reason(s).
�Reviewer's Signatures: Z
Environ. Health: Date
CSD Director:
Date 2 of 2