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HomeMy WebLinkAboutWAT2023-00207 - WAT Application - 11/1/2023 WATT 7,3 -oc)-Z-0 -7 415 N.66 Street MASON COUNTY Shelton,WA 98594 COMMUNITY SERVICES Shelton:360-427-9670,Ext.400 Belfair:360-275-4467,Ext.400 eme�"sa�mngfrwvmmemJ xnnhmmmwnyx«im Elon, 360492-5269,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 II Name on Applicant: M��— T_ � Date: h << ( � , Mailing Address: 22 Phone: ^Z7�-7Z-0'6 Parcel Number: 7'?Asjo -Opp S-0 G-0 7-02-3_ 001'­111 Type of Water System Reason for Application ❑ Public/Community Water System(2 or more L Building permit connections) ❑ Division of land: Individual water source(one connection), #of Parcels? SPL ❑d Well ❑ Boundary line adjustment �j 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 connections) 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. Print Name of Water System Manager Phone Signature of Water System Manager Date This form may be scanned and available for public view at www.co.mason.wa.us. l:TH Forms\Drinking Water Revised 4=021 Individual Water Well Water well report(attached to application). Depth (06 ft. Q Well capacity Test(attached to application) "Z-0 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 rapacity 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/Igis.co.mason.wa.us/planning 14_)�15_16_22_ Water use or limitation recorded................................... N/A_, ,Yes_ Well Drilled ............................................................... Date v,1� OWV1 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). Reviewer's Signatures: 1 Environ. Health: ° '" I Date This form may be scanned and available for public view at www.co.mason.wa.usYSQ.`.mason.wa.us. Page 2 of2 Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA. 98584 Customer: Prime Location and Solutions Well Tag#: no tag Phone: (360) 277-7206 Depth: 66' Well Site Address: 1161 E Mason Lake Rd., Shelton Pump Set: 60' Date of Test: 7/2412 0 2 3 Static 45.8 TIME LEVEL GPM RECOVERY 1 Min 46.1 8.0 TIME I LEVEL 2 Min 46.1 8.0 1 Min 1 45.8 3 Min 46.1 11.0 4 Min 46.3 11.0 5 Min 46.3 11.0 6 Min 46.3 14.0 7 Min 46.7 14.0 8 Min 46.7 14.0 9 Min 46.7 14.0 10 Min 46.7 20.0 15 Min 47.1 20.0 20 Min 47.1 20.0 25 Min 47.1 20.0 30 Min 47.1 20.0 35 Min 47.1 20.0 40 Min 47.1 20.0 45 Min 47.1 20.0 50 Min 47.1 20.0 55 Min 47.1 20.0 1 Hr 47.1 20.0 Vanguard Laboratory 2635 Parkmont Lane SW,Suite A Olympia WA 98502 pfMto*D 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM DOW Semple Wd l Time= County 07/25/2023 ,� a o.N Mason taa oa v.e _._t♦Fu Typeal Wahr SryaWm(Mad mryme ka) ❑GmpA ❑Cwup B ■Olher— _ GrmpAm GmpaSystems-RwWahan WeWr FadWw Inenbry(WFII'. ID1 _ Srslrn Name: Robert Flath Canted Person:AnatlW 041lrg,Inc Dayphone'.(360 )/263385 Cell Phnne:( ) Emaa: Eve.Phme'.1 1 $alalrenaa b:IPnnttWl sale,WM6 atl zip obOaFinatll vMaQarcputiutrp wn AND ws®urati W nmrpmm SAMPLE INFORMATION Sample cateued by(name):Seth Speck loceym Mae.emo.odlectE: Spedel'mehucknaawnmenk 1101 E wsoh Lake Ra.Shelton Typo of Smpk(eeleclmry aria rNe of sampk ham types 1 tllrmgN 5 pelow) 1.❑Routine Diddleat Semple(Am) 2_❑ Repeal Sample We) ChbnnaWU:Yes No (lmm aevi000n system Aa unsat mdee) Unsal¢latloryroutine lab number ChbnraRWtlual:Tdel_Fiee_ 3.GreuM Water Rule Sours Sampk — --- lMsaWlectay roufine tolled Eala: S I ) ) Dfia aleL'.Yes_No_ ❑Tiggaal(Ain) ChbMe Remjual'.rolal Free ❑Ameaemed(AR) t SudxeecGWl WrSaume Walx Sample(Enumemfim) ❑E.pap ❑Fecal Fm.m ye` 5.®$Ynpb Cdbcletl br Nlamallm Ohl,'. LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unaaliefictery TMI Cd oon Present and Ssaalackry ❑Ecnr prmenl ❑Eonlraaaent Bacterial DaWRy Result:ToWlColilam I1wrol. EcaP /1Dpd. Fecal CaNWm ItOanl. IVC /tat RplxmWnt Sample ReRulraE: ❑TNTC ❑Sampk We oB ❑ Sample Volume 0Dam,e6Cuntina ❑ IA palest.Numtia 7 Z4 L L WtjArempc: AWaloO Cale: S 11 1)YRaWe.1b DC11 tAUroey LOH IabSmpW 285- re.wunaawmnl w e....>an.r�s. d���s m.am.Raa�ane..a.tan.a.en.wr.+a`v.�