HomeMy WebLinkAboutWAT2023-00313 - WAT Application - 5/15/2023 WAT �- (Xj�jlyl
415 N.6'n Sued
MASON COUNTY Shekel,WA 98584
0 COMMUNITY SERVICES Shelton:360427-%70.Ext.400
Felled:360-275-4167.Ext.400
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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: Applicantl Parcel Identification
Name on Applicant: Sam Martin,Agent for Lennar NorthwestDate. 5115123
Melling Address:
33455 aM Ave S,king 1.6 Federal Way,WA 990 Phone:
03 253-294.1322
Parcel Number: 12328.51.00042 231 rJE F3el(tt'If S�ti{1un
Type of Water System Reason for Application
® Public/Community Water System(2 or more 3 Building permit -60 2OZ-6•Q 130Lp
connections) ❑ Division of land:
❑ Individual Water source(one connection), #of Parcels?_ SPL
❑ Well ❑ Boundary line adjustment
❑ Spdnglsurface water
❑ Other(explain) ❑ Other(explain)
❑ Replacement or Remodel(please indicate name
If you have more than one residence connected of water system below it 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:
3 Public Water System
7 Name of Water System:
Water Facility Inventory(WFI) Number.. os-3S0 (write-none'for two-party)
❑ I am the manager of this water system.The water system has been approved for f 4D3 services.There
are presently -7 41 connection(s)in use.This will be the 7`f2 connection.
❑ I 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 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
-b/y state and local regulation.
Print Name of Water System Manager aA Phone 315,0';Z75=3009
Signature of Water System Manager Date 5- ,il
This form may be sunned and available for public view at www.co.mason.wa.us.
I TH Ferran Drinking Water Revised @712021
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) npm 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.
❑ Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area WRIA)
Development within which WRIA http://gis.co.mason.wa.us/planning 14 15 is 22
Water use or limitation recorded................................... N/A Yes
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:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefnilely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code.TNe 6,Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
CI Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of as intended use for the following
reason(s).
Reviewer's Signatures: /
Environ. Health: Date `D�3t 17i 3
This form may be scanned and available for public view at www.co.mason.wam
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