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HomeMy WebLinkAboutWAT2023-00299 - WAT Application - 9/28/2023 REC`;Ls C© • `AE1\11N ON 18 2023 615 W. a'?J °�D _ o . Alder Street WAT ,� N�PL� 415 N.6th Street L11611 `� Y SheMASON COUNTlton,WA 98584 COMMUNITY SERVICES Shaun:360427-9670.Ext.400 lkll'oir:360-275-4467,Ext.400 Bulling Planning Ernnonmen al Health Community Fteahh Elm:360-482-5269,Ext.400 Ham{ Application for Determination of Water Adequacy / 7 7 Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully cIL-1'7 mpleted. 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 EMPIRE HOME CONSTRUCTION LLC /) J 3 Name on Applicant: Date: 806 Mailing Address: PO BOX 241.KELSO.WA 98626 Phone: 751 2 Parcel Number: 22 0 1 7-50-00047 Type of Water System Reason for Application Public/Community Water System (2 or more El Building permit O LO ?O 3-01 26)3 connections) ❑ Division of land: O Individual water source (one connection), #of Parcels? SPL ❑ Well 0 Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ® Other(explain) new construction. 0 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: �/ l� Public Water System /!'Name of Water System: hD't--!"1`Y Cc r''►�14,7 '4 Water Facility Inventory(WFI) Number. �Le i 76V( /(write"none"for two-party) tt tam-the manager of tills water system. The water system has been approved for/ H/ services. There are presently Kr? connection(s)in use. This will be the 6i.3-c connection. 0 I 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. /I//I Signature of Water System Manager /� L 1/ Date / C This form may be scanned and available for public view at www.co.mason.wa.us. 1•EH Fams1 Drinking Wager P.<\ .rd-1:2111 s Individual Water Well o Water well report(attached to application) Depth ft. O 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 contractor. O Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto://ais.co.mason.wa.us/nlanninq 14_15_16_22_ Water use or limitation recorded N/A Yes Well Drilled Date Individual Spring/Surface Water O WDOE permit(attach to application) O Method of disinfection O 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 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 Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Re viewer's Signatures: Environ. Health: (Z--1D\Q4\1 (W Date 1 ((3Q I -3 This form may be scanned and available for public view at www.co.mason.wa.us. i"agc2of2