HomeMy WebLinkAboutWAT2023-00332 - WAT Application - 11/14/2023 WAT -m
415 N.B°Street
MASON COUNTY Shelm WA 98584
0 COMMUNITY SERVICES Shelton:360427-9670,Ext.400
Beltair.360-2754467,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 she plan must accompany this application.
Part 1: Applicant[ Parcel Identification
Name on Applicant: CMH Homes, Inc Date: November 14, 2023
Mailing Address: 5000 Clayton Rd Maryville TN 37804 Phone: 253-225-2808
Parcel Number: 32021.59-03041
- / Type of Water System Reason for Application
H Public/Community Water System(2 a more Building permit BLDADA3"0139/
connections) ❑ Division of land:
❑ Individual water source(one connection), p of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
It you have more than one residence connected of water system below if applicable—no
to this well, check the PubliclCommunity 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: Shorecrest Estates Water Company
Water Facility Inventory(WFI)Number: 78602-1 (write"none"for two-parry)
❑ 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.
67 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: Building Permit-Existing Meter Connection
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 Kdstle Hutchinson Phone 36D-426.0773
Signature of Water System Manager Date 11/14/2023
This form may be scanned and available for public view at www.co.mason.wa.us.
11 H Fomu\Aiekinr W. Revised4 M021
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 contractor.
❑ Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA http://qis.co.mason.wa.us/olanning 14_15_16_22_
Water use or limitation recorded................................... NIA_Yes_
WellDrilled ............................................................... 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 indefinitely in the future,or guarantee compliance with all applicable WOOE water resouroe regulations.
Recommended approval Indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Determination of
Adequacy for Building Permits are safisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
F Unsatisfactory Determination:
Applicanfs water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures: rr p
Environ. Health: Date l7 � U(23
This form may be scanned and available for public view at www co mason.wa.us.
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