HomeMy WebLinkAboutWAT2024-00146 - WAT Application - 3/13/2024 MASON COUNTY WAT 2o2,4 - wi to
COMMUNITY SERVICES
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415 N 6' Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 6 Beftr.(360)275-4467 ext 400 J Elms:(360)4825269 ext 400
FAX(360)427-7787
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
Name on Applicant: �s Date: �. Ll - `d.Li
Mailing Address: t-, I nnr-.ryo die Bhpfie: <3�On - ,:21P5- N370
Parcel Number: a-poi
Type of Water System Reason for Application
X' Public/Community Water System(2 or more ❑ Building permit -W w -oO3,41
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
ff you have more than one residence connected of water system below if applicable-no
to this well, check the Pubfic/Community,Water signature required)
System box.
Part 2: Water Connection Information A-"0VZe,4 ,Z, -P,P 7 ��
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: T
Water Facility Inventory(WFI)Number. n
(write"none"for two party)
❑ I am the manager of this water system.The water system has been appro ad for 2. services.
There are presently I connection(s)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. •^�
Signature of Water System ManagT Date
This form may be scanned and available for public view at www.co.mason.wa.us.
I:Na Fmmr\I)rivkmg Weser R.vi 1/25MIS
Individual Water Well
Water well report(attached to application). Depth V`h
`Well capacity Test(attached to application) �' pm 7�' 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. _
`p' Satisfactory bacteriological test(attach to application).
,> Water Resource Inventory Area(WRIA)
Development within which WRIA htto'//gis.co.mason.wa.usiplanning 14[---1 15�R'fC[—]22=1
Water use or limitation recorded................................... WAQ Yes 1�n 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)
�I IS determination
Determination:
.a 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 W DOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,TPoe 6,Chapter 6.66.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
❑ Unsatisfactory Detennination:
Applicants water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures: 2 Environ. Health: �0W! : �� Date J(Z"7
CSD Director: Date zorz
NICHOLSON DRILLING INC.
PUMP TEST
NAME: KENNEDY,SADIE DATE November 15.2023
SITE: 51 NE LYNWOOD BEACH RD TIME 9:00 AM
BELFAIR WA.9=8
WELL DEPTH UNKWN Feet WELL DIAMETER 6" Inches
PUMP MAKE UNKNOWN PUMP MODEL UNKNOWN
TANK MAKE TANK MODEL
Time Depth Draw Rate Time Depth Draw Rat Time Depth Draw Rate
iiawu To (lows 9pm to Down GPM to Dawn 9Pm
Water Water Water
Static 23.6 0.0 40 72.8 49.2 680 0.0
1 31.3 T7 45 72.8 49.2 720 0.0
2 38.0 11.4 50 72.8 492 780 0.0
3 43.3 t8.7 60 72.8 492 125 Bd0 0.0
4 48.1 24.5 70 72.9 49.3 90D 0.0
5 61.6 252 14.0 80 72.9 49.3 960 0.0
6 552 31.8 00 729 49.3 1020 0.0
7 58.0 34.4 100 72.9 49.3 1080 O.p
8 00.5 36.9 120 73.0 49.4 12.5 1140 0.0
9 62.6 39.0 150 73.0 49.4 1200 0.0
10 64.5 10.9 14.0 180 73.7 49.5 1280 0.0
11 86.0 42.4 210 73.1 49.5 1320 0.0
12 W-1 38.5 240 73.1 49.5 U.5 1380 mu
13 682 44.6 270 Do 1440 me
14 89.1 45.5 300 0.0 1500 0.0
15 69.6 46.0 NX 0.0 1560 0.0
20 71.6 48.0 12.5 420 0.0 low 0.0
25 72.3 48.7 480 0.0 1880 0.0
30 72.5 48.8 540 0.0 1740 0.0
35 72.6 49.0 800 D.0 1800 0.0
RECOVERY
Time Draw Time Depth Draw Time Depth Drew
to Down to Down to Gown
Wetter Water Water
1 6/.4 40.8 11 0. 45 0.0
2 58.3 34.7 72 0 60 0.
3 528 29. 13 0. U.
4 48.0 24.4 1d 0. 70 0
5 43.9 20.3 15 0.0 BO 0.
6 10.4 18. 20 0. U.
7 37.4 13.8 25 0.0 10D U.
8 35.0 11. 3D 0.0 120 0.
9 32.8 9 35 0• 150 0'
10 31.0 7. 40 0. Itrul I0.
SIGNED BY: �/`"`
CHRISTOPH6R CHILTON:PUMP SUPERVISOR
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Grantoe(s): (1) —C�Jj I i ClQ in.eeq- i . (2)
Grantee(s):(1)PUBLIC 1
Legal Description(1)<2/2 112 U F 61LO O b F dt>• 3y - A
(Abbreviated form:'i.e.lot block Plat or section,township, range)
Assessor's Tax Parcel: (1) o� O ) -,;1- 3 - 0 0 1 y Q
5 1.�aa,—I�a
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA)
I (We),the undersigned grantor(s), hereby place this notice on record that the described real
estate situated in Mason County, State of Washington is subject to water use restrictions and
conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These
restrictions and conditions are based on location of property and/or Water Resource
Inventory Area or WRIA.
WRIA: _
Maximum Annual Average Gallons Per Day: `I�L� gallons
Dated on this_L?L day of 20�
Signature of Grantor(s):
(1):5 1 . (2)
State of Washington )
County of Mason )
Page 1 of 2
I, the undersigned, a No Public�i _nd fo_r'.the above na ed County and State, do hereby
car' th t on this y of F 20
1 personally appeared before me,who is known to be
signer of the above instrumen and acknowledged that he (she)(the ) signed it.
GIVEN under my hand and official seal the day and y r last o ritten.
P':••• •3 ry Publicn i nd f e State of Washington,
,�gaioa E;pv�•
pOTARY V = residing at
23038426 My commission expires:
a Nam; PUBLIO
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