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Home My WebLink AboutWAT2021-00093 - WAT Application - 2/5/2021 ENVIRONMENTAL � WAT �^, L- MAWlr TIODUNTY COMMUNM SERVICES Nidiq WnwpfmYmm�rW ll�Xx Ccmnnlry NeNF !�C r1 'ViRONMEN 415 N 6e Street.Bldg 6,Snenon WA 98584, �6 eft \/�Il .I(Tt27-9670 ex1400 O Be r( 60)))42754467 7 7787 xt 400 o Elms (3601peCai-61a84LL Application for Determination of Water Adequacy; �33 Instructions 1. Complete Pan 1. No delermina9on 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 applioation,with any required attachments for review. 4. An approved building she plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: .be Viviano a Ashley Sowle Date: 215/21 Mailing Address: 405 W Anderson Rd POB 162 MMWck 98M Phone: 586-Ul-7206 Parcel Number: 620177500023 Type of Water System Reason for Application ❑ PuWicJCommunay Water System(2 or more -1pe Building permit nn� iG connections) ❑ Divisionofland: j3Lf�abpm�J'�13g8 Individual star source(one connection), a of Parcels? SPL Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel(please indicate name N you he"more Man one residence connected of water system below If applicable—no to this wee, check the PublidQommundy 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: (wr to*none'for two-party) ❑ 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. ❑ 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 Manager Dale This form may be scanned and available for public view at wwW.co.mason.wa.us. Nwird Iasnols 1 TH Fw ,N UrAi,Nnmr Individual Water Well Water well report(attached to application). Depth V1 Well rapacity Test (attached to application) — gpm pled. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water wall 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 lest, a well capacity test,which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. Satisfactory bacteriological lest(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto//g s co mason wa us/planning 14_15_18_221�- Water use or Imitation recorded................................... WA_)�_Yak___ WellDrilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 haver mm,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 gin the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason Court Community Services Evaluation (staff use only 1`6.Satisfactory Determination: VV This determination does not address adequacy of Oe distribution system,guarantee an adequate supply of water indefinitely in the future,or guarantee compliance wAh all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.61I.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply Chapter 36.70A RCW. r Unsatisfactory Determination: Applicant's water supply does not appear adagwle to meet the needs of as intended use for the following reason(s). ��y y Reviewer's Signatures: Environ.Health: \ V7rl✓� Date Prints °ate ar R7 E'VE- 13 2023 15 W.W. AldIderStreet INVOICE IRONMENTAL DATE. 04R9Q01G HEALTH DUE DATE 05N91207B INVOICE B 992P1 AmaEia Dah,IncTo . Sbal lWA �� Sliellui,WA B950a +�\\\�sYYY 1 Prone:(D80)4x 11s }� Email.ashWAamEieNAN-aom / 7 b Denise Gorman Denise Gorman Email Only 201 Do0 Gore Lane Email Only Ma1MLk,WA 98560,Uniteel Stales ITEM DESCRIPTION QTY PRICE PER UNIT AMOUNT T SERVICE CALL-1ST SERVICE CALL-1ST HOUR 100 $250.00 Itam $250.00 Y FIR ON SIGHT(SEE MEMO-WELL INVESTIGATION) SERVICE CALL- LABOR FOR ADDTL HOURS 2.00 $145.OD Item $290.W Y ADDTL BACTI BACTI WATER SAMPLE 1,00 $28.00 Item $2800 Y MINERAL SAMPLE MINERALWATER SAMPLE Y SUBTOTAL $653.00 TAX RATE' 8.6000% TAX $55.51 OTHER TOTAL $708.51 PAID $708.51 BALANCE $0.00 TECHNICIASUBN ONSITE REMOVED EXISTING DEEP WELL INJECTOR ( PUMP COMPONENTS)AND INSTALLED A TEMPORARY 1I2HP LISTYING DOWN TEST AND WATER'ERFOSAMPMED LE COLL LLECTION ION WPMT NG LVVELL SEALO PUMP FROM WELL AND RE-SEALED 5'DEEP WITH STATIC WATER LEVEL AT T 5'ANDODUCING ROUGHLY 5GPM. IF YOU FEEL THAT 5T ENOUGH WATER WE CAN DO A QUOTE FORL STORAGE AND BOOSTER SYSTEM PLEASE CONTACYSRMF PUMP AND PPFICE IF YOU RESSURE SYSTEM)ULD LIKE A TO FINISH Printed From Vanguard Laboratory 2635 Parkmont Lm SW,Suite A Olympia WA A98502 V ff". 0 360-967-7010 \' COLIFORM BACTERIA ANALYSIS FORM . oaw samowcpaaplae • ran � 1ct 1-d U �c 23 � � Mason 5 Type of Was Snbn lc+n aal wepd ❑(lr qA ❑Gaga Dns G pAaq Cy 3Snaan-AV 6;Waar ."Y.,nor, VFI) IN $yMn Nn }I-72oE, upew.t ' I Emr S�emuee law Aaww.mwtaaxwaevasmrl CMa'l SAIWLE NFORNATM S. cy(nwp.) 3—oe V'✓4,0 s��w�� sroalt:.eumeammw�a � en (�njeb irya ol9aNa IaawclaVy onatppaU pwapW 41Wa t Ewgls E.n) 1.❑RMm NtnEutm SWVW OM 2❑RWM Sm"(A" C. Y. w Mmamwaa�m.m ar wtmw.i (>:a'.MRaaNwl 7p F. lY�ufawcM�aMaYDnunOW I GnM Wale lbw Snm Sw pw ----- I C I I I un..mwmynaa.wwn a.w. t i_1J —J_J— gYaYWtl Yw_N. ❑T^99ae,IWP) (n.RnWal latl__F._._ ❑Assm t(MP) a %u aGM RnS oWa Sampw Rmae.a l ❑E.co< ❑.a>v U� 5 .apa carom a Wam.m a.¢. LAB USE ONLY DRINKING WATER RESULTS LAB-us ONIY ❑UmNhWn TM Cddam plwwl and ®Saeehcbry ❑faWwil ❑ii<Mabatl BWM Nnsk,n is Tpa Caabnn 11)OrH Eml____nqM Fa roum� noon Npc.-_.__ _i1�+ Rp nrd SmW Rmhc! ❑MTC ❑s midwdw ❑ SdMWVw ❑Dunlap Cm ❑ m aRK 1 21112 3 1 5:33 k1ko 1 - R.«au�er 7.5 SM922]B Daw Remrape DDa Na IN,L CWr OJN:N S+Mea 265-