Loading...
HomeMy WebLinkAboutWAT2023-00320 - WAT Application - 10/10/2023 ' WATT- _ MASON COUNTY COMMUNITY DEVELOPMENT 415 N 6-Street,Bldg B.Shelton WA 98584. Shelton:(360)427-9670 ext 400 4 Belfer:(360)2754467 ext 400 S Elms:(360)482-5269 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: NICOLAE NUTU Date: 10/10/23 Mailing Address: 60 E ANTHONY RD GRAPEVIEVPhone: 206.890.3383 Parcel Number: 221212002000 Type of Water System Reason for Application ❑ Public/Community Water System (2 or more 0 Building permit Bl,b;w3-036-7 connections) ❑ Division of land: O Individual water source(one connection), #of Parcels? SPL 0 Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) ❑ 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: Public Water System Name of Water System: Water Facility Inventory(W FI)Number. write"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. ❑ 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. Signature of Water System Manager Date 10/10/23 This form may be scanned and available for public view at www.co.mason.wa.us. J:F Forms\Drinking Wetcr Rwis 1/25MI8 t Individual Water Well El Water well report(attached to application). Depth 140 El Well capacity Test(attached to application)40 gpm pd. 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. El Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto//gis co mason wa uslolanninc 7ILO 15�160 22= Water use or limitation recorded................................... N/AJZL Yeses Well Drilled ............................................................... Data 10.5.2008 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 WDOE waterj��eeesource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.r�QQg[erm�Iiyn,ation of Adequacy for Building Permits are satisfied. Additional Growth Management requireme _ ' \ Chapter 36.70A RCW. O ❑ Unsatisfactory Determination: //�� Applicant's water supply does not appear adequate to meet the needs of its iny���use f6ref�ll�wing reason(s). ?473 Reviewer's Signatures: ry pJq Nr Nq` Environ. Health: Date i zu l /loz3 tip/ CSD Director. Date 2 vr2 FL WATER WELL REPORT tvnvh l,yl oapeaal• ..m-F.ewar.r.Wln-o..rn s"«In-a.ige. CURRENT ii ate 5 v Notice of lntent No.VVE12202 N Gonslrucoon/Deeommission("x"in circle) 3 ® Construction Unique Ecology Well ID Tag No.BBM 3 Mn o ��� �s-ioln ORIGINAL INSTALLATION Water Right Permit No._ J)40 1 Notice OjlNeM Nunlh¢r ppRcaty OWnar Name NICK NIJTU C PNOPOSnn OSe: ® DomeA. UInameiY Q Mwcip.l O ❑ O.wxm ❑ tn;r.nw ❑ Tm Wal ❑ Gam_ Well Street Address 110 ELDMAR HOLLOW C TYPnoFwoRK ownm'.aumMof»m 0fmamam ape)_ Cily SHELTON County MASON C O N--M ❑ RcmNti MMW:O Oun ❑ Bve1 ❑ n:iren T+ ❑ D.MW ❑ C.Ne ® Racy ❑ 1mN Location hol/4-1/4 _"1/4 Sccjj Twngt Rj CW DMFNSION5: UmbavalQ ia.aganlWIN& .0` vvn 4 CONSIRULTIONDETA11S I+t/Loag wiMO C (s,t,r Still LAt Deg _ Min_Sec Gwaa ® wema ¢' a.m.uae us 9.. temu.a: ❑ uvimlaa_' u�R®_e.m _L RFRUDIED) Long Deg_ Min_ Sec _ N ❑ TNmmtl _^ nl.e.Fmm_Lb L C'ON3IRUC➢0N0R DRCONMISION PRIX;Lalla6 Pmfi.W.m Y. ® No Pa.mmiaa:pmnLa byaob,.ae.[Im,elm ofmimid evd em:.a...edrae liva®a V T>D.afWrom^emed_ mtmeefae mmmin ie a.e.awm:Me.tr.b4 vid�Wosmtry ter M<h.hmae afa:fmmiov. NSR ADDITIONAL aFMEIS nNECL45ARY) a1T8 ofPmnJJ>aY�b:ab ro.Mpe6_Bae_ftbJl. MATERIAL FROM I TO C &,am: ® Ym Elm 0 x- a lae.daa_ CLAY BROWN 0 20 M amna '.N.m. MONSON GRAVEL a CLAY BROWN I55 t T* _Mmtl No._ SAND a CLAY BROWN 55 105 t0 a.m¢Sla.jz am134R.mjdQL GRAVEL CLAY BROWN 105 115 Due ala um aoe rtm n. GRAVEL H2O BLUE 115 140 N GnMlPferpeba: 0 Y. 10 No aimofa v ae_ ase IAaiiW Fl:ad fiom_n.m_R. T sema ser. ® rm ❑ No T.v adwh7.jQft MemW«.d u wI SENTONITE ` na.oymn.am+n:mm.ek wvv ❑ Ym ® No Tyaeorw.IGl_ Depaofu _ R 3 MNhoaofdioa W.meH_ F PUMP. Mmo6emi'.N. O Typ NP Z WATLRLEWS: IJndeef.0 ekraiwamw m.m e.4il_L fA Smti.Inxl,jT�ft hW mpofwell Am 10b10 Room 40 Admnpw:vc_Ib.pc.mei acR O.te_ 'C1 AM®wlvsamolblFy_ op.�T.am.) T WSLL TFSIS G.�.amnumwml via k�sl4bvgtlbbw YklM Wmzp Mva&? 0 Ye IR m U)a..Mw ? � YwM_Sllmic wa! R.A.vaowe efli�M. V YMd:_/1/min via_ftA.wdowe ali_N. LU YWt�IA®.vim_nd..Wwo.ltr_.:s !,— i C nmvmrydwamede:mxem WimryumP m.vWal9 MmerAWl.eomMhm.well 1. royrorxe.l..{1 y Tie. W.,rl Tlme W>v1eW T. WMlawl Cy _ sp fsr.afweurec 4�w/mio..dmQn.ei,mnn.m4mv of EcolFZ��- N®aai_n.r_I.. Am.i.e aov�.p.m.llme_ StM DBf4 laced Date 1 1 4) T.mpm.meawm_wm..A®ia®h i.®m1 El Ym ® No ITax Parcel No.221212002000 t F weu.coNRTTwenoN cgRnFlc,Lnon: I mnsouaed mw«ec«p rmpaaamaay 1«c«mtruatian orOds wen,mw in compliao.c wiM e11 washingfm,.Wu mnsWabn aenderds. Malerivls usW ana Ne information repotted move aR true to my baa bpvdedge and hlicf. ®D.iBa[]EngW,[)hums Ddlla«avinec Ui No.1773 Drilling Com9avy CODLWATEIDfUl LNGJNC Nenm(vmtae.m)MIS,LYLE Add.109E HOLLY R➢NW Dnll«/Pa "n.a/➢uvveS vane C'ry,Slvie Zip BREMERTON WA. 99312 m TRANEE:WH sLiceme No: Conua««'s Dn0as3' Regis iw No.COOLWD1941OM Daej410-10 ECY OS0.1-m(Rev 3N5) Falogyua EfWOfgo« VEmpmym "L/roNM BACTERIA ANALYSIS D.es.rp,rybya m. " sM„y, UIi31 �031° Ow M� I� DEC 1 120Z3 ipe bl Webr SYelem(aRy wM alm lv) G. ❑GmlgB ❑� GmW AeMGRupBSryama-pmige loam µ'atriFw;,{ssap �--- Y � M'p>rYflMFll cones Mqm . EmW % cMlaw�.l i lelS E�� •wen e I -. LlfGl41L�9._ ._ _ ld i 4I SAMFLEINFORMAiION vdyege ly,n al re ac.mnn�mareu.rem eampp mlw<e srwala.w.4�a o,mm,,..u'. 1'y11'Wn"1 " *vtl"aSempb(�the on"nem,olxlmmgnwlisee cebwl JZ R'e14�p''n MWkfl.n Semplo :.Reryat Sampl.Pllarunsal mu�inel .."„Impeu:rg_xu_ ❑Glamwcon ersbm l rnfleatlugaobl_Frte_ Qbnnaw Yes_Fo___. W+4r Sourtabample Cnbnne Resi l Tmal Fme E ca4-4WR(Np) ^ Lecal-smucx'i.�u^n�muvvmi pnsaasla]pymulrc lab nurtMr Fluiatve� o_ ❑Assessmam Monibny 1w) unea4latbry nuenamlbcl nak'. ❑olnu S i.p s.mpb wn ace roemlormamnomY nreaepau fmspvypn/PepW CWx IASUSE.ONLY. .DRINKING WATER RESULTS USE ONLY unaanaannry Tub,cnMomi pressnlane sa4abacry "Rquimd pm" ❑F. ab9em x COl loim eelRloet Sample Repuimde bo oM pb pours) ❑INTC �_-¢'R/Pmllc Tdalfgibim__�/1Wm1. EmY� /1IXhnl.vm Ilou l Enblawcal.- 11W ml.: SM9V [ISMSU21 vni apeN❑SMZm 8 ❑Enkmkxa 2AMMaeT om ReWnW.lruMr W/'enalbl let use OrvY.0 �¢ -�— pwrpmw��ve•�3mn