HomeMy WebLinkAboutWAT2024-00168 - WAT Application - 5/28/2024 WAT _- QQLSQl^�
415 N.6°Sum
MASON COUNTY Skelton,WA 98584
COMMUNITY SERVICES Sheltw:360427.9670,Ext.40D
Whir.360-275407.Ext.400
x hh Elm:360.482.5269,Ext.4W
Application for Determination of Water Adequacy
Instructions
i. Complete Pan 1. No determination can be made until Pan 1 Is fully completed.
2. Complete only the portion of Pan 2 applying to the type of water connection utilized.
3. Submit completed application,with any required attachments for review.
4. Ana roved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Mel' fTehn r,Date: p p'
Mailing Address, r 1 (Wons: 360— 07V' 7 0
Parcel Number: 3.1 lea oyao 0
Type of Water System Reason for Application r
❑ Public/Community,Water System (2 or more Building permit �LIVO( -2 �OL
connections) ❑ Division of land:
t i- Individual water source(one connection), #of Parcels?_ SPI.
4 W911 ❑ Boundary line adjustment
❑ Spring/surface water ❑ Omer(explain)
❑ Other(explain)
❑ Replacement or Remodel(please Indicate name
If you have more then 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: r
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 Connectlon(s)In use.This will be the connection.
❑ 1 am the manager or this system.This connection will be tp upgrade or change Ins use or an existing
connection on this system (i.e.: rticreabonal to full time).Please Indicate on the following line the nature
of this change:
This water system is able and wiling to provide water to this (these)connection(®)without exceeding
the limits of the water system or any limits set by stale and local regulation,
Signature of Water System Manager Date
This form may be scanned and available for public view at Ypi0d.CQ.Ma on.wa.W.
19Flt Fomat Drinking Wmm R.+ivcJ HH2pls
Individual Water Well
;,Wv,::,
rwell report(attached b application). Depth S _ff.
capacity Test(attached to application)�_9Pm�_qpd.
Te 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 wall report does not have a capacity test,
a wait 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 Invent Area RIA
Development within which WRIA httpJ/qis.co,masor.wa.us/RI anni 1 _X5_18_22_
Water use or limitation recorded................................... WAX,Yes_
WellDrilled ............................................................... Date tM
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 1 have reason to believe thatthis 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 on/
Satisfactory Determination:
tThis determination does not address adequacy or the distribution system,guarantee an adequate supply of
waterindefnnely 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•Deteminmlon of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply, Chapter
36.70A RCW.
unsatisfactory oaterrnlu stion:
Applkani's water supply does not appear adequate to meet the needs of its intended use for the following
resspl
ff 11��PP � 0 ��U P,Reviewer's Signatures: cc.�� h,
Environ. Health: Date Lf
Tits form may be auntiad and available for public view at
Pete 2 of 2
Arcadia Drilling Inc.
P.O.Sox 1790
Shelton,WA.98584
Customer: Melvin Hohn Well Tag R: None
Site Address: 691 SE Binns Swiger Loop Rd,Shelton Depth: 37'
Date of Test: 6/10/2024 Static: 23.3'
TIME GPM LEVEL RECOVERY
1 Min 6.8 28.9 TIME LEVEL
2 Min 6.8 29.7 1 Min 25.8
3 Min 6.8 29.7 2 Min 24.3
4 Min 8.8 29.7 3 Min 23.8
5 Min 11 29.7
6 Min 11 29.8
7 Min 11 29.7
8 Min 11 29.7
9 Min 11 29.6
10 Min 7.7 29.6
15 Min 7.9 29
20 Min 7.9 29.5
25 Min 8 29.5
30 Min 8 29.5
35 Min 8 29.55
40 Min 8 29.5
45 Min 8 29.6
50 Min 8 29.6
Total Gallons Pumped =400.2
sy �AV 28 06�
1p�4D
Vanguard Laboratory
2635 Parkrnont Lane SW
Olympia,WA 98502
360.967.7010
VANGUAR]D Report of Laboratory Analysis
LABORATORY
Collected by:
HaWkios Well hupectiom Marla Drinking Water
360M1.5353 Labantory ID: V240125-5
Sampling Addrna: Date Sampled: M52413:20
691 Bins Swiger Loop Rd Date Received: 1/25/24 14:00
Shclmn.WA 98548 Dan Reported: 1/M024
Sample ID: 691 Blom Swlger Loop Rd
Analysis Result SDRL MCL Units DF Date Analyzed
Total Conform&E.call by SM 92238 QDEXX) Batch ID:V240125-5 Analyse Vl
Colifotm,Total Negative 1 1 MPN/100mL I 1/25/2416:00
E.co1i Negative I 1 MPN/100mL 1 1R5/2416:00
No.
MPN:Mort P:ubable Number
Opn:pne pof millpn
aid:mndnxt Renewed by Robert Smallin&Chemist on(1/26/2024
Na:nm applicable
SDRL:Su¢Defective Reporting Limit Apptged by Turi Johnson,Openthims Manager on 01/26/2024
DF:Dilution Factor
nols mn
MCL:Maxim in Cameremar 1n'd :ioaat . Page I of I 10
Samples were reulvedin incepuble condition.The«sulps)inthisnpenrelateonlymamp omollheasmplets)teened.All arwlysowetepmonamaicaahtmt
with tMQuality Assaanttprogtm of Vanganl labommry.Pleaee contact the leboremryifyou shmW have any 4uasonot abort the main.
2635 Parliament Ln SW,Suite A,Olympia WA 98502 I Office:360.967.70101 testinggvanguardlaboretory.com I
www.vanguardlabomtory.com