HomeMy WebLinkAboutWAT2024-00037 - WAT Application - 7/6/2023 WAT_alIVt�- ()(y)
MASON COUNTY Sh an,WA 986
COMMUNITY SERVICES Shchon:360427-9670,Ext.400
eclfair:36 275�167,Ext.400
Elms:360482,5269,Ext.400
Application for Determination of Water Adequacy
Instructions
L
CompletePart1. No determination can be made until Part 1 is fully completed.
Complete only the portion of Part 2 applying to the type of water connection utilized.
Submit completed application,with any required attachments for review.
An approved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Sam Maran,Agent for Lennar NorOiwest,Inc Date: 7/W O23
Mailing Address: 33455 eth Ave S.llnh 1-9.Fe ml Wav WA ww3 Phone: (2531294-1322
Parcel Number: 12328-51.ON70 'Far Fuure HsfAO
Type of Water System Reason for
rrArppprliccaation
® ,
® Public/Community Water System(2 or more Building permit mogAf-00rr-/,
connections) ❑ Division of land:
❑ Individual water source(one connection), It of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water
❑ Other(explain) ❑ Other(explain)
❑ Replacement or Remodel(please indicate name
ff you have more then one residence connected of water system below if applicable-no
to this welf, check the PubliclCommunffy Water signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
pp Public
l 0Water Systtem
Name of Water System: Belfa t1r Lt-a( Cl /sAn&
Water Facility Inventory(WFI)Number: IIS3SV
(write"none"for two-party)
I am the manager of lh' water system.The water system has been approved for 1401 services.
There are presently 1 f4y,._connection(s)in use.This will be the '741/ connection.
❑ 1 am the manager of this system.This connection will be to upgrade m change the use of an existing
connection on this system(Le.: 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 a set by state b"I regulation.
Signature of Water System Manager _ Date 7 lb
This form may be scanned and available for public view at cow v.co.mason.wa"us.
].,EH Formal Dunking Water Re, MG2018
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) apm 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 a the water well report does not have a capacity test,
a well capacity test,which provides stabilization of draw-dawn 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:/Igis.co.mason.wa.us/pldnning 14_15_16_22_
Water use or limitation recorded................................... WA Yes
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)
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 W DOE water resource regulations.
Recommended approval indlcetes requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
`. Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of as intended use for the following
reason(s).
Environ. Health: o rp 1
Reviewer's Signatures:
Date
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This form may be scanned and available for public view at wyp�.co.mason.wa.us.
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