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Home My WebLink AboutWAT2024-00042 - WAT Application - 7/6/2023 WAT a0' 4- 0000- 415 N.6*Snect MASON COUNTY Shchav,WA 98584 COMMUNITY SERVICES Shelton:360 427-9670,Ext.400 Belfair:360-2754467,Fxt.4W sassw..:rorm:a,.,.n.i 9.wl.c<,,.,..ro'awn Elmo:36"2.5269,Ext.400 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: Sam Martin.Agent for Lennar Nanhv t.Inc Date: 7I612023 Mailing AddreSS: 33455ath A,mS Unit/-B Fedeml Wav WA.99W3 Phone: (2531294-1322 Parcel Number: .amsa •Fm Foaae HS a50 Type of Water System Reason for Application ® Public/Community,Water System (2 or more ® Building permit Sxada4-00076 connections) ❑ Division of land: ❑ Individual water source(one connection), #of Paroas? SPL ❑ Well ❑ Boundary line adjustment ❑ Spdng/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 PubficJCommunity 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 WCJCLVr✓ttTM � Water Facility Inventory(WFI) Number: O63b1D (write"none'for two-party) 1 am the manager of this water system.The water system has been approved for AZ_0 services. There are presently 770 comnection(s)in use.This will be the I / 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 tKts(these)connection(s)without exceeding the limits of the water system or ny set by state n ocai egulatlon. Signature of Water System Manager Date I Z This form may be scanned and available for public view at www.co mason.wa.us- J:EH Forms,Drinking Weta xc,'ised W4R918 Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) 910rn 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. ❑ Satisfactory bacteriological lest(attach to application). Water Resourcelnvento Area RIA) Development within which WRIA htto 7/gis co mason wa us/olanning 14_16_16_22_ Water use or limitation recorded................................... N/A_Yes_ Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ W DOE permit(attach to application) ❑ Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day:andfor 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 indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may aptly Chapter 36.70A RCW. l Unsatisfactory Determination: Applicants water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: Environ. Health: Date This form maybe scanned and available for public view at www 00 mason.wa.us. Pegc 2 of2 400499 415 N.6TH STREET,BLDG B.WnTON NN WSN MASON COUNTY SHELTON:3Ee427 Mrs.FM.40 COMMUNITY SERVICES eP1Pae:a6s.as.a.eT,Ezr.°°° coon aw.4ex52sa,P)ti.4o6 lobn4Nann,rg Enwvnm{elHeeM fnmmWlr HraliM1 rAl]fiPi2]-/!96 Application for Determination of Sewer Adequacy Instructions: 1.Complete Part 1 of application. Permit number may be added at later date. 2.Take application,Site plan,and any other associated informafion with the proposed development to the Sewer System Manager or Designated Employee for approval. 3.Submit completed application and(Mono etion to Permit Center or Mason County Public Health for review. NOTE:you must supply the System Manager with a site plan for the projec4 showing all existing or proposed sewer components and lines in relation W proposed development and property. Part 1:Applicant Parcel Information Applicant Sam Martin,Agent for I ennar Northwest,Inc Dale; 7/6/2023 Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way WA,98003 Site Address: 310 NE Olympic Ridge phone; (2s3)2%.1322 Parcel Number 12328-51-00058 Permit Number. R)L a.Oaaq'0007A Part 2: Sewer System Information Name of Serer System: BNai. 9 Site Plan atcr hed4 Official use only: Sewer System Manager or Designated!Employee is to complete. Ms. 0 lia- M1mrevF.maO lta elVEra^k inMnal'unaM NwrroivwaalU Meats LeuMy PudkHeats apprmnrq tie areegar[I'vi8 ' eemry P ❑ PxkWe Cmna laaxmvimM low elmrmrYa NnMnalbnaM lave mlevur�WN Nmm Cwmry PiticHWRl eppronrq tro mrroepmtlirq M Mown LouMy Perm6. ❑ IMclerkwM Me al�Wiunla inromal'uneM M1ave tlelmm+eE aewermnmclknvo,rtently NOT evalsNB 4.Inroy qua eM pe kymq Co,Mllmts)on Mew,r�adap Meam CauTy Pm„&frytlaxlf Must meet all Mason County design and construction standards must pay all fees including:connection fee with permit and inspection nd Latecomers charge(TED), Richard Dickinson 7/13/23 p,Ea.e N.ne ersyn..,M.maneaaror.. syvaea,asrym Mvymlapblaa om Part Mason County Public Health Review/Approval IZg�Z� {:7�6aYsfactory ❑ Unsatisfatlory 1 SIpuW2 WFnvidw2NN HmIN ar Jalhl Dek TMs form may be scanned and avallable for public view on We Mason County Web Site. ,ma�aaraen