HomeMy WebLinkAboutWAT2024-00046 - WAT Application - 7/6/2023 WAT O�24 -- OM
415 N.6-Sacra
MASON COUNTY Shelton,WA 98584
COMMUNITY SERVICES Sheiton:360-2754 70,Ext.400
aeifitichon:360427-9670,Est.400
Elm.:360482-5269,Exi.400
Application for Determination of Water Adequacy
Instructions
11. 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.. Ana roved buildingsite Ian must accompany this a Ilcation.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Sam Macon,Agent«Lennar Northwest Inc Date: 7/6*023
Mailing Address: 334555th Avea Una 1-B F.ftmi Way.WA,980D3 Phone: (253)2941322
Parcel Number: 1 5 -00072 'Far Fi+ire HS 472
Type of Water System Reason for Application
® PubliclCommunity Water System (2 or more ® Building permit bxgo;2{-Q00V
connections) ❑ Division of land:
❑ Individual water source(one connection), If of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain) ❑ Replacement or Remodel(please indicate name
fl 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: 6e.��c. L.�NL'fX WtC� c. JIL
Water Facility Inventory(WFI)Number. 05'3 ib
(write"none"for two-party)
10 1 am the manager of this water system.The water system has been approved for IUOS services.
There are presently -77X connedlion(s)in use.This will be the 7-L.&—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 vide water to this(these)connection(s)without exceeding
the limits of the water system r any limbs t by slat regulation.
Signature of Water System Manager Data e_7/�_
This form may be scanned and available for public view at www.co.msson.wa.us.
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Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpm 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 rf 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 test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA http'l/,qis.m.moson.wa.usiplanning 14_15_ 16_22_
Water use or limitation recorded................................... N/A 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 rat address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in Me 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 apply. Chapter
36.70A RCW.
❑ Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
mwon(s).
Reviewer's Signatures:
Environ. Health: -Date (�2
This form may be scanned and available for public view at www co mason wa us.
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