HomeMy WebLinkAboutWAT2024-00193 - WAT Application - 4/9/2024 WAT 00j-7.3
MASON COUNTY S h WA9M
0 COMMUNITY SERVICES Shelton:360427-9670.Ea 400
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Application for Determination of Water Adequacy
Inettucdon s
1. Cmpiste Pon 1. No determinati n carr be morels urd Pan t is yggcomolded.
2. Cmplits only the potion or Part 2 applying to the type dwater connection utilized.
3. Slbna mrpisted application.with any re9ldrad alrsc meda for review.
4. M sib pion moat accompuriv 9%
Part 1: Appikarrif Parcel Identification
Name on Applksrd: ErIc D.Showtund Data, April 9 2024
Me ft Address: 511 E.Eanean tar Or E c#Redanra6a, Phase 360 932 9075
Parcel Number 32124-50-00044
Type of Water System Reason for AppScatlonnn,r,,�
x UrNter System(2 or mac JC Building pert BLD9�-OC 2-
❑ Division of lard:
❑ Individual water source(one corsedio.), a of Parcels? SPL
❑ Wal ❑ Boundary era a iustmdd
❑ Springhrafecs water ❑ other(a pisva)
❑ Other(wpkun) ❑ RapMarram or Remodel(passe indicate name
Myou have matey statics resid6nce corredad d water system below If Wplicable-no
to e61s wet c aelrlMAreNoCom imily Wrier signature required)
System boor.
Part 2: Water Connection Information
Complete the section appropriate for the type of water comas" bang evaluated:
Public Water System
Name of Water System:-Emend Wee
Water Facft Inventory(WFl)Number._23294 W ragee'none'for two-party)
■ 1 err the manager of this wear systerm The water system has been Wpm bat 1s services. There
ars pnews Ily�_ ab nemon(s)in uss.This will be�mn nion.
❑ 1 am the manager of this sysism.This mnnecth wli bs to upgratle or dares the use of an existing
sanction on this syslam(ire.:aeaeetlaW to full time). Pisese hMicate m the following line the nature of
this longs:
This water system a able and wasp to provWs water to this(these)caaedbrgs)without exceeding the
limits of the weer system or any cote sec by slats and local repltafbn.
Prism Name of Water System Yardage ALvJr.a w J /1e610 Phone 2 jE!j 7 d GYk
Signobim d vwlr System Yrrgar 4"-A .ket4�-- Date
This form nary be scanned nd&=Babb for pmBc vier at
J: 1 r mrebR Wrz aerlrNL!)/A21
Group B Water Systems
❑ Satisfactory bacteriological test within last year(attach to application).
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 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 test within last year(attach to application).
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 Der 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)
U 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 WOOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.66.040-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
reason(s).
yReviewer's Signatures:
Environ. Health: 7 Date
This form may be scanned and available for public view at www.masoncountywa.gov
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