HomeMy WebLinkAboutWAT2024-00057 - WAT Application - 1/16/2024 MASON COUNTY WAT
COMMUNITY DEVELOPMENT
rermltA isUmer Weuddim P4mmr
415 N 6m Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 O Belfair.(360)27541467 ext 400 O Elms: (360)4825269 ext 400
FAX(360)427-7787
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: JOSEPH BUILDERS NW Date: i I S
Mailing Address: Phone: 364449173911
Parcel Number: 32235-75-00080
Type of Water System Reason for Application
ElPublic/Community Water System (2 or more El Building permit fl b909.'T aX61
connections) ❑ Division of land:
El Individual water source(one connection), #of Parcels? SPL
O Well ❑ Boundary line adjustment
❑ Spring/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 PublialCommunity 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:
Water Facility Inventory(WFI)Number:
(write"none"for two-party)
❑ I am the manager of this water system.The water system has been approved for_services.
There are presently connection(s)in use.This will be the 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 to this(these)connections)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager _ Date
This form may be scanned and available for public view at www.co.mason.wa.us.
J:\EH F.\nnind,Weta Rc is 1/2 M18
Individual Water Well
Water well report(attached to application). Depth 4
Well capacity Test(attached to application) 9pm 7 y� 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.
ey Satisfactory bacteriological lest(attach to application).
/ Water Resource Inventory Area (WRIA)
Development within which WRIA http�//qis.co.mason.wa.us/planning 14,,15_16_22_
Water use or limitation recorded................................... NIA
_� /Yes��7
Well Drilled ............................................................... Date �l 7i 3
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 WOOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-13etermination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RC W.
❑ Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures: 7 f
Environ. Health: -
Date `Y/41�
This form may be scanned and available for public view at www.co.mason.wa.us.
Pagc 2 or2
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2206496 MASON CO WA
• 01/16/2024 10:38 AM NOTGE
]OSEPH BUILDERS NW #194159 Res Pee S306.50 Pages. 2
IIIIII!IIIII III IIII IIIIIII IIIIII IIII IIII IIIII IIIII IIIIIII III 111 I1111 All IN
Ratum To
w' fs N t<J
/V 11 i vt lGZ
THIS IS NOT AN
ORIGINAL DOCUMENT
Grantor(s):(1) 5igA leh F• k14Gn .(2) J)OVIA
Grantee(s):(1)PUBLI
Legal Description(1) Tf2 11 Ing S�r t/ 1 1 P�S 7-10-24S
(AbbraviatedAmn:l.e.lot block,plat orsection•township,Tango)
Assessors Tax Parcel: (1) 3 '2, Z "S --1g- O O D eb O
a3sTaa- izJ
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AtIEA(WRIA)
I (We),the undersigned grantor(s),hereby place this notice on record that the described real
estate situated in Mason County.State of Washington is subject to vrater use restrictions and
conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These
restrictions and conditions are based.on Ioca6w of property andfor Water Resource
Inventory Area or WRIA
wRla:_ 4
Maximum Annrurall Average Gallons Per Day: gallons
Dated onthis f j_day of bmtk4bL
Signature of Grantor(s): off
State
t
Sete—of 7WtarrYYyMn'
County a me 7D 1'1nSLriI )
Page 1 of 2
I,the undersigned,a tJotary Public In and for th�a above named County and State, do hereby
cf. on tbis�Lday of 201.3,
hL Do ersonally appeared before me,who is imown to be
signer of the abov nsbunlant,and acl ovA dL d that he(she)(they)signed it.
GIVEN under my hand and official seal the da d year last aboveewwriiittart.
/�
Notary Pubficin and for the Stal9ofiMOIRgipm, LL�✓151-5
rtornnyvueuc.smamxansee residing at .Y03 S lj$ ` rtnn r mt�Oriref 5rDMERO XS
My�E'n" D>il "d, My commissionexpires: {'
Page 2of2