HomeMy WebLinkAboutWAT2024-00202 - WAT Application - 8/24/2023 WAT - ODaO�
415 N.6a Street
MASON COUNTY Shelmp,WA 98584
COMMUNITY SERVICES Shclwn:360427-9670,Ext.Min
aelfair.360-2754467,Eat.400
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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 appmved buildinil site plan must acatunpany this application,
Part 1: Applicant/Parcel Identification
Name on Applicant Sam Mamn,Agent far Lennar Northwest low Date: Ml 023
Mailing Address: 3345561h Ave S.Unit t-B Federal Way,WA seeps Phone: (25312WI322
Parcel Number: 1232651,xxiSS - a F t,. HSaaa
Type of Water System Reason for Application C�y�
® Public/Community Water System (2 or more ® Building permit
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other ex
❑ Other(explain) (explain)
❑ Replacement or Remodel(please indicate name
ff you have more than one residence connected of water system below 0 applicable—no
to this welt, check the PubliclCommunify 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: Atffipl�
Water Facility Inventory(WFI)Number. 05'3529
(write"none"for two-party)
XJ I am the manager of this water system.The water system has been approved forlys; services.
There are presently 1302 connection(s)in use.This will be the R o3 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 willin rovide water to this(these)connection(s)without exceeding
the limits of the water system or y liml set by state an local regulation.
Signature of Water System Manager Date
This form may be scanned and available for public view at vrvvw.co.mason.wa,us.
1:1Ell Fans\Dunking Wain Re ,B 4142018
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpm gpd.
The well duller 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(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA htto9/gis.m.mason.wa.us/planning 14_15_16_22_
Water use or limitation recorded................................... INA 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 delenrination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE 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 RCN.
I Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use far the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
This form may be scanned and available for public view at www.co.mason.wa.us.
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