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HomeMy WebLinkAboutWAT2024-00159 - WAT Application - 3/21/2024 WAT XIA_M6? MA�ON COUNTY NN1EN COMMUNITY DEVELOPMENT ENV1R�r �1T PermltPSSlsUnceCents,BUQEing,PlannlnQ H�L11� 415 N 6'^Street,Bldg 8,Shelton WA 98594, EE IIV E D Shelton:(360)427-9670 ext 400 O BelfFi 3 0)275-446787M 400 J El ma:(38 yex`400 MAR 21 2024 Application for Determination of Water Adequacy Alder Street Instructions �, Complete Parl 1. No determination can be made until Pan 1 is tulle completed. 2. Complete only the portion of Pan 2 applying to the type of water connection utilized. 3. Submit completed application, with any required attachments for review. 4. An approved building site Ian must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: Ryan Finn Date: 03121-2024 Mailing Address: 103 W. Story Rd Shelton 98584 Phone: 415-310-2648 Parcel Number: 32031-14-90010 Type of Water System Reason for ,Appplic-attii)onOb385 p Building permit ( ��(.�-/ p conne/CommunityWster System (2 or more ❑ Division of land: connections) ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Springisurface water ❑ Other(explain) ❑ other(explain) ❑ Replacement or Remodel(please indicate name of water system below if applicable—no If you have more than one residence connected u nature r to this well, check the Public/Community Water signature required) g� /� System box. �i vja Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: 105 107 W. Story Rd Water System Water Facility Inventory(WFI) Number: None (write"none"for two-party) El I am the manager of this water system.The water system has been approved for 2 services. There are presently 0 connection(s)in use.This will be the 1 St 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)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Date 03-21-2024 Signature of Water System Manager This form may be scanned and available for public view at www co mNsao�nwaota 1,EHFo \DriNtiog Water Individual Water Well El Water well report(attached to application). Depth 119.5 El Well capacity Test(attached to application) 35 Prn , LtV O o 9Pd. 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. El Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA hftP:I/ais co mason we.us/olanjDate 4�7h�18�p?� Water use or limitation recorded................................... �_Yes_ FWell D lied ...................... 02-22-2024 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) 70A actory Determination: ermination does not address adequacy of the distribution system,guarantee an adequate supply of definitely in the future,or guarantee compliance with all applicable WDOE water resource regulatlons. ended approval indicates requirements of Sanitary Code, Title 8,Chapter 6.88.040-Determination of cy for But Permits are satisfied. Additional Growth Management requirements may apply. Chapter RCW.sfactory Determination: t's water supply does not appear adequate to meet the needs of its intended use for the following ). Reviewer's Signatures: Environ. Health: Date CSD Director. Date_ 2of2 2)L0q,c) A - vb3g5- ENVIRONMENTAL HEALTH WATER WELL REPORT U51111111191PARTMENTOF Noticcoflidart. WE495% RECEIVED ECOLOGY , Holm Ecology wall m Tag Nn BPD 'Type of WorN: abbW WnM:ftM p`1aT�Fp-.Ty-.rr1.F © Commr<ncn Sim Wcll Name(ifmom thm one all; 1'I/111 L 1 LUL� ❑ DmOnm:ievw b pr:0^al mudYdw NOI Nn Water Right PernauXerti6cem No Pm..d uee: a DOmmua Ow ee e] ❑habldpal P-P"0—Name RODERIC DOHLE et ❑Dewatwby ❑brope. ❑Tue Waa ❑Ca a Cemo-urdco rypw Messed: Well Strom Address 106 W STORY ROAD ®t "11 ❑Alootboa ❑p ❑Ioaed OGbNTad City SHELTON Coomy MASON ❑Dmpenag 0O11m ❑Dog OAh- O1dW&mry T.Pieed No. 320311490010 DImW: uimrm orbming a fa,m 120 L DapeaofcompkW w011rd ! wmaveriuNe approved to,ft.w JIY ❑Yet ONe CeuAwdb perea: Wass Ify vaetweathevarianecfolr Curry Lam Hamm Free To Tbmtas bud PVCW'adid Tmssd IE 1 ❑ a in e—W 11L' IN m IN I 0 93 0 Leattion(xemaboeb.00112). ❑wY/Mm❑EWM ❑ 1 ❑ _in _w 0 1 0 O 0 SE /.-Yibfthe NE u;S— ❑ 1 ❑ _m O 10 ❑ I ❑ 31 T 20N a _RaogW ❑ 1 ❑ _m _art ❑ to ❑ 0 Otilula(Exampla:47.12345) 4718112 Pmamlbw: OYm ANe TaxapmPo:omrmao Lon@rude(Et000lle:-IMA23d5) 12310188_ Nn arpmamima_ S�of DM r'a Lo Conatroefloo or Demmmisdoo Rmedvb perrontiona_iny_in Fmoadon Omrdbaby cobr cFmeam,ore ofmrmidavtl rammaaM die lend and Pu®m: my. Om _lmlow 6muW rm@w mwOfrhe:namridavA bier psmaueA wiaw Wnaae envy baad:Ohaaar e( 8ermor: RYm ❑Na 0K-makerC papa IIT L iahrmeion Tb,, Uw addmmatbm ifvwruy Na:m AMlad WNbm Warts Mdeiel PeatPeatToypo SSS T Taie Model No pi.m-mrs in. Slw.o l't in saw 10 !to 1t9' d. CLAY BRN 0 B wmeur— in sweet— in 6Om !m_a CLAY WIGRAVEL PIECES RN 6 14 ii-ornwpaee:DYm ®NO aisorpG:nmwi.l_in. CLAY W/GRAVEL BRN 14 - 23 M aroliplacmfiom_h.m_@ GRAVEL SAND &CLAY BRN 23 29 awamasml; my. No TO Mte daps[ 1g It, CLAY W/GRAVEL GREY 29 M Mum.l meemwd ya den eenbnb CLAY STIC GREY 44 47 Did wymm rmmumnmable.M ❑Yu ONO SILTY CLAY GR 47 51 Typo afwmrt OepaefeOm SILTY CLAY W/OCC GRAVEL G 61 72 MmhodefrNmyaaYaR SILTY CLAY BRN - BD Pnm: Mm:fimvmt Nmm Tb,`' SILTY CLAY WET GR a9 104 CLAYW/GRAVEL WAS BRN 104 100 NP_ Fump mvaaaeplb_@ prissmlparema:_ssm GRAVEL&SAND W/O BRN 105 WamrLnA: Lwdam6ce elcrtion aymwmam YN_a sod:-werbp arwen wane t_-e' rt.be..mamdeam Smicwam&i. ,,ojee ofwdleaete Dam P112(A24 Anm:an pwavuw_Ra per aquutimA pW I Amaim wawumnnolled by (<y,ydya,ap) Wall Tmb: Wuapmpn:ywpm(omwdl ONO OYm b ywb®t Ywe_®m wirx_a.dra. adm_6,. Yam_apm via_d.aawdpwaaam_M if W_ppm wia_fl,aewdmia dy_In Rwwry dm(nma�ma wFen P�mm a vmad nS-wwr IeW mmrueE room well ey bvmlenl) Time wmmlewl Tme WaW WN Tins warty l<e4 Mbofp:uwmyrtn Rdwm:_aemwia_adaflw_aa Air.a aS awa wabaw:rmm IN too k oar?a,. am 21P2/2024 Arlin apw_Bom reapmmeefwam_•F wwacb®aaleaayd.vJat 0Yet ONo Start Dem0222/2024 CmoPteted Dam 02922024 10KELL.CONS7RUCTION CERTIP)CATION: I cmntrucmd avNm ettept reapmdibildy(or LMdmgion o[ais yell,W as mmplaenm Wia Nl Walaiopm wdl wmtruclian smadnds.Materiels used and the infoemehea,reported above are true to my beat ber0brp and belief. ❑Ddllar❑Tram.0 PE-Pried Name DA EL CARPENTER Drilling Calumny American Pump&DrWing 3'pwum \ -a Addrate PO Box 14996 IJmme NOMII _ _ -__ City.Bette,Zip Tpmwelx WA88611 IF TRARM:Spoemr's Ueeme No. CaMcbr a Spensm'a Sinmbve _ Registration No.AMERIP0781JK DYs ECY 050-1-20(Rev 08/19)Ijype bed au docemenr in an ahernarejormor,p/ema edit the Wow Reeomeer Program m 360,07,8R Perroromlrhhvngims=ml)711for Wmh[Vmr)Ulq&e m. Permro Wia adpeaeh ra'mbilitytmr m11877d33-6311. RECEIVED fla��a '�3gS ENVIRONMENTAL MAR 21 2024 HEALTH 6 16 W. Alder Street Vanguard Laboratory 2635 Parkmant Lane SW Olympia,WA 98502 360.967.7010 �J-k1ILff 1D Report of Iaboratory Analysis LABORATORY Collected by: Amencen Pump and Drilling �y qt 360-754-7867 Cay Imo" ys..s T' � Lvb,rator,W Dr4172 8e� ICJ eWact Sw,Rd CVs ' f\..n(�V` ���� Date ReDate ceived: 2/2J24 I3:ted 04 Shelton,WA 9H584 1 �1V Date Reported: 3/12024 Semple lD: Vinn Analysis Result SDRL MCL Units DF Data,Analyzed Total Cobform A,E.tall by SM 9223B(IDFMQ Batch M V240227-8 A.WW;V3 Coliform,Total Negative 1 1 MpWlD0 mL I 2272417:00 E.coli Negative 1 1 1,014/100 nil, 1 2272417.00 Nitrate by EPA Method 353.2 Bach M:V2402272 Analyst AP Nitrate(as N) NO 0.50 I0,00 m8/L 1 222A 10.W Notes: MPN:elan tebte Nurnhn apm:pars pat mulon M n°mdo e a Reviewed by Robert Smalling,Chemist on 03/012024 M.net appliaaWe SDRL:Shoe Detection Reporting Lunn Approval by Torl Johnson,Oceratk m Mamgor on 03/012034 DR Gleam Factr Ma Mrumvn Conumimnt IevU 1,7&=gat7 staaAomp Ban Page 1 of I Sample were cceived in areepsble conion v.The rwa(a)m We spartrtJale oNy to the poniov ofds nnnPle(s)tend Au anal vdN the QWitY Assiwae pmpam prV Yanxohe mad wmisum WuaN labmatwy Pleere wnsn tM1e IaMralory ifyou shoWd M1ave any 9ustum absq ns s+Wh 2635 Patlmtom Ln SW,Suite A Olympia WA 985021 Office:360.967.70101 testing@vanguardlabomtory.com 1 3vww.vatlgoardlatemetory.com 2210266 MASON CO WA I on,ao,wx+ o I will IIIIIII III'III II1li III l''II IIl1111'l411,11:1111�111111f���� Return To a°o Afr c /70 1.Ir I07 W Sfr Rol S/.� I �o, , wl4 gFrs4 Grentor(s): GrzMee(s): (1)PUBLIC Legal Description(1) f( C I 134A S) 1-19 PTIV Se NE 31-da-3 (Abbreviated form:i.e.lot,block,plat or section,township,range) Assessor's Tan Parcel: (1) 3 :) e31 _ )y _ 160 to TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(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 water use restrictions and conditions set by Washington State senate BIII 6091 and Mason County Code 6.68. These restrictions and conditions are based on location of property and/or Water Resource Inventory Area or WRIA. WRIA: I Maximum Annual Average Gallons Per Day: el 9'0 gallons � Deed on this��''''��day of 76 T— 2011. 1i8nature o - (2) State of Washington t( County of Mason ) assesses I,the undersigned,a No ry Public in and for the above named County and State,do hereby certify that onnn/this dayof I 20ZE �.40t personally appeared before me,Who is known to be signer of the above instrument,anA acknowledged that he(she)(they)signed R. GIVEN under my hand and official seal the day and year last above wri Nota Pub mandWthe5 teof Washington, residing at Z r'cR� t Lt My commission expires: c'-/0-2'7 �`a..'.nSTANTo°�. c rn; oa ei .0 SOT�y icc n�ie�tc � r, %.S•SMumb!..... ��'�ogtll,FiW io�S`: