HomeMy WebLinkAboutWAT2024-00269 - WAT Application - 6/26/2024 WAT
415 N.6'^Ssreer
MASON COUNTY Shelwn,WA 985M
COMMUNITY SERVICES Shelton:36 9670,Ext.400
Nelfam:36o-275z?sr461,E=1.400
a+a.a w„:yt�c� Elr a 361F482-5269,Ext.400
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: Patricia Armstrong Date: 0R19R/2024
Mailing Address:1950 Hardwav Lane Bremerton WA 98312 Phone: 509-940-7342
Parcel Number: 221237590052
Type of Water System Reason for Application
yJ PublidCommunity Water System(2 or more SJ Building permit V 161 2b'Ll •Ob7Sq
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ 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 it applicable—no
to this well, check the Public/Communily 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: Three Fingers
Water Facility Inventory(WFI)Number: 61129J (write"none"for two-party)
❑ lam the manager of this water system.The water system has been approved for 80 services.There
are presently 47 connection(s)in use.This will be the 48 ��crroyyn�pnnfefl1ctionFF������}}��
❑ 1 am the manager of this system.This connection will be to upgrML9fange!IReFA49a 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.
Print Name of Water System Manager Melissa Cox on behalf of NWS Phone 360-876-0958
I �
Signature of Water System Manager on behalf of NWS Date 06/26/2024
This form may be scanned and available for public view at www.co.mason.wa.us.
3:\EN Forms\p mg Wa Revised WM021
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(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA htto//gis.co.mason.wa.us/olannina 14_15_16_22_
Water use or limitation recorded................................... IVA_Yes_
Well Drilled ............................................................... Date
Individual SpringfSurface 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 Counly 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 WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Tide 6,Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
f l Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
y�/R1/evvie�wer's Signatures:
Enviro ie
n. Health: Date I G I L
This form nay be scanned and available for public view at www.co•mason•waus.
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