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Home My WebLink AboutWAT2024-00257 - WAT Application - 3/29/2024 WA-T 2 - 00251 MASON COUNTY COMMUNITY DEVELOPMENT Parent Assistance Center,Building,Plan ring 415 N sin Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 * Belfair.(380)275.4467 eld 400 @ Elms:(360)482-5269 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: JH Rigger Ent. - Scott StuderuS Date: 3/29/24 Mailing Address: PO Box 985 Phone: 360-850-8500 Parcel Number: 12332-50-00021 Type of Water System Reason for Application ElPublic/Community Water System (2 or more El Building permit- ftp� a#_007;?-5 connections) ❑ Division of land: ❑ Individual water sounce (one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spnng/surface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel(please indicate name It you have more than one residence connected of water system below if applicable—no to this well, check the Public/community 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: -t -C> a.LN * 1 Water Facility Inventory(WFI)Number: 105,3 L) (write"none"for two-party) bd I am the manager of this water system.The water system has been approved for 005 services. There are presently q I I connection(s)in use.This will be the 911. 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 a its set by state and local regulation. ,, Signature of Water System Manager Date `t I `I 1 :.Cb'�'1 This form may be scanned and available for public view at www co mason.wa.us. J?EH Ferri Drinldn8 Water RPAltd 1/25/2018 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 rapacity 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://ois.co.mason.wa.us/planninci 14015Q16=220 Water use or limitation recorded................................... N/A_[-_L 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 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,TiVe 6,Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. Unsatisfactory Determination: Applicants water supply does not appear adequate to meet the needs of As Intended use for the following reason(s). Reviewer's Signatures: Environ. Health: Date L CSD Director: Date 'U2 NRWATER Isr, Belfair Water District#1 .p ESTABLISHED i9b6 22451 NE ST RT 3 PO Box 563 Belfair WA 98528 Office(360)275-3008 -' Fax(360)275-6410 Website : belfairwater.org Water Adequacy Determination Application Instructions 1.Complete Part 1,No determination will be made until fully completed 2.Once form is completed and determination made,$500.00 fee must be paid 3.The$500.00 will be waived or credited upon purchasing of water connection. 4.This determination stays with the parcel for two years from date of purchase. Belfair Water District#1 Reserves the right to withdrew the adequacy after two years,or if the use to the parcel charges and alters Me total adequacy requlretl to service the parcel. Name of Applicant: 1H Rigger Ent.-Scott Studerus Date: 4/4/2024 Mailing Address PO Box 985 Phone: 360-850-8500 Parcel Number 12332-50-00021 Reason for Application Building Permit for a single family residence behind the existing dental practice building. Water System Information Name: Beffalr Water District#1 Water Facility(WFI)Number: 05350 XXX I am the manager of this water system. The water system has been approved for 1430 ERU's(equivalent residential unhsloonnections). There are presently 911 ERU's allocated and/or in use. This will be the 912 ERU(s)allocated for this service connection. I am the manager of this water system. This adequacy will be a upgrade or change in use of an existing service. Nature of the change: This water system is able and willing to provide water service to this(these)connection(s)(ERU's) without exceeding the limits of the water system or any limits set by stale and local regulation. Print Name of Water System Manager ale Webb P no 360-275.3008 Signature of Water System Manager Date \ \ / � (� !. . ! E ) � | § � R n ! B � < � � / \ ! / \ \ § # ! % � e . w w:, . ■ � ! ; . . . �. , . . . . �f LL ; J k