HomeMy WebLinkAboutWAT2024-00258 - WAT Application - 6/13/2024 wATaoa _ oa5
MASON COUNTY
COMMUNITY DEVELOPMENT
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415 N 6'"Street, Bldg 8,Shelton WA 98584, ) e�6IIatfd00V E D
\�1 `]prelton:(360)427-9670 ext 400 4 Belfair (360)275-4467 ext 400 4 Elma:(360 4
FAX(360)427-7787
Application for Determination of Water Adequacy JUN 13 2024
Instructions 615 W. Alder Street
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 a2proved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Daniel Weiskopf Date: May 30 2024
Mailing Address: 2012 East Miller St Seattle Phone: 646-326-3274
Parcel Number: 21g0103091004
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more ❑ Building permit'��9aoa�"���W
connections) ❑ Division of land:
El Individual water source(one connection), #of Parcels? SPL
S Well Permit#WEC2022-00067 ❑ Boundary line adjustment
El ❑ Spring/surface water ❑ Other❑ El Other(explain) (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 PublicYcommunity 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)
❑ 1 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.
❑ I 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.
Signature of Water System Manager Date May 30 2024
This form may be scanned and available for public view at www.co.mason wa us.
PRH F.A Dnn)d,A x', Revised I/25/ZIII B
Individual Water Well
FW'
well report(attached to application). Depth
1 t 9 ft.
pacity Test(attached to application) 1� apm 7 pd.
ll driller often performs well capacity tests at the time the well is constructed. Results from
ests are noted on the water well report. Results from these tests will be accepted. If the water
port cannot be located by the applicant or if the water well report does not have a capacity test,
apacity test,which provides stabilization of draw-down and recovery data, must be performed
nsed contractor.
ctory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA http://gis.w.mason.wa.us/plannina 14'�15=]16(]220
Water use or limitation recorded................................... N/AQ Yes# '-7
Well Drilled ............................................................... Date �i po (Z `,
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,Title 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:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: & ok PC-C
Date -7
CSD Director: Date 241
WATER WELL REPORT DEPARTMLN7 Of Nniceofirmal No. WE4B995
ECOLOGY Unam,Erology Wall ID Tag No, BNV859
Type a Wart: 911M skrr of warhiman
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Latitude(Example:47.12745) 0.2333191 N
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5 WELL CONnRDCf10N CERTIFICATION: I construckdmdlw auept om,mosibility for rumination ofthis evil,and its rmmplumar with all Washington melt
congraition smdads.Materials used and the information rapped above am mue to my best knowledge and belief.
O Driller❑Trainee❑PE-Print Nun 9hylHi m Dennis,C piny Arvadia MIN I
si,,uturc 77 Address PO Bar 1790
Leame No.2053 _ City Said Zip Shelton WA 98584
IFTRAML•E'g licame No Conturows
Spo SL toe Ree'steafoa No ARCADDIDOM Date 918/22
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Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA.98584
Customer: Daniel Weiskopt Well Tag#: BNV854
Phone: (646)3263274 Depth: 119,
Well Site Address: 540 E South Island Dr.,Shelton Pump Set: 100,
Date of Test: 9/1212022 Static 18,
TIME GPM LEVEL RECOVERY
1 Min 6.0 20.7 TIME LEVEL
2 Min 6.0 23.2 1 Min 27.0
3 Min 6.0 23.8 2 Min 26.0
4 Min 6.0 24.0 3 Min 25.2
5 Min 6.0 24.2 4 Min 24.1
6 Min 6.0 24.4 5 Min 23.5
7 Min 6.0 24A 6 Min 23.0
8 Min 6.0 24.6 7 Min 22.5
9 Min 6.0 24.9 8 Min 2.2.1
10.10 Min 0 25.0 9 Min 21.8
15 Min 10.0 29.5 10 Min 1 21.2
20 Min 10.0 30.5
25 Min 1 10.0 1 31.9
30 Min 20.0 33.2
35 Min 20.0 35.1
40 Min 20.0 37.5
45 Min 20.0 38.0
50 Min 20.0 38.5
55 Min 20.0 38.5
1 Hr 20.0 38.5
' VanguuM Laboratory
V 2635 Parkmont Lane SW,Suite A
Olympia WA 96502
vbryq p 360-967-70I0
COLIFORM BACTERIA ANALYSIS FORM
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