HomeMy WebLinkAboutWAT2024-00238 BLD2024-00664 - WAT Application - 9/12/2023 ( WAT - � � I
415 N_6'h Street
MASON COUNTY Shelton,'WA 98584
COMMUNITY SERVICES Slielion:360-427-9670,Ext.400
Belfaii:360-2754467,Ext.400
.Buildin%PlaningEnvironmentalHeakh,CommunityHealth Elriia:.360-482-5269,Eat.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: Sarni Martin,Agent_for-Lennar Northwest,Inc Date: 8/2172023
Mailing Address: 33455 6th Ave S,Unit 1-B.Federal.Way,WA;98003 Phone:. (253)294A322
Parcel Number: 12328-51-00136 `For Future HIS#136
Type of Water System Reason for Applicationn�l/,,/
® Public/Community Water System(2 or more ® Building'permit'PLX V i(-00&6W
connections) I] Division of land:
E Individual water source(one connection), #of Parcels? SPL
❑ Well O Boundary line adjustment`
❑ Spring/surface:water
q Other(explain) ❑ Other(explain)
❑ Replacement or Remodel(please indicate name
!f you have more than one residence connected of water system below if'applicable—no
to this well, check the PubliclCommunity 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, C WC1 ` )Zs W c� i
Water Facility Inventory(WFI).Number:
(write"none"for two-party)
I am the manager of this water system. The water system has been approved for'Lqp services.
There are presently 9>01 connection(s) in use.This will be the 60PI _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(Le.: recreational:to full.time). Please indicate on the following line the nature
of this change:
This water system its able and willing to provide water to this:(these)connection(s)without exceeding.
the limits of the water system or its set by state and local regulation.
Signature of Water System Manager Date ty3:
—�— -
This form may be scanned and available for public view at www.co.mason.wa.us.
lndividual Water Well
p Water well.report(attached to application). Depth ft.
❑ `Well capacity Tes.'attached to application) gpm gpd.
The.well driller often performs well capacity#ests at the time thewell 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 Oaihnot.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 http.ftis co:r* anon wa.us/bIanning: 14_15 1:6_Z2_.
'Water use.ar Iimitaton:recorded..............................
N!A Yes...
Well Drilled :..:.::.:.:.. .....::.::...:...,:.:.,.:.....;.,.:,. Date'
Individual Spring/Surface Water
0 WDOE`permit(attach to,application)
Q Method of disinfection;
I have reason to-believe thot`this water source,can,provide,at least$00 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: .Masoh County Community Services Evaluation. (.staff use:only).
D Satisfiactory Determina#ion
This determination.:does nof:address.,adequacy of the distribution system,guarantee an adequate supply of
T.water indefinitely in.the future;or:guaranted g6hJpl1ance:with all:applicable WDOE'water'resource regulations:
Recommended approval indicatesfequirements of Sanitary Code,Title:6,Chapter 6.68.040-Determination of
Adequacy for Bui.ld.ing Pern'iits are.satisfied. Additional Growth:Management requiretnerits.may:apply, Chapter
36.70A RCW:.
Unsatisfactory Determination:
Applicant's water supply doe's not::appear adequate to,meet the needs of'its intended:use for the following
reason(s):
RevidWA des.'Signatures
Environs Health Date
This form may be scanned and available for public View at www.co.mason.wa.us.
Paee.2 of 2
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915 N.ST'H STREET BLDG 8.SHE fJN VJA965@"
SHELTON 360 427 9670,PCT.4QD
MASON COUNTS
-j C.OA rR ra NIT �y�I ICES BELFPIR 360 275 g467 E?CT 400
l�/)L.� l�.{�1 1 �"L ,;®/ ( d EWA:WO*-482 5269 EXT.400
1 '" Buifdin ,Plannin,Emiiron yenta)Health tomtnunit Health
FAX 360,427-7798 fr
Application for Dgterminaf on:of Sewer Adgquacy
Instructions:
1 Complete Part.1 of application:, Permit number may be�added at later date.:
2 Take:application,Site plan,and:any other`assoclated mformation wi{ti the proposed development,to the�Sewer,
�System..;Manager:or Designated Erriployea for approyai ,
5
3 Submit completed application antl information to Permit Center orMason County Public Healih,for review ;
s
-:NOTE You mustsuppryahe System Manager with a site plan for the project,showing all ersUngot:proposed ,
sewer components and it in relation to proposed deyetopment snit property:;
_
Part1;Applicant.1 Parcet tnformation"
Applicant:Sarh;Martin,Agent for Lenriar Ngrt iwest,Inc. Date;;_.8/2.1L2025
MOngAddress: 33455.bth Ave S,Unit 1-8. City,:state,Z,p: Federal'Way;WA;98003
Site Address: 12l1 NE Olympic;Ridge Phone:P (253)24i322
. .
Parcel Number 1232A sl ooi36 I3St3b Permit Number. (�0�'}'—Q �Q
Part,2:Sewer System anformatfon
Name of Sewer System. ;Belfair. Site;Ptan attached?
Q<fci0 use only;Sewer-Sy Manager or Designated;Emptoyee is to complete. '`
New Connection:I have ievtewed the appticants informa brizad:fiave ho issues V iM,Mas9n County Public Health apprcMng,the cotrespondirig
Mason County Peimit.
Exisfing Connection thane reviewed the apphc86ts information and have notssues with A9ason:69'unty PnhTic Health approvrg the
co"riesponding.Mason Cotinty'Permit
❑ it have pwewed:theappfcantsinformationand,h0ue:determ,ned:sewer:r jnecGgnisa,rtentlyNOTavailahleloathis;properfiy
a
:Please add the fopowingtondjtion(s)qo the corresponding Mason:County Perrnit;,(optioni#)
Must meet all•MasonCounty design and construction standards, must p.ay:ail fees
including:connection fee with:permit'and'inspection:fee,and Latecomers charge:•(TBD)..
Richard Dickinson: `.:""'`'`. 917/23 .
y Printed:Name of System managsr/Eriipfoyee signature;ofSyslem Managed Employee' Date
9
' Part 3:.Mason County Public Health Rev'iewl Approval: Jill
0 satisfactory [] Unsatisfaptory
Signature.oi Enyironmentat Heaith:SpedaAsf Date
j;
?; This form may be scanned'and available for publi6view on the Mason,County Web Site.
3.