HomeMy WebLinkAboutWAT2024-00221 - WAT Application - 11/7/2023 WAT - DDaal
415 N.a Street
MASON COUNTY Sheller,WA 98584
COMMUNITY SERVICES Belmn:360-27544?7,at.400
6Elm:360482-526?.at.400
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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 accom an this application.
Part 1: Applicant/ Parcel Identification
Name on Applicantiauren Fafnls,Agent ror Lennar NoMarest.Im Date: 1117/23
Mailing Address: 334556lh A S Unt l-a Faderel We,,WA sews Phone: (253)30a-0265
Parcel Number: 3 z i2 ez .00ao o 'F Hs ae6
Type of Water System Reason for App�3licTa�tt7iion�r1ryry���
® Public(Community Water System (2 or more ® Building permit
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
ff you have more then one residence connected of water system below if applicable-no
to this well, check the Public/Community Wafer 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: LSaI ' r kl A ' &off 4t yel
Water Facility Inventory(WFI)Number. O 5 3S U
(write"none for two-party)
I am the manager of this water system.The water system has been approved7anexisfing
s.
There are presently A/5 connection(s)in use.This will be the _
❑ 1 am the manager of this system.This connection will be to upgrade or changistingconnection on this system(Le.:recreational to full time).Please indicate on 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 nd at regulation.
Signature of Water System Manager I Date / /a
This form may be scanned and available for public view at www co.mason.wa.us.
J�EH Fame\Dnnxing Water
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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://ais ce mason wa uslylanning 14_15_16_22_
Water use or limitation recorded................................... NIA—Yes—
Well Drilled ............................................................... Date.
Individual SpringtSurface 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 W DOE 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.
Unsatisfactory Determination:
Applicanfa 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
This form may be scanned and available for public view at warw.co.mason.wa.us.
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