HomeMy WebLinkAboutWAT2024-00253 - WAT Application - 11/7/2023 WAT 0�.- OOa53
415 N.&Sa
MASON COUNTY Sbeltm.WA 98584
COMMUNITY SERVICES Shelton:360427-9670,at.400
Belfaic 360-2754467,at.400
a,msa�asr,.�,.,xdxwx.�.mniyw+�n Elm:360482-5269,Est.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 Appllcantw�ren Farris,Agent for Lennar Nonh,wvt Ina Date: 11/7/23
Mailing Address: 334556th Ave 5 Una 14a Fatieral Way,WA NW3 Phone: (2531308-0 65
Parcel Number: 1232"1 1 4 m nt •F Fu reesau
Type of Water System Reason for Application
i3 50 Public/Community Water System(2 or more ® Building permit uZI2-0¢4-007CtP
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Sprung/surface water ❑ Other(explain)
❑ Other(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 Public/Communily,Water signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
) n Public Water System
Name of Water System: �aC.t fd ri Wa6 O;ti rGF .4 1,
Water Facility Inventory(Vit Number. 05"3$O
(write"none'for two-party)
)3! I am the manager of this water system.The water system has been approved for services.
There are presently 51P connection(s)in use.This will be the CI"1 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 i s set by stat and local regulation.
Signature of Water System Manager Date if /
This fomr may be scanned and available for public view at www.co.mason.wa.us.
J rEN Fmms.Dnnkmg Wafer Aairtd 4/42018
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) opan 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 IA
Development within which WRIA hltp:lfois.comason.wa.us/olannino 14_15_16_22_
Water use or limitation recorded................................... N/A Yes
Well Drilled ............................................................... Date
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ I 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 on/
-t 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.
Recommendetl 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
36JOA 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: Date
This form may be scanned and available for public view at www.co.masan.wa.us.
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