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Home My WebLink AboutWAT Application - 7/30/2024 WAT f MASON COUNTY COMMUNITY DEVELOPMENT Pnmlt Assbtance ante,BWldlny PI. Ml 415 N 6-Street, Bldg 8, Shelton WA 985a4, Shelton:(360)427-9670 ext 400 O Belfair: (360)275-4467 ext 400 0 Elms:(360)4825269 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: Applicantl Parcel Identification Name on Applicant: KAREN GREEN Date: Mailing Address: 5471 NE NORTH SHORE RD Phone: 206-465-1471 Parcel Number: 22210-12-00071 Type of Water System Reason for Application ❑ Public/Community Water System (2 or mom O Building permit BL.Aaoa4-OUiB`>t connections) ❑ Division of land: O Individual water source(one connection), #of Parcels? SPL 0 Well ❑ Boundary line adjustment ❑ Spring/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 PublicYCommunity 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: 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. ❑ 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 any limits set by state and local regulation. Signature of Water System Manager Date This form may be scanned and available for public view at www.co.mason.wa.ua. J?EH F.ms D.rkn g Wm.r Gmked II25R018 Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) opm 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 repovery data, must be performed by a licensed contractor. ❑ Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto://ciis.co.mason,wa.us/plannina 14015[= 160220 Water use or limitation recorded................................... N/AQ Yeses 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,Title 6,Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. C Unsatisfactory Determination: Applicants 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 CSD Director: Date 2°f` %vu Pumper Inc. 340 9VP Davie Ya'm Id WIalr,Va 98528 (360)801-6/07 Project 5471 NE North Shore Capacity Test TAG: Date 12/13/23 Pump 1/2 HP Sub Well Depth 34.3ft Static Water Level 11.5ft Draw Down Recovery Time Water Level GPM Time Water Lever 0 min 11.5ft 0 0 13.7ft 5 min 13.6ft 14.3 1 min 11.6ft 10 min 13.6ft 13.9 2 min 11.6ft 15 min 13.6ft 14.1 3 min 11.6ft 30 min 13.6ft 14.4 1 hr 13.6ft 14.3 2 hr 13.6ft 13.9 3 hr 13.7ft 14.2 4 hr 13.7ft 14.1 Capacity Notes: On average, the well at 5471 NE North Shore Rd Belfair, WA produced water at a rate of 14.15 gpm. Over the span of a 4 hour time period, and at the average rate of 14.15 gpm, the well produced approximately 3,396 gallons. The well was subject to tidal fluctuations, so during recovery the well did not achieve its original static water level. The test started at a higher tide, with the tide steadily going out over the course of the test. 36:TAT.»mejCOUr.ORM cPECTRA Labomtorica Kitw Faubb%WA95 BACTERIA ANALYSIS FORM ONOSWOOGnq TM as Ev) GapAa 0o B&pmW-Fmrl9e9vu VAMFriesWwOWY('Flk d — _ — _ _ caxAaFW.m: w,Rma CaIPhuO:' BM: Eva PIiOnN YIaIMLah Ttl W�r�VnIA4uY�rllanMabliYY1F1�� BAMtLENFORMAT01l SWnFY mIr�OM4®OOk T]p N YNFM(OMtl�aih Oia bm) 1.❑BOiAANa OIMhutlon Ympk WWl s.I]YWrpmd9lAPl aftkww:Y.El wo WOnaaaMOOWuOrraua�uaul UmOMOaaOrwaiVaE naoE9c CNNIB itmku9t Tdel_Fne_ ].OWYM VhbrlWkBmwAOFWa --- ----- � I I I IFyOLYelakwuGaoolx[Jlle 8 QWaMOE:Y�_M_ ❑T^BA� IAP) CI9ONWYWWLTda_Flr_ ❑Pivewnm!(!uP) d.YAeoe or OVA YWSwm Naar BOmpe�nina9Am) ) 8 ❑ Ec ❑Feral 5. �9a Cq'eMhlmaMlm uJ/ LAB LSE ONLY DMKMDWATERRESULT4 5iLISEON.Y ❑Umtl WMTOWGRbm FNnei ❑ECA mw ❑EM WaeA YrbrYlOwgYoelb:Tool OdSm_�WrV190rL EooY_ _mVOH00N. F9vI dAWm dV10aN wC cEtl1W. Y[aemrtut 6artFk RquNk ❑TNfG 09.0 w ❑SarykValma ❑VaiyeaCaWOOr O — yDIYAOYuo XaeCa m m ) O.MIBm p/Irt G( VGYQR u�tMna ��'YYM1 YJa�FY�r. wrw� �anrn.r �M�1 Oa1W-aeaA eysYr br4p• 01rYlA9rOa'YI ?dada I' ,"Inc 340 9yf Daum Tarm lid &Vair.'Wa 98528 (360)801-6107 7/30124 To whom it may concem: Subject: 5471 NE North Shore Road, Belfair, WA 98528- Serviceability of Well Under Proposed Garage Construction I am writing on behalf of Ms.Karen Green regarding the proposed construction project at 5471 NE North Shore Road, Belfair, WA 98528. The project involves building a garage over an existing well, and I would like to clarify how this construction will not affect the well's serviceability. The planned construction ensures the well remains fully serviceable. We intend to replace the existing pump system with a new PEX pipe setup, allowing for manual access and maintenance without the need for heavy equipment. Additionally, garage doors will be installed, providing ample space for accessing the well and any required maintenance activities. It is important to note that the well is shallow, facilitating handwork for any necessary servicing. The placement of the garage will not inhibit the well's functionality or the water system's serviceability. Our team has carefully considered the logistics and design to ensure that the garage construction does not pose any risks or complications to the well. We believe that the project aligns with all relevant safety and accessibility standards. If there are any specific concerns or requirements that we need to address, we are more than willing to cooperate and ensure full compliance with county regulations. Thank you for your time and consideration. Please feel free to contact me directly if you require any additional information or have any questions. Thank you, Lacey Davis (360) 801-6107