HomeMy WebLinkAboutWAT2024-00223 - WAT Application - 3/14/2024 MASON COUNTY I
COMMUNITY DEVELOPMENT
Pe itMvMncec W.ewdine.w NM
415 N 6° Street, Bldg 8,Shelton WA 98584.
Shelton:(360)427-9670 ext 400 tr Belfair.(360)275-4467 ext 400 4 Elms: (360)4825269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination ran 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: Janice Saeger Date: 3/14/2024
Mailing Address: 1346 SE Arcadia Rd Phone: 360-791-3611
Parcel Number: 320282400020
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more ltf Building permit N1 ;Wzq - 00;7�54
connections) ❑ Division of land:
El Individual water source�(on IF connection), #of Parcels? SPL
El Well ntvll ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
ff you have more than one residence connected of water system below if applicable-no
to this well, check the Public/Community 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(WFQ 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 Data 3/14/2024
This form may be scanned and available for public view at www.co.mason.wa.us.
1dE8F 8\Dnniang water Revised 1/25/2018
Individual Water Well
Water well report(attached to application). Depth
Well capacity Test(attached to application) Zin gpm / /�Q 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. p ( 7
Satisfactory bacteriological test(attach to application). 0 �J�ZQ kY
Water Resource Inventory Area (WRIA)
Development within which WRIA hlto//gis oo mason wa us/plannim 14115_116_22_
...... ........ a�
Water use or limitation recorded.............. ...... N/A_Yes !"'1/ AFW721sJ/0
.
Well Drilled ............................................................... Date ml .
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 only)
�i Satisfactory Determination:
This determination does not address adequacy of the dismbufion system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource re uI tions.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-Det a n of
Adequacy for Building Pennits are satisfied. Additional Gmwlh Management requirements may app >7gle^r
36.70A RCW. I 1
❑ Unsatisfactory Determination: I'
Applicants water supply does not appear adequate to meet the needs of its intended us Will o�i'O�j V
reason(s). "O
Reviewer's Signatures:
Environ. Fieabh: Date
This form may be scanned and available for public view at wim co.mason.wam
Page 2 of2
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089
Arcadia Drilling Inc.
P.O.Box 1790
Shelton,WA.98584
WeIITag#: BOT544
Customer: Janice Saeger Depth: 90'
Site Address: 1346 SE Arcadia Rd,SheBon Static: 49'
Date of Test: 8112/2024 pum Set: 80'
RECOVERY
TIME GPM
LEVEL TIME LEVEL
1 Min 7.7 1 Min 59.8
2 Min 7.7 2 Min 58.8
3 Min 7.7 3 Min 58
4 Min 7.7 4 Min 57.5
5 in 18.5 5 in 57.4
6 Min 16.5 6 Min 67
7 in 16.5 7 Min 56.9
8 Min 16.5 8 Min 56.6
9 in 16.5 9 Min 56.3
10 Min 20 10 Min 562
15 Min 20
20 Min 20
25 Min 20
30 Min 20
35 Min 20
40 Min 20
45 Mln 20
50 Min 20
55 Min 20
1 Hr 20
1 Hr 10 Min 20 AUG 2 8 20T4
RECEIVED
2215388 MASON CO WA
09104/2024 09:5B RP NOTCE
d.NICE SRGGER p201214 Rcc Fee- $304.50 Gages. 2
Return To
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Grantor(s): (1) , (2)
Grantee(s): (1)PUBL''IIC�C
Legal Description (17 r05 1 St p{-n rF nE I,ell)
(Abbreviated form:i.e.lot, block plat orsection, township, range)
Assessor's Tax Parcel: (1) .3 2. 2. - Z �- (� 2 2 0
rio, K s
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA)
I (We), the undersigned grantor(s), hereby place this notice on record that the described real
estate situated in Mason County, State of Washington is subject to water use restrictions and
conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These
restrictions and conditions are based on location of property and/or Water Resource
Inventory Area or WRIA.
WRIA:I
�0
Maximum Annual Average Gallons
sPPer
ytDay:
- "/�. gallons
"
Dated on this "day of 6_TT�` 20�1q
Si nature of%Gre
(1) (2)
State of Washington )
County of Mason )
Page 1 of 2
I, the undersigned, a Ngt�ry Public'n a d fo the above na ed County and State, do hereby
certify that on this� ay off,20�,
�% (It V Q ? Ir- _personally appeared before me,who is known to be
signer of the above instmme d, and acknowledged that he she)(they)si ad it.
GIVEN under my hand and official seal the day a ar I t above wri
:,,u.........M
PT'. sioii• B}� otary Pu is in and e S e of Washington,
NOTARY 'G;; i residing at
23038426 My commission expires:
to. PUBLIC s
:••.'.q'nrz..
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