HomeMy WebLinkAboutWAT2024-00220 - WAT Application - 5/20/2024 MASON COUNTY I WAT -
COMMUNITY DEVELOPMENT
Permx Asslip„ced W,,Budding,Planning
415 N 6-Street, Bldg 8,Shelton WA 98584,
Shehon:(360)427-9670 ext 400 A Belfair: (360)2754467 ext 400 4 Elma: (360)482-5269 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 Dian must accorn2any this a2plication.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Kevin SII1s & Lisa Denton-Sills Date:
Mailing Address: PO Box 850 Lakebay, WA 98349 Phone: 206-488-7922
Parcel Number: 52009-75-90183
Type of Water System Reason for Application
❑ Public/Community Water System(2ormom 0 Building pemift$LJ)a'nZ}-00591
connections) ❑ Division of land:
ElIndividual water source (one connection), #of Parcels? SPL
El Well❑ Spring/surface water ❑ Boundary line adjustment
O Other(explain) ❑ Other(explain)
❑ Replacement or Remodel(please indicate name
ff you have morn 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:
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 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 wwvv co mason wa us.
t:\EH Forms\Drinking Water Revised 1/252018
Individual Water
//v11�elWell
.}Water well report(attached to application). Depth eft.
Well capacity Test(attached to application) Sz) pm Z �-(00 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.co.mason.wa.us/planning 14C] 15=1 16=]22L3y
Water use or limitation recorded................................... N/A M Yes c
Well Drilled ............................................................... Date J
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
t3:r'Mason County Community Services Evaluation (staff use only)
u l-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:
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: " ' ' vl` Date
CSD Director: Date 2°f`
�a
JUN 1 02024
WATER WELL REPORT DEPARTMENT OF Notice of Intent No WE555m RECEI fD
ECOLOGY Unnm Ecoloaa W<a)DTag No BPF 26
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at
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non' aatim s inultu s.MMeridseaed nil fhe infonmtion sePaned above are true to my best knowledge aril Mief
O FA,.jNr O Inuartm O PE-Proof Nerve Josh Vlomppa II Ama6a OrIIIM9Im.
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Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA.98584
Customer: Lesa Denton-Silis Well Tag#: BPF128
Site Address: 300 W Reeves Hill Drive,Shelton Depth: 99,
Date of Test: 528t2024 Static: 34.V W'[/
Pump Set: 89 JUN 01024
TIME GPM LEVEL RECOVERY
1 Min 4.5 34.3 TIME LEVEL RECEIVEp
2 Min 4.5 34.5 1 Min 34.9
3 Min 4.5 34.5 2 Min 34.8
j 4 Min 4.5 1 34.5 3 Min 34.7
' S Min 8.5 34.5 4 Min 34.6
i 6 Min 8.5 34.7 5 Min 34.5
7 Min 8.5 34.8 6 Min 34.4
8 Min 8.5 98 7 Min 34.3
9 Min 8.5 34.8 8 Min 34.1
10 Min 12 34.8
15 Min 12 35
20 Min 12 35.1
25 Min 12 35.1
30 Min 12 35.1
1 35 Min 12 35.1
40 Min 12 1 35.1
45 Min 12 35.1
50 Min 12 35.1
{ 55 Min 12 35.1
f 1 Hr 12 1
3Hr 10 Min 12 :'Ni5.
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2635 Parkmont Lane SW,Suite A
Olympia WA 99502
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CORN BACTERIA ANALYSIS FORM
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CWM024 , D. MASON
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� - - - - - - 02024
LESA DENTON-SILIS RECEIVED
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9AAIIPLE M11101MATION
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300 W Raeaes Hdl Dr. Shelton
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LAB uSE oNLY ORR00NO WATER RMUS LAB USE ONLY
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2210691 MASON CO WA
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Grantor(s): (1) 4 vi • �'�S (2) l>t . �c; �r�S
Granbee(s): (1)PUBLIC
Legal Description (1) -boo l.J r< 2 VAT jh /( .cJ/L � -1 ♦ u-Jlf
(Abbreviatedform:i.e.lot block plat"section, township,mngnge)
Assessor's Tax Parcel: (1) S O _L)
4- z o 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:
Maximum Annual Average Gallons Per Day: 3,00o gallons
Dated on this,I!day of 6
Signatu Grardor(s):
State of Washington )
County of Mason )
Page 1 of 2
I, the undersigned, a Nq(ary Public in and for the above named County and State, do hereby
certify tha on this _ y of LNQ
, 20 ,
pe onally appeared before me,who is (mown to be
signer of the abope instrument and acknowledged that he(s e)(they)signed '
GIVEN under my hand and official seal the day an ar last bove wri n.
Apo"�gFJ?_SE(B"�1*e ub is I d for a fate o ashington,
PP'''• �BIOM Q p 1
.'o+�NOTARY residing at rfTi
n
0 23039426 s My commission expires:
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