HomeMy WebLinkAboutWAT2024-00334 - WAT Application - 9/24/2024 WAT�g7s�- po3�
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
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415 N 6-Street,Bldg 8, Shelton WA 98584. (`�P 9 ` 2024
Shelton:(360)427-9670 ext 400 O Bel fair: 36AX 600) 42-44677 ex1400 A Elma:(360)482-52ti9 e,2400
7-7787 815 W.Alder Street
Application for Determination of Water Adequacy
Instructions
11. Complete Part 1. No determination can be made until Part 1 is fully comoleled.
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 n this a licetion.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Wolf Industries/Kaitlin Bailey Date:
Mailing Address: 591 E Benson Loop Road Phone. 9713943587
Parcel Number: 220215090031
Type of Water System Reason for Application
❑ Public/Community Water System(2 or more El Building permit
connections) ❑ Division of land.
El Individual water source(one connection), 9 of Parcels?_ SPL
O 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 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
rWater
e of Water System:
Facility Inventory(WFI)Number:
write"none"for two-parry)
am the manager of this water system.The water system has been approved for services.here are presently connection(s)in use.This will be the connection.
on
ll be to
ade or
ge the use of an existing
connection on this system I am the manager of this system.
recreational o'full time). Ple ser ndicate onnthe following line the natture
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 1NW W co masoon,W*
1?EFI Faems\Drinking�'no
1
Individual Water Well
O Water well report(attached to application). Depth1237 ft. -1
❑+ Well capacity Test(attached to application) 3�!gpm 7 y(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.
El Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA h //gai.co.mason.wa.us/planning 14=]1501f[]22[]
Water use or limitation recorded...................._........_.,. N/A�YasQ
WellDrilled ............................................................... Dale
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 Boo 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 disminution 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-Determinaton of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A 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
2�f2
CSD Director: Date
WATER WELL REPORT DEPARTMENT OF Nmbanfl.kla Np. WE55531
ECOLOGY Uniquepooh,,WCUMT3140. BPF143
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Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA.98584
Customer: Roxanne Vanderber Well Tag#: BPF143
Site Address: 591 E Benson Loop Rd, Shelton Depth: 237'
Date of Test: 8/52024 Static: 102'
flMini
: 220'
TIME GPM LEVEL OVERY
1 Min 6.5 104.8 LEVEL
2 Min 6.5 104.8 104.1
3 Min 10 105 103.7
4 Min 10 105.8 103.5
5 in 10 105.8 103.3
6 Min 10 105.8 103.1
7 Min 10 106 102.9
8 Min 10 106.2 102.5
9 Min 10 106.4 102.7
10 Min 10 106 102.6
15 Min 10 1026.8 n 102.5
20 Min 10 106.8
25 Min 10 106.9
30 Min 10 107
35 Min 10 107.1
40 Min 10 107.2
45 Min 107
10 .2
50 Min 10 107.2
55 Min 10 107.2
1 Hr 10 107.2
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