The URL can be used to link to this page

Home My WebLink AboutWAT2024-00321 - WAT Application - 9/11/2024 MASON COUNTY WAT COMMUNITY DEVELOPMENT Perm It 4aIII renW,gnnI Planning RECEIVED 415 N Sit Street,Bldg 8,Shelton WA 98584, mt Shelton:(360)427-9670 god 400 O Belfair.(360)275-4467 ext 400 O Eirl(360)482-52694�L40q Lu24 FAX(360)427-7787 FY 1 Lu Application for Determination of Water Adequacy615 W.Alder Street 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 Nameon Applicant: CAtYldtl II Date: �'I'a'I 202.k1 Mailing Address: S 401 W• D6LtCx t'l��kY?FPhone: �qyT�O _ nr+ '� Parcel Number: 310101.-5 O-OO O1-f S Type of Water System / Reason for Application ❑ Public/Community Water System (2 or more L'3 Building permit nnections) ❑ Division of land: Individual water source (one connection), #of Parcels? SPL Ur 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 PublidCommunity 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. ❑ I 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.us. J BEN Forms\Drinking Watar Rt,,,N 1'252018 Individual Water Well BI(Wattierwell report(attached to application). Depth q3 Fr ft. GI'Well capacity Test(attached to application) = gpm 7�{0C 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. V( Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA hfto://gis.co.mason.wa.us/olanning 14=15ED16=22= Water use or limitation recorded................................... . N/AQ Vest 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. ❑ Unsatisfactory Determination: Applicants water supply does not appear adequate to meet the needs of as intended use for the following reason(s). �,y'l,,�AQ,�o Reviewer's Signatures: Environ. Health: Date CSD Director: Date 2°f 2 WATER WELL REPORT MDEPARTMENTOF Noiuoflnm No, WP3883D ECOLOGY uni9 Ecology wen mTae No. emme iFP•orwo.E: auh of wmN:gron SRe WcRNmm(ifmaedueaeevmR): 0 taco ❑ Oxun:mueim o 'iiInwiom wmw.. Wrt Riphl PmmiUCedifimc No. pia e�U IN O� ❑Dltl:imiJ a� PmperyO Neme ,.-_°._�.. .. Wtll Strut Ad 401 WMWM Pn Rd cmeemam lYpn NmYM: City SMltan C—q ld wn O New vdl ❑A4e:mim ❑Drive ❑lama O04Y Teot pp�gp ❑pas ❑Dq ®AE- QE1dRmry Tax Pmcal No. 31908-86000.'e gmemlom: UmtroPOmup 6 v.m 97 L WmavenmcetBProvWmr Misaw111 ❑Ym (INo OymofmmpbdweD 97 a Ryq wiut Wea tM1e veMMa mrt Cmetrxtloc Deter: wa htieE fine Diemen Fmm To Tbi.>a`m S:d wewe T 0 1 ❑ a m o 43_ mi m 0 1 ❑ 0 1 ❑ Incation(sx mwmliam®peg 2): OWWMW❑hAR.t ❑ 1 ❑ —m _m ❑ ❑ ❑ 1 ❑ SW Y'/.oflhc NE_Y°:S 6 Tw.* 16N Rm 3W ❑ 1 ❑ —b —m ❑ I ❑ ❑ 1 ❑ �1°'a°(R'e°'Ple:p.12315)41.16719 ❑ ❑ —m' LanpO (E plc120.12MS) -IMIO642 Pmrmadem: ❑Ym GNo TraofpmfmwmmW OrBkr'a l.og/Costreetloa ar0.xommmeue PrmWem N.ofpvfmtiom— SimefWf^:viw—:UY—m F.®:iom DmaRe FYwler.rm:1c.e�of®nul mi renen.md:hetid mi PnBmaa Evm—Lm—LEelow�e� mesufine mrteeiYmanleW pmn+Y8v0NalmmemeYly wtebep of 5meve: pYa OF, OK-Perl� bDep691 L mm�m�°e UR °I med°N�T Nmdxova.Nme A9 MarllbiE Worke LfazHiN Fem To Tra Sblinless 9loead MWNNo. m la 0 6 Diemmr s_ sbr®D1e mam e2 cm 0] 8 31 fameer_ slmm mLvm —!m_e b Cown BnarrcdN am smlN 6 — memmll eana, v NM Mm.4 31 46 & .,,e OYm MM 3®ofpekanil_u Gnn,Po Wnnsdun anal 46 61 Manialapts'd bam_flm_d Gmy medium sand,fine b medium lInIM, 61 FWnSuI: G]Yn ON. Towl &F&? 19 L MR DIMer MmnelmW mnY 13 lone &ins Grz meOWmsand.Mu -cdomd M-IWIUM m wm ..mmammb . ❑Ym O) ravel,maul.lw stalk ry ofwet °fNO101 arwm silty mw3 am s 84 BO Of°'� off arDwn EnesaAnnu6it lb ffm WMVd W Poup: Mm�tmefeNm Tyln nmml,WdwM d g1 Np._ F:mpml6h der%-_L DNWW6fw —P geml�reU:Iyam(eelcreuoeWwemse�kml 190 L Sti}-poPmpdw.Jlmvmg 1_a eehmv Pemaemfv arWrwe MN BD flFelow bpofwe0�'8 Dme 1/ 4 .lrrtsmPnme—@aWN^e'°sL Dn .1r¢rvuwmucamoDW EY (mAeelm.vt) Wa Tmb: Wme�mtpm6medl WNo ❑Yn C Iym r m—9PmwOh_a mewmwe.m_m. Yield_mm.dh_Ran+aomaBv_1u Yield_gmwiW_ft drewdo«n e9c_Lr+. psowyaueltimi sm w6m P'y°pueuvea oH-wmlewlm�WDomweB mpmwnrlesp Tlm Wmfevel T®e Wmmla.Y 'f WmrLee°I putofp:mpiva nt Behr my_BPm w16_6 a:ewMu Mm_hn ptr¢y 12 ppmweha®wa60 8E1 cow Om 1/d/26 A.nieoaen—mm impvmme ofwNm 62 IF Wn♦demi+lemtytD meat! OYm allo pl..1l3/24 CompldW Date 1132a WELL CONMUCTION CRRTO]CATION: 1rpemmtWevd/m a.agft ree iilily mr coMlMctim afthisxell,eM b mmPlimwcwnh ell Waeldn =xeR wnsuuction emntlsWl.AfetsialsuyA am bk infoavalian mpP above ralme w myne:<mnwlWgeem kw m DdOm❑Ttemm❑PE—Pdm N•^• rP DriOinRC°'°PeM'�' DNIIb91 n. S. I Addrul PO Box 1790 I.irenxN 2053CityS bp S'MBon WA9e6E4 IF TRAINEE Svamot ]3cmeeN CoObacoOrS SPOOrOi Swud _ R,i"ion No.ARCADD1098K1 Daq 1IYlA ECY 050.1-29(Rev 09/IB) ((yao mrdthiadarmmm Nmidrernattfomnt Plearr roll use Warer Rnomas Propvm m380I01-8911. Perswu wl✓18mevl8 maravn mRlll�or Warmrgmn Rrmy$ermrr. PersovwiMaryexAGmbiliym:mR811d334341. Vanguard Laboratory jTL35 PuFmont Lane SW, Suite A �•/ Olympia WA 98502 360-967-7010OLIFORM BACTERIA ANALYSIS FORM onbSaryk Coeama T.SauPle County 01/08/2024 ,ww 07. ON MASON 14a � _dry T"dW SpaWn�dNld myy aN bm) ❑Cn A ❑G.pB polka OWAW Ga W B Sypme-Pmdk ftW FKU.k.Ixy WFl IN _ _ _ _ _ _ &fl+en N— BLOC PARK, LLC CaOsl Paean:M WDra ,Inc aYAlall[(380 )4ffi M CePPhww( ) Faml: Ex Rnie:( ) �M W u n.ia m.e.d m Xan v.mery .w0.a.s.e+nmm�ANp wny..+u.mlkbam WIP EINFORYATION SaepkmkdeC by(name).SETH. swdkkgmm $Wpewko spedelbebuotimeacmnmenk: fWF158 401 W alight Pk RC,Shelton TypeottmgM(eebgoNyeslWeo15nK1e 5mf"1 eemgh5 bebm) 1.❑Ro .oWa"SAmpk(�) 2❑ RapW$.Wk WN) Chun wy. _No_ RamaekAmsaWn mbruem morel QN ReelMg:ToW_Fne_ Uneeklsby W. numbw. 3.G.n Wlx RuklbmmsNPk — — IAmelskamY iouimmbd�: ChbM~:Y®_No_ ❑Tm� (w) Chbi%ResidATOW_Free_ ❑AusanaA(W) 4. S dMw GWIRn Sou.WaW5IMpb(&.mmatim) II s_ I1 1I ❑Ec ❑Feml mwr YX_X_ 5.ws.*ca WWpm V. LMUSEONLY DMPOMWATER#BUO %- aNt<y. �C ❑Uma rYTmalC P,M,aid ®oeb4aemy Ol❑EmFp t ❑Eweekall l� I IQO B-WU DenehyR b:ToWCOW.. HObh Fol /IM. Fe Cafbm NOdld NPC NmL Repkp, Sanpk RIWAID: ❑TNFC ❑so"boom ❑ SmpbVobme ❑DWM*Um ❑ p10Yni1io'"` 1/9/2411:00 NIWTWCC: 9.0 NMaac SM9223B ENS b00N uo W0tly. 00B IIUSmelke 285- p�XpYan n s,ry MN•A�XXne�au,Y�M�PMtl,IX' 4m