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HomeMy WebLinkAboutWAT2024-00325 - WAT Application - 9/17/2024 WAT zo24 MASON COUNTY 415 N.6 Street �ceheltmy li5 414 00 3helwn:.9y-T`7b970.4kt�400 Public Health & Human Services Belfelo 360-2754467,Ect.400 615 W Alder Street Application for Determination of Water Adequacy Instructions 11. Complete Part i. 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 a22mved building she plan must accompany this application. Part 1: Applicant/ Parcel Identification Name of Applicant: Tho Nguyen Date: Se�temhar 17 2024 Mailing Address: 333543rd PI NE Phone: 253-332-0086 Parcel Number. 3202153-M38 Type of Water System Reason for Application (f Public/Community Water System(2 or more Building permit connections) ❑ Division of land: ❑ Individual water source(one connection), #of parcels?— SPI. ❑ 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 PubliciCommunity Water signature repujrgdi ROVE D System box. /Aj�P•7 P Part 2: Water Connection Information ����y OCT 08 2024 Complete the section appropriate for the type of water connection being eval(MII&COUNTY ENVIRONMENTAL HEALTH Public Water System RET Name of Water System:Shorecre t Estates WaterCompany Water Facility Inventory(WFI)Number. 78520-1 (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. V 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 o this change: Existing Connection-Building Permit 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. Print Name of Water System Manager Kristie Hutchinson Phone tom)428-0773 Signature of Water System Manager Date September 17,2024 j This form may be scanned and available for public view at www.masoncountvwa.aov j19Ea F..s\Ddnkl Wear Reci,ad Oi/OBrz02a Pogei uf2 3 s Group B Water Systems ❑ Satisfactory bacteriological test within last year(attach to application). Individual Water Well Falimn�d ll report(attached to application). Depth ft, Wellacity Test(attached lo application) apm opd. driller often performs well capacity tests at the time the well is constructed. Results from ts are noted on the water well report. Results from these tests will be accepted. If the water rt cannot be located by the applicant or if the water well report does not have a capacity test, acity test,which provides stabilization of draw-down and recovery data, must be performed sed contractor. ❑ Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water Fattach to application)fection belie;thatg;this�terource can provide at least 800 gallons per day;and/or t a ra minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) atisfactory Determination: This determination does net address adequacy of the distribution system,guarantee an adequate supply of water indefinitely in the fture,or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code.India 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: Applicants water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Rfviewers Signatures: (� Environ. Health: 7 M Date 0 (1 This form may be scanned and available for public view at www.masoncountvwaawr Peg,2 of2