HomeMy WebLinkAboutWAT2024-00331 - WAT Application - 9/18/2024 WAT 2o2.A - 0o3�,1
MASON COUNTY 415 W 65
S WA 9884
Public Health & Human Services R eta 21;EExxt 4400
SFp 18 20211
Application for Determination of Water Adequacy
615 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
Name on Applicant: AS Fine Homes LLC Date: 9/4/2024
Mailing Address: 871 E. BEACH DR. Union,WA 98592 Phone: 360 8980055 ext 3
Parcel Number: 32104-50-00086
Type of Water System Reason for Application
v Public/Community Water System(2 or more W Building permit
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ 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 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: Alderbrook
Water Facility Inventory(WF0 Number: 01050E 00te"none"for two-party)
❑ 1 am the manager of this water system.The water system has been approved for 636 services.There
are presently 538 connection(s)in use.This will be the 539 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.
Print Name of Water System Manager Brandy Milroy Phone 360-8775249
Signature of Water System Manager o , Date 09/1212024
This form may be scanned and available for public view at www.mawnwuntywa.aov
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Individual Water Well
❑ Water well report(attached to application). Depth k.
❑ Well capacity Test(attached to application) apm 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 rapacity test,which provides stabilization of draw-down and recovery date, must be performed
by a licensed contractor.
❑ Satisfactory bacteriological test(attach to application).
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)
SatisfaMory Determination:
This determination does not address adequacy of the distribution system,guarantee an ad supply of
w Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040-0ete of
Adequacy for Building permits are satisfied. Additional Growth Management requirements may apply. relf
36.70A RCW. �`,,//
❑ Unsatisfactory Determination: MgSONC 00).
Applicant's water supply does not appear adequate to meet the needs of its intended use4,"follow My71
reason(s).
Reviewer's Signatures: O N�Nrq�h»,
Environ. Health: Date 10 1 ZO
This form may be scanned and available for public view at www.masonmuntywa.gov
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