HomeMy WebLinkAboutWAT2024-00340 - WAT Application - 10/3/2024 WAT Alm 1 40
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MASON COUNTY Shelton,WA98584
COMMUNITY SERVICES Shelton:360-2754467,Ext.400
aEl.:360482-5269,Ext.400
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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 plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: ;:Tao 'cor..- Date:
n
Mailing Address: 70 & 132E Phone: 3LB.G P'P� G827
Parcel Number: IX.267- 79- 00570
Type of Water System Reason for Application q
❑ PublicJCommunity Water System(2 or more :pa- Building permit �W�W-Q«7 /
connections) ❑ Division of land:
❑ Individual water source(one connection), fl 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 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
){
Name of Water System: t V d1 W a" J a(pleM
Water Facility Inventory(WFI)Number:
(write"none"for two-party)
-;5X 1 am the manager of this water system.The water system has been apprd for Z services.
There are presently connection(s)in use.This will be the connection.
❑ I am the manager of this system.This connection will be W 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 G ,a.k Date_ W )
This form may be scanned and available for public view at www.co.mason.wa.us.
J:1En Fame\Dno gWam
R—,W 4i4n01s
Group B Water Systems
❑ Satisfactory bacteriological test within last year(attach to application).
Individual Water Well
Water well report(attached to application). Depth lvil
Well rapacity Test(attached to application) pm
7 LCOC7 opd.
Ill�i
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 within last year(attach to application).
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)
atisfactory Determination:
w his determination does not address adequacy of the distribution system,guarantee an adequate supply of
ater 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.
U Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Revlev�rer'sSignatures: C�13 h�
Environ. Health:�'��4 �w Date
This form may be scanned and available for public view at www.masoncoun�a.aov
Page 2 of2
Davis Drilling
340 NE Davis Farm Rd
Beijair, WA 98528
275-5367
Test pump for: Juan Rivera
i Project: 1950 E Rasor Rd W,Belfair WA
Pump: sub
Well Depth:
Static level: 52'
Date: 01/18/2024
Well ID:
Draw Down
Time Water Level Flow GPM
0 min 52' 0
5 min 71' 17
30 min 72' 17
1 hr 72' 17
2 hr 72' 17
Recovery
Time Water Level
0 min 72'
lmin 62'
2 min 681
3 min 67'
4 min 66'
5 min 66.5'
30 min 52,
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