HomeMy WebLinkAboutWAT2024-00345 - WAT Application - 10/10/2024 REI,wAT 80a2 - Lb3
411 N.6°Streit
MASON COUNTY Shelton,WA 98584
OCT 10 W24 Shelton:3 6042 7-9 67 0,Ext.400
COMMUNITY SERVICES B06ie 360-2754467,Ext 4W
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EQ, b MENIAL
Application for Determination of Water Adequacy HEALTH
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 aeproved building site plan must accompany this application.
Part 1: Applicantl Parcel Identification
Name on Applicant: Jahnee Dragoo Date: 9117QO24
Mailing Address: W7 SE Eaton Blvd Battle GrourM,WA 996W Phone: 56"12-9507
Parcel Number: 320215301044
Type of Water System � Reason for Application
Public/Community Water System (2 or more Y Building permit BLO
connections) ❑ Division of land:
❑ Individual water source (one connection), #of Parcels? SPL
j ❑ Well ❑ Boundary line adjustment
91 ❑ 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: Shorecrest Estates Water Company
Water Facility Inventory(WFI) Number: 78620-1 (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.
d 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: Existng 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 Kdstis Hutchinson Phone (360)426-0773
Signature of Water System Manager Date Sept 17,2024
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This form maybe scanned and available for public view at mnny co mason.Wa.us"
LtEF1 PormsA priN'3ng Wale' R,,,M 4RD2021
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Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) qpm 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 lest,
a well capacity test,which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
❑ Satisfactory bacteriological lest(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA httoi/uis co mason.wa.us/gLanning 14_15_16_22_
Water use or limitation recorded..... ................... N/A_Yes_
WellDrilled ............................................................... 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 Eday;andlorprovides water al a rate of 2 gallons per minute based on the following observat
Author of Statement Date
Relationship to Applicant
Part 3:, Mason County Community Services Evaluation staff use only
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Satisfactory Determination:
{ This determination does not address adequacy of me distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resou gulations.
Recommended approval indicates requirements of Sanitary Code,t N
-fife 6,Chapter B .090- n of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may a r
3 36.70A RCW. O
1 ❑ Unsatisfactory Determination: P
Applicants water supply does not appear adequate to meet the needs of its intended u ��e fo
jreason(s). ryFNi„
t Reviewer's Signatures: ✓q�Ng1F,h,j
I Environ Date. Health: r/y
This form may be scanned and available for public view at www.co.masen.waAm. Psr 2 ore
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