Loading...
HomeMy WebLinkAboutWAT2024-00374 - WAT Application - 11/7/2024 wAT a0 - D 3 MASON COUNTY COMMUNITY DE VELOPMFJif C E IV E D Permit lance Cnim.euiidinc Namm,, t�,II((�I ((�i��44 584, Shelton: (360)427-9670 ext 400 5} Belfai�360)2,Bldg 75-446 exl 00,Shelton WA 60 Elma:(360)0526�.2T2AO FAX(360)427-7767 615 W. Alder Street Application for Determination of Water AdequERVI RON M E NTAL Instructions HEALTH 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 r1 Name on Applicant: Date: (JUl � T Mailing Address: UA t1�wr QaKSCI3F.Tu119WMty Phone: 5lt0- -1q 1- 0195 Parcel Number: 511014 11 000�- Type of Water System Reason for Application I� PubliclCommunity,Water System (2 or more qll Building permit e)Lpaday-bJ` 3 connections) ❑ Division of land: ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Springisurface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel(please indicate name ff you have more than one residence connected of water system below if applicable—no to this well, check the PublicYComin ity Water signature required) ? System box. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Walter System,., Name of Water System Water Facility Inventory(WFI)Number, (write"none'for two-party) XI am the manager of this system.The water system has been approved for services. There are presently connection(s)in use.This will be the 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 top vide water to this(these)connection(s)without exceeding the limits of the water system or any limi t by qate and local regulation. Signature of Water System Manager Date l 1 Z This form may be scanned and available for public view at wwir.co"mason.wa.us. LTH Farms\Drutl,m,Water Revived 1125201M Individual Water Well Water well report(attached to application). Depth s�7-N� 4 —/ft. �.l ,�1 ell capacity Test(attached to application)�gpm V v 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 data, must be performed by a licensed contractor. Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto://gisco.mason.wa.us/planning 14015[=16=]22F—) Water use or limitation recorded................................... N/Aj=Yeses 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 W DOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Tide 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: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). ,yn CR�erviiewweees Signatures: Environ. Health: F J Date CSD Director: Date 2 ot2 to / } \ 0 2 @ § Ljj W L . 7 C_ / f . / . G . . . � . . . . . . . . a .. . .. . . .. . . � . . � � . . „( ! � \ Ae t ! ! { , . | / ! ! / , § § H §j | w! | w]• ! j d§fit IMIMAP111 • w= � . . ! : ` \ / . ton g. ) ! � • ! \ ( � a $ | • A£ , / H \| Q ! � ° © m ` |2� ! • ■ | � � yam q Q � • � �% �h ® � � ! | @ ■ � / &i\ ! /� � 55 E |� �\ ! \ \ � � R ; 6�nao�� -o►337 ENVIR�" `:IENT"dlaDri0inglnc. P.O.Box 1790 _ - 'V E D HE, Shelton,WA.98584 Customer: Logan Spear Well Tag#: BPF197 NOV - 7 2024 Site Address: SE Lynch Road Depth: 202' Date of Test: 7/31/2024 static: 95' 6'. z) W. Alder Street Pump Set: 140' TIME GPM LEVEL RECOVERY 1 Min 3.5 96 TIME LEVEL 2 Min 3.5 96 1 Min 98 3 Min 3.5 96.1 2 Min 97.3 4 Min 3.5 96.1 3 Min 96.9 5 Min 12 96.1 4 Min 96.9 6 Min 12 98.7 5 Min 96.9 7 Min 12 98 8 Min 12 99 3 9 Min 12 99 1i 10 Min 23 99.1 15 Min 23 103 20 Min 23 103.4 25 Min 23 103.6 30 Min 23 103.9 35 Min 23 103.952 40 Min 23 104 45 Min 23 104 50 Min 23 104.1 55 Min 23 104.1 1 Hr 23 1 104.2 1 Hr 10 Min 23 1 104.3 Vanguami:aoonmry ab2"t—p43 � 2635 PatkmonLL aae SW.Saito A Olympia WA 98502 T Q 360-%7.7010 COUFOR H BACTERIA AMYSiS FORM R r- E 4 V E D DWSW4 Uam TknSww rA OSM?/2024 uFe�a ow mksc NOV - 7 2024 "r 615 vv. Alder Street Tim dwo SSA"tdmd Q*m bw DBmwcA ❑Gmws now eavAndemse6Faleas-9�cYNabamWer Fa9aukw FM4$ fN�,. -,,tea D - _ - _ _-._ - vI fNTAC rewA= LOGAN SPEAR *N cnmr.Wh Am"$D Mq,eY Ema. Ere.Pnona{ I. [I�t 9e anr.atlwe Ni4mh a sw6 SAIMLE WFORMATNIN '. sac.mamam(t ,),SHAD Sp kIomwvftm ammo RfuY+waaaarcawmnra foPFi9T SE LrCh Rd,&*Non .. TI'pMLapY4wladmN'amhPol.<mpbiawbMstlmy�shab�i. z0RWWSM*b ." Gebkoka Y%_—„-,Ra_ a waweeR.ew n ptlminx RusUaa.ToW_Frce_ �. un.�mgmmneane�maec 3.araeelYWer WNSaww anFU taamlK9CtlYc Tl^J— CMo�abe:YeA_eq__ OT%Wedvm CNmtmReo&cl T* _FWL___ e. NmwaaM Rzir6aaeeaW aeeM>✓e tE+A l 1 S t t 1 IIEdae OF+w aw+u_w__. 1�1�1.--1 5 is�Gotlxxab mMrtWbn 4y'. LAB USE ONLY WBNNNN3 WATER RESULTS V.B.USE ONLY. Dcmeoe»a DC40ab a B"MD=*Reeuw:TgdCaNum_.__,Ji " EmY___fWft R aaeWeR 01WM Dana xacm -. SO. jm•.e —__ 9$ sy�17.4 Ila 30 rr . e1p°0Q"Ae SM9223B ar Agee *Dw leblffiaer 2W