HomeMy WebLinkAboutWAT2024-00338 - WAT Application - 11/12/2024 WAT -
415 N.@a Street
Shelto WA 99584
MASON COUNTY r
Shelton:360-275 4467,Ext.400
0 COMMUNITY SERVICES
Belfeir:360-275-awy Ext.400
Eli 360482-5269,Ext.400
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. Ana roved buildingsite Ian must accompany this application.
lication.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Talonna Hanft Date: 11/07/2024
Mailing Address: 130 W Prairie Loop Rd. Elma WA 98541 Phone: 360-791-8568
Parcel Number: 519085000097
Type of Water System Reason for Application
b/ Public/Community Water System(2 or more ❑ Building permit
connections) ❑ Division of land:
❑ Individual water source (one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
ElSpring/surface water ® Other(explain) Completion of 94'Home Inspection
❑ 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 Wafer 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: Star Lake Community Club
Water Facility Inventory (WFI) Number: 836809 (write"none"for two-party)
IaJ I am the manager of this water system. The water system has been approved for 279 services. There
are presently 182 connection(s) in use. This will be the Existing connection.
-C-6-nn-eclion
❑ 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 ,,/yM,�e�lissa Cox on behalf of NWS Phone 360-876-0958
Signature of Water System Manager,7P1P(Isill (•ib.lron behalf of NWS Date 11/07/2024
This form may be scanned and available for public view at www co mason wa us.
1:\EH Foma\Drinking Water Reviud 4/M021
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpm apd.
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 test(attach to application).
Water Resource Inventory Area RIA
Development within which WRIA http'/lais.co.mason.wa.us/plannina 14_15_16_22_
Water use or limitation recorded................................... N/A_Yes—
WellDrilled ............................................................... Date
Individual Spring/Surface Water
❑ W DOE 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 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.
G Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: ` Date
This form may be scanned and available for public view at wwar.co.mason.wa.us.
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