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Home My WebLink AboutWAT2024-00149 - WAT Application - 10/30/2024 WATag2�. -�Qj�{Z MASON COUNTY I COMMUNITY SERVICES BuildiigrWmigFnriaimewl Nrllh CannuMHxM 415 N V Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 + Beeair:(360)2754467 ext 400 O Elme:(360)482-5269 ext 400 FAX(360)427-7787 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: Andrew Spear Construction Date: 10/28/2024 Mailing Address: 2000 W Shelton Valley Rd Phone: 360-490-0324 Parcel Number: 'L'ZZ 3351000(a0 Type of Water System Reason for Application ❑ Public/Community,Water System(2 or more O Building permit �Wo�a2'7'—�035ovZ connections) ❑ Division of land: O Individual water source(one connection), #of Parcels? SPL 0 Well Cl 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 PubliUCommunity 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: Water Facility Inventory(WFI)Number: (write"none".for two-party) ❑ 1 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. ❑ 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: 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 Date This form may be scanned and available for public view at www.mrnason.wa.us. 1-LII Poma D, k.,vW', Rcv 1125Re1P Individual Water Well El Water well report(attached to application). Depth 131 ft. ,�//((yy�� El Well capacity Test(attached to application) 15 gpm 7-6"� P . 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(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto:l/gis.w.mason.wa.uslolanning 140 15=160 220 Water use or limitation recorded................................... N/An_Yeses Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE pernit(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 on Satisfactory Determination: This determination does not address adequacy of time 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,The 6,Chapter 6.68.040-Determination of Adequacy for Builrfing 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 mason(s). Reviewer's Signatures: Environ. Health:� Date CSD Director. Date 2°f2 WATER WELL REPORT DEPARTMENT OF Naiceofwmd NL WEM46 ECOLOGY DnigmadmWeUMT.L(meacom 1yP..rw..m smm orwabwpron ® commukn Site Well Nmne(ifmom thm oa wdl). ❑ Dvavmmiuion C Onpnnlimulkum NOl Na Wba Ri&I iLCWifinem No. Propee Um N Dmrcsi, ❑WWN60 ❑M iPl Aopmy Owler Name J811ma MCKav ❑r --ia9 0In,,.. ❑Tw Weu ❑qhv ._ Wdl Sued AM. 5170 E Mason lake Dr W CMabu11 iYW: MIIaY: — O New well ❑Apenlim ❑Pi— ❑k!E ❑CaNe Tool City CifBDRVBM' Cpmly MR8a1 ❑D e —, ❑odw, ❑De 0 Ak. O Mwtl.Rm Tbs Pond No. 22233-51-0009D dmemlm: INam.=,of Exdae B w.b 133 R. Wbevaimceappwedfarhiswell? Ely. (mm DepbofwmpkbewW 131 . L C. DeWY: Wa Ifyes,wlmrwM We vmaaree fort Camfl Lim D®,m Fmm To Thkkeu Sbd WCwwd lLatl N 10 a m a 131 25 im 0 1 ❑ m 1 ❑ I tim(seeiwmlimsw,m,2): OWWMa❑EWM O 1 ❑ �N i. 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OYa ONw MMEcdwad grevel,loam toMRe sand waYr 117 131 TY dwamn _ Deem area. mufti-colored gram,one bows swd WL Im 131 MbIW of ualiig imla oR �� 1m Pabp: Mendacmrer's Nane Ty HP_ I'ump Aodcph._t Da®ptlflaw :_ppm Wak,I eh: laN fi—ekvpiooeFowmuowkvel 222 A. Slic4-vp ofbp of well urwg 10 above poani aw( $Wic wamrkW eJ RtebxlopofwAmaiM 11ue 1W752A Amsun pevnurt_M.perspuert ixh Wb Anrsi ware,is<aemlletl by (sgtnM.m) WNI Tee.: WvaPumpu .Pnb,mee?LINO OYe b byw ? Ykltl_em wib_Ld:ewdowoeb_hw vwd_¢mwiw_a.enNewnaen_M Pied_Wm wiw_B.Ikaxdown efler_ten RmmmY tlme0aa-mm xkaa v.m wmwaxD-w.m k,d�M Rm was mpmwtlm kwn Time Wekr Level rime Wmleael Ti. Wrmfmrel oau orPaagkw.a Ibibr aw_rym wm_L tndown aflm_h:e Aw al 15 mm wakuman 120 R.m. 1 bm. Ipeb 10115221 n aMw_gpm hmperona ofwmm 40 'F wue iemkaluwysh mm? ❑Ya FI No $wd Dae 1W11RI Complded Dwe 1W1524 WELL CONMUMON CERTIFICATION: I ppnalrlxlN wWa accept rapaabiliry famalrafim ofNu well,end im complwae with all WMh'vMlm well conswdien awrdmds.Maewals used Md 0m wfolrlaion repotted awve ere Iae to my pat krmdedg wd belief O IXilla❑Trdna❑PE-Nwl Naa Dnlline Company fviceda Daft Inc. 5 Mwture // ® Address Fro Eoa 1]00 Ucrose N.. 2874 City Sww Zip SheRan WA 08584 IF TRAINEE:Spwmor'S Lkaaw W C.wcrar'a Spopspr s Siym9a Reeimmlion No.ARCADDID3BK1 Dam 1011524 ECYD51-20(Rev09/I8) Ifpu nad Aka umwa In an allemNfomal,phew call de Wame Aewu Pmgam w 360407{d]1 PersaowilhheadWWswnmll]Ilfo WWinBron&iaysrwce. Pema wlfha. ech&m&lfrymnrall8774336341. vanguard Laboratory , 2635 Parkmont Lane SW, Suite A Olympia WA 98502 pugomyD 360-%7.7010 COLIFORM BACTERIA ANALYSIS FORM ore,Sam&Cdktled Time Sample Cowrty toll im 10/23/2024 MASON a a ow rva ow Y. Type of Wake 9ysbm(dwrA ady and bm) ❑GMpA ❑GMpB ■Ctlwr Gram A and Caap B Brokers-Preside fiom Waller Facilities Iv"(W FI): Dry 3ysbm Nww: JAMES McKAY CMbdPewax Arcadia DrNsy,Im Dry Plwnw(360 )4263395 Cel Phoro:( ) E d: Eve.Phmw:( 1 Swd�W klarml Nr sere,aidue mdrYmw waauiD eab 6eio�ama.�nrg Im�d�u.mm SAMPLE WFORMATION Sw*cdbMd by(name).MAX Spedk baba whwa wmpboalbdd: SpatieliretrucGore acamwnE: 5170 E Mason U 0,W,Grapeview Typedempe(sebdo*or type Of sampbhan Was 1 bough 5 beba) 1,0 Radba Dendulkn Sample tW 2.O Repwt Sempb(AIP) Cbbnna@d.Ya_N. fired disNbuwnsysNm Mwumat mutw) UrsaYsleclwy motme lab renter Chbdre Residue,Total Free_ 3.6 oImal Wate,ftle SommlIe Sample Ursab,%*gmWwooWdW: I _J�_ ChMswbd:Yw_No_ ❑Ttlggemd(AR) ChWWResWW:Tobl_Free_ ❑Assessment(AR) 4. Surbcs or GM Raw Ssacs Water Swsqe(Enapmsb6) s E.M❑ b El Fecal RbM Yw_w_ 5.®Sarple Caretrd ter blamWw Cary: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑ursedatadory Taal Canons Piaem and BI sese-dam ❑EwSpwem ❑EcoN al,ad BwWWDwm4Rw :TOWCCRam HOOrd, EMI' HCCmI. Fecal Coliloim HCpd, NPC Hai Ragxamem Sam*Required: ❑TNTC [I Sample aso old ❑ Sample Volmae ❑Damaged M iew ❑ rya I.M Relerera Numbw-` b Pamlo'T'"Pc' "'"°°`°"' SM9223B aw lbgvwtl b CCf 1 Ieb bw or4 OeM145n' alas 285-02818 m.sa��.aa ..amara.a,....a...®sae, aMnvy,m