HomeMy WebLinkAboutWAT2024-00371 - WAT Application - 10/30/2024 WAT 2024-0 371
COUNTY N,bas
MASON 9a4
SYnlmrt]WA2)-`16]b.ExtA�.
40 Public Health &Human Services
adiaiclN}2t5-0iG¢.hµfW
Application for Determination of Water Adequacy
InatretNOna P 1 N wmh^nmationcanbe maleunti 1.VOYC Wn Nliie
IrII' Complete ea of Pen 2 ePPMna la iM rype
Complelb on)dre Pomon uiredattechmentslorre+ii
3 Subma campble4 application wim any rag
p An roved bu Id n s@e Iedm��t accom an this a lieatan.
Part I Applicann Parcel identification
Date trno¢s-------- .
Noma do AOpikantKpe{alfhei ---.. Pnorre. 3fi —
mdm9 Address:
'Parcel Number.. aarfze- ----_—._
Reason for Application
Type of Water System Building Parma
❑ pWlluchmeeM water system(2 or more ❑ nNision of land_
connedwas) p of percale?_-____ SPL
pis Inciedualw�er source lolu tan^actlonl. ❑ Boundary adlusbaent
c` vlwt Inai
❑ Spihngrsuribi0aatar z ❑ Olher(asplain)
❑,Mer(explain) ❑ Replacement Remodel or Remodel(Please indipte name
otwater system bebw rf apphcabla-no
I(Yat+nevemfra Nan unb reaMark¢ a81etl sl,hature refiulred)
to tds wait meek the put eirrat Y.W
System hox.
Part 2: Water Connection Information
Complete the aedioe-ppepdafe ror the type of wdtt"Onnecbon being evaluated
Public Water System
Name of Wafer System
(V!M¢ On2 IOf Nr0-Party)
Water FacIISY lvvemory lWFl}Number
ved for_ services Them
il Ism i,e,,ahhger olth5 waheaYhha" The wMar system has Been apPwnpei
PresenNy T,�wnnec4o�r(s)in uea.Tfia kbatha�.---
� � am the mxnagu ot[hasYsla'n TMaxwnrledl�na�Aa�uS9rade or charge the
res eaon Pn ihls syx[em{ta..
PlaaSe indkatean Sha rollow'l9 tna the store of
tfus change;
i � r°YeNw°
Icao'nnectld whodl axreg the l
The salxaYafamisabpedw�a9 daw✓ Aa1eF at
!�etsd the waaatdhtaAYsivelo � �
�.. Para NamaM,wb&ar 'rlAn;ihk!!�tgar Phony I
�... glpnalrAouf Date _ �:
Individual Water Weil _ __--�
ft
g water waiter od late...dwapptic hu" oeplh 11 >40U
Well capainV Teat letlached to aDDlliaoonl
apm gpd.
DI
Tne welt tlrilkr often perlbrrtH well..,ectly tests at thetlma the watt I t conaheat6 Reeuif the were,
IKRat or a the water well mead does rat have a oap-ay teat,
these IesK ere noted on the wafer well report Rasuda Irom IDasa testa will tla5e�m ed�lf ttl
we,reped cannot be toceletl b ner the s
a well capacity test.which nrovMes steblizetpn of draw-down and recovery
ey a I,,a,coatrador.
Sat-sfade,y baderblog-c"test i"taoh to ap eavenonj --
Individual SpringiSurfaeg Water
_--_
(') t9D0E pent t/attach to appticetion)
i� Ma'hea of disneptac__ II
r e reaxr o he e ve that this water source can provide at%.at 800 9ailona par day.andlw
pm.des wai t at gate of 2 9a Ions per minute based on the followitg observatbns. —
Data
Author of Statement__
,,onsh.p to Apphcoet
Part 3: Mason County Community Services Evaluation(staff use only)--
.
her,ah
Sausfadtory patarmination
TMs detertnawiwn dwa aCdreea adequacy oilhadWnWhon system Ie9w90E adequate
rag ula
of
wale,re ions
wsYar aAabrulelY in the fWuro-1 or guwanjae C,Om411'°PrA t`^Ih all app4eab
Reruntrnedtlad approvq MdlGeka rprylrar,gilla rif 8®a#&Y CodQ•7rda 8 GM1aprer B. 0atem nation, of
Mar,aOantani requirementsmenth may app r :CnaDfm
Adequacy bBukrlg Permlb ere eaaaaed. gRam,
381M ftCW �. `f* Cti
�: UixarlafaMory Deteraf yc � :� ;r �MrWed use for ire loikvnn9
Appliram'a webP eaPpiY
r¢amrMah ?y, .- .,4312i724
x
CURRENT
WATER WELL REPORT Notice offliemt No, A fR 27�
r i••u 0ngivJ dt tee apy- ,eWff,god aPY'°
& Wj
�EED Dnque&Oogy Wen roTagNn.
f cnstMO OrnlsRctiom/DKOM1["°R("'-w'i`") JUN 13 2003 water Hight Pun"tN°'
•'.�'. p�Dxosnmussion ORIGINAL CONSIRUCTTON Nonce n /
//l✓ '� { Y TOW /
O of fw n Nronber OEPARTNENT OF ECOLOGY property O Name
O" MuviciW We11 SDeel
PROPOSED USE: Dooxctic Iodusvld
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❑MWOe hdgadw NestWa O .CityAn R n HWM cire4
W PEOPwOPA: tTwnrfa°umber of wclt(if mos rhamu°el lyR.ytimj J4-1/1//G1/d Sec1L Two1= eJ�one
ew WeR ORemvdid°oed Mefhad'ODug ❑Hard ❑Dm-
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O CONSTRUCTION DHTAD.S �� CONSTRUCTIONOR DECOMMISSION PROCEDURE
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O WELL CONSTRUCTION m.RTRHCATION: l cwnwwv dmid/os aecept tesponsihilily fnr OOnsm1fim Of this well.and in mrnplisnce with all
Wealdngmu wen wmsuucaao atardards.Mazeaals used end the infoOVT reported shove are true m mY best krwwldge mtd cL
y tNr' )billing Company ✓�.'
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