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HomeMy WebLinkAboutMEP2024-00020 Restore for Bldg site - MEP Application - 9/9/2024 MASON COUNTY Mason County Permit Center Use: COMMUNITY SERVICES MEP 2.02A - ()102n Building,Planning,Environmental Health,Community Health Date RcvR EC E I V E D 615 W.Alder St.—Bldg.8,Shelton,Wa 98584 Phone:(360)427-9670 ext.352 ♦ Fax:(360)427-7798 SEP 0 9 209-)4 QMASON ENVIRONMENTAL PERMIT(RESIDENTIAL):$115 `0 HABITAT MANAGEMENT PLAN:$300 615 W.Alder Street ® MASON ENVIRONMENTAL PERMIT(NON-RESIDENTIAL):$1500 OCONDITIONAL USE: $2000 Mason County Resource Ordinance(Chapter 17.01 MCC) ENVIRONMENTAL PERMIT APPLICATION .,. The purpose of the Resource Ordinance is to protect Mason County's natural resource lands and critical areas and is under the authority of Chapters 36.32,36.70A, 39.34, 58.17, 76.09, 84.33, 84.34 and 90.58 RCW. PLEASE PRINT 1. PROPERTY OWNER Name: Mailing Address: t/$2 � s� +fit 4`w GT Work Phone: 0 Home/Cell Phone: 3 Gv ! Email Address: JiOty - e 9 5 Q 4 1 an agent is actin or the property owner during the permit process, complete #2. 2.AUTHORIZED AGENT Name: Mailing Address: Work Phone: Home/Cell Phone: Email Address: 3. PROJECT SITE Site Address: G -1 Parcel#: Z qNq Legal Description: Directions to Site: 2 08 Attach a site plan showing a following: Lot Dimensions,Flood Zones,Existing Structures,Fences, Water Lines, Driveways,Drainage Plans, Shorelines, Septic System,Topography,Proposed Improvements, Easements,North Arrow, and Scale.Also draw a separate topography diagram. Rev.August 2022 4. State which section requires permit: ❑ Long Term Commercial Forest,Chapter 8.52.060 ❑ Frequently Flooded Areas,Chapter 8.52.130 ❑ Mineral Resource Lands,Chapter 8.52.090 ❑ Geologically Hazardous Areas,Chapter 8.52.140 ❑ Critical Aquifer Recharge Area,Chapter 8.52.120 ❑ Seismic Hazard Areas,Chapter 8.52.150 ❑ Erosion Hazard Area,Chapter 8.52.160 ❑ Fish&Wildlife Habitat Conservation Areas,Chapter ❑ In-Holding Lands,Chapter 8.52.070 8.52.170 A'Wetlands,Chapter 8.52.110 5. Identify current use of the property with existing improvements: V AC A/1� >> 6. Identify and describe the proposed project,including the type of materials to be used,construction methods, principle dimensions,and other pertinent information(attach additional sheets, if needed): Am,J 7. Describe why the action requiring this permit cannot be avoided. T 3Ae1 need 4-z, r �� � 8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes® No O 9. Identify any surface water on or adjacent to property(circle one): Saltwater © Lake ® Stream O Pond O Wetland© Drainage Ditch 10. Identify existing septic/sewer connection(circle one): If septic is located on project site,include records. Connected to SepticQConnected to Community Septic© Connected to Sewero None Existing 11. Identify existing water supply(circle one): Public Water Supply Q Well 11. Type of Job (circle one): New Add 0 Alteration 0 Repair 0 Demolition 0 Other: PHnt Name SfgnCuW Date Rev.August 2022 An easement for the use and purpose of conveying water from the well to the property of (owner name,parcel#, name of subdivision,and lot number adiacent to well). Said easement shall be five(5)feet in width and shall extend on,over,across,and underneath said strip of land from designated well site to shared property line.No new permanent type of building shall be allowed to be constructed upon the water line easement except as needed for the operation of the well and water system. Maintenance and Repair of Pipelines All pipelines in the water system shall be maintained so that there will be no leakage or seepage, or other defects which may cause contamination of the water,or injury,or damage to persons or property.Cost of repairing or maintaining common distribution pipelines shall be born equally by both parties.Each party in this agreement shall be responsible for the maintenance,repair,and replacement of pipe supplying water from the common water distribution piping to their own particular dwelling and property.Water pipelines shall not be installed within 10 feet of a septic tank or sewage disposal drain field lines. Prohibited Practices The parties herein,their heirs,successors and/or assigns,will not construct any potential source of contamination, maintain or suffer to be constructed or maintained upon the said land and within 100 feet of the well herein described,so long as the same is operated to furnish water for two-party domestic use.Any potential source of contamination may include but is not limited to: septic tanks and drainfields,sewer lines,underground storage tanks, feed stations and/or grazing animals pins where manure can accumulate,enclosures for maintaining fowl or animal manure,liquid or dry chemical storage,herbicides,insecticides,hazardous waste or garbage of any kind.New structures and/or barns shall meet required setbacks and not harbor any potential source of contamination.The parties will not cross connect any portion or segment of the water system with any other water source or waste water disposal outlet without prior written approval of the Grant County Health District and/or other appropriate governmental agency. Provisions for Continuation of Water Service The parties agree to maintain a continuous flow of water from the well and water system,herein described in accordance with water supply requirements of the State of Washington and Grant County.In the event that the quality or quantity of water from the well becomes unsatisfactory the parties shall develop a new source of water. Each undivided interest and/or party shall share equally in the cost of developing the new source of water and installing the necessary equipment associated with the new source. 2 Party Shared Well Users Agreement 2 of 4 1 P a g e Restriction on Furnishine Water to Additional Parties It is further agreed by the parties hereto that they shall not furnish water from the well and water system herein above described to any other persons,properties,or dwelling without prior consent of both property owners and written approval from the Grant County Health District. Restriction on Water Use State water right laws prohibit this system from using more than 5000 gallons of water for indoor domestic use on any day without first obtaining a permit from the Washington State Department of Ecology.Also each parcel may irrigate no more than 1/4 acre of noncommercial lawn or garden. In order to remain in compliance,each proposed lot of subdivision,lot and lot is prohibited from using more than 2500 gallons of water on any given day for indoor domestic use. Further,the total amount of yard,garden and other irrigation used by each property cannot exceed 1/4 acre or 10,890 square feet. Termination of this Agreement This agreement may be revoked at anytime;however,it may not be revoked without each property obtaining a sufficient acceptable potable water source and prior consent of both property owners.Termination of this agreement shall require the property owners to provide: 1)proof of a notarized revocation of this agreement and 2)proof of the potable water source for each property to the Grant County Health District for review and approval.After, review and approval by the health district the property owners shall then file: 1)the notarized revocation of this agreement and 2)proof of the potable water source approved by the health department for each property at the Grant County Auditor's Office as a recorded document that runs with the title of the land. Heirs. Successors. and Assigns These covenants and agreements shall run with the land and shall be binding on all parties having or acquiring any right,title,or interest in this land described herein or any part hereof and it shall pass to and be for the benefit of each owner thereof. Signed: Owner(s)of Property with the Well Print Name: State of Washington ) )ss County of ) 2 Party Shared Well Users Agreement 3 of 4 P a g e I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this day of ,20 ,personally appeared before me to me known to be the individual(s)described in and who executed the within instrument,and acknowledge that he(she)(they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. Notary Public in and for the State of Washington, Residing in: My Commission Expires: Signed: Owner(s)of Second Property Served by the Shared Well Print Name: I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this day of ,20 ,personally appeared before me to me known to be the individual(s)described in and who executed the within instrument,and acknowledge that he(she)(they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. Notary Public in and for the State of Washington, Residing in• My Commission Expires: 2 Party Shared Well Users Agreement 4 of 4 1 P a g e