HomeMy WebLinkAboutWAT2024-00397 - WAT Application - 12/12/2024 MASON COUNTY
COMMUN]ITYeDEVELOPMENT
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415 N e Street,Bldg 8,Shelton WA 98584,
Shelf=(360)427-9670 ex1400 9 BelfFAX(360)75 7787 x1400 4 Elma:(360)4825269 ex1400
Application for Determination of Water Adequacy
instructions
1. Complete Part 1. No determination can be made until Pad 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: PWW PROPERTY DEVELOPMEDate: 12-12-24
Mailing Address: 11 E FLAGGWOOD LN Phone: 360-490-5106
Parcel Number: 32104-56-00001
Type of Water System Reason foorAppplicratiop(,
O PubIIGCommunity Water System (2 or more El Building permit w)275 —
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels?_ SPL
❑ Well ❑ 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 weft, check the Public1community 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
F
ter System:ty Inventory(WFI)Number; 01f13one"for two-party)
manager of this water system.The water system has been approved for services.
re presently connecfion(s)in use.This will be the connection.
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: _j -'"`yr?- 4„ /lC iiV'e
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 bX state and local regulation.
J)A4urt Signature of Water System Manager UC /G. Date 12-12-24
This form may be scanned and available for public view at lme,oa rnsnms
JW1 F.in\UnAi,Weur
Individual Water Well
I
❑ Water well report(attached to application). Depth
ft.
❑ Well capacity Test(attached to application) opm 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 at,
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).
it
Water Resource Inventory Area WRIA)
Development within which WRIA httol/gis co.mason.wa.us/glannina 14=15[— 16022E=]
Water use or limitation recorded..................... NIAJ= -Yes-0-
WellDrilled............................................................... Date
Individual Spring/Surface Water
i
❑ 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. i
Author of Statement Data
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 668.040-Deternination of
Adequacy for Building Pernik are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
❑ Unsatisfactory Determination:
Applicants 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
3 0[2
CSD Director: Date