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HomeMy WebLinkAboutWAT2024-00394 - WAT Application - 12/9/2024 WAT -� MASON COUNTY COMbnce RMerMUNITY DEVELOPMENT PermilAssls .auildi�p;.PWnninB 415 N 6-Street,Bldg 8,Shelton WA 98584, ___ D Sheton:(360)427-9670 ext 400 b Ralf(3(660) 4 S�6f7 xt 400 b Elma:(360)4 -ny FAX Application for Determination of Water Adequacy DEC -9 2024 nmaGTA set lete only of(Part 2 applying tothe type of waterucennectrontuulized.ion,with an required attachments for review. ENVIRONME TALit comple y roved bIan must accom an this a Nation. n i_ Part 1: Applicant/ Parcel Identification 12-04-2024 Name on Applicant ais Uarbonneau Ale Dale: hone: 5t5-788-9t17 Mailing Address: 4466 wa-to&sheaon,WA 98584 P Parcel Number: 41927-33-00010 Reason for Application Type of Water System �, 'ptll� Oil u y U Building permit� 7 ❑ Public/Community Water System (2 or more ❑ Division of land: connections) #oi Parcels? SPL Individual ter source(one connection), ❑ Boundary line adjustment Well ❑ Spring/surfaa water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel (please indicate name Of water system below K applicable—no chec if you have than one residence connected signature required) to this well, check the Pubtic/Community Water 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. an or use an ❑ i am the connection on 9his�ystem(i.e.-this ecrheational to full time) Pleasis connection will be to e indicate de ate onnh a olllowinglline the existing re 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. ao Signature of Water System Manage - -- - — - — This form tray be scanned and available for public view at •W o ma�n waorn J.\ Fm -\Dsiak warn Individual Water Well Water well report(attached to application). Depth se ft. Well capacity Test(attached to application)_ zo °Pf°�Pd. The well driller often Performs well capacity tests at the time the well is wristruaed. 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 drew-down and recovery data, must be performed \\,,,, by a licensed contractor. �tisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA hftp://ois.co. n8son wa u r lanninq 7 42�15� 1 220 Water use or limitation recorded....,,.,. N/A Yes WellDrilled .....................................I.........I............... Date 4+2022 Individual Spring/Surface Water ❑ 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. Author of Statement 61B1 ae _ ram Relationship to Applicant Part 3: Mason CountY Community Services Evaluation (staff use only) Satisfactory Determination: is 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 ragulations. Recommended approval indicates requirements of Sanitary Code.Title 6, Chapter 6.68.040-Determination of 36.70AAdequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter Adequacy RCW. Ej Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following mason(s). Pq"Ce i wer's Signatures: Environ. Health: Date CSD Director: Date of, R ����� ENVIPON ,RENTAL HEALTH mRRECr® PARCEL wnac 9 2024 nl Ider Street 0[P/:0.LM[Ni Of Nul:U of lnvry No wEQ1 � F \ WATER WELL REPORT ECOLOGY Unque—IM Wdl 1D Ty Na 1 SaneMwnhYMr¢n Snc Wdl Nam¢(I(macllwl one ry � Cwwnun Wpm 0.ighl P«miuCcnrrcde No. O Dmemn.:m o Qi0^d aolYum NOI Ne. ❑Mriepd Property Omer N¢mc Prgbee law ®0.uMi< ❑ .-4 ❑OoaabaW ❑InWm ❑T.Wdl ❑DIYe Wrll S1rM Admen Al§ S R 1 MCHeI: Cib Ilm Cw 41nY 92 0 Ca�bsd�TPR: ❑D,;,,a ❑alr ❑cca T.¢I 7-33-00010 o ❑� ❑oy ®<,:. ❑udLa.rr rn Purei no - m5q M1. wnavar�arte apposd rw @u welll 0Y. NO Lr`bw a»M¢ W 88 t I(Yn,uA¢t was the vot'mr[e(a� Oeul: WA wC w.uM lar..e f3 WWMa❑EWM Cwbaeioa Fbn T¢ 1Ndau Se0 13d ❑ Locniw(seeiwrucliabmpyc 2): O ❑ ^-'n. u aL D2 m ❑ I ❑ ❑ ❑ vvorde_�w v.;Sacdon TJ To".M'W Rerg¢_21"L ❑ 1 ❑ -- --m ❑ I ❑ ❑ 1 ❑ O[iwdc(E mNe 47 i2M5)R.1 N ❑ 1 ❑ llll -- n ❑ ❑ ❑ 1 ❑ Laoptlde(Eomd¢.I20.IiH5) 'S w ❑ 1 ❑ --N, -- —' n-•hramr 'ieu,6...oeodnM Pnc[arc Permnd¢b: OYa N. 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