HomeMy WebLinkAboutWEL2008-00073 - WEL Application - 2/23/2009 MASON COUNTY
PUBLIC HEALTH .
I
426 W CEDAR ST, PO BOX 1886, SHELTON WA 985M
Stel (360)427-9670 ELMA (36C)482-5269 BELPAIR (WC)2754467
VVEB hdo/'wwwcomasonwaus FAX (360)427.8442
"23OF A TWO-PARTY WATER SYSTEM
T2009
nn Number: VOBL: Attach to exls'Complete Part 1,(475.co Fee).Incompiete appGcetivaS wig be letedetl. Make sure all required documents have been subminetl h e.well log,Water
serlgle and rewid�aocpmenls)Submit appacoaden and appropriate fee(s)W the Meson County Health Dept.
PART 1:APPRcant I Parcel IdendRcatkM
Water System Name Adventure Venture Systems
Site Address 185 E Capitol Peak Dr.Shehtoln WA 98584
APPli ant .� V'8-1 PtUt-P_5( 1.�. • Phone (so3)BzsaloB
PO Box 898
Malting A dress
Coy Sandy Slate OR Zip
Parcel Number 32130 75 00010
Directions to Site Brockdale Rd to Jereen RcL.Amost at end ofl Rchattop ofsteephill)W d Strait onto
Capitol Peak Dr.Take a left at the'T'/'Y",then end of road is a loop,go done driveway to Garage
_A
PART 2:Health Department Review(Staff Use Only)
_yES NO NA P�
a�'21 ❑ ❑ if ater Well Report atlequaCe pump test Dollar GPM
If no,date of mpaggy,test Dnikr OPM
0 ❑ Received Sa85factory Bacledobgical Are lysts?Data of t"L A442q C9
Received Signed,Notarized,and reforded Agreement or NotrceT
❑ System appears adequate to serve(wa single-family residences based on mfomletipn provided?
System ApprovedlLM System Denied'.
'COMMENTS. / '.
01
Sanit 'a Signet= te
Unfiled Notes Pa¢e 4