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Home My WebLink AboutWAT2024-00372 - WAT Application - 11/5/2024 - - MASON COUNTY WAT ZDZ , COMMUNITY DEVELOPMENT Mml[/u:lsbna tenter,galeng,aamim 415 N 60 Street,Bldg 8,Shellon WA 98584, Shelton:(360)427-9670 e t 400 4 Beralr(360)276-4467 ext 400 4 Elms:(360)4B2.5269 ext 400 FAX(360)427-7787 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 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 dentification Name on Applicant: ny.K Date: 2d2,�1 Mailing Address: Phone:�,I a, a 5 'n4TT Parcel Number. 77 11'-�-'� I- L IU Ali"— tJJA'J 66Z4 Type of Water System Reason for Application ❑ Public/Community Water System(2 or more Building permit -61el 74V-4-0 133Z 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 well, check the PublirlCommunity Water signature required) System box. C oO�� Part 2: Water Connection Information d ��Z�� Complete the section appropriate for the type of water connection being evaluated: ` Jv" Public Water System Name of Water System: I Water Facility Inventory(WFI) Number: 0 nE / (wdte"none"for two-party) H I am the manager of this water system.The water system has been appr ved for ;� services. There are presently I connection(s)in use.This will be the 4 onnection. ❑ 1 am the 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: This water system is able and willing to provide water to this (these)connections)without exceeding the limits of the water system or any limits ttt by state and local regulation. Signature of Water System Managei Data This form may be scanned and available for public view at www co mason wa us. J:TH Fa s\Drinking Warr lk v,,ed 112512018 Individual Water Well Water well report(attached to application). Dep M ft. v Well capacity Test(attached to application) pro 7 w qpd. TThe 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 test, 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). Water Resource Inventory Area (WRIA) Development within which WRIA http)/nis.co.mason.wa.us/planning maso wa us/olanri gco maso wa us/olann o 14= 15=16=22[D Water use or limitation recorded................................... N/AQ YesQ WellDrilled ............................................................... Date 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 Date 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 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. fl Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reasoms). Reviewer's Signatures: Environ. Health:�� Date ( (v7 'L�- CSD Director: Date a of 2 Rhonda Thompson From: Rhonda Thompson Sent: Monday,January 27, 2025 11:30 AM To: Wendy Mathews Subject: Well log BNA109 needs correct parcel number Attachments: BNA109.pdf Hello, During my review of a building permit, I encountered a well log with the wrong parcel number and address. WEC2021-00050 Applicant Nick Reynolds Start Card:WE42666 Well Tag:BNA109 The parcel number on the well log is incorrectly listed as 22114-14-00010 and 141 E Wild Grape Way,which is owned and developed by David Coble and has no relationship to this well construction or adjacent properties owned by Nick Reynolds. A two-party well permit was approved using this well log to provide connections to Parcels 22114-41-90010 and 22114-41-90020:llttps://dms.masancountvwe.aov/LR[L191<Vieyi..aspx�id=56B543&d bid=4$,[apo=meson When the well was drilled,it was on parent parcel 22114-41-00000, but after being subdivided in 2023,it is currently on 22114-41-90010.We would like to get a corrected well log to show the current parcel number for our permitting purposes.Thank you, Rhonda Thompson, IRS Senior Environmental Health Specialist Mason County Public Health 415 N 6rh St.Shelton,WA 98584 360-427-9670 ext.581 Rthompson@masoncountywa.gov 1 WATER WELL REPORT UtPAAiMtYi of Nwia.rlraM1W wF�wea �ECOLOCY �peiwwAWtl,mLeNu.aN4A yr.rw.n, a:.m gwewlpn ryr,K, Sip WellN.melifinert da:ou wet ❑Gow�tY AIkM eI.- NOlw W+e,Ri{K P. aw.. Ns F•rw/W. vl4 u1MwY uKrlh•I Irwmy O.ar Nw. peWtlt ❑p,.nap 0-ri•e ❑Tn WA Oa4r Wdfbm ±NEWi7Ga YKv cwlleeee R elre! •rk.sU OnKi.el ae.•. 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M1Tv.lr xinloy.TaA dvAIN:.m Mltlrf-tl)I.MN i. Rhonda Thompson From: Wendy Mathews Sent: Tuesday,January 28,2025 1229 PM To: Rhonda Thompson Subject: Reynolds -corrected well log Attachments: Reynolds -corrected Well Log.pdf From Mike Davis. In my email I asked that it be resubmitted to ECY. The owner could be informed to keep an eye on the ECY site to be sure it gets there. In the meantime, Mike or Emily sent the corrected form. Respectfully, Wendy Mathews, EHS Sr. Mason County Public Health & Human Services Environmental Health Solid Waste Program 415 N 61h St, Shelton,WA 98584 (360) 427-9670 ext. 584 wmathews4onasoncounlywa eQy 1 Vanguard Laboratory 2635 Paskmont Lane SW Olympia,WA 98502 360.967.7010 VANGUARDReport of Laboratory Analysis LABORATORY Collected by: Davis Pumps Matrix Drinking Water 360-329-2699 [..baramry ID: V250110-15 Sampling Address: Date Sampled: I/t025 15:15 Wild Gape Date Received: 1110125 17:14 Gapeview,WA 985" Date Reporhd: 1/152025 Sample ID: Nick Reynolds Analysis Result SDRL MCL Units DF Date Analyzed Total Cagform&E.can by SM 9223B(IDE3M Batch IDV250110-15 ArWyst:AF Coliform,Total Negative 1 I MPN/100 not, 1 1/102517:25 E.coli Negative 1 I MPN/IOOmL 1 1/1025 17:25 Notes: MPN:Moss Probable Number ppm:panspermillion dd:noodetect Reviewed by 1Astin Newman,Laboratory Director on 01/15/2025 Na:not sppliw le SDRL:Soon Detection Reporting Land Approved by Ton Johnson,Operations Manager on 01/152025 OF:Won..Factor 170252417 MCL:MaximumCootavwmo[Level iw.rmxr. Samples were teceised in acceptable rendition.The exeulto)in this tepon m1an duty,o the portion ofthe sampletsl used,All enat,.wwe performed eomimolt with the Quality Assurance progam of Vanguard labaamry Please contest the labour,ifyou should have any question,about the reauin. 2635 Parkmont Ln SW,Suite A,Olympia WA 985021 Ofim:360.967.70101 testing@vanguardlaboratory.com I ..vanguardlaboratory.com loft