HomeMy WebLinkAboutWAT2025-00004 - WAT Application - 1/14/2025 MASON COUNTY WATy�z�
COMMUNITY DEVELOPMECEIVED
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415 N 6m Street, Bldg 8,Shelton WA 98584, ���I �Il�lr
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Shelton:(360)427-9670 ext 400 4 Belfair:(360)275-4467 ext 400 4 Elms: (360)JA ek
FAX(360)427-7787
Application for Determination of Water Ade%%#f Alder Street
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 Identification
Name on Applicant: Shanea Bowman Date:
Mailing Address: PO Box 3422 Belfair 98528 Phone: 360.860.1234
Parcel Number: 22005-55-00021
Type of Water System Reason for Application
p Public/Community Water System(2 or mom El Building permit
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 Public/Community Water signature required)
System box. 7O"1-0
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated.
Public Water System
Name of Water 100 E WillChar Blvd
Water Facility Inventory (WFI er: None - 2 Pany
(write'none"for two-party)
El I am the manager of this water system.Th er syste s been approved for 2 services.
There are presently 1 conne (a)in use.This will 2nd connection.
❑ 1 am the manager of this sys .This connection will be to upgrade or ch the use of an existing
connection on this sys I.e.: recreational to full time). Please indicate on the o line the nature
of this change:
This waters m is able and willing to provide water to this (these)connection(s)without exce
the limi he water system or any limits set by state and local regulation.
Sig re of Water System Manager Date
This form maybe scanned and available for public view at www.co.masan.wa.us,
l:\EH Fp \Dnnkin6 W., Revised la5a0l$
Individual Water
Well
� nn
❑ Water well report(attached to application). Depth
Ilk Well capacity Test(attached to application) k 0 opm gpd.
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 test,
a well capacity test,which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
2• Pa-441 weU
Satisfactory bacteriological test(attach to application). -*wkL 90,io.0:50:fO
Water Resource Inventory Area (WRIA)
Development within which WRIA htto//cits.co.mason.wa.us/121annincI 14[Zj 10M 16E3 220
Water use or limitation recorded................................... N/Aj::]—Yeses
Well Drilled ............................................................... Date
Individual SpringlSurface 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-Detenoination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
❑ Unsatisfactory Determination:
Applicant's 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
CSD Director:
Date 2 vf2
Arcadia Drilling Inc.
P.O.Box 1790
Shelton,WA.98584
Customer:Darlene Pennock
Phone:360-866-6288
Well Site Address: 100 E Wilchard Blvd,Shelton
Date of Test: 10/16/19
TIME GPM
1 Min 10
2 Min 10
3 Min 10
4 Min 10
5 Min 10
6 Min 10
7 Min 10
8 Min 10
9 Min 10
10 Min 10
15 Min 10
20 Min 10
25 Min 10
30 Min 10
35 Min 10
40 Min 10
45 Min 10
60 Min 10
55 Min 10
1 Hr 10
1 Hr 10 Min 10
1 Hr 20 Min 10
1 Hr 30 Min 10
1 Hr 35 Min 10
Technician ran the well at 10 gallons per minute for 95
minutes and pumped approximately 950-gallons of
water.During this test the water performance
maintained this flow rate for the entire test period.
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