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Home My WebLink AboutWAT2024-00120 - WAT Application - 9/12/2023 w t � r WAT ZDZ`I - 601010 415 N.61°Sheer MASON COUNTY Shelton,WA 98584 COMMUNITY SERVICES BStielro^:360-2754467,Fxt 400 B lfwr.Elm:360482-5269,Ext 400 a�em"n n."nw,srrm�mm•.w w.n.comm�ro'� Elms:360-082-5269,ExL 400 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 Identification Name on Applicant: TURNER, CHRISTIAN 8 REBECCA Date: 09/12/2023 Mailing Address: 413 Bear Creek Estates Rd Sequim Phone: 360-460-4860 Parcel Number: 9294 75-9W91 &A-�Ab()q Type of Water System Reason for Application G TnJ Public/Community Water System(2 or more Building permit�7IL V24- 66965 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 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 Name of water system: Hamma Ridge Water Facility Inventory(WFI)Number: 05867 H (write"none"for two-party) I am the manager of this water system.The water system has been approved for 44 services.There are presently 27 connection(s)in use.This will be the 28 connection. ❑ I 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)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Print Name of Water System Manager Brandy Milroy Phone 360-877-5249 Signature of Water System Manager�4 Date 0226204 This form may be examined and available for public view at www.co.mason.wa.us. J1EH F..\Dr.W,wear MA M272021 r Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) gpm 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. ❑ Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http'//gis co mason wa us/planning 14[D 15[:D 16EJ 22[::] Water use or limitation recorded................................... N/Aj�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 ode ate supply of water indefinitely In the future,or guarantee wmplienca with all applicable WDOE water regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6.68.040 abon of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may y hapter 36.70A RCW. Q'41d ❑ Unsatisfactory Determination: ON [A Applicant's water supply does not appear adequate to meet the needs of its intentled Q,�� Fhe'tQyaWi�9 O reason(s). J 1S.... Reviewer's Signatures: ✓q /IfF*14e Envlron. Health: - Date� nr CSD Director: Date 2 of 2 WATER FACILITIES INVENTORY (WFI) Quarter: 1 w.aaer.se�Dr#a####f FORM Updated 01/08/2025 IF*Health ted On-Demand ONE FORM PER SYSTEM wFl Prim For Printed For. n-Damantl Submission Reason: Update Update RETURN TO: Central Services-WFI, PO Box 47822, Olympia,WA, 98504-7822 or email wf@doh.wa.gov NAME 3. CWNTY 4. GROUP IL TYPE " HAMMA RIDGE MASON A Corm S.FRMART CONTACT NAME S MAGING ADDRESS 7.OMMER NAME S MAILING ADDRESS BRANDY A. MILROY[WATER RESOURCE MANAG] MASON COUNTY PUD I WATER RESOURCE 21971 N HWY 101 BRANDY A.MILROY SHELTON,WA 98584 21971 N HWY 101 SHELTON,WA 98584 STREET ADDRESS IF DIFFERENT FROM ABOVE STREET ADDRESS IF DIFFERENT FROM ABOVE 4TTN ATTN ADDRESS ADDRESS :ITV STATE ZIP CITY STATE ZIP 9.24 HOUR PRIMARY CONTACT INFORMATION 10.OWNER CONTACT INFORMATION Drimary Contact Daytime Phone. (360)877-5249 Owner Daytime Phone. (360)877-5249 x268 3nmery Contact MobilelCell Phone: (360)490-2459 Owner M051IeICell Phone: (360)490-2459 contrary Contact Evening Phone: (xxx],ox.xxxx Owner Evening Phone: (xxH.-xxxx Fax'. E-mail bxxxxxmQmason-pool org Fax (360)877-5339 E-mail'. bxxxxxm@mason-pudt.org 1.SATELLITE MANAGEMENT AGENCY-SMA(it "only ana) Not applicable(Skip to#12) ITvneo and Managed SMA NAME: MASON COUNTY PUD 1 SMA Number 111 Managed Only n owned Only 12.WATER SYSTEM CHARACTERISTICS(mark a800 apply) Agricultural n Hospital/Clinic Residential Commercial I Business ❑ Industrial ❑Sell Day Care Licensed Residential Facility Temporary Farm Worker Food Sen icelFuoo Permit ❑Lei ❑Other(church,fire When,etc.p 1,000 or mare person event for 2 or more days per year El Recreational I RV Park 7.WATERRIP(mark only am) (gal Association County Ei Investor jiSpeoel Distrito City I Town F1 Federal Fi Private State 40,000 15 18 W 13 19 20 21 22 23 24 SOURCE NAME INTERTIE SOURCE CATEGORY USE TREATMENT DEPTH SOURCE LOCATION m in F 'a_ $ in 0 LIST UTILITY'S NAME FOR SOURCE a, S D AND WELL TAG to NUMBER. Z i < < O m myre c° Example: WELL#1 XYZ456 D 9 v m D ,+zi v O o $ Z an O r Z p D T m p m ; 3 A � 22 r yj m� T Z O a, IF SOURCE IS PURCHASED OR INTERTIE F = T min r to ➢ D D O D m m Z y $ j 2 0 z� iI O c i INTERTIED, SYSTEM O ■ a LIST SELLER'S MANE ID m in m m m -t y�u i m ? tinny yc0 q t I y f K O m z at y 2 ae S A 9 m Example: SEATTLE NUMBER 1. 6 m G o o at A Sol WELL#1 AK8308 X X Y X 480 45 NENE 03 23N 03W