HomeMy WebLinkAboutWAT2025-00017 - BLD Water Adequacy - 1/31/2025 MASON COUNTY
ENV�R�NME COMMUNITY DEVELOPMENTS I_r FJ V
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C• 415 N 6-Street,Bldg 8,Sheltan WA98584, I
Shelton:(360)427-9670 ext 400 9 Belfair (360)275-4467 ext 400 4- Elma:(360)482-5 ;15
FAX(360)427-7787 615 W. Alder ���rreet
Application for Determination of Water Adequ&dp vv. Float Street
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fumy 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 a2proved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Amber Ensley Date: 213I 25
Mailing Address: 625 W Railroad AVE #321 Phone: 360-601-1703
Parcel Number: 42024-34-90049
Type of Water System Reason for Application
El Public/Community Water System (2 or more El Building permit &.VZR5_00
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/Communify Water signature required)
System box. 44a// -7,L1—(D0 k)!;-1
Part 2: Water Connection Information _V JD-�� n
Complete the section appropriate for the type of water connection being evaluated: �W" ' ' J
Public Water System
Name of Water system: RP-4 Berry Ridge
Water Facility Inventory(WFI)Number: None
(write"none"for two-party)
El I am the manager of this water system.The water system has been approved for 2. _services.
There are presently 0 connection(s)in use.This will be the 1st connection.
❑ 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)connection(s)without exceeding
the limits of the water system or any hs et by is of local regulation. r7 I
Signature of Water System Manager Date c-I �5
This form may be scanned and available for public view at www.co.mason.wa.us.
1:\EB Fame\Drinung watu Revised 1'25201A
J///''' Individual Water Wee�lll
S „ Water well report(attached to application). Depth�7 ,�ft.
rr
I�JWell capacity Test(attached to application) [iV Apm "� "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,//qis.m.mason.wa.us/glanninci 14[::]15=16=22=:]
Water use or limitation recorded................................... N/AQ Yeses
Well Drilled ............................................................... 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 detemnination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable W DOE 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.
F Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
CReviewer's Signatures:
Environ. Health:�D • ' Date
CSD Director.
Date 2 of 2
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