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HomeMy WebLinkAboutWAT2024-00391 - WAT Application - 3/21/2025 MASON COUNTY WAT COMMUNITY DEVELOPMENT vmnhrusimnmtmtn,eun4ing.Hannay 415 N 6r Street, Bldg 8, Shelton WA 98584, p C v E D Shelton:(360)427-9670 ext 400 4 Belfair: (360)275-4467 ext 400 4 Elma:(360)4 FAX(360)427-7787 Application for Determination of Water Adequacy ��� U 5 202q Instructions 615 w. AIftrBtreet 1. Complete Part 1. No determination can be made until Part 1 is fully completed L4.2. 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. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: (,hhS Prrnod Date: 121Z 2y Mailing Address: 2toUtc PWl \Mn%GN %Qd Phone: &ao-36q Zglo'1 Parcel Number 3'Z417--% Ot 001ai Type of Water System / Reason for Application PublictCommunity Water System(2 or more ,�` 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. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Beacon Hill Water Facility Inventory(WFI) Number: AFE 754 (write"none"for two-party) 91 1 am the manager of this water system. The water system has been approved for 6 services. There are presently a connection(s)in use. This will be the 4th 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 limits set by state and local regulation. Signature of Water System Manager � Date 11/2712024 This form may be scanned and available for public view at www.co.mason.wam J.TH Fmrns\Drinking Watc Revised 1/25/201 g Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) 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. ❑ Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA hlto://ais.co.mawn.wa.us/olanning 14=j15016022= Water use or limitation recorded................................... N/AQ Yes_= Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source win 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. 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: ,� VISW`/l17 b' " � Date CSD Director: Date 2 vf2 WATER FACILITIES INVENTORY (WFI) Quarter: 0 Updated: 03/ZOR025 NVmFm Slone lklvN,m(oJ FORM Z*Health ONE FORM PER SYSTEM Praised: 3)202025 Wn' f in �.w.", `""^ WFI Primed For. On-Demand SUtrmisebn Reason: Owner Update RETURN TO: Central Services-WFI, PO Box 47822, Olympia,WA,98504-7822 or email wf@doh.wa.gov I. SYSTEM ID NO. 2. SYSTEM NAME 3. COUNTY L GROW S. TTPE Aa52]J SEAGULL WAY MASON 6.PRIMARY CONTACT NAME 8 MAILING ADDRESS ].DINNER NAME 8 MAILJNG ADDRESS ANDREW J. NOBLE[SMA 140] TIMOTHY LANGTON H2O MANAGEMENT SERVICES INC 1751010TH AVE E PO BOX 2026 SPANAWAY,WA 98387 SHELTON,WA 98594-5034 3TREET ADDRESS IF DIFFERENT FROM Aeon STREET ADDRESS IF DIFFERENT FROM ABOVE aTTN ATTN 4DDRES5 ADDRESS 'ITV STATE ZIP CITY STATE ZIP 9124 HOUR PRIMARY CONTACT WO TION 10.OWNER CONTACT INFORMATION 'nary Contact Daytime Phone: (360)42]-0654 Owner Daytime Phone: (253)213-3876 36mary Contact Mobile/Cell Phone: (MIS 463-6189 Owner MobilelCell Phone: (253)21338]6 'nary Contact Evening phone: (360)427-0654 Owner Evening Phone: =a.: E-mail. h2omgtsys@gn l.core Fax E-m ail: tlangton®ncpowersystems.com 1.SATELLITE MANAGEMENT AGENCY-SMA(olMck only orM) ❑ Not applicable(Skip to N12) Owned and Managed SMA NAME. H2O Management Services Inc. SW Number:140 Managed Only Owned Only 12.WATER SYSTEM CHARACTERISTICS(mark all that apply) ❑Agricultural ❑Hos tat/Clinic a Residential ❑Commercial/Business ❑Industrial ❑Scheel ❑Day Care ❑Licensed Residential Facility ❑Temporary Farm Worker ❑Food ServiceWacm!Permit ❑Lodging ❑Other(chum',fire station,etc.): ❑1.000 or mare person event for 2 or more days per year ❑Recreational/RV Pak 3WA MOWNE P( or4Y DIM « q ❑AssuastlOo ❑County ❑Investor ❑Special District __Gty/Town ❑Federal Private n5lale 15 ifi i] 18 to 28 21 23 33 24 SOURCE NAME INTENTIF SOURCE CATEGORY USE TREATMENT DEPTH BOUNCE LOCATION f p S O UTUTY'S NA 1 FOR SOURCE A re x i tq O AND WELL TAG ID NUMBER. - G w p — D m Example: WELL lH XYZA56 F m F '^ D n y re A t $ L O m O i IF SOURCE IS PURCHASED OR INTERTIE v C 4j F F D O D Fri 4pi in; ~ sr O O r-wi �� m x O INTERTIED. SYSTEM m R R -f x s, on x A O y i my c0 m w v LIST SELLER'S NAME m R 2 D m A < y )t O m �R{ O O C T on <z g x 22 Example: BEATRE NUMBER O o D O O a P < A < 0 3 x x S A yx =w A p an MI WELL p1 AFE754 X X Y X 300 45 NENE 12 NN 03W 1 Rhonda Thompson From: Kosarot, Pi(DOH) <pi.Kosarot@doh.wa.gov> Sent: Thursday, March 20,2025 3:31 PM To: Rhonda Thompson Cc: Tim Langton; DOH EPH DIN WFI SWRO;Kosarot, Pi (DOH) Subject: RE:BEACONHILL WATER SYSTEM AB527J SEAGULWAY Attachments: WFI Report(2).pdf Caution:External Email Warning]This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender,are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Hi Rhonda and Tim, I've updated the WFI and attached the current copy. The WFI on external Sentry will show as updated by Saturday. PI Kosarot Pronouns: they/them Water System Data Manager, PHA2 Southwest Region,Office of Drinking Water Washington State Department of Health Di.kosarot@doh.wo.gov 564-669-3862 1 www doh wa aov ©©®0©® From:Rhonda Thompson<RThompson@masoncountywa.gov> Sent:Thursday, March 20,2025 2:26 PM To: Kosarot, Pi(DOH)<Pi.Kosarot@doh.wa.gov> Cc:Tim Langton<TLangton@ncpowersystems.com> Subject:RE: BEACONHILL WATER SYSTEM AB527J SEAGULWAY External Email Hi Pi, I believe you are the one accepting/reviewing these changes for DOH.Can you let me know when DOH has accepted this new change of ownership?It is tied to a building permit application under review. i Thank you for your time, Rhonda Thompson, RS Senior Environmental Health Specialist Mason County Public Health 1