HomeMy WebLinkAboutWAT2025-00009 - WAT Application - 1/21/2025 WAT 2025 - 00009
415 N.6a Street
MASON COUNT E I VE D She1ton:360-427-9670,Eat 400
Public Health & Human Services 'B�1(4 ;13P`754467,Ext.400
JAN 21 2025 ONMENTAL
Application for Determi&itfoWoCW*iM/4gquacyFILALTH
Instructions
11. 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. Ana roved buildingsite Ian must accompany this a licalion.
Part 1: Applicant/ Parcel Identification
Name of Applicant: Important Business Portfolio LLC Date: January 21 2025
Mailing Address: 7002 Bailey St BE Lacey,WA 98513 Phone: (360)789-6781
Parcel Number: 32021-56-02010
�./ Type of Water System Reason for Application
V Public/Community Water System(2 or more d Building permit BLD2025-00069
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: Shorecrost Estates Water Company
Water Facility Inventory(WFI)Number: 78620-1 (write'none"for tyro-party)
I am the manager of this water system.The water system has been approved for 690 services.There
are presently 624 connection(s) in use.This will be the 625 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.
Print Name of Water System Manager Kristle Hutchinson Phone (360)426-0773
Signature of Water System Manager Date January 21,2025
This form may be scanned and available for public view at www.masoncountvwa.gov
1:1F.a Forms\Drinking Water Revised 05/082024 Page 1 o1`2
Group B Water Systems
rO Satisfactory bacteriological test within last year(attach to application).
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) cpm opd.
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 within last year(attach to application).
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.
❑ Unsatisfactory Determination:
Applicants water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Re�vi�w�err�'s Signatures:
Environ. Health: �er ° I Date � Gb
This form may be scanned and available for public view at W W W.mi soncountywa.eoy
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