HomeMy WebLinkAboutWAT2025-00054 - WAT Application - 4/17/2025 • MASON COUNTYtill CommNay DEVELOPmENTI wAT cl* - a:C1)15.d.5
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415 N 6''Stmt.CtIgi 8, Shale WA 98584,
S ot= 42?-9870 col 400 o 8+ k: )2754487 sod Ek {5 FAX 0 by 7 W ]
Application for Determination of Water Adequacy APR 2 12025
instructions
RECEIVED
cool:400mA 1_ No deferral/lotion can be rrtede tuMS Pam 1 le hdi ma d.
Complete only Me portion of Part 2 epplylingi to tttie type of waiter.connection demi
F4,
. Suibmlt oort leleti t m
application,with required ate for review.
. Art a p vad bui dIrr site Jl+r tryhie�p iaelion,
Part 1: Applicant /Parcel identification
Nem on Applicant art41 __ Deltic 3 111 ias _
Malang Address: 2,5'I L to ildfrd phone: e - _
Parcel Number: at - tg 6003
to Tyke of Water System Reason for Application
b�munity f8 y+ (2 moreii<BOON permit ELDR t 5--1510.2 .
connections) 0 Division of land:
•t —16-`indlvidtsal water Seurat(one corw n , N or Pam ? SPL
. 'etieli a boundary lima adjustrmwtt
0 Sprfrorsulane weer 0 Other Co )--
0 ter*Wain)i 0 Replacement or Remodel
of w
If nia tlhat �' M no`�" 'indicate ria cat
system below tf
to this mil chodt Me Misr eignature ceuited)
Sffittoin box.
Part 2: Water Connection rn txtlortmatlQn
Corripiete.Me ostikin apprciprielo for the type cif w+etter connect n tang tvetuabed:
•
Public Water System 2~MI fenAltili(i
r----Narr>ie od wr. Lam.
Weiler Fatfty inner ry� Number: r10 V
tone a `nave*for two-party}
IPS I am Me manager of thisAmter system.lbetweitefwfsteen het been approrie for services.
There There WO presently Qannecisa s)to use.This will be the .o_
0 t em the manager of Mir system_T consteolion wa be to upgrade or charge the use den exist
g.
lion on this system(Les recteetionei to fuN One).Ptetee Indicate on the lolling lino Oho'nature
of this ch ngo:
This water system b able and willing to provide wa1 t to this (these)oo nection(syr out v
the*nu of tit wager system or goy r stele and local rocjutrtion. 4
,// _n,,
5 ►epee of Warr m Manager ego!"
'- - Meta
i
Group B Water Systems
❑ 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) 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 within last year(attach to application).
Individual Spring/Surface Water
O WDOE permit (attach to application)
O Method of disinfection
O I 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: / .Qp
Applicant's water supply does not appear adequate to meet the needs of its intended u4 the fble
if ik,,, ,,,,,„.
reason(s). 04/7), s
N4O
Reviewer's Signatures: O,J 4/4/4-4/7
Environ. Health: 1.-; - Date 1/(7z c(J yFgl�;y
This form may be scanned and available for public view at www.masoncountywa.gov
Page 2 of 2
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
-- Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
SPEAR ET AL LOGAN & BRENNA
ANDREW & MARCY SPEAR
SHELTON, WA 98584
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2024-00030
XXXX SE Lynch Rd
319024190004
The 2-party water system, Lynch Rd Lot D (3190241900041319024190003), has been reviewed and
is hereby APPROVED for 2 connections. Please continue to follow best management practices with
maintaining your water system including regular water analysis, landscaping, keeping wellhead area
free of contaminants, and stormwater management around the water source.
If you have any questions, please contact me at 360-427-9670 Ext.353 or email at
danderson@masoncountywa.gov
Sincerely,
David Anderson
Environmental Health Specialist
Mason County Environmental Health
WM/ 7a2
2213754 MASON CO WA
07/26/2024 02.42 PM NOT
CE
Return To
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Lnydri. spec,✓ 467
(400 w chi lt cii.. gi( .104 Z�,�
sh�1 fin, �i - gQ591 RE�F nZ�
Grantor(s): (1) L.O4o,t $,Oev Vf ennq$Peaf , (2) knJre u5pe2Y ilkerCy 5,e4v
Grantee(s): (1) PUBLIC to _
Legal Description (1) 5�r fiat 2 , 1-Awn z4'J 1 fr plat section, township, n9e)
(Abbreviated form:i.e. ot, block, pu
Assessor's Tax Parcel: (1)_3_ I q 0 - ' - 9 o o o -t
NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM
I (We) the undersigned grantor(s), certify that the water source located on the above-described
real estate under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason
County, State of Washington, has been designated to serve a source of water to the following
parcels situated in Mason County, State of Washington; herein described:
Tax Parcel: (Connection 1) 3 I I d Z - 9 1 - g 6 0 0 Li
Tax Parcel: (Connection 2) 31 70 2 - `l 1 - q n o 0 3
The system owner is responsible for keeping this system in compliance.
The name of the water system is: Lynch Rat_ Let 0
This system is designed to provide for two service connections. Planning and design approvals
must be obtained from the department prior to expanding beyond this number of services.
Additionally, a water right, obtained from the Department of Ecology, is required if the water
system exceeds exemption standards.
This system (has/ has not) been granted one or more waivers from specific provisions of the
regulations.
Dated on this .Z6 fn day of i ( , 20 .
Signature of Grantor(s): 40001111W'
(1) is. ' (
54V C4146.'7
Page 1 of 2
State of Washington )
County of Mason )
I, the undersigned, a Noy Public in1 an for the above name County and State,'o hereby
certi that on this Ja. t,day of ct t_)t t. o
per onally appeared befor me, o is kn•,°' to
signer of the a ove instrument, a d acknowledged that he (s Al signed it.
GIVEN under my hand and official seal the day and ye r last above written.
tttttt
\_ • _ aSZA
�,.••`'��,,KE R ��;tt Notary Public d fo the State of, 1�A iington,
. • \1'5'0" ?'o'• residing at �P n tO
r �: _ -a�
, NoT�Ry �: � My commission expires: �,
NI3 P(js c io=2
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