HomeMy WebLinkAboutWAT Application - 3/26/2025 •
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MASON COUNTY
COMMUNITY DEVELOPMENT
aV�, 6ly Permit Assistance Center,Building,Planning
415 N 6th Street,Bldg 8,Shelton WA 98584,
Shelton: (360)427-9670 oxt 400 •:• Belfair: (360)275-4467 ext 400 4• Elma:(360)482-5269 ext 400
FAX(360)427-1787
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: Deborah Wallace Date: 3-26-25
Mailing Address: 810 E. Old Farm Rd. Phone: 661-789-7718 _
Parcel Number: 22019-75-00030
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more El Building permit Fo2 oa5'
6103` e
connections) 0 Division of land:
p Individual water source (one connection), #of Parcels? SPL
O Well 0 Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
0 Other(explain) El Replacement Remodel please indicate name
if you have more than one residence connected of water system be ow i applicable—no
to this well, check the Public/Community Water s' quired)
•
System box. ADDITION/ REMODEL
EXISTING CONNECTION
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System:
Water Facility Inventory(WFI)Number:
(write"none" for two-party)
•
❑ I am the manager of this water system. The water system has been approved for services.
There are presently connection(s)in use. This will be the connection.
O 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.
Signature of Water System Manager Date 3-26-25
This form may be scanned and available for public view at www.co.mason.wa.us.
J:11:1I Fonns\Drinking Water Revised 1/25/20I R
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
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 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:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
R viewer's Signatures:
Environ. Health: {/ Date
This form may be scanned and available for public view at www.masoncountywa.gov
Page 2 of 2
Rhonda Thompson
From: Don Zech <dgzech@gmail.com>
Sent: Thursday, April 24, 2025 4:00 PM
To: Rhonda Thompson
Subject: Curran, BLD2025-00282
Attachments: Curran, reserve drainfield area .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.
Hello Rhonda,
I have coordinated with Thad Bamford with regards to an Operation
and Maintenance report as well as designating a reserve drainfield
area. Attached is an updated plot plan showing the items requested.
As the permit portion of the application is for rough-in, under the slab
plumbing only, (for a future bath) there is not a tank and pump
chamber at the shop at this time. That will require an additional
permit.
Thad will be turning in his report.
Please let me know if you need anything else,
Thanks, Don
Don Zech
360-710-4211
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