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HomeMy WebLinkAboutWAT2025-00124 - WAT Application - 7/9/2025 WAT 2025 - 00124 MASON COUNTY Shelton,W `h Street WA 98584 no.n. Shelton:360-427-9670,Ext.400 Public Health & Human Services Belfair:360-275-4467,Ext.400 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 of Applicant: Empire Home Construction, LLC Date: February 20, 2025 Mailing Address: PO Box 241 Kelso, WA 98626 Phone: (360) 751-8062 Parcel Number: 32021-55-01012 Type of Water System Reason for Application ce Public/Community Water System (2 or more Building permit BLD2025-00720 connections) ❑ Division of land: O Individual water source (one connection), #of Parcels? SPL O Well 0 Boundary line adjustment O Spring/surface water 0 Other(explain) ❑ Other (explain) 0 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. EH APPROVED Part 2: Water Connection Information Rhonda Thompson 07/09/2025 Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Shorecrest Estates Water Company Water Facility Inventory (WFI) Number: 78620-1 (write"none" for two-party) I am the manager of this water system. The water system has been approved for 680 services. There are presently 625 connection(s) in use. This will be the 626 connection. ❑ 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. Print Name of Water System Manager Kristie Hutc inson Phone (360)426-*0773 yi J t.j%� Date February 20, 2025 Signature of Water System Manager � ? l� This form may be scanned and available for public view at www.masoncountywa.gov J:1EH Forms\Drinking Water Revised 05/08i2024 Page 1 of 2 BLD2025-00720 apt SCALE , t =z a \ �' \ \ PLvT PION *3\ S2 ' `, AS \ \ �t-1P�2e. t{a►-te ez N�vtti vet-t a*1 I li \i0 rNin. \ E Ptbtk wer� L j1 ® L- on1 )t-0A et'85 S9 PR°PDse.f�4'kI J K EH Setbacks 3BR N A.) Drainfield/Reserve requires 10'setback from fooUng,foundati ons ,L.� r X 4 i r ( B.)Septic ks) 5' etb f footing/fods C.)No foundation/Peri tan requires meter Drainss ack withinrom 30ftall ,downgradientunation of Drainfield/Reserve area / • D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within 50ft,down gradient of Drainfield/Reserve area E.)Use approved mitigation from section C1-9 of the department of a 0►;� jrn ecologys"Criteria For Sewage Works Design."when sewer 1ii transport lines are within 10ft of water supply lines. O DR AV EwA EH APPROVED Rhonda Thompson 07/09/2025 I © c 15, I •\T bU gsiiw et,D LN -- • D'