HomeMy WebLinkAboutWAT2025-00176 - WAT Application - 9/9/2025 WAT Xtc26-
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415 N.6th Street
VJyp4 1 `� Shelton,WA 93584
MASON COUNTY
Shelton: Shelton,
Ext.584
400
t 1. ` COMMUNITY SERVICES Bclfair:360.275 a467,Ext.400
�•�� Building,Planning,Environmental Health Community Health
Elma:360-482-5269,Ext.400
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Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until
t the ort of 1 is fully
ter lly connection 2. Complete only the portion of Part 2 applying type
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: Important Business Portfolio, LLCDate: September 9, 2025
Mailing Address: 7002 Bailey St SE Lacey, WA 98513 Phone: (360) 789-6781
Parcel Number: 32021-56-02014
Type of Water System Reason for Application ��/���
X Public/Community Water System (2 or more
Building permit e4„O LJ
connections) ❑ Division of land:
❑ Individual water source (one connection), #of Parcels? SPL
❑ Well 0 Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain) ❑ Replacement or Remodel (please indicate name
of water system below if applicable— no
If you have more than one residence connected signature required)
to this well, check the Public/Community Water 9
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: Shorecrest Estates Water Company
Water Facility Inventory(WFI) Number: 78620-1 (write"none" for two-party)
0 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.
XI 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: Existing Connection-Building Permit
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 Hutchinson
Phone (360)426-0773
Signature of Water System Manager Date September 9,2025
This form may be scanned and available for public view at www.co.mason.wa.us.
Revised 4;27/2021
1:\EH Forms\Drinking Water
Individual Water Well •
to application). De th
❑ Water well report(attachedp __ __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(attach to application).
Water Resource Inventory Area (WRIA) .
Development within which WRIA http://gis.co.mason.wa.us/planning 14_15 16_22___
Water use or limitation recorded N/A 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 can provide at least 800 gallons per day; and/or •
!II
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) I
7 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 ROW.
El Unsatisfactory Determination:
Applicants water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
> h` liY\loW`I/1. 10/6/25
Environ. Health: Date
This form may be scanned and available for public view at www.co.mason.wa.us.
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