HomeMy WebLinkAboutWAT2025-00094 - WAT Application - 9/29/2025 .
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A licOLlOn for Determination of Water Adequacy '?Fc �910�
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Print 1: Applicant/Pat 4dentiflcsUtan
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Parcel M 1 -'i' - ,21
a!Wes*; x stem Reason for Application
k TypeLi Building patirst EId..O5e25-}050
larobneXorrononoty Oder System i2 or more Ct lah�bi�+ 'land:l SPL
CI tn6wk ,al w+r skt (true c eitt tion), #Paroets7
la WO C] Boundary Me adlullzno rl
a firomosurfeoe view ci :Other(uxp '")
fa tamer fsrctttalrr►tt Amt.,. ltl,..-. Cl Repiecorr►eM W liemodel(please inti csie'nedne
:'#you bay.more(Nolan totiderr!19 tortoodrad of%vete/s$atam belaww If applicable—tw
•of dril►t wry t lhitt�►t1 t P`urt C o+++!u eYX Wato algrcabtme femikutl I
t Sysbigni box-
Post 2: Water Connection Information ied
, /4.,, , the e to caafor the typo Pt water nnection bating erakrated: 2` `"€l l
Public Water System
Ramat Water*slew. r+ ...
Weiler fly tr tin ey CWrFI}Number ,nr, (wnreu'ram'tot tyro-party)
t t on ow frianteraff d this eager high The wdOt r s y stumn has boo grouts for saivices. Ibete
are presently 0 Vie►)a r utrn.71tiac will t'u ttw_ I. ,cannoclton,
0 1 ern the rrs utgar of this systerm,This aonnacnost will Go to upgrade or Mtge the use of no existing
ca4nnace a on ihkayslitt►il,o.:teuestional to toil Ins). Please tndkleso on glib tattooing low the nt• . .0
,„ the Orange;
This sysior system is able end wtifutq 1t►provtdo scalar to this!Ibsen)oonruectiel(s)islihotit toiceorbrta Nine
tiffs of Me voter ►slam or any knits sot by stela end lootrotpAsti�:
. ?not Nsrne of Wet*$y►aitrrt 44110001 I` r►t21 i) 11 P1►046 3 a.�L �C M {•'�
:hwe or Waft(System Matt4por ' 1f. Dot° °i_ZS!,
form'say be scanted sod atonable for pubikwlew et ww urrtyrrtsr,
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Group B Water Systems
❑ Satisfactory bacteriological test within last year(attach to application).
Individual Water Well
K Water well report (attached to application). Depth NO S ft. r50/I
7 Well capacity Test (attached to application) / gpmv gpd Wif«C1
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). celg(L 7f
IIndividual 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
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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.
I Unsatisfactory Determination: ,,, F.,
Applicant's water supply does not appear adequate to meet the needs of its intended use for the follovyi`tQ
reason(s). l'rl,,a tial di
t'C
Reviewer's Signatures: C ylt�, ,J?a �4
Environ. Health: Date f(z L `3
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This form may be scanned and available for public view at www.masoncountywa.gov � He4lj
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