HomeMy WebLinkAboutWAT2025-00191 - WAT Application - 10/13/2025 i 'C
W AT ;�i),� - (R l 1
MASON COUNTY 415 N.6'h Street
Shelton,WA 98584
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 8/19/25
Aaron Buechel
Name of Applicant: 360 490 5302
Mailing Address:
6381 W Shelton Matlock rd. Phone:
Parcel Number 322325078009
Type of Water System Reason for Application
ti
Building permit
19( Public/Community Water System (2 or more 0 Division of land:
connections)
❑ Individual water source (one connection), Date:
#of Parcels? SPL
❑ Well 0 Boundary line adjustment
❑ Spring/surface water 0 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 g
System box.
EH APPROVED
Part 2: Water Connection Information Rhonda Thompson 10/13/2025
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: Hood Canal
Water Facility Inventory (WFI) Number: 34050 M (write"none"for two-party)
19 I am the manager of this water system. The water system has been approved for 273 services. There
are presently 133 connection(s) in use.This will be the 134 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
Brandy Milroy Phone 360-877-5249
'/ Date 08/14/2025
Signature of Water System Manager\,�y ,a..>ril �`l"'.t�:c.ct-
This form may be scanned and available for public view at www.masoncountywa.gov
):\Gl-1 Forms\Drinking Water
Revised 05/08'2024 Page I of 2
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EH APPROV D ;-}y-,•1/c ev, //
Rhonda Thompson 10/1t3/2025 /
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EH Set acks � f t-,
A.) Drainfield/Reserve requires 10' etback from footing/foundations f;.1'
B.)Septic tank(s)requires 5'setbac from all footing/foundations /y'
C.)No foundation/Perimeter Drains ithin 30ft,downgradient of
Drainfield/Reserve area /
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within /
50ft,down gradient of Drainfield/Re erve area /
E.)Use approved mitigation from s tion C1-9 of the department of /
ecology's"Criteria For Sewage Wor s Design,"when sewer // Imo, .. P°Se,^( 'e i�1oj'r.,eJr"'
transport lines are within 10ft of wat r supply lines. !-..-(a
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RV space Personal Use Only- Not / .
permitted as a Short Term Rental or ;y/ \
Rental Space r'-
,,,r
I �
la+ NOT AN APPROVED SEPTIC DESIGN
�. SW�025 00293
Must use for septic installation
7 k.
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ivIst '?fr bas e . 0�,'
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Disclaimer.Mason County does not require a } �� — . 35' -.___
survey to obtain a building permit.As a result.site
plans may not reflect accurate data.It is the
applicant's responsibility to comply with setback ,` ;
•
requirements. .
10/10/2025 1 o \
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APPROVED
•
MASON COUNTY DCD PLANNING
SCOTT RUEIIY,AICP
Digi!alty I''� 1
signed 1' ;�i',: - ,1/'.
=,aa.as by
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p • y
RR2.5 Zoning /l e,c ^y.
Front Yard Setback. 25'.
Side & Rear Yard Setbacks. Residential dwelling '
and accessory structures is 20'. -- - ,'
OR 10% width of lot if not more than 100' wide
OR approved ADV E 0