HomeMy WebLinkAboutWAT2026-00006 - WAT Application - 1/19/2026 WAT 2026-00006
415,WA Street
MASON Shelton,N.
5 98584
Shelton:360-427-9670,Ext.400
Belfair:360-27S-4467,Ext.400
�f������ Public Health & Human Services
Application for Determination of Water Adequacy
Instructions
1. Complete Part'1. No determination can be made until is fully connection completed.
2. Complete only the portion of Part 2 applying to the type of
wate3. Submit completed application with any required attachments for review.
4. Ana roved buildin site Ian must accom an this a lication.
Part 1: Applicant/ Parcel Identification
6l-f Date:
Name of Applicant: u /JPU�lf1^Tw��� 3�,D ���l��d7
1 ' ' 9F56...5-A Phone: l�I/)to
Mailing Address: /'���x 3�T �Q�/ • �''f�w,�k �
Parcel Number: 3a3�3 JO'O��°27 —
Type of Water System Reason for Application
pe.Building permit
Public/Community Water System(2 or more O Division of land:
connections) SPL
water source(one connection),
#of Parcels?
Well 6'2/^1,11/% O Boundary line adjustment
O Spring/surface water O Other(explain)
0 Other(explain) O Replacement or Remodel(please indicate name
of water system below if applicable—nn
if you have more than one residence connected o nature squired)
to this well,check the Public/Community Water 9
System box.
EH APPROVED
Part 2: Water Connection Information Rhonda Thompson 01/20/2026
Complete the section appropriate for the type of water connection being evaluated:
Public Water System A
Name of Water System: /f / d ~
'none"for two-party)
Water Facility Inventory(WFi)Number: (writeY23445-6
I am the manager of this water system.The water system has been approved for /bg services.There
are presently 3iLn connection(s) in use.This will be the S'7'4.— 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. 0 7 6 b
itluf5 1�_ Phone �6
Print Name of Water System Manager ti / �-Ztia
Signature of Water System Manager DJ!/ Date /'
This form may be scanned and available for public view at www.masoncoantywa.gov
J:9EH Forms\Drinking Water
Revised 05/08/2024 Page S of 2
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
/r y CHANGES SUBJECT TO APPROVAL
L I�f 'r
By. *AO+Ewnf!ftk Date.12/17/2025
I V A Sht) Disclaimer:
Mason County does not require a survey to obtain a
building permit.As a result.site plans may not reflect
accurate data.It is the applicant's responsibility to
+r• �$ comply with setback requirements.
C V RR5 Zoning
L `�'CI`\ Front i Yard Rear
Yard S.25'.
W'V �Yl s�i n Side&Rear Yard Setbacks.Residential dwelling
and accessory structures is 20'.' \ i . S -'2 10°/0 width of lot if not more than 100'wide
OR approved ADV
WN4°464._ ,'
L r
/� _ 5 in i
Lilt I Y
�, oro9.�httY
•
V 10' n with
X1 x S 1� 1 �z.
i _ _i reserve
- b 4b
to' It V)
I _% x,sit,A 0
-----________,______--
QV Cokitr 1) F. 1-‘04 LA .
•
€k►s1(ir.cts
•
ltd
co54l he
EH APPROVED
Rhonda Thompson 01/20/2026
EH Setbacks
L 1 A L t-}� A.) Drainfield/Reserve requires 10'setback from footing/foundations
i, ` r+5 lA B.)Septic tank(s)requires 5'setback from all footing/foundations
"1 C.)No foundation/Perimeter Drains within 30ft,downgradient 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
ecology's"Criteria For Sewage Works Design,"when sewer
transport lines are within 10ft of water supply lines.