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Home My WebLink AboutWAT2026-00028 - WAT Application - 3/20/2026 WAT 2026-00028 MASON COUNTY 415 N.6'h Street Shelton,WA 98584 •, Shelton:360-427-9670,Ext.400 Public Health & Human Services Belton':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 ldettifica�tion + 03�Z0 1�� ff ucf'�0�fV W Date: 2 -(7 ,�i Q Name of Applicant: ��n nat. �CO".{"� s Phone: .7 � 4 �� :` -1 liowKSf tc Mailing Address: chef-ton I,A/A Parcel Number: ( 2220- So-2.7003 Type of Water System Reason for Application IN Public/Community Water System(2 or more 4 Building permit connections) O Division of land: ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well O Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) O 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. Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System -F -P A-1 n Name of Water System: Par o �� O Water Facility Inventory (WEI) Number: (write"none"for two-party) N I am the manager of this water system. The water system has been approved for 436 services.There are presently 10 0 connection(s)in use.This will be the G O/ 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. Phone 360 Lit Z7 0691 Print Name of Water System Manager. Signature of Water System ManagerH n d rew .1 Noble le Date 03/W/ZOZ 6 This form may be scanned and available for public view at www.masoncountywa.gov Water l;AE Forms\Drinkin8 Revised 05/08/2024 Page 1 of 2 ,(f Group B Water Systems ❑ Satisfactory bacteriological test within last year(attach to application). Individual Water Well ❑ Water well report(attached to application). Depth ft. O Well capacity Test(attached to application) qpm 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. O Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water O 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 • • Part 3: Mason County Community Services Evaluation (staff use only) 21 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. D Unsatisfactory Determination: Applicant's`water supply does not appear adequate to . meet the needs of its intended use for the following reason(s). Reviewer's Signatures: RS 3/20/26 Environ. Health: Date This form may be scanned and available for public view at www.masoncountywa.ciov * SEE ATTACHED CONDITIONS FROM PORT OF ALLYN* Page2of2 ort r��.e"A ,I►1►� F�� xkil4,„;, Of Allyn Port Staff Judy Scott February 2nd 2026 .Comnussioner, Estn°t.` Jacob Dryden Michael Curtin Attn: Pinnacle Construction NW LLC Con zo e' Diana 2 110 W K St Ste C John A.Sheridan Shelton WA 98584 Comhissioner,Distract 3 Travis Merrill Eseeutave Director Dear Mr. Dryden: Justine Nix Admanistmtive.Assistant. The Port of Allyn ("Purveyor") hereby provides an assurance of current water availability to Natalya Merrill Jacob Dryden ("Owner") in response to the Water Availability Request Form and Water System IT Administrator Extension Application for Mason County Parcel#12220-50-27003(the"Assigned Lot"). This letter("Water Availability Letter") documents the Purveyor's assignment of one(1) standard 5/8 Port Facilities: x 3/4-inch metered connection to the Assigned Lot as of the date of this Water Availability Letter, pursuant to the Purveyor's Water System Policy Manual adopted November 6, 2017,Amended The Dock at Allyn April 1, 2019, and further amended July 14th, 2025(the"Water Policy").t Purveyor has a The Allyn limited number of available connections as specified by the Washington State Department of Boat Launch Health. New connections are provided on a first come, first served basis. The North Shore. Marina Water availability is subject to the following terms: The North Shore Boat Launch 1. The assignment provided by this Water Availability Letter is subject to a twelve(12) The Allyn Waterfront month expiration date from the date of issuance of this Water Availability Letter 'Park pursuant to Section 2 of the Water Policy. Owner may request an extension in writing, which the Purveyor may consider at its discretion. The Allyn Kayak Park and Launch 2. This Water Availability Letter is not a contract for water service,this is not a guarantee The Port of Allyn Water of water service for the Assigned Lot. Until the Owner executes and fulfills the Company. requirements of a Developer Extension Agreement ("DEA")with the Purveyor, or a billing account is otherwise established with the Purveyor,this Water Availability Letter may be revoked consistent with the Water Policy. This Water Availability Letter may be 1856o.E;State..Route-3 revoked pursuant to the Water Policy,the terms of this Water Availability Letter, the P°BOX terms of the DEA, or as otherwise provided by law. All}m WA98524 360-275-2430 3. The information used to arrive at this determination of availability is believed to be accurate at this time, but future demands are not always predictable. Similarly, new staflt portofanyncom laws, regulations, or ordinances could also limit the ability to provide water service in www.portofallyn.com the future. El MI 4. Any expenditure which you make in anticipation of future water service is strictly at your own risk Sincerely, Travis Merrill Executive Director 1 See current Port Water Policy for relevant definitions.