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HomeMy WebLinkAboutWAT2026-00087 - WAT Application - 5/19/2026 TWAT 2026-00087 MASON COUNTY Public Health Human ices Application for Determination of Water Adequacy Instructions f tthpót1ytho potl ,f P2 aptyito t Eyre âfwatér cfiøtkiz it pokx1 app °ooi' rrt tr r0qwad attachmont 4. lad, t m cati .. - f Parcel identit1catoi Wamof A mrr , Date: 4 / Jcfz .Mebng d - s; Phone. Parcel a r �., Type of Water System Reason or Application .0a b or rn aty'Wate System(2 of More l i g BLD2026-00332 aele It of IancA Individual a rf ttort #of Pai d S Wcfll O Bouncatytir adjustrnaflt l p' u. a to O th to plaItr a to ernent or. e od e jrtdote mime If you ta nte th r ons ridme wcted of water system belowif applicable—n to thf f ôti *me PbftrommwiIy S4fer signature required) Sytom box. See Two Party Part 2: Water Connection information WEL2025-00029 Complete the StFe soction appropriate for the type of water connection being a lneteth Public Water System MameofterSysterIi: Richard Water System Miieract1ty Inventory Numbor none (wroonofor.twapacty I a 't am ofthiwatersystem& The water system has been approved for r t e a., ere atfneerdtnneci in use. TWA wilt be the recur, 0 t sin the manager of this system.. Ms connection will be to upgrade or cliange the use of an existing connection on this system(be,.:recreational to full time)_Please indicate on the following` Mete nature of this change: This water system isante ancf willingto profdo water to this(tha e) cone:.:.. ►on( w out e e ir°a ,the tlrt f the ter y t or an °rs sot b state and local.' . latlon. Prtht Na ._of Water System Manager ono Signature Water Systen. aer Date ThtsfOflnti avallblefor public view at n wa. °3E *fngWt Pax I N Group _ Water Systems Ma.Macty bee logicat test ft cast year(attach to tipp tion)- Individual Water Wefl ter welt report(attached to ppitcat . >pth 80 L ll paces , stt d to: pp ti 20 >400 rt; The welt drilter often pefonns welt parity teats at the time the w ti is ust uc1et Raults from z noted' n the waterwott ret Rem -:. f m these tests"be pted. Irthe water WON report cannot be located by the Applic nt or if the waterwelt report•dbes not haveacapacttytest,, welt oapaclty test,WtIkh pfdes stabilization of draw-down and reovey data,flsIbe patfórmed by licensed contractor aisbactorioaprAic ti r m Individual Spring/Surface Water tMJOE permit(attach to application) Methoct of Wi if r i have season tobetleve that this wawater sou..: ti;pwvide 4t ieat 8G gallonspr d , provctes water at s rate,of 2 gallona per rritute.besed tni the foal.owltig o ions. Author of 8tatornnt Date - RelatIonship to Applicant Part Maaoa Couflty Communityice u tion (staff use only) t6fztct ry DeterminatIon is etermbelln es oct eddiassado dequj of the thstrlutcr syterny lluaedoc en adeqtata of : watei"thdeflnié1yts at €t ft :r` urn ut _t. sr approval irr t rngisire of*s. e Cone TItle e.Chapter 8 64U-Dsherrrralie M Z�taii t n Prmt are sf d Mdthonat Grth Management raqwmment may apply Chapter 5. " C U ink :: " • i • • Appintawtarauppldces not appearadequatetacneettha needs of its intended use frthefoflawmg Retie* rs Sigñatures Env i ..dealt: Oats 5/19/26- Y .Thortn may be scanned an availth)efor public vi - at 0 Ct* ELL is *_^ ATE ` ELL REPORT CURRENT Of'IodtVt Nn:W192318 ,Thai R i'"rPY^ErturR�'a«F�-sacn3"spa g+ltutcr iJnqueECO10 YWeltr 7agpia. C, 1,"4 4 �• dos cdenlD axnmission("x"ift eircte) j!j Water Right Penniit.No.F ► kL fznstxuction L�inlxl t#tf t7R C3JN L tNSTAUATION OtiCe. Piopecty(hvner2tan3e GARY WiLSON crfTiatent lueraber Well Street Addt�e5s.784 E,fSLANO LAlCI�Utt11E' taidiiatsiat l Mur≥s sT city SHELrON0 ' county'MASUUN I'ROlt?EDttSfa Demr.ae - t= ❑Titwcu CJ 0 �._-- sE DUcWuar Irrign 4W ` Location mw-im E 114 sec a Tom' wwra rimoPWORk. tt�+ae'emsmtrcresprli(tCmwo acwcaa)�_.�..-- --- air a� Cia is r d «a f;pp o ©Ioja OD' , i gtlLon g'(s.t,r Lat Deg tvlin/S _:.:: ©W i GibO ©Y �„ Drrel �oris: ofwdaf anchaa.drit#+ 8b S. Still REQUIRED) Long Deg Lang MifdSec Dcpakatcsalstelwcit $ __. 324A5(>e14402 Tax Pafccl Na. +C{yNgMUCnON OR DXCOMMMON .s> I�atatted T fa ixcalltd Diva.fr a fL w s. Ted_ m oia . Formati4� u ~raars�.�.sa! mu .�aee .a�f ranatsa: Yea• rig o ;� b « �a ►o � fa, g &�fomtatsXa�4 SEA LMONAL-SN m-w NEC Sm MATERIAL TO � , .aft � fl t3 s1ZEafT 4i scrasax 'Yes ONO li?ae Lxsdaa QARIC BRCiW?1 SIL Y CSRAVEL 1 BROWN 3j T.BOUND SAND.GRAI P+Sats aYieatc t $ i tti4bde,Aic.__ -- LOfl$B"C3�AVEL ANO WATFi $Itxsizt - ! ! rT S$ ..�.-r-•.-�- ` Yca Ntti D s ft Les Nu Taswhitde tl&2 Srf6a1.QYea � - �� ttidsaexisi slcal scii LDid atuy saat+toeutla cteassbk watch OY O No T}�ro nf >xt1` De}ttltof mom _ i.r PiMPi Mme f r• Name tI__ ____::::==_======:o "Ty* rtzFiae a +i A bdowCfWU ran ..,x.1. `5—R ta�a t_ — Pt icl, nut As , ritMU03t3edby tafffiOS$f1I[al.3'IL'Yeti5l �1'SRwita4ClYet o + was s atmg teuz e7 Yea O No i[Xes,ELY�aed.___—" e a tm aner ba.- d i —�n.dnsoom ars 1 Waev cuet Utat WSW Level Time tt Ba to teen r Ssi+ .u uh Arawdvswn ate tsxs y tus ,S;tea=t 2G - egad heaa.a'r`tth sumhtz at?0 _fl.fat l,jsdin l4ow ,: RPp. ". -.__.^_.^»made? y' �Na ILaId`45 T Afwater Wan a ehtm oat attaallysss ' SUttt Dsta l t11b143 Centgt m6 elate r } WELL COPiSTItUG"17ON CER.'TMCA,TION: I-constructed aacUor accept resPotisibiiiry for constrlls Lion of this welt,and its compihalos with all Whingtonwil onstnicticn:ti;andtsrds.,Materials used and the information ret*atcd above are true to my best knoWlcdgd and belief NELSON t s ,p .ARCADIA DRILLING INc- Ci Bxi e d es' «Q Tnima Ltisne A{Ifliss PO BbX 1794 DkitStr/EtisiuteeTtstntt sitsast�re City,stuee Zip SHELTON WA 9$584 � aa 18!1�≥M 8L'r,�a�ciot's i i137r"OS i 1►7�► �tlVF . Rcjt ratianNO.ARGAilDIa9Ei4I Dam Deillra'a ilcexa ad 41a _ Ecckg j,an Egtut'a0—sitY Dtiiis�`a 51�ature } ; O i T warranty the Data andtor rbfOrn ati;�rs on this Well Report j ,1 it ��f_ E 1 tom' Printed rom Muon County DM Arcadia Drilling Inc. P.O.Box 1790 Shelton,WA.98584 Customer:Todd Fague Well Tag# ALL322 t"e Address:782 E Island Lake Dr,Shelton Depth:80' Date©f Tt st:.6124125 Static,36' Pump Set:70' 11ME GPM LEVEL RECOVERY 1 Min 20 42 TIME LEVEL 2'Min 20 43.2 Fl Min 37.5 3 Mn 20 43.5 2 Min 36.3 • 4 Mn 20 43.6 3 Min 36 5 Min 20 43.7 • 8 Min 20 43.8 7 Min 20 43.8 8Min 20 • 43.8 9 Min 20 43.8 10 Min 20 43.8. 15 Min 20 .. 43.8 00 Miss 20 438 25 Min 20 43.8 30 Min 20 43.8 35`Min 20 43.8 40 Mm n• 20 43.8 45 Min 20 43.8 (°' ? 'Total GaIoPU4 !01TTJ lons Pnned From MesonCounty DM 3 i Pdra d€from Meson County DMS V angttara L aDoratory 2635 Parkmont Lane SW,Suite A Olympi WA 98$O2 q ja�tto 3609674O1U COLIFORM BACTERIA ANALYSIS FORM Datesampeçoflated me Sampie County 0412912025 3 4 0 MASON tt Idarat t3sy' Year ....�.— t- Type of Yyystern( only sle ta0)' 0 Go4JpA O Gro l B ®fir • A l3tosip 9 Sys;—Provide flan W Fps lnv2ntory(WF): tD /` sys mt me TODD IFAGUE"' GontactPetstmAr ad'ra Drpiing,fnc Day Pttor :(360 }426 3395 001 Pha '{ ) Eve.Phaae: } S,Wr4tES lS!3 ki«ane 0drewandzipCadeore etftta�Snrt�cttC�klp coAI;AND je�ti���AR�7fl com .� - c w P SALE INFQRMAT1 1 Scâon $iece same a ecled: spedal r De ans yr 782 E Island.Lk Dr;Shelton Type of Saigr pk(seed one'type or sample trom'type$I ttwough 5 below) 1.Q Rca eD t Sam o(A P) 20 RepeitSampJP) Chioonated:Yea No t o synfem after mat,rnrrr ) UnsaouthbflUmber: ChbeReSi&J3t TotaL ,Free_ Grotty War Rule Sean,aam UetmymeaoUectate: LII Chlorvtated:Yes No- 0re ,(NP) ch eR 0t otat_ Free Q Assent(AIP) A. Surtaco or GWi Raw Sotrme Water Sample(Enum mOw) o E.call' CI ccaI aa 's_w 5„IN Sape Coctedks khrm n City;_ •LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY Q u ctcry Total Conform Present a nd I Setlmfactory C]Ellallpmsmt 0 Ecotial ent Deralty Reautta:TOW Cow, . tlODml, E: rl}tml, Fecal Co₹en&_ J100m1 tiPG ti Irrt,. Rcptacornertt Sarrspts R equltd: O TNTC 0 Sample Eoo okl L7 S r18 Vadusrtie 0 Damaged Cctalner 0 r tau dreg TmrC WtedCodeSM9223B De ROthOOH Lit«Ur.e ter: DOH LS From frinted Pow -ifMntyDM5 Prrted from M x. .F s aarz�-a�nw�ruunarrRnertaa�aar?rs?�- r c��rx i.".«,•+wi..«id G.-+s..�..t.w ww..n,s......e..i'..:ww.." •