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Home My WebLink AboutWAT2026-00098 - WAT Application - 6/5/2026 WAT 2026 - 00098 415 N.6th Street MASON COUNTY Shelton,WA 98584 COMMUNITY SERVICES Shelton:360-427-9670,Ext.400 Belfair:360-275-4467,Ext.400 Building,Planning.Environrnental Health,CommunityHealth Elma:360-482-5269,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 Name on Applicant: Chrysalis Real Estate Solutions LLC Date: May 11, 2026 Mailing Address: 21530 NE 29th St Sammamish,WA 98074 Phone: (425)503-6121 Parcel Number: 32021-54-02001 Type of Water System Reason for Application )Z Public/Community Water System (2 or more )( Building permit BLD2026-00422 connections) ❑ Division of land: ❑ Individual water source (one connection), #of Parcels? SPL ❑ Well ❑ 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 Name of Water System: Shorecrest Estates Water Company Water Facility Inventory (WFI) Number: 78620-1 (write"none"for two-party) X I am the manager of this water system. The water system has been approved for 680 services. There are presently 635 connection(s) in use. This will be the 636 connection. O 1 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 Kristie Hutchinson Phone (360)426-0773 Signature of Water System Manager Date May 11, 2026 This form may be scanned and available for public view at www.co.mason.wa.us. J:\EH Forms\Drinking Water Revised 4/27/2021 Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) gpm 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(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa.us/planninq 14_ 15_16 22_ Water use or limitation recorded................................... N/A_____N/A Yes WellDrilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 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) X 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. O 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: EH APPROVED Environ. Health: ''"d""on050a°'R Date 6/5/2026 This form may be scanned and available for public view at www.co.mason.wa.us. Page 2 of 2 WATER FACILITIES INVENTORY (WFI) Quarter: 1 Updated: 09/05/2024 FORM ® Printed: 6/5/2026 ONE FORM PER SYSTEM WFI Printed For: On-Demand o aALTSubmission Reason: Pop/Connect Update RETURN TO: Central Services-WFI, PO Box 47822, Olympia, WA, 98504-7822 or email wfi@doh.wa.gov 1. SYSTEM ID NO.''- 2.T SYSTEM NAME , 3. COUNTY 4. GROUP 5. TYPE 78620 1 SHORECREST ESTATES WATER CO MASON A Comm 6.PRIMARY CONTACT NAME&MAILING ADDRESS 7.OWNER NAME&MAILING ADDRESS JOHN R. POPPE[OPERATOR] SHORECREST ESTATES WATER CO ADMINISTRATOR 50 E SYLVAN LN KRISTIE HUTCHINSON SHELTON,WA 98584 50 E SYLVAN LN SHELTON,WA 98584 STREET ADDRESS IF DIFFERENT R ENT FROM ABOVE STREET ADDRESS IF DIFFERENT FROM ABOVE , F , ATTN ATTN ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP 9.24 HOUR PRIMARY CONTACT INFORMATION 10 OWNER CONTACT INFORMATION Primary Contact Daytime Phone: (360)308-8330 Owner Daytime Phone: (360)426-0773 Primary Contact Mobile/Cell Phone: (360)340-8372 Owner Mobile/Cell Phone: (360)580-9440 Primary Contact Evening Phone: (xxx)-xxx-xxxx Owner Evening Phone: (xxx)-xxx-xxxx Fax: (360)427-8593 E-mail: sxxxxxxxxxxxxxr@aol.com Fax: E-mail: pxxxxxxxxn@gmail.com 1.SATELLITE MANAGEMENT AGENCY-SMA(check only one) Not applicable(Skip to#12) — - MA Number: O, Owned and Managed SMA NAME: S_ —.- — „"--- -- o Managed Only Owned Only 12.E WATER SYSTEM CHARACTERISTICS(mark all that,apply) E]Agricultural o Hospital/Clinic [Residential )(Commercial/Business O Industrial 0School O Day Care Licensed Residential Facility OTemporary Farm Worker Food Service/Food Permit O Lodging DOther(church,fire station,etc.): 1,000 or more person event for 2 or more days per year p Recreational/RV Park Q RTCR Seasonal System 3.WATER'.SYSTEM.-OWNERSHIP(mark only one) 4. STORAGE.CAPACITY(gallons) ]KAssociation ❑County Investor w m Special District p City/Town O Federal p Private State 156,000 15 16 17 18 is 20 21' 22 23 24 SOURCE NAME INTERTIE SOURCE CATEGORY USE TREATMENT DEPTH SOURCE LOCATION to. LIST UTILITY'S NAME FOR SOURCE z z z m AND WELL TAG ID NUMBER. Z z c c O m m' O `. 1•_ °c Example: WELL#1 XYZ456 o cn D r ° M m r A � m0 mm � IF SOURCE IS PURCHASED OR INTERTIE F F y Z z D Iii D Q roDrnG) -a o . z r C° INTERTIED, SYSTEM -ni i S LIST:SELLER'S'NAME ID m M — m M -4 + M s m z z � o - - — x m0 CO — W uz C m mm . Example: SEATTLE NUMBER r v v G) v,;o ; C -+ r -< o m z `z z S z -42 m z U m S01 InAct 08/14/2012 Well#1 AHB668 X X Y X 230 150 NW NE 21 20N 03W S02' 78617/SBCWC S01 Well#2 AHB669 8" X X Y X 285 240 NW NE 21 20N 03W S03` Well#3 BCA356 8" X X Y X 329 180 NW NE 21 20N 03W n/111 nn.1 ^44 ion/nnnc� .- .- ,' . -,.,.,• i WATER FACILITIES INVENTORY (WFI) FORM - Continued 1 SYSTEM ID NO. 2. SYSTEM NAME 3. COUNTY 4. GROUP 5. TYPE 78620 1 SHORECREST ESTATES WATER CO MASON A Comm DOH USE ONLY! OH USE ONLY ACTIVE CALCULATED APPROVED SERVICE ACTIVE CONNECTIONS CONNECTIONS CONNECTIONS 25:,_SINGLE FAMILY RESIDENCES(How.many of the following do you,have?) 618 680 A. Full Time Single Family Residences(Occupied 180 days or more per year) 619 B. Part Time Single Family Residences(Occupied less than 180 days per year) 0 26. MULTI-FAMILY RESIDENTIAL BUILDINGS(How many of the following do you have?) A. Apartment Buildings,condos,duplexes,barracks,dorms 0 B. Full Time Residential Units in the Apartments,Condos,Duplexes,Dorms that are occupied more than 180 dayslyear 0 C. Part Time Residential Units in the Apartments,Condos,Duplexes,Dorms that are occupied less than 180 days/year 0 27. NON-RESIDENTIAL CONNECTIONS(How many of the following do you have?) A.Recreational Services and/or Transient Accommodations(Campsites,RV sites,hotel/motel/overnight units) 0 0"" 0 B. Institutional,Commercial/Business,School,Day Care,Industrial Services,etc. 11 11 - ' 0 26. TOTAL SERVICE CONNECTIONS 630 680 29. FULL-TIME RESIDENTIAL POPULATION A. How many residents are served by this system 180 or more days per year? 1310 30. PART-TIME RESIDENTIAL POPULATION JAN FEB MAR APR MAY JUN JUL AUG" SEP OCT NOV DEC A. How many part-time residents are present each month? B. How many days per month are they present? 31. TEMPORARY&TRANSIENT USERS JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC A. How many total visitors,attendees,travelers,campers,patients 10 10 10 10 10 10 or customers have access to the water system each month? B. How many days per month is water accessible to the public? 30 30 30 30 30 30 32. REGULAR NON-RESIDENTIAL USERS "JAN FEB " MARK APR, MAY JUN- JUL AUG SEP OCT NOV DEC A. If you have schools,daycares,or businesses connected to your water system,how many students,daycare children and/or 10 10 10 10 10 10 10 10 10 10 10 10 employees are present each month that are NOT already included in the residential population? B. How many days per month are they present? 20 20 20 20 20 20 20 20 20 20 20 20 33. ROUTINE COLIFORM SCHEDULE JAN FEB.` MAR APR MAY JUN JUL AUG SEP" OCT NOV DEC 2 2 2 2 2 2 2 2 2 2 2 2 34. NITRATE SCHEDULE QUARTERLY ANNUALLY ONCE=EVERY:3.YEARS , (One Sample per source by time period) 35. Reason for Submitting WFIi ❑Update-Change ❑ Update-No Change ❑Inactivate ❑Re-Activate ❑ Name Change ❑New System ❑Other 36. I certify that the information stated on this WFI form is correct to the best of my knowledge. SIGNATURE: DATE: PRINT NAME: TITLE: r,�i i flf, n„ /,•1!,nnC\ ., o,,.,..• WS ID WS Name 78620 Shorecrest Estates Water Co Total WFI Printed: 1 r r 1177i nil 1.1 nI lfOC\ r+�� n Dnnn• '2 'V . Washington State Department of HEALTH Water Facilities Inventory(WFI) Report Create Date: 6/5/2026 Water System Id(s): 78620 Print Data on Distribution Page: ALL Print Copies For: DOH Copy Water System Name: ALL County: -- Any -- Region: ALL Group: ALL Type: ALL Permit Renewal Quarter: ALL Water System Is New: ALL Water System Status: ALL Water Status Date From: ALL To ALL Water System Update Date ALL TO ALL Owner Number: ALL SMA Number: ALL SMA Name: ALL Active Connection Count From: ALL To: ALL Approved Connection Count ALL To: ALL Full-Time Population From: ALL To: ALL Water System Expanding ALL Source Type: ALL Source Use: ALL WFI Printed For: On-Demand M^1 I nn4 n44 14n/nnnC r�.•.. Dnni.•