HomeMy WebLinkAboutWAT2026-00143-WATER ADEQUACY - WAT Application - 7/13/2026 AT 2026 U014;3
MASON COUNTY
„r� COMMUNITY VICES
Buiiding,P3�rir*in Envtcoazmerx4z+l N+ralch,Community Heath
416 N 6ii,Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 "*«+ Belfair:(360)275-4467 ext 400 +:• Eirna:(360)482-5269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1 Complete Part'1, No determination can'be made until Part I is;fuliv-corn 9)leted.
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 • Ana roved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: l l____ _ Date: J
Mailing Address: 1 . Phone: + ° '—
Parcel Number:
4 - co for Application
Type of Water ystean Reason
o PublicfCommunity Water System (2 or more building permit BLD2026-00554
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water O Other{explain)
Other(explain) / t/ O Replacement or Remodel(pleas indicate name
If have-more than one residence connected of water system below if applicable.—no
to this we!!; check the PubliclCommunhfy Water signature required)
System box.
Part 2: ater`Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public. ater System
Name of Water System: VJ 1(1
Water Facility Inventory(WFl) Number:
(write"none"for two-party)
I am the manager of this water system_The water system has been approved forts „services.
There are presently LkLk1 connection(s)in use.This will be the________connection.
I am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this syste (i.e.:r creational tq full time) Please i dlcate on'-the following line the nature
of this change. dt(A 74rib1 C,1l ie C tp Pk'? vie. f�$ e- e
This water system is able and willing to provide water to this (these)connection(s)without exceeding
the limits of the water system or arty lirtli set b to and'local regulation.
ate 7{t /
C
Bigriature of Watef System Manager
Printed name: Jaron Satori
This form may be,scanned and available for public view at www.co. ason.w .us.
J:IE}T Fonngt-T rinking Wt r .1tuv std-l(2 12t11S
sw.
Individual Water Well
0 Water well report(attached to application). Depth ft,
O Well capabit 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. I the water
well report cannot be located by the applicant or if the water well report does not have a capacityr 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 appiicatiori}.
ater Res urce Inv ntr3 e.a
Development within which WRIA httia/Trite co rrtasari,wa.us/ lanninri 14_i5_....18 22 .....
Water use or limitation recorded...... .. .... ............... N/A Yes
WellDrilled ........ ...................................................... bate
Individual Spring/Surface Water
0 W OE.permit(attach to application),
0 Method of disinfection
a 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
n is n y o unityr �s v luati�n (sta use araly
x Satisfactory Determination` :
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
ter.indefnitely in the future,or guarantee compliance.with all applicable WDOE water resource r ulatio .
Recommended approval indicates requirements of,Sanitary Code,Titre 6,Chapter 6.6ti040-Determivation of
Adequacy for Building permits are satisfied. Additional Growth Management requirements may apply. Chapter
3670A RCtt.
Unsatisfactory Determination:.
Applicant's water supply does not appeef adequate to meet the needs of its intended use for the following,
reason(s).
Reviewer's Signatures:
vii on. I alth Date 7/14/26
C ID Director: Date �r
Rhonda Thompson
From: Jennifer Fox <info@fsconstructionseptic.com>
Sent:. Tuesday,July 14, 2026 10:01 AM
To: Rhonda Thompson
Subject: Re: BLD2026-00554
Attachments: Havey Water Adequacy.pdf
Rhonda,
Please see the attached water adequacy report from Jaron Satori.
Thank you so much,
Jennifer Fox
F&S Construction and Septic
Operations Manager
360-229-1220
On Fri, Jul 10, 2026 at 2:19 PM Rhonda Thompson <RThompsonc masoncountywa gov>wrote:
Thank you.Yes, I understand. I would actually still call that living space,just not"sleeping" space since
it will be heated and finished.
Rhonda Thompson, RS
Senior Environmental Health Specialist
Mason County Public Health
415 N 6th St.Shelton,WA 98584
360-427-9670 ext.581
Rthompsonccbmasoncountywagov
To register for an upcoming homeowner septic workshop,please visit:https://extension.wsu.edu/mason/event/SePtiC-
summer/2026-06-1 8/
1
From:Jennifer Fox<info fsconstructionseptic.com>
Sent: Friday,July 10, 2026 2:12 PM
To: Rhonda Thompson<RThompson masoncountywa.gov>
Cc:Josephstoffel38@gmail.com
Subject: BLD2026-00554
Dear Rhonda,
Thank you for your email regarding the building permit.
I would like to clarify that the space above the garage is a game room and storage area, not a living
space. I confirmed this detail with the building department. I wanted to ensure all departments are
aware of this clarification.
An employee at Fawn Lake who helps manage the water systems completed it and that is what he
handed Joe. I will reach out to the appropriate supervisor to ensure the form is filled out correctly and
returned to you as soon as possible.Joe is on his way to deliver it to Jaron himself.
Please let me know once you hear back from Maggie Kipple.
l _
Thank you,
p3
Jennifer Fox
F&S Construction and Septic
Operations Manager
360-229-1220
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