HomeMy WebLinkAboutWEC2005-00311 - VAR Application - 11/10/2005 ' MASON COUNTY UWZ5
DEPARTMENT OF HEALTH SERVICESEirvlro al Health Water Qualifyth
LOCAL.(360)427-�670
Application for Waiver/Appeal BEL.FAIR t16a,2754467&4468
FAX(360)427-7798
Amount Paid.-
ReceiptNuniber•
Instructions
it
a . rl u
. ..: .. .. .. . o.. k... E4t
PART 1: Applicant/Pareel Identification
Name of Applicant �a S i Date
Mailing Address L`_/lo ,�if� 7�"oe '� Telephone
Assessor's Parcel Number 3 Z1 7
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal NO/1'
❑ Food Sanitation Requ1��
Y
❑ Oa Site Sewage Requirements 010 V
❑ Building permit review policies ❑ Solid Waste Requirements C �f
❑ Location, WAC 246-172-09SOI ❑ Group B Water System Requirctu
a Holding tank WAC 2 46-2 72-12 5 0 1 ❑ Water Adequacy Requirements tij y
❑ On-Site Standards ❑ Enforcement Timelines
❑ Ceditication contractor(pumper, ❑ Departmental Determinations
designer, installer, O&Mspecl requirements ❑ Other
Description of Waiver/Appeal(include justification,additional material ray be attached): Ad ��
!o!
Applicant Signatur Date
e —�—
It.iWD TAVACHTMWAIVEXWr update:tip(it25•1997
PARTS: Health Department Evaluation(Staff Use Only) '
IA.Type of Detemination Required: 1B. Type of On-Site Waiver(if applicable):
❑Appeal Waiver ❑None required ❑Class A ❑Class B ❑Class C
2. Identificaton of Specific Code/Standard/Detennination(include date of determination or latest
codc/standard revision):
Water adequacy policy
3. Nature of Appeal:
Receive building permit prior to well being drilled.
4. Hearing Official:
❑Board of Health ❑Health Officer
L.Pollution Control Hearing Board QjlcaldL Services Director
❑ Certified Contractor Review Board Enviro¢naental Health Manager
5 Mitigating Factors:
A) WEC#_ DS-o�3//
B) DO
E#�r
C) Two vicinity well logs
D) Letter from well driller
E) Condition permit.Well log and satis bacti to be submitted prior to occupancy.
6. I have reviewed this waiverAwionee request It is complete,and midgatim required by state and local
polity has been submitted.
Staff: D - Date:
PART 4i Determination of the Hearing Official
The hearing official has ddeamined that approval of this request will not adversely affed publie health and
is herebygrattted. 16is decision is based on the following fmdings and maditio¢s:
The hearing official has determined that approval of this request could potentially have an adversely affect
public health and is hereby dettied, ibis decision is based on the following findings:
Hearing Offra Date: !
HAWAIVELM30C Update:November 23,1999
170 SE Walker Park Road
PO Box 1790
Shelton,WA 98584
Phone(360)426-3395
55
1�► a '1l1T1g mC. ;-
November 3,2005
Owner. Site:
Shawn&Nichole Kinney Off Mason Lake Road between Catfish&
E.590 Dartmoor Drive Mikkelsen Rd. - Shelton,WA(Mason Co.)
Shelton,WA 98584 Parcel#321343490033
To whom it may concern:
The owner noted above have contracted with Arcadia Drilling Inc.to drill(1)one 6"
diameter water well for single-family domestic use on the property also noted above.
tstiniated depths in the area range from approximately 100'to 235' depending on land
surface elevations and other variables. Well productions average approximate 25 GPM
-(Galfous l'er Minute). Some property owners do treat for minor Iron and Manganese.
There areno known"dry wells"or critical water problems in the area.The foregoing
mfonmati m is based on supporting water well reports from the area. Copies have been
provided.
Arcadia Drilling,Inc. cannot however guarantee water availability or quality. If you have
any questions please call.
Sincerely,
L
�'Od-Qc"
Connie Williams
Arcadia Drilling,Inc.
$" Jtttg&irll�l 2en