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Home My WebLink AboutWAI2022-00077 - WAI General - 6/3/2022 UN N I .14°1:) "I °CIS:7°1 7 tilIPT::1,. MASON COUNTY �� '� z COMMUNITY SERVICES ,, ,,, Building,Planning,Environmental Health,Community Health . .frLivekvv 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 •:• Belfair: (360) 275-4467 ext 400 ❖ Elma: (360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal --) I g T. 0 CI Ri Amount Paid: °VA - JUv 0 [ j [ j A Receipt Number: /►Z Instructions By.._ . I 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant JENNIFER FORRESTER Telephone Mailing Address of Applicant PO BOX 1942 City ALLYN State WA Zip 98524 12-digit Tax Parcel No. 2 2 1 0 3 - __ 5 0 _= 0 0 0 3 2 Site Address 30 E BENSON LAKE DRIVE, GRAPEVIEW Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations 12' Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): SEE ATTACHED FOR DETAILS Applicant Signature: yx,54 Date: S'(,a.v (ate J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal ❑Waiver ❑ None required xglass A ❑ Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/ Standard revision) I0 6ti( -k C1455 3. Nature of Appeal: `,) :c- f-L444 Pr4,ti F „Art bF bud ( (/ccct) 1) ka ttJel� 6-jus5 A-) 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board 0 Environmental Health Manager 5. Mitigating Factors: olive 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. Staff Signature: Lj "-\, tv �� ,? Date: 7, f< PART 4: Determination of-the Hearing Official The hearing official has determined that approval of this request will not adversely affect public health and is hereby granted. This decision is based on the following findings and conditions: 0 The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied. This decision is based on the following findings and conditions: Hearing Official Signature: Date: ?0/2-Z J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (1) JENNIFER FORRESTER Local Health Department/District (2) (see instructions) Address: PO BOX 1942 ALLYN, WA 98524 Telephone: ( ) Signature: Property Identification: (3) 2230-00 32 30 E BENSON LAKE DRIVE Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A 0210 100FT DRAINFIELD TO 50FT (68 ACTUAL) DRAINFIELD Subsection: TABLE IV PRIVATE WELL (RESERVE) TO PRIVATE WELL Justification(mitigation measures to be provided): (7) SEE ATTACHED. MEETS ALL CLASS A MITIGATION REQUIREMENTS. Section III. (completed by health officer) Review Criteria: (8) Mitigation Measures(in additi n to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) ]Class A [ ] Class B [ ] Class C Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes No If needed, are agreements, easements, etc.properly filed? Yes No Section IV. I (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. [ ] Denied [4)L pproved /Granted—Subje o all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) Date: 7 a DOH 337-021 Page 26 of 32 PIONEER DIGGING INC. Robert H. Paysse 3083 E Mason Benson Road Grapeview WA 98546 5/18/2022 Mason Co. Health Dept. Re: Jennifer Forrester - 22103-50-00032 Reference Requirement Request Mitigation WAC246- 5ft from septic tanks 2ft from septic tanks Property line is not oca\ 272A-0210 (3) and drainfield to and drainfield to downgradient. Slope & Table IV property line northern property runs parallel to line Of 9e line requested. WAC246- 100ft from drainfield 90ft from primary Well logs attached. 272A-0210 (4) to private wells drainfield to System will meet TL- ti` & Table IV applicant well B without disinfection and has 24" of vertical W separation for increased treatment prior to disposal. Annual O/M required and tracked through OnlineRME. WAC246- 100ft from drainfield 50ft from reserve (1) Annual O/M 272A-0210 to private wells drainfield to required and tracked & Table IV neighboring well through Online RME. (2) System will meet Primary area meets TL-B without ttO Pr 100ft requirement. disinfection and has t 24" of vertical separation for increased treatment prior to disposal. (3) Well is upgradient of disposal area and well log attached shows cemented confining layers. (4)Neighbor notification sent certified mail. Other attachments: • Cover letter • Site plan and detail • Well log for the neighboring well • Neighbor notification PIONEER DIGGING INC. Robert H. Paysse 3083 E Mason Benson Road Grapeview WA 98546 5/18/2022 Mason Co. Health Dept. Re: Jennifer Forrester - 22103-50-00032 The applicants are looking to upgrade their existing 2 bedroom pump-to-gravity system. The system was recently inspected by AAA Septic where a new pump, alarm and riser was installed on the pump tank. Both tanks were found to be in good condition, but no drainfield evaluation was performed. We uncovered the drainrock in two places and found the system is showing signs of wear with significant root intrusion. The applicants would like to upgrade the system to 5 bedrooms to accommodate future plans which may include an ADU. A new primary and reserve area has been located in suitable soils with maximum distances from lake and nearby wells. The proposed primary is 100ft from the lake, both neighboring wells and 90ft+ from the applicants own well. The reserve area is proposed 68ft from a neighboring well, which prompts application for a Class A waiver. Proposal also includes utilizing the existing tanks and transport line which will pump up to a new BNR-600 and 1500 pump tank with timer. Using the existing tanks allows for additional capacity and storage prior to treatment and disposal. Using the existing transport line is needed, as the pathway to the homes outlet is very limited. System will be far superior of that existing and we believe all mitigation is included for waiver approvals per state and county requirements. Any questions or concerns, let us know. Sincerely, c?-'0'(74'A't'" Robert H. Paysse Onsite Wastewater System Designer r �I B4'NS0 *UNCOVER EXISTING 1000 --,q GAL 2- COMP. SEPTIC TANK k��2iVF AT TIME OF INSTALLATION ,, AND INSTALL RISERS TO I I j FINISHED GRADE. MAKE SURE r SEE ALSO ATTACHED I WAIVER APPLICATIONS RISERS AND LIDS ARE i I I WATERTIGHT ON BOTH I I I I I SEPTIC AND PUMP TANKS. \ \\ I I �p EXISTING 1 \00 4I WELL \ I 1 V 1 1125+ SOFT 5 BED \\ 1 j r �) IN RESERVE AREA \ i I (20 X 57) \I 750+ SOFT 5 BED .1 \ 1 I ,, EXISTING GARAGE PRIMARY AREA I NO I IIIillll W/ LEAN-TO SEECROSS-SECTION ET OIL 38) II II,III I FUTURE ADU DETAIL I/ III�� I O-1 % SLOPE � � I 1 PROPOSED TAN5:' / r POSSIli E SEWER NUWATER BNRb00 \ i 1500+ PUMP TANK I \/ LINE FROM FUTURE ADU I I\`01 MAINTAIN 50FTTO WELLS EXISTING I Q�I EXISTING WELL —\, ,\O WELL I II PROPERTY LINE CROSS-SECTION APPROX. EXISTING T/LINE 1 APPROX. I PROPERTY LINE TO BE REUSED EXISTING SEPTIC & PUMP I \ o TANK TO BE REUSED \ I EXIST. CURBINGi NEW PUMP & ALARM I ____ NETAFIM DRIPLINE RECENTLY INSTALLED I �i EXISTING 3 BEDROOM HOME BENSON LAKE I _—� 1 APPROX. EDGE OF LAKE I _\1._I DESIGN NOTES: INSTALLATION DESIGNER SIGNOFF/ASBUCT FEE WILL BE CHARGED TTIME OF INSTALLATION. ANY PROPOSED STRUCTURES ARE SUBJECTTO OTHER DEPARTMENT REVIEWS,DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRE i TED TO SEPTIC COMPONENTS. PIONEER. DIGGING, INC. ARCELn#:22 03 50-000332 TER SCALE TEST HO E01:I TEST HOLE 2: TEST HOLE 3: I SEPTIC DESIGNS ADDRESS: 30 E BENSON LAKE DR 0-18 OLD FILL 0-45 GLS 0-37 GLS 18-44 GLS 45+H2O 37+H2O 3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE OFFICE-360-426-1803 FAX-360-427-2353 DESIGN PAGE SITE PLAN 244-272A- Soil dispersal Down to 50 feet. 1)Enhanced aced treatment performance 1a)Treatment component or sequence listed as meeting Treatment Level B. 0210(4) component 75 feet from except not in Disinfection can not be used to achieve the fecal colifoem limit of the treatment non-public well or Soil Type I level.The soil disposal component maintaining at least 3 feet vertical separation: suction line i.e..sand filter followed by a gravity distribution SSAS with at least 3 feet of vertical separation or bye pressure distribution SSAS with at least 2 feet of vertical separation.A mound system with 2 feet of sand media may be allowed.if them is at least 3 feet of available soil depth. 2)Performance assurance of treatment 2a)Management program established which assures the on-going proper operation system and maintenance of the system. 3)Hydrogeologic susceptibility 3a)Adequate protective site specific conditions existing.such as physical settings with low hydrogcologic susceptibility from contaminant tallltratmn:i.e.evidence of confining layers and or aquitards separating potable water front the OSS treatment zone.excessive depth to groundwater.down-gradient contauummt smart.or outside the zone of influence. 4)Determination of any existing covenants 4a)Notification of proposed encroachment to the well owner if there are no existing or easements for maintaining a salutary covenants or easements establishing a control area. control area V WATER WELL REPORT Start Card No. W062311 Unique Well I.D. k ABH311 • STATE OF WASHINGTON Water Right Permit No. (1) OWNER: Name MASSIE, RONALD Address 9116 122ND PLACE SE NEWCASTLE, WA 98056- (2) LOCATION OF WELL: County MASON - SE 1/4 NW 1/4 Sec 3 T 21N N., R 2W WM (2a) STREET ADDRESS OF WELL 'or nearest address) E BENSON LAKE ROAD, SHELTON (3) PROPOSED USE: DOMESTIC (10) WELL LOG (4) TYPE OF WORK: Owner's Number of well Formation: Describe by color, character, size of material (If more than one) and structure, and show thickness of aquifers and the kind NEW WELL Method: CABLE and nature of the material in each stratum penetrated, with . ............................................ at least one entry for each change in formation. (5) DIMENSIONS: Diameter of well 6 inches Drilled 83 ft. Depth of completed well 83 ft. MATERIAL FROM I TO .. ....... -........ BROWN GLACIAL FILL 0 j 22 (6) CONSTRUCTION DETAILS: GRAY CEMENTED GRAVEL 22 j 45 Casing installed: 6 " Dia. from +1 ft. to 78 ft. CEMMTED BROWN SAND 45 j 50 WELDED CASING " Dia. from ft. to ft. BROWN SAND GRAVEL & WATER 50 ) 66 " Dia. from ft. to ft. GRAY CLAY 66 j 71 LARGE GRAVEL & WATER 71 j 83 Perforations-: NO Type of perforator used SIZE ofperforations in. by in. • j perforations from ft. to ft. perforations from ft. to ft. perforations from ft. to ft. I I j Screens: YES I Manufacturer's Name WESCO ) Type SLOTTED Model No. Diem. 5 slot size .040 from 78 ft. to 83 ft. Diem. slot size from ft. to ft. N r" • j Gravel packed: NO Size of gravel �n Gravel placed from ft. to ft. z a Surface seal: YES • To what depth? 20 ft. j g Material used in seal BENTONITE C Z ' '�"+ Did any strata contain .nusable water? NO D _ � �. j Type of water? Depth of strata ft. r le.'' Method of sealing strata off _.===.. =_...._....__ C� vD P` 7) PUMP: Manufacturer's Name Type H.P. C 9) WATER LEVELS: and-surfaceelevation j .. • above mean sea level ft. ! ! Static level 49 ft. below top of well -Date 07/24/95 Artesian Pressure .bs. per square inch Date Artesian water controlled by Work started 07/19/95 Completed 07/24/95 9) WELL TESTS: Drawdown is amount water level is lowered below WELL CONSTRUCTOR CERTIFICATION: static level. I constructed and/or accept 'responsibility for con- Was a pump test made? NO :f yes, by whom? struction of this well, and its compliance with ail Yield: gal./min with ft. drawdown after hrs. Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. Recovery data Time Water Level Time Water Level Time Water Level NAME ARCADIA DRILLING INC. . (Person, firm, or corporation) (Type or print) ADDRESS SE 170 WALKER PARK RD Date of test / / Sailer test 12 gal/min. 18 ft.• drawdown after 1 hrs. (SIGNED) D<-J'•-' ' 4w V License No, 1706 Air test gal/min. w/ stem set at ft. for hrs. Artesian flow g.p.m. Date Contractor's Temperature •of water Was a chemical analysis made? NO , Registration No. ARCADDI098K1 Date 77/25/95 . • 1El , , 7 I- ill AUG 14 1995 Printed ` 1 Mason County OMS Printed from Mason County DMS -�P4I SF V ICFC I TANK PUMPING REPORT Site Name: Location:30 E BENSON LAKE DR Service Company: p Y: Grapeview Tax ID:221035000032 AAA Septic LLC uae: PO Box 1460 Shelton,WA 98584 360-427-6110 Serviced:04/22/2022 by: Debra Lovely Submitted 05/11/2022 by:Debra Lovely Dump Location:Bio-Recycling Jurisdiction ID:221035000032 COMMENTS Needs new pump and floats. 4/28/22:Installed new pump and floats. 5/10/22:Installed outdoor alarm and service disconnect and j-box. TANK:Septic Tank-2 Compartment Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): NO Corrected Total Gallons pumped from tank(Number only,no text): 1000 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): Access Risers installed to grade(N/A if not present): N/A Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): YES Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: NO Were repairs made to the Tank or Tank Components?(if YES explain in comments): YES Compartment 1 Scum accumulation(Inches,if other specify): 10 Compartment 1 Sludge accumulation(Inches,if other specify): 12 Compartment 2 Scum accumulation(Inches,if other specify): 4 Compartment 2 Sludge accumulation(Inches,if other specify): 10 ANK:Pump Tank Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 100 Effluent level within operational limits(if NO explain in comments): NO Corrected Total Gallons pumped from tank(Number only,no text): 100 Tank depth below grade(inches): Access Risers installed to grade(N/A if not present): YES Tank Construction Material: Concrete Tank Condition Good: YES Effluent screen cleaned(N/A if not present): YES Effluent surfacing around site components(N/A if not checked): NO Pump operating as intended: NO Corrected Controls operating as intended: NO Corrected Alarm working as intended: NO Corrected Tank abandoned after pumping: NO Were repairs made to the Tank or Tank Components?(if YES explain in comments): YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 6 This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportiD:582418 View pump reports online at www.onlinerme.com Page 1 of 1 Pioneer Digging Inc. 3083 E. Mason Benson Rd. Grapeview, WA 98546 MASSIE REVOCABLE LIVING TRUST, RONALD L& DONNA K RONALD L& DONNA K MASSIE TRUSTEES 50 E BENSON LAKE DR GRAPEVIEW WA 98546 5/20/2022 To whom is may concern: I am a Septic Designer working with your neighbors on Benson Lake, Jennifer& Mesphin Forrester, on a new septic design. This letter is to inform you that they have made application for a waiver to locate their septic reserve drainfield closer than the standard setback of 100ft from the well located on your parcel, but not closer than 50ft. Actual distance from the proposed reserve drainfield is around 68ft to the closest point. The new proposed primary drainfield will meet the 100ft setback and is far advanced than the existing gravity from 1974 (in the same location). The reserve area is only a designation and nothing is installed unless the primary fails. The primary will receive annual O/M to ensure its operating correctly, reducing the expectation of needing this reserve area. Washington State allows these setback reductions provided it meets specific mitigation measures which include enhanced treatment prior to disposal, annual operation and maintenance inspections, and evidence of confining layers. This proposal will meet all required mitigation measures and be a vast improvement to the older conventional system they have now. I have attached the site plan from the design for your information. We are required to notify you of this application as part of the review process. If you have any questions or concerns you may contact myself or Mason County Health Department at the numbers below. Thank you for your time. Pioneer Digging Inc. - 360-426-1803 - (Robert H. Paysse/Designer) Mason County Health Department - 360-427-9670 - Ext. 400