HomeMy WebLinkAboutWAI2023-00014 - WAI Health Waiver - 2/10/2023 . L„,p, t 10 v? Food 4 ,i- , ..,:,F 1{23 LE ii W Lc" !i:
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MASON COUNTY By
y ' COMMUNITY SERVICES
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, � Building,Planning,Environmental Health,Community Health
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
Amount Paid: Ire
Receipt Number: '
Instructions
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 MARK TANSEY Telephone
Mailing Address of Applicant 410 NE 103RD ST APT 6B
City KANSAS CITY State MO Zip 64155
12-digit Tax Parcel No. 3 2 1 2 4 - __ 5 2 _= 0 0 0 3 1
Site Address 251 E EMERALD LAKE DR W, SHELTON
Subdivision Name and Lot EMERALD LAKE DIV. 3/LOT 31
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation 0 Food Sanitation Requirements
O Building Permit Review Policies 0 Group B Water System Regulations
EX Location, WAC 246-272A-0210 0 Water Adequacy Requirements
O Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM LAKE TO DRAINFIELD,FROM 100 DOWN TO 75.
SEE ATTACHED
Applicant Signature j ?dral--74). Date:.4 /v ( -2—;,_
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only) / d c �(
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
- Appeal > aiver i None required 7 Class A Class B Class C
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal: 76 -f a v(eC41/1--e.
4. Hearing Official:
❑ Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
5. Mitigating Factors: -Q a (le r 1-1(4{ 6e f i'a,fi dr/ C N 2
`-7' 1� d?re(1
(0 "6' layers
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: t/ �/�V`� �l�' Date: — 2 i ��
PART 4: Determina on of the Hearing Official
g-- 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:
❑ 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: 77 / / i
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
•
PIONEER DIGGING INC.
Robert H. Paysse
3083 E Mason Benson Road
Grapeview WA 98546
2/8/2023
Mason Co. Health Dept.
Re: Harrison Laird
Reference Requirement Request Mitigation
WAC246- 100ft+ from 75ft+from See below
272A-0210 (4) drainfield to surface drainfield to surface
& Table IV water(lake) water(lake).
WAC 272A-0210
(4) The horizontal separation between an OSS dispersal component and an individual
water well, individual spring, or surface water that is not a public water source can be
reduced to a minimum of seventy-five feet, by the local health officer, and be described as
a conforming system upon signed approval by the health officer if the applicant
demonstrates:
(a)Adequate protective site-specific conditions, such as physical settings with low
hydro-geologic susceptibility from contaminant infiltration. Examples of such
conditions include evidence of confining layers and/or aquatards separating
potable water from the OSS treatment zone, excessive depth to groundwater,
down-gradient contaminant source, or outside the zone of influence; or
(b) Design and proper operation of an OSS system assuring enhanced treatment
performance beyond that accomplished by meeting the vertical separation and
effluent distribution requirements described in WAC 246-272A-0230 Table VI; or
(c) Evidence of protective conditions involving both (a) and(b) of this subsection.
Proposed Mitigation:
• Low risk to subsurface water table, see attached well log showing a 34-58ft till
layer. Lot is on a gentle and even slope towards lake with no downslope cuts or
risk of short-circuiting treatment zone. Planned development and excavation to
occur upslope of drainfield.
• Drainfield soils and designed excavation depth provides enhanced treatment with
48"-53" (36"required) of vertical separation prior to a restrictive layer or seasonal
water table.
WATER WELL REFER : Star_ Card No. W09414
Unique Well I.D. n
STATE OF WASHINGTON Water Right Permit No.
t. IWNER: Name EMERALD LAKE COMM. CLUB Address E 140 EMERALD LAKE DR. E. GRAPEVIEW, WA 98546-
;• '2 LOCATION OF WELL: CCJrty MASON - NW 1/4 NW 1/4 Sec 24 T 21N N., R. 3W WM
.2a) STREET ADDRESS OF WELL :or nearest address) EMERALD LAKE, GRAPEVIEW
3' PROPOSED USE: DOMESTIC :10, WELL LOG
i4 TYPE 2? WORK: c 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
. .s--- at least one entry for each change in formation.
:S. D_MENS_ONS. Diametst' of well 8 inches
Dr,. ._d IC9 ft O>p=i of completed well 109 ft. 11ATERZAL ' 77,: i :
BROWN TILL AND COBBLES I 0 34
,S• C•DNSTRUCTION DETAILS: BROWN SAND & GRAVEL SILTY 34 60
Casing installed: 8 " Dia. from +2 ft. to 101 ft. MEDIUM SAND MOIST GRAVEL 160 75
WELDED CASING " Dia. from ft. to ft. CLEAN BROWN SAND GRAVEL 75 89
" Dia. from ft. to ft. SILTY GRAVEL 89 90
BROWN COURSE SAND GRAVEL A WATER 90 109
Perforations: NO GREEN BLUE CLAY 109
Type of perforator used )
SIZE of perforations in. by in.
perforations from ft. to ft.
perforations from ft. to ft.
perforations from ft. to ft.
Screens: YES
Manufacturer's Name HOUSTON
Type SLOTTED Model No.
Diem. 8 slot size .040 from 99 ft. to 109 ft.
Dior). sLot size from ft. to ft.
2revel packer NO Size of gravel I ..`
;,ravel placed from ft. to ft. I -et,. I% )
-_
Surface seal: YES To what depth? 20 ft. t1 •
• .
Material used in seal BENTONITE _ — i
Did any strata contain unusable water? NO I _
�ti
Type of water? Depth of strata ft. I .
Method of sealing strata off I r I I
a===-= •I = r,
,l, ?MP. Manufectvrer's Name I -. -_
(3; WATER LEVELS. Land-surface elevation I
above mean sea level ... ft. I
Static level 39 ft. below top of well Date 10/03/96
Artesian Pressure lbs. per square inch Date
Artesian water controlled by
Work started 09/26/96 Completed 10/03/96
'9) WELL TESTS: Drawdown is amount water level is lowered below I WELL CONSTRUCTOR CERTIFICATION.
static level. I constructed andior accept responsibility for con-
Wes a pump teat made No if yes, by whom? atruction of this well. and its compliance with a_1
Yield gal.imta with ft. drawdown after hrs. Washington well constr cttor. standards. Materials used
and the information reported above are true to my bast
knowledge and belief.
Recovery data
Time 'late_ Level Time Water Level Time Water Level NAME ARCADIA DRILLING INC.
;Person. firm, or corporations :Type or print)
ADDRESS SE 170 WALKER PARR RD •
Date of test / I
3aller teat 40 gal.min. 28 ft. drawdown after 1 hrs. (SIGNED) De.-- % .Ar• License No. 1149
Air test gal/min. wl stem set at ft. for hrs.
Artesian fi•o. g.p.m. Date contractor's
Temperature of water Was a chemical analysis made? HO Registration No. ARCADDIO 8K1 Date 10/24r96
, A.
STATE OF'WASSINGTON•'I ... _ - i::
.' DEPARTDIE:&-OF ECOLOGY-:.• • •.• - _ - _- .- .-.
,. =_Pea-, Toff? - ' • - - . ._
WELL LOG e I --_.; ', ^.. .
Record by....b E-..iJ.l.a I
• Source..._..W.,Q�..I.i_...Cep0r --1- - ..--,__. - •,__ .' .•. ,. •,. •
t, 1 • ,
Locdtion: State of WASHnIGTON , •�
County-..: LZ.S,Q.n.'. »._._.....». •• •• - �•_:l'' r _ 1_. 'y.�::. _ . ....: :.«1• :r . •
Area. ».. . 4.�'
• 1 _ .. 1 Lil,� 1 • ,
Map....._. ..»_. _._:..... . _ - •
__..tom:_� ` fi; � _ : '' —
. S�t�N..3/a NU1/•t seed?... Yf_T2-j_N., R. ._ w•- rat��o Sectton ."� _,.-. ._
Drilling ao,../{Ar..Q P.Lmp' - . '-f/ :4r9t. ;7-- f, ;» .s... .•:,'_, _ •
Address-RI.c.?�_.»__SL?X...,7.LLQ.,.....tc ,.,L? • •41,-;. .-ash.. -as- a._�
Method of Drilli g. *Date..d_. /..�.. 1�9.LR - ' - . •. . .
• . owner. O.'1..'��rG-{.2l�L.-.. ................... V C l.t.�:(J..'. . .. - .'._... _ . .
Address.-[:t?:_. , .�.g.3..1:.i" q_l by �O'z ge37�_. . . _ . - . . ..
•Laud surface, datum -- _ •fkbelow' L..�.....�.^^. � ..'. i.. - .
SWL' • 7 ....... ... Date t7 :,19- -. .Ditrla,:-. ..:-_. .; : •• _.. .._ ..t__ . _
Comm- MATERIAL - .e . _ { From. To_ = .t_. i' =
1 LATratt M _ 1. _-• , I. Gfet}. (feet) •_ ..
(Transcribe driller's terminology literally but paraphrase ns necessary:in petenti>aee.: . •
If rnetet•ial Lvate -benring, so state and record static.level if reported. Oive depths in feet . _. _ -,_ M . .
below land-surface dntum•unless otherwi.,e•indicated. (�orrctate with.,ttmtieraphirpolumn. • _ •• —�
if feasible. Following Ice of materia ,:.list, akl•easiMts, perforations-..scregna,-ec:2___. ' • _ -_ -. .�
• J O(,e '- t�' G�Jz�1 ti' alrt �� (x��r� - ._.. :1 .._,
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float,- tn - - •P5• . I�a<3. , ' • *r
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