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HomeMy WebLinkAboutWAI2022-00126 - WAI Health Waiver - 3/7/2023 7....------`, 415 N.6"STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 1 : -' COMMUNITY SERVICES BELFAIR:360-275-4467, ext.400 ELMA:360-482-5269,ext.400 �\,, Building,Planning,Environmental Health.Community Health FAX:360-427-7798 A pjica 'o for Waiver or Appeal Amount Paid - -:_ Receipt Number: o7-1 oS�`d3 WA! Zo27 - 0° 17' ( 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 Information Name of Applicant Brad & Shawna Killman Telephone (360) 359-5085 Mailing Address 2620 36th Ave SE City Olympia, State WA Zip 98501 Parcel No. 2 2 3 1 9 -- 5 0 -- 0 0 0 6 2 Site Address 2820 NE Tahuya-Blacksmith Rd, Tahuya, WA 98588 WOOTEN LAKE TRACTS TR 62&VAC ST ADJ PCL 1 OF BLA#09-41 S 36/110 S 51/233 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal (� ❑ Onsite: Class A Waiver ' ra II Z ►�] ood Sanitation Requirements ❑ Onsite: Class B Waiver 0 roup B Water System Regulations ❑ Onsite: Class C Waiver P. r•.7 7,1?3I ater Adequacy Requirements El Onsite: Location, WAC246-272A-0210 ' 0 1 ilding Permit: EH Review Policies ❑ Onsite: Holding Tank,WAC246-272A- 0 A'ppeal: Enforcement Timelines 0240 ElAppeal: Departmental Determinations ❑ Onsite: Contractor Certification „,_,r::::=---'-"" -.0 Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): 1) reduce setback from drainfield from neighbor's and owner's wells from 100' down to 75'. 2) reduce setback from septic tanks to lake from 50' down to 25'. 3) reduce setback from seasonal drainage from 30'down to 15'. **See attached mitigation, state waiver form,well logs, neighbor notification 4-4 Applicant Signature: Date: L-Z$--23 -.'1c c V-2-b\--o' -- +W`- O t ` - Revised 8113/2018 This form may be scanne and available for public view on the Mason County Web site. Page 1 of PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) o Appeal Waiver None required y. Class A Class B Class C �'L� ' 2. Identification St ndard'revis on1}Stan�\d�ar��te�te�rm��t��(�c���date of determination or latest Code 3. Nature of Appeal: �r}G(it Ft) b> is - pv. uce. Y� 7D h f-�i►I Stilfca -6/01 d p ik So/ +a 2s A us jAi�. f S I e-fiia- -mow► -luh l-5 f� 6 L'n-fi d S,2A+c-c.' to `^Pt 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board 54 Environmental Health Manage 5. Mitigating Factors,- � a � YY\ ,nC Gl plot K1 - L13 .. U t ' J Ve(o►zt -- vu2 i l pw rer✓ hu�'►�-I,'z7-7 - l Dal-t d 1 i I-e't k -k�S - 2(4" \I S - t'ltinAiY1 —i 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: (4)/Y3 Date: 7I? /Z 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: Health Official Signature: 4‘407 Date: ���/Z 7 Revised 8;13/201 E This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) R!i uest for Waiver From State R• ' •tions Section L (completed by applicant) Local Health Department/District (2) Name; (1) 1 " (see instructions Address: 2-co o 3 b S E —_— Telephone: (No Signature: -0c4 ,,r.•Property Identification:Identificahrion: (3) Gt A--* 2-1,S11— - C_oo(O2 y 00-� _ ` L-A o�( -4-[ 3�0 Lo Section IL I (completed by applicant) WAC Number: (4) WAC Requirement: (5) , Waiver Sought: (6) Q t EtA404 St -_ �- c O -dew` t 246-272A— o 2_, 1 O Ck) � c , . 2� 'N''i , Subsection: gyp` �•,o,.. a- `t` ,n�`�'``A ° J Justification(mitigation measures to be provided): (7) Section IIL 1 (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver. (11) biClass 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. j (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. I ]Denied $Approved/Granted—Subject to all comments,conditions and requirements Sections II and III. 3 Local Health Officer (13) Date: j 27 19 Application for Waiver/Appeal Mitigation (updated) 2-21-23 Owner: Brad & Shawna Killman Phone: (360) 359-5085 Mailing Address: 2620 36th Ave SE, Olympia, WA 98501 Site Address: 2820 NE Tahuya Blacksmith Rd., Tahuya, WA 98588 Parcel Number: 22319-50-00062 Property Description: Wooten Lake Tracts TR 62 &VAC ST ADJ PCL 1 of BLA#09-41 S 36/110 1) Local Waiver Sought: Reduce horizontal separation between primary and reserve drainfields and owners proposed well and existing neighboring wells from 100' to 75' minimum. a) Local Waiver Mitigation Measures: The proposed septic system is NuWater BNR-500 to subsurface drip drainfield with timed dosing, which meets Treatment Standard B without disinfection. Vertical separation is 24"+ and subsurface drip distribution will reduce hydraulic susceptibility due to micro-doses of effluent spread over the entire infiltration area.. The general direction of slope in the drainfield area is downhill to the southwest, not in the general direction of the wells which are to the southeast. b)Area well logs are attached. Local wells show multiple till/hardpan and/or clay layers. c) Neighbors have been notified via certified mail and documentation is attached. 1) State DOH Waiver Sought: Reduce horizontal separation between septic tank(s) and surface water from 50' to no less than 25'. a)Waterproof surface barrier applied to concrete tank consistent with Manual of Concrete Practice ACI 515.1R. Flexible rubber boots or compression seals meeting ASTM C 1644, or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to provide flexibility in case of tank settlement while still maintaining a watertight seal. An approved double-wall plastic or fiberglass tank may be used in lieu of a concrete tank. b) Concrete tank tested for water-tightness consistent with ASTM C 1227. Fiberglass tank tested for water-tightness consistent with IAPMO/ANSI Z1000-2007. c) Access openings at or above finished grade with lockable lids or secured to prevent unauthorized entry. 2) State DOH Waiver Sought: Reduce horizontal separation between drainfield and down- gradient seasonal drainage ditch from 30'to no less than 15'. a) The proposed septic system is NuWater BNR-500 to subsurface drip drainfield with timed dosing, which meets Treatment Standard B without disinfection. Vertical separation is 24"+ and subsurface drip distribution will reduce hydraulic susceptibility due to micro-doses of effluent spread over the entire infiltration area. b)A"Notice of Operation & Maintenance" has been notarized by the owner and filed on the property deed. **Note: Per survey, parcel is 16,446 s.f. and exceeds minimum lot size for State Waiver eligibility of 12,500 s.f.** Start Card�. 067350 F>"Department sad Firth Copy with WATER WELL REPORT DepsKment of Ecology 7 Third second cODY-Oweer's Copy STATE OF WASHINGTON Willer Right Permit No Copy-0,Oar'.Copy Bi31LII1-S Adtlrese T — -Blacksmith Rd Tahuya WA ` (t) OWNER: Warn. �" 23 2� W.M. o Mason `:'SW % NE ti ...,r 19 T._N..R O' (2) LOCATION OF WELL• county g 13 2630 Tahuya Blacksmith Rd Tahuva 8588 (2a) STREET ADDDRESS OF WELL(or moonset address) � 5 (3) PROPOSED USE ® Dornestie Industrial C Municipal C (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION 2D El D w a, [l Other E formation: Describe by color, character. size of restertet and structure. sad show Dew etey Test Wall O ter thickness of aquifers and the kind and nature of the material*each stratum penetrated. n Owners nusrttrar d ores with at Maal on►s entry for_-sects crle+rge of iafamemou- i mow TO (4) TYPE OF WORK: (d riven alas one) -- — ttATEAtaL _ — ug ❑ Bored u i Abandoned G New wort? :7C Method: Dable �C1 Driven L 0 12 Deepened Rotary Jetted f7 O Reconditioned i (5) DIMENSIONS: Diameter of well h n chess_ 12 1 40 4 D Hardpan rilled 210 teat. Depth of completed well 21 Q---tt' - -- (6) CONSTRUCTION DETAILS: Sand & gravel with water tementPd 40 _` 80- he to 705 h' - --- - --- Casino Installed: _el....* .—el....• earn.horn—Q-- 80 I 17t)_ - welded • Diem.from tt.to—._.._.--a. Hardpan .- Liner installed • L Omm.from h.to h. 91 Threaded e — C nth sANs} & graved with water 17SZ_ i 172 � Perforations: Ye►� No Ea I — 5 Type ofpaAorstorused --- --_- 172 I _ 185 SIZE of Worsham. in.by in' Hardpan + ppCS perforations from ft to —tt. -- -.... 210 c II.to t. , Sand & gravel with water IQl psAoratbns from 4 pe toretiooss from h.to- h• 4 Screens: Yes E $01 I y Manuuctwar's Name Cook _ - - r. Type Staff nl PSS Model No. 5„ -_.Slot ski. 35 from_205 it to 0 ft. Diem. Slot sae front__ R.to ft• i. 4 tarsus?Peeked: Yes No sizecogravel 1_ L. Ptil Greve plated from A.to h. y G To wMt depth?__ 18 n I --- 2. Surface seal: Yee LX No -- r Material used in Beal Bettnlite — 7 Did any strata contain unuaabN water? Yes L� No ibl Type of water? _-- Depth of strata ---. _ .3.1 - ._.- . maim of treating Wats oh -- -- - 3 (7) PUMP: Alanutaetur.r'.Hsme Jacuzzi Type: sub --H.P t fiend-enrtau Wevstton a. _-- - - . ., (8) WATER LEVELS: eeoY.m.at*eatewt static level 170 h below top of wet: Dalt LI Artesian presents Iba.per square Inch Data — - U Artesian w.ter meomiOdsd by tGo.•alv+,a�)7 5 5 92 Work started____-_.1g Completed .19_ O (9) WELL TESTS: Drawdowwa is arrt unl water level to lowered balaw static level - Wes a pump test made?Yee?_.: meal. If Yell.byWhom? WELL CONSTRUCTOR CERTIFICATION: '. ,hit. y Yield pal.raun.wRh ff. -__ I constructed endfor accept responsibility for conatructlen of this well, ►. -- ---' - and its compliance with all Washington well construction standards. - Meterfeta used and the Information reported above ere true to my beat J --� _ - "---" - --- knowledge end belie?. n.n Recovery data(time liken al zero when pump turned on)(water twat measured from wall lop to wets(level) Iy Teta weer Laval runs Wet*,level Tim* Water Lever NAME Davis Drilling 1 — (PERSON FIRM.OR CORPORATION) (TYPE OR Mier) y —__ Address Belfair WA 98528 _ -- ---' pale of tell (Signed) License No. 1884 25 tt.drswdown after.�— (tWEu OW gal.f nun.wan tree Bade test Contractor's Palest gal.ewur.with stem eat at n.for tire. Regi�rp)jgfl� o. 111)AAVV�� �T 11( Date y 19 N Artesian now _g.D•m. Date�"-- _--. _ Temperature oI water Wee*Ch.mu;al anaiyete made? Yes ' NoR: (USE ADDITIONAL SHEETS IF NECESSARY) ' ECY OSO I2U Iin in) i!i2J• .111.w7 WATER WELL REPORT CURRENT Original&I'copy-Ecology,2m copy-owner,3tdcopy-driller Notice of Intent No.W 354017 mt. rn+ARTMr.T OF Unique Ecology Well ID Tag No.64H 051 ECOLOGY _Construction/Decommission('X"in circle) "Cans Water Right Permit No. O Constritc ion O DeconTmlission ORTGD L INSTALLATION Property Owner Name Brian Trimble Notre ofintent Number !! PROPOSED USE: ® Doreestie 0 Industrial 0 Municipal Well Street Address 2840 NE Tahuya Blacksmith Rd. Q DeWater 0 Irrigation 0 Test Well 0 Other City Tahttva County Mason TYPE OF WORK: Owner a number of well(if more than one) Location SW 1/4-1/4 NE 1/4 Sec 19 Twn 23 R 2 Ewm 0 E'! CR New weH 0 Reconditioned Method:❑ Dug 0 Bored ❑ Driven Or i Q Deepened ® Cable 0 Rotary 0 Jetted (s,t,r Still REQUIRED) vvW El DII ONSe iltlameter of well 6 inches,drilled230 ft. ` • .i nopdt of completed wets 230ft. Lat/Long Lat Deg Lat Min/Sec CONSTRUCTION DETAILS of Deg Long,Min/Sec 5 Casing ® Welded 6" Diana.from +1 ft.to 225 ft. Installed: ❑ Liner installed Diam.from ft.to ft. Tax Parcel No. (Required)22319-50-00051 = I7 Threaded " Diam.From ft.to ft. Perforations C] Yes ® No CONSTRUCTION OR DECOMMISSION PROCEDURE W. Type of perforator used Formation:Describe by color,character,size of material and structure,and the kind and W. nature of the material in each stratum penetrated,with at least one entry for each change Or SIZE of perfs in.by_in.and no.of perkfrom_ft.to_ft• of information. (USE ADDITIONAL SHEETS IF NECESSARY.) im Screens: ® Yes 0 No ® K-Pan Location 223 MATERIAL FROM TO ii.+� Manufacturer's Name Johnson Top soil 0 2 airType stainless Model No. Brown till 2 5 = Diam.5Slor size 20 from 225 ft.to 230 ft. Gray till 5 68 pig„ Slot size from ft.to ft. Lite brown till with seepage 68 121 ,s CravtUFilterpaeked: (:j Yes E) No Size of gravel/sand Gray till 121 143 2 Materials placed from ft.to ft. Brown till 143 167 a.' Surface Seal: )Et Yes ❑ No To what depth?32ft. Gray tip 167 192 Material used in seal Betonite Brown cemented sand&gravel - BDid any strata contain unusable water? 0 Yes ® No with some water 192 209 3 Typi of water? - ` Depth of strata Sand&gravel with water 209 230 i Method of seating strata oft Z PUMP:-Manufacturer's Name Goulds Type:Sub. H.P. 1 WATER LEVELS: Land-surface elevation above mean sea level ft. = f Static level 203 .below top of well Date Artesian pressure lbs.per square inch Date V Artesian water is controlled by _ (cap,valve,etc.) CWELL TESTS: Drawdown is amount water level is lowered below static level 5 Was a pump test made? 0 Yes El No If yes,by whom? Yield:_ aaIJmin.with_ft.drawdown after hrs. Pr ow Yield:_gallmin.with_ft.drawdown after hrs. Yield:__gaifmin.with R.drawdown after hrs. Recovery data(time taken as zero when pump turned q)(water level measured from t� well top toter le wavel] E Time Water Level Time Water Level Time Water Level MAY .29 2014 gl _____ — —..-- — 5 Date of test VGA Stare tie t Railer test 12 gal/min.with 2f1 drawdown after 1 hrs. of Ecology (S • • } Airiest P2U stern min.with ste set at ft.for hrs. `� Artraiat flow__gpm Date Start Date 11/27/13 Completed Date 1/16/14 _ i Temperature of water Was a chemical analysis made? ❑ yes ® No • "— . _ - - S. • WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well -1 ono • constntction standards. Materials used and the information reported above are true to my best knowledge and belief. Driller 0 Engineer❑Trainee Name( )Man Henningsen y Drilling Company Davis Drilling Driller/Engineer/Trainee Sigma use Address 340 NE Davis Farm Rd. City,State,Zip Belfair WA, 98528 • Driller'or trainee License No.3077 IF TRAINEE:Driller's License No: Contractor's s loi Driller's Signature: Registration No. DAV iSDI I I OOA Date Jan.2014 tea ECY 050-1-20(Rev 02/10) If you need this document in an alternate format,please call the Water Resources Program at 360 4D7- Persons with hearing loss can call711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. $ W Card Nd. W 075716 Flee Orfytnaf and First Copy withWATER WELL REPORT UNIQUE WELL I.D.i ACJ 835 Dsparbsheeht of Ecology Second Copy-Owner&Copy STATE OF WASHINGTON Meterlgiht pit No. Third Copy-Driller's Copy j (1) GINNER: rum Darlene Norlin Address 3341 I_ CnvP Tacoma, WA 98407 D NE ,;, _,asec 19 T 23 N.a 21: •-wM. • (2) LOCATION OF WELL: Gaily Mason c67A gRSRR �) STREET ADDRESS OF WELL for nearest address!_ NE 24 � Bl a karni t h Rci Tahc_nta, Upai (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION / (▪ 3) PROPOSED USE: 3 Domestic TestIndu Well O Mure i 3 Irripat ton Formation:Oeecnba by COIOr.dharecber,size o1 malarial and etrtr<turo,and show tAdtrtesa of equiters peWater Test Well 0 Other C and the kind and nature of the materiel in each stratum penetrated.with at bast one entry for each charge et Inbrmaucn. (4) TYPE OF WORK: sr anoer j r'"81' MATERIAL 1 SOY TO 5 Abandoned 0 New well CX ��CDu9 U Bored_.I . Deepened i i Driven] - Recondrndrhed 0 Rotary c Jetted 0 , Brown conglomorate 5 (5) DIMENSIONS: Dhartteter or well 6 Inches. 4 184 Drilled 191 wet" Norl ftf oompieled well 192 ft. Brawn harr(pan j (6) CONSTRUCTION DETAILS: Sand & gravel with water 184 I 191 ▪ Casing installed: 6 • Dern.tom 0 ft.to 188 ft 1 ▪ Warded S] • Diem.from ft.to ft Liner Metalled E • Diam.from ft to ft. 5 Perfoeetiona: Yes❑ No E — Type of perforator used 3 SIZE of perloretlons . in.by In. 5 perforations from It to ft- Q pertoraonns from tt.to ft 3 perforatbrts from ft.to ft. Screens: Yes® No❑ 7 u manufacturarsName S�',$1]1 esS wire Wrap yrr Z► . a Type Cook Model No. * III Diem Slot size 20 from 1 R8 R to 1Q3 ft a_S a t; Diem. Slot size from ft is ft. -- Grew Z )pocked: Yea❑ No Q Size or gravel 1,, Gravel placed from ft.to ft. c A r- t, VD - Surface seal: Yea E No❑ To what depth? 30 ft- ) Material used in seal Betonite t1.1- W Dad any strata contain unusable water? Yes❑ No a Type of water?__. Depth of strata --- Method of seeing strata off - = (7) � PUMP: Manufacturer's Name_ Gould S Type: sub. - H.P. I 1 (8) WATER LEVELS: 4/29/97 ,19. Corrpiad 5/7/97 .1s Mew�sea bvel tt Worhs Started ,) Static level 167 N.woo.top or wail Pas. WELL CONSTRUCTOR CERTIFICATION: Artesian pressure _in per squareirhCth Dag 5 An.......cortrailact by I constructed andror accept resQonslbil ty for construction of this well. and its [Dap.vatva.ail compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief- ▪ (9) WELL TESTS: Orawdown is amount water level is lowered below static eve ll U Was a pump NO made?Yes El No E Il yes,by whom? NAME Davis Dri l ling Yield: - gal.rmin..rlth ft drawdevn after ins. iPEPecritKew.are CORPORATICee (TYPE OR Mir) a , ., w w Address Belfair WA 98528 Z (Slgrhed) rho' License No. 1773 u Recovery data(lime taken as zero whM p imp mitred ofn(wafer level measured from reel bop to water level) u Time Wafer Lever Time Water Level Time Water Level Contractor's No.Registration VI SDI1100A Date May ,1997 (USE ADDITIONAL SHEETS IF NECESSARY) Date of test Bailer test gal./min.weth . _ft drawdown after_�-hrs. q Opportunity r For spa �� hrs. Ecology is an Equal un and Affirmative Action employer.A few 9af•/rran weft stem ft.for— ciat accommodation needs.contact the Water Resources Program at(206) Artesian flow g.p.m. Dela 407.6600.The TOD number is(206)407.6006. Temperature of water Was a chemical analyses made? Yes Q No 2 EC'r 050-1 20(9.93) I Notice of Intent WE01905 Fit First Copy e Original Department cology WATER WELL REPORT UNIQUE WELL I a# AKR418 Second Copy-Owrtters Copy }, STATE OF WASHINGTON Water Right Permit No WA --- r Third Copy-Onliers copy /5p�V g -- -T--�--T-_ (1)OWNER: Name GARY MINES ActOresS 5130 165 DI LN SW,ROCHESTER,WA S85'79 - $W 114 la 1/4 Sec 14 T 23 N,R �_ W M (2)LOCATION OF WELL: County (MASON (2a)STREET ADDRESS OF WELL(or nearest address) 2500 TAHUYA BLACKSMITH RD TAX PARCEL N0. 223195000077 DESCRIPTION. (3)PROPOSED USE: XD� ^Industrial Oval (10)WELL ation xLOG e color.CO character, ,PROCEDURE no the tins I C DeWater n [Test Well ❑Other Fonature of the material in each stratum penetrated,with at react one entry for each change ofinfonneson Indicate all water encountered ' (4)TYPE OF WORK: Owners number of well(It more than one) MATERIAL I FROM f TO OX New Well Method _ BROWN CLAY AND GRAVEL 0 . 12 0 Deepened ❑Cab Omen BROWN CLAY SAND AND GRAVEL 12 1 22 ❑ReConditroned C Case �Driven 22 34 [Decommission It Rotary OJe BROWN CLAY HARD 342 134 inches BROWN CLAY AND GRAVEL 127 1917 (5)DIMENSIONS: Dray of well SIX ft SAND GRAVEL AND CLAY Drilled 207 feet Depth of completed well 207 GRAVEL.CLAY,SAND AND WATER 191 199 (6)CONSTRUCTION DETAILS: GRAVEL SAND AND WATER 199 207 Casing Installed:vveided , from +1 ft to _ ft- 202 Ebner installed 6 " Dorn from -- ft to ft --- ❑Threaded " Dlam from It to ft pertoBtlpns: Pees [No 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: 2 Yes ❑No ]K-Pac Location 202 1Venufaaruers Name JOHNSON Type STAINLESS STEEL Model No TEL Dram 6 Slot size 14 from 202 ft to 207 ft Dram Slot size from ft to ft GraveUFltter packed: ]Yes X No ❑ Size of gravel/sand _ __ Material placed from ft to ft ��d,fit i-� \j ED Surface seal: X Yes [No To what depth? 37 ft Material used in seal BENTONITE A P H 14 20 4 Did any strata contain unusable water? [[Yes X No Type of water? Depth of strata Method of sealing ��'�. ,i����`Itrl� Jut ai 1, (7)PUMP: Manufacturer's Name Depur.n)ei�t ol t c)ic�ry Type. H P (8)WATER LEVELS: Land-surface umeanseea level ft Work Started 3/30/2004 ,19 Completed 4/5/2004 ,19 Static level 1$0 ft below top of well Date 4J512004 WELL CONSTRUCTION CERTIFICATION: v Artesian pressure lbs per square inch Date I constructed and/or accept responsitxtity for consLucOon of this well,and its Artesian water is controlled by compliance with all Washington well Constructor standards. Materials used (Cap.valve.etc) and the information reported above are true to my best knowledge and belief l (9)WELL TESTS:Drawdown is amount water level is towered below static level Type or Pdnt Name NICHOLAS J.ERNST License No 2147 l Was a pump test made? El Yes fX'No If yes.by whom? (Licensed DnuerrEnpmeer) Yield gal/min with ft drawdown after hrsTrainee Name _ License No. i Yield gal/mm with ft drawdown after tyre Yield gal/min with ft drawdown after hrs Dnlling Corn TOP DOG DRILLING CO l Recovery data(time taken as zero when pump turned off)(water level measured• i`1` from well top to water level) (Signed) a. License No Licensed Driller/Engineer)Time Water Level Time Water Level Time Water Level Address PO BOX 2227 BELFAIR..WA. 98528 L Contractors Registration No TOPDODCO54RA Date 4/8/2004 ,19 i ,. Date of test (USE ADD1T10NAL SHEETS IF NECESSARY) • Baiter test 12 gal Imm.with 1 ft drawdown after 1 tyre Ai gal/min with stem set at ft.for hrs Ecology is an Equal Opportunity and Affirrnatve Action employer. For Artesian flow o P m Date 4/5/2004 special accommodation needs,contact the Water Resources Prcgralm at Temperature of water Was a chemical analyses made' JYeS [}No - (360)407-6600. The TDD number is(360)407-6006 Arrow Septic Designs, Inc 171 E. Vuecrest Dr. Union. WA 98592 Brian &Amanda Trimble ET AL Toben Hull 1327 Hoyt Ave Everett, WA 98201 November 8, 2022 RE: Brad & Shawna Killman Septic with Well Waiver- Parcel#22319-50-00062 Dear Brain, Amanda &Toben: This letter is to inform you that we are submitting a septic design on the property next door to yours for Brad &Shawna Killman at 2820 NE Tahuya Blacksmith Rd, Tahuya, WA 98588. Along with the septic design, we are applying for a local Mason County health department waiver to reduce the setback between the proposed drainfield and your well from 100 feet down to 75 feet. The proposed waiver is to place the drainfield no less than 75 feet from your well located at 2840 NE Tahuya Blacksmith Rd, Tahuya, WA 98588. The standard setback is 100 feet, but the state and local health code allows us to lessen this distance down to 75 feet with proper mitigation. A similar waiver was obtained in order to develop your property back in 2012-2013. To mitigate the setback reduction on this project, the septic system proposed is a NuWater BNR-500 pretreatment tank to shallow pressure drainfield system with timed-dosing. Also, the general direction of slope/drainage in the proposed drainfield area slopes downhill toward the southwest and not toward your well which is more to the southeast. The proposed drainfield exceeds the 100-foot standard setback to Wooten Lake so we are not asking for a reduction there. The proposed system meets treatment level B without disinfection, meaning that the septic effluent/water is cleaned to a high standard before it even goes to the drainfield. No response to this letter is required, it is for notification only. You can feel free to contact the local Health Department or myself with any questions. The Mason County Health Department regulator contact information is as follows: Mason County Department of Health Services Attn: Rhonda Thompson. Jeff Wilmoth or Luke Cencula 415 N 6th St Shelton, WA 98584 (360)427-9670 ext. 581 (Rhonda) (360)427-9670 ext. 543 (Jeff) (360)427-9670 ext. 353 (Luke) If you need further information, please contact my office at(360) 898-2255. Sincerely, ©0 ‘W' Paula J. Johnson Licensed Onsite Wastewater Treatment System Designer U.S. Postal ServiceTM • • CERTIFIED MAIL° RECEIPT • ru Domestic Mail Only • m For delivery information.visit our website at www.us s.com" . PT..f •r•! rl Certified Mail Fee $t !1,1 U46E i m _ . r- $ � - 04 • Extra Services&Fees(check bes addles a$Tro _ 0 ❑Reran Receipt( ccpy) _; ❑Ream Receipt(electronic) _, U.LIU Postmark O ❑Cerefled Mau Restricted Delivery $t 'Sit_all Here • Q 0 Adult Signature Requtred $ N. $j-1_,.Of? ❑Aduk Signature Restricted DeMery$ \ . o�g _ 0 I:P e .60 i- $ 11 08/2022 . • ru Total Postage and Fees.. .-, Sent To • �!' r i a•...a I`cawy�e. er At- "vobe�y K.. N StieeianiiNif. rc.,or7fD foxfo.F (3 zz l 40 �- A4.re c1y,eState,1,..._ w J� 9 S 2.0 PS Form 3800 A•ril 2015 PSN 7534o2-co0-90:7 See Reverse for Instructions ' _N =: . 'i,?LcTE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1,2,and 3. j ■ Print your name and address on the reverse /�f / 0 Agent • f so that we can return the card to you. L1�.11,/__. ❑Addressee R Attach this card to the back of the mailpiece, B. 'eceived by(Printed Name) C. Date of Delivery or on the front if space permits. • 1. Article Addressed to: D. Is delivery address different from item 1? 0 Yes ,r�,,,,I A__ 1 e -c-c-, �� ecAL If YES,enter delivery address below: ❑No ' - 9 SU)1 air. 'S Y liIIi Nino II In Service 0 Priority Mail C Registered Mar', ® ❑Adult Restricted Delivery ❑Reg ste a MallRestricted9590 9402 5079 9092 5817 35 ❑Certified Me® Delivery ❑Certified Mal.Restricted Delivery �Retu�ptfer • ❑Collect on Delivery 0 Collect on Delivery Restricted Delivery ❑Signature ConfirrnationTM' 2. Article Number(Transfer from service labeS1 _ —.Mall ❑Signature Conrrnnation 7 017 2 40 0 000 0 7 317 4 3 2 4 ''+il Restricted Delivery Restricted Delivery . L. . . . .1 PS Form 38.11,July 2015 PSN 75307Q2-000-9053 1 Domestic Return Receipt