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Home My WebLink AboutWAI Health Waiver - 6/10/2022 tigr".. ' MASON COUNTY t;; re', ,,,.., 1, COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health 415 N 6`h 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/Aeal Amount Paid: 1160 qv Receipt Number: a.-0 I7- Instructions 1. Complete Parts 1 and 2. No determination.can be made until these parts are fdilycompleted. 2. Fees may be billed for waivers and appeals, based on the Environmental Healtl •;Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health:for review. PART 1. Applicant/Parcel Identification / \ Name of Applicant (Z�be�-* Sc e `(�`2t' Telephone `LF J 99 8 - S 13(0 Mailing Address of Applicant (OQ\ !J.6 \0.` Q- V. City ---7 \'^``-Lt• State Zip 9 SS 88 12-digit Tax Parcel No. Z 2 3 3 0 -- s 0 - 0 0 0 9 Site Address S-r f2- Subdivision Name and Lot \-kc` 'L La-Ace- , L_S 9O - 1 I (C.o-cti10'r¢..) PART 2: Nature of Waiver/Appeal 0 Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies El Group B Water System Regulations >3( Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): S ems. k* C)^e2c, Applicant Signature: --cik0Date: (0-t0-22 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) L 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal ..re-Waiver E None required J Class A c Class B c Class C 2. Identification of Specific Code! Standard/ Determination (include date of determination or latest Code/ Standard revision) WI '? Ic. -)-1')rA.-0?'(0 3. Nature of Appeal: elLa--;,_ 1-40s Ca, t„Al.l S -7ri' ,oa"'w.' 4. Hearing Official: ❑ Board of Health _ 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board ..iir. Environmental Health Manager 5. Miti ating Factors: O sc.�•. . 6 U #(.4-'4 €F C.ts`„'L'A-4.cr.dC(•ov.`'r-S ' '�`-'�'t L#/ ti— )e . L_ 1_• a1-b ' • • 6,, tic*t1--.-rc�..2 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: Date: 1 j"Y(•f)4..)">'" --- 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: Official Si nature: 17"---- Date: 7/2_ C, L Hearing g 1 J:\EN Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 Application for Waiver/Appeal Mitigation 6-9-22 Owner: Robert Scheffler Phone: (425)998-3136 Mailing Address: 601 NE Haven Lake Dr., Tahuya, WA 98588 Site Address: same Parcel Number: 22330-50-00092 Property Description: Haven Lake/Lots 90-91 (combined) 1) Waiver Sought: Reduce horizontal separation between primary and reserve drainfields and owner's proposed well and two existing neighboring wells from 100' to 75' minimum. 1)Mitigation Measures: Drainfield system is NuWater BNR-500 to OSCAR mound drainfield and timed dosing, which meets Treatment Standard B without disinfection. General direction of slope is downhill toward lake and away from all wells. Area well logs are attached. Local wells show multiple till/hardpan and/or clay layers. Neighbors have been notified via certified mail and documentation is attached. srrt and No. W 100266 . . ""h WATER WELL REPORT UNIQUE WELL ID./A..cL( 3 ) SecOnd Copy—Owner's Copy STATE OF WASHINGTON Third Copy—OAMr'a Dopy Water Right Perron No. 5 (1) OWNER: fine Earl Hurm Adtkeea3314 Robin Ave. , Bremerton, WA 98312 Z ,11 C (2) LOCATION OF WELL: toper u.Mason . SW Ill NE s.c 30 T. 23 N..a 2W W.K. ( ) SThEET ADDRESS OF WELL(or nem*sd*eee) NE 591 Haven Lk. Dr. , Tahuya, WA 98588 a (3) PROPOSED USE: 4C Dornestrc Industrial C Municipal ❑ (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION ❑ Irrigation by odor.charather,et•of material sad structure.end srow thickness of .._) DeWefer Test Wall ❑ Other ❑ Formation: �naure of the maMriel ineach smitten penetrated.with st(sit one entry lot*peers 3 (4) TYPE OF WORK: Owner's number of well pt°1O`" t O"" , (N more tthnn one) teA7lE1,1AL MOM TU Aberhdahed(_1 New Metth°dCable[7C Bored Driven 0 Reconditioned° Rotary° Jetted°6 Brown conglomora to 0 5 DIMENSIONS:� (5) Dolmens of Ares -— ,note.. 5 27 c- Drleed 237 feet Depth of completed weir 237 n- Gray hardpan 5 (6) CONSTRUCTION DETAILS: Cemented sand & gravel with water 27 98 - Camino U,statl.d: 6 • a.m.from 0 ft.to 232 ft. - Welded • DtLe.from ff.to n• 98 " 100 Brown hardpan • rnU _.. • plain.from ft to h. wtioradot,.: Yes D No Ci Sand & gravel with some water 100 105 5 Type of perforator used 3 SIZE a perforator* in.W an. Cemented sand & gravel 105 134 4 perforations harry n.to ft. I Si perforationsfrom h.to h. Gray hardpan , 134 176 � perforations from n.to n. Screens: Yea ® No❑ Brown hardpan 176 205 U Manufacturer's Wine Cook _ • • Tyr. stainless wire wrap 232 Model No. o237 Sand & gravel with water 4 205 237 s► Dlartt. 5 slot aaa 50 from >L ri. Dorm. _Slot size from tt to ft. Gfawl packed: Yes❑ No ® Size of gravel _ Ns C Greve;pieced from ft.to ff. W Is • — f3ialac....i: Yee No ❑ To what depth? 18 rt. • oor Mea*pwaat Betorsito ____-- ) - tv f � Did an cv y strata nta n unusad fer e water? Yes E No tit Typed water? Depth of strata U Method of sealing strata ow - — 3 3 (7) Pl.IMP: ecturer'sHams Berkley Type: SUM. H.P. 1 — r D (3) WATER LEVELS: •sun n woo(surte 6/24J98 .10. c 7/15/98 .tti soars mean sea Myer C. stoat freer 205 e below top of sea fear. WELL CONSTRUCTOR CERTIFICATION: LI Artesian pressure tbs.per spy-pre inch Des Arlie en water as cornro'Md by I constructed and/or accept responsibility for construction of this well,end its 5 (Cep,vale,Mc.) compliance with all Washington well construction I/tender*.Materiels used and the information reported above are true to my best knowledge and belief. -+ (9) WELL TESTS: newborn is amount water levet is lowered below static level U Was a pump test made?Yee❑ No® If yes.by whom? NAME Davis Drilling Yield: gal./min.with fLdrawdormalter hrs. rrriesaa FMK orrt:onrOftAnorrt gym onofaun J y,/r ” " •• moms; Belfair WA 98528 11,i 1, r, 11 S. )ram D Recovery data(tens taken as zero when pump turned os)(water level measured from well (Signed) .JL ' I.( e t_ianse No. 1884 top to water levet) v Time Wear Level Time Water Level Time Water Level Connector's Registration n No. — VTSFIT1100A Date July .19 98 (USE ADDITIONAL SHEETS IF NECESSARY) Date of feet Bailer test 12 gat./min.with 5 h drawdown after 1 hrs. Airiest gal.tmin with stem set at h.for hrs. Ecology is an Equal Opportunity and Affirmative Action employer.For spe- ArfW en flow p p.m. Date cial accommodation needs,contact the Water Resources Program at(206) Temperature of water Was a chemical analysis roads? Yes❑ No 50407-8800.The TN)number is(206)407-8006. WY 0501-20(943)•'I WATER WELL REPORTat. - .....::?...f,---)A1--)Ori ' l&1"W -Eeol ,2""copy-owner,3"'rnpy-drillerCURRENT .,,, ,,,,, Original copy Ecology, 'le CO t.o s r Notice of Intent No.W 228542 Construction/Decommission ("x"in circle) a-1 2,, Qb • ® Construction Unique Ecology Well 1D Tag No.APS 658 El Decommission ORIGINAL INSTALLATION Water Right Permit No. Notice of Intent Number W 228542 Property Owner Name KCK ENTERPRISES,LLC PROPOSED USE: ® Domestic ❑ Industrial 0 Municipal 0 DcWater 0 Irrigation 0 Test Weil 0 Other Well Street Address 600 HAVEN LAKE DR TYPE OF WORK: Owner's number of well(if more than one) City BELFAIR County MASON ® New well 0 Reconditioned Method:❑ Dug 0 Bored ❑ Driven 0 Deepened 0 Cable ® Rotary 0 Jetted Location NVVI/4-1/4 SEl/4 Sec 30 Twn 23N R 2 EWM 0 DIMENSIONS: Diameter of well6 inches,drilled239 ft. or Depth of completed well 239ft. Lat/Long wwM CONSTRUCTION DETAILS (s,t,r Still Lat Deg Min ec Casing El Welded 6" Diam.from +1 ft.to 234 ft. LongDegMin Sec Installed: 0 Liner installed__" Diam.from ft.to ft. REQUIRED) El '(mod Diam.From ft.to R . CONSTRUCTION OR DECOMMISSION PROCEDURE Perforations: 0 Yes El No Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each stratum penetrated,with at least one entry for each change Type of perforator used of information. (USE ADDITIONAL SHEETS IF NECESSARY.) SIZE of perfs_in.by in.and no.of pmfs from ft.to_ft. MATERIAL FROM _ TO Screens: ® Yes 0 No ® K-Pac Location CLAY&GRAVEL BROWN 0 90 Manufacturer's Name JHONSON CLAY&GRAVEL BLUE 90 170 Type STANL Model No. CLAY&GRAVEL BROWN 170 220 Dian.6Slot size 12 from 234 ft.to 239 ft. GRAVEL H2O BROWN 220 239 ' Diam. Slot size from fL to ft. Gravel/Fitter packed:'0 Yes la No Size of gravetfsand Materials placed from ft to ft. Surface Seal: ® Yes 0 No To what depth?20ft. Material used in seal BENTONITE • Did any strata contain unusable water? 0 Yes El No Type of water? Depth of strata Method of sealing strata off PUMP: Manufacturer's Name GOULDS Type:SUBMERSIBLE H.P.2-18GS20-3 WATER LEVELS: Land-surface elevation above mean sea level ft. Static level 226ft below top of well Date 9-14-07 Artesian pressure lbs.per square inch Date Artesian water is controlled by cap,valve,etc.) 1t WELL TESTS: Dtawdown is amount water level is lowered below static level Was a pump test made? ® Yes ❑ No if yes,by whom? - Yield:18galJmio.with 511.drawdown after 4hrs. Yield: galJmin.with ft.drawdown after hrs. Yield: *Arvin.with_ft.drawdown after hrs. R E C a+'.V E ' Recovery data(time taken as zero when pump turned ofj)(water level measured from well {�-I top to water level) OCT Z 9 Z00 r Time Water Level Time Water Level Time Water Level - . _____ DEP i. OF ECOLOGY Date of test Baiter test 18 gal./Min.with 5ft.drawdown after 4hrs. Airtest gal/min_with stem set at ft.for hrs. Artesian flow g.p.m. Date Start Date 9-4-07 Completed Date 9-11-07 y Temperature of water Was a chemical analysis made? 0 Yes la No Tax Parcel No.223305000327 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. ❑Driller❑Engineer 0 Trainee Driller or trainee License No.2516 Drilling Company COOLWATER DRILLING,INC. Name(print Last,Fun)P11 lb,CLAYTON Address 10921 HOLLY RD NW Driller/Engineer/Trainee Signature City,State,Zip BREMERTON, WA, 98312 IF TRAINEE:Driller's License No: Contractor's Driller's Sig ature: Registration No.COOLWD1941QM Date 9-19-07 ECY 050-1-20(Rev 3/05) Ecology is an Equal Opportunity Employer WATER WELL REPORT CURRENT ECOLOGY Original&1' copy-Ecology, 2adcopy-owner, 3 copy-driller • Notice of Intent No.W 280101 Construction/Decommission ('1"in circle) Unique Ecology Well ID Tag No BCA 503 Construction . Decommission ORIGINAL INSTALLATION 'Water Right Permit No 140QQ T j Property Owner Name Notice of Intent Number Ben Amende PROPOSED USE: ❑x Domestic ❑ Industrial ❑Municipal ❑DeWater ❑Irrigation ❑Test Well Cl Other Well Street Address 501 NE Haven Lake Dr TYPE OF WORK: Owner's number of well(if more than one) City Tahuya County Mason New well Reconditioned Method El Dug ❑Bored ❑ Driven 2 ❑ O Cable ❑Rotary ❑ Jetted Location SW 1/4-1/4 NE 1/4 Sec 30 Twn23 R EOM 0 Check ❑ Deepened DIMENSIONS:Diameter of well 6 inches,drilled 260 ft (s,t,r Still REQUIRED) WWM One Depth of completed well 260 ft CONSTRUCTION DETAILS Lat/Long Lat Deg Lat Min/Sec Casing ElWelded 6 Dam from +1 ft to 255 ft Long Deg Long Min/Sec Installed: II Liner installed " Diam from — ft to ft ❑Threaded " Diam From ft to ft . Tax Parcel No (Required) 223305000102 Perforations: ❑Yes 0 No CONSTRUCTION OR DECOMMISSION PROCEDURE Type of perforator used • Formation Describe by color,character,size of material and structure,and the kind and SIZE of ifs in_by in and no of perfs from ft to ft nature of the material in each stratum penetrated,with at least one entry for each change Pe of information (USE ADDITIONAL SHEETS IF NECESSARY) Screens: ❑x ycs ONO lK-Pac Location 253 MATERIAL FROM TO Manufacturer's Name Johnson Type stainless Silty sand&gravel,redish brown I 0 10 Model Na • Brown till 110 29 Diam 5" Slot size 20 from 255 ft to 260 ft Sand&gravel with some water 29 32 Dram Slot size from ft to ft Gravel/Filter packed: CI Yes 0 No Size of gravel/sand Gray till 32 54 Brown till 54 Materials placed from ft to ft 86 . Sandy brown clay with some water 86 105 Surface Seal: 0 Yes ❑ No To what depth? 30 ft Gray till 105 165 Material used in seal Betonite 'Brown till 165 215 Did any strata contain unusable water? ❑Ycs 0 No • Gray silty sand&gravel 215 220 Type of water? Depth of strata Gray till 220 1238 Method of sealing strata off ,• Cemented sand&gravel with water 238 i 254 PUMP: Manufacturer's Name Goulds , . • ' Sand&gravel with water 254 260 Type sub H P 11/2 WATER LEVELS: Land-surface elevation above mean sea level ft Static level 222 ft below top of well Date Artesian pressure lbs per square inch Date Artesian water is controlled by (cap,valve,etc) WELL TESTS: Drawdown is amount water level is lowered below static level t I Was a pump test made? ❑ Yes 0 No If yes,by whom? 1 Yield gal/min with ft drawdown after hrs Yield gal/min with ft drawdown after hrs • Yield gal/min with ft drawdown after hrs ' . arnik a�. Recovery data(time token as zero when pump turned off)(water level measured from well ri a I t 4/1-11 top ro water level) - • Time Water Level Time Water Level Time Water Level pp ,t G O n l VVA Stott tier' ..,, ,iiA-t of Frnlnni, /Cutinr\ Date of test —— ci" \'-' t v' Bailer Test 16 gal/min with 2 ft drawdown after 1 his Airtest gal/min with stern set at ft for hrs Artesian flow g p m Datc 2/24/1 Temperature of water Was a chemical analysis made? ❑ Yes 0 No Start Date 1/9/11 Completed Date WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards Materials used and the information reported above are true to my best knowledge and belief ODrillerD Engineer DTrainee Name(Poet) Stan Davis Drilling Company Davis Drilling Driller/Engineer/Trainee Signature ,,,_' i 4 "\ ejt,,,.--• Address 340 NE Davis Farm Rd Driller or trainee License No 967 City,State,Zip Belfatr , WA , 98528 IF TRAINEE Driller's License No Contractor's iDriller's Signature Registration No DAVISDI1100A Date Feb 2011 ECY 050-1-20(Rev 06/08)If you need this document to an altenate format,please call the Water Resources Program at 360-407-6600 Persons with hearing loss can call 711 for Washington Relay Service Per.cnrtc with a.tneech d,cnhrhry inn,-,Il R77-R2 LAld 1 Arrow Septic Designs, Inc 171 E. Vuecrest Dr. Union, WA 98592 Larry Schlemmer& Nancy Lindley 4014 N 33rd St Tacoma, WA 98407 June 9, 2022 RE: Robert Scheffler Septic with Well Waiver- Parcel#22330-50-00091 Dear Larry & Nancy, This letter is to inform you that we are submitting a septic design on the property next door to yours for Robert Scheffler at 601 NE Haven Lake Dr., Tahuya, WA 98588. Along with the septic design,we are applying for a local Mason County health department waiver to reduce the setback from 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 591 NE Haven Lake Dr..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. To mitigate the setback reduction on this project, the septic system proposed is a NuWater BNR-500 pretreatment tank to a low-profile OSCAR mound drainfield system with timed-dosing. Also, the general direction of slope/drainage in his drainfield area slopes downhill toward the lake and away from your well. The proposed drainfield exceeds the 100-foot standard setback to Haven 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. A septic design has been previously approved in this same exact location, with the same reduced well setbacks back in 2003. 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, Paula J. Johnson Licensed Onsite Wastewater Treatment System Designer - 13 21, Arrow Septic Designs, Inc 171 E. Vuecrest Dr. Union, WA 98592 Kristine & Craig Tompkins P.O. Box 367 Belfair, WA 98528 June 9, 2022 RE: Robert Scheffler Septic with Well Waiver- Parcel#22330-50-00091 Dear Kristine & Craig, This letter is to inform you that we are submitting a septic design on the property next door to yours for Robert Scheffler at 601 NE Haven Lake Dr., Tahuya, WA 98588. Along with the septic design, we are applying for a local Mason County health department waiver to reduce the setback from 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 631 NE Haven Lake Dr.. 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. To mitigate the setback reduction on this project, the septic system proposed is a NuWater BNR-500 pretreatment tank to a low-profile OSCAR mound drainfield system with timed-dosing. Also, the general direction of slope/drainage in his drainfield area slopes downhill toward the lake and away from your well. The proposed drainfield exceeds the 100-foot standard setback to Haven 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. A septic design has been previously approved in this same exact location, with the same reduced well setbacks back in 2003. 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, (g0 rT1:7 Paula J. Johnson Licensed Onsite Wastewater Treatment System Designer `{vtpC/ CSLC (o-,3- t- COMPLETE THIS SECTION ON DELIVERY • SENDER: COMPLETE THIS SECTION i • • A. S:•ature CI Agent • Complete Items 1,2,and 3. ■ Print your name and address on the reverse X ` l 0 Addressee so that we can return the card to you. B. Received by "nted Nam}i C. Da e fDp livery • Attach this card to the back of the mailpiece, t Q�S/?,�''ti or on the front if space permits. e , ❑! Yes 1. Article Addressed to: D. Is delivery address different • Item 7 If YES,enter delivery address below: 0 No Q.0 • fox S(. 1 {del ,;'% L'' `l ls2$ Milt I'll 111I I,III'IIIIII'Ell II II 11111 • 3. 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