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HomeMy WebLinkAboutWAI2023-00043 - WAI Health Waiver - 5/2/2023•II6 y ILA.1ao 1.% - abo0? (-- MASON COUNTY �- ,.„ , COMMUNITY SERVICES l'`,f� c, 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 n� Intl' 131E1 --f Application for Waiver/Appeal U Amount Paid: L MAY 0 2 2023 1_!J) Receipt Number: 10.) ab Instructions By lig . 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 STEVE HOYT Telephone Mailing Address of Applicant 1240 NE TEE LAKE ROAD City TAHUYA State WA Zip 98588 12-digit Tax Parcel No. 3 2 3 3 5 - -- 5 0 -- 0 0 9 0 4 Site Address 641 NE TEE LAKE ROAD Subdivision Name and Lot 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 ❑ Group B Water System Regulations ' Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE SETBACK FROM NEIGHBORING WELL TO DRAINFIELD,FROM 100 DOWN TO 75. REDUCE SETBACK FROM DRAINFIELD TO PROPERTY LINE FROM 5 DOWN TO 2. SYSTEM MEETING TL-B WI 21"+VERTICAL SEPARATION PROVIDING ADDITIONAL TREATMENT PRIOR TO DISPOSAL. WELL OWNER NOTIFIED. VACINITY WEL LOGS ATTACHED SHOWING CONFINING LAYERS. PROPERTY LINE IS NOT UPGRADIENT�¢ OF DRAINFIELD. Applicant Signatures ) 4P,i °k w , Date: 51/ .5/7. J:\Ell.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 XWaiver None required Class A Class B Class C t'ZO.. 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/ Standard revision) OK 2-H6 -z./211 -2(0 &) 3. Nature of Appeal: v� , -50t1 erSperso( CosaponP47-?5'-From non-pvb((`c ivel( bvf < l00 ) ►eft/616 [iUCP.d hole nf4/ S Qo& - Kepest,ri fed&c& h t 2a✓11, l 141b(G1.Ae,tkreeY► dtCi•s ftc(d ad poor f 141t 4. Hearing Official: ❑ Board of Health 0 Health Officer O Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board ( Environmental Health Manager 5. Mitigating Factors: -firiltriccei eemm i- yo 1 th 7Z ( riivvr{ei-- l NRsoo) Oh Ind►e- teha►? 2 r " or free-Mot 54oe#7 ,r/l - ifott'faair'4h Id of PV'osel( McrocgArptiv to tit (/ovierr' - Preferf, Inv, t #'kr f- /44 '6,7 f of c/ M icX(d. 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: 5l C D/Z/ &3 PART 4: Determination of the Hearing Official 01—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: //1 Date: S,r U I J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 L_ Pioneer Digging Inc. 3083 E. Mason Benson Rd. Grapeview, WA 98546 POLLOCK, DAVID F & SHEILA J 4/14/23 11315 SE 313TH PL AUBURN, WA 98092 To whom it may concern: I am a Septic Designer working with your neighbors on Tee Lake, Steve Hoyt, on a new septic design. This letter is to inform you that application has been made for a waiver to locate a new septic drainfield closer than the standard setback of 100 ft. from the well located on your parcel, but not closer than 75ft. Washington State allows these setback reductions (WAC246-272A-0210(4)) provided it meets specific mitigation measures. The proposed system includes these mitigation measures with enhanced treatment, maintenance requirements, and evidence of confining layers. 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. Although these waivers are common in the onsite septic industry, we understand reasons for concern and would be happy to answer any questions you have. 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 a i alWATER WELL REPORT CURRENT Origin!&1a espy-Ecdore,2'a copy-aware,3's copy-driller Notice of Intent No.W t�300RR �t-.vwv.•c. ECOLOGY Construction/Decommission Cs"in circle) Untrue Ecology Well ID Tag No. BJM987 Jqw MConstruction Water Eight Pemut No. Decommission ORIGINAL INSTALLATION Notice of Intent Number WE300N73 Property Owner Name William Bef3ley PROPOSED LSE: ■ Domenic 0 lndurtral 0 Mttnttn .l m`-1 Well Street Addnx.a Tee Lake Rd 0 Atwater 0 Irrigation 0 Test Well 0 Other _------�.-- City Tahuvah County Mason TYPE OF WORK: Owner's number of well Of more than one) IN New well ❑ Reconditioned Nerhod-❑ Dug ❑ tiered CIIDn en Location 1;4-1 4 _t:d Sec_ Two It EWM 0 O Deepened ■ Cable ❑ Ratan ❑ hated (a.1,r Still REQUIRED) Or WWM 0 DIMENSIONS: (Nameterofwell 6 inches.dntkd 23R a. Lot/Lenz Depth of comptetcd well no a. Lett Deg Lau Min'Sx CONSTRI)CTWN DETAILS Long Deg Long MirCSer Casing ■ Welded 6 _ thane from +1 ft.to 233 it hastened: 0 Liner intoned " Data rmm A to ft. Tax parcel No.(Required)a12335-50.809R0 0 Threaded " tram From ft In ft. Perforations: ❑ Yes ■ No CONSTRUCTION OR DECOMMISSION PROCEDURE Type of perforator used Formation:Describe by color,character.size oftnatnial and structure, SIZLof fs in. and the kind and nature of the material in each stratum penetrated.wish at per by in wed no.of from R so�1 least one entry for each change of information. (USE ADDITIONAL t Sereesa: 0 Yes ❑ No ■ K-Par Location 231 SHEETS IF NECESSARY.) g Maautnorm's Name Maclaine Alloy Works _a MATERIAL. FROM TO a Diem s Slot fix io from 1 V Model No. Brown Till 0 185 A.to lie R. Bane Clay 185 197 3 ntam. Ska size from A.to R. Brown Clay&Gravel 197 215 GrrssYFlher paekedt 0 Von ■ No Suer of pavcl.asod Saud&Gravel w/Water 215 238 c Manrials placed from ft.to ft. o -- ...qe4 Surfers Seal: II Yes CI No To what depth'to fl. Gat Manna'used in real neaoaW E Did any strata contain untoabk water' ❑ Yes ■ No s. w Type of water - Depth of urau l --' t i MaSIXi of acnli strata off PIMP: Manufacturer's Name Grandfoa o Type:sub H•P I WATER LEVELS: land-surface elevation ribose moan sea level A n Static level 205 fl.below cup of well Date 9/5/2018 O _ in - A,wmmn preawro lbs.per Kum inch Date 4 Anccsan water a custtralkd by _ (lap salve,mc.l IWELL TESTS: Draw own is amount water level i,lowered hub%sum level 1 e' Was a pump test mute' 0 Yes CI h a If yes.by w boot' 1' c Yield. sod.netp with ft.dmadowa after lets. Yield:_ �� [3a'�� 0 il- pi nun with (t.drawdow after his . — — Yield: gal.man with_tt.drawdown alter hrs. „t-,r 0 Recovery data(tow tries as u.i:err en pump earned oft)1uaSr level mrosurn)f t.ar J` i t `sJ, Z writ top to wafer level) 3 Time Water Level Time Water level Tine Water Level DPpc rtme I l Orrice Well D i lie W Dale of test A— v w 0 Barter tar 15 gaL'mrn.with 2 tt drawdown after 1 hrs. V e Aimt IDullmin with nem set at fl for h.t _.— & Artesian flow g.p.m Date Temperature of water War o chemical analysis nude'' ❑ Yes ■ No Stan DQt&8/31/2018 Completed Date 09/05/2018 F --- WELL CONSTRUCTION CERTIFICATION: I constructed ond'or accept responsibility for construction of this well,and its compliance with all Washingro:n well construction standards. Materials used and the information reported above arc true to my bat knowledge and belief. ®Driller 0 Engineer EjTrtainee Name Lyle Drilling Company Davis Drilling Driller or traineeer.Trainee Signature p , Address 340 NE Davis Farm Rd Driller or License Na 1773 City,Stale,Zip Bdlair,We 98528 IF TRAINEE:Driller's License No: / Contractor's Ihiller's Signature: Registration No. DAVISD1110OA Date 9/7/2018 ECYOSO-r-20(Reg 02-1010) To repro ADA accommodation including materials in a featat jar the visually impaired,call Ecology Water Resources Program at 340-407-6d'2. Persona with Inspaired hearing may call Washington Relay Service at 711. Persons with speech disability play call ITY as 87'433-63/1. { Temperature o-0 f water -Was a chemical analysis made? ❑ Yes ® No I WATER WELL REPORT Original&1"copy—Ecology,2n°copy—owner,3i'copy—driller CURRENT MefrI O f 1 COU7t Construction/Decommission ("x"in circle) Notice of Intent No.W 354034 uwe a+..+ ® CoiIstruction0 Decommission ORIGINAL INSTALLATION Unique Ecology Well ID Tag No.BCA 543 Notice of Intent Number Water Right Permit No. PROPOSED USE: (3Domestic 0 Industrial 0 Municipal 0 DeWater 0 Irrigation 0 Test Well 0 Other Property Owner Name Corey Sollom y, TYPE OF WORK: Owner's number of well(if more than one) Well Street Address 571 NE Tee Lake Rd- ® New well 0 Reconditioned Method:0 Dug 0 Bored 0 Driven +.4 0 Deepened ,;, ® Cable 0 Rotary 0 Jetted CityTahu a County Mason DIMENSIONS::Diameter of we116 inches,drilled48 ft. Y CONSTRUCTION DETAILS Depth of completed well 46ft. Location SW 1/4-1/4 SE1/4 Sec 35 Twn 23 R 3 ewM 0 Cf (s,t,r Still REQUIRED) Or wwM Casing ®,Welded • 6" Diam.from +1 ft.to 41 ft. to Installed: 0 T Liner readed installed " Diam.From fl.to Diam.from ft.to ft ft, CONSTRUCTION OR DECOMMISSION PROCEDURE Th Formation:Describe by color,character,size of material and stricture,and the kind an Perforations: ❑ Ycs ® No d 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.) ft.to_ft. MATERIAL FROM TO C SIZE of perfs`in.by_in•and no.of perfs_from_ • 4 Screens: ® Yes ❑ No ® K-Pas Location 39 Rrnwn sand Rr crravel 4 4 • Gray till 99 t Manufacturer's Name Johnson Cemented sand Rr gravel with 99 4n Type stainless Model No. • water • 4R 12 Diam.5S10t size20 from 41 ft.to 46 ft. Sand R,gravel with water • 40 fg Diam.. Slot size from . ft.to ft. !O GraveUFiilter packed: ❑ Yes ® No Size of gravel/sand /}7 Materials,plaud from fl:ro R • V Surface Seal: ® Yes 0 No "To what di:pth?22ft., r:t Material used in seal Betonite c ,yai. Did any strata contain unusable water? 0 Ycs ® No CF 6 3! i O' ;. 446 Type of water? Depth of strata c[g � Method of sealing strata oft'_ JLf �2 "'i�r . - .. ..-: G i'UMP: ManufaCturer's Name Goulds ra mPnt Type:sub. H.P. 1/2 WA S et e ``",vy{��} 1 " WATER LEVELS: Land-surface elevation above mean sea level ft. nt�Ecology � 0 Static level 15ft.below top of well Date • Artesian pressure lbs.per square inch Date t . Artesian water is controlled by _ (cap,valve,etc.) WELL,TESTS: Drawdown is amount water level is lowered below static level Was a pump test made? ❑ Ycs 0 No If yes,by whom? t Yield:`gal./min.with_ft.drawdown after, hrs. •Yield:__gal/min.with`ft.drawdown after hrs. 15 Yield: gal/min.with ft.rrawdown after hrs. Recovery data(lime taken as zero when pomp fumed oIp(water level measured from 4.144 fit•.i', r well top to water level)46 fit• Time Water Level Time Water Level Time • Water Level Start Date 7/2/14 Completed Date 8/2/14 Lat/Long . - Lat.Deg ._ Lat Min/Sec ..- . Date of test Long Deg Long Min/Sec ' Bailer test 12gal/min.with25ft drawdown after ihrs. Tax Parcel.No.(Required)323355000079 Airiest gal Min.with stern set at ft.for , hrs.... . Artesian flow__g.p.m. Date.• . . .. tit , . WELL CONSTRUCTION CERTIFICATION: I constructed and/or orabove ptare true responsibility il knowledgeconstruction andft is st eflf and its compliance with all Washington well �? construction standards. Materials used and the informationreported to mybest n Davis Drilling '� 0 Driller 0 Engineer 0 Trainee Name(Print)Emily Davis Drilling pa y ECY 050-1-20(Rev 02-2010) To request ADA accommodation including materials in a formal for the visually impaired,call Ecology Water Resources Program at 360-407-6872. Persons with impaired hearing may call Washington Relay Service at 711. Persons with speech disability may call TTY at 877-833-6341. F Department First Copy with WATER WELL REPORT Noticedkttent W 093243_ . UNIQUE WELL I D # AFr296 Seuw'id Copy-Owner's Copy STATE OF WASHINGTON Third Copy•Drifter's copy f�r-7� Water Right Permit No N/A __ -• i (1)OWNER Name CREIGHTON_BRIGI1L Address 6925_SE CLEYI.AND_ST,_CIRTORCHARD,WA9835§_-_0 . Q (2)LOCATION OF WELL County MASON - _. - ._NW.114 SE 1/4Sec i6- TrA3 N R -3w_ W M U (2a)STREET ADDRESS OF WELL(or nearest address) 94LTEE_LK RD -- - Ce TAX PARCEL NO 32335:5Q40072 Q) (3)PROPOSED USE. ❑X Domeste f tidustriat _Mwircipat (10)WELL LOG or DECOMMISSIONIN OCEOURE DESCRIPTION ❑Imgabon ❑Test Well ':Other Femur:no Deacnbe by color character use ofmil nil and atrucerre and the kind and DeWater rstunt of the mataal in each stratum penstratedAvIth at least one entry for each charge of information Indicate ail wafer encountered U) (4)TYPE OF WORK Owners number of well(If more than one) `` •--' ,C XJ New Well Method MATERIAL. FROM TO ++ ]Deepened •]Dug ❑Bored BROWN CLAY AND GRAVEL b _5 i C ❑Recandtbaned ❑Cable flDnven BROWN GRAVEL o ❑Decornmissron ARotary UJetted GREY LAY 1,17 146 = (5)DIMENSIONS lJiameter of well SIX_ ides ORS CLAY FINE SAND 146 151 O Drilled _ifi1 feet Depth of completed well 161 ft BROWN SAND AND GRAVEL WATER BEARI G 151 161 77+ 03 (6)CONSTRUCTION DETAILS E Casing Installed s.. XlWelded —6 • Diem tram +5_ ft to 156 n w {]Lmennstated Oiam from ft to ___ ._ ft C ❑Threadee ' Oiam from a to ft - d Perforations _:Yes IXINo -- —.0 Type Type of perforator used -- SIZE of perforations in by -- in --- _ L perforabons from ft to fl O perforations from - ft to ft --- perforations from ft to ft C Mi Screens X Yes ❑NO ❑X K-Pac Location J55 t'3 Manufacturers Name COOK__4-0 v3 TYPe STAINLESS_,ST£EL Model No TEL O Dram _ 6 Slot sze _ 16 from 156 ft to 161 it U Diem Slot size from _ ft to ft — - -- - - -RECV - is.+ Gravel/Filter packed LYes IXINo 0 Size ofgraed/sand — .• — 7A(� Material placed hem ft to ft - 2-5-�fl41 C Surface seal NI Yes FI No To what depth? 18 ft C — 03 Matenal used m seal BENTONITE .- -- - a _ Did a strata contain unusable watery Yes X No -� I1I rig TII fit III i �..._�...-. C to Type of water? _ Depth of strata _ Iki)]0ILLLf]L'I1LQLELO�)=Y Method of sealing strata off _ - - I-- (7)PUMP Manufacturer Name GOJJLOS _ -- O Type SUB --— --- H P _,75 — -_ — z (B)WATER LEVELS �ve meansea le ft Work Started�q/2001 19 Completed 6/29/2001— 19— N C) Static level 106 ft below top of well Date 6/ /2001_ WELL CONSTRUCTION CERTIFICATION Artesian pressure Ibe per square Inch DateTS I constructed and/or accept responsibility for construction of this well and its Artesian water is controlled by compliance with all Washington well consbudion standards Materials used (Cap.valve etc) • and the information reported above are true to my best knowledge and belief I, O 9 WELL TESTS Drawdown Is amount water level is lowered below static level Trile a prim Name License No ( ) Was a pump test made? X Yes [Novby whom? NICFIOLAS_J�ERNST 2147_ O ❑ yes TQD_C— -- (L,cnnsed OnnerlErgineei) U Yrold 18_ gal)min with 22 ft drawdown after -._-1- his W Yield _ gal tmm with ft drawdown after his Trainee Name -- License No til Yield gal 1mm with It.drawdown after hrs Onning Company TOP CO_ 0 Recovery data(time taken as zero when pump turned off)(water level measured ' �' r C from well top to water level) (Signed) lam, License No 2147 0) Time Water Level Time Water Level Time Water level (Licensed DnbaOEngeteer) E -_ .. _ Address PO BOlX.2227 BELFAIR,WA._9028 i-t Contractor's CS __ — Reglatrabon No TOP_DOJQC054RA Date 711/2001 19-- Cl. Date of test 6/29/2001 Q) Bailer test 10 gaUmin with 12 ft drawdown atler 1 his (USE ADDITIONAL SHEETS IF NECESSARY) O Airiest gal/min with stern set at ft for his Ecology is an Equal Opportunity and Airmatne Action employer For d Artesian flow g p m Date 6/29/2001 special acccenmodation needs,contact the Water Resources Program at .0 Temperature of water Was a chemical analyses made'' ❑Yes [ilNo (360)407-6600 The TDD number is(360)407-6006 I- WATER WELL REPORT G _... • CURRENT �'�`— „:,, , Original&I"copy-Ecology,2i0 copy-owner,3'4 copy-driller h C'O L'0 6'Y CODstruCtion/Decomniission("x"in circle) �� —7 Notice of Intent No.W 228526 AUG ' �oo� ® Construction I Unique Ecology Well ID Tag No.APL-104 bv:,s;1;n ,a1i State 0 Decommission ORIGINAL INSTALLATION Water Right Permit No. �,. At Notice of Intent Number W 228526 "'`�''' '-(If EColoay PROPOSED USE: El Domestic 0 Industrial 0 Municipal Property Owner Name ROB DOYEA ❑ Dewater ❑ irrigation 0 Test Well 0 Other Well Street Address 621 TEE LAKE RD TYPE OF WORK: Owner's number of well(if more than one) City BELFAIR County MASON ® New well 0 Reconditioned Method:0 Dug 0 Bored ❑ Driven ❑ Deepened Ig Cable 0 Rotary 0 Jetted Location SWl/4-1/4 SE1/4 Sec 35 Twn 23N R 3 DIMENSIONS: Diameter of well 6 inches,dril1ed62 ft. EWM 0 Or Depth of completed wc1162ft. Lat/Long 121 CONSTRUCTION DETAILS WWM Casing El Welded 6" [ham.from +1 ft.to 57 ft. (s,t,r Still Lat Deg Min Sec Installed: 0 Liner installed " Dram from ft.to ft. REQUIRED) Long Deg Min Sec 0 Threaded " Diam.From_ft.to _ft. CONSTRUCTION OR DECOMMISSION PROCEDURE Perforations: 0 Yes M 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 perfs from_ft.to ft. MATERIAL FROM TO Screens: ® Yes 0 No El K-Pac Location CLAY&GRAVEL BROWN 0 43 Manufacturer's Name JHONSON GRAVEL H2O BROWN 43 62 Type STANL Model No. __ Diam.¢Slot size 12 from 57 ft.to 62 ft Diam. Slot size from ft.to ft. Gravel/Filter packed: ❑ Yes ® No Size of graveVsand Materials placed from ft.to ft. Surface Seal: ® Yes ❑ No To what depth?22ft. Material used in seal BENTONITE Did any strata contain unusable water? 0 Yes ® No Type of water? Depth of strata Method of sealing strata off PUMP: Manufacturer's Name GOULDS RECEIVED Type:SUBMERSIBLE H.P.1/2 WATER LEVELS: Land-surface elevation above mean sea level ft. lu AUG 0 9 20flr " Static level 17ft.below top of well Date 5-30-07 11V (�j Y Artesian pressure lbs.per square inch Date DEPT. OF ECOI" Artesian water is controlled by cap,valve,etc.) WELL TESTS: Drawdown is amount water level is lowered below static level Was a pump test made? ® Yes ❑ No If yes,by whom? • Yield:]$gal./min.with 4ft.drawdown after 4hrs. Yield: gal/min.with_ft.drawdown after _hrs. Yield gat/min.with ft.drawdown after hrs. Recovery data(time taken at rem when pump turned oj)(water level measured from welt —- top to water level) Time Water Level Time Water Level Time Water Level Date of test Bailer test 5-22-07 18 gal/min.with 4ft.drawdown after 4hrs. Airiest gal./min.with stem set at fl.for hrs. Artesian flow g.p.m. Date Start Date 5-11-07 Completed Date 5-16-07 Temperature of water Was a chemical analysis made? 0 Yes 181 No Tax Parcel No.323355000905 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 0 Engineer 0 Trainee Driller or trainee License No.2516 Drilling Company COOLWATER DRILLING,INC. Name(Print tact,Era)PITTS,CLAYTO 6 / Address 10921 HOLLY RD NW DrillerfEngineedfrainee Signature /�/// City,State,Zip BREMERTON, WA, 98312 IF TRAINEE:Driller's License No: Contractor's Driller's Signature: Registration No.COOLWDI941QM Date 6-6-07 ECY 050-1-20(Rev 3/05) Ecology is an Equal Opportunity Employer lam.