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HomeMy WebLinkAboutWAI Health Waiver - 6/21/2024 lip wgil MASON COUNTY COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health 415 N 6"Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 h Bell' ir: (360)275-4467 ext 400 A Elma: (360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/AppealEn Amount Paid: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 Michael s Natalie Penn Telephone 33p42 nl Mailing Address of Applicant 230 E puck cove Rd. City Shelton State WA 1WA Zip saw 12-digit Tax Parcel No. Z Z 3 1 2 -- � -- q 0 3 3 Site Address 240 E Dock Cove Rd,Shelton,WA 98W Subdivision Name and Lot TR 3 c of of coin LM 3 Tr 3 of SMiA3 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 ❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Other Description of Waiver/Appeal(include justification, additional material may be attached.): Applicant wishes W upgrade an existing nangreheated draingeld located vermin 75'of existing community well.Exisgng system system(20(1 is hot pretreated(TL C)and has 12'vetliml immoral New system will be pretreated W TL A,have 24'va iwt separation,is lowWd in an area of low hydngeologip suaceptibilly,will actions ongoing system O&M with Notice to Title covenant, and does not f ether Impose on existing sanitary oonwl arse.Please sea attached materials. Applicant Signature: i Date 04 M Z " pied lit JMR Fomtsi Waiver-Appeal Mason ounty Local Revised 1/202017 Pagc I of PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal '1eWaiver ❑ None required ❑ Class A ❑Class B ' .Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/ Standard revision) W W7,4 3. Nat ur of peal: 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 9 Public Health Director ❑ Certified Contractor Review Board PS, Environmental Health Manager 5. Mitigating Factors: v/I 0. 7 � VCfh ' `V 1 \� SCwI rr _� n WE 44{M*, �, S. 1 have received this waiver/appeal request. It is complete and mlti tion required by the state and J local policy has been submitted. Staff Signature: Date: ro Z( -Z.H PART 4: Determination of the Hearing Official The hearing official has determined that approval of this request will not adversely affect public health and !she by granted.This decision is based on the following findin an yondk��, -1�1 J is yt lX a . .r �urc /s r,< �; �Y'! a'M w /oaI psYNVilE+7( SO•/s` AYru��L o�'s4.f' ��0. r� ❑ 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: Iq Hearing Official Signature: Date: ! 3 1:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations ,�ts H EA LT H Section I. 1 (Completed by applicant) Name: (3) Michael & Natalie Penn Local Health Jurisdiction Received (2) -_- (See instructions) -----. Address: 230 E Duck Cove Rd. __ - --------- Shelton, WA 98584 - -------- -- ---- Telephone: (360)4264221 Signature. AA ' Property ld � i : (3) 2213241-90033 TR 3 C of Govt Lot 3 TR 3 of SP#2543 Section II. I (Com e by applicant) WAC Number:(4) WAC Requirement:(5) Waiver Sought:(6) 246-272A 0210 Drainfield &Transport line 100' Replace existing drainfield&transport line 75'from --- - 's-well-with-upgradeddrain6eld and-transport---- Subsectlon: Table IV from putillc weft— line. Justification(Proposed mitigation measures):(7) There is already aapermitted repair drainfield 75'from this well (TLC with 12" vert sep). Applicant wishes to install a new upgraded drainfield (TLA with 24" ver sep). in same area due to bldg. footprint change. Section III. (Completed by local health officer) Review Criteria:(8) Additional Mitigation Measures:(9) Comments/Conditions: (10) Type of Waiver:(11) Class A Class B nClass C—Request DOH review before granting? yes I I NoFj Neighbor Notification:(12) Required?yesF]No❑ If needed,are agreements,easements,etc.filed? yes ❑ NoLi 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. ❑DeniedApprov/ed/+ ntyQ)-Su ' to all coytments,conditions and requirements no d ections II and III. Local Health cer(33) Date: 2� DOH 337-175 February 2024 1 Penn Well Walwrdustific fion Notes-page 1 of 6 PENN JUSTIFICATION NOTES - WELL WAIVER Existing System The existing drainfield is a repair system installed in 2004. The existing 3-bedroom system • is approx 73'from the upslope public well • has approx 12"vertical separation over restrictive glacial till • is not pretreated (Treatment Level C) Proposed System Upgrade The proposed upgrade to this system is due to the owners wanting to remodel the existing home footprint to include a garage that would encroach on the 2004 system. The owner's are proposing that in the process of moving the drainfield to accommodate the garage, their system be upgraded to • be 75'+from the upslope well • have approx 24"vertical separation over restrictive glacial till • meet Treatment Level A Mitigation measures will include: • Enhanced Treatment Performance o NuWater BNR-500 with Jet UV ■ meets Treatment Level B without the add-on UV disinfection ■ will meet Treatment Level A with the add-on UV disinfection o Shallower trench installation will maintain 24"of vertical separation with time-dosed, pressure distribution • Performance Assurance- Notice of Operation & Maintenance of On-Site Sewage System covenant to be notarized and recorded on property title • Assurance of Low Hydrogeologic Susceptibility o This site provides significant aquifer protection due to the shallow restrictive layers (aquatards) that prevent surface water and effluent from moving downward vertically. Well log attached. ■ restrictive layer 1: 54'thick layer of hardpan (4'to 58') ■ restrictive layer 2: 12'thick layer of blue clay (1 16'tol28') ■ restrictive layer 3: 30'thick layer of red clay& gravel (128' to 158) ■ restrictive layer 4: 53'thick layer of blue clay(167' to 220') ■ restrictive layer 5: 18'thick layer of cemented gravel (220'to 238') i Pem Well Waiver Justification Notes-page 2 or 6 o This shows that combined, there are approximately 167'of restrictively impermeable aquatard layers between the surface zone where the effluent will be distributed and the well intake o Additionally, the proposed drainfield is located downslope from the existing well at an elevation approximately 6 feet lower than the well site which means that effluent encountering the upper restrictive layer will flow downslope and away from the well location o Additionally, a bentonite surface seal was placed on the well casing to a depth of 18'to prevent any surface/subsurface water contamination from migrating downward along the casing • Extra Protection of Integrity of Pressure Sewer Transport Line c Pressure transport line to drainfield will be located less than 100'from the well. Mitigation will include: ■ 2"transport line installed inside 4" schedule 40 PVC casing where within 100'of existing well ■ Line installed within casing installed with bentonite grout or casing spacers per AW WA PVC Pipe Installation Manual M23 and with ASTM D 2774. ■ Transport line leakage tested consistent with ASTM D 2774 to 150% of design operating pressure for 1 hour • Maintenance of Sanitary Control Area o The well is owned by the applicants and has 3 connections o The applicants own 2 of the parcels connected to the system o Notification of the 3rd connection owner to be made in writing and sent certified mail explaining that the existing system already 75'from the well is being upgraded to meet higher levels of vertical separation and treatment Normal Local Waiver Class A Waiver This Site Horizontal 100, 99'-75' 74'- 50' 75' Setback private/public private well private well public well well Vertical 24" pressure 24" pressure 12" pressure 24" pressure 24" pressure Separation in Type 3 soil in Type 3 soil in Type 3 soil in Type 3 soil w/time-dosing in Type 3 soil Treatment TL E TL E TL C TL B TL A: Level w/out add on (Nu Water meets disinfection TL B without add-on disinfection. Adding Jet UV boosts this to TL A) Penn Well Waiver Justification Notes-page 3 of 6 Proprietary Product Name/Model Multi-Flo FTB-0.5,FTB-0.6, FTB-0.75, FTB-1.0, FTB-1.5 ✓ ✓ Nayadic M-6A-F/M-6,M-6A-C/M-6AC-F, M-SA-F/M-8A, M- 1050-F/M-1050A,M-1200-F/M-1200A, M-2000-F/M- ✓ ✓ 2000A NuWater B-500 with Salcor 3G UV NuWater BNR-500, BNR-600,BNR-750, BNR-850, BNR- ✓ ✓ 1000, BNR-1500 NuWater BNR-500, BNR-600, BNR-750, BNR-850,BNR- ✓ v"' 1000, BNR-1500with Salcor 3G UV aaaaaaaaaa '10-277A- Soil dispersal Downu50feet, fl EnhanmdtreabnempeAomunve 02210131 component 75 feet firm cccept not in non-publicwellor Suil Type suctionline 2)Performance assurance of treatment system 3)Hydrogeolore susceptibility 4)Determination ofany existing covenants or easements for maintaining a sanitary control area 1 a)Treatment component or sequence Iisled as meeting Treatment Level B- Disinfection cannot be used to achieve the fecal col iform limit of the teoment leveL The soil dispersal component maintaining at least 3 feet vertical separation; i.e-,sand filter followed by a gravity distribution SSAS with at least 3 feel of vertical separation or by a pressure distribution SSAS with at least 2 feet of vertical separation. A mound system with 2 feet of sand media may be allowed,if there is at least 3 feet of available soil depth. 29)Management program established which assures the on-going proper operation and maintenance of the system. 3a)Adequate protective site specific conditions existing,such as physical settings with low hydrogeologic susceptibility from contaminant infiltration;i.e.evidence of confining layers and or squitards separating potable water from the OSS treatment zone,excessive depth to groundwater,down-gradient contaminant solace,or outside the zone of influence. 4a)Notification of proposed encroachment to the well owncr if there are no existing coveronts or easements establishing a control area. peon Well We mr Justification Notes-page 4 of 6 WAC Specific Item Waived Extent or Degree Miain rna Issnes/Ctiteria to Consider' Section Waived FT246-2'2A- Aessrne sewer transport IuleSQ_ Down to 25 feet 1)Extra protection ofintegrity oflure 10(t) feet from non-public well or 1 00 156 within 50 feet of well able TV suction line 2)Performance testing of line 3)Detemtuwtion of any existing covenants or easements for tnaintaururg a sanitary control area WAC Specific Item Waived Extent or Degree Minumrnr Issues/Criteria to Consider' Section Waived 206-272A- Pressure sewer tramport Ime50 Down to 25 feet 1)Extra protection of integrity of line 0210(1) feet from non-public well or l 00 155 within 50 feet of well Table IV" suction line 2)Performance testing of lure 3)Detennuution of any existing covenants or easements for maintaining a sanitary control area Penn Well Waiver Justification Notes-page 5 of 6 oen D" vi'ei aCaDr am J WATER WELL REPORT wvPua•da n.. a.aaa im.,i"Insrs cpY Tmn a«—o,vwn tear STAU OF WABMRNGTON _ (1) OWNER: xama__._L12Ww ,�coolm waa C 4LO 14A _i(AY._1Q'a ..S1Mt11fGIl._71seh...... (2) LOCATION OF WELL: eaap _KWA e_«nna aw ananae ram Wauow«abmn.wa ama _ __ _ 0) PROPOSED USE: Dimaaus ustishnia C Namaewl p (10) WELL LOG: trns•aea D r•x weu t] owve p Tam.a,we:a.an.w xv Na«,eRavara.,ava of rnetaMt ad insouciant.as !MN thfi*"tr a/aawUrra and mr niM a.d W Wr b 1M aWarW 4 aaM (4) TYPE OF WORK: :tworrI nua«a wmi retaab emreraed. ww nt Iwx as anxv!« sax rMeer al wmwvan. .0 me rMx ma..,. . xew rear ]aemw: pat G tarts G Dwawa p came a pnva G — -- — —.. _ I e.anmewnaD xeaarr� ritual a snot �laiv .ID __T. O 4' 4>) DIMENSIONS: 6 —b��-.•_----._. 4 `8' Dumna or sea man«. Red C14-Y_ i!;_M �.._ .. ._ L 58 11 1 .axa.d...._. 242._n. nam Nawnatma w.u......._242...x. 3ed ClAlj 16_1281 (6) CONSTSUCTION [DETAILS; rrrt11���J Red C1AY � DDTavel �— —�_,���1•�G8� ii +[�[reR�r " Casing Installed:...,V....."nlr+l, tram 0. .., n.b t'Y-E_. fl. GMIX ¢ watET' _ Trynratc Aiye elaY T 67 12201 . ...._.._..•• Dwa. nwn n.w ..._...... u. wrlaa w it, 1 ' Gravwl A tmtar 8 4za PerEontlana: Yap N. i 1« N 5 ntwSUEE i I.e e arrlanoYN ._.___.............. m. b> ....._ __ 16 � —'•".' n. 4 __............... ....�. ......_.___.perteraobm Dam n. b._.-.........._. K I ..__D•rl.nne////N trmv .........„..._. It. w _......-........._K Screens: Yta❑ N - NaarMaeela _-.- TIM......._.......�_ taadx W...0 DwIt. ...... fat"alie_-._.him,.-�.It.Y Dam......__fbt tIa......,�Srom—It. Gnx<l packed; Y.0 xe ew a a•w:._.,...._..— �---_ GnvN_ 1.rNm ___ ____ AL i Surface seal: m xe❑ ra wwa eaame -_.18__ K --- _—! —... . . I1Irn_ _ sawrw vaa m rw_..__....flY.B�.QRI.�e.9.__......_._._.s_. — ma ant tv ramb w TYW at wage__ DapN et mtw.,..,»..,...... NaMe el ewaw r4aY M_T._._____. .— Map 1 -- (:) PUMP: N.nvunv,are xo W��n$...__.___ --- WARM T>pr: __.311ttaesnl hix _..x)___1_ OF EG� ZiIJUTRWRT prf lflt$M1F 9fftCf (9) WATER LEVELS: _.... 195...,__.__a beleW wY a .m Da.S0�bX81..._ I i _ ww+an aea . ..___ta.. «. uwa D•ta___�..___ w.be.wear Isa.nvvuae bl.r_---___,. ___ --- I (9) WELL TESTS: rn•wa u amount i m v ._ -- a a. loww eaa . anew b..i comYlarea—i0 1Is wag•Duma we mraa xa G xe�u rat.nr wMmr. .....__ YI w' w m wtm n anwooww aMr nra. WELL DeIL[.E85 STATEMENT: Tnb wA was drilled urines my initilictiao ..it Chia true b the bast at my kaawlitip this belles. R wnvap wnw laxm ,ants eei Iwlee .vwl a' w ur NON Hume mea.vnatrain w.0 wD w Ma NANE���_139011 IP..P.1IDlA...&..U£1k Tana f« r.r«I I Tuna MM LaeN I TIM Wws Lrvel a.._.P._....) _.._. �w araa,arm. It corpetNbnl IT)D et Dmisl_......_____....._._.._•___ ...._____�._.:__.____�._..__-_.._-. AddreN_._.1" R• ek111san St. Shelton, wash. ._.___..._.____._......_._...._..._...__,_..____.__..._...__.__. ._ _ .__.. .....___.....__.._..__...._.___m_.._..._.._........_._. (.signed(._. Omwr era—_lsp-smlbb.wm.�._....at.anwwn Wv—.]--Ln- Iw.x DrtWr� hmptawn N.aav—.....,wasa aam al Nww r maaw Ya O me Ucaatc>.. 00)2 •�se wDDITtONAL SILC': :Y <CCL6Cwui'� i,� « Penn Well Waiver Ju.tift.fion Note�-page 6 of 6 / / § ° e k § ` \ it ) US 2 ( ( — \ \ \� /z q a | | _§§ � _ ) ` ^ ^ \§ j bz | & ° ; ! / § Z } \ ell / N ! © 2a /