HomeMy WebLinkAboutBLD2019-00024 BLD2019-00020 - BLD Application - 1/9/2019 "rn- 1�,'',3 z6�(-( -CQ 2-o
MASON COUNTY COMMUNITY SERVICES Permit No:..���O LOCOS,
PERMIT ASSISTANCE CENTER: (off
\ .BUILDING•PLANNING.PUBLIC HEALTH•FIRE MARSHAL
815 W.Alder Street,Shelton,WA 98584
Phone Shelton: 27-9870 ext.352•Fexr 2 98 Phone
BeBair(3W)275-467•Pharre Elma:(380)482-5289 ENVIRONMENTAL
BUILDING PERMIT APPLICATION HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:�/
NAME:LgOWRCZ— �/ 50 / NAME:fAr>.s/t 'ie"ASy,c
MAILING ADDRESS: / .E /14V AILING ADDRESS: � �— pR• ' " J
CITY: ^STATE:AO,ZIP: 96 u CITY:TA Am STATE:WA ZIP:18 5g3 i
PHONE#1: Zd b 3 53 7/S$ PHONE b 77S 03 ELL: +fii
PHONE#2:' EMAIL: t s'Lof A
EMAIL:IA"y el Es/•QSa.J Ea ec Ye-9-0%.ir.�' L&I REG# EXP. /_/4-1
PRIMARY CONTACT: OWNER❑ CONTRACTORS OTHER Q i
NAME v`-`Vff� 5 EMAfj Imo!/L,OJ /Ll7T/LS�'`i ��G.c•1!q
MAILING ADDR SS0 AfX LA/Glic 'PR- CITY TAM101 4 STATE ZIP
PHONE 2S; 5/y- -777- CELL Ls0 275 tip
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 27Z-336 - 6O-OO/10 ZONING iZg S'/A,s2A`
LEGAL DESCRIPTI N(Ab eviate�d1). tC - an/ -VAVAC1J )-W&A- FIRE DISTRICT
SITE ADDRESS f7l,1e- NAV194 L IG DP- CITY 7-4NtiH64
DIRECTIONS TO SITE ADDRESS
I �
i IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESW NO❑
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkoll rharulNrly):
SALTWATER❑ LAKE RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW' ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Reslrlencc.Y/orage,Commerciul Bldg,Erc.) SsNsS�� /�� �yf !�S�OSnfG� ��meW
�--
IS USE: PRIMARY❑ SEASONAL NUMBER OF BEDROOMS NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES lirholeBWF YES lPun(s/ojtildg)❑ NO❑ ,
DESCRIBE WORK ewers-"ZVCr
SQUARE FOOTAGE:1prulwse eriuingy
I ST FLOORED 9Z sq.ft. 2ND FLOOR 4W6 sq.ft. 3RD FLOOR q.ft. BASEMENT "5 sq.ft. i
DECK �I57 sq.ft.• COVERED DECK f sq.ft. STORAGE�-7f sq.ft. OTHER sq.ft.
GARAGE l-sq.ft. Attached❑ Delached❑ CARPORT --- sq.ft. Attached❑ Deloched❑
MANUFACTURED HOME INFORMATION: "4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE A14 MODEL YEAR _LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ 1 NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YE� NO❑ 1(yes,anuch canrpleted Water Aeleyuaev Form
PERIMETERNOUNDATION DRAINS PROPOSED? YE§�;b NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS _
OWNER acknowledges that submission of inaccurate information may result In a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of Interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or If construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Signature of OWNERaustbeslined th 0 ER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Printed Fr .
Printed from Mason County DMS
o �
' ENVIRONMENTAL
HEALTH
F�
I
SIGHTLINE
SETBACK i `C
, &,4 ->An5 PPRp �
SHORELINE `JE6 lt�t v1�18_YXb82
SETBACK 50' JAPPROVED WELL R-75 AS MAR 0E 2019
EXISTING LOCATION 1 COU,+irYEN✓IR
RESIDENCE ' ykV ONMENr
15 LOPE j
n o o o Lo o Ln o o in o n o n o
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! I o o I\ LLJ
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= 1 1 1 II I �. —I--�— -- 7.5 BL�„ \BSBL Q C�
50' ADORES 431 NE LUYEM LAID:LMt 1 288'
PARCFLL R 22330--5D-W10 j _ U
LOT AIEA 14.40D.4 T1 \ / -Bic
2�1 1•' 0 c
BASEMENT AREA 5W SQ FT 174 IRI FiN. 1 / � N10
MAN FL"AREA: 1092 S0 FT
fz
LOFT . I �F �/ C
B EA BOOR AR 446 SO FT I EXISTING �`' �ti �.....,. / / (-('� D 26 1 Qj- �' `Q'
CM AREA 457 m FT RESIDENCE \
am Kr:DW 29'-r ND MAN A sr-r BASE I GARAGE 3 E EXISTING
y� r-
BU LDM FAM HOMES
C1ASSC HOM I 1 20 O `�
e0 NE LAM DR 1 C
TAHVYA.WA 9E5B0 L
d
SCALE: �
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Page 1 of 1
Mr. Kuzawa,
Corrections report received—thank you.
I will schedule a site visit with the builder to review the deficiencies and come up with corrections.
John Hodge P.E.
Hodge Engineering, Inc.
2615 Jahn Ave NW Suite E5
Gig Harbor, WA. 98335
253-857-7055 fax 857-7599
OHp
enge inq�iac.
!PLEASE NOTE:
As of July 11 we will be located at
3733 Rosedale St. NW Suite 200
Gig Harbor,WA 98335
From: Dave Kuzawa<dkuzawa@co.mason.wa.us>
Sent: Friday,June 28, 2019 3:04 PM
To:dipino.john@gmail.com;John Hodge<John@Hodgeengineering.com>
Cc:Kristopher Nelsen<KNelsen@co.mason.wa.us>
Subject: BLD2019-00024; Hodge Project 180780
Good afternoon,
I have attached the framing corrections/observations from the inspection on June 26,2019. Please call if you
have questions.The project is scheduled for re-inspection on Monday,July 1, 2019. Please cancel the inspection
if you will not be ready.
Mr. Hodge -I strongly recommend a site visit.
Sincerely,
Dave Kuzawa
Mason County Building Inspector/Plans Examiner
Printed From Mason County DMS
file:///CFYIY§'6igf fie'ls8iV,ApPDAtA"6eal/Temp/XPgrpwise/5D193579Masonmail100132326... 7/1/2019
Hodge Report# 8077/807019
80A
engineeringinc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
Gibson Residence
Framing Corrections
To eliminated the hinge points on the two story wall the builder to sister 2x6s to the
existing studs in the wall and extend the 2x6 to the upper plate. Cut the top plate to
make that extension. The sistered 2x6 are to extend 4ft down past the triple plate and
be nails off with (2) rows of staggered 10d nails @ 16" on center. Sstrap across cut
triple plate with CS14 Strap on the interior and exterior.
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Install (2) continuous king studs on either side of the window for a total of 4 new
continuous studs.
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Printed From Mason County DMS Ia=<(= ?8.� --599
Printed from Mason County DMS
7/12/2019
jpHoidg Report# 180780A
engineering inc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
4Y.
Gibson Residence
Framing Corrections
To Whom It May Concern:
I have provided the lateral and gravity load engineering for the Gibson Residence,
located at 431 NE Haven Lake Drive, Tahuya.
At the request of the builder I have reviewed the Mason County correction notice dated
June 28, 2019. Below are engineering solutions to the framing issues listed in the
inspection report. Items not addressed below are to be completed by others. Images
clips from inspection report.
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Below are the two areas in question which continuous studs were not installed per the
engineering. An image clip of the detail included below.
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3-1n'xO-111'GLB
OW;601315TUD5 54ALL 8E CONTMUOJS
FROM 50L E PLATE TO TOP PLATE
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Hodge Engineering, Inc.
.John E. Hodge P. E.
. - 7615 Jahn Ave NW Ste. E5 Gig Harbor,WA 9P
Printed From Mason County DMS (-253)557-7055 Fax(2S3)857-7599
Printed from Mason County DMS
7/12/2019
Hodge Report# 180780A
engineeringinc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
Gibson Residence
Framing Corrections
Cut the suds below the upper stairs and install a bottom plate with a 4x10 DF#2 beam
or greater below to support the stairs. Block around beam at exterior wall and strap to
stud pack with CS14s below at interior wall for positive connection. To close the
opening the builder is to install 200 HF#2 joist at 16" o.c. Hang joist off 4x10 beam with
LSU210 hangers and place them on bearing wall at other end. Beam calculations
attached to report.
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7/12/2019
Report#180780A
John Hodge P.E.
This report is the professional opinion of the Engineer and is not intended to allow the builder der to dAnY gardsch Code
le or
requirements,change agreements with the owner,or perform work outside the approved
cost impact is the responsibility of the builder and/or owner. This report does not allow changes to the approved
plans-it addresses the impact of the proposed alternate methods to the engineering only. The Building Inspector,
not the engineer,has the authority to allow field changes,alternate methods,and fixes to the approved plans. The
engineer provides an opinion only and not the authority.
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Printed From Mason County [CMS Fas(-7:3)8.57-
Printed from Mason County DU15
7/12/2019
HOdg Report# 180780A
engineering inc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
Gibson Residence
Framing Corrections
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Printed From Mason County DMS
Printed from Mason County DMS
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Report# 180780AHodge
engineering
inc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
Gibson Residence
Framing Corrections
As a fix for the missing continuous studs resulting from the continuous horizontal 4x8
header across 3 openings complete sheathing the wall with 7/16" OSB and following the
SW1 nailing pattern.
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Itms listed aboye must be corrected to gain compliance. r
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Tinted From Mason County DMS --_-
Printed from Mason County ISMS
7/12/2019
Hod Report # 180780A
engineering inc.
RE: 431 NE Haven Lake Drive, Tahuya, WA 98588
Gibson Residence
Framing Corrections
i
As a fix for the single story wall strap each stud with CS14 straps on the interior and
exterior. The exterior straps can be eliminated if the exterior sheathing is continues over
the stud breaks.
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b'=)rinted From Mason County DM - -
Printed from Mason County DMS
i iI F O R T E MEMBER REPORT UPPEF FLOOR FRAMING,STAIR BEAM(RFS-7.12.19) PASSED
1 piece(s)4 x 10 Douglas Fir-Larch No. 2
Overall Length:4'8 12"
0 0
— 4
0 0
All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal.
Design Results Actual 0 Location Allowed Result LDF Load:Combination(Pattern) System:Floor
I Member Reaction(Ibs) 671 @ 4'7" 4253(3.00") Passed(16%) -- 1.0 D+ 1.0 L(All Spans) Flember Type:Flush Beam
Shear(Ibs) 367 @ 1'2 3/4" 3885 Passed(9%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential
Moment(Ft-lbs) 673 @ 2'5 1/2" 4492 Passed(15%) 1.00 1.0 D+1.0 L(All Spans) Building Code:IBC 2015
Live Load Den.(in) 0.003 @ 2'5 1/2" 0.142 Passed(L/999+) -- 1.0 D+ 1.0 L(Ali Spans) Design Methodology:Aso
Total Load Dell.(in) 0.006 @ 2'5 1/2" 0.213 Passed(U999+) -- 1.0 D+1.0 L(All Spans'
•Deflection criteria:LL(LJ360)and TL G1240).
•Top Edge Bracing(Lu):Top compression edge must be traced at 4'9"o/c unless detailed ctherwise.
•Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 4'9-o/c unless detailed otherwise.
•Applicable calculations are based on lips.
Bearing Length Loads to supports(Ibs)
Supports Total Available Required Dead Floor Total Accessories
Live
i-Stud wall-NF 5.50" 5.50' 1.50" 340 1 393 733 Blocking
2-Stud wall-NF 3.00" 3.DD' 1.50" 311 360 671 Biakrrg
-Blocking Panels are assumed to carry no loads app'.Ied directly above them and the full bad is applied to the member being designed.
Tributary Dead Floor Live
Loads Location(side) width (0.90) (1.00) Comments
0-Self We,ghl(PLF) 0 to 4'8 1/2" N/A 8.2
1-Uniform(PSF) 0 to 4'8 1/2"(Top) 4' 10.0 40.0 FLOOR
2-Unform(PLF) 0 to 4'8 112"(Top) N/A 90.0 - WALL
Weyerhaeuser Notes �V 5U5TAINABLE FOREsrlry woiAnvE
Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values.
eyerhaeuser expressly disclaims any other warranties related to the software.Use of thus software is not intended to circumvent the need for a design
ofessional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is
mpatible with the overall project.Accessories(Rim Board,Blocking Panels and Squash Stocks)are not designed by this software.Products manufactured at
eyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by 1CC ES
under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards.For current code evaluation reports.Weyerhaeuser
product literature and installation details refer to www.vreverhaeuser.com/woodoroducts/document-library.
The product application,input design loads,dimensions and support information have been provided by KO
7/12/2019 4:24-54 PM
Forte Software Operator Job Notes
-- Forte v5.5,Design Engine:V7.3.2.4
James 6T.Ioiiey 180780-BEAM CALCULATIONS.4te
Hodge Engii ecnng Inc.
(253)e57-7055
Inmesl4hod3cengmeeurg.com Page 1 Of 1
Printed- From-Mason Count - DNS
Printed from Mason County DMS
i F V R T E MEMBER REPORT UPPER FLOOR FRAMING,FLOOR JOIST(RFS-7.12.19) PASSED
1 piece(s) 2 x 10 Hem-Fir No. 2 @ 16"OC
Overall Length:5'7'
0 0
5'
a a
All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal.;Drawing is Conceptual
Design Results Actual 0 Location Allowed Result LDF Load:Combination(Pattern) System:Floor
Member Reaction(Ibs) 194 @ 2 1/2" 2126(3.50") Passed(9%) -- 1.0 D+1.0 L(All Spans) Member Type:Joist
Shear(Ibs) 120 @ 1'3/4" 1388 Passed(99/6) 1.00 1.0 D+1.0 L(All Spans) Bowing use:Residential
Moment(Ft-Ibs) 231 @ 2'9 1/2" 1917 Passed(12%) 1.00 1.0 D+1.0 L(All Spans) Building Cork:IBC 2015
Live Load Den.(in) 0.007 @ 2'9 112' 0.172 Passed(L1999+) -- 1.0 D+1.0 L(All Spans) Design methodology:Aso
Total Load Den.(in) 0.009 @ 2'9 1/2" 0.258 Passed(L/9994) 1.0 D+1.0 L(All Spans)
T3-Pro'"Rating N/A I
•Deflection cntena:LL(1J360)and TL(L/240).
•Top Edge Bracing(Lu):Top compression edge must be braced at 5'7"o/c unless detailed otherwise.
•Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 5'7-'0/c unless detailed othenrise.
•A 15%increase in the moment capacity has been added to account for repetitive member usage.
•Applicable calculations are based on NDS.
•No composite action between deck and joist was considered in analysis.
Bearing Loads to Supports(Ibs) .--
Supports Total Available Required Dlirad Floor Total Accessories
Live
I-Stud wall-HF 3.5W 3.50" 1.50" 45 149 194 Blacking
2-Stud wall-HF 3.50" 3.50" 1.50" 45 149 194 Blocking
•Blocking Panels are assumed to carry no loads applied directly above them and the full load is applied to the member being designed.
Dead Floor Live
Loads Location(Side) Spacing (0.90) (1.00) Comments
t-UnAcrm(PSF) 0 to T 7" 16" 12.0 40.0 Residential-Uvmg
Areas
Weyerhaeuser Notes l SUSTAINABLE FORESTRY INITIATIVE
1 Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. l
Weyerhaeuser expressly disclaims any other warranties related to the software.Use of this software is not intended to circumvent the need for a design
professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is
compatible with the overall project.Accessories(Rim Board,Blocking Panels and Squash Stocks)are not designed by this software.Products manufactured at
Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered lumber Products have been evaluated by ICC ES
under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTI•i standards.For current code evaluation reports.Weyerhaeuser
product literature and installation details refer to wvnv.weyerhaeuser.com/woodprocltxts/document-library.
The product application,input design bads,dimensions and support information have been provided by KO
Forte Software Operator Job Notes 7/12/2019 4:12:16 PM
Forte v5.5,Design Engine:V7.3.2.4
James 910.007
Hodge Engineering Inc. 180780-BEAM CALCULAT/ONS.4te
(253)867-7055
I;uresi?houFeengineenno.com Page 16 of 33
Printed From Mason County DMS
Printed from Mason County DMS
Page 1 of 1
John,
Please accept this message as confirmation that the inspection result of"Fail" by the county on 4/29/2019
stands.
I have reviewed your supplied photos and our file copy of the approved plans for permit BLD2019-00024,
which appears to have several discrepancies.In the photos supplied,I observe no point load or interior footings
have been set up prior to prepping the interior slab.It appear that your approach is to mono pour the point load
and interior footings with the slab. However, in your supplied photos it is unclear on the placement of the point
load and interior footing as called for on S-1 of the approved plans. Per the approved plans,there also needs to
be a thickened footing at all hold down locations.In several of the photos it appears that the rebar is
either simply laying in a channel or piercing the vapor barrier,which would then would not be enclosed.Again,
this is also unclear if meeting the entire depth and size of the called out point load and footing.Once the point
load and interior footings have been set,the insulation requirement of R-10 would also need to be
placed through the entire floor and inspected prior to pouring the slab.
Prior to scheduling a reinspection, please set up all point loads, interior footings,with rebar tied in place.
Sincerely,
Kristopher Nelsen
Permit Assistance Center Manager
Community Services Department
Public Hours Mon-Thur 84:30,Fri 8-noon
Mason County
knelsen@co.mason.wa.us
Phone:360.427.9670 Ext:359
>>> John DiPino <dipino john8@gmail.com> 5/1/2019 8:58 AM >>>
It got sent to the wrong person
---------- Forwarded message---------
From:John DiPino <dipino.iohn8@gmail.com>
Date:Tue,Apr 30,2019, 10:47 AM
Subject: Pictures of Gibson job site
To: <knelson@co.mason.wa.us>
Good morning here are a few of the pictures of the slab being poured and footings in place is there anyway we
can get signed off by Thursday no later as we already had to push mud back from today till Friday thank you
very much
Printed From Mason County DMS
file:///CYUgeit/K rel AOO /Db'dtl/Temp/XPgrpwise/5CC98B2EMasonmai110013232... 7/1/2019
Mason County
MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W.Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
B DD2019-00024 NEW SINGLE FAMILY RESIDENCE
PROJECT DESCRIPTION: NEW 2203 SQ FT SFR - ISSUED: 03/25/2019
SITE ADDRESS: 431 NE HAVEN LAKE DR TAHUYA
EXPIRES: 09/21/2019
PARCEL: 223305000110
APPLICANT: WILLIAM C&LAUREL GIBSON OWNER: WILLIAM C&LAUREL GIBSON
200 SW 176TH ST 200 SW 176TH ST
BURIEN,WA 98166-3091 BURIEN,WA 98166-3091
GENERAL CONTRACTOR'S LICENSE: FAMILY CLASSIC HOMES License: FAMILCH883JO
Expires: 04/30/2020
253.377.6463
VALUATIONS: EES: Paid Due
Uncovered Deck 457.00 $6,855.00 PI Check Fee $1,435.25 $0.00
R-3 VB Residential, one- 2203.00 $266,012.25 Planni Review Fee $240.0 $0.00
and two-family Change in enant- Minor EH $1 .00 $0.00
U VB Utility, miscellaneous 174.00 $8,317.20 Plan Review
Building Permit $2,208.08 $0.00
Plumbing Base Fee $25.00 $0.00
Mechanical Fees $296.00 $0.00
Mechanical Base a $30.00 $0.00
Plumbing Fe $159.99 $0.00
State F - esidential $6.50 $0.00
Total: $281,184.45 Totals : $4,510.82 $0.00
FIXTURES
tOty Mechanical Fixtures Qty Plumbing Fixtures
1 Furnace(s) 1 Number of Bath Tubs
1 Heat Pump(s) 2 Number of Clothes Washers
2 Dryer Vent(s) 2 Number of Dishwashers
y�Q2 Kitchen�Exxyhaust Hood(s)
/� y�} 2 Number of Kitchen Sinks
11 1 1 1B f 1 1 IO CIS 1 ! County 1 ty DIMS
Page 1 of B
Printed from Mason County DMS
Mason County
( MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W.Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
(sty Mechanical Fixtures QQty Plumbing Fixtures
2 Wood/Gas/Pellet Stove(s) 2 Number of Showers
5 Spot Vent Fan(s) 2 Number of Water Heaters and or Vent
3 Number of Hose Bibs
3 Bathroom Sink
3 Number of Toilets
REQUIRED INSPECTIONS
Setback Inspection Rough-Plumbing Inspection
Footing Inspection Mechanical Inspection
Foundation Wall-Pre-Pour Inspection Insulation Inspection
Shearwall Inspection BLD-Final Inspection
Framing Inspection
CONDITIONS
' The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility
of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked
"APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is
responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of approved documents will result in failure of required building inspections.
The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the
approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule,
minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being
performed or approvals granted.
* The foundation/footing must be placed on undisturbed, firm-native soil.
" A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit
application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the
responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that
Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement
of any development activities. "NOTE if Stormwater Management option"A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel
Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the
development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other,
parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater
management system have been installed as approved on the stormwater site plan.
�d o�1''�'I`�i031 X196H County DIMSPage 2 of 8
Printed from Mason County DMS
Mason County
MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W.Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
* All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as
adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted
classification. Any non-approved change of use or occupancy would result in permit revocation.
* The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more
than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards
for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to
another fire apparatus access road which connects to a county maintained public road.
* All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and
plans are not available on site, then approval will not be granted. In addition, a re-inspection fee(refer to current fee
schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections
being performed or approvals granted.
* All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building
Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration.
Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No
more than one extension may be granted.
* A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more
information contact Public Works, at(360)427-9670, ext.450 or 100 W Public Works Dr. Shelton.The building permit will
not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and
approved.
* Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly
corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of
pressure treated material.
* All building permits shall have a final inspection performed and approved by Mason County Building Department prior to
permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property
records on file with Mason County as being non-compliant with Mason County ordinances and building regulations.
* WIND LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic
wind speed for Mason County is 85 MPH.
* Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer
specifications and in accordance with IRC Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level
of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of
fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or
created.
* A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance
with IECCIWSEC Section R404.1.
* Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site
plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
1 IMORTMI I I 'M 71 County DMV Page 3ofB
1
Printed from Mason County DMS
Mason County
MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W. Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
Installation of heating equipment in a single-family residence shall meet the requirements of the current IECC/WSEC
R403, applicable sections of the IRC, and IMC.
Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. Heating and design load calculations for the
purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted practice, including
infiltration and ventilation. Design calculations shall be available for inspection during inspection.
Referencing IRC M1601.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct
systems and seams shall be made substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other
approved closure systems. Closure systems used with rigid fibrous glass ducts shall comply with UL181A and shall be
marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape. Closure systems used
with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure-
sensitive tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings
shall be mechanically fastened. Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B
and shall be marked 181 B-C. Crimp joints for round metal ducts shall have a contact lap of at least 1-1/2 inches (38 mm)
and shall be mechanically fastened by means of at least three sheet-metal screws or rivets equally spaced around the joint.
Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation
instructions.
Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be
insulated to R-8
DUCT TIGHTNESS TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit
documenting test results in accordance to IECC/WSEC Section R403.3.3 shall be provided to the Mason County Building
Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website
titles, "Duct Leakage Affidavit" or"Duct Leakage Testing Results (Existing Construction)." Duct tightness testing is not
required if the air handler and all ducts are located within the heated space.
PrIn6�G�.iB III a 611 County D!V1S Page 4of8
Printed from Mason County DMS
Mason County
MASON COUNTY Mason County Community Services
.01 COMMUNITY SERVICES
615 W.Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
* Adopted IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U-
Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation
R-30, Ceiling Insulation min. R49, Vault Insulation R-38, and Slab Insulation R-10.
F
CIENT BUILDING ENVELOPE 1a:
ve compliance is based on Table R402.1.1 with the following modifications:Vertical fenestration U =0.28
8rade R-10 perimeter and unde entir slab Below grade slab R-10 perimeter and under entire slab
Compliance based on Section R402.1.4: Reduce the Total UA by 5%.
2a-AIR _L_EAT0ne.E CONTROL AND EFFICIENT VENTILATION 2a:
Compliance based on R402.4.1.2: Reduce the tested air leakage to 3.0 air changes per hour maximum
and
All whole house ventilation requirements as determined by Section M1507.3 of the International Residential Code shall be
met with a high efficiency fan (maximum 0.35 watts/cfm), not interlocked with the furnace fan. Ventilation systems using a
furnace including an ECM motor are allowed, provided that they are controlled to operate at low speed in ventilation only
mode.
To qualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the
maximum tested building air leakage and shall show the qualifying ventilation system.
3a- HIGH EFFICIENCY HVAC EQUIPMENT 3a:
Gas, propane or oil-fired furnace with minimum AFUE of 94%,or Gas, propane or oiled-fired boiler with minimum AFUE of
92%
5c- EFFICIENT WATER HEATING 5c:
Water heating system shall include one of the following: Gas, propane or oil water heater with a minimum EF of 0.91
or
Solar water heating supplementing a minimum standard water heater. Solar water
heating will provide a rated minimum savings of 85 therms or 2000 kWh based on the Solar Rating and Certification
Corporation (SRCC)Annual Performance of OG-300
Certified Solar Water Heating Systems
or
Electric heat pump water heater with a minimum EF of 2.0 and meeting the standards of NEEA's Northern Climate
Specifications for Heat Pump Water Heaters
* All changes to"approved"building plans that effect compliance with the international codes as amended and adopted, or
any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
* All property lines shall be clearly identified at the time of foundation inspection.
* Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,
Contractor Compliance Division.There are potential risks and monetary liabilities to the homeowner for using an
unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
* REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
I e FM III031V1zi 11 County DM. S Page 5oT8
Printed from Mason County DMS
Mason County
MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W.Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
` Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and
MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either
private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an
existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance
and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting
from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any
construction which is proposed to be located within 25'of a Mason County road right of way, it is suggested to contact that
office to review future planned work which may affect your project.
` A Road Access Permit or Approval must be granted and approved by the Washington State Department of Transportation.
For more information contact Washington State Department of Transportation, at(206)357-2620, ext. 630.
A permanent certificate, completed by the builder or registered design professional, shall be posted on a wall in the space
where the furnace is located, a utility room, or an approved location inside the building. When located on the elctrical panel,
the certificate shall not cover or obstruct the visibility of the circuit directory label, service disconnect labek, or toher reqyired
labels.The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab,
basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; 0-factors for fenestration; and the
solar heat gain coefficient(SHGC)of fenestration.Where there is more than one value for each component, the certificate
shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service
water heating equipment, duct leakage rates including test conditions as specified in WSEC Section R401.3& R402.4.1.2,
and air leakage results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 5 air
changes per hour when tested with a blower door in accordanve with IECC/.WSEC Section R402.4.1.2.
The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution
panel. Air leakage testing is not required for additions less than 500 square feet. Reference IECC/WSEC R402.4.1.2.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2015 Certificate"and are
available in '/4 or M2 sheets. The Mason County Permit Center will also have some available.
Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance
with Mason County Title 14.28 and 14.17.
Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
& Industries (L&I).
For more information contact L&I for additional information. In Olympia call(360)902-6350 and in Bremerton call (360)415-
4000.
All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor
increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way.
` By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your
"Approved Site Plan"to ensure these structures meet the setback conditions listed.
F�'I`I` �G B' `� I�'t��'t�V9811 County DMS Page 6 of 8
Printed from Mason County DMS
Mason County
i MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W.Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
" CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING
DEPARTMENT AND THE ADOPTED BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All
construction must be in conformance with the international codes as amended and adopted by Mason County. Any
corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting
additional inspections.
* Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or
given an equivalent type of erosion protection (silt fencing or straw matting).
Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel.
RR5
" Height of structure not to exceed 35 feet from average grade.
PER MCC 8.52.170.D(4)(k)-View Corridors. Buffer alterations for view corridors are allowed with emphasis placed on
limbing and with selective timber removal minimized to the extent possible. Proposed alterations shall be the minimum to
afford views within the buffer and shall minimize shrub vegetation removal and ground disturbance while maintaining the
large mature trees. Under this provision, no more than ten percent of the shrubs and ten percent of trees in the buffer less
than six inches in diameter at breast height may be cut without specific authorization from Mason County.
A separate inspection in addition to the inspections required in the IBC, Section 110 shall be required in accordance with
the 2015 IBC, Section 1705.12.2 and Section 1707.1. The additional inspection is required when shear wall fastener
spacing is required to be 4 inches or less. The shear wall schedule shown on sheet S3 designate wall(s)type SW2 with
fastener spacing 4 inches or less.
The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified
to inspect lateral connections, the Engineer of record (EOR), or an authorized representative of the (EOR). The special
inspectors duties and responsibilities shall be as specified in Chapter 17. When a third party inspector is used to perform the
inspection, special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton,
WA 98584 and also available on site for review by the Building Official. Inspection reports shall be completed and submitted
to the Mason County Building Department in a timely manner and shall be submitted prior to the framing inspection of said
project.
Anchor bolts and hold-downs must be in place at time of foundation inspection. See plans for locations and requirements
On-site Septic System final installation approval required prior to temporary/final occupancy of the residence.
Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered.
A.) Drainfield/Reserve requires a 1Oft setback from all footing/foundations.
B.) Septic tank(s) requires 5ft setback from all footing/foundations.
C.) No foundation/Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area.
D.) No Cut Bank(s)(greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/Reserve area.
��( tddentm0l M County DMS Page 7of8
Printed from Mason County DMS
Mason County
MASON COUNTY Mason County Community Services
COMMUNITY SERVICES
615 W. Alder St. Bldg. 8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
NEW SINGLE FAMILY RESIDENCE BLD2019-00024
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By:
Contractor or Authorized Agen Date:
1 ��e� iG�e Me(er�er1d 1 1 103 5/�0� ®n �!®� n ty D M. S
Iv� Page 8 of 8
Printed from Mason County ISMS
INSPECTION CARD
MASON
OUNTY
COMMUNI"rV SERVICES Mason County
OMMUN
615 W. Alder St. Bldg. 8, Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
PERMIT# BLD2019-00024 PROJECT ADDRESS 431 NE Haven Lake Dr Tahuya, WA 98588
PARCEL# 223305000110 PROJECT DESCRIPTION NEW 2203 SQ FT SFR
OWNER WILLIAM C&LAUREL GIBSON ADDRESS 200 SW 176TH ST PHONE
CONTRACTOR FAMILY CLASSIC HOMES ADDRESS 60 NE LAKE DRIVE PHONE 253.377.6463
CONTRACTOR LICENSE FAMILCH883JO LENDER
INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments
Setback Inspection Rough-Plumbing Inspection
Footing Inspection T Mechanical Inspection
Foundation Wall-Pre-Pour Insulation Inspection C2� cs
ShearwallInspection BLD-Final Inspection _ 0
Framing Inspection
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WAT
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COMMUNITY SERVICES•
Budding,Planning,Environmental Health,Community Health
415 N 61h Street,Bldg 8, Shelton WA 98584, a
Shelton:(360)427-9670 ext 400 Belfair. (360)275-4467 ext 400 ^ Elma: (360)482-5269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application, with any required attachments for review.
4. An approved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant:� < 3SC,-" Date: /ZAA&
y.3/ �✓F_ Al.o✓ L 4►—m P2
Mailing Address: 7-ANaijA wA 9856$ Phone: (�G�
Parcel Number. Z2
�.330_50 —
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more /�RP Building permit
connections) ❑ Division of land:
Individual water source (one connection), #of Parcels? SPIL
X Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel (please indicate name
If you have more than one residence connected of water system below if applicable—no
to this well, check the Public/Community Water signature required)
System box. D IT Ir.--,Y B�y�
Part 2: Water Connection Information BAN I 01 2���- 11
f1 ,q
Complete the section appropriate for the type of water connection being evaluated:
Public Water System BY:_____________
Name of Water System:
Water Facility Inventory(WFI)Number:
(write"none"for two-party)
❑ I am the manager of this water system. The water system has been approved for services.
There are presently connection(s)in use. This will be the connection.
❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature
of this change:
This water system is able and willing to provide water to this (these)connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Date
s This form may
p�b�e^gy scanned
iand available for public view at www.co.mason.wa.us.
Prtr1�{�1 rrs ,,i,,wl lYfason G"' o my DKA Rmsed l,25!2Oltt
(C Printed from Mason County DMS
Individual Water Well
-/
7Jw ater well report (attached to application). Depth PQ ft.
❑ Well capacity Test(attached to application) gpm gpd.
The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test, which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA http://gis.co.mason.wa.us/planning 14_ 15_ 16_22_
Water use or limitation recorded................................... N/A Yes
WellDrilled ............................................................... Date
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Date
Relationship to Applicant
Part 3: Mason County Community Services Evaluation (staff use only)
Satisfactory Determination:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date �� 1
G D Director- Date 2 of 2
Printed from Mason County DMS
. `
'
Drawing:Plot Plan
Waivers/Variances:STATE WAIVER
Bob Pa)lsse Septic Designer Scale: 1"=30' Scale Bar:
NEIGHBORS
WELL
NEIGHBORS
\ LOCATION
bo
. M~~._ ___.
Printed from Mason County DMS
1
STATp
o £
Q2
STATE OF WASHINGTON
DEPARTMENT OF ECOLOGY
PO Box 47775 o Olympia,Washington 98504-7775•(360)407-6300
December 3,2007
CERTIFIED MAIL
7006 2760 0000 0402 7128
Mr. Michael F. Piechoski,L.HG
Robinson,Nobel,& Saltbush,Inc.
3011 South Huson Street, Ste. A
Tacoma, WA 98409
RE: Variance request to Chapter 173-160 Washington Administrative Code(WAC)for well at
431 NE Haven Lake Drive,Mason County, Washington(NW '/4, SE '/4, Section 30,
Township 23 N,Range 02W)
Dear Mr. Piechoski:
This letter is in response to your written request for a variance to the Minimum Standards for the
Construction and Maintenance of Wells,Chapter 173-160 Washington Administrative Code.
Specifically, your request is to drill a new water well 75-feet down slope from an existing
drainfield and 75-feet upslope from a new drainfield. The requirement of Chapter 173-160-
171(b)(iv)is that"for water wells other than for public water supply"the well will be"100-feet
from the edge of the drainfield." This variance request is necessary due to the location of wells
and drainfields on adjacent parcels, and roadways,driveways, buildings, and the limited land
area available to be developed.
After an investigation, interview,and review of proposed septic system plot plan for the lot, and
of the well log data for the area,a variance is hereby granted to WAC 173-160-171(b)(iv),
Ecology will allow a well to be 75-feet from a drainfield. This variance is granted under the
following conditions:
1. The well will be a minimum of 100-feet deep. No other openings in the casing,except a
Washington State Department of Health approved pitless-style adapter, installed as
recommended by the manufacturer,can be less than 100-feet below land surface.
2. The surface seal must extend from land surface to 30-feet below land surface and must
use a temporary surface casing at least 30-foot long and 4-inches larger in diameter
than the permanent casing diameter. The entire length of the surface seal must be cased
Printed From Mason County DMIS
Printed from Mason County DMS
before installation of the bentonite. Open hole drilling of the surface seal and sealing
without a temporary surface casing IS NOT APPROVED.
3. Bentonite for the surface seal must be installed as required in Chapter 173-160-231 (2)
and(3).
4. All well construction work shall be performed by a licensed driller as set forth by
WAC 173-162.
5. You must submit a Notice Of Intent To Construct A Water Well form(Start Card),with
fees to Ecology so that it reaches our offices at least 72-hours prior to construction of any
well.
6. You must submit Water Well Reports)describing the construction to Ecology
(Southwest Regional office)within 30 days after completion of the well. Attach a copy
of this variance to the well report.
7. With the exception of the provisions set forth(above)in this variance,all state and local
(Mason County) requirements shall apply.
You have a right to appeal this decision. To appeal thus you must:
• File your appeal with the Pollution Control Hearings Board within 30 days of the"date of
receipt"of this docu vent. Filing means actual receipt by the Board during regular office
hours.
• Serve your appeal on the Department of Ecology within 30 days of the"date of receipt"
of this document. Service may be accomplished by any of the procedures identified in
WAC 371-08-305(10). "Date of receipt"is defined at RCW 43.21B.001(2).
Be sure to do the following:
• Include a copy of this document that you are appealing with your Notice gfAppeal.
• Serve and file your appeal in paper form;electronic copies are not accepted.
1.To file your appeal with the Pollution Control Hearings Board
Mail appeal to: OR Deliver your appeal in person to:
The Pollution Control Hearings Board The Pollution Control Hearings Board
PO Box 40903 4224—6th Ave SE Rowe Six, Bldg 2
Olympia WA 98504-0903 Lacey WA 98503
Printed From Mason County DMS
Printed from Mason County DMS
2.To serve your appeal on the Department of Ecology
Mail appeal to: OR Deliver your appeal in person to:
The Department of Ecology The Department of Ecology
Appeals Coordinator Appeals Coordinator
P.O. Box 47608 300 Desmond Dr SE
Olympia WA 98504-7608 Lacey WA 98503
3. And send a copy of your appeal to:
Bill Lum
Department of Ecology
Southwest Regional Office
PO Box 47775
Olympia WA 98504-7775
For additional information visit the Environmental Hearings Office Website:
http://www,eho.wa.gov. To find laws and agency rules visit the Washington State Legislature
Website: http:/hi,wvi,].Igg wa.gov/CodeReviser.
DATED this 3rd day of December, at Olympia, Washington
Sincerely,
Thomas Loranger
Water Resources Section Manager
TL:BL:th
cc Arlene Hyatt,Mason County Public Health
Printed From Mason County DMS
Printed from Mason County DMS
WASHINGTON STATE POLLUTION CONTROL HEARINGS BOARD
ENVIRONMENTAL HEARINGS OFFICE
Physical address: Mailine address:
Environmental Hearings Office Environmental Hearings Office
4224-6th Avenue SE PO Box 40903
Rowe Six,Bldg.2 Olympia WA 98504-0903
Lacey WA 98504-0903
(360)459-6327 Fax:(360)438-7699
Web Address: littp://wtvw.eho.wa.gov
E-Mail: eho@eho.wst.gov
"Your Right to Be Heard"
Board Members Administrative Assistant
William H.Lynch,Chair Robyn Bryant
Kathleen D.Mix
Andrea McNamara Doyle Heating Coordinator
Judy Greear
Administrative Appeals Judges
Phyllis K. Macleod Secretary
Kay Brown Debbie Joblonski
Cassandra Noble
This is your informal guide to your rights and responsibilities in an appeal. It is not exclusive and does not have force and effect of state law or
regulation. More detailed information,in RCW 43.21B,the act creating the Pollution Control Hearings Board,and in a chapter of the Washington
Administrative Code entitled,"Rules of Practice and Procedure of the Pollution Control Hearings Board,WAC 371-08,"is available at your county
law library or upon request from the Environmental Hearings Office and at the Environmental Hearings Office website at http:/hvww.eho.wa.gov.
For more detailed information,please open up on the web page the Environmental Hearings Office Handbook and the Environmental Hearings
Office Sample Formbook ALTERNATE FORMAT AVAILABLE UPON OUEST
YOUR RIGHT TO BE HEARD of the three must be an attorney. All are Pollution Control Hearings Board
salaried employees of the State, who also
Tile Pollution Control Hearings Board serve on the Shorelines Hearings Board. Physical address:
(PCHB) hears appeals from orders and 4224 6th Avenue SE
decisions made by: Bldg.2,Rowe Six
DO YOU NEED AN ATTORNEY? Lacey,WA,98504-0903
1. Local and regional air pollution Mailing address:
control agencies or authorities. An attorney may represent you,but the law PO Box 40903
2. The State Department of Ecology, does not require one. Consider this very Olympia WA 98504-0903
and carefully before deciding to represent
3. Other agencies as provided by law. yourself. The appeal process can be Within 30 days of receipt of the decision,
complicated and significant rights may be you must also serve a copy of your appeal
The Board's sole function is to give you, at stake. The hearings are conducted more with the Department of Ecology or Air
and all other litigants in a disputed matter, like court trials, instead of city council Pollution Authority or other agency whose
a full and complete hearing,as promptly as meetings, order or decision you are appealing.
possible, followed by a fair and impartial
written decision based on the facts and law. If you are appealing a decision on a permit,
WHEN,WHERE,AND HOW TO FILE you should also serve a copy of your
The Board is not afTiliated with the AN APPEAL appeal on the holder of the permit unless
Department of Ecology or any other you are the permittee.
agency. To insure[lie Board's impartiality,
the stale Legislature created this No fee is required for filing an appeal. Failure to observe the 30 day deadline for
independent, quasi-judicial state agency filing with the Board and servingthe
entirely separate from any other state, or The Board must RECEIVE your appeal Department of Ecology or Air Pollution
regional resource or regulatory a enc or within 30 days of the"receipt"Rerip is
the order P BY
g agency or decision. "Date of Receipt" is defined Control Authority or other agency will
local unit of government. in RCW 43.21 B.00 1(2) result in termination and dismissal of the
appeal.
The Board consists of three full-time The original of the appeal must be filed
members, who are appointed by the with the Board at:
governor and confirmed by the State
Senate for staggered six-year terms. One
Printed From Mason County DMS
Printed from Mason County DMS
Service on all parties shall be by personal the purpose of arguing your case. The
service or by mail. Service by mail is conference has three purposes: to discuss
effective on the date of mailing; however, interest in settlement, including use of the MOTIONS
filing with the Board is only effective on Board's no-cost mediation program, to
actual receipt by the Board. determine the legal issues, and to set a
schedule for preparing the case for hearing Any party may file a motion. A motion is
Filing of the appeal does not stop(stay) if settlement is not reached. Prior to the a request by one of the parties asking the
the effectiveness of an appealed permit. pre-hearing conference each party is Board,or the Presiding Officer to rule on a
For information on how to obtain a stay required to submit a preliminary list of particular issue.
or temporary restraining order, please legal issues, proposed witnesses and
refer to RCW 43.21B.320 and Civil exhibits. After the pre-hearing.conference, A motion may be dispositive or non-
Rules for Superior Court 65(CR 65). a written pre-hearing order will be mailed dispositive. A dispositive motion may be
to the parties. It will include the hearing based on an issue or issues, or the whole
date, the list of legal issues, hearing case. A non-dispositive motion is a
re aration deadlines,and other important
request for relief,which does not decide an
CONTENT OF THE APPEAL procedural information. p _ issue or issues or the whole case. An
example of a non-dispositive motion is a
Your appeal should include the following motion in limine. A motion in limine asks
items: CAN THIS DISPUTE BE SETTLED? the Board, in advance of the hearing to
exclude certain evidence. Dispositive
• A copy of the order or decision you motions are decided by the full Board. An
are appealing,and if the order or Litigation is time and energy consuming example of a dispositive motion is a
decision followed an application,a for the parties. Each party needs to think motion for summary judgment. A motion
copy of the application. about possible compromise. For settlement for summary judgment is typically based
• Your name and address(mailing and to be reached, each side needs to offer on sworn statements of fact from a person
legal,ifdifferent)and,ifapplicahle, something. Patties are encouraged to having personal knowledge of the facts
the name and address efyour begin settlement talks,without waiting for alleged. A sworn statement may be either
representative. Board participation. a declaration or an affidavit. An example
• A daytime phone number. of a declaration may be found on page 29
• A brief statement why you are The Board has a no-cost mediation of the Environmental Hearings Office
appealing. program to assist parties in reaching (EHO) Sample Formbook. This
• The relief you seek(what you want settlement. It is a voluntary program Formbook may be found by going to the
the Board to do). offered to the parties without charge. All EHO website at http://www.cho.wa.gov.
• A statement,signed by you or your parties must agree to mediate before a After you have opened to the home page,
representative,attesting the content of mediation can be scheduled. A trained click on the "Resources" button under
the appeal is true. Administrative Appeals Judge will work "Research." When that page opens up,
with the parties to resolve the case. click on "The Environmental Hearings
Office Sample Formbook" under "Other
IF YOUR PERMIT IS APPEALED If the parties settle directly or through Resources."
mediation, a written document containing
the settlement terms will ultimately be A declaration or affidavit may also
Perhaps you have been granted a permit by signed by all, and filed with the Board, identify and attach documents as exhibits.
the Department of Ecology,air authority or which will dismiss the appeal if the This is the format of the declaration
another agency, but another parry has settlement conforms to the law. contained in the EHO Sample Formbook.
appealed. You have a right to defend the
permit and are automatically a respondent BEFORE THE HEARING
in the appeal before the Board. All
subsequent sections in this publication C Diapositive Motions
apply to you as well as to the appellant. Before the hearing you will want to
prepare. You have the right to review the The scheduling of dispositive motions is
agency's file of their decision. Contact it set forth in the pre-hearing order. Please
HEARING DATES to arrange a time and place to see the file. file with the Board an original and
You and the other parties have the right to sufficient copies of the dispositive motion
When an appeal is filed, the Board will for each Board member and the presiding
assign and notify you of a date for hearing find out in advance what witnesses and officer, if the presiding officer is not a
other evidence will be used at the hearing. Board member. A co should be served
flu case. This may be provided to you without copy
simultaneously on the date the motion is
formal procedures, such as by looking at filed,on each party in the case.
public records. If done formally, this
THE PRE-HEARING CONFERENCE discovery is best accomplished with the Any party opposing the motion will
assistance of a lawyer. Examples of formal
typically have 14 days from the day it
Soon after the appeal is filed,a pre-hearing discovery are: Deposition-questioning received the motion,to file an original and
conference is scheduled with the Presidingwitnesses before the hearing, under oath
the requisite copies of a response with the
Officer. The pre-hearing conference is with a court reporter present. Board, and serve a copy on each of the
usually held within 4-6 weeks of the Interrogatory-presenting written other parties. The moving party generally
appeals' filing and is generally conducted questions to the other side. There are will have 10 days from the date it receives
by telephone. This conference is not for formal rules that apply to discovery, the response, to file an original and the
y c.� 1' ,: 4 tart' i - t 4 •k ��^' t yA1 Mi^ �.�2�� 111 r"1.j, ` !�, _1.'..
�'t � �i 4r � ✓.,} 77 tjG t,�' ?S, t>1Ms �}}��a r '�-�3]y � s.
•3 _ .•rfi' .[.L_�S�i°.r'>J4 ..t- l.•.s�+. ''- 14.i�1::Sa.i�C1yll+�yc.+,w<�7�
Printed from Mason County DMS
FILE:ORIG.8 FIRST COPY-DEPT.OF ECOLOGY WATER WELL REPORT START CARO NO.WE33622
SECOND COPY-OWNER:THIRD COPY-DRILLER STATE OF WASHINGTON UNIQUE WELL ID BLH 636
WATER RIGHT PERMIT NO N/A
(1)OWNER NAME: FAMILY CLASSIC HOMES ADDRESS: 60 NE LAKE DR.TAHUYA,WA 98583
(2)LOCATION OF WELL: County MASON SE 114 NW 114 SEC 30 TWP 23N R 2W
(2a)STREET ADDRESS OF WELL(or nearest address): 431 NE HAVEN LAKE DR PARCEL:223306000110
(3)PROPOSED USE: DOMESTIC i .(10)WELL LOG OR DECOMMISSIONING PROCEDURE DESCRIPTION
(4)TYPE OF WORK: NEW WELL I
METHOD: ROTARY I
I MATERIAL I FROM I TO
DARK BROWN SANDY SILT 3 CLAY 0 3
(6)DIMENSIONS: Diameter of well 6 inches. BROWN SANDY SILT,SOME GRAVEL 3 COBBLES 3 101
Drilled 240 feet. Depth of completed well 237 ft.I BROWN SILT i FINE SAND I 101 I 156
BROWN SILT 6 GRAVEL,SOME SAND I 1b6 I 176
GREY SANDY CLAY,SOME GRAVEL I 175 1 220
BROWN SANDY SILT,SOME GRAVEL 3 CLAY 1 220 1 229
(6)CONSTRUCTION DETAILS I BROWN SANDY SILT d GRAVEL(W.B.) I 229 I 238
Casing inst1d: 6 Diam.From +1 ft. to 232 ft.I DARK BROWN SANDY CLAY,SOME GRAVEL i 238 ; 240
Welded 1 Diam.From ft. to It. 1 I
Liner ❑ Diam,From ft. to ft.I 1
Threaded ❑ I
I
I 1
Perforations Yes ❑ No
I I
Type of perforator used I I
Size of perforations In.by In.I
perforations from ft. to in.I I 1
perforations from ft. to in.I I 1
perforations from ft. to in.I I
I i I
I I
1 I 1
Screens: Yes 2 No ❑
Manufacturer's Name: JOHNSON
Type Model No. 1
Diam 6T Slot size 0.020 from 232'2 ft. to 237'2" ft.1
Diam Slot size from ft. to ft.
I
I
I RECEIVED
.�ta I
Gravel packed Yea ❑ No ❑ Size of gravel? I our E C E I /E a+� I I
Gravel packed from ft to ft.
I a �` v C old■ I I
I I I
I I
Surface seal: Yes ❑ No ❑ To what depth? 36 11.i JAN 2 8 2019 1 1 I
1
Material used in seal BENTONITE CHIPS
1 WA State Department1 1
Did any strata contain unusable water? Yes❑ No❑ I (
Type of water? Depth of Strata ft.I ( 0) I I
Method of sealling strata oft i of Ecology (SWRO)
I I
(7)PUMP: Man.tact.mes Nam. 1 1 1
Type H.P. 1
i
r
I I I
(8)WATER LEVELS: Surface elev above mean sea level ft.1 I I
Static level 199 below top of well Data 12/14118
Artesian pressure lbs.Per sq.in. Date 1 1 1
Artesian pressure is controlled by
I _ r
I
(9)WELL TESTS: Pump test made? By Whom I Work Started 1 7J0711 8 Completed: 12/14/16
Y..ld palrnin wdn a dnwd.wn Attar hn.l
Yww saun.n wdh Is drawdawn*flat no. WELL CONSTRUCTOR CERTIFICATION:
Ywld G.I.In n with n drawdown an.r nn.1 I constructed andlor accept responsibility for construction of
Recovery data: this well,and Its compliance with ail Washington well construction
Time uvv Lvl. Time Wtr Lvl. Time wtr LYI. I standards. Materials used and the Information reported
I above are true to my best knowledge and belief.
I
(Name: RICHARDSON WELL DRILLING COMPANY INC.
Date of test: IAddress: P.O.BOIL 44427 TACOMAA,WA 98444
Boller teat ial.fmin wiN n.areddnwn.n.r ran.i � '^ J>)�
Airtest 26 gavmin stem sot at 236 ft. for 1 nta.1(Slgned) ,>f i ��r r�r Lic No. jQ�1
Artesian flow galimin Date I was 0 a'n t
Temperature of water Was chemical analysis made? NO )Contractor's Registration No.RICHAW 32108 DATE 12127/18
Printed From Mason County DMS
RICHARDSON WELL DRILLING
Aquifer Test Data
Well ID# BLH-636 Owner Family Classic Homes
431 Haven Lake Dr
Pumping Well Drawdown Data
Pump On 1/16/19 1:15pm Pump Off 01/16/19 2:40pm
Date Time Date Time
Reference Static Level 198'4" Feet 2Hp 16 Pump Size
Recorded By Time Water Levels Comments
Date Clock Elapsed Time Reading In Depth To Drawdown
Since Start G m Water
Aaron R 1/16/2019 1:15 198'4"
1:17 2 Min 24 199'6" 1'2"
1:19 4 Min 24 199'8" 1'4"
1:21 6 Min 24 199'8" 1'4"
1:23 8 Min 24 199'8" 1'4"
1:25 10 Min 24 199'8" 1'4"
1:30 15 Min 24 199'8" 1'4"
1:35 20 Min 24 199'8" 1'4"
1:40 25 Min 24 199'8" 1'4"
1:45 30 Min 24 199'8" 1'4"
1:50 35 Min 24 199'8" 1'4"
1:55 40 Min 24 199'8" 1'4"
2:00 45 Min 24 199'8" 1'4"
2:05 50 Min 24 199'8" 1'4"
2:10 55 Min 24 199'8" 1'4"
Aaron R 1/16/2019 2:15 1 Hr 24 199'8" 1'4" End
Printed From Masan County Dab .
Printer!from Mason County DIMS
SPECTRA Laboratories ...where experience matters
2221 Ross Way • Tacoma, WA 98,121 1'S:1 272�4850 t itx (273) 572-9838 • www.shectra-lab.com
O1/18/2019
Project: Family Classic Homes
Client ID: 431 Haven Lake Dr
Richardson Well Drilling Sample Matrix: Drinking Water
PO Box 44427 Date Sampled: 01/16/2019
Tacoma,WA 98444 Date Received: 01/17/2019
Spectra Project: 2019010463
Spectra Number: 1
An_ alyte Result Units Method
Coliform Bacteria Absent SM 9223
E.coli Bacteria Absent SM 9223
SPECTRA LABORATORIES
oper,Laboratory Manager Page i of i
rin o "' rorn Mason County DIMS
Printed from Mason County DMS
U HUSH
SPECTRA Laboratories FeeAPPilea
2221 Ross Way-Tacoma WA 98421
(253)272-4850 www.s ectr:-lab.cono
COLIFORM BACTERIA ANALYSIS
Date Sample Collected Time Sample County
Collected OAM
li Day Year ;z-' 2- 9""
Type of Water System(check only one box)
❑Group A ❑Group B nvate Well
Group A and Group B Systems-Provide f5oyl Water Facilities Inventory(WFI):
IDr r6mj/V C GSSle yo"r s
I-1 System Name or Well Address if Private: �i/ '(% tl d/' v�
Contact Person: � - -(,
Day Phone:057)97 7_ 1-7,-? Cell Phone:( )
Email Address:
Client Information:rP,'nt ful/�name,malting address andrp
--------��1_Ca.��_-.�-�i! LY—J(--_j__��
RQ
Sample collected by(name):
;e/J I
Specific location sample collected(well,bath): Special Instructions or comments:
Well
PUBLIC SYSTEMS FILL OUT SHADED AREA(must check only one box of 11-5)
1.❑ Routine Distribution Sample 2.Repeat Sample(kP)
Chlorinated:Yes—No— (from distriballonsyslemafterunsaLrbutfne)
Chlorine Residual:Total_Free_ Unsatisfactory routine lab number:
3.Ground Water Rule Source Sample —
S Unsatisfactory routine collect date:
r /
❑Triggered(ArP) Chlorinated:Yes —No
❑Assesment(A/P) Chlorine Residual:Total_ Free_
4.❑Sample orGWI Raw Source Water Semple(Enumeration) S
❑E.cols ❑Fecal Filtered Yes--- No
5.❑Sample Collected for Information Only
Investigative_ Construction/Repairs_ Other_
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑Unsatisfactory Total Coliform Present and Satisfactory
Cl E.coil present ❑E.cofiabsent
❑Fecal coliform present ❑Fecal coliform absent
Replacement Sample Required:
❑Sample too old(>30 hours)❑TNTC ❑ __-
❑Improper Container ❑Turbid Culture
Bacterial Density Results:Plate Count /ml. Ecoii /100m1.
Total Coliform /100mi. Fecal Coliform __ /100ml.
Date/rme Incubated Date and Time Received
-I 19 1245 O
Date/T•�e And rzed: �' Reported- Tem fb Rec'd by
_ I
?Sample Number(DOH number plus fha dloae) Paid:
118- ��'cJ ' —
White•DOH Olympa Blue•Laboralory Green-water sv*iar Gold•COH Regional
Printed Frorn Mason County DIMS
Printed from Mason County DMS
2104773 MASON CO WA
10: AM NOT
FRMIBY VISSICZHOMES *JSS 47 Rec Fee 98.00 P'[a�s' '
I IIIIIII 111111 III 1NI V�1N 111111 III III���I pl�l III�h MINI ail
Return to:
�11z V C
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA(WRIA)
I(We),the undersigned,hereby place this notice on record that the to(lowing described real estate situated in Mason
County,State ul'Washington;to wit: OR
Subdivision Division Lot an c Township Section
imd having the Tax parcel Number of�';�3-'�'-c-•--5 Q •-b--G 1—�-0
is subject to water use restrictions and conditions set by Washington State Senate Bill 6091 nail Mason
County Code 6.69. These restr9cNo11s and conditions are based on loention of properly and/or Water
Resource lnvcu r tov Area or WRIA.
)
WRIA: / MRxinunn Annual Average Gallons Per Day: __ V
Dated on this 201 .
Signature Signature
Statc of\vas inglon )
County of Mason )
1,the undersignW,a Notary Public in and for the above named County and Slate,do hereby certify that(MI this
`day ot' p-�Ju rub_ 20�, o prrwnally appeared
before me,who Is known to the signer of the above instrument,and acknowledges nt lie(she)(they)signed it.
(liven,under my hand and official seal the day and year last above%Nritten.
JkCiEy�j NOIRD PublA'111, aA"orfe State of Wash't ton,
�•�,\N�ZpMTE�Ngexpires:
T�+m••� ,�� kcsiding at
xpMy coninission eires: _
.;
•,•..AU90 •?_
, •O.r
Printed From Mason County DM
Printed from Mason County DMS
MASON COUNTY 415 N SHELTON 360-427-670 EXT8400
COMMUNITY SERVICES NOV 0 g 2018 BELFAIR:360-275-4467, EXT.400
ELMA:360-482-5269, EXT.400
Buiianq.Plamm�q Erwrmmmal H�ahh,Comrr.niry Healtl, FAX:360-427-7787
NOTICE OF INTENT TO CONSTRUCT A WELL
Permit Number Payment Information Instructions
1. Complete Part 1. Incomplete applications will be rejected
WEC Receipt Number 2. Attach a plot plan and vicinity map.
0 Cash 3. Submit this completed application with appropriate fee a minimum
Check of 24 hours in advance of initiating well construction. Refer to
Mason County Environmental Health fee schedule for cost.
Da e of Payment JJ( 4. Mason County Public must receive notification at least 24 hours
prior to the drilling of the well.
L PART 1: Applicant/ Parcel Identification
Site Address Start Card# _$-fZlL
Drilling Firm At�C��✓dsovv �c Jr Zz. /��s Phone 7-7JI Z
Applicant � �t�a �,Jc// ��1-�� Phone
Mailing Address Z�__�Z�
City -T� t��,,.,. State s Zip `�p P-y
Parcel Number 2 23.7} GO//O
Directions to Site
GiG�gO/�11 OIL f rT� -
Is the well site within 100 feet of salt/seawater? ❑Yes MNo
If yes, a variance from DOE is required. Have you applied/received (circle one)a variance? Yes ❑No
NOTICE: proposed connections to new wells are subject to water adequacy requirements at time of building permit per Mason County Title 6.68.
Water u e resMctions a dditional fees may apply to all new wells drilled after January 191",2018 per ESSB 6091.
App icant/Agent Signature
PART 2: Health Department Review(Staff Use Only)
YES NO TAG# �l ! 3 _ Called In —
❑ Driller on Site? 5�4�
❑ ❑ Is the well capped and Vented? 4
❑ ❑ Is there evidence of a surface seal?
❑ Is there a 2"annular space on all sides of the casing?
❑ ❑ Has the seal slumped?
❑ ,� Is the well flowing or is there evidence of other leakage?
❑ Is there evidence of cascading water?
❑ Is there evidence that the seal is at least 18 feet long?
❑ Do the well site set-backs appear to be appropriate?
Comments
o I$I'l I tI StAI Ibi�I (�. 3� � CkS ,� G� fi'"� of t✓rS�tc1(�"1
Pass ❑ Fail Inspector _ Date f z 2 o t
This form may be scanned and available for public view on the Mason County Web site. Reviscd:2/7/2018
Printed From Mason County DMS
Prinf.ed from Mason County DIMS
a
2
z py�
STATE OF WASHINGTON
DEPARTMENT OF ECOLOGY
PO Box 47775 Olympia, Washington 98504-7775• (360)407-6300
December 3, 2007
CERTIFIED MAIL
7006 2760 0000 0402 7128
Mr. Michael F. Piechoski,L.HG
Robinson,Nobel,& Saltbush, Inc.
3011 South Huson Street, Ste. A
Tacoma, WA 98409
RE: Variance request to Chapter 173-160 Washington Administrative Code(WAC)for well at
431 NE Haven Lake Drive,Mason County, Washington(NW '/4, SE '/4, Section 30,
Township 23 N,Range 02 W)
Dear Mr.Piechoski:
This letter is in response to your written request for a variance to the Minimum Standards for the
Construction and Maintenance of Wells,Chapter 173-160 Washington Administrative Code.
Specifically,your request is to drill a new water well 75-feet down slope from an existing
drainfield and 75-feet upslope from a new drainfield. The requirement of Chapter 173-160-
171(b)(iv)is that"for water wells other than for public water supply"the well will be"100-feet
from the edge of the drainfield." This variance request is necessary due to the location of wells
and drainfields on adjacent parcels,and roadways, driveways,buildings, and the limited land
area available to be developed.
After an investigation, interview,and review of proposed septic system plot plan for the lot,and
of the well log data for the area,a variance is hereby granted to WAC 173-160-171(b) (iv),
Ecology will allow a well to be 75-feet from a drainfield. This variance is granted under the
following conditions:
1. The well will be a minimum of 100-feet deep. No other openings in the casing,except a
Washington State Department of Health approved pitless-style adapter,installed as
recommended by the manufacturer,can be less than 100-feet below land surface.
2. The surface seal must extend from land surface to 30-feet below land surface and must
use a temporary surface casing at least 30-foot long and 4-inches larger in diameter
than the permanent casing diameter. The entire length of the surface seal must be eased
Printed From Mason County DIft
CIO
Printed from Mason County DMS
before installation of the bentonite. Open hole drilling of the surface seal and sealing
without a temporary surface casing IS NOT APPROVED.
3. Bentonite for the surface seal must be installed as required in Chapter 173-160-231 (2)
and(3).
4. All well construction work shall be performed by a licensed driller as set forth by
WAC 173-162.
5. You must submit a Notice Of Intent To Construct A Water Well form(Start Card),with
fees to Ecology so that it reaches our offices at least 72-hours prior to construction of any
well.
6. You must submit.Water Well Reports) describing the construction to Ecology
(Southwest Regional office)within 30 days after completion of the well. Attach a copy
of this variance to the well report.
7. With the exception of the provisions set forth(above)in this variance,all state and local
(Mason County)requirements shall apply.
You have a right to appeal this decision. To appeal this you must:
• File your appeal with the Pollution Control Hearings Board within 30 days of the"date of
receipt"of this document. Filing means actual receipt by the Board during regular office
hours.
• Serve your appeal on the Department of Ecology within 30 days of the"date of receipt"
of this document. Service may be accomplished by any of the procedures identified in
WAC 371-08-305(10). "Date of receipt"is defined at RCW 43.21B.001(2).
Be sure to do the following:
• Include a copy of this document that you are appealing with your Notice of Appeal.
• Serve and file your appeal in paper form;electronic copies are not accepted.
1.To file your appeal with the Pollution Control Hearings Board
Mail appeal to: OR Deliver your appeal in person to:
The Pollution Control Hearings Board The Pollution Control Hearings Board
PO Box 40903 4224—6th Ave SE Rowe Six, Bldg 2
Olympia WA 98504-0903 Lacey WA 98503
Printed From Meson County DMS
Printed from Mason County DMS
2.To serve your appeal on the Department of Ecology
Mail appeal to: OR Deliver your appeal in person to:
The Department of Ecology The Department of Ecology
Appeals Coordinator Appeals Coordinator
P.O. Box 47608 300 Desmond Dr SE
Olympia WA 98504-7608 Lacey WA 98503
3.And send a copy of your appeal to:
Bill Lum
Department of Ecology
Southwest Regional Office
PO Box 47775
Olympia WA 98504-7775
For additional information visit the Environmental Hearings Office Website:
http://www.eho.wa.gov. To find laws and agency rules visit the Washington State Legislature
Website: http://wwmil.leg.wa.gov/CodeReviser.
DATED this 3rd day of December,at Olympia, Washington
Sincerely,
Thomas Loranger
Water Resources Section Manager
TL:BL:th
cc Arlene Hyatt,Mason County Public Health
Printed From Masan County DMS
Printed from Mason County DMS
WASHINGTON STATE POLLUTION CONTROL HEARINGS BOARD
ENVIRONMENTAL HEARINGS OFFICE
Physical address: Mailine address:
Environmental Hearings Office Environmental Hearings Office
4224-6th Avenue SE PO Box 40903
Rowe Six,Bldg.2 Olympia WA 98504-0903
Lacey WA 98504-0903
(360)459-6327 Fax:(360)438-7699
Web Address: http://www.eho.wa.gov
E-Mail: eho@eho.wa.gov
"Your Right to Be Heard"
Board Members Administrative Assistant
William H.Lynch,Chair Robyn Bryant
Kathleen D.Mix
Andrea McNamara Doyle Heating Coordinator
Judy Greear
Administrative Appeals Judges
Phyllis K. Macleod Secretary
Kay Brown Debbie Joblonski
Cassandra Noble
This is your informal guide to your rights and responsibilities in an appeal. It is not exclusive and does not have force and effect ofstate law or
regulation. More detailed information, in RCW 43.21B,the act creating the Pollution Control Hearings Board,and in a chapter of the Washington
Administrative Code entitled,"Rules of Practice and Procedure of the Pollution Control Hearings Board,WAC 371-08,"is available at your county
law library or upon request from the Environmental Hearings Office and at the Environmental Hearings Office website at http://www.eho.wa.gov.
For more detailed information, please open up on the web page the Environmental Hearings Office Handbook and the Environmental Hearings
Office Sample Formbook ALTERNATE FORMAT AVAILABLE UPON REOUBST
YOUR RIGHT TO BE HEARD of the three must be an attorney. All are Pollution Control Hearings Board
salaried employees of the.State, who also
The Pollution Control Hearings Board serve on the Shorelines Hearings Board. Physical address:
4224 6th Avenue SE
(PCHB) hears appeals from orders and Bldg.2,Rowe Six
decisions made by: DO YOU NEED AN ATTORNEY? Lacey,WA,98504-0903
1. Local and regional air pollution
Mailing address:
control agencies or authorities. An attorney may represent you,but the law PO Box 40903
2. The State Department of Ecology, does not require one. Consider this very Olympia WA 98504-0903
and carefully before deciding to represent
3. Other agencies as provided by law. yourself. The appeal process can be Within 30 days of receipt of die decision,
complicated and significant rights may be you must also serve a copy of your appeal
The Board's sole function is to give you, at stake. The hearings are conducted more with the Department of Ecology or Air
and all other litigants in a disputed matter, like court trials, instead of city council Pollution Authority or other agency whose
a full and complete hearing,as promptly as meetings. order or decision you are appealing.
possible, followed by a fair and impartial
written decision based on the facts and law. If you are appealing a decision on a permit,
WHEN,WHERE,AND HOW TO FILE you should also serve a copy of your
The Board is not affiliated with the AN APPEAL appeal on the holder of the.permit unless
Department of Ecology or any other you are the permittee.
agency. To insure the Board's impartiality, No fee is required for filing an appeal.
the state Legislature created this Failure to observe the 30 day deadline for
independent, quasi-judicial state agency The Board must RECEIVE your appeal filing with the Board and serving the
entirely separate from any other state, or within 30 days of the"receipt"of the order Department of Ecology or Air Pollution
regional resource or regulatory agency or or decision. "Date of Receipt" is defined Control Authority or other agency will
local unit of government. in RCW 43.21B.001(2) result in termination and dismissal of the
appeal.
The Board consists of three full-time The original of the appeal must be filed
members, who are appointed by the with the Board at:
governor and confirmed by the State
Senate for staggered six-year terms. One
Printed From Mason County DMS
Printed from Mason County DMS
Service on all parties shall be by personal the purpose of arguing your case. The
service or by mail. Service by mail is conference has three purposes: to discuss
effective on the date of mailing; however, interest in settlement, including use of the MOTIONS
filing with the Board is only effective on Board's no-cost. mediation program, to
actual receipt by the Board. determine the legal issues, and to set a
schedule for preparing the case for hearing Any party may file a motion. A motion is
a request by one of the parties asking the
Filing of the appeal does not stop(stay) if settlement is not reached. Prior to the
the effectiveness of an appealed permit. pre-hearing conference each party is Board,or the Presiding Officer to rule on a
For information on how to obtain a stay required to submit a preliminary list of particular issue.
or temporary restraining order, please legal issues, proposed witnesses and
refer to RCW 43.21B.320 and Civil exhibits. After the pre-hearing.conference, d motion may be dispositive or non-
Rules for Superior Court 65(CR 65). a written pre-hearing order will be mailed dispositive. A dispositive motion may be
to the parties. It will include the hearing based on an issue or issues, or the whole
date, the list of legal issues, hearing case. non-dispositive motion is a
preparation deadlines, and other important request for relief,which does not decide an
CONTENT OF THE APPEAL procedural information. issue or issues or the whole case. An
example of anon-dispositive motion is a
Your appeal should include the following motion in limine. A motion in limine asks
items: the Board, in advance of the hearing to
CAN THIS DISPUTE BE SETTLED? exclude certain evidence. Dispositive
• A copy of the order or decision you motions are decided by the full Board. An
are appealing,and if the order or Litigation is time and energy consuming example of a dispositive motion is a
decision followed an application,a for the parties. Each parry needs to think motion for summary judgment. A motion
copy of the application. about possible compromise. For settlement for summary judgment is typically based
• Your name and address(mailing and to be reached, each side needs to offer on sworn statements of fact from a person
legal,if different)and,if applicable, something. Patties are encouraged to having personal knowledge of the facts
the name and address of your begirt settlement talks,without waiting for alleged. A sworn statement may be either
representative. Board participation. a declaration or an affidavit. An example
• A daytime phone number. of a declaration may be found on page 28
• A brief statement why you are The Board has a no-cost mediation of the Environmental Hearings Office
appealing. program to assist parties in reaching (EHO) Sample Formbook. This
• The relief you seek(what you want settlement. It is a voluntary program Formbook may be found by going to the
the Board to do). offered to the parties without charge. All EHO website at http:f/www.eho.wa.gov.
• A statement,signed by you or your parties must agree to mediate before a After you have opened to the home page,
representative,attesting the content of mediation can be scheduled. A trained click on the "Resources" button under
the appeal is true. Administrative Appeals Judge will work "Research." When that page opens up,
with the parties to resolve the case. click on "The Environmental Hearings
Office Sample Formbook" under "Other
IF YOUR PERMIT IS APPEALED If the parties settle directly or through Resources."
mediation, a written document containing
the settlement terms will ultimately be A declaration or affidavit may also
Perhaps you have been granted a permit by signed by all, and filed with the Board, identify and attach documents as exhibits.
the Department of Ecology,air authority or which will dismiss the appeal if the This is the format of the declaration
another agency, but another party has settlement conforms to the law, contained in the EHO Sample Formbook.
appealed. You have a right to defend the
permit and are automatically a respondent
in the appeal before the Board. All BEFORE THE HEARING
subsequent sections in this publication Dispositive Motions
apply to you as well as to the appellant. Before the hearing you will want to
prepare. You have the right to review the The scheduling of dispositive motions is
agency's file of their decision. Contact it set forth in the pre-hearing order. Please
HEARING DATES to arrange a time and place to see the file. file with the Board an original and
You and the other parties have the right to sufficient copies of the dispositive motion
When an appeal is filed, the Board will for each Board member and the presiding
assign and notify you of a date for hearing
find out in advance what witnesses and officer, if the presiding officer is not a
other evidence will be used at the hearing.
the case. Board member. A copy should be served
This may be provided to you without simultaneously on the date the motion is
formal procedures, such as by looking at filed,on each parry in the case.
public records. If done formally, this
THE PRE-HEARING CONFERENCE discovery is best accomplished with the Any party opposing the motion will
assistance of a lawyer. Examples of formal typically have 14 days from the day it
Soon after the appeal is filed,a pre-hearing discovery are: Deposition-questioning received the motion,to file an original and
conference is scheduled with the Presiding witnesses before die hearing, under oath the requisite copies of a response will,the
Officer. The pre-hearing conference is with a court reporter present. Board, and serve a copy on each of the
usually held within 4-6 weeks of the Interrogatory-presenting written other parties. The moving party generally
appeals' filing and is generally conducted questions to the other side. There are will have 10 days from the date it receives
by telephone. This conference is not for formal rules that apply to discovery. the response, to file an original and the
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