The URL can be used to link to this page

Home My WebLink AboutWEC Letters / Memos - 7/15/2003 a MASON COUNTY . ' ' DEPARTMENT OF HEALTH SERVICES :��,�iini�,,�1r • 1 i I .. , Environmental Health Water Quality 'erso , Health LOCAL(360)427-9670 Application for Waiver/Appealn BELFAIR(360) 275-4467&4468 p TOLL FREE 1-800-562-5628 / FAX(360)427-7798 Amount Paid: /UU G/ , Receipt Number: / cz l d `/7- Instructions : 2. -:(k-. 46- - i.s {:igGa le ars: az .d: : , � w . : d u:ntt tk spart 1u:Y... o::::P:d:.. ted «.:; : «�>>'> }:» . .: : ,,:.-.... ......... . .......: ;» a• ;> ta : « Ps:mabulled ~�rve �: . �s nie:ed04:iiiai igilif ehedute :git: > :: : r :. Y,:�baikrAmiii ed appl. a z.aia,wtt h.a. c : W liatxiictita : eev : > < c4i?> : ?< , PART 1: Applicant/Parcel dentification o Cam. Name of Applicant R�� N E.Q' "` Date 3�,(� /S. )--0 03 Mailing Address 33 0 T, ,..,6t., T,, i_..'-5 Telephone 360 -31 Y- / ( tk - > L-. 1/4A I s5 5 Assessor's Parcel Number 3 3 S-- 7 S -/C b3 a I Se_z-`9OJ3 2 a Subdivision Name and Lot Ti 1¢vT i A Q.S S 4 1 Q - s• n'-- PART 2: Nature of Waiver/Appeal ❑ On-Site Sewage Requirements ❑ Food Sanitation Requirements El Building Solid Waste Requirements equirements ❑ Location, WAC 246-272-09501 ❑ Group B Wat t LIcts� ti D o Holding tank WAC 246-272-12501 Water Adequ e _❑ On-Site Standards El Enforcement ' fines o Certification contractor(pumper, 0 Departmental DeterminatA'c, 1 2,2003 designer, installer, O&M spec)requirements 0 Other Description of Waiver/Appeal(include justification,additional(mater'al may be attached): �L't' EBV ICES 14A4`.e- Wyk,\ \o .^N. Se,,,4- ' Si c 1��tL�Qr"'.��lo5ti cf -5f r: fa�',,.i� a W...; 1_1-. �-k.. , • c1,�P(1� a r al fi 471, i S e, dve S-,r. tl.,, SQL. e.r- ►.-•. 41 O0E S4-cv..4L(..s/•d . Applicant Signature: ile . ,C Fr f&.o)� Date: O H.'IWDATAIARCHIf'2 WAIVER.WP Update:April 25,I` PART 3: Health Department Evaluation (Staff Use Only) IA. Type of Determination Required: l B. Type of On-Site Waiver(if applicable): O Appeal 0 Waiver 0 None required 0 Class A 0 Class B 0 Class C 2. Identificaton of Specific Code/Standard/Determination(include date of determination or latest code/standard revision): �.� Itt„ G.-rLej uc� 3. Nature of Appeal: c.cj IJ,.�y -fAL-yr?, f f' ot,4.. t j Q/ b e c t.(J1IEa. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control Hearing Board 0 Health Services Director ❑ Certified Contractor Review Board 0 Environmental Health Manager 5 Mitigating Factors: l)C,UEC. 2 e — c u(ay J) IOL. W 01i4Z.. Loc(1,1 G,.J-<Z1 L y.a. s)c�ti I-10-j A, ?k .0 .ti G ccClip al-, y ,✓ 6. I have reviewed this waiver/variance request. It is complete, and mitigation required by state and local policy has been submitted. a.)a„tStaff: CL Date: S'( I J /03 PART 4: Determination of the Hearing Official The hearing official has determined that approval of this request will not adversely affect public health and is h rebygrantedd.//This decision is based on the low following findings and conditions: p rl C'h[I Y C� ./}f• l s 1 !�\ . 0 The hearing official has determined that approval of this request could potentially e7,aikvlIctfi\T‘ public health and is hereby denied. This decision is based on the foll w�utg u'&d� ir 03 Hearing 11:1WD4TAWR! 'blWA!VERWP Update:April 2'. 1997 File Original and First Copy with WATER WELL REPORT $""Card No ( 1535 Department of Ecology - Second Copy-Owner a Copy STATE OF WASHINGTON =' Third Copy-Drrlter's Copy Wetnr Right Permit No. i (1) OWNER: Nam• Don C. Warren Address F. 9051 Hwy ME* I1ninn WA 98592 w (2) LOCATION OF WELL: County Mason . SW is SW v v Sac 35 T. 22 _N..At_Lw M. (2a) -STREET ADDDRESS OF WELL(or nearest address) (3) PROPOSED USE: I X Domestlo Industrial ; H Municipal 0 (1 0) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION G Irrianon Test Well ❑ Other 0 G Da DeWater Formation: aquifers thekind emend nature of the melonal is eaehiatralm penetrated. wii. and Meow thickness a allsNe (4) TYPE OF WORK: c(reathas eon j f 411/1 with at beat ore entry for each dteTEaoe`el ietownation. F1110.1 I TO Abandoned I I New well 2 Method: Duo 13 Bored C] - - - 1 - T - -- Deepened i Cable iI Driven f.] -- I Reconditioned 1 Rotary [1 Jetted I I , Brown conglomorate _.-.-.-- ._.--.___:.-4 ' 2Q.. (s) DIMENSIONS: Dismeterof well_ 6 inches. I i — Drilled 58 feet. Depth of completed well 58 n. -Sand & gravel with water ! 20 _5E_ (6) CONSTRUCTION DETAILS: Casing Installed: —_ Down.from__a_n.a 51 a. _____ -- welded • Diem.from ft.to ft. _- Liner installed I . I Treaded I ff''•1 Diem.from ft.to ft. Perforations: reap NoL3 _---. -- ._.. - -- -- - - t — Type CO perforator used --- i • SIZE o1 perloralioes in.by ie. I - Perforations from ft to ft -- I I I perforations from_ ft to n. • — peAoratlalN(rdm ft.to It. ( I Screens: Yes® No❑ 1 ktanufedwer's,N'am�e1 _ - _ Cook . _ ..__ . . ------- _— - Type _stainless Modelllo. {` I Diam. 5ff Slot size 40 from 53 n.to .- -ft. _ __--- _ _ _.- t -- Diem. Scot awe from ft.to ft. I Gravel peeked: Yes LJ Pieria Size of gravel Gravel placed from ft.to ft. Surface seal: Yes® NOD To what depth? 18 H. - . Material used in Net Betonite Did any strata contain unvsabte water? vas LJ Ho Type of water? Depth of abbe I.-..._—_ _ _ -- _ Method of sealing strata oft _ -. (7) PUMP: Msmlfadurer'a Name GrundfOS - ..- - t.._. Type.__ Ruh_ H.P -- --- -- I i — WATER LEVELS: Land-etrfaceelevnron R. --- ___---•_ I -- ---- (8} ■Dow mean sea iewl. Stauc level 13 n.below top of will Dale— --' ' - Artesian pre Wiese tbs.per square inch Dale— - �—__-. _.. -.---�.I 1 - . Artesian wafer is controlled by_- (Cap vol.*.etc 1j — Work staaed_11 Y9_1 IP Completed_ 110/91-. ig_. (9) WELL TESTS: Orawdown is amount water level is lowered below static level Was a pump teal made?YesLJ No a II yes.by whom? WELL CONSTRUCTOR CERTIFICATION: Y.•Id gal item.web _It dravrdownaller _ lee. I constructed and/or accept responsibility for construction of this well. _. and its compliance with all Washington well construction standards. • — — .• Materials used and the information reported above are true to my best . -- knowledge and belief Recovery data(lime taken as Fero when pump turned on)(water level measured Iron well top to water level) f,me Water level T+ne With level 'Nee watts level NAME Davis Drilling FIR - (PERSON. M.OR Co ATION) (TYPE OR PRINT) -- - - — Address— Belfair WA 98528 Date of tea_. _.. /� (Signed) 3 - S 0797 License No. _._ Bailer test ._�1L_gel'men.huh 7 —II driwdownafter 1rs. ( l GRILLER) Contractor's [lq Airiest __.._—pal. min.with i Irt sir at_ II for hre. • Brin• e a r§D 11ry0A Date Nov. .nab. Artesian now ._ ." ii p m Dale (r� t,��/1J�Ji Wrl Temperatureotwater--_ Was a chemical velvets made? YesL_i NO{ (USE ADDITIONAL SHEETS IF NECESSARY) 0 _.. ._. GIs., ,.. ......, File Original and Fast Copy with Department of Ecology WATER WELL REPORT Application No Second Copy—Owner's Copy Third Copy—Drillers Copy STATE OF WASHINGTON Permit No . . -----—_ - (1) OWNER: Name John W. Coker Address . . ....___ .. . . . . (2) LOCATION OF WELL: county lia49.4 — IA ...; see.35 . T. 22 3W . .N.. R.. .. W m 4 !tearing and distance from section orsubdivision corner - (3) PROPOSED USE: Domestic gi Industrial 0 Nfunicipal 0 (10) WELL LOG: _ 0 Irrigation 0 Test Well 0 Other 0 Formation: Describe by color, character,sue of material and structure,and show thickness of aquifers and the kind and nature of the material in each stratum penetrated, with at least one entry for each change of formaticrn. (4) TYPE OF WORK: oorrm,eor's numbero an )f well — MATERIAL —" FROM TO New well le Method: Dug 0 Bored 0 Deepened 0 Cable i Driven 0 — ----• — .. Reconditioned ): Rotary D Jotted 0 Gravel & clay 0 --7 (5) DIMENSIIOINS: Diameter of well . In 7 . ches. Hard aln 7 38 Sand & clay ----3F.-67— Drilled 1510 ft. Depth of completed well.. 1.5P............._ft. Hard _Ran 67 82 Sand, gravel & clay (6) CONSTRUCTION DETAILS: Cemented gravel --158 151 Casing installed: ......6.... ." Dhun. from ° ft. to 156 ft. Gravel & water 151 156' Threaded (D " Dtam. from ft. to ft. ' Welded, ' " Diem. from ft. to ft. _ r--- Perforations: yes D Noi - - Type of perforator used _ _ SIZE of perforations ............. . in. by .. .. .......—___ In. ... ... perforations from . .......... ft. to ...............--.... ft. ?6•CE'l VE0 '-- --- .. ... .. . perforations from ... .... ft. to -- . .. perforations from . ft. to ft. APR Z _nzi : — Screens: yes 0 No _sl!tamentor="11 ... .—_ — *-- Manufacturer's Nam Pet El)* Type Model No (Co Diem Slot size from ft. to ft. — -- Dlam. ... ..... Slot size from ft. to it. Gravel packed: yes 0 t No Size of/ gravel• — --I --— Gritvel placed from ft. to ft. Surface seal: Yes Si No 0 To what depth? 18 ft. -,- — Material used in seal.. Bentonite . ... . c\y/ ____ Did any strata contain unusable water? Yes 0 N i Type of water? ..... — Depth of strata....._........... Method of sealing strata off.. . . .............. . .. . ..................... ---1 (7) PUMP: Manufacturer's Name -- Type: .... . .. ... .. . . .H.P— - (8) WATER LEVELS: La a nvde-snulanceseelaellvti:in... ..10 ... . Static level . 13 . ft. below top of well Date ....411/..e... Artesian pressure . (be. per square inch Date. Artesian water is controlled by (Cap,valve. etc.) ] -- — (9) WELL TESTS: Drawdown Is amount water level Is towere below static level — Work started__...1/..2.5......_.._, 19..... .. completed_ 21-1:..7:8.14..... iv... .. Was a pump test made? Yes n No if yes, by whom? Yleld: __gal./min. with ft. drawdown after hrs. WELL DRILLER'S STATEMENT: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief. ______ Recovery data (time taken as zero when pump turned off) (water level measured from well top to water level) NAME...Bede.11...Furnp & Drilling Co. Time Water Level I Time Water Level i Time Water Levet r .. .... (Person, firm, or corporation) (Type or print) . 1583 E. Dickinson St. Shelton, Wash. I . Adcicatk, Date of test ...i.. . .. ...,LPV,, [Signed] /27,kef.41r,/ '1(7 -,--tiieZ Bailer test 3Y gal./min. with .ft. drawdown after.. 1 his. (We I Driller) Artesian Row .g.p.rn. Date 2/264 Temperature of water.. . Waaideereernical analysis made? Yes(7) No License-No CtsfaZt., Date , 19. t USE ADDITIONAL SHEETS IF NECESSARY) 4:1111.s File Original and First Copy with - Department of Ecology WATER WELL REPORT Application No - Second Copy—Owner's Copy Third Copy—Dnller's Copy STATE OF WASHINGTON Permit No. . . .. .. ...... . (1) OWNER: Name...W.. H. .Cr lln...... ... ....... Address...E _8.07.0 Hwy. ...10.6 Union .WA.... . (2) LOCATION OF WELL: County. Mason . .— i, {; sec....3.5. T22....N.. R.. 314/.M. Bearing and distance from section or subdivision corner TRS 4-5 of Lots 3 & T.L. EX__________ _______ ___ (3) PROPOSED USE: Domestic i9 industrial 0 Municipal ❑ (10) WELL LOG: irrigation ❑ Test Well 0 Other 0 Formation: Describe by color.character,size of material and structure,and show thteknesa of aquifers and the kind and nature of the material to each stratum penetrated, with at least one entry for each change of formation. (4) TYPE OF WORK: °wner's number of well -- uf more than one).-.. MATERIAL FROM TO New well E') Method: Dug 0 Bored 0 Deepened 0 Cable a Driven 0 — Reconditioned 0 Rotary❑ Jetted ❑ Rrnwn conglomorate 0 45 (5) DIMENSIONS:o/� Diameter of well .. 6...•.•.•.. Inches. Cf?mpnt'eci sand c�_graxPl. Drilled .. . 90.... ._ft. Depth of completed well �._....._...ft. — — wlth water 45 I . 85 .. (6) CONSTRUCTION DETAILS: — Sand & gravel with water 85 90 Casinginstalled: ... ..6_.• 8 5 Diem. from .....� .... K. to . K. Threaded 0 .. Diem. from . . .. ft. to K. Welded DC " Diem. from ... ....... ft. to ft. -- -- Perforations: yes Q No EX -_ Type of perforator used .. _.._._.._......._. ......_................. SIZE of perforations ...... in. by in. perforstiona from ft. to ft. "- perforations from ft. to . . ft. — —` perforations from ..... ... K. to ft. --—- . Screens: yes)p No Q • Manufacturer's Name.......J.a11t1ScI1........_._..._........._...._-._........... ' .. 'Lype...S.t.ain1e.S.S le<odat No........-- - - ..... — - - Dlam. 5 ...... Slot size .6.0 from ...-.&S.. K. to 90 ft. _. . _ Diem. Slot size ......... ... from ... ft. to ......._...__ ft. - .. -- 7 _ Ct Gravel packed: — —__`a_ ___ Yes Q No Et Size of gravel: D - Gravel placed from ft. to ft. — — • _�_ ._ •Surface seal: Yesx] No p To what depth? .........1❑ ft. — `— • TI Material used In seal .....bet.on.ite. -- - Did any strata contain unusable water? Yea 0 No OC -- --- Type of water?..._. Depth of strata... —— Method of sealing strata oft.. ...... ..... ........._............ (7) PUMP: Manufacturer's Name --- 4 -� Type: ..... ILP - _ - -- --•- (8) WATER LEVELS: abo Lanve d-surfacemeanu elea lation vevel.. ----- Static level ... 3 ft. below top of well Bate.. . .........._..tt- Artesian pressure ....... .. lbs per square inch Date ... .................. Artesian water is controlled by................................................... ...... ICap, valve. etc.) _ (9) WELL TESTS: Drawdown Is amount water level Is -- lowered below static level 8.7 Work started........_.... . is t omp►tted .Marsh........ ,�.. Was a pump test made? Yes 0 No N) If yes, by whom? .. Yield. gal./min. with ft. drawdown after hrs WELL DRILLER'S STATEMENT: This well was drilled under my jurisdiction and this report is •. .. true to the best of my knowledge and belief. Recovery data Rime taken as zero when pump turned off) (water level measured from well top to water level) NAME.. Davis...D.ri.11in Time Water Level Time Water Level Time Water Level (Person. firm, orCorporation) ITypa or print) Address.H.e.lIa l.r.... 98528 Date of test . ............ ............_.... . [Signed] NA J. Bailer test 2.0 gai/min. with.40 ft. drawdown after 1 hrs. (Well Driller) Artesian flow.......... g.p.m. Date I, Temperature of water Was a chemical analysis made? Yes 0 No a License No. 0.7 l 7 n l�7 Date 1�-).ar. h , 19.8.7.. • (USE ADDITIONAL SHEETS IF NECESSARY) 11ilb-3 File Original and First Copy with Department of Ecoloty WATER WELL REPORT Application No Second Copy-Owner's Copy Third Copy-Driller's CoPi, STAYS OF WASHINGTON Permit No .... . - (1) OWNER: Name. .. . ..Dick Address Buechel P.O.Box 1170, Union, Wa. . . . " (2) LOCATION OF WELL: County Mason _ . tfe 1,,, Sec.... 5 . T.?f?......N.. R.,W.... W.M. Bearing and distance from section or subdivision corner (3) PROPOSED USE: Domestic 0 Industrial El Mtuilcipall (10) WELL LOG: _ Irrigation 0 Test Well 0 Other 0 Formation: Describe by rotr.characte .size of material and structure,and show thickness of aquifers and the kind and nature of the material in each 'graham penetrated, with at least on* entry for each change of formation. (4) TYPE OF WORK: ownees number of well . __ if mop than one). MATERIAL FROM TO New well Method: Dug 0 Bored 0 — Deepened 0 Cable 0 Driven 0 --- Reconditioned 0 Rotaryd Jetted 0 Sand & gravel _ 0 4- (5) DIMENSIONS: Diameter of well 6 Hard.an Cemented gravel 4 24 -- 24 L 56— Drilled 82 ft. Depth of completed well.. 8inch:st: Brown clay 5611 71 (6) CONSTRUCTION DETAILS: Cemented gravel 71 78 Gravel & water 78 — 82 Casing installed: 6 " Dlam. from 0 ft. to 82 ft. Threaded 0 .. ..." . y Main. from . ft. to ft. ... - Welded ......... ." Diem. from ... .... ft. to ... ft. Perforations: yea 0 Noi ___ _ Type of perforator used SIZE of perforations _..........•............ In. by ..• .. •• .......- In. i __ ti perforaons from ft to ft ?Wm t --- ...... ...... perforations from . . . ft. to ft. - perforations from ft. to ft. _ M __ Screens: yes Ej No Z blanufactiner's N -.. . _Gi___,2 *n.C. Type Model No - t--- Di . . Slot size from . ft. to ft. Diem. Slot size from . . ft. 10 ft- •ff Ce Lai ITIr fi Gravel packed: pea 0 Nod Size of gravel: Ir. - Gravel Placed from ft to ft Surface seal: yes 18 No 0 To what depth? tt - - -- Material used in seal .....BentOlate . . .... ...... ....... Did any Arabs contain unusable water? Yes 0 No D Type of water? Depth of strata. _ Method of sealing strata off _ (7) PUMP: Manufacturer's Name Type: ...............-...... . . . HP. _ (8) WATER LEVELS: ai..antie-,,?nrresanceieelevieamn... . .16. Static level .... 13. ... . ...tt. below top of well Date ....1.01?7.0-- - Artesian pressure ...... . . lbs per square inch Date Artesian water is controlled by — - (Cap. valve. etc.) - -----'------ (9) WELL TESTS: Drawdown 13 amount water level is lowere below static level -- -* --- Work started 1071T1 . i,... , .. Completed ... i071-2784. 19. Was a pump test made? Yes n No If yes.by whom?.. . ... ...• ••••• Yield: gal./mln. with ft. drawdown after hrs. WELL DRILLER'S STATEMENT: _. .. - This well was drilled under my jurisdiction and this report is - - true to the best of my knowledge and belief. — -- Recovery data (time taken as zero when pump turned oft) (water level measured from well top to water level) Bedell Pump & Drilling .Co. NAME •• •• • Tone Water Level Time Water Level Time Water Level (Person. firm, or corporation) (Type or print) Address 1583 E. Dickinson St. Shelton, Wa. • Date of test .... .. . . [Signed] 9/...;4•I'D .. . Bailer test. 45gal/min. with. 60 ft. drawdown after. .I. bra. (Well tiller) Artesian flow .-...........-..... ..... ........ ..g.prn. Date Temperature of water Was a chemical analysis made? Yea El No License No 0032 Date..... .....1................. , 19. • (USE ADDITIONAL SHEETS IT NECESSARY) 4E430 3