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HomeMy WebLinkAboutWAI2025-00076 - WAI Health Waiver - 12/19/2025 • 415 N.6t"STREET,SHELTON WA 98584 7. MASON COUNTY SHELTON:360-427-9670,ext 400 3ViBELFAIR:360-275-4467,ext.400 COMMUNITY SERVICES ELMA:360-482-5269,ext.400 Building,Planning,Environmental Health,Community Health FAX:360-427-7798 . . to for Waiver or Appeal EcEll rE Amount Paid: � = �: � Receipt Number. 6_o Li y9 b0 -7 4,^ AFC 9 ?025 WAI e.C;a.5 _ C) eY (AUL) Instructions: 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant & Parcel Information Name of Applicant Charles & Sandra Tyrian Telephone (360) 621-9795 Mailing Address 8090 Daniel Place NW City Silverdale, state WA Zip 98383 Parcel No. 3 2 2 2 5 _- 5 1 -- 0 0 0 2 10451 E State Route 106, Union, WA 98592 Site Address Subdivision Name and Lot Patricia Beach, Lot 17 & 1/2 Lot 18 PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver O Food Sanitation Requirements o•. Onsite: Class B Waiver O Group B Water System Regulations ,'1 Onsite: Class C Waiver O Water Adequacy Requirements Onsite: Location,WAC246-272A-0210 O Building Permit: EH Review Policies ❑ Onsite: Holding Tank, WAC246-272A- O Appeal:Enforcement Timelines 0240 O Appeal:Departmental Determinations O Onsite: Contractor Certification O Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): Multiple Waivers - See Attached Applicant Signature: Ct4 Date: / -ZS Revised 8/13/2018 This form may be scanned d ava abl or public view on the Mason County Web site. Page I of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) r Appeal Waiver None required I Class A Class B X Class C )e Local 2. Identification of Specific Code/ Standar / Determination (include date of determination or latest Code/ Standard revision): kl/itt ZY6-Z7Z4 -0Z(D 3. Nature of Appeal: 1 k' c G-luew�hori Z0INgI Se�la►r cbn b weer d/Gsnf'eid"(5�i(ace 14 fro', /A9f# fv Sddf t c(�SS G:Reducc hvr,7urq( s(4r�a drag)1 'etd c( dO �radiaf C4/ho ,t 4 0.ijdit to1s .. 3 i I4 c5 c: ua� hort to/I to I se Ervor, 6tf+�ce✓(c( Nokia ((Awn c(f4 s" -f ro.t 30f4 40 IS f�. LOCO( : cdvr-e hw mv�al 5eparaf>t1 between nrm fief it lion-'obh,c oval from wolf iv 154. 4. earing Official: O Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: 1)c1055(:p)Enanced trcuf► -level -to TLA/8LI t m emus nun t 11 6 Etmiewe of a cue (e 2 W Z tf Fnh c met T A PI re 4- class C:0 Fn hurlctc .rcatr1 t 1 f lee( / no t 0 ur►4deor proyrzwn re ,� Hl10011 : ernn°n* %wef owl /ct ( to TM/ / 16 coy to et su it 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local polic ha een submitted. Staff Signature: iDate: 1 60a PART 4: Determination of the Hearing Official p-The hearing official has determined that approval of this request will not adversely affect public health and is hereby granted. This decision is based on the following findings and conditions: ❑ The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied. This decision is based on the following findings and conditions: Health Official Signature: l , Date: V 'L 2 Z6 4.\"--/ Revised 9/29/2025 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1.2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (1) Local Health Department/District (2) Se t+4_1-4, instructions) Address: -601.0 e\xu... �• ti?v.� �145�'l a_ -- _ 83 Telephone: (3(.0) (o-Z,( 9D-161S-- Signature ` M Property Identification: (3) _. ac�c ._ t -- 0o a2 ----— ._....... __— 'a.Im �_ f -« .....�Lz ' Section IL (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) —__ —_._._._._-•______._.-----------..__-.-- ------•-....--•----.._ .._._-....__....------.__......------------..._246-272A—— Subsection: Justification(mitigation measures to be provided: (7) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) ---- - --..... — fee c rd t i/a frbin Type of Waiver: (11) [ ]Class A [ ]Class B 9] Class C —Request DOH review before granting? Yes No Neighbor Notification: (1 2) Required? Yes No If needed are agreements, easements. etc.properly filed? Yes No Section IV. ( (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. [ ] Denied $4 Approved /Granted—Subject to all comments,conditions and requirement noted i Sections 11 and III. Local Health Officer (13) Date: Y 2. 1- DOH 337-021 Page 26 of 32 Application for Waiver/Appeal Mitigation 12-17-25 Owner: Charles & Sandra Tyrian Phone: (360) 621-9795 Mailing: 8090 Daniel Place NW, Silverdale, WA 98383 Site Address: 10451 E State Route 106, Union, WA 98592 Parcel Number: 32225-51-00023 The following requested waivers are for the construction of a shop/garage with a 2- bedroom living space located on the upland(non-waterfront) side of the property. A Class C Waiver is Sought due to the site having Soil Type 1 underneath a Soil Type 3, so a Class A Waiver does not meet standard mitigation. In order to mitigate further, we are proposing an OSCAR XO2M system that meets Treatment Level A, B, C, BL1, BL2, BL3 & E without disinfection and 24"+ of vertical separation. 1) State Class C Waiver Sought: Reduce horizontal separation between drainfield and stream from 100 ft to a minimum of 50 ft. 2) Mitigation Measures: The septic system proposed is an OSCAR XO2M system with 24"+of vertical separation, which meets Treatment Standard A without disinfection. This is a higher treatment level than the standard Class A Waiver mitigation. The new system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance. This area has excessive soil depths and over 24" of vertical separation. The drainfield is in Type 1 Soil underneath a Type 3 Soil, so we have sized the drainfield as a Type 3 at 300 square feet with an application rate of 0.8 gallons per day per square foot; the entire drainfield will be utilized equally allowing for consistent distribution and absorption of the septic effluent,thereby protecting the water quality and reducing hydraulic susceptibility. The direction of slope in the drainfield area is gently sloping parallel with the creek, not necessarily towards it. A Notice of Operation and Maintenance has been filed on the property deed. (See Attached Recorded Document) . 1) State Class C Waiver Sought: Reduce horizontal separation between drainfield and down-gradient cut bank with less than 5 ft of native soil from 50 ft to a minimum of 25 ft. 2) Mitigation Measures: The septic system proposed is an OSCAR XO2M system with 24"+of vertical separation, which meets Treatment Standard A without disinfection. The new system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance. This area has excessive soil depths and over 24" of vertical separation. The drainfield is in Type 1 Soil underneath a Type 3 Soil, so we have sized the drainfield as a Type 3 at 300 square feet with an application rate of 0.8 gallons per day per square foot; the entire drainfield will be utilized equally allowing for consistent distribution and absorption of the septic effluent, thereby protecting the water quality and reducing hydraulic susceptibility. The geotech engineer has done a report to verify slope stability will not be compromised by the drainfield placement. (See Attached Letter) The project civil engineer has designed a cut-off drain near the top of slope in order to prevent erosion of the bank/steep hillside and protect slope stability/integrity. (See Attached Project Engineer's Drawings) A Notice of Operation and Maintenance has been filed on the property deed. (See Attached Recorded Document) 4 1) State Class C Waiver Sought: Reduce horizontal separation between drainfield and down-gradient interceptor/ curtain drain (specified by project civil engineer)from 30 ft to a minimum of 15 ft. 2) Mitigation Measures: The septic system proposed is an OSCAR XO2M system with 24"+of vertical separation,which meets Treatment Standard A without disinfection. The new system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance. This area has excessive soil depths and over 24" of vertical separation. The drainfield is in Type 1 Soil underneath a Type 3 Soil, so we have sized the drainfield as a Type 3 at 300 square feet with an application rate of 0.8 gallons per day per square foot;the entire drainfield will be utilized equally allowing for consistent distribution and absorption of the septic effluent, thereby protecting the water quality and reducing hydraulic susceptibility. The project civil engineer has designed a cut-off drain near the top of slope in order to prevent erosion of the bank/steep hillside and protect slope stability/integrity. (See Attached Project Engineer's Drawings) A Notice of Operation and Maintenance has been filed on the property deed. (See Attached Recorded Document) 1) Local/County Waiver Sought: Reduce horizontal separation between drainfield and owner's well from 100 ft to a minimum of 75 ft. 2) Mitigation Measures: The septic system proposed is an OSCAR XO2M system with 24"+of vertical separation,which meets Treatment Standard A without disinfection. The new system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance. This area has excessive soil depths and over 24" of vertical separation. The drainfield is in Type 1 Soil underneath a Type 3 Soil, so we have sized the drainfield as a Type 3 at 300 square feet with an application rate of 0.8 gallons per day per square foot; the entire drainfield will be utilized equally allowing for consistent distribution and absorption of the septic effluent,thereby protecting the water quality and reducing hydraulic susceptibility. The well is at a lower elevation than the drainfield, but not directly down-slope. Also, there is a retaining wall being built in between. Area well logs show various layers of till, clay and cemented soils between the surface and the water table. (See attached logs.) A Notice of Operation and Maintenance has been filed on the property deed. (See Attached Recorded Document) 2230928 MASON CO WA 09/19/2025 09 OR AM N0TCE TYRIAN, CHARLES #214199 Rec Fee $304 50 Pages 2 IIII 11 II II!li i U UI N Ili1l ill I V!IItI IIIII IUIUI !IIUI III Ali Return To Charles & Sandra Tyrian 8090 Daniel Place NW Silverdale, WA 98383 Aittentex(s): (1) Charles Tynan , (2) Sandra Tvrian Grantiee(s): (1)PUBLIC Legal Description (1) Patricia Beach TR 17 &W'A 18 &T.L., NLY of RMl PCL 1 of BLA#98- 23 (REV 1) (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 32225-51-00023 NOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM I (We)the undersigned grantor, hereby place this notice on record that the described real estate situated in Mason County, State of Washington; to wit the described real estate is served by an on-site sewage system that was approved and permitted on the condition that it would receive on-going operation and maintenance to assure it would continue to function in a manner that provides adequate treatment and disposal of sewage. Operation and maintenance of the on-site sewage treatment and disposal system must be done in accordance with the Mason County On-Site Standards, the Mason County Board of Health On-Site Sewage Regulations and Washington State Administrative Code: 246.272A On-Site Sewage Systems. These covenants shall run with the land and shall be binding to all parties having or acquiring any right, title, or interest in the land described herein or any part thereof, and shall inure to the benefits of each owner thereof. Dated on this /d day at , 20 � Signature of Grantor(s): (1) ( y , (2) d./")) Page 1 of 2 State of Washington County of Mason I,the undersigned,all. otary Public in and for the above named County and State,do hereby certify UPiethat on this day of Wk-W1(l K20 TS—,IV 114 Ar2"3 Oi,f personally appeared before me,who is known to be signer of the above instrument,and acknowledged that he(she)(they) signed it. GIVEN under my hand and official seal the day and year last above written. CINTHIA AVERY Notary Public in and for the State o Washington, Notary Public State of Washington residing at License Number 23O07421 My commission expires: j �ZJ. My Commission Expires March 01, 2O27 Page 2 of 2 evuvvoteCli PLLC, 4eotecl1vicaL 0 eo.virov,.vtn.evtai Drava e 0 RAadWa'J September 24,2025 Charlie Tyrian RE: Geotechnical Report Addendum#1 for Tyrian Structure 10451 E State Route 106,Parcel 32225-51-00023, Union,Washington To Whom It May Concern: Envirotech Engineering, PLLC (Envirotech) has completed this geotechnical report addendum for the above referenced project.The original report,dated January 5,2025,was prepared by Envirotech(Project #24415).This addendum was prepared in order to address the onsite septic system. Based on the preliminary septic design, it is our understanding that the pressure distribution drainfield is planned to be at least 25 feet upslope from the top of the critical 40%+ slope. The septic transport line traversing the critical slope may be surface mounted or directionally bored. Envirotech supports the planned septic design, and trees located on the critical slope and between the top of slope and drainfield should be avoided if at all possible. If tree removal is necessary,then a sapling of same or similar species should be replanted as close as possible to the removed tree without affecting the project.Alders,if any,may be removed without replanting. Please contact Michael Staten at 360-275-9374 if you have any questions, comments, or require additional information. Best Regards, Envirotech Engineering Eti ctY bk. sT o a'.l r k 43t14>o, 9/24/25 Michael Staten,P.E. Geotechnical Engineer PD 12.0X934 13.e:fa was iv.gtov.9852' off: 36v-27.5-93:-^4 Celi.: 360-689-6045 ev vixotea ot eck14.1zaLi vvlo.covIA. Sc.- L �� t,: t" - ' o to zo v 40 f— , . 1.0-T 121.p,t, 1 /ox3c, [s .l.t,E �' @Ntt' - ac 71.,,z, � �S nF v.S9r fl�.C -t.- *# 32225--5't- boo 7.-XL(!o X 3o I ko 5l e LvTP -S Rao tt(c, 7 N&'►S0 .sro xoz �g �'�S U VD hl 1 c.�Pc SS- ' 9 - o C.Se-€._- PID` is L 6. = -res�•- 1-E lsz_. , 1j...50 ' 1,(:)..=`rte '-C 1Q55 C - ��o' <S( 0I l (-Dv cr. O.�}v.ANso® 0►.C.t{D -�ven� 7110,5 .� -1$ 1 -. O- Hitt GL MSC - ) • / S ho 4-o-A o l I`f 1(-- 30(28 EGLC S Cz.4) --,........ 1S c fir) ‘"f`t. # 2. : O-Z.o G-LµSCT-rre.3) � �S> 2 —'-F'-f(tic) G-L c-s C� L) .�,� ;I.. -tom (S a 'CI t � t O 0 �� 'lC ,, **Note to installer** r(,h,,s to b,` -• , Sleeve waterline when within 10' t" r3Fe� 'p S ,a , �_ :} of septic transport line. Maintain ssi�c 10' minimum between water N°b L ' so` (� line and septic tanks/drainfield. O Control Panel with Audio-Visual Alarm I IA, s.f s ti O Cleanout "..'` -1- i ] r 1,500 Gallon Septic/Aeration Tank `� ` 8 O 2-Compartment with air diffuser O4 1,500 Gallon Clarifier/Pump Tank 1 2-Compartment joo O t -�I rl, _. OS Headworks Q ! o .- .`� 2. . {:'ro foseAk O,,_v-Lr N'e V. © ire nt. -a(' — -N,S-{Q B-k- a�1- 1,,.,.^ k-v'-}'t+ C) `t s S l..-c e ' -K-. lu.-w------ vim' O. +ar 1c vsiVers -5- 0 iv I.4.k A4v5,rt ti{o CoX . tcre- p4- Ex, --4-ii S 0 < t-i t r ` zo t t •..** i4ktUce _1 5 ' I '� �...k ........"ti, 1'7* 120 01S- Iv(p •. 5100343 ..•"".......-----. AICZ PAULA JOY JOHNSON ' EXPIRF.3 1 b/ '` C2.-tq ZT`Vb 02- V k (0(4 (wit, . 716,040WATER WELL REPORT CURRENT 7Vi S? MIIIIIIIIIIS Original&i"copy—Ecology,2°d copy—owner,3`d copy—driller Notice of Intent No.WE 15625 DEPARTMENT Of 997 ECOLOGY Construction/Decommission ("x"in circle) Unique Ecology Well ID Tag No.ALH stole of washing= ® Construction Water Right Permit No. O Decommission ORIGINAL INSTALLATION Property Owner Name Pamela Covey Notice of Intent Number PROPOSED USE: ® Domestic O Industrial 0 Municipal Well Street Address 10591 E State Route 106 O DeWater O Irrigation O Test Well O Other City Union County Mason TYPE OF WORK: Owner's number of well(if more than one) Location SW1/4-1/4 NE1/4 Sec 25 Twn 22N R 3W EWM D ® New well O Reconditioned Method:O Dug O Bored O Driven El Deepened r Deepened ® Cable 0 Rotary ❑ Jetted (s,t,r Still REQUIRED) w Or Ilil DIMENSIONS: Diameter of well 6 inches,drilled128 ft. Depth of completed well 128ft. CONSTRUCTION DETAILS Lat/Long Lat Deg Lat Min/Sec Casing El Welded 6" Diam.from +L5 ft.to 126 ft. Long Deg Long Min/Sec installed: O Liner installed " Diam.from ft.to ft. Tax Parcel No.(Required) 322255100033 ❑ Threaded " Diam.From ft.to ft. Perforations: 0 Yes 0 No CONSTRUCTION OR DECOMMISSION PROCEDURE Type of perforator used Formation:Describe by color,character,size of material and structure,and the kind and SIZE of perfs in.by_in.and no.of perfs_from_ft.to_ft. nature of the material in each stratum penetrated,with at least one entry for each change of information. (USE ADDITIONAL SHEETS IF NECESSARY.) Screens: El Yes O No 0 K-Pac Location 122 MATERIAL FROM TO Manufacturer's Name Johnson • Dark rich topsoil 0 3 Type Stainless Slotted Model No. Brown siltbound sand&gravel 3 12 Diam.5"Slot size.016 from 123 ft.to 128 ft. Gray siltbound gravel 12 18 Diam. Slot size from ft.to ft. Brown silbound sand 18 27 • Gravel/Filter packed: O Yes 0 No Size of gravel/sand Brown siltbound sand&gravel 27 54 Materials placed from ft.to ft. Brwon silty sand&gravel wet 54 59 I Surface Seal: ® Yes 0 No To what depth?20ft. Gray clay 59 62 Material used in seal Bentonite Chips —Gray siltbound sand&gravel 62 66 Did any strata contain unusable water? O Yes 0 No Brown siltbound sand&gravel 66 75 Type of water? Depth of strata . Dark brown siltbound sand 75 84 Method of sealing strata off Very hard brown cemented 84 95 Siltbound sand&gravel 95 98 PUMP: Manufacturer's Name Brown clay bound gravel 98 106 Type: H.P. Brown siltbound sand&gravel 106 WATER LEVELS: Land-surface elevation above mean sea level 12 ft. extremely hard and tight 115 Static level Eft.below top of well Date 01/16/2013 Brown silty sand&gravel 115 126 • Artesian pressure lbs.per square inch Date Sand&gravel,water bearing 126 128 Artesian water is controlled by (cap,valve,etc.) I WELL TESTS: Drawdown is amount water level is lowered below static level Was a pump test made? O Yes ® No If yes,by whom? Yield:_gal/min.with_ft.drawdown after hrs. RECEIVED Yield: gal./min.with_ft.drawdown after hrs. Yield:_gal./min.with_ft.drawdown after tins. Recovery data(time taken as zero when pump turned off)(water level measured from FEB 0 0 2013 well top to water level) Time Water Level Time Water Level Time Water Level WA Star Deoartmohrt of Ecology (SWRO) Date of test • Bailer test 10 gal./min.with 70ft.drawdown after 2hrs. Airtest ealJmin.with stem set at ft.for hrs. Artesian flow g.p.m. Date Start Date 01/03/2013 Completed Date 01/16/2013 Temperature of water Was a chemical analysis made? O Yes 0 No WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. ®Driller 0 Engineer 0 Trainee Name(hint)MiNelso Drilling Company Arcadia Drilling Inc. Driller/Engineer/Trainee Signature ess Po Box 1790 Driller or trainee License No. 1992 City,State,Zip Shelton . Wa, 98584 IF TRAINEE:Driller's License No: Contractor's Driller's Signature: Registration No. ARCADDIO98K1 Date 01/17/2013 ECY 050-1-20(Rev 02/10) If you need this document in an alternate format,please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. i lender+ g' � . WATER WELL REPORT • CURRENT / Notice of Intent No. W 249619 . WIL, Original&1"copy-Ecology,r'l copy-owner,3` copy-driller• 1--f 34:2 i''C'ECOLOGY Unique Ecology Well ID Tag No; Construction/Decommission (`z"in circle) a Construction Water Right Permit No. 1 0 Decommission ORIGINAL INSTALLATION Notice Property Owner Name Benjamin Selters of Intent Number 5 Z iA Well Street Address 10391 E Hwy 1 0 6 i PROPOSED USE: fg Domestic D Industrial ❑ Municipal City Union County Mason ❑ DeWater 0 Irrigation 0 Test Well ❑ Other LocationSE I/4-1/4SW 1/4 Sec_25₹•wn 28 3WE� circle 1 TYPE OF WORK: Owner's number of well(if more than one) WWM °R° s l2C New well O Reconditioned Method:O Dug 0 Bored ❑ Driven i 0 Deepened IR Cable 0 Rotary ❑ Jetted Lat/Long(s,t,r Lat Deg � Lat Min/Sec • DIMENSIONS: Diameter of well 6 inches,drilled 1 2 4 t. Still REQUIRED) Long Deg Long Min/Sec 1 Depth of completed well 124 n. 32225-51 -00020 - CONSTRUCTION DETAILS Tax Parcel No. i Casing ❑)(kidded 6 " Diam.from +1 ft.to 1 19 'ft. . Installed: ❑ Liner installed " Diam from ft.to ft. CONSTRUCTION OR DECOMMISSION PROCEDURE i 0 Threaded Diem.from ft to fl. Formation: Describe by color,character,size of material and structure,and the kind and • Perforations: O Yes XI No nature of the material in each stratum penetrated,with at least one entry for each change of < . 1 -Type of perforator used information, (USE ADDITIONAL SHEETS IF NECESSARY.)- _ • i SIZE of perfs• in.by in.and no of perfs from_ft.to__•_ft. MATERIAL FROM -- TO I Screens: 6 Yes ❑ No OCK-Pac Location ' 1 17 le Manufacturer's Nam . Johnson . Top soil 0 2 stainless Model No. i Type rF I Dram. 5 Slot size 20 from 1 1 9 ft.to 1;2 4 ft' Dram. Slot size from ft.to ft. Brown sand & gravel 2 17 1• Gravel/Filter packed: 0 Yes IXNo ❑ Size of gravel/sand i Materials placed from ft.to ft. Brown till- 12 85 , w Surface Seal: 8 Yes 0 No To what depth? 18 it rMaterial used in seal Betonite . . Cemented sand & gravel Did any strata contain unusable water? ❑ Yes Ito with water 85 1 1 5 i Type of water? Depth of strata I. Method of sealing strata off • Sand & gravel with water 115 124 • PUMP: Manufacturer's Na I Name Type: H.P. ✓ ' WATER LEVELS: Land-surface elevation above mean sea level ft. 1 Static level . 31 ft.below top of well Date - Artesian pressure lbs.per square inctr Date $ Artesian water is controlled by os - (cap,valve,etc.) D WELL TESTS: Drawdown is amount water level is lowered below static level • Was a pump test made? ❑ Yes C?CNo If yes,by whom? 1 Yield: gal./min.with ft.drawdown after hrs._ i---- Yield: gal./min.with ft drawdown after hrs.Yield: gal./min.with Si.drawdown after hrs. n >� " � - Recovery data(trme taken as.zero when pump turned on)(water lei measured from well —,� ._ AD rap to water level) - ��p Time Water Level Time Water Level Time Water Level 0CT7 21N.1 1 t� i i Was-11?b Oil St.^..ie i Date of test DepafllIteltt(*.if E,Cel@gy L Bailer tut 20 gal./min.with 15 ft.drawdown after 1 sus. 1 Airiest gal./min.with stem set at ft.for hrs. Artesian flow g.p.m. Date . Temperature of water Was a chemical'analysismade? 0 Yes IX No 5/3/08 5/30/08 • Start DateCompleted Date WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. ( Driller.O Engineer ❑Trainee Name, - t) Dwane Knapp ///��� Drilling Company Davis Dr i 11 i ng c Driller/Engineer/Trainee Signature Address P.O. Box 536 Driller or trainee License No. 1706 City,State,Zip Belfair, WA 98528 If TRAINEE, Contractor's - Driller's Licensed No. Registration No. DAVISDI-1100A -=Date May 08'=,x.;-' Driller's Signature Ecology is an Equal Oppommity Employer. 1 !,4- ECY 050-1-20(Rev 3/05) The:Department of Ecology does NOT warranty the Data and/or Information,on,this Well Report. ,7s]t Yv.vt:LSfrr wry N n w(m ci_clrsc Y(YLCIW Ati F.EaR S(IE.410Nn 333-4 HAW W,eR c1Y.;?ACWa,'k:005 . ,..c 149,irt...„.5 N YPtI „.•.!c:x. Im(•J AtA'AIDECH 02.62,004(MHE3C3T.A IV ES TO'I:IE FUXYi YyS15. - -1;1 C1 , sw5:4LrxEa tR:;F o sroa w::xl:•i!�..^m'A ttw(n n erc•A'r+P as...a *Mt.6Ltkk:M;.44:FLUSH18'r,UP0. I?4RE BEA4 GOWER OM 0 P 4149 IM CAII a-064x:..T'106.,6 MM. ..I.S.010...*6 to y'I•WILE.AiTLY A G1W}�.L OK O(/lYN54S R.,-...' 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