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HomeMy WebLinkAboutWAI2025-00093 - WAI Health Waiver - 12/22/2025 �' ,, MASON COUNTY au" 'z8 COMMUNITY SERVICES .,y am, - i`1O, ru.1v�N~ay Building,Planning,Environmental Health,Community Health• 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 •: Belfair: (360)275-4467 ext 400 ❖ Elma: (360) z• a -:• FAX (360)427-7787 t >J Ei Application for Waiver/Appeal Amount Paid: ti �� DECEC ?2 2015 Receipt Number: �� 6.)., By t Instructions (O41 07,oa5 - ouc)ct 3 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant JOHN EGBERT Telephone Mailing Address of Applicant 301 SABLE DRIVE City EVERSON State WA Zip 92247 12-digit Tax Parcel No. 22233-52-00068 -- _ _ -- Site Address 2791 E MASON LAKE DRIVE EAST, GRAPEVIEW Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation O Food Sanitation Requirements ❑ Building Permit Review Policies O Group B Water System Regulations L9' Location, WAC 246-272A-0210 O Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 O Enforcement Timelines ❑ Mason County Onsite Standards O Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): 1. REDUCE SETBACK FROM DRAINFIELD TO WELLS (100FT DOWN TO 75FT) 2. REDUCE SETBACK FROM TANKS TO PROPERTY LINE&FOUNDATION. 1.DF MEETS TLB W/24"+VS,PRESS.DIST.,TIMER,ANNUAL O/M REQ.,WELL UPGRADIENT,EVIDENCE SURFACE SEAL. 1.EVIDENCE OF CONFINING LAYERS,SEE ATTACHED WELL LOG FROM NEIGHBORING PARCEL 2.PROP. LINE AND FOUNDATION UPGRADIENT. *THIS SYSTEM IS REPLACING A DRYWELL<100FT TO THE LAKE Applicant Signature: 4 /C7d-4e- Date: 12/22/2025 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal ' .Waiver ❑ None required ❑ Class A ❑ Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/ Standard revision) V���/ :O � � _L-7Zh--o7.4 O 3. Nature of Appeal: re ►vir► tu( car--•-fives, oviiqAr phi v. . I ?mitinbuvS ge ce. YI4 ui.76 a- - 1V1 i to (AN L 4. Hearing Official: '4'J Z—P1— 61\b"L � ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board O Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: tleA"tC",vvRA are_ tfitoft(ter-F cag#(1511:17ctsd-e , 1v�(lt6' '! `tus k-�-p„joi - d- AAs 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. • Staff Signature: Date: Z� 9 r 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 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: Hearing Official Signature: Date: 1t-e7 Z‘ J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 ------ // N 441- / *REMOVE EXISTING OUTHOUSE IN \S��44, DF AREA. OUTHOUSE IS VERY OLD, Fp UNUSED AND HAS NO SPECIAL \ R/V� BACKFILL NEEDS. Se, F'4ST \ Q *DBL SLEEVE TRANSPORT/SEWER \ ------ LINES 10' EA DIRECTION AT \ --'---- ..\ WATERLINE CROSSING, INSTALL \\ WELL �N 1 BELOW WATERLINE (PER PIPELINE \ /// ��. N SEPARATION GUIDELINES) \ 0, /�� 4./1-- I" WELL I R\C // 11 10�, \ 1 / R \ 1 / I / \ \ / I ___ / \ \ \ A = CLEANOUT \ / I x // \ FUTURE GARAGE � WELL �,( 1 © = CONTROL PANEL \\ / / r \ I \ I / / / \ \ I / i / ---------- / \ / I \ I / NEW WATERLINE TO BE \ / / / x/ // \\ I INSTALLED 10'+ FROM j / // �"b �/ \ I TANKS, DRAINFIELD & LINES �, iN / c§; // \ / \ / V *CONTRACTORS NEED TO DISCUSS II - ---- /11 ELEVATIONS TO ENSURE GRAVITY // \�� 5� �. WELL / \ FLOW TO TANKS I/ / R1 // \ //11 / / / ABANDON / / '2 3' / FUTURE PARKING AREA(ADJUSTED) / EXISTING OSS /�10'+ �\ / �� / / �` //. PROPOSED \ ` / \\ / O / NUWATER & ,` / N , / 100% RESERVE AREA / PUMP TANK *\ \ I .x\ --- N I PROPOSED PRIMARY -- y ., B O I 10' X 36' PRESS. BED WELL I /--.--- �j 30' SETBACK TO ®/ -x FOUNDATION DRAIN O o APPROXIMATE NEW HOME ,\C 11 h \\ (PLANS IN PROGRESS) ���,,, \ � 41 \ i�'���`wefy9��11 EXISTING CABIN/DECK \ 73.TO BE REPLACEDy 60 `° MASON \ ALEX L.PAYL3E o2 $ LAKE APPROX. OHWM \\ LICENSED DESIGNER \ vvv EXPIRES // \\ / 74 JOHN EGBERT TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 I- 0-60 VGMS 0-60 VGMS 0-60 VGMS i..,...,-, PARCEL: 2 2 2 3 3 - 5 2 - 0 0 0 6 8 ROOTS-60 ROOTS-60 ROOTS-60 ��� ALPINE SEPTIC SITE:2791 E MASON LK DR EAST SLIGHT COMP. TH @ 60/NO R/L COMP @ 60 -DESIGN- ALEX L PAYSSE,DESIGNER SHEET:SITE PLAN SCALE: 1"=40' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE.APPLICANT/COUNTY PROVIDED PLATS OR 3089E MASON BENSON RD SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. GRAPEVIEW WA 98546 PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT 360-607-1646 I0 I0.5 I1 I2 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS. File aOrlginitorarioagCopy with WATER WELL ZF�(1 T Application No. Second Copy—Owner's Copy x Third�,lcPy--Driller's Copy - STATE OF WASHINGTON Permit No. .... a 7 ♦`)•O : Name......Js�0.3....P-arro.tt Address , ' ' (2) LOCATION OF WELL: County .Mag.�Y1 _...._....— - R..._._:....W.ig. Bearing and distance from section or subdivision corner i (3) PROPOSED USE: nomesticX7 Industrial 0 Municipal 0 (10) WELL LOG: Irrigation ❑ Test Well ❑ Other 0 Formation:Describe by color,character size of material and structure,any show thickness of aqu!}ere and the kind and nature of the matesint iw.each stratum penetrated, with at least one entry for each change of formation• (4) TYPE OF WORK:• Uwner's number of well (if more than one).... MATERIAL FROM TO' New well �b Method: Dug 0 Bored ❑Deepened 0 Cable Driven [ Ai 1----- 0 .. Reconditioned 0 Rotary 0 Jetted 0 bankrun gravel 5- 9_.. - c grey ha rd pan 9 . 6(5) DIMENSIONS: Diameter of well ......... +6"inches• cemented gravel - 34__J___.53._L I, Drilled-.-.7.2-_6.-._. Depth of completed welL7.2 6._...._...._St. hardpan _- 53 ry (6) CONSTRUCTION DETAILS: Water bePri ng_ gravel 67 1216" Casing installed: 6._...., Diam. from .Q n. to 72'••641. ' Threaded 0 •' Diam from ft. to . ft_ - -Welded t " Diam. from ft. to ........__.... ft. Perforations: yes❑ No at Type of perforator used__..._................_......_...._..._....._...-•----....._ •. SIZE of perforations __...._ in. by _.__...__........_...w.. in. ;- _-.— __..._.perforations from ft.to .-.--___..... ft. '• __._. perforations from _ __—_-..____ perforations from ...-._..__....._.._ ft. to __._--_.- ft. • Screens: yes 0 No dr t • Manufacturer's Name_. —_..—_..._.._.... ... _—._.... _. ... Type_ Diam. Slot size _._..—.__from _..._....-. ft. to _. n. r i Diam. ._--.-.__. Slot size..._ from ft.to __.- ._ ft. Gravel packed: Yes 0 No g Size of gravel: Gravel placed from_.__.. ...._..._.._......_ft.to. _....__ft- Surface seal: yes g No 0 To what depth? _...-[_. ____ ft. 'r' Material used in seal Clay Did any strata contain unusable water? Yes O No 0 Type of water? Depth of strata----•---._..---._... ' • Method of sealing strata o0 _...—........._..._...._. , .' (7) PUMP: Manufacturer's Nam+e...._..._...__.. ... ...._ __..._....._..._..._...._.. Type: 1;I.e_t HP...._ . (8) WATER LEVELS: eve meaneseaeieve -_. ....1Q0___..ft• -.Static level ___....3.55..................._..ft. below top of well Date_......._..._....__......__ t. •Artesian pressure .....__._.._...___Ms_per square inch Date...--...-_........._...._ • Artesian water is controlled by.._. _..._ _.._.........._...__ (Cap,valve, etc.) .•!:•>• 1) WELL TESTS: lowered is amount lw ter level is `�f�S — e- Work started.=-3.1- -.6.Q•..•, 19__...._. Completed-4_..7..._..9....._ -.. 19...._.... :`'r:• „Was a pump test made? Yes 0 No❑ If yes,by whom?...._..__...._.........._..-•-- . Y2dd: gal./min.with ft. drawdown after hrs. WELL DRILLER'S STATEMENT: ' This well was drilled under my jurisdiction and this report is .4-?!!2...4...• ,. •• true to the best of my knowledge and belief. ..'Recoverymeasured to (time taken as zero ll top waterhen)pump turned off) (water level T T f Time Water Level Time Water Level Time Water Level NA112E-G �' .B�'�'� � '�•.D$i.�tL (Person,firm,or corporation) (Type or priest) Address..752.5--.Dixie...Id. W..,.....Tacoma _............... Date of loaf _.__..._....._...__........M......_..._.............. [Signed] Gene Battell ', Bailer test.....2Q..._..gal./min.with_....1Q_...It. drawdown after_..2..„......hrs. (Well Driller) 223-02-8246 6-21-73 Temperature of water--.-__ Was a chemical analysis made? Yes 0 No O License No Date , 19..._... (USE ADDITIONAL SHEETS IF NECESSARY) Pr rrrl'Mason Coin i y u-vi 3 BUEHS,JANET M 12/22/2025 4509 GUSTAFSON DR NW GIG HARBOR WA 98335 RE:2781 E Mason Lake Drive East,Grapeview Dear Property Owner, This letter is to formally notify you,as required by local and state regulations,that a setback waiver application is being submitted to the local health department for a proposed septic system located on the neighboring property at 2791 E Mason Lake Drive East(John Egbert). The waiver request seeks approval to reduce the required horizontal setback from an existing private drinking water well from 100 feet to 75 feet in accordance with WAC 246-272A-0210(4).This notification is informational in nature and is provided to ensure transparency during the review process.The final decision regarding approval or denial of the waiver rests solely with the local health department. To mitigate potential risk and provide additional protection to groundwater and nearby wells,the proposed septic system incorporates enhanced treatment beyond the minimum requirements of state regulations. In addition,the design and supporting documentation include other protective measures, such as: • Drainfield siting at lower elevation (well is upgradient). • Evaluation of subsurface conditions demonstrating the presence of confining soil layers (such as glacial tills and cemented soils) • Review of well construction details, including surface seals. These measures are intended to provide a level of protection equal to or greater than that achieved under standard setback requirements. If you have questions regarding the waiver review process or wish to provide input,you may contact Mason County Environmental Health directly at 360-427-9670, ext.400. Thank you for your time and attention. Sincerely,4g276,04.4.4. • Alex Paysse,Onsi Wastewater Designer �j� ocon Alpine Septic Design, LLC otr ALE I LOOS'*.sg x,,. 360-507-1546 , t � �