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Home My WebLink AboutWAI2023-00009 - WAI Health Waiver - 1/30/2023 `\ 415 N.6th STREET,SHELTON WA 98584 MASON COUNTY SHELTON: 360-427-9670,ext 400 • 1' F COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA: 360-482-5269,ext.400 Budding.Planning,Environmental Health,Community Health FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: _ Receipt Number: v({� WAI22.0) 0000' d 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 NICOLE NORRIS Telephone Mailing Address PO BOX 3137 City SHELTON State WA Zip 98584 Parcel No. 3 2 0 0 1 _ 2 1 _0 0 0 0 0 Site Address 101 E SCARLET ROAD, SHELTON Subdivision Name and Lot PART 2: Nature of Waiver/Appeal CY Class B Reduce Vertical Separation 0 Food Sanitation Requirements O Building Permit Review Policies 0 Group B Water System Regulations ❑ Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements O Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal (include justification, additional material may be attac� -- REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE bSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: ,A ,L /7 4a-4- Ca / Date: 7/3C/2-O20 Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal iWaiver None required , Class A v/Class B Class C 2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/ Standard revision): WAC246-272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board El/ Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 2. i`[ 7)l<Z 1 ) 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: C. ��/VA Date: .< -1 S- 3 PART 4: Dete rminatidn 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: 0 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: 1Health Official Signature: Date: Z-//f/23 Re‘ised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 rA T. MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building.Planning,Environmental Health Community Health CLASS B WAIVER WORKSHEET 415 N.8TH STREET,BLDG 8,SHELTON WA 98584 (State and Local waiver forms required) SHELTON:360-427-9670,EXT.400 - BELFAIR:360-275-4467.EXT.400 ELMA 360-482-5269,EXT.400 - FAX'360-427-7798 009 APPLICANT NAME NICOLE NORRIS WAIVER PERMIT NUMBER WAI 9.0 2-77 1 6 0 MAILING ADDRESS PO BOX 3137 cm SHELTON STATE WA ZIP 98584 SrrEADDRESS 101 E SCARLET ROAD. SHELTON cm( TAX PARCEL NUMBER 32001-21-00000 PROPOSED DRAINFIELD TYPE ❑ CONVENTIONAL GRAVITY Lot CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: I The soil seriesUp-slope vertical separation must be greater than 18" Shelton, must n Alderwood,Harstine,Hoodsport, for gravity and greater than 12"for pressure. Shelton,or Sinclair Gravelly Sandy Loam. NI/ Alderwood Gravelly Sandy Loam V 0 Greater than 12" ❑ Harstine Gravelly Sandy Loam 0 ❑ Greater than 18" ❑ ❑ Hoodsport Gravelly Sandy Loam ❑ 0 -Determined by: El ❑ Shelton Gravelly Sandy Loam 0 0 Depth to hardpan Sinclair Gravelly Sandy Loam 0 0 Depth to mottling i a Other ❑ ❑ Both 2.SOIL TYPE: 6.WATER TABLE LEVEL: If test holes show evidence of a seasonal water table ISoil types must be Medium Sand,Loamy Sand,or Sandy above restrictive layer,a curtain drain may be required Loam.Gravel percent must be less than or equal to 35%. Evidence of seasonal water table: _ Medium Sand 0 ❑ Yes ❑,/ 0 a Loamy Sand No lrJ Els Sandy Loam 0 Curtain Drain required: 0 Percent Gravel: co-Less than or equal to 35% 0 Yes E 00 n Greater than 35% 0 ❑ Norts 7. HORIZONTAL SETBACKS: 3.SOIL DRAINAGE: F F. ro Primary Drainfield must maintain 200'from down-gradi- Soils must be moderately well drained to well drained. I z ent marine shorelines,surface waters,and wells. 0 111{ `.c c Moderatelyll Drained V a -Are increased horizontal setbacks met: 0 Well Drained ❑ 0 Yes Other No ❑ 0 4. DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. A 50 foot horizontal attenuation zone is required Gravity is Pressuresly a is allowedo oe on 3%opes rom %.% 15%. down-gradient of the primary drainfield. is on to 30%. Is there 50 ft or greater between the down 3Less than 3% V El gradient side of primary drainfield and 1%to 15% ❑ ❑ property boundary: ,/ Greater t 3ha ❑ ❑ Yes tI ❑ than 30% No ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable I /� --- .1 prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: Proof of lJ parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Pdaced arzrzon THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. • 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. 1 (completed by applicant) Name: (1) Local Health Department/District (2) NICOLE NORRIS (see instructions) Address: PO BOX 3137 SHELTON, WA 98584 Telephone: ( ) Signature: ,Rt .L. /07 7 uG t Property Identification: (3) 32001-21-00000 - 101 E SCARLET ROAD, SHELTON Section II. I (completed by applicant) WAC Number: (4) AG-Reiti 5) Waiver Sought: (6) 246-272A— 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR PRESSURE OSS (O Subsection: TABLE VI 36" OF V/S R-GRAVITY 18" OF V/S FOR GRAVITY Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those pro osed): (9) itr/I/ i (�'} - ,l ipvr-e gleerovevt Comments/Conditions: (10) Type of Waiver: (11) [ ]Class A Class B [ ]Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes— No If needed, are agreements, easements, etc.properly filed? Yes No Section W. I (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. [ ] Denied Vig Approved /Granted—Sub'ect to all comments,conditions and requiremen s note li Sections 11 and III. Date: 2 Local Health Officer (13) Page 26 of 32 DOH 337-021