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HomeMy WebLinkAbout2021/11/16 - BOH Packet MASON COUNTY COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health HEALTH MASON COUNTY BOARD OF HEALTH is • REGULAR MEETING 1J oVemir�r 110, 21 3:00 VIA ZOOM Shelton, WA 98584 DRAFT AGENDA 1. Welcome and Introductions Peggy Van Buskirk Chair 2. Approval of Agenda—ACTION Board Members 3. Approval of Minutes of September 2021—ACTION Board Members 4. Health Officer Report Dr. Gardner a. COVID b. Other 5. Administration Report Dave Windom Funding discussion 6. Environmental Health Report Alex Paysse Onsite Standards-ACTION 7. Community Health Lydia Buchheit 8. Other Business and Board Discussion Board Members 9. COVID Update Staff 10. Public Comments 11. Adjourn 12.Next meeting January 18th, 2022 If special accommodations are needed,please contact McKenzie Smith,427-9670,Ext.589. From the Belfair area,please dial 275-4467,Ext.589;from the Elma area please dial 482-5269,Ext.589. Mason County Public Health 415 N 61h Street,Bldg 8,Shelton WA 98584, Shelton: (360)427-9670 ext 400 Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400 FAX (360)427-7787 MASON COUNTY BOARD OF HEALTH PROCEEDINGS 411 North 5`h Street,Shelton,WA September 28,2021 Virtual Attendance:Randy Neatherlin,County Commissioner;Kevin Shutty,County Commissioner;Sharon Trask, County Commissioner;Peggy Van Buskirk,Hospital District#2;Dave Windom,Mason County Community Services Director;Lydia Buchheit,Mason County Community Health Manager;Alex Paysse,Environmental Health Manager;Darrin Moody,Hospital District# 1;Keri Davidson,Shelton School Board;Kathy McDowell,City of Shelton Council Member Seat#2;Dr.Dan Stein,Health Officer;McKenzie Smith,Clerk of the Board. 1. Chair Peggy Van Buskirk called the meeting to order at 3:00 p.m. 2. Approval of Agenda—Cmmr. Shutty/Trask moved and seconded to approve the agenda as presented. Motion carried. 3. Approval of Minutes—Cmmr.Trask/Shutty moved and seconded to approve the July 27,2021 minutes as presented. Motion carried. 4. Health Officer Report by Dr.Stein Dr. Stein will hand over the Health Officer position to Dr.Keri Gardner next week and shared his thanks to the Board and the Commissioners. 5. Administration Report by Dave Windom Dave discussed the following graphs: Case Count,Hospitalization Count,Percent Vaccinated within Age Group,and Hospital Admission Rate by Vaccination Status in those 45 to 64. The Delta variant spiked up and plateaued,cases are coming down. Case rate was 30-34 per day and is now 20 or less per day. The hospitalization count spikes up and down and the importance is the availability of beds. The lower age group that is less vaccinated is the group most seen in the hospital. More than 90%of cases and deaths recently are unvaccinated. The backside of the Delta variant is a fairly steep drop and under an infection rate of less than 1. This is slowly inching up as we go into the flue season. Dave gave a Foundational Public Health Services(FPHS)presentation. Foundational areas include programs and activities specific to a Health Department and/or the community's needs such as communicable disease control;chronic disease and injury prevention;environmental public health; maternal,child,and family health;and access to and linkage with clinical care. It wasn't until last year that FPHS was funded. The$200k covers programs such as the Hepatitis C program and the syringe exchange program. FPHS also can cover the foundational capabilities such as quality improvement,human resources,financial management,and legal. Funding is also being used for a new person in finance to work with contract and grant management. $761k will be coming in the fall and backdated to July 1,2021. The foundational capabilities include assessment,all hazards preparedness/response,policy development/ support,communications,community partnership development,and organizational competencies. A lot of funding is still available for COVID response. The Consolidated Contract comes out every two years and funding runs on the State fiscal year of July 1 to June 30. The County runs on a calendar year. 6. Environmental Health Report by Alex Paysse Alex highlighted some code enforcement updates in his Environmental Health Report and shared Title 6.76 On-Site Sewage Regulation updates. Amendments were briefed in July. These updates were based on program feedback collected over the last several years and were worked on with On-Site Sewage Advisory Committee. Updates have not been done since 2009. The draft updates were sent to the State to review and the Department of Health agreed with the code changes with minor clarifications. Ultimate approval and implementation will be done in January 2022. Darrin Moody/Kathy McDowell moved and seconded to move the On-Site Sewage Regulation updates to BOARD OF HEALTH PROCEEDINGS September 28,2021—Page 2 the Mason County Commissioners. Motion carried. 7. Community Health Report by Lydia Buchheit Lydia shared that a total of five people will be hired to take over COVID work. School is starting and rising COVID numbers has brought on an array of problems. Two people have been hired so far and two clerical positions will be filled on Monday to assist with the filing backlog. The nurse position is still open. Information is going up about the COVID boosters. Lydia highlighted the COAP/COSSAP(Community partnerships,Systemic change,Program coordination) project which is coming to an end this month. Many great programs have spun off from this. Community Health Assessment and Data was updated which is done about every three years. This is still a draft. 8. Other Business and Board Discussion 9. COVID Update by Dave Windom 10. Public Comments 11. Meeting adjourned at 3:37 p.m. BOARD OF HEALTH PROCEEDINGS September 28,2021—Page 3 ATTEST MASON COUNTY,WASHINGTON BOARD OF HEALTH MASON COUNTY,WASHINGTON McKenzie Smith,Clerk of the Board Darrin Moody,Hospital District#1 Kathy McDowell,City Commissioner Kevin Shutty,Commissioner Randy Neatherlin,Commissioner Sharon Trask,Commissioner Peggy Van Buskirk,Hospital District#2 Gary Plews,Fire Commissioner Keri Davidson,Shelton School Board Reminder, get your flu shot! From the Director's Desk November 8, 2021 Gobble, gobble. i r Happy Thanksgiving! Fall seems to be the time of meetings and conferences.This year that has all changed in response to COVID-19. As an agency, we are doing meetings in a variety of remote platforms and doing the best we can to keep connected. It works but it does have some limitations. In public health we're starting to reconnect in person,to re-establish relationships across the state, and work in a more unified way to address rural health. The Delta variant has been rough the past two months. We've had our highest case rates we've had during the pandemic; our hospitalizations have been high but have come down, and things seem to have plateaued. Or vaccination rate for those eligible are at 53.5%. Our epidemiological curve doesn't look like the state curve, we didn't peak as high and are currently running about a 27 cases per day average. CASE COUNTS •Probable Cases Confirmed Cases Incomplete(Probable Cases) Incomplete(Confirmed Cases)—Total Cases(7 day avg.)---Incomplete(7 day avg.) 150 Mason County Cases 100 50 0 .. _.........._ -...._. ....._ _u,..�.-.....__.... Apr 2020 Jul 2020 Oct 2020 Jan 2021 Apr 2021 Jul 2021 Oct 2021 Soecimen Collection Date Hospitalized Deaths Test positivity _4-DAY CHANGE LAST Tb`t01bEEKS -2% 7 No data available ALq y ua tic.. - ALLAGES 1-2 AND LP 65AND UP Fully vaccinated 54% 62% 82 Reminder, get your flu shot! Funding for COVID-19 work remains a major concern. Our current CARES Act funding expires on December 301h. We have not seen proposals for its replacement, but we have funding available through several other sources that will carry us forward. We did not add as many staff as other health jurisdictions which allows us to stretch available funding farther. In September we turned over case and contact investigation to the state and added several new positions exclusively to COVID.This allows our staff who have worked so diligently in COVID for the past year and a half to return to their normal non- Covid related programs. Dr Keri Gardner has come fully on-board as our health officer having spent time in the office, meeting and working with staff, and is in the process of connecting with the community and her peers in the Health Officer Committee. In addition to COVID work, she's very excited to begin working on chronic disease such as obesity, diabetes, and heart disease.We will have funding available in 2022 to begin to have more effort in chronic disease. I'd like to take this opportunity to commend the public health team we have. 2021 has been an incredibly tough year and it's not over yet. Our community health folks with Lydia at the helm continue to lead the way at the local level and set the example for COVID response.The team takes personal interest in every case making sure they have support and information. Casey and administrative folks keep things humming and provide support for the COVID response through efforts of collecting and disseminating the daily information updates. Environmental Health continues to support the county through onsite septic work, shellfish protection, solid waste and food safety. Alex coordinates efforts to house those who cannot isolate at home. We truly have a sharp, involved, and energetic team. Looking forward to 2022 Dave Windom, MSHS Draft Dates for BOH 2O22 January 18 March 15 May 17 July 19 September 20 November 15 Environmental Health Report For Board of Health November 16th, 2021 From Alex Paysse, Environmental Health Manager Fall and winter is always a busy time for Environmental Health. We have updated our EH Fee Schedule with the commissioners and will be working on educating contractors and updating our permit system. Back in 2013 the commission approved a resolution allowing an increase every year by the July to July CPI-U. Following the resolution, this year we processed a 5% increase. Fees will go into effect on January lst, 2022. Staff is working on renewal invoices for all our licensed establishments. These annual licenses include: Sewage contractors, Food establishments, Public pools, and Solid waste facilities. Most licenses are setup on a calendar year with expiration at end of December. This makes for a busy end of the year for our staff printing invoices and preparing for payments in January. There are approximately 438 licenses needing to be billed and processed. Vector Program In October we received a racoon specimen that was processed for rabies testing after coming into contact with a resident. Results were found to be negative. Bats are the primary animal that carry rabies In Washington State. According to DOH about 1% of bats in the wild are infected with rabies. Between 2015 and 2019, Mason County has tested 33 bats and found 3 positive specimens. While racoons have not been identified recently in Washington, the virus can be transmitted from bats to racoons or other mammals. Water Qualify Program Our water quality program staff have been working closely with the State Dept. of Health and Ecology on a shellfish harvest closure that went into effect in Oakland Bay due to agricultural runoff and high fecal coliform concentrations. The closure continues to impact over 400 acres of commercial shellfish harvesting and a popular public harvest access off Hwy 3. Sewage Program The BOCC held a hearing on November 9th for the proposed amendments to Chapter 6.76 On-site Sewage Regulations. The amendments were approved with an effective date of January 1It, 2022. Staff will be working to educate the public, realtors, contractors, designers, etc.. ahead of the upcoming implementation date. Food Safety Program Travis Casey has stepped up and into the food safety program. We have been working with Travis on the necessary certifications and training to carry out program activities. Because of the staffing turnover, a decrease in routine inspections will be found in October. We regularly work on cross- training our EHS staff to cover programs in times of need like this. We hope to bring some more staffing and depth to the food safety program with use of Foundational Public Health Funding from the state. Additional items or actions for BOH review: MASON COUNTY A. COMMUNITY SERVICES • Action: OSS Standards Update (see attached) aaenq.�.,nnng.erm « iN.aim.conmnry erim To: Mason County Board of Health From: Alex Paysse, Environmental Health Manager Rhonda Thompson, Environmental Health Specialist Date: November, 16th, 2021 Item: Updates to Mason County Onsite Sewage System Standards (see attached) Background The Mason County Onsite Standards address design and construction requirements related to onsite sewage systems (OSS). Mason Co. program staff work closely with the Onsite Sewage Advisory Committee (OSAC) on maintaining these standards with common industry practices to ensure proper design and installation of onsite sewage systems. Staff presented a few program conflicts to the OSAC back in June of this year. The OSAC discussed these topics across multiple meetings and unanimously voted in favor of the following changes with an effective date of Jan. 1 It, 2022 to allow time for contractor education on revised requirements. Summary of changes Septic and Pump Tank Capacity (Page 4 & 5) • Sewage tanks have a working capacity and a flood capacity. Current MC standards outline minimum size requirements for design and installation but do not specify working or flood. This is creating conflicts at time of installation and final approval. Staff and sewage contractors need more clarification. • Proposed changes: Septic Tank sizing requirements will be clarified as working capacity, pump tanks to flood capacity. The proposed changes align with state codes and guidance. Drainfield Piping Requirements (Page 5 & 9) • Class 200 is a thinner wall PVC with less reliability in various situations. Incorrect use or installation of Class 200 is more likely to result in breaks or cracks. Not only is this a health hazard, its also creates more cost to homeowners for repairs. Most contractors already make exclusive use of 3034/Sch. 40 piping. • Proposed changes: Removes Class 200 PVC and requires 3034 and Schedule 40 on all piping. Transfer of Ownership Requirements (Page 9) • Standards outline property transfer requirements according to Mason County Code Chapter 6.76. This section of code and requirements were updated recently to reflect necessary changes. • Proposed changes: Replaces language in standards with most recent changes adopted by BOH and BOCC. Recommendations Recommend review and adoption of proposed amendments to the Onsite Sewage Standards with an effective date of January 1, 2022. Review&Approval of piping material changes by OSAC July 13, 2021, DONE Review&Approval of tank capacity changes by OSAC Sept. 14, 2021, DONE Review and adoption of revised standards by BOH Nov. 16, 2021 Effective Date January 1, 2022 Mason County Public Health On-Site Standards Y o � Revised Deeember- 29, 201 Gjanuary 1 st, 2022 TABLE OF CONTENTS SECTION ONE: PROCEDURAL REQUIREMENTS 3 A. Criteria For Test Hole Number And Location 3 B. Criteria For Test Hole Dimensions 3-4 C.Final Approval 4 SECTION TWO: DESIGN AND INSTALLATION REQUIREMENTS 4 A. Use of Recommended Standards and Guidance for Performance 4 B. Septic And Pump Tanks 4-5 C.Drainfield Requirements 5 D. Curtain Drain 6 E. Winter Observations 6-7 SECTION THREE: RECREATIONAL VEHICLE HOLDING TANKS 7 SECTION FOUR: OPERATION AND MAINTENANCE 8 A. O&M Frequency 8 B. Terrelift 8 C.Transfer of Ownership 9 SECTION FIVE: GRAVITY SYSTEMS 9 Revised DeeembeF 28,2MJanuary 1,2022 Page 2 SECTION ONE: PROCEDURAL REQUIREMENTS A. Criteria for Test Hole Number and Location A minimum of 2 to 4 test holes is required per site, depending on the location of the reserve repair area. If the reserve area is located interior to the primary system(Example A,below), a minimum of 2 test holes is required. If the reserve area is located contiguous to the primary system (Example B, below), a minimum of 3 test holes is required. If the reserved area is located in an area separated from the primary system (Example C, below), a minimum of 4 test holes is required. Primary I'rnnan Reserve Reserve x x x Primary Reserve Example A: Example B: Example C: Two Test Holes Three Test Holes Four Test Holes B. Criteria for Test Hole Dimensions The holes are generally excavated by a backhoe, but hand dug holes are acceptable when dug to proper dimensions and with adequate spoils pile setback. Test holes only need to be dug into the restrictive layer. When a restrictive layer is not identified during test hole excavation,test holes must be dug a minimum of 5 feet deep. The reason for this depth is to verify that the site can accommodate a 2-foot deep drainfield with an additional 3 feet of vertical separation. Excavator requests for test holes shallower than 5 feet(without encountering a restrictive layer)due to site-specific concerns such as soil sloughing characteristics and access to the site by children or animals will be considered by Public Health on a case-by-case basis. Public Health will work to identify ways to meet the excavator's concerns other than digging shallow test holes, such as arranging to meet the excavator on site so the holes can be immediately covered. In some cases hand dug test holes may be preferred by the applicant or designer. Hand dug test holes might be preferable for sites that have a shallow restrictive layer or sites where construction equipment could damage the usable soil. In such cases,the test holes need to be dug a minimum of 5-feet deep or into the restrictive layer,whichever is shallower. Test holes must be 2 feet wide,and long enough for an entrance ramp. The ramp must be no steeper than 1 foot vertical to 1.5 foot horizontal. If the hole is deeper than 4 feet, a platform must be constructed at the 4-foot depth to allow the inspector to complete the test hole inspection while standing no deeper than 4 feet deep. If test holes cannot meet the above criteria, prior approval is required from Public Health. Revised January 1.2022 Page 3 The toe of the spoils pile must be 2 foot from the test hole. Ramp slope=1 ft vertical to 1.5 ft horizontal a � • 4ft Sft Ir ♦ * lft • 10 dip • Note: Safety is a legitimate concern of both backhoe operator and Public Health staff. Holes should be excavated with a 5-foot deep end and a 4-foot deep shelf. The end of the shelf should then be ramped up to the ground surface. This allows staff to enter and exit the hole via the ramp, and to examine the 5-foot sidewall without going deeper than 4 feet by standing on the shelf. C. Final Approval The system installation will be verified as complete and within current code when a record drawing (as-built) is signed by both the installer and Public Health and Public Health signs off in the permit database. SECTION TWO: DESIGN AND INSTALLATION REQUIREMENTS A. Use of Recommended Standards and Guidance for Performance,Application,Design and Operation & Maintenance. Washington State Department of Health (www/doh.wa.gov)has established guidelines for various on-site technologies. Although these guideline documents have not been formally adopted as regulation in Mason County,they are considered by Mason County Public Health to be valuable technical guidance. Therefore, on-site system designs shall adhere to the guidelines. B. Septic and Pump Tanks Install only approved two-compartment septic tank with a minimum volume based on the number of bedrooms in the home,as follows: Number of Bedrooms VA',ma Capacity of Tank(in Gallons) 1-2 1,000 -1 1,200 5+ Add 250 Gallons per Bedroom Must have an appropriately sized two-compartment septic tank followed by an appropriately sized pump tank. Revised January 1.2022 Page 4 Pump vault systems in a single compartment septic tanks are not allowed. 24"risers(minimum)required over each compartment of a septic tank. Single compartment tanks greater than 1000 gallons shall require 24"risers at each end of the tank. Risers shall be a minimum of 24"with an effective opening no smaller than 18". Pump tanks shall be 2.5 times the design flow with a minimum of 1000 gallons in flood capacity. Grease traps shall be 2.5 times flow of the kitchen wastewater and not counted toward septic tank size. C. Drainfield Requirements Pipe For sewer distribution lines ASTM 3034 pipe and fittings. • For gravity systems, 4-inch ASTM 2729 rigid pipe or better is required for drainfield piping. For pressure and other distribution systems, use Schedule 40Class 200-or better. Valve and Distribution Boxes • Valve and distribution boxes must have a barrier material placed under component. Cleanouts and Observation Ports • Ports must be anchored properly. • End of lateral pipe must be accessible in the observation port and have threaded caps. • Observation ports must be installed in a valve box or equivalent at finished grade. Time Dosing, Elapse Meter, Event Counter • Time dosing,elapse meter and event counter shall be required for all systems using a pump. Systems consisting of a septic tank and gravity drainfield shall require metered water. Electrical Box • The installer will be responsible for assuring that an electrical schematic is left in the electrical box of the residence. If the electrical box has not been installed at the time of installation,the installer will leave the schematic at the site along with the record drawing(as-built). Reduction • No drainfield reduction will be allowed. Onsite Systems with Greater than 2,000 GPD and Less than 3,500 GPD Shall Require: • Pressure distribution. • Annual operation and maintenance. • All of the Recommended Standards and Guidance for pressure distribution must be followed. The required drainfield area shall be split into two 50 percent drainfields.A third 50 percent drainfield shall be constructed initially in order to provide for alternation(long term resting). A reserve area equal to an additional 50 percent is required. Where facilities have an automatic resting cycle like a campground,the requirement for three 50 percent drainfields may not be necessary.A 100 percent reserve is required when a third 50 percent drainfield is not required. Barrier Material • Geotextile(filter fabric) is required as a barrier material for all systems except systems using gravelless technology. Revised January 1.2022 Page 5 D. Curtain Drain The following illustration represents a typical curtain drain. ORIGNALfFNISHEDGRADE aL1NFF1D F1Ll tU TO DpyyHHlL atM1NFQp 18'MNDAUIIA DRAN WIDTH FILTER FABRIC OPTIONAL FILTER FABRIC REQURED ON TOP OF GRAVEL ON SIDES OF GRAVEL ---------- ------ 6b4IL PLASTIC SHEETNG �O 00 O OPTIONAL ON DOWNHLL � SUE OFGRAVEL 0 '7)8 GRAVEL GRAVEL 18-24' i 00 O •1-114'DRANROCK MNUJMABOVE � 'PEA GRAVEL RESTRICTIVE LAYER i O�O0 'EZ4_AY,ETC_ 0 ✓ (� H 6-iZ'NPO 4'MNUJM DY►. O REST RICTIVE LAYER SLOTTED/PERFORATED /CORRUGATED PPE PPE N BOTTOM OF TRENCH J E. Winter Observations A winter monitoring program will be conducted after completion of the appropriate application form and payment of fees. Monitoring will be performed by a Licensed Designer(with 3 quality assurance inspections by Public Health). A minimum of 2 observation ports will be installed in locations representative of a cross section of the proposed drainfield area. Recommended monitoring port design will consist of a vertically oriented section of 4-inch diameter perforated pipe,wrapped in filter fabric and bedded in clean, washed drain rock or pea-gravel that has been back filled into a 12 to 24 inch test hole. The drainpipe should be capped and flagged so as to be easily visible to Public Health staff. Revised January 1.2022 Page 6 Winter observations will take place during the months of January to March. The frequency and timing of observations will be dependent on site characteristics, and on rainfall characteristics that occurred during the monitoring period. The designer will submit a minimum of 6 observations along with USDC rainfall data for the area during the period of January to March. The observations will record the date and time of observation, and the depth to water. Monitoring results will not be considered valid when the rainfall for the period of observation did not exceed 80%of the ten-year average rainfall for the area during the six-month period of October to March. SECTION THREE: RECREATIONAL VEHICLE HOLDING TANKS Holding tanks for Recreational Use Vehicles are permitted through a state and local waiver process. A. Application Requirements • An Onsite Sewage Application form and Plot Plan • Completed State and Mason County Waiver forms B. Waiver Requirements • A 1200-gallon tank from the Washington State Department of Health List of Registered On-Site Treatment and Distribution Products ,risers to the surface and an audio-visual alarm. • A letter from the property owner stating that the owner agrees to have the tank inspected annually and pumped as needed. • A copy of a recorded Notice to Future Property Owners of Recreational Use Holding Tank on the property deed. This form must be completed,notarized, and recorded with the Mason County Auditor. A copy of the recorded document must be submitted to Mason County Public Health prior to permit approval. • A Mason County Certified installer must install the tank, request a final inspection, and provide a completed a Mason County Record Drawing(as-built) form. Revised January 1,2022 Page 7 SECTION FOUR: OPERATION AND MAINTENANCE A. O&M Frequency All on-site sewage systems require operation and maintenance care in order to function satisfactorily over an extended period of time. The following table summarizes minimum O&M frequency needed for each type of system, and the homeowner's options for who can perform the work: System Type • Conventional • Conventional . Mounds Aerobic • Non- Gravity Pressure * Treatment Units residential • Open-bottom • Sandfilter * • Glendon Commercial Sandfilter • Recirculating Gravel Filters • Sub-surface Drip • Community Drainfields Inspection Frequency Every 3 years Annually Annually Annually Annually (Waste—strength testing may be required) Approved Service Providers • Homeowner • Homeowner Homeowner • Operation& • Operation& • Pumper • Pumper • Operation& Maintenance Maintenance Maintenance Specialist Specialist • Operation&Maintenance Specialist • Proprietary Specialist Device Licensee Mason County Public Health recommends a Certified Operation and Maintenance Specialist inspect theses stems. Tanks should be pumped as needed. Frequency depends on age of system, number of people using system, size of tank,what you put into the system,and other factors. B. Terrilift Terrilift is not allowed for maintenance or repair of an on-site sewage system. Revised ,2 January 1022 Page 8 C. Transfer of Ownership As per Mason County On-Site Regulations 6.76.070,when a property contains and/or is served by an on-site sewage system, an inspection service report by a certified operations and maintenance specialist is required within 12 months prior to the sale of property or transfer or ownership. The inspection service report shall include the status and findings of all system components at time of the inspection and use the form prescribed by the director. " Id Anil system eensisfing solely of a septie tank and dr-aiififiPeld and annually for-all other-en site sewage Sepviee fer-an on site sewage system eensisting selely ef a septie tank and gfavity dr-ainfield shall be peFfeFmed by a Mason County Cet4ified Pumper-or-a Mason County CeFtified Operation and ,Maintewmee Speeialist. All ether-en site sewage systems will require a r-epeFt fr-em a Mason SECTION FIVE: GRAVITY SYSTEMS Pipe • 4-inch ASTM 2729 rigid pipe or better is required for drainfield piping. • 4-inch ASTM 3034 rigid,pipe or better is required for sewer distribution piping. Trenches • Divide flow equally between trenches by using a distribution box(D-box) located at or above the uppermost trench. • Stepdowns are not allowed. Bed Pipe Layout • Interconnect laterals at the ends to form a closed loop; level entire closed loop. Use minimum of 2 laterals. Lateral separation must not exceed 3 feet. Separation of outer lateral from edge of bed excavation must not exceed 24 inches. • Design layout so the outer lateral is separated from edge of bed excavation by a distance equal to 1/2 the separation between laterals. Distribution Box • Distribution boxes (D-boxes)are required in order to achieve equal distribution of effluent on sloping sites and on flat sites where more than two drainfield laterals are utilized. • Install D-boxes on undisturbed or compacted soil. Effluent must be tightlined a minimum of 3 feet from each outlet of a D-box, except where the D-box is located on the interior portion of a bed design. • The outlets of the D-box must be water leveled by the installer prior to the final inspection by Public Health. • Distribution box construction must allow unobstructed view of all outlets, in order for Public Health to verify proper installation. • Public Health recommends use of Dial-a-Flow or equivalent for easy,precise equalization of D-box outlet flow. Revised Deeember 28 'n'nJanuary 1,2022 Page 9 y � w Community , He lth y, I I _ Manager Report a• 1 September-October 2021 Communicable Disease & Notifiable Conditions (3 programs-CD, TB, STD) Staff:Audrey O'Connor, Back-up: Elizabeth Custis&Lydia Buchheit September-October our communicable disease(CD)program nurse received 54 reports requiring data entry into the State database, and/or investigation and follow-up. *Chronic Hepatitis C cases are being directly entered into new WDRS database by DOH. This does not include their work in COVID-19 case investigations.We are no longer keeping COVID line list.Current case numbers provided by WA DOH. Disease Sept-October Total to date COVID-19/2021 * 4143 as 10/2021 Campylobacteriosis 2 15 Cryptosporidiosis 0 1 Giardiasis 0 0 higa Toxin 2 0 1 higellosis 1 1 Mumps 0 0 Haemaphilus Influenza 0 0 Hepatitis B-Acute 0 0 Hepatitis B-Chronic 0 0 Hepatitis C-Chronic Hepatitis C-Acute 0 0 Hepatitis D 0 0 Lyme 1 1 Pertussis 0 0 almonellosis 0 1 1 ersinia 0 0 Coccidioidomycosis 0 0 Carbapenemase-resistant 0 1 enterobacteria(CRE) Hepatitis A—Ruled out 0 0 Meningitis-Ruled out 0 0 ibrio-Ruled out 0 0 Listeriosis-Ruled out 0 0 Legionella 0 1 Suspected rabies/sample sent 2 5 Malaria 0 1 Tuberculosis-Ruled out 0 1 Tuberculosis-Latent 0 0 Tuberculosis-Active/open cases 0 0 ibriosis(non-cholera) 0 1 Listeria 0 0 Congenital Syphilis 0 2 Chlamydia 35 168 Gonorrhea 10 62 Syphilis 1 9 Herpes 2 10 HIV 0 0 Totals 54 280 Hepatitis C Screening Staff:Christina Muller-Shinn Staff is compiling an academic detailing presentation for local providers to explain the current HCV situation in Mason County,some modelling on numbers and the impact of not increasing treatment options locally, as well as information about the"new" (2019) guidelines reducing barriers for providers to begin treatment. We are hoping to gain excitement and momentum to start a county-wide collaboration program to address this issue. Maternal Child Health Staff: Elizabeth Custis Elizabeth provides COVID guidance as part of this grant. Elizabeth works with childcare and Headstart/ECEAP agencies regarding COVID cases, response guidance, and testing. She continues assisting with other COVID calls and outbreaks,such as long-term care. 2 Staff continues to participate in the SMART(School Medical Autism Review Team) in Mason County which helps to evaluate and potentially diagnose children with Autism.Team members are Dr Rayos and Dr Tuladhar,Speech/Occupational Therapy/Physical Therapy from school districts and Mason General Hospital Pediatric Rehabilitation Team, Special Education teachers, and Birth to Three Early Intervention Providers. Without this team, many children wait 12-18 months to see a specialist for diagnosis,which can delay needed services. Our local pediatricians and other providers on this team have been specially trained to evaluate children. Elizabeth's role is to assist families to get the support and resources needed after their child is diagnosed with Autism. We are lucky to have this team in our county to fill the gap. Many counties do not have this in place. Maternal Child Health Parenting Program-Incredible Years No Incredible Years parenting classes were offered due to COVID. Future work will be with DCYF for Child Protection Services. Breastfeeding Coalition of Mason County Breastfeeding Coalition meetings and support group are on hold during COVID. Elizabeth has continued to share breastfeeding COVID immunity and vaccination information with MGH OB Department and Mason Clinic Pediatricians. Early Learning Coalition of Mason County Elizabeth is back to participating in the monthly meeting and will be involved in the mapping project in December to see what resources we have and what is missing to support early learning.This team works together to support early learning, identify gaps, and assist with promoting opportunities for early learning for children in Mason County. Immunization Improvement Grant Elizabeth continues to encourage parents and newly vaccinated adults to apply for online access to their child's and their own Immunization Information System records.This is for COVID records and other vaccines. Children with Special Health Care Needs Elizabeth has been able to increase time in this program for consultation and care coordination via phone to families with children that have special health care needs in the Mason County area. Referrals continue to be submitted to RN. RN is now able to participate in monthly Pediatric Care Coordination Meetings that include Mason Health Pediatricians, Birth to Three Early Intervention,School and Mason Health Speech, Physical, and Occupational Therapy, and Developmental Preschool and Special Services staff. Social Service Programs Staff: Todd Parker, Abe Gardner, Haley Foelsch Housing($5,994,321 Annually: 12 funding sources—grants,tax, local recording fees, 12 subcontracts, and 20 programs) Staff:Todd Parker Haley Foelsch started October 19 as a new member of the Community and Family Health Department and will be working in the Homeless and Affordable Housing programs. A status report on the Local 5-year Homelessness Plan was submitted to the Department of Commerce. Covid impacts are felt across all sectors, and eviction prevention programs are still the primary focus. Crossroads Housing has 400 households they are working with under the eviction prevention program to determine eligibility and provide financial assistance. The 5-year plan and report can be viewed here: 3 Local Government 5-Year Plans-Washington State Department of Commerce Applications were received and evaluated for a Housing Needs Assessment RFQ.The contract is being developed with plans to have it finalized by early December. Behavioral Health Mason County Mental Health &Substance Use Disorder(SUD) Response(7 programs) Staff: Abe Gardner, Christina Muller-Shinn,Audrey O'Connor Overdose Data to Action (OD2A) In September,the University of Washington's Addictions, Drug, and Alcohol Institute's 5-year PDO Naloxone grant officially ended. We are in the process of analyzing our data and will share results soon. Washington's DOH has been awarded the second rendition of PDO and have taken over all naloxone distribution in the state. Unfortunately, Mason County will likely be receiving less naloxone than we have in previous years; before we were able to get kits from both ADAI and DOH.This may reduce the amount of naloxone we give out in the community. We will continue to prioritize the people most likely to experience and witness an overdose, meaning people in active use and their immediate friends and family, but at some point,we may have to restrict the kits we have been giving out to community members who are less likely to witness an OD. Regarding the issue we wrote about during last report where a larger portion of opioid users— specifically individuals who are using the counterfeit fentanyl pills—are smoking their drugs and not injecting and are therefore not receiving overdose prevention education or naloxone from Public Health staff, a tool many programs around the state and country are using is providing safer smoking supplies at syringe exchanges. Many programs are reporting a significant increase in interactions with people who were not engaged in services before,which could be a major benefit in our rural community. Coincidentally,ADAI's 2021 syringe service program survey(this survey takes place every 2 years and informs state-wide policies and programs)that we participated in during this reporting period asked questions directly about this subject. Out of 30 people who participated in the survey: 27 people reported that they would want safer smoking supplies if it was offered, 2 said no,and 1 was not sure. When asked if they thought they would inject less often if they had access to safer smoking supplies through the program, 15 said yes,4 said no, and 7 were not sure.When asked how many people they know who only smoked drugs, and did not inject, responses varied widely; answers ranged from 0 to 30, with a mean of 12. Many people do request safer smoking supplies at the Substance Use Mobile Outreach,and mention that programs in neighboring counties give these out. Mason County may consider similar interventions as overdoses continue to rise sharply throughout Washington. In September,the Thurston-Mason Safety Net Counsel which OD2A staff Christina Muller-Shinn co- chairs, held the first of a three-part series on sex trafficking in our region.The first session consisted of a panel of outreach workers from agencies such as Innovations Human Trafficking Collaboration, Catholic Community Services of Western Washington's Arrest and Jail Alternatives, Department of Corrections, Capital Recovery Services,and Firefly describing what this issue currently looks like. There was strong attendance at this meeting,signifying this is a major topic of interest.The next session, on November 24,will have a panel discussing what is currently being done to address this issue,and the third will cover what gaps in services exist and ways the community can help support the work that needs to be done. Although Public Health staff have reached out to many agencies in Mason County to learn more about this issue locally,there has not been very much information available. It should be noted, 4 however,that sex trafficking and sex exploitation often occur to people involved with substance use. Support for victims and survivors is a gap that has been identified in our community. Substance Use Mobile Outreach of Mason County Substance Use Mobile Outreach had 74 interactions during this reporting period.Services continue to operate as normal. COAP/COSSAP(Community partnerships,Systemic change, Program coordination) The COAP/COSSAP project completed the four-year grant at the end of October. Staff is working with our researcher to put the final touches in the White Paper of the project. Mason County was honored by being asked to be one of four COAP/COSSAP projects to present at the 2021 Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) National Forum on November 17, 2021. The emphasis of system coordination,which the COSSAP project was highlighting,will continue to be a priority, and moving forward will continue to fall under the purview of Public Health as the backbone organization in Mason County. MCLEAD (Mason County Law Enforcement Assisted Diversion) Mason County's LEAD program is awaiting the new contract from the Health Care Authority (HCA). The program continues to do well. Mason County's program is being used as an example of program fidelity for other interested agencies in Washington State. The new contract with HCA will extend the program until 2023 and should be in place by the first of the year. Behavioral Health Navigator Program The Behavioral Health Navigator Program expanded services to include the Shelton Police Department as well as the Mason County Sheriff's Office during September and October. This expansion was made possible due to a partnership with Olympic Health and Recovery,who has hired and on-boarded new staff. Referrals have increased, and the program is a needed resource for our law enforcement as well as the clients being served. Behavioral Health Transportation Support(pilot program) The pilot program looking to provide at-will/low-barrier transportation for folks navigating the local and surrounding area's behavioral health system released a Request for Qualifications (RFQ) in September and received 3 proposals. These are under review with next steps to present recommendations to the County Commissioners, negotiate the contract, and implement the pilot project in January 2022. RCORP (Rural Communities Opioid Response Program) RCORP progress was slow during this reporting period. Mason Health's peer resigned in September,and their replacement was not able to start until the end of October. Olympic Health and Recovery Services have had a difficult time finding qualified peer applicants, so are not able to fully implement programming yet. However,they are in the process of developing their case management program and have started working with clients. September was the major data reporting period, so staff spent time working with the partners. 5 Substance Use Prevention Staff: Ben Johnson& Melissa Casey The primary goals are: 1) Establish and strengthen collaboration among communities and public and private non-profit agencies, as well as federal, state, local, and tribal governments to support the efforts of community coalitions working to prevent and reduce substance abuse among individuals 18 years of age and younger. 2) Reduce substance abuse among youth and, over time, reduce substance abuse among adults by addressing the factors in a community that increase the risk of substance abuse, and promoting the factors that minimize the risk of substance abuse. The newly developed Mason Substance Abuse Prevention Coalitions have continued to meet via zoom, most recently meeting together on projects that include all county youth. This year the coalition will focus on providing prevention programming throughout the entire county. We are happy to announce that the Mary M. Knight School District has agreed to assist with the development of a youth prevention leadership group at the Jr. and High school levels. We are also continuing our partnership with prevention leadership groups at the North Mason and Shelton school districts. We completed two virtual vape prevention trainings in October,facilitated by the American Lung Association.We are currently planning our second virtual Town Hall Event scheduled for Wednesday December 8th. Partners include Shelton and North Mason Youth Connections, iFiber One Radio, Cedar High School, Gay City Pride,Youth Marijuana Prevention Education and North Mason School District. Mason County Public Health and the Mason County Substance Abuse Prevention Coalition also partnered with Family Education Support Systems to provide Guiding Good Choices parenting training in October. Community Health Education, Assessment and Data Staff: Melissa Casey The second draft of the 2021 Community Health Assessment (CHA) is underway. Please continue to send comments and feedback to Melissa Casey at mcasev@masoncountywa.gov.The target deadline for the final CHA is by the end of the calendar year;work on the 2022-2026 Community Health Improvement Plan will begin after the start of the new year.The Mason County Community Health website (healthymasoncounty.com) is also being revamped as a hub for data and resources. We invite community members interested in joining the Mason County Health Coalition to please contact Melissa Casey at 360-427-9670 Ext 406 or.mcasey@masoncountywa.gov. Emergency Preparedness Staff: Lydia Buchheit,Alex Paysee,Sunni Evans, COVID-19 Response Staff: Rebecca Shipman,Jacob Ritter,Cesar Apaez-Mendiola,Alyssa Medcalf,Toni Monnier Welcome to our new COVID Team that has been hired to relieve our team that worked tirelessly for the past 20 months. A big THANK-YOU to Audrey O'Connor, Elizabeth Custis, Melissa Casey, Sunni Evans, & Alex Paysse for the incredible work they have done, along with other Health Department staff that pitched in during this very long COVID response. We are now giving the original team time to return to their previous public health work Our new team is busy with orientation,working with schools, and updating community information on vaccine boosters as well as vaccine for children. 6 COVID Curative Kiosks Elizabeth responded to our county need for COVID testing by researching options and worked with DOH to bring a Curative testing kiosk to Shelton and to Belfair. At that time,there was only one site for testing in the entire county and our COVID cases were rapidly rising. She connected with county agencies that could possibly accommodate the space for a kiosk, and then worked with DOH and Curative to make this happen quickly. With her diligence and hard work she was able to get a Shelton testing kiosk on Mason Health property near the Medicine Shoppe in August and in Belfair at the HUB for Seniors in September. Our thanks to Mason Health and the HUB in Belfair for agreeing to have a kiosk on site! We were the second county in the area to get this amazing resource, with Grays Harbor being the first. In September-October Mason County's COVID-19 cases had a rolling average of a high of 40 and a low of 27 cases over a 7-day period.The 7-day rolling average continues to drop and is now averaging below 20 cases. We want to give a caution about following daily case numbers as the numbers reported are dependent on when labs drop into the Washington State's disease reporting system, and due to glitches can be held up and then drop in all at once. making it appear as if there were many more cases on one day. It is best to use the trend of 7-day rolling average to better observe the disease in the community. You can check the Covid 19 data dashboard for the most up-to-date data. https://www.doh.wa.gov/Emergencies/COVID19/Data Dashboard#dashboard 7