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Home My WebLink AboutWAI2022-00033 - WAI General - 4/21/2022 r ,/ !' i 415 N.6th STREET,SHELTON WA 98584 l.� .,. r`\ MASON COUNTY SHELTON:360-427-9670,ext 400 f COMMUNITY SERVICES BELFAIR:360 275 4467,ext.400 ELMA:360-482-5269, ext.400 \,, - Building,Planning,Environmental Health,Community Health FAX:360-427-7798 Applicatiog for Waiver or Appeal Amount Paid: Q.-7 Receipt Number: as -0/0 a LI WAI tolls - Qoa -eroS3 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 NELSON C/O B-LINE CONST. INC. Telephone 360-426-4221 Mailing Address 2971 E PHILLIPS LAKE LOOP RD. City SHELTON State WA Zip 98584 Parcel No. 22104 -- 43 50200 -- Site Address 401 BENSON RIDGE RD. Subdivision Name and Lot LOT 2 OF LLS #20-02 PART 2: Nature of Waiver/Appeal rie Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: Date: Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) Appeal a/Waiver q:: None required r:: Class A VCIass 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 CONVENTIONA GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board V Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OU ED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION N (AFN ! 3767 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local poli h s been su mitted. Staff Signature: Date: y--'Z'(�� PART 4: Determinatio of e Hearing Official Li`The hearing officia as 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: Health Official Signature: Date: Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Pale 2 U£2 t MASON COUNTY MASON COUNTY PUBLIC HEALTH I ,? COMMUNITY SERVICES Y , CLASS B WAIVER WORKSHEET ti -f-�_ �4"�� Building, Health,Community Health 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 (State and Local waiver forms required) SHELTON:360-427-9670,EXT.400- BELFAIR:360-275-4487,EXT.400 ELMA:360-482-5269,EXT.400-FAX:360-427-7798 APPLICANT NAME NELSON CIO B-LINE CONST. INC. WAIVER PERMIT NUMBER WAI MAILING ADDRESS 2971 E PHILLIPS LAKE LOOP RD. ow SHELTON STATE WA ZIP 98584 SITE ADDRESS 401 BENSON RIDGE RD. �,n SHELTON TAX PARCEL NUMBER 22104-43-50200 PROPOSED DRAINFIELD TYPE 0 CONVENTIONAL GRAVITY M CONVENTIONAL PRESSURE 1.SOIL SERIES: S.VERTICAL SEPARATION: The sot series must be Alderwood,Harstine,Hoodsport, Up-slope vertical separation must be greater than 18" Shelton,or Sinclair Gravelly Sandy Loam. ,�,, for gravity and greater than 12'for pressure. Alderwood Gravelly Sandy Loam 8 ■. Greater than 12" 0 Harstine Gravelly Sandy Loam ❑ ®. Greater than 18" IN Hoodsport Gravelly Sandy Loam ❑ ill -Determined by: Shelton Gravelly Sandy Loam 0 0 Depth to hardpan Sinclair Gravelly Sandy Loam 0 0 Depth to mottling ❑ Other ❑ 0 Both ❑ ❑ 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy Sand,or Sandy If test holes show evidence of a seasonal water table Loam.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand E •1.ki -Evidence of seasonal water table: Loamy Sand Yes I 0 , � No Sandy Loam 0 t2 a „, Percent Gravel: ro -Curtain Drain required: 0 -Less than or equal to 35% M 0 � Yes El 0 -Greater than 35% El 3 No El1]/- rD rip 3.SOIL DRAINAGE: N 7.HORIZONTAL SETBACKS: 0 h I Soils must be moderately well drained to well drained. I Q Primary Drainfield must maintain 200'from down-gradi- ro ent marine shorelines,surface waters,and wells. z 8 ic-.e- .:(-- Well Drained Moderately Well Drained ❑ -Are increased horizontal setbacks met: Other 0 0 Yes Dia 6 No ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. Gravity is only allowed on slopes from 3%to 15%. A 50 foot horizontal attenuation zone is required Pressure is allowed on 3%to 30%. down-gradient of the primary drainfield. Less than 3% ❑ ❑ -Is there 50 ft or greater between the•• 3%to 15% gradient side of primary drain - d and 16%to 30% 0 K property boundary: Greater than 30% ❑ 0 Yes ® ❑ No 0 0_. The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildab - I � � prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: 111 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof ot Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE update 17 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. l (completed by applicant) Name: (1) NELSON C/O B-LINE CONST. INC. Local Health Department/District (2) (see instructions) Address: 2971 E PHILLIPS LAKE LOOP RD. SHELTON, WA 98584 360 426-4221 Telephone: ( ) Signature: Property Identification: (3) 22104-43-50200 Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR PRESSURE OSS (OR) Subsection: TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS 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: 2L1-g 371 ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) 4--Cvt/140 Id-, zoitic < Q�f,...1.re ,lo r t v( � 4 npv w1 PP Comments/Conditions: (10) Type of Waiver: (Li) [ ]Class A C ass B I ] 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 IV. 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 [( Approved /Granted—Subject to all comments,conditions and requirements t ted in S• Lions II and Ill. 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