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Home My WebLink AboutWAI2022-00083 - WAI General - 6/17/2022 ,C�,C31'l CO j,v . . .,),,, - ..... Public r, Healt Always working fora safer a healthier Mason County PO Box 1666,415 N 6th Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 Belf Fi (t60) 42�67 ext 400 ❖ Elma: (360)482-5269 ext 408 AX O� (jy � �.� Application �for Waiver/Appeal ./r � > Amount Paid: � ReceiptNumber: •® ()®? .7 / WAI xZc_- OQc_5.T e® ee Instructions ee 1. Complete Parts 1 and 2.No determination can be made until these parts are ft�11v completed. 2. Fees may be billed for waivers and appeals,based MasonE County Public Health for revHealth Fee iew. 3. Submit completed application with attachments PART 1.Applicant/Parcel Identification r ` Ye, Telephone d 1- 4 111 Name of Applicant Y' D,� v Mailing Address of Applicant i n0 Fw _ a_`1 City C7 r .:2V Z State WA Zip ` 854(P 2 Z t l 4 -- -- g o 12-digit Tax Parcel No. �7 p �y�j Site Address E W ' ` d G'''o'"p 2" W cL ) " ra.-�e I e V.1l u3 r v -ig-54 � � y S gas Subdivision Name and Lot L d i" ZJ 0E- L 5 01 `C e s PART 2: Nature of Waiver/Appeal '41 Class B Reduction in Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 ❑ 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.): au., ` erg C` -(:) ' eell_e-�l Applicant Signature: N\Rice Date: 6 -(7-Z-Z- r.�v C` „ „y" " � —t 0 --,-vLp/1. Revised 1/22/2015 This form may be scanned and available for public view on the Mason County Web site. Page 1 oft 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 ci-Gass B ❑ Class C ?. Identification of Specific Code/ Standard/Determination(include dateofodetermination or latest Code/Standard revision): Wk C_ 7 y�- 3. Nature of Appeal` Pere l ): �, ,c,� f er ,'�"s s`"`. ` -` )44 • 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Public Health Director El Pollution Control hearing Board nvironmental Health Manager Ill Contractor Review Board . 5. Mitigating Factors: IAjJ.r_ Vr Z � °"- 2.11313 7 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: '1 11 I Vzrti PART 4: Determination of the Hearing Official 1231_ 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: Hearing Official Signature: )(K Date: 7®7Z-2- / ' tr222oi5 Revised This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) R.- $uest for Waiver From State R• ' ations Section L (completed by applicant) Local Health Department/District (2) Name: (1) - see instructions Address: O VV �(. r Telephone: (j(26) O 4'i l property Id-I: cation: (3) 0-1' . L. S -- Section II. (completed by applicant) Waiver Sought: (6) ��lt,c ti WAC Requirement: (5) WAC Number: (4) --C��e , , 1 . 246-272A— �,1 �vvu,w -'64- I Z Subsection: �1 �D t � 1 . be provided): (� - 1 Justification(mitigation measures to P ► : L - s Q ► - - - :,1 4 - .on TEL (complete,by health officer) Mitigation Measures(in addition to those proposed): (9) Review Criteria (8) --._. Comments!Conditions: (10) _ -_ _ _ _..---- -- DOH review before granting? Yes— No Type of Waiver. (11) [ ]Class A 0 Class B [ l Class C—Request Neighbor Notification: (12) Yes NO— Required? Yes No— If needed are agreements,easements,etc.properly filed? Section IV. (completed by health officer) 246-272A WAC On-Site This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 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. nts . :. in Sections II and III. [ l Denied �pproved/Granted—Su.je to all comments,conditions and requireme nts ' ?i' AI Health Officer (13) Date: 7 r 19 • '� k MASON COUNTY PUBLIC HEALTH �G�t CLASS B WAIVER WORK51-{EET Public - �H (State and Local waiver forms required) Always working for a safer healthier Mason County PO Box 1666,415 N 6th Street,(Bldg 8)-Shelton WA,98584 Shelton:360-427-9670 ext 400 Belfair.360-275 4467 ext 400 1, WAIVER PERMIT NUMBER AI �� Y 'Ah aYre. APPLICANT NAME �!J� kdo MAILING ADDRESS (�/n `�O e_ w 1 k5t5v PP �� " SPATE myGuJ CTTY G_—e-i e..v//y _ — SITE ADDRESS l/�`" 'ICI �ONVETQnONAI PRESSURE //► _Goo D PROPOSED DRAINFIELDTYPE ❑ CONVENTIONAL GRAVITY l�pc, TAx PARCEL NUMBER f.� - `'�v 5.VERTICAL SEPARATION: 1.SOIL SERIES: Up-slope vertical separation must be greater than 18 The soil series must be Alderwood,Harstine,Hoodsport, for gravity and greater than 12"for pressure. Shelton,or Sinclair Gravelly Sandy Loam. / � rA T5� Greater than 12"..........._......__......................._................ Loam..............._.............."""�„ 0 Harstine e Gravellyd SandyGravelly SndyGreater than 18"..........._......_......................Harstine Loam....................... � 0 -Determined by: 0 Hoodsport Gravelly Sandy Loam................................ ❑ Depth th mto hardpan..............__......_......._...........,_.. ....... ❑ Shelton Gravely Sandy Loam...................................... ❑ El Depth to mottling .. .......Sinclair Gravelly Sandy Loam..............................• ......❑ 0 Both...................................-........._............ Other 6.WATER TABLE LEVEL' 2.SOIL TYPE: If test holes show evidence of a seasonal water table Soil 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%. 0 ❑ -Evidence of seasonal water table: ,..� , MediumSand..............._.........._. „� � Yes...................................-..._---...._. _ LoamySand..................._....__............................................ ❑ 3 No p ••••••.-.... . "— p Curtain Drain required: PercentSandy Loam Gravel:....._........................ ❑ CI o 0 a Yes.........__......_ .................._. -Less than or equal to 3596 CI 0 � No � 7.HORIZONTAL SETBACKS:Greater than 3590 ra � 3.SOIL DRAINAGE: 9 f9 Primary Drainfield must maintain 200"from down-gra i- en Soils must be moderately well drained to well drained. O WellDrainedent marine shorelines,surface waters,and wells. on ❑ 0 -Are increased horizontal setbacks met: ns Moderately Well Drained Yes.........-•_ _ ❑ Other .............. 0 CI ‘g 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. A SO foot horizontal attenuation zone is required Gray ty is only allowedon slopes from 3%to 15%. down-gradient of the primary drainfield. Pressure is allowed on 3%to 30°h. -Is there 50 ft or greater between the down ....... --••••••'•"'•"""" ❑ 0 radiant side of primary and Less 3% ohan 3%........................_....__. er CI Cl property boundary: 16%to 30% ❑ ❑ Yes — El than 30%......._.._................................ No roe as unbuildable �, 3 The 50 foot horizontal attenuation zone is required to be recorded orn the deed of the p P atilda r+rly Proorof Recording: prior to design apPro`�l•?F'e attenuation zone is not to be used for the contruction of roads,deco,p updated zrvzo1s parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. 7I-U5 FORM MAY BE SCANNED AND AVAILABLE FOR PUBLJCVIEw ON THE MASON COUNTY WEBSITE 2183337 MASON CO CIA 06/1712022 01:41 PM DECL BRIRN JARRETT 0176281 Rec Fee: $204.60 Pages: 2 1 III i III1I II III IIIIII Iii1111II1 II11111111111111Ili Ifi l I111 I111 Return To Brian Jarrett - 630 E Wilson Way Grapeview, WA 98546 Grantor(s): (1) Brian Jarrett , (2) —- Grantee(s): (1) PUBLIC -- — — _w--_- - - - Legal Description (1) Lot 3 of LLS #07-08 S 38/108, SEC14, TWP21 N, R2W (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 22114-14-50030 DECLARATION OF COVENANT FOR ON-SITE SEWAGE ATTENUATION ZONE 1 (We)the grantor(s) herein, am (are) the owners in fee simple of(an interest in)the described real estate situated in Mason County, State of Washington; hereby declare this covenant & place the same on record; to wit the described real estate on which the grantor(s) owns and operates an on-site sewage disposal system which has been granted a Class B State Waiver to reduce the Minimum Vertical Separation requirements and grantor(s) is (are) required to maintain a 50-foot horizontal attenuation zone down gradient of the on-site sewage system to facilitate treatment of the sewage effluent. It is the purpose of these grants and covenants to prevent certain practices hereinafter enumerated in the use of the grantor(s) land which might encumber the land set aside for further sewage treatment and disposal. NOW, THEREFORE, the grantor(s) agree(s) and covenant(s)that said grantor(s), his (her) (their) heirs, successors and assigns will not construct or install any trench, channel, ditch, road cut, utility chase, or other structure of excavation what would intercept or serve as a conduit for migrati ground water. Dated on this, / day off �-�-ri-�— , 20 Page 1 of 2 Signature of Grantor . (1) / (2) State of Washington ) County of Mason • ) I, the undersigned, a N t Public r _andr the above named County and State, do hereby ce ify that on is / day , 20 ! r ter— 9 -- �rr 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 da year last ab otary P is i and for the State of Was ington, CHARLES G RHODES residing at ,-L��-1,jet Notary Public My commissi expires:0o+/. l� State of Washington 9 License Number 114075 My Commission Expires November 21, 2026 Page 2 of 2