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Home My WebLink AboutWAI2022-00046 - WAI General - 4/14/2022 ,1 415 N.6th STREET,SHELTON WA 98584 .,7 .' MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 J.`„r.. ELMA:360 482 5269,ext.400 y,4 Bu �rpr�pyij�� •mmunity Health r� <.,. i11..11�� \\VVVV// FAX:360-427-7798 APR°`134) Rp eg for Waiver or Appeal Amoud Paid: ' ' Receipt Number: 2 o WAI ��- epooti6 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 SLroi d- >3o66 Loudiovk Telephone Mailing Address �7y5 Sc /104/Le, &..//a Pi- City Po fl- 3 ftL oicA State w Pt Zip 9 1 36 7 Parcel No. a 3 .3 I -- 5 of -- O 0 U L. (o Site Address ;ql c - 1.A/ , T&LLAye, Subdivision Name and Lot PART 2: Nature of Waiver/Appeal lY Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations O 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 O Contractor Certification Requirements ❑ 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: Z'ZZ-ZozZ 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 VWaiver ❑ None required ❑ 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 PRESSURE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board EY Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTL HIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (A N 2t Y5 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local polio has been submitted. /66 Staff Signature: t/U ('L' Date: 5-c? 7.2 PART 4: Determinat on 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: Health Official Signature: Date: ��-17--- Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY LLM1 , r COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH \ - Building,Planning,Environmental Health,Community Health CLASS B WAIVER W O R KS H E ET 415 N.6TH 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 APPLICANT NAME V a 9 2- go61D t Monte-Loudon I P WAIVER PERMIT NUMBER WA I MAIUNG ADDRESS 774.SI_ SG Rt.-An \ 1 9� /µ� AQ �J CITY I0r` 0fC�Gla STATE uV/' J /ZIP 1 �+L3� 1 SITE ADDRESS I I•/�r�'//�� jR�jAIO►7[(GC. LA) CITY /O' 1)b"/A TAX PARCEL NUMBER p`OI 313 I- 5 Z-oc0 L-16 PROPOSED DRAINFIELDTYPE 0 CONVENTIONAL GRAVITY [<ONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil 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 0 ❑ Greater than 12" M/ ❑ Harstine Gravelly Sandy Loam El El Greater than 18" 0 ❑ Hoodsport Gravelly Sandy Loam Ci ❑ -Determined by: / Shelton Gravelly Sandy Loam lit El Depth to hardpan Li El Sinclair Gravelly Sandy Loam 0 El Depth to mottling ❑ ❑ Other 0 ❑ Both ❑ El 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 0 0 Z -Evidence of seasonal water table: Loamy Sand ❑ 0 o' Yes 0 z ❑ ro Sandy Loam LJ ❑ 'st- No ❑ - Percent Gravel: a -Curtain Drain required: p -Less than or equal to 35% ❑ fl Yes ,❑,( CI-Greater than 35% 0 El 3 u No ❑ ro 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: ' ro C Soils must be moderately well drained to well drained. I p Primary Drainfield must maintain 200'from down-gradi- ro �,{ . ent marine shorelines,surface waters,and wells. Well Drained LYJ ❑ , Moderately Well Drained El El -Are increased horizontal setbacks met: 1 Other ❑ ❑ Yes IJ 0 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% ,.❑_/ El -Is there 50 ft or greater between the down 3%to 15% pp 0 gradient side of primary drainfield and 16%to 30% ❑ ❑ property boundary: / Greater than 30% 0 0 Yes (� ❑ No ❑ 116 The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable �/ ,� prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AF : ( 4 61 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSIIE. updated 3/2/20 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. (completed by applicant) Name: 1 Local Health'Department/District OP (2) 1..Oin61cn (see instructions Address: . 7/.795 sE 0I04i - Ba6-p� - -- - -- - — ------------- -------------- -- --------- ----- ------------- ---------------- ---- - ----- --- Telephone: (360 ) $`1I .3Wit Signature: ply 4.vT Property I entification: (3) D�Ccd�— as 3.3 I.: 52-_600_9_6___-- Section IL (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) ---------------------- -------------- -------------------------------------- -------------------- 246-272A— 0230 24" OF V/S FOR PRESSURE ,_ - 12" OF V/S FOR PRESSURE OSS --------- ----------------------------- ---------------------------------------------------------------------------------------Subsection: TABLE VI 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: 2/1S (13‘' � ) Section'III. (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) 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 IV. (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 ,pproved /Granted—Subjec to all • ents,conditions and requirementsAZZ- noted in Sections II and III. Local Health Officer (13) / Date: 2— DOH 337-021 Page 26 of 32