HomeMy WebLinkAboutWAI2023-00004 - WAI Health Waiver - 1/13/2023 AEI
y 'ktb. �— 415 y STREET,SHELTON WA 98584
MASON COUNTY HOZ I NV(' HELTON: 360-427-9670,ext 400
COMMUNITY SER'\ C iLFAIR:360-275-4467,ext.400
� U ELMA: 360-482-5269,ext.400
07 Budding.Planning.Environmental Health.Community H.J
-•!*r i(A. -- FAX. 360-427-7798
Applicationat for Waiver or Appeal
Amount Paid: , O\CI.JJ _ Receipt Number:
WAI aor, - 00o out
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 Seo0._ -7 c 0 — 0 001
Name of Applicant l'--A LkG S- Telephone 3(s - Z i - (1)0 3 e
Mailing Address 'it3 tS- S -
City U-11_ State CJ k Zip Ci (i S-i r r
Parcel No. \ y 0 -- -- 9 0 c) 3 v
Site Address n C.C,i.1 _ s.L • S,I 1,--071f
Subdivision Name and Lot cj — c t>k-x.T 3 \. A- l
PART 2: Nature of Waiver/Appeal
CCil 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: I (..32—'4n
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page I of 2
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PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
n Appeal k'Waiver n None required ❑ Class A ti'CIass B E 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:
O Board of Health ❑ Health Officer
O Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board ISZ Environmental Health Manage
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 1,1g2-to3(o )
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: r'/t Date: (7-S17-
ql PART 4: Determination 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:
❑ 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: l/ 3 03
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 MASON COUNTY PUBLIC HEALTH
'.p
f COMMUNITY SERVICES
CLASS B WAIVER WORKSHEET
�
�: Building PlannLiy.Environmental Health,Community Health
415 N.8TH STREET,BLDG 8,SHELTON WA 98584 (State and Local waiver forms required)
SHELTON:380-427.9870,EXT.400 -BELFAIR:380-275.4487,EXT.400
ELMA:360-482-5289.EXT.400 - FAX'380-427.7798{ n
APPL l>ICANT NAME ' . NC,d. -y� � r �` WAIVERV V PERMIT NUMBER A I 'T3— 1 )0 W�
MAILING ADDRESS i 5 Col- 3 Ci`^K) "�1 V----1 1 . S'-�t t •.-}
P crry V.�U0.. --Se��CC� -ems (� STATT C.,j4' ZIP �` d S, `9
SITE ADDRESS '7 00 S S're�`Z AA,�•A. V D L f� J -e • CITY - L'-cJ t`.
TAX PARCEI.NUMBER " ` l7 .-- \ ` " 'U 0 3 0 PROPOSED GRAINFIELD TYPE 0 CONVENTIONAI.GRAVITY CONVENTIONAL PRESSURE
1.SOIL SERIES: S.VERTICAL SEPARATION:
The soil series must be Alderwood,Harstlne,Hoodsport, Up-slope vertical separation must be greater than 18"
Shelton,or Sinclair Gravelly Sandy Loam. ,,,,��{{ for gravity and greater than 12"for pressure,
Aiderwood Gravelly Sandy Loam Et ❑ Greater than 12"
Harstine Gravelly Sandy Loam 0 ❑ Greater than 18" ❑ ❑
Hoodsport Gravelly Sandy Loam 0 0 -Determined by:
Shelton Gravelly Sandy Loam 0 ❑ Depth to hardpan ❑ 0
Sinclair Gravelly Sandy Loam 0 0 Depth to mottling ❑� 0
Other 0 IF Both L.,/ R
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 C5K Z -Evidence of seasonal water table:
Loamy Sand DI ro Yes 0 0
Sandy Loam L i' ❑ z No 11Ct. Y'
-Curtainst
CD
Drain required:Percent Gravel: 9
-Less than or equal to 35% [ o Yes ❑ ❑ -
Greater than 35% 0 ❑ No a I ' 3
3.SOIL DRAINAGE: 7, HORIZONTAL SETBACKS: n
ro
I Soils must be moderately well drained to well drained. ! O Primary Drainfield must maintain 200'from down-gradi- ro
ent marine shorelines,surface waters,and wells. z
Well Drained ❑ ❑ s`
Moderately Well Drained 9' -Are increased horizontal setbacks met:
Other ❑ ❑ Yes
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 309'0. down-gradient of the primary drain field.
Less than 3% ❑ 0 -Is there 50 ft or greater between the down
3%to 15% 1.2 51, gradient side of primary drainfield and
16%to 30% ❑ 0 property boundary:
Greater than 30% 0 0 Yes
No ❑ ❑
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, AFN: ZA a_ Sc.a
parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof o&Recording:
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSfTE. updated 3/2/2017
1 1
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 `'VAC)
Request for Waiver from State Regulations
Section I. (completed by applicant)
Name: (1) Local Health Department/District (2)
t�l b►�._ �= s __....._ ...� see instrerctions)
Address:
Telephone: (3(a3)
- 0038
Signature:
Property Identification: (3)
A4Lc. Q S,
Section II. (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: 2 etz3 )
Section III. (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Comments/Conditions: (10)
Type of Waiver: (11) I ] Class A Pa Class 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. (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 yj Approved /Granted—Sub'ect to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13) Date: � 0 /1-1
DOH 337-021