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Home My WebLink AboutWAI2022-00089 - WAI Health Waiver - 7/13/2022 • 415 N. 6th STREET,SHELTON WA 98584 MASON COUNTY SHELTON: 360-427-9670,ext 400 11' COMMUNITY SERVICES BELFAIR:360-275-4467, ext.400 ELMA:360-482-5269,ext.400 '-• — Budding.Planning,Environmental Health,Community Health FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: Zn • Receipt Number: WAI ZV VI. — vVd�j9 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 &nnPLarcel Information Name of Applicant J'\ll 1 S 11l oil S Telephone Mailing Address 739 1D�sh 14 t1 Pc,,(K ISLV P City K n oX Vac_ State Zip 29 Parcel No. 3 2 z 7) 5 -- L. 3 -- 61 o I 6 Z. Site Address l Z`tO I ;,,v, I Acs DR hi0A D -F Subdivision Name and Lot JUL 1 3 2022 _L L I PART 2: Nature of Waiver/Appeal By ,t40� • 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 CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: Date: -7 • 15- ZO Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal N./Waiver i None required -_ Class A '/Class 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 CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer 0 Pollution Control hearing Board 0 Public Health Director 0 Certified Contractor Review Board V Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN Z.LQj�LC-7(p ) 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: fi:th\D-1 l `n Date: it) I l I LZ PART 4: Determination of the Hearing Official 14- 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: /y ised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Il. \', MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building Planning,Eiwwnmental Health Community Health CLASS B WAIVER WORKS H E E T 415 N.6TH STREET,BLDG 8,SHELTON WA98584 (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 BA" P 31 VAC2INS WAIVER PERMIT NUMBER WAI It) ✓.7.-- 0O01:3 61 MAILING ADDRESS ),—)54 g IAsn'c J- PO1 r\< &I..VP � CITY l{�1,V; (IG STATE i N ZIP 3"79 Z// SITE ADDRESS 12'1 0 E I rry.,b<r T p1.s D CITY (11;o V1 TAX PARCEL NUMBER 3 Z Z 3 3-'1 3- cl 01 b z PROPOSED DRAINFIELD TYPE IA CONVENTIONAL GRAVITY ❑ CONVENTIONAL 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 ❑ ❑ Greater than 12" ❑ ❑ Harstine Gravelly Sandy Loam 0 ❑ Greater than 18" ❑ 2/ Hoodsport Gravelly Sandy Loam ❑ U, -Determined by: Shelton Gravelly Sandy Loam L� Depth to hardpan ri V Sinclair Gravelly Sandy Loam ❑ ❑ Depth to mottling ❑ Cl 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 ❑ ❑ _ -Evidence of seasonal water table: Loamy Sand ❑ ❑, , Yes 2. i Sandy Loam [ I's No I l Percent Gravel: -Curtain Drain required: p -Less than or equal to 35% d 121 Yes y �co � -Greaterthan35% ❑ El No 3. SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: z F. c Soils must be moderately well drained to well drained. O Primary Drainfield must maintain 200'from down-gradi- r° ent marine shorelines,surface waters,and wells. 0 z Well Drained L U/ - t& ' Moderately Well Drained Ltd" -Are increased horizontal setbacks met: Other 0 ❑ 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 30%. down-gradient of the primary drainfield. Less than 3% ❑ CI -Is there 50 ft or greater between the down 3%to 15% g 11V gradient side of primary drainfield and 16%to 30% ❑ ❑ property boundary: 1 Greater than 30% ❑ CI 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: 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 WEBSFTE. updated 3/2/2017 • 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 (2) YYtO\5 (see instructions) - Address: 'v E -i'm b-er 1-4,s De. Untoh-_ WA Telephone: (ie) ZO$ - 3 q ZO Signature: Property Ide 'cation: (3) o-Cc4l # ZZ35- 1-13-...1OIbZ Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 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: 7-t$nC1-76 ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) [ ]Class A VI-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 4Approved /Granted—Subject to comments,conditions and requirements(j' noted in Sections II and HI. Local Health Officer (13) Date: r/70-L DOH 337-021 Page 26 of 32 2187976 MASON CO WA 09/19/2022 11:45 PM DECL IIIIIII IIIII IIF fill IIIIIII IIIII Fos.Ilf M5203.50 IIIIIIItll III I UIII I1fl lilt IIII • Return to: O Phirip Simons and Debra Simons 1916 MOBLEY WAY APT 101 KNOXVILLE TN 37922 0 DECLARATION OF COVENANT R ON E SEWAGE ATTENUATION ZONE I(We)the undersigned grantors hereby declare thi vena d place the same on record. I (We)the grantor(s)herein,am(are)the owners in fee simple of(an interest in)the following described real estate situated in Mason County,State of Washington;to wit (Division and Lot Number or Ran Township/Section Number. Note: Range,township,section numbers are the 1 u 5 digits of the parcel number) OR 3W 22N 35 Subdivision D'vision Lot Range Township Section and having the Tax C um 3 2 2 3 5 _ 4 3 -- 9 0 1 6 2 on which the granto. s • • operates an on-site sewage disposal system which has been granted a Class B Waiver to redu iV ical Separation requirements and grantors)is(are)required to maintain a 50-foot horizontal att••u . gradient of the on-site sewage system to facilitate treatment of the sewage effluent. It is the •• ..s- , these grants and covenants to prevent certain practices hereinafter enumerated in the use of the grant. )l: • ich might encumber the land set aside for further sewage treatment and disposal. NO •,T .EF a' ,the grantor(s)agree(s)and covenant(s)that said grantor(s),his(her)(their)heirs,successors and •, ' s will not construct or install any trench,channel,ditch,road cut,utility chase,or other structure of • :t . .hat would intercept or serve as a conduit for migrating ground water. Dated . th' /Z-r:A day of /ode✓ ,20 ZZ. de,/i a -...,-- ---- D"4-'1. i --RSPLA/Thisr\Al Signa .re Signature State of Washington-TEr14 ESSEE ) County of-Macon. KAray ) I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this Ia day of S EP ,20?a , QNILW 490 Q t'.SQ4 SIAO4S 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 day and year last above written. - Notary Public in and forihe State of Wa3hiegtenl leNAESSLE G/45"11% residing at 1.0Joy (.00,7`( My commission expires: h10.30.42.4 STATE 1 Of TENNESSEE NOTARY pu8LIC 'fix cO Gmaii Kenn Webb <kenn@acmeseptic.com> Re: Parcel 32235-75-90174 1 message mcposk@outlook.com <mcposk@outlook.com> Wed, Aug 17, 2022 at 9:36 PM To: Kenn Webb <kenn@acmeseptic.com> Correct, no well is located on the property, however a septic system has been installed. From: Kenn Webb<kenn@acmeseptic.com> Sent:Tuesday, August 16, 2022 1:47 PM To: mcposk@outlook.com <mcposk@outlook.com> Subject: Parcel 32235-75-90174 Hi Leo, thank you again for taking my call a few minutes ago. I just want to confirm that your parcel (32235-75-90174) on E Timber Tides Dr. currently has no wells nor any wells in the process of being drilled. Is that correct? Thank you for confirming, Kenn Regards, Kenn Webb Acme Septic Design & Maintenance Licensed Designer Drafting Supervisor 360-698-8488 Kenn@AcmeSeptic.com • WE ARE A GREEN COMPANY AND CONDUCT OUR BUSINESS VIA INTERNET. PLEASE CONFIRM RECEIPT. It is the sole responsibility of the customer or representing agent to provide Acme in writing with any and all information pertinent to the septic feasibility and/or design including utility location, property dimensions, easements. buffers. and setbacks required by governing or regulating entities. ,00'99 I. v >m D0) zm :xi m< vm D X . //' ‘ //::/' Z r G) v W m N.) N -0 X WCP D cn 0 � n o0 � yr� _O �\ G.,\ v $ AMINIMININI m z 7 O v -9 CO p • ; 3 nNoz isiol vnrr uVr,os 4 -OA 'd I --0 ' i 3A213S'it p r `\ %00L 10 A r b m 3NOZ crone ON,OL , H° 0 ?935%13 , 13.0- s II1{l oL e 3SnoH be-? o3S0dO d 3�lW'13$V3 LL(1 AL i ye ca to cn o ' d3S d02ld I +t I i. _ •. . .-49..- .AV, I 1 et 03SOd(Nd 9 3dO13AN3'JNIOIIws 1 `: 1 I ' �� 9AI?:Ia S Oft H291A1I± 3