Loading...
HomeMy WebLinkAboutWAI2023-00033 - WAI Health Waiver - 4/12/2023 11 ` 11 i ql I I ' MASON COUNTY 415 N.6`h STREET,SHELTON WA 98584 SHELTON: 360-427-9670,ext 400 411111° .'- ' COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 Building,Planning.Environmental Ilealth,[unununity tiueRl ELMA:360 482 5269,ext.400 FAX:360-427-7798 • Application for Waiver or Appeal ll22 � - Amount Paid: LTJ5 - Receipt Number: 0 , G ',1-p WAI at) 1.")_ " b ol0 3 APR 12 2023 , Instructions: By_.___ .i 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 ,5-4J tr 20 Z 2- 0 U G Z8 Name of Applicant NOEL/KATHY MAGNUSSON Telephone 360-789-4080 Mailing Address 211 E AGATE RD City SHELTON State WA Zip 98584 Parcel No. 3 2 1 2 7 -- -- 5 4 0 0 0 7 7 Site Address 211 E KILMARNOCK RD, SHELTON, WA. 98584 Subdivision Name and Lot • PART 2: Nature of Waiver/Appeal ISe Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations 14 0 Location. WAC 246-272A-0210 0 Water Adequacy Requirements 0 Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ 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 . PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: C.- Date: ri 7 1 7.0 243 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 v'Waiver None required Class A n'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 PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board &( Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN I C(r� ) 33 ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local is has been submitted. Staff Signature: #I (1\ U�A' Date: ce— /-(-2,3 PART 4: Determin do - Hearing Official Cg_. 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: `t/(/'-- Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2of2 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. I (completed by applicant) Name: (1 Local Health Department/District 2 EL AND KATHY MAGNUSSON P () (see instructions) Address: 23871 E AGATE RD SHELTON, WA. 98584 Telephone: ( 360)789-4080 Signature:e/ /totef 41/) Property Identification: (3) 32127-54-00077 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 . 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:_ ) Section III. (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) /w/t( a7ce 4 86*ar wtAyec Are rot/ kle I IP re r Comments/Conditions: (10) Type of Waiver: (Il) [ ]Class A 1)1]Class B [ ]Class C—Request DOH review before granting? Yes— No)( Neighbor Notification: (12) Required? Yes No X !f 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 no ed in Sections II and III. Local Health Officer (13) _ Date: 1,/Z J DOH 337-021 Page 26 of 32 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES Building,PlanningEnrwnmental Health,Community Health CLASS B WAIVER WORKSHEET 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.380-427-7798 APPLICANT NAME NOEL AND KATHY MAGNUSSON WAIVER PERMIT NUMBER WAI MAILING ADDRESS 871 E AGATE RD CITY SHELTON STATE WA zP 98584 SITE ADDRESS 211 E KILMARNOCK RD CITY SHELTON TAX PARCEL NUMBER 2 3 1 2 7-54000 7 7 PROPOSED DRAINFIELD TYPE O CONVENTIONAL GRAVITY ® CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soli 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" 0 ❑ Hoodsport Gravelly Sandy Loam ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam ❑ ❑ Depth to hardpan Ii 0 Sinclair Gravelly Sandy Loam ❑ 0 Depth to mottling 0 ❑ Other _ 0 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 0 0 -Evidence of seasonal water table: Loamy Sand 0 &.. Yes ❑ 0 m Sandy Loam El © Q-- Percent Gravel: ( -Curtain Drain required: p Less than or equal to 35% ® ❑ o Yes ❑ ❑ o Greater than 35% 0 0 No © O___74. ro ro 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: al c Soils must be moderately well drained to well drained. 0 Primary Drainfield must maintain 200'from down-gradi- ro z ent marine shorelines,surface waters,and wells. O Well Drained 0 `c Moderately Well Drained ❑ ❑ -Are increased horizontal setbacks met: Other 0 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% 0 ❑ -Is there Soft or greater between the down 3%to 15% ® 0 gradient side of primary drainfield and 16%to 30% 0 0 property boundary: Greater than 30% ❑ ❑ Yes 0 ❑ No ❑ The S0 foot horizontal attenuation zone is required to be recorded on the deed of the property as unhuildable G� ' prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: "0 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 WEBSITE. updated 3/2/2017 (/✓W L.'kd c) eist4 11ar L.ei.4 atvrN✓s4 • # MASON r V, i j ' *1. • ay s;• b.� 3 ,7 ft • ,- y y j may,. t 4` C ea• 1 `c CV _ _ tc 7• ,,� lay.iii ✓: Y f�`' '� If S e ' 15 o C r I m d A t-' ,Jr f � ;i c. �.. /�-t-._--r+ �, �, ,•ram % k,t i 2 v , �� -ti i �3 25 t t,--,._ f� 8 ;,•�i.j f • fi; f q0 cn v �' .1f � t t` • m m o0 Y tt�i,J;• I v, cCp i.'� o sv a _ - 1� 1 , y 1 gm o • � ,. d $ m 1 1 • 1 t`(g 11-L 4. o f E E + ''' rY+ I �. R J'2 o c ! s N -g - 4•-I 0.� E. m J Q Z 'tali to it `_. r it _�, .e. 0 - _N E ///�/ { t� "Cr"--N. _ h C F ..-✓+•. vp ytr' •�--- 1 -r i_ ••. ` it a' a ...L.- _ • ,l__.. • N a /// try -6/ 5:•t --- �• ...-- fr a, r" •-w 8'` Bayshore �' ' ' — '. '_,1 sr j? Pt / -___•-."�'�`'`-'_ .:,I' t�uz 4 '