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Home My WebLink AboutWAI2023-00030 - WAI Health Waiver - 3/30/2023 415 N.6th STREET,SHELTON WA 98584 .\.. MASON COUNTY SHELTON:360-427-9670,ext 400 ( COMMUNITY SERVICES BELFAIR: 360-275-4467,ext.400 ELMA: 360-482-5269,ext.400 Building.Planning.Environmental Health,Community Health / FAX:360-427-7798 Application for Waiver or Appeal ' ^ Amount Paid: Receipt Number: MAR 3 01023 WAI 11) - OID By `s: 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 ROUSE CIO B-LINE CONSTRUCTION Telephone 360-426-4221 Mailing Address 2971 E PHILLIPS LAKE RD. City SHELTON State WA Zip 98584 Parcel No. _3_ _2 _ _ _5_ -- _4_ _ -- _a _a _L Site Address 1122 E CRESTVIEW DR., SHELTON, WA 98584 Subdivision Name and Lot TR 1 in SE SE EX PART 2: Nature of Waiver/Appeal IS2/ Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations O Location, WAC 246-272A-0210 0 Water Adequacy Requirements O 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: 1.GS Date: 24 MAL 21 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 ,/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 0 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 ZV f S7Z I 1. 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: "X'V) Date: 13'1;7D PART 4: Determination of the Hearing Official jgi. 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: `f'' 6/Z 3 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 COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Bwlding,Planning,Environmental Health,Commu nay Health CLASS B WAIVER WORKSHEET 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:380-482-5289,EXT.400- FAX:380.427.779E �f APPLICANT NAME ROUSE C/O B-LINE CONSTRUCTION WAIVER PERMIT NUMBER WA I v- `,�}� _ v 3 0 MAILING ADDRESS 2971 E PHILUPS LAKE R0. CITY SHELTON STATE WA ZIP 98584 SITE ADDRESS 1122 E CRESTVIEW DR..SHELTON,WA 98584 CITY SHELTON TAX PARCEL NUMBER 32015-44-00010 PROPOSED DRAINFIELDTYPE ® CONVENTIONAL GRAVITY 0 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" ❑ 0 Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" X Hoodsport Gravelly Sandy Loam ��❑ttt1 ❑ -Determined by: Shelton Gravelly Sandy Loam 'M ❑ Depth to hardpan ❑ ElSinclair Gravelly Sandy Loam ❑ Depth to mottling ❑ Other ❑ g 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 ❑ I o Yes K 0 Sandy Loam o- No ? Percent Gravel: -Curtain Drain required: O Less than or equal to 35% n Yes sX4ro -Greater than 35% No ❑ ❑ 3 ro 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: z N V, Soils must be moderately well drained to well drained. O Primary Drainfield must maintain 200'from down-gradl- rL ent marine shorelines,surface waters,and wells. 70 Well Drained El -c Moderately Well Drained -Are increased horizontal setbacks met: Other 6 ❑ Yes K 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% ❑ ❑ -Is there 50 ft or greater between the down 3%to 15% i!t f. gradient side of primary drainfield and 16%to 30% property boundary: �,, Greater than 30% 0 ❑ Yes K Y No ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable �� I 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. Prcof of Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. updated T'J,JC 1? v 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) ROUSE CIO B-LINE CONSTRUCTION _(see instructions) _ _- Address: 2971 E PHILLIPS LAKE RD. SHELTON WA 98584 Telephone: ( 360-426-4221 si o... ,u1,Q+2s0. Gc� Property den on: 3) �', 32015-44-00010 TR 1 in SE SE EX 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 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: Z� tS1ZI ) 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 14Class 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. 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 IL] Approved / Granted—Subjec o all comments,conditions and requirements no ed i Sections Il and III. Local Health Officer (13) Date: C_' li DOH 337-021 z z 7 0 n, !� a 0(A6'.6 cozzS COCQ,LS OOC6TZ' OCIAZ6 OOlC1.LS 0006Z6 TA777S OOms co M N w .2boat 0 O I,1.Lh: 't MI e N 0 . R U • � 5 U ,(.4:„.„::,.....„\--44 , i ii GI c _ o _ c i . 1\. \\ _ II U ,.o i co ? 2 'O P S'. 1.• k gip' rl Z .) o j ynj U 43 it by tin ••„ , 1 0 s g �6. QQ vfi'4'f'W (� M d • f a. •-1 U ".."N) , r §1 • ,t oiN U F N5 Z Z U M.IPZ an ' / m.tv.L oat 1 OO LN 00;6?ZS 0066ZL5 00a,aS CC:13>rz5 00)6zzc 71W..4, urwn 8ZLS em 008s' 0 k 7 P t Soil Map—Mason County,Washington Map Unit Legend Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI Bd Bellingham silt loam,0 to 3 9.6 5.9% percent slopes Cc Cloquallum silt loam,5 to 15 j 38.8~ 24.0% percent slopes Ce Cloquallum silt loam, 4.9 3.1% moderately shallow over cemented till,5 to 15 percent slopes le Indianola sandy loam,5 to 15 1.0 0.6% percent slopes Sf.00) Shelton gravelly sandy loam,5 94.8 58.7% to 15 percent slopes 1 Sg Shelton gravelly sandy loam, 12.3 7.6% . 15 to 30 percent slopes 1 Totals for Area of Interest 161.3 100.0% usl)n Natural Resources Web Soil Survey 3/26/2023 Conservation Service National Cooperative Soil Survey Page 3 of 3