HomeMy WebLinkAboutWAI2023-00039 - WAI Health Waiver - 4/28/2023 '"..\ 415 N.6th STREET,SHELTON WA 98584
,/' '4 0117 \\, MASON COUNTY SHELTON:360 427 9670,ext 400
COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
-- ' ELMA:360-482-5269,ext.400
•\,,. ,i Building.Planning.Environmental Health.Community Health FAX:360-427-7798
Application for Waiver or Appeal
Amount Paid: (313. . Receipt Number: X3-' —
WAI oo J - QC
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 J 65 k (... \\C.J.N TelephoneZ61 - 326 — CX63
Mailing Address Pc (,c>c 7O&
City &,Qti r ` State C n Zip Cr Si a
Parcel No. 3 Z 3 3 Li -- J 5 _ -- & CS / .3
Site Address 2 7 C S O -.,tc-V-1 A- •
Subdivision Name and Lot i ( I S, or S v r gp o
PART 2: Nature of Waiver/Appeal
IV Class B Reduce Vertical Separation 0 Food Sanitation Requirements
O Building Permit Review Policies 0 Group B Water System Regulations
❑ 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 ❑ 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 ATTENUATION ZONE
Applicant Signature: Date: 4"-2 -2-.3
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)
I Appeal a/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 GRAVITY OR
PRESSURE OSS.
4. Hearing Official:
0 Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
0 Certified Contractor Review Board li Environmental Health Manage
I
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN )
3W genes of Sfu t c, *vest toil(' dogol vittilt4 t pr'nary c(/G i'A fiWd.
t,W, W&US vi.ktil lle of cfoOlf`
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: 3i,./.'".....- Date: S/(/za��
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: Q1. ---- Date: /L _
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
err,
4 =w• MASON COUNTY MASON COUNTY PUBLIC HEALTH
'4—�' COMMUNITY SERVICES CLASS B WAIVER WORKSHEET
Wilding Manning E,..I.�.,til Heald Community Na+teh
415 N.6TH STREET,BLDG 8.SHELTON WA 98584 (State and Local waiver forms required)
SHELTON'360427-9670.EXT.400- BELFA R 360-2754487,EXT 400
ELIA&360-4 -5269.EXT 400- FAX-360427-7798 ^ ///
APPLKANT NAME 7(6 V\k C3.4, 1WMER PERaVTNU118ER WAI 2O -3 `�003/
NAILING ADDRESS/ eO >c_Nx. 0(0 . (/� t r_
vi
CfTY 0.Te,` �. r c. -•_,'_,'t�1}�` STATE o- (�rN_ ➢, /8�2 ,E
SrTE ADDRESS ,f� 7 c S "�()C.NUNOC' an 1 1%, C�'
TAX PARCEL NUMBER 3 Z 3 3%- ( - ( O 13 1 PROPOSED DRAINFIELD TYPE CONVENTIONAL GRAVITY VITY ❑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_________El 0 Greater than 1 Y --•• 0 0
Harstine Gravelly Sandy Loam__ .—_.._._ 0 0 Greater than 18" _ _ ---_ . ID 181
Hoodsport Gravelly Sandy Loam.__.._._........_..___.. 0 0 -Determined by:
Shelton Gravelly Sandy Loam 0 ❑ Depth to hardpan •••Ea til
Sinclair Gravelly Sandy Loam 0 0 Depth to mottling - 0 0
Other -.--0 0 Both _.......__.._..__..._._.._. ..._..._.... W 0
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 3596. above restrictive layer,a curtain drain may be required
Medium Sand_____________________________0 0 -Evidence of seasonal water table:
LoamySand.........._..___.,_._...... __._..._.....__._..._❑ ❑ re. Yes...__ ... __ ._ ...._..__._. .. .... __. .. ❑ ❑
Sandy Loam________.........___________.........____® ® a No _ __.._._ IR z
Percent Gravel: „ -Curtain Drain required: p
-Less than or equal to 35%__ ..v_..._. ® ® o Yes....._.._. _—. ____..._ ___. _.._.... ❑ 0 a
-Greater than 35%.._v _ — _ CI 4 No.__...._.____.. _._....._.... _. ..—_._ .__......... �I
m.
3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS:
F.co F.
Soils must be moderately well drained to well drained O Primary Drainfield must maintain 200'from down-gradl- ro
ent marine shorelinessz- ,surface waters,and wells. 0
Well Drained.. _... ..... _ 0 0
Moderately Well Drained._....._..__...__.—......__..._® 15 -Are increased horizontal setbacks met
Other _._...._. ❑ ❑ Yes ._..___._._....._. .. ...___ El g
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 0 Is there 50 ft or greater between the down
3%to 15% g gradient side of primary drainfield and
16%to 30%-----Y .._. ❑ M property boundary:
Greater than 30% . _ _ ___ 0 ❑
No ❑ 0
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 contraction of roads,decks,patios, AFN: ZI q i-3Z''-
parking areas,vehicular traffic or other similar such uses.The owner must agree to all these conditions. P,00f of Recording:
THIS FORM MAY BE SCANNED A ND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEBSITE. updated i, ,2017
r..
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: (/)
,, Local Health Department/District (2)
6 S� F "-kO 1`C h (see instructions)
Address:
T\ac - A. w a cl�S'Zfr
Telephone: (3 ) ( J
2 1 326- cos3
4 Signature: l
Property Ide fication: (3)
3? 3341 — 7s"- Co / 3 (
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 Q6' OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OS�
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 I Q.7.:Z)
Section III. I (completed by health office')
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Comments/Conditions: (l0) $ (.. Q55 e l✓Ql�L! tonics v( l (�Q(1ef)
Type of Waiver: (ll) I ]Class A w Class B ( ]Class C -- Request DOH review before granting? Yes No X
Neighbor Notification: (12) Required? Yes-__ No X 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 aApproved/Granted Subject to all comments,conditions and requirements n ted in tions II and III.
Local Health Officer (13) --.- Date:
DOH 337-021 Page 26 of 32