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Home My WebLink AboutWAI2023-00047 - WAI Health Waiver - 5/1/2023 "1" R�yM1ik. 415 N.6th STREET,SHELTON WA 98584 ri MASON COUNTY SHELTON:360-427-9670,ext 400 • I' r COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,ext.400 Building Planning Environmental Health.Community Health .,ri,v„+`'' FAX:360-4 2 7-7 798 Application for Waiver or Appeal Amount Paid: 5 Receipt Number: WAl c3)04; , - C3C Li I 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 �L Telephone Mailing Address � !'I �`j - .. City V4A lTrvQ`-t— State I L. Zip (e009 4 Parcel No. I 2 3 1 9 — q -z — 5 U O p Site Address '(&`�,� c-J YS Z6 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal IV 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 ❑ 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 DECLARATIO F ATTENUATION ZONE Applicant Signature: Date: /"Z3 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 r- None required Class A V'CIass 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 ❑ Public Health Director O Certified Contractor Review Board t2' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 2-Yt (0 0 3 v ) 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: i\VV \.f 1 Date: f2-Z.l2 PART 4: Determination of the Hearing Official FL 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: (47Date: St? 0/zJ Revised 8'21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 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: (I) \ C Local Health Department/District (2) i ' ��` V\ (see instructions) Address: 34 f C q Telephone: Signature: 4 Property Ident• tc ion: (3) g /Q 4- Z a-c L L S 4 Cj,r-/`l T‘1*).‘ i'.D I Z � 1 q L S`00 3 0 ISection II. ('completed by applicant,) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A--• 0230 24" OF V/S FOR PRESSURE (OR)J2"OF VLS F• PRESSURE OSS (OR) Subsection: TABLE VI " OEV/S FOR GRAVITY �8"OF V/S FOR GRAVITY OSS Justification(mitigation measures to be provideJ): (�) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: ) 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) I Class A (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. 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. I ] Denied A-Approved/Granted—Subject to all comments,conditions and requirements oted in Sections II and III. Local Health Officer (13) Date: s.y 0,t? DOH 337-021 4 MASON COUNTY COMMUNITY SER. CES' 1 2 . 'PA ON COUNTY PUBLIC HEALTH , �tNY Building.Plarniry,Er+hcrynartalHeaM,Ca aItyHerd, CLASS B WAIVER WORKSHEET 415 N.6TH STREET.BLDG 8.SHELTON WA 98584 B..(:-----------•---------- (State and Local waiver forms required) SHELTON:360427-9670.EXT 400-BELFAIR-360-275-4467.EXT.400 ELM&360-482-5269.EXT.400- FAX 360-427-7798 APPLICANT NAME pi (_, t L?'r'f Iv\ WAIVER PERMIT NUMBER WAI MAILING ADDRESSJ J -1 c'i 1/ �PVI-(Ie..,Z tC)1 • --} ® ��,1 ell CITY f...Cn3 l T r c:V 'T L STATE •-L L np I�E'�"- SITE ADDRESS R. 54 'z\ cf , ,w.11 CITY 6 I4L�r 2-TAX PARCEL NUMBER I. 3 ` <1 V v Z. c U 3 PROPOSED GRAINFIELD TYPE iti,CONJENT10NAL 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______ I Greater than 12' ...... 0 0 Harstine Gravelly Sandy Loam_______ 0 E Greater than 18" „,.., ISI r.5' Hoodsport Gravelly Sandy Loam._........_.._ 0 0 -Determined by: Shelton Gravelly Sandy Loam ❑ 0 Depth to hardpan I❑ 14 Sinclair Gravelly Sandy Loam __________0 ❑ Depth to mottling_ .. Other ---❑ ❑ Both _...._....._____.....—__—_........____._..... El El 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: Loamy Sand ._._._._._......_....._ ._ .__...____.0 0 a Yes ___ ._ _ __.. ..__. 0 0 ro SandyLoam.._............_.._._.__... __..........._..._Et 131 3- No.._._._........_. .........._.......... .. . _.. .. ....._ .. ..53 o Percent Gravel: 0 -Corbin Drain required: p -Less than or equal to 35%..__...__.__..._._..._._.la IFP a Yes — ..__..._._. _ _ _. ...._. ._ 0 0 1 -Greater than 35%_..____...._.._...._...._.........._..._.® 14 q No. ci 14 i 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: uc Soils must be moderately well drained to well drained Q Primary Drainfield must maintain 200'from down-gradi- ro ent marine shorelines,surface waters,and wells. 0 Well Drained...._..._..... _ ❑ 0 Moderately Well Drained.._____._ �.___...IF.I 0 -Are increased horizontal setbacks met: Other _ ❑ ❑ Yes...._.......__...---_.._._.._...._...._...._....__..._........_.._..la al No_.. _ _._ _ ❑ 0 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 3096. Gravity Is only allowed on slopes from 3%to 15%. A S0 foot horizontal attenuation zone is required Pressure Is allowed on 3%to 3096. down-gradient of the primary drainfield- Less than 3% __ ❑ 0 -Is there SO ft or greater between the down 3%to 15%.._.._..._._ 0 a gradient side of primary drainftehd and 16%to 30% ____._ _ ❑ 0 property boundary: r�-fy Greater than 30% ____. 0 0 Yes_» _.._ t7s lik NO ___ —...— _ _— _..._ 0 0 The SO foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable p prior to design approval.The attenuation zone Is not to be used for the contructlon of roads,decks,patios, AFN: Z� i k) U O3 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording: ORS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. updated 3/2/2017 1