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HomeMy WebLinkAboutWAI2023-00034 - WAI Health Waiver - 6/14/2023 MASON COT.TAT 415 N. 6th STREET,SHELTON WA 98584 4111"117 dJ 1�I • COMMU SHELTON:360 427 9670,ext 400 NIT :SERVICES BELFAIR:360-275-4467, ext.400 j $ulldiny,Planning,Environmental Health,'ComrnwnityNeaa ELMA:360-482-5269,ext.400 h FAX:360-427-7798 • Application for Waiver or Appeal Amount Paid: e r Receipt Number: ?7 WAI oLC� 6t >(--•\ • 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 MARGOT& ZACHARY CONNOLE Telephone 360-556-5233 Mailing Address PO BOX 1995 City OLYMPIA State WA Zip 98507 Parcel No. 4 2 0 3 5 1 4 9 0 0 7 0 Site Address Subdivision Name and Lot • PART 2: Nature of Waiver/Appeal Eii/ Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location, WAC 246-272A-0210 ❑ Holding Tank WAC 246-272A-0240 0 Water Adequacy Requirements 0 Enforcement Timelines❑ Mason County Onsite Standards �" ❑ Contractor Certification Requirements / ti 0 Departmental Determinatio 0 Other Lr;(Installer, Pumper, O&M Specialists) / Description of Waiver/Appeal (include justification, additional material may be attached. ApR C2023 !7 REDUCE VERTICAL SEPARATION FOR CONVENTIONAL PRES / �RE.pSS t CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: 6—f La. (' Gl` "4) Date: This form may be scanned and available for public view on the Mason County Web siite.ised 8i21/2017 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 s/Waiver n None required r_ Class A sClass B _J 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. 70 W TAFFS TERRACE 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board I2' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN ?. (' 661Iq )_ 9 0 7' 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: Iik Date: )7' PART 4: Determination of the Hearing Official p-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: ('1/7k Date: J./L1' I/ Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2of2 MASON COUNTY ill win ? COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building,Planning,Environmental 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:360-427-7798 APPLICANT NAME MARGOT&ZACHARY CONNOLE WAIVER PERMIT NUMBER WAI MAILING ADDRESS P O BOX 1995 CITY OLr, ,.p,A., STATE WA zeP 98507 SITE ADDRESS 70 W TAFFS TERRACE CITY SHELTON TAX PARCEL NUMBER 42035-14-90070 PROPOSED DRAINFIELDTYPE 0 CONVENTIONAL GRAVITY ® CONVENTIONAL PRESSURE 1.SOIL SERIES: S.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 0 0 Greater than 12" 0 Harstine Gravelly Sandy Loam 0 0 Greater than 18" ❑ Hoodsport Gravelly Sandy Loam 0 0 -Determined by: Shelton Gravelly Sandy Loam 0 0 Depth to hardpan Sinclair Gravelly Sandy Loam 0 0 Depth to mottling 0 /g Other yip v-P re ❑ ❑ Both 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 35%. above restrictive layer,a curtain drain may be required Medium Sand 0 -Evidence of seasonal water table: Loamy Sand o (es CI • CIZ Sandy Loam ❑ S. No © Z a Percent Gravel: -Curtain Drain required: 0 -Less than or equal to 35% ® ❑ o Yes 0 ❑ iTi -Greaterthan35% 0 ❑ - No © ;o ro 3 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: z ro I Soils must be moderately well drained to well drained. I p Primary Drainfield must maintain 200'from down-gradi- no zent marine shorelines,surface waters,and wells. 0 Well Drained 0 .< Moderately Well Drained 0 111 -Are increased horizontal setbacks met: Other _ ❑ 0 Yes 4. DRAINFIELD SLOPE: NO ❑ 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 50 ft or greater between the down 3%to 15% ❑X �E gradient side of primary drainfield and 16%to 30% CI ❑ property boundary: Greater than 30% ❑ 0 Yes © 0 No ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable J prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: ( l0 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof o Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. u updated 3/2/2017 (Ann brie .41-( - L'.I ed 4f c,1 EPi 3 retw/ 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. 1 (completed by applicant) Name: (1) Local Health Department/District (2) MARGOT&ZACHARY CONNOLE • Address: • (see instructions) PO BOX 1995 OLYMPIA, WA. 98507 Telephone: (74e) SS'J— Signature: Ziv A) 44.e( Property Identifeion: (3) 42035-14-90070 Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5 Waiver Sought: (6) 246-272A— 0230 24" OF V/S FO PRESS . E (OR) 12"OF V/S FOR - : 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: • . - Section III. (completed by health olce,) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) [ ]Class A [)g 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 [,Approved/Granted—Subject to all comments,conditions and requirements noted in Sctions II and III. Local Health Officer (13) f Date: DOH 337-021 Page 26 of 32