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HomeMy WebLinkAboutWAI2023-00034 - WAI Health Waiver - 4/17/2023 • 1 415 N.6`h STREET,SHELTON WA 98584 . 1 1 Ms ; MASO N COUNTY j1r SHELTON:360-427-9670,ext 400 i � � ! COMMUNITYSERVICES BELFAIR:360 275 4467, ext.400 r: ! : 4 / $ullding,Planning.Environmental hitalthjCommunityHealth ELMA:360 482 5269, ext.400 FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: a s r!' r Receipt Number: Q• WAI 2-C) 2 C.36t)3L4 • 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 S 1 ,: i 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 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 Cl Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ,"----.,, 0 Mason County Onsite Standards 0 Departmental Determinatio )39❑ Contractor Certification Requirements ❑ Other �;� •. (Installer, Pumper, O&M Specialists) 8 ('/r`- `-.,� APR 1 t/ / Description of Waiver/Appeal (include justification, additional material may be attached.r 13 2O 23 i REDUCE VERTICAL SEPARATION FOR CONVENTIONAL PRESS R E-Q�S L CLASS B WAIVER CHECKLIST ��----„. RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: C3 Lat p Date: /it l til 202_.. Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) i.I Appeal s/Waiver ;; None required Class A ('Class B i 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: 0 Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director 0 Certified Contractor Review Board a Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN .? (q igegq 9 7q 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: „6,6Date: PART 4: Determination of the Hearing Official c/4' 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: �/7 Date: �/ �r/L 1 Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Arm • MASON COUNTY SERVICES MASON COUNTY PUBLIC HEALTH COMMUNITY 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:360-275-4487,EXT.400 ELMA 360-482-5269,EXT.400- FAX:360-427-7798 APPLICANT NAME MARGOT&ZACHARY CONNOLE WAIVER PERMIT NUMBER WAI MAILING ADDRESS P 0 BOX 1995 crry OLy,,,,,pi w„ STATE WA ZIP 98507 SITE ADDRESS 70 W TAFFS TERRACE city SHELTON TAX PARCEL NUMBER 42035-14-90070 PROPOSED DRAINFIELO TYPE 0 CONVENTIO NAL GRAVITY ® 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. ice, I Alderwood Gravelly Sandy Loam 0 0 Greater than 12" ❑ 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 ig- Other CAC•vI' p if ❑ 0 Both 0 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 35%. above restrictive layer,a curtain drain may be required Medium Sand 0 ❑ Z -Evidence of seasonal water table: Loamy Sand 4-'o Yes ❑ ❑,, Sandy Loam 0 0 St No ElQ Percent Gravel: -Curtain Drain required: C/ -Less than or equal to 35% I1 ❑ o Yes 0 0 o -Greater than 35% 0 ❑ §. No III ,3 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: z N to Soils must be moderately well drained to well drained. 0 Primary Drainfield must maintain 200'from down-gradi- ent marine shorelines,surface waters,and wells. 0 Well Drained E Moderately Well Drained ❑ 'D -Are increased horizontal setbacks met: Other _ 0 ❑ Yes ElLi No ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. 1. 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% ❑ gradient side of primary drainfield and 16%to 30% ElJ❑ property boundary: Greater than 30% 0 0 Yes © 0 No ❑ ❑ 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 contruction of roads,decks,patios, AFN: :290 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof a Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE updated 3/2/2017, LE]1 E1e 01.(j 1,cc_ cfLikilf of EP1 1 t•At.J 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. (completed by applicant) Name: (/) Local Health Department/District (2) MARGOT&ZACHARY CONNOLE • (see instructions) Address: • PO BOX 1995 OLYMPIA, WA. 98507 Telephone: ( GU) S"S'(,_..rzy9 • Signature: A Aac Property Identifita on: (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 ESS 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: L-I ct U 711 ) _..... Section III. (completed by health office') Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) [ ]Class A [4 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 Sections 11 and III. Local Health Officer (13) ry t/✓/ Date: — DOH 337-021 Page 26 of 32