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Home My WebLink AboutWAI2023-00068 - WAI Health Waiver - 6/26/2023 415 N.6th STREET,SHELTON WA 98584 , MASON COUNTY SHELTON: 360-427-9670,ext 400 ....t • - COMMUNITY SERVICES BELFAIR: 360-275-4467, ext.400 • —f ELMA:360-482-5269, ext.400 Building.Planning,Environmental Health.Community Health I, FAX:360 427 7798 Application for Waiver or Appeal IQ is ,� /� I _ Amount Paid: �� Receipt Number: - ' SUN 2 b' 202. I p d WAI a6 --3 - 0bo6S sy Z 3 U 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 DARREL ANDREWS Telephone Mailing Address 13 SE SKOOKUM VIEW DRIVE City SHELTON State WA 4ip 98584 Parcel No. 22029 41 90030 -- -- Site Address XXX DAWNVIEW DRIVE, SHELTON Subdivision Name and Lot PART 2: Nature of Waiver/Appeal EY Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations O Location, WAC 246-272A-0210 0 Water Adequacy Requirements 11 0 Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines O Mason County Onsite Standards 0 Departmental Determinations O Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) i si. _�- Description of Waiver/Appeal (include justification, additional mater'� maybe attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY/ OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature:(` O'Pe J" Date: Iv(z-)A 7-3 Revised 8/21/2017 Th'S 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 ✓Waiver 1- None required Class A c/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 RAV 0 PRESSURE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer O Pollution Control hearing Board 0 Public Health Director O 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 Z2003t 5 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: C iLt..4 /"l Date: / 2 PART 4: Determinat' n 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: Date: 7A721 Revised 8/21/2017 This form may be scanned and availabl for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building,Planning Environmental Health Community Health CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLOC 8,SHELTON WA98584 (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 DARREL ANDREWS WAIVER PERMIT NUMBER WA I MAIUNG ADDRESS 13 SE SKOOKUM VIEW DRIVE city SHELTON STATE WA LIP 98584 SETE ADDRESS XXX DAWNVIEW DRIVE,SHELTON city SHELTON TAX PARCEL NUMBER 22029-41-90030 PROPOSED DRAINFIELD TYPE ® CONVENTIONAL GRAVITY ❑ CONVENTIONAI.PRESSURE rl.^^y 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 0 ❑ Greater than 12" 0• 11717 Harstine Gravelly Sandy Loam 0 0 Greater than 18" V ❑ Hoodsport Gravelly Sandy Loam ❑ _❑ -Determined by: Shelton Gravelly Sandy Loam V g--) Depth to hardpan Di El Sinclair Gravelly Sandy Loam ❑ n Depth to mottling Other 0 0 Both ❑ *"."- 2. SOIL TYPE: 6.WATER TABLE LEVEL: ISoil*'des must be Medium Sand,Loamy Sand,or Sandy If test holes show evidence of a seasonal water table ILoam.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand Ind 0 -Evidence of seasonal water table: rt .^a ro Loamy Sand ❑ ►i�-. Yes 0 a • Sandy Loam ❑ • S- No M s CD Percent Gravel: -Curtain Drain required: 0 -Less than or equal to 35% 0 0 a Yes i �❑ ` -Greater than 35% El g No 41' r0 rp 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: z F.Soils must be moderately well drained to well drained. O Primary Drainfield must maintain 200'from down-gradi- ro Well Drained ❑ � ent marine shorelines,surface waters,and wells. 3g2 Moderately Well Drained 0 -Are increased horizontal setbacks met: 0 El Yes 12( er No ❑ 0 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% Ni gradient side of primary drainfield and 16%to 30% ❑ ❑ property boundary: 0 Greater than 30% 0 0 Yes No -----,❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuilda e �� - prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: parking a'eas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Ptoof of Recording: THIS FORM MAY BE SCANNED AND AVA LABLE FOR PUBLIC VIEW ON THE MASON COUNTY\NEBSITE. ��_ u ed 3/2/2017 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 : .. i 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) DARREL ANDREWS (see instructions) Address: 13 SE SKOOKUM VIEW DRIVE SHELTON, WA 98584 Telephone: ( ) t i ovvva_S'g 472x,.444440 029 u( L3 Property Identification: (3) -41-90030, XXX DAWNVIEW DRIVE, SHELTON Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 24" OF V/S FOR " - 't• . -E (OR) 12" OF V/S FOR P OSS (OR) Subsection: TABLE VI 36"OF V/S FO+GRAVI 18" OF V/S FOR VITY O S Justification(mitigation measures to be provided): (7) C• . D 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) Jac Comments/Conditions: (10) -ary .A 1 Type of Waiver: (11) [ ]Class A lass 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 b is chapter WAC. [ ] Denied ,Approved/Granted—S bject all comments,conditions and requirements ted in ections II and III. Local Health Officer (13) Date: 7 /7 DOH 337-021