HomeMy WebLinkAboutWAI2023-00063 - WAI Health Waiver - 6/22/2023 voimilliiik
p ;�JUNf�2 2�l � r
2023 �L
415 N.6 STREET,
REET, SHELTON WA 98584
(. ''''' I MASON COUNTY ` \�— SHEL ON: 360-427-9670,ext 400
r COMMUNITY SERVI == _ == IR. 360-275-4467, ext.400
r ;.I,:,; r:.uuuny Er,omNurn W.i��i, ELMA: 360-482-5269, ext.400
FAX: 360-427-7798
I eion for Waiver or e a I
Amount Paid: Receipt Number: ve Illb 1.
WAI 1'/-_POO63
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 ROBERT SEGREST _ Telephone
Mailing Address PO BOX 1949
City ALLYN _ State WA Zip 98524
Parcel No. 2 2 2 1 3 7 7 0 0 0 6 0
Site Address XXX E JOHNSON RIDGE
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
2/ 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
0 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 : PRESSURE OSS
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE
Applicant Signature: ail _ Date: 1. Li 23
Rs\ised R/21!2017
This form may be scanned and available for public view on the Mason County Web site.
1'agc I oft
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
Appeal ✓Waiver None required Class A ✓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
PRESSURE OSS. —
1 4. Hearing Official:
❑ Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
0 Certified Contractor Review Board ' Environmental Health Manage
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST MEETS ADDITIONAL REQUIREMENTS OUTLINE ftN
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AF ./20 I O (, )
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local poli has been submitted.
Staff Signature: Date: t
PART 4: Determinati n of the Hearing Official
iii- 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:
Y
Health Official Signature:
Date: - 7 /2.,1
,
li , Itc��s�il x/2I/2017
This form may be scanne and available for public view on the Mason County Web site.
Page 2or2
y
Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WA('
Effective Date: Jul) I.2007 Revised April 2017
On-Site Sewage Systems (Chapter 246-272A WAC)
Request for Waiver from State Regulations
Section I. I (c•umpIGrd by upp/icunf
NankOgkRT SEGREST Local Health Department/District (2)
(see instructions)
A d•es :
BOX 1949, ALLYN, WA. 98524
Telephone: ( 1
C
Signature:
4 fr7/Zo23
Property Identiticat- . (3)
22213-77-00060
Section II. j (completed hr 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 -RESSURE •SS (OR)
TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GR A ,
Subsection: •SS
Justification huiti utiun measures to he provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED,
(OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN.
ZONE (AFN: )
Section III. I (completed hr health?officer)
Review Criteria: (8) N litigation Measures(in addition to those proposed): (9)
IG1.-0 5 cke.c(c<< 5 --'
N 4-0 b 4-1`e d 22 c210a y
comments:Conditions: (llq
Type of Waiver: (1l) [ ] ('lass A IA Class B 1 ] Class C --Request DOH review belbre granting? Yes _ No X
Neighbor Notification: (12) Required? Yes____ No X. ii needed. are agreements. easements. etc..properly filed? Yes No
Section IV. 1 (completedht•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 fir their ability
to provide public health protection at least equal to that provided by this chapter WAC.
I ] Denied (p4,Approved /Granted St ,ect to all comments,conditions and requiremei : noted i i Sections II and III.
Local Health Officer (/3) Date: 7 / 7vj
DUI 1337-021 Page 26 of 32
MASON COUNTY MASON COUNTY PUBLIC HEALTH
„,'r I COMMUNITY SERVICES
Bmldmg Mannmglnvnnnm;nui Ural 1,<<„,u„un,,,•NraIi CLASS B WAIVER WORKSHEET
415 N 6TH STREET.BLLXi 8.SHELTON WA 98584 (State and Local waiver forms required)
SHELTON-380-427-9670.EXT 400- BELFAIR 360-275-4467 EXT 4CC
ELMA 360.482-5269 EXT 400- FAX 360-427-7798
•
APPLICANTNAMI ROBERT SEGREST Sv.uvniJ'HMUNUMBER WAI 20,� 3 v C900 6 Z.
MAR IN6 ADDfiE SS PO BOX 1949
(nY ALLYN, STAII WA ZIP 98524
SIZE ADDRISS XXX E JOHNSON RIDGE CoylA%VARCEL NUMBER 22213-77-00060 PROPOSEDtRAINHELD IYT'E 0 CONVENT IONAL GRAVItY ® LONVEN IIONAL PRI SSU It!
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 ® J Greater than 12" El Xi
Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" ❑ ❑
Hoodsport Gravelly Sandy Loam ❑ ❑ -Determined by:
Shelton Gravelly Sandy Loam ❑ ❑ Depth to hardpan ❑ ❑
Sinclair Gravelly Sandy Loam 0 ❑ Depth to mottling ❑ ❑
Other_ 0 ❑ Both ❑ ❑
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 ❑ ❑ _ -Evidence of seasonal water table:
Loamy Sand ❑ �❑,/r, Yes ❑
Sandy Loam idK T No ® a
Percent Gravel:
t -Curtain Drain required: CD
-Less than or equal to 35% ❑ ❑ a Yes ❑ ❑
Greater than 35% El ❑ No 0 9 ro
3. SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: M
c
I Soils must be moderately well drained to well drained. I p Primal),Drainlield must maintain 200'from down-gradi-
ent marine shorelines,surface waters,and wells. 0
Well Drained
Moderately Well Drained ❑ 'BC -Are increased horizontal setbacks met:
Other ❑ 0 Yes 21
4. DRAINFIELD SLOPE: No ❑ ❑
8.ATTENUATION ZONE
Slopes must be between 3%to 30ao.
Gravity is only allowed on slopes from 3%to 15t . A 50 foot horizontal attenuation zone is required
Pressure is allowed on 3°n to 30%. down-gradient of the primary drainfield.
Less than 3% ❑ iiii0 -Is there 50 ft or greater between the down
3%to 15% ® gradient side of primary drainfield and
16%to 309'o ❑ property boundary:
Greater than 30% ❑ 0 Yes ® ❑
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: .0/Q 6 y
parking areas,vehicular traffic,or other similar such uses. The owner must agree to all these conditions. I'out,If Rr„„d„,q
{ THIS/OHM MAYBE SCANNED AND AVAILABI I I OR NUM VIEW ON f HE MASON COUNTYwrltStl F. �p G
1
2pip ?o(14
1
R. 2 W. R. 1 W.
\ Iu. -a. Eh Ef
.'_ j
..1.:1,5.4 i, ...i ' ..,...,..
I fj , , fl ' 2T i1 `N\;i7/ri '• •;'t : /, t i
• T? /' _ ✓.4..I ', 0En • lb to
• p" t El(
) ,ts ,,,'".--..."-\\,/ I );:;:—.'.— i t • .)
r r •) I' l
/,_..,:/ / c 0! / , — .ts
%1 `I .4=:. 1 r: 31� 1'.•
• .„....„ ,..,/,`"..s' 1"...."--•-;,,,A,fr'''. , I:..44),.,...,,k,''s '... s,,,3 4,.,,...,1:4! .t , . i „
•
•
•
Le
ijob
1 f\ ._ ` �• , it
J
� • ` ,
•
), . I i. 1 ' P� �/ , lb � . •i • '�,j
•
t \ \, , ra.
4
Ark . 3 '1 \y
,d :- '_ • ;;
i t t .. - i'j
(/). lit 1 \ .,/ "'.• ;',',r..g .
'' l `� �_ �' -� 1 r , Rose
,J
•
r /
Cr • i/
•
•
N.
// •a••• i .�•- \ ,.
!sunset Belch'\
, ` )
1?t. ii,,,,,,- - \i \''''. I : ' -.4%
)" S (A•: , ) : •
,�y Al // fIl ;�, 3 ,
: ▪ { V 4,,
0.
• ,' / Ji % i � At: t!
nl / t
•
/". 1,.�` {
/ _L.. v J .
1/2 1 Mile 4
--- -L _,—.---- .1 Scale 1:31680 --