HomeMy WebLinkAboutWAI2023-00073 - WAI Health Waiver - 7/20/2023 '14' 415 N.6th STREET,SHELTON WA 98584
i MASON COUNTY SHELTON:360-427-9670,ext 400
,1. 7 COMMUNITY SERVICES BELFAIR: 360-275-4467,ext.400
ELMA: 360-482-5269,ext.400
Building,Planning.Environmental Health,Community Health
,,,,,/ FAX:360 427 7798
Applicationpl� for Waiver or Appeal
Amount Paid: �v Receipt Number: 1-4? — 2
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WAI )-2P- O<)'1 JUL 2 0 2023
Instructions: • I
y Q 1
1. Complete Parts 1 and 2. No determination can be made until these parts are fu�y-eettipleted--- -
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
il Name of Applicant WILLIAMS C/O B-LINE CONSTRUCTION Telephone 360-426-4221
Mailing Address 2971 E PHILLIPS LAKE RD.
City SHELTON State WA Zip 98584
Parcel No. 1 2 2 2 9 -- 4 4 -- 0 0 0 2 0
Site Address 151 E NELSON ROAD, GRAPEVIEW, WA
Subdivision Name and Lot TR 2 OF GOVT LOT6 AND TAX 411-E
PART 2: Nature of Waiver/Appeal
Ed 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 0 Departmental Determinations
❑ Contractor Certification Requirements 0 Other
(Installer, Pumper, O&M Specialists)
Description of Waiver/Appeal (include justification, additional material may be at d. :
REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY PRESSU E OSS
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE
Applicant Signature: ` ,_ ei Agal711111 p * ea • ) Date: (1l J(.4 L.-'( 202 7
IV
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 1of2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
Appeal VWaiver i 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. Na of Appeal:
DUC ERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR
cRESSUR OSS.
4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
O Certified Contractor Review Board Eli Environmental Health Manage
I 5. Mitigating Factors:
CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN TO i 6272 )
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local poli as been submitted.
/ (i-lim
Staff Signature: ( L l/ % Date: ! —Z
3
PART 4: Determina on of the Hearing Official
gt. 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: C�M" Date: YAl/2 1
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 2of2
MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH
Building,Planning.Environmental Health,Community Health CLASS B WAIVER WORKSHEET
• 415 N.BTH STREET,BLDG 8.SHELTON WA98584 (State and Local waiver forms required)
SHELTON:380.427-9870.EXT 400- BELFAIR'380-275-4487,EXT.400
ELMA:380-482-5289,EXT 400• FAX:380.427-7798
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APPLICANT NAME WILLIAMS CIO B•LINE CONSTRUCTION WAIVER PERMIT NUMBER WAI
MAILING ADDRESS 2971 E PHILLIPS LAKE RD
•
CITY SHELTON SIAtE WA LIP 98584
SITE ADDRESS 151 E NELSON ROAD,GRAPEVIEW,WA CITY SHELTON
TAX PARCEL NUMBER 12229-44-00020 PROPOSED DRAINFIELD TYPE ❑ CONVENTIONAL 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.
Alderwood Gravelly Sandy Loam 14 ❑ Greater than 12"
Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" ❑
Hoodsport Gravelly Sandy Loam 0 0 -Determined by: �/
Shelton Gravelly Sandy Loam El g-- Depth to hardpan pd lg
- Sinclair Gravelly Sandy Loam ❑ Depth to mottling 0 ❑
Other ❑ ❑ 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 ❑ ❑ Z -Evidence of seasonal water table:
Loamy Sand ❑ ❑ o Yes ❑, LI
No a
Sandy Loam 3-
Percent Gravel: -Curtain Drain required: p
-Less than or equal to 35% ❑ ❑ o Yes ❑, ❑❑ a
-Greater than 35% ❑ El - No 3
os
3.SOIL DRAINAGE: c 7. HORIZONTAL SETBACKS:
9 c
Soils must be moderately well drained to well drained. O Primary Dramheld must maintain 200'from down-gr.ta
ent marine shorelines,surface waters,and wells. O
Well Drained v Rc....zs`
Moderately Well Drained 0 -Are increased horizontal setbacks met: �,/
Other 0 ❑ Yes Lla ❑
No ❑ ❑
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 drainfeld
Less than 3% ❑,/ El -Is there 50 ft or greater between the down
3%to 15% pQ 1:5C-) gradient side of primary drainfield and
16%to 30% ❑ 0 property boundary: L�
Greater than 30% El El Yes
No ❑
The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 7
prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: ( °
parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording;
THIS FORM MAY Eft SCANNED AND AVAILABLE I OR PUBLIC VIEW ON THE MASON COUNTY WEBSITE updated 3:2'20''
1
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) Local Health Department/District (2)
WILLIAMS CIO 6-LINE CONSTRUCTION (see instructions)
Address:
2971 E PHILLIPS LAKE RD.
SHELTON WA 98584
Telephone: ( 360) 426 -4221
Signature: 1
Property[den i i on: 3)
12229-44-00020
TR 1 in SE SE EX
Section II. I (completed by 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 PRESSURE 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: 2.20(6 72 )
Section III. I (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Comments/Conditions: (/0)
Type of Waiver: (1/) [ ]Class A 4-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.
[ ] Denied [„Approved/Granted—Subject to all comments,conditions and requirements n ed in Se tions II and III.
Local Health Officer (13) 42V
Date: T. / 2-)
DOH 337-021