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Home My WebLink AboutWAI2023-00081 - WAI Health Waiver - 8/9/2023 • 1"",.e LOut/ 410 II!STREET, SHELTON WA 98584 MASON COUNTY • HELTON. 36DP 427 9670, ext 400 `e` 'I '4' COMMUNITY SER ICES" 992023 - BELFAIR 360-275-4467, ext.400 cfi ..�^ . ELMA'. 360-482-5269,ext-400 FAX'.360-427-798 Application for Waiver or Appeal Amount Paid aC/S Receipt Number. 23 WAI 1J 2.7 - 000 \ 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 RALPH FAHSHOLTZ Telephone 253-579-3193 Mailing Address 3333 E HARSTINE ISLAND RD S City SHELTON State WA Zip 98584 Parcel No. 1 2 0 3 0 2 3 9 0 0 5 0 Site Address 3333 E HARSTINE ISLAND RD S Subdivision Name and Lot PART 2: Nature of Waiver/Appeal Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location. WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 D Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations - ❑ 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 GRAVITY CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE ir Applicant Signature: — ( � ( y34— / Date: 1/7/ ZuL 3 fii / Rc,I.LJ x.,l.'oc This form may be scanned and available for public view on the Mason County Web site. I'eec I el'_ 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 CONVENTIO L GRAVITY .,.. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ 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 2.2C7 y ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local p has been submitted. Staff Signature c L I i Date: (6/ 3 3 PART 4: Determi tion e 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: D 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: 4• Date: AV S j21 It:s lad 8Q 1 21117 This form may be scanned and available for public view on the Mason County Web site. I'. 2ol2 8 ='" MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH CLASS B WAIVER WORKSHEET .. r . Sio - (Stale and Loc^I waiver forms required, ,v i_+, NOV RALPH FAHSHOLTZ 3333E HARSTINE ISLAND RD S it SHELTON .I WA :: 98584 i , ))1, 3333 E HARSTINE ISLAND RD S i. .SHFI TON WA. 98584 .. i.,It NI,rrF 12030-23-90050 1. SOIL SERIES: 5.VERTICAL SEPARATION: The soilw 'mist he Alderwood.Harctine.Hoodsport dpslopea r,cal separa.ion must be greater han 19' Sneltnn,or Sinclair Gravelly Sandy I cam loi grav H and apparel than 12"for preesme Alderwood Gravelly Sandy loam _.. _. ❑ ❑ Greater than n- ❑ ❑ Harstine Gravelly Sandy Loam Greater than 18 BC. Hoodsport Gravelly Sandy Loam 0 -Determined by: TIC Shelton Gravelly Sandy Loam 0 0 Depth to hardpan a Sinclair Gravelly Sandy Loam... 0 0 Depth to nmuluny ❑ Other 0 0 Both ❑ ❑ 2. SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand.Loamy Sand or Sandy If to:holes show mil le ice of a seasonal stater table Loan,-(bevel percent must be less than or equal to 35 `- above restrictive layer a curtain drain may s requireci Medium Sand... 0 ❑ z -Evidence of seasonal water table: Loamy Sand 0 0 a Yes ❑�// ❑ Sandy Loam - w -- No-. Ex o Percent GraveP. O -Curtain Drain required: p -Less than or equal to 359b o yes_. ❑ ❑ a -Greater than 351-0 L� S No ® [ n 3. SOIL DRAINAGE: c 7. HORIZONTAL SETBACKS: t tl,"3 c Soils must be mod_ately well drained I jell drained. 0 f I my l] h li st maintainDar down-grade- w 1 slit in,IFIFIL 5110PCIIIIELS-,AVFLILl 4"..1101 IIIJ wclE. 0 Well Drained _.... Moderately Well Drained 0 -Are increased horizontal setbacks met: .n Other 0 ❑ Yes _ yy No ❑ 4. DRAINFIELD SLOPE: 8. ATTENUATION ZONE 'II(pes num be between 4°. to 50, Gravity is only allowed on slopes from 3 to la Asu not liauoiaal atievi,niun Lon: eymned Pressure is allowed on I'.:l0 30L. doa n gra.neat shin ;Him, y dns:fleld Less than 3°0 tJ -Is there 50 ft or greater between the down i'Ir to 15°., gradient side of primary drainfield and 16^0 to 30.. 0 property boundary: Greater than 30_y ❑ 0 vas _.._.. _.. ® No_ ❑ The SO cooth „tat attermatan zone is requiredI he rr led on the deed oftl parts w imbriildable prim t. design approval. The attenuation ones not Io E,P IISPtlfill the(011111[111C,11 01urls aecks r_non AFN. 22UZ /(re, parking areas vehicular mfc,(Jr other sirrular such uses lheownei mum agree In all these cm-minims. .r. (joins below left) R. 2 W. I R. 1 W. a � F. li - 4 n �" F. Ballow a i% 11 .a 12{uf i'' " • 1 , �: 9 18 /if / —� Y \A�Y �f' if -. ;), . 18Tji - ! . F I u //, r e$ % f . 8 1 1. ' ' ,r- -- 2 1 x V F . e .10 li /• p o \` a. .. b•` 44". Wilson r 23i - -."�- � 4e #. 15 _ Ci7 The 1%Iapks / _ _ 1' '� + S-H Ill, . '�' ,` .�I - / 'I �� ' a 26 25 met : �r'30 (5 / . • Jf �,0 4' cn I! _ 0 i2�'' ieko ii 4 ' `F 9 I te. R E S -'r 1 § F' /yti 'tP 35 G .36 31 .� ��f"J C Cil ) :'.1,‘I( -. ?' \9 • 9 50001e, i loins 'reel, shee^ 24) SJ /6.2 Granting V\aiter3 from State On-sire 'semam co.Ism ReguHIiuru C haplar'_J( ' ' V M. F1133cl133: Dais Jape I. 'on- Rmisca April '_017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (ewnple(ed In r appliemru Neu AePH FAHSHOLTZ I ()cal I leallh Depanmem District (21 rsrc ie,.(r unirun Address'. 3333 E HARSTINE ISLAND RD S SHELTON, WA. 98584 I clephoao' (253-579-3193 Sienaturc I'ropa7s Idenuticat ton: (3) 12030-23-90050 Section II. I (er,mplrlyd hi nppll.ana VA AC Number: (4) A AC Rcquircmcnt IS) AAaper Sought: (6) 246 2-72'\ 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR PRESSURE OSS (OR) cnHeolou. TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS Juailical ton (miti,¢et inn unneswras m he pr.nidrdi• (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: Section III. lamvphhd hr ImaGh,4/Isom Rciett Criteria: (R) Alitigation Ica to srLI JJdiriin 'h..So hroposOJr (9) P frv7/o -€ �60 `+ comnwnLs conditions. (11)) /� I spc of Vsai.er: (II) I ] (la..A IX] class li I ] Class ( lierlucs( D1111 resims before eranting" ties No _X Neighbor Not dieation: (12) Required? Fes No X 1/nr.e I tT, G;r.entiff. ;Lnrmon ✓, pn,pnrh /'le:l' )r Nu Section IV. I (caxrpLard hr hrohh nllirrn his Request for AA AA a p er front State 12eu11latio1);haN heen rut ie eJ record nip to the prmisioro of C'hare] 246-2'2:A A4 Al n-Site Ssraue Stslclns_ the revietc criteria applied.and the mitigation measures proposed and or requilred huts been evalnared for their eh 1111) to proeide public health protection at least equal to that prof ided M this chapter AV 1C. I ] Denied pielApr' r-..^r•,d eels F o, ,a „mmoni, condillon>anti requirement. noted iu S ruous II and III. Local Health Officer (131 _ 1 ' _,_ Date: J 1)t)11337-02I P.Itrc 2h of 32