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Home My WebLink AboutWAI2023-00088 - WAI Health Waiver - 8/28/2023 415 N.6th STREET,SHELTON WA 98584 7 f' 9 yt MASON COUNTY 1 SHELTON:360-427-9670,ext 400 1 COMMUNITY SERVICES BELFAIR:360-27S-4467,ext.400 ELMA:360-482-5269,ext.400 Building.Planning.Envaonmental Health Community Hedlt6 FAX:360-427-7798 Application for Waiver or A peal Amount Paid. Receipt Number ♦. II Ij WAI aC - OMa$b 1 $ 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 TYLER ARNOLD Telephone Mailing Address 800 W WYNWOOD DRIVE City SHELTON State WA Zip 98584 Parcel No. 42025-75-00260 - Site Address SAME AS MAILING Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 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 materi ched.): REDUCE VERTICAL SEPARATION FOR CONVENTIONA GRAVITY O0PRESSURE OSS CLASS B WAIVER CHECKLIST � RECORDED DECLARATION OF ATTENUATION ZONE r{F/p• Zw;/j I CL Applicant Signature: �icp'0.(4� a r./�� Date: Br 24)/33 (U/✓✓ Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page I of PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) E Appeal vWaiver T. None required E Class A n/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 GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board El Environmental Health Manager 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN iwsi _I ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. (y'� y/ Staff Signature: 4--- /Date: ! / ( / 7O? PART 4: Determination of the Hearing Official Zi 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: .ram Date: 175r/1 Revised R/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Am("r '-f COMMUNITY SERVICES --, MASON COUNTY MASON COUNTY PUBLIC HEALTH 03 39 Sulld189.9lanning Environmental 14448h,Community health CLASS B WAIVER WORKSHEET 415 N 6TH STREET,BLDG B.SHELTON WA 9E1584 (State and Local waiver forms required) SHELTON 380-427-9670 EXT 400 . BELFAIR•360-275-4467.DC 400 EL MA 380-482-5269 DC 400- FAX 360-427-7758 APPtICANT NAME TYLER ARNOLD W419E39E394-I NUMBER WAI 21)21-OW git MAILING ADORES5 BOO W WYNWDOC DRIVE cy SHELTON DIKE WA zip 98584 snaDoctss SAME AS MAILING CITY TAX PARCEL HUMBER 42025-75-00260 PROPOSED CIFIAINFIELD TYPE 0 coovntrioNse cveni 0 CONVEFFOONAL 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 Irfor pressure. Alderwood Gravelly Gravelly Sandy Loam D 0 Greater than 12" i iiir Harstine Gravelly Sandy Loam 0 El Greater than 18" Hoodsport Gravelly Sandy Loam _JD EL., -Determined by: Shelton Gravelly Sandy Loam M M Depth to hardpan 0 0 Sinclair Gravelly Sandy Loam 0 0 Depth to mottling El EV-- Other 0 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 Lk Litz -Evidence of seasonal water table: Loamy Sand Id a Yes 0 it Sandy Loam 0 0 No St Percent Gravel: W -Curtain Drain required: -Less than or equal to 35% D El .?, Yes _,El l2i4 -Greater than 35% 0 o g No M 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: re Fi re Sr Soils must be moderately well drained to well drained. Primary Drainfield must maintain zoo'from down-gradi- ent marine shorelines,surface waters,and wells. 0 Well Drained Pi MA z Moderately Well Drained ID 0 -Are Increased horizontal setbacks met: Other 0 0 Yes V Firr No 0 0 4. DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. Gravity is only allowed on slopes f rom 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% la Et -Is there soft or greater between the down 3%to 15% gradient side of primary drainfield and 16%to 30% El 0 property boundary: MI 11---- Greater than 30% 0 0 Yes . No . ID 0 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 contruttion of roads,decks,patios. AFN: 2245131 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Reco,ding THIS FaiM MAY 82 SCANNED AND AVAILAOIF FOP PUBLIC VIEW OX TIE MASON COUNTYVIEB5111. ,pd,ted 4i,F24„ Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July I,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) TYLER ARNOLD (see instructions) Address: 800 W WYNWOOD DRIVE SHELTON, WA 98584 Telephone: ( ) Signytgrra:' � 144, Property IIdentification 4202 5 -00260 Section II. (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" OR GRAVITY OS 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. LZ0315, Section III. /completed by health officer) Review Criteria: (8) Mitigation Measures lin addition to those proposed): (9) Comments/Conditions: (70) (-ea_ ea C/u5C- B /Vr Iwo/sped- Type of Waiver: (Of [ ]Class A Class Bll [ ] Class C—Request DOH review before granting? Yes Neighbor Notification: (12) Required? Yes No IIfneeded, are agreements. cavemen's. etc properly filer? 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 toted in Sections II and Ill. Local Health Officer (13) ' "q / / _ _ Date: 7A/tec Doll 337-021