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Home My WebLink AboutWAI2023-00116 - WAI Health Waiver - 11/24/2023 415 N.6th STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,ext.400 Bu,Id ng.PAnrvny.Enrvonmmlal 'ea10.Commmniy lenl[li FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: Receiptec 3 Not Z - WAI ZbZ3• C'xot 16 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 METCALF C/O B-LINE CONSTRUCTION Telephone 360-426-4221 Mailing Address 2971 E PHILLIPS LAKE RD. City SHELTON State WA Zip 98584 Parcel No. 2 2 0 1 9 -- 1 1 -- 0 4 0 1 0 Site Address 5626 E AGAGE RD, SHELTON, WA Subdivision Name and Lot S 1/2 W 1/2 NE NE (R:2W, T:20N, S:19) , --. - PART 2: Nature of Waiver/Appeal `t 0' Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations O 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 O Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE firi0,1205, Applicant Signature: ! Date: ZAINOv Z.m2 3 Revised 8/212017 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) n Appeal VWaiver r_ None required I Class A dClass B c Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/Standard revision): WAC24B-272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official: O Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board V Environmental Health Manager 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)H RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN ZZ(II,S7 M ) 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: Date: I/f/zoz Y PART 4: Determination of the Hearing Official A- 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: IWWW Date: V- �Z eased sn_leon This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY MASON COUNTY PUBLIC HEALTH ,in 's COMMUNITY SERVICES :�✓_ ` CLASS B WAIVER WORKSHEET , a.,14,.9Pir..,.9F..,o.mwi.IH�le.comm.nR,He,lr. a 8.SHELTON WA9e594 (State and Local waiver forms required) SHELTON 7-35042 WWO Err 400- BELFAIR 360-275-4467 E%i.400 ELELM?. 360.4S75269 EXT 400- FAX 360-427-7700 APPLLANr NAME METCALF C,O B.LINE CONSTRUCTION WAP R PERMIT NIIMe1R WAI CITY SiEL TON STATE WA ZIP ease. SITE ADDRESS 5525 E AGATE RD.,SHELTON,WA cry SHELTON TAX PAe✓I NUMRI n 22019-II-04010 PROPOSED omINFrem TYPE 0 CONVFNTIONAI GRAVITY 17i c Nv[NncaAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood,Harstine,Hoodsport, Upislope vertical separation must be greater than 10" Shelton,or Sinclair Gravelly Sandy Loam. for gravity and greater than 12"for pressure. Alderwood Gravelly Sandy Loam 121 Greater than 12" 0 0, Harstine Gravelly Sandy Loam 0 0 Greater than la" LVJ LSS Hoodsport Gravelly Sandy Loam.............................. ❑ 0 -Determined by: Shelton Gravelly Sandy Loam . 0 ❑ Depth to hardpan . ❑ 0 Sinclair Gravelly Sandy Loam . 0 0 Depth to mottling On 0 Other .........0 0 Both og L7 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 Loan.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand .. 0 ❑ -Evidence of seasonal water table: �/' Loamy Sand M' E7 r Yes . I t q Sandy Loam 0 0 3 No 0 ❑ -. Percent Gravel: O -Curtain Drain required: J ��0� -Less than or equal to 35% IA 0 o Yes m L7 0 -Greater than 35% ❑ 0 3 No ❑ ❑ 3 3.SOIL DRAINAGE: '- 7.HORIZONTAL SETBACKS: c T C Soils must be moderately well drained to well drained. 0 Primary 0 ra infield must maintain Zoo lion down-gradi- entmarine shorelines.surface waters,and wells. 2Well Drained gi Moderately Well Drained 0 ❑ -Are Increased horizontal setbacks met: Other 0 ❑ Yes . ILV RI" No 0 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 Presure isallowed on 3%to 30%. down-gradient of the primary drainfield Less than 3% 0 0 -Is there 50 ft or greater between the down 3S'o to 15% . IS/ ' gradient side of primary drainfield and 164%to 30% 0 0 property boundary: @I WC 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 unbuildable �/// prior to design approval. The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: Z)W5} 70 parking areas.vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Pool oiRemNing. 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. j (completed by applicant) Name: (I) Local Health Department/District (2) METCALF C/O B-LINE CONSTRUCTION (see instructions) Address: 2971 E PHILLIPS LAKE RD. BHELTON WA 98584 Telephone: ( 360) 42 4221 tur P eroperly Identlt. • t" 22019-11-04010 S1/2W 1/2 NE NE Section IL (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 SO" OF V/3 FOR GRAVITY 'Tr OFIT/S-PC/R-GRAaintrOSS 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': ZZOSQT6 ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments!Conditions: QO) fee, af4-.c/_ ✓ Capp p waiver L„�ktt ,_ ,#: l'ype of Waiver: (II) ( ] Class A ip Class B I ] Class JC—Request DOH review before granting'? Yes No y Neighbor Notification: (12) Required? Yes No X 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. I ] Denied Approved / Granted—Subject to all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) Date: lc/Lr DOH 337-021