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HomeMy WebLinkAboutWAI2023-00118 - WAI Health Waiver - 11/22/2024 415 N.0'STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,eat.400 ELMA:360-482-5269,eat.400 Bo0dh%P1swn%Enww.W l M,C ..rAry K.M FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: Receipt Number: Z3 WAI12 -:'it Instructions: 1. Complete Pads 1 and 2. No determination can be made until these pans 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 P Name of Applicant ANDY GRUHN Telephone 3607897890 Mailing Address 2318 65TH LN NW city OLYMPIA State WA Zip 98502 221332150004 Parcel No. — — — — — — — — — — —Site Address XX PICKERING RD, SHELTON _ } Subdivision Name and Lot LLS 22-02 LOT 4 ; NO'V 2 9 2023 ! PART 2: Nature of Waiver/Appeal Class B Reduce Vertical Separation ❑ Food Sanitation Requirements 0 Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ 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 GRAWF`eR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE --�]% Applicant Signature: Date: 11/22/23 Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal VWaiver ❑ None required ❑ Class A 6/Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/Standard revision): WAC246-272A-0230,TABLE A 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL eFb VnY-6R- PRESSURE 055. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager' 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN %A04481 ) 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 77 Staff Signature: W Date: z Z Z( leZj PART 4: Determination of the 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: ❑ 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: Date: 62 Revised WI2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 5„..:IaU ..,E ..i -B EAR:] 275M8I.M. EWA:a60da232a9.M.400- FA%:360H27-119B AFVUCANiNN.1F ANDY GRUHN WawArewnxDMBEa WAI MAILMADDAESE 2318 65TH LN NW n,.,OLYMPIA STATE WA 98502 sm AccArn XX PICKERING RD, SHELTON MY TANAAACELNUMBEA 221332150004 rMs,osmoauNnunnn ❑comexslDNucAAWD J� E „N F..AE 1.SOIL SERIES: S.VERTICAL SEPARATION: Thesoil series mart be Nderwood,Hars[ine,tbodsport, upslopevertiral separation must be greacerthan le' Shelton,or Sinclair Gravelly5andy Loam. (orgravhyand greacer than so us pressure. Alderwood Gravelly Sandy Loam.._.........................© Greater than 32'..._._._...._.......__..........._......... ❑ Harstine Gravel"ndy Loam.........................._.. ❑ ❑ Greater than l8'.....___._.._....._..___._._...... ❑ ❑ Hoodsport Gravelly Sandy Loam................._._...... ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam.........._....._..............❑ ❑ Depth to hardpan...............__..._.................. ❑ ❑ Sinclair Gravelly sandy Loam........._......_---------- [I ❑ Depth to mottling..._.__._.-----.._...._._._..._ ❑ ❑ Other _._....❑ ❑ Both..........................__._....._._._.._.__.__..._.._._.__.. ❑ 2.SOIL TYPE: 6.WATERTABLE LEVEL: Soil types murtbe Medium Sand,Loamy Sand,or Sandy Iftest holes showZdence ofasrason B watertable Loam.Gavel percent murt be less thano d,. [o 35dy above hot-1 .h ayer,acurtaindminmay be required ! _ -Evidence of seasonal water table: I.O Medium Sand......................... ...._. ......._._.... ❑ ❑ I. Loamy sand..........................._.............................❑ ❑ Yes................................................................ ._................... ❑ o Ji No.................._._...._..._........._....._....._._._.__._........ ❑ ❑ z SandyLoam........................._............._..._.._.._._...❑ O Percent Gravel: -Curtain Drain ...... ed: m Ja Yes......_.............._.._..........------..------._._.__........ ❑ Die -Less than or equalm35%._................_.__._._.. ❑ No.................._._.._......_......_.___.____.._._......... Isa -Greater than 35%............___....._..............._.........❑ ❑ q � 3.SOIL DRAINAGE: c 7.HORIZONTAL SETBACKS: Primary Drunfield must maintain 20D'from down-gredi- T Soils must be moderatelywell drained to well drained. ent marine shorelines,surfacewattmrcf wells. F < WellDrained........................._........................._........ ❑ ❑ -Are increased horizontal setbacks at:.... LNJ Moderately Well Drained..._._...__........_.._.........._❑J J Other _._....... ❑ ❑ Yes....._..........._......... . ...... .................. . ............. ❑ 4.DRAINFIELD SLOPE: 8,ATTENUATION ZONE Slopes must be between 3%to 30%. Graviryis Doty allowed on sbpes from 3%tols%. A5ofoothorlmmalattenuation mne is required Pressure isallowed on 3%to M. tlown-gradient of the primary drainfield. Less than 3%........_..................................._... ._..._.._.... ❑ ❑ -Is there 50 ft or greater between the down ... 3%m 1 ..........................._......_....._...._._........ - gradient side of primary drainfield and 30% 16%to 30% ........................................._._.._...._.._.... ❑ ❑ Property boundary: Greaterthan 30%.....__...._.__._....._......._._............ ❑ ❑ Yes............................................................................. _._..© TheSgfoot horizontal attenuatlonzone is requiredtoberecordedonthe deed of the property as unbuildable / pdortodeslgn approval Theattenvation zonelsnatto be used(or the contmaion of roadxdeckxpadox AFN, 15tR411e parking areas.vehicular treffiooroth urularsmhuses.Theowner must agree 1,111h esecondit on, ✓Ilem�eiq u0dretl LYM1) MIS FORM wu BE SCANNED A„DAVABABLE ECA neUCYEWON r„E NASCN CDUN Wu"'L i r 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) Re ueSt for Waiver from State Regulations Section 1. (completedbyapplicant) Name: (1) ANDYGRUHN Local Health Department/District(2) see irishuetions Address; 2318 65TH LN NW,OLYMPI ,WA 98502 Telephone: ( 1 360-790-3183 — -----_- — Signature: Property Iden ati ) —__—__._...........__._--..........................._._-._.—.............._.......................... — .- XX PICKERING RD, SHELTON LLS 22-02 LOT4 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 IS 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: 9 Section Ill. (completed 0 health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) G S/ — Type of Waiver: (11) [ ]Class A Class B [ ]Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes_ No 1f 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 thew ability to provide public health protection at least equal to that provided by this chapter WAC. [ ]Denied O_Approved/Granted—Subject to all comments,conditions and requirements noted in Sections II and 113. Local Health Officer (13) Date: lvtm IO2� DOH 337-021 Page 26 of 32