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HomeMy WebLinkAboutWAI2023-00099 - WAI Health Waiver - 10/4/2023 P-+.�,,y 415 6`h STREET,SHELTON WA 98584 �` MASON COUNTY N. 6th STREET, N: 360 ELTON70,ext 5400 84 /.. 467 ext.400 'I�' y,, COMMUNITY SERVICES BELFAIR: 360-275 4 -, f ELMA: 360-482-5269, ext.400 ij, / Building.Planning.Environmental Health,Community Health FAX: 360-427-7798 Application for Waiver or Appeal Amount Paid: Receipt Number: 1-3 WAI 20L ) - COC `� 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 Telephone 5�/ - ZO , - `/4l 6 3 Name of Applicant �G.1�i,c ,K•t_. C-q � p Mailing Address I S t Q ,Rgr I- .gt. City • -c.. kLt,„ State (.,)/t- Zip `t 8SX'f Parcel No. 1-1 Z i L 41 c-- f 3 -- t © 0 1 Site Address ) I L= t It 2 , k,c^,..,_ tik5A` 925q2 Subdivision Name and Lot Tr- c (— SE 25 73 PART 2: Nature of Waiver/Appeal % Q 'q U ti, 12/ D � � Class B Reduce Vertical Separatio Food Sanitation Requirements ❑ Building Permit Review Policies Q�� �` ' ��D 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 rt.' _— ��- 0 Departmental Determinations ❑ 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 PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE : AHN z 7-2.o 1aoa A.-- Applicant Signature: C4 tk -) Date: /0/1 / 2 0 ZS Revised 8/21/2017 r, This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) — Appeal Waiver r, None required - Class A v/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 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board EY Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 224 470z_ ) 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: ( O( ti/?o l) PART 4: Determination of the Hearing Official AThe 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: Date: l 1 ` 4/2-*' Revised 8/21/2017 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 .II- x' COMMUNITY SERVICES . Building,Planning,Environmental Health,Community Health CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 (State and Local waiver forms required) SHELTON:360-427-9670,EXT.400- BELFAIR:360-275-467,EXT.400 ELMA:360-4825269,EXT.400- FAX 360-427-7798 APPLICANT NAME1. C.uG (,K L CAS l WAIVER PERMIT NUMBER WAI Za Z 3—0 0017 MAILING ADDRESS I -S ( ct PlI To 4-- s4- .1 t\„, STATE � �y LIP -( &SM1 Y SITF ADDRESS j) L WC b i 'r I( (?a, CITY fin( ►n�. TAX RAKE!NUMBER L if• ( — ` . 9 o O I "1 PROPOSED DRAINFIELDTYPE 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 0 Greater than 12" ' _ Lg Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" 0 0 Hoodsport Gravelly Sandy Loam ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam 0 0 Depth to hardpan El Sinclair Gravelly Sandy Loam 0 El Depth to mottling 0 ❑ Other ❑ 0 Both ❑ 0 2. SOIL TYPE: 6.WATER TABLE LEVEL: If test holes show evidence of a seasonal water table Soil types must berc Mediumd Sand,Loamy orSand equal or Sandy35%. I above restrictive layer,a curtain drain may be required Loam.Gravel percent must be less than to 35%. I Medium Sand ❑ ❑ -Evidence of seasonal water table: Loamy Sand ❑ 0 a Yes 0 IXIa Sandy Loam �.. NI s No 9- 0 -Curtain Drain required: Percent Gravel: CD riti -Less than or equal to 35% a Yes ❑ a Greater than 35% ❑ M 3 No . ' z 3. SOIL DRAINAGE: c 7. HORIZONTAL SETBACKS: c Primary Drainfield must from ( I Soils must be moderately well drained to well drained. 0_ maintain200'fm down- radi- rD ent marine shorelines,surface waters,and wells. =O tY1- Ill Well Drained 0 0 -Are increased horizontal setbacks met: Moderately Well Drained 0 Ela ' Yes Other No ❑ ❑ 4. DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. A 50 foot horizontal attenuation zone is required Gravity is only allowed on slopes from 3%to 15%. down gradient of the primary drainfield. Pressure is allowed on 3%to 30%. Less than 3% ❑ ❑ -Is there 50 ft or greater between the down 3%to 15% ,7,! 4 gradient side of primary drainfield and 16%to 30% 0 0 property boundary: Greater than 30% 0 ❑ Yes No ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 14�,2/v�7.,'prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, Proof of Recording: parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. AFN: 0 updated 3/2/2017 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 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: (1) Local Health Department/District (2) VC“LUe.Jo%s�----•CS __ (see instructions) ......_.._..._......._. __._....---.__. Address: Rge,_-. Telephone: ( ) 3q 1 Zoto_....r eie-1 b.3 - _......._..._ Signature (4.41t Property Identification: (3) 1Ti'&i2 C ____...._..__._........... nIt Yfr(e4 ti. t...? ---Ic.! - - 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 i• 2" OF V/S FOR PRESSURE OSS (OR) Subsection: TABLE VI 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: 270 707 ) Section III. (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) e_ C(0- # L q titre"- 4/o✓l(s'' (a1..4C-kedJ Type of Waiver: (11) [ ]Class A ['Class B [ ] Class C—Request DOH review before granting? Yes No 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. [ ] Denied [4Approved/Granted—Subject all comments,conditions and requirements noted in Sections II and III. Loc al Health Officer (13) Date: ['�/.14/1-7 DOH 337-021