HomeMy WebLinkAboutWAI2023-00044 - WAI Health Waiver - 4/30/2023 415 N.6th STREET,SHELTON WA 98584
,, MASON COUNTY SHELTON:360-427-9670,ext 400
VCOMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
ELMA:360-482-5269, ext.400
Building.Planning,Environmental Health.Community Health
FAX:360-427-7798
A plication for Waiver or Appeal cog
Amount Paid: 6, Receipt Number: G — 02,1 c
wAl (2W3 - 000(-414
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 Informationi 2/ e� / Q,p
Name of Applicant MAY' /` `v<M ✓G -3! 71 / [f,11/70Telephone
Mailing Address 2 t 7 N E 'e--/-0') Acoull 10
City ere inf r 7oJ- State 14) A Zip 9 f 3 /o
Parcel No. / .2 f11/ 13 -- a. -- /0 '/ t 0 0 3 O�y `/
Site Address ,� 7 ( #4". k 1 Hill ,U, /IYiL, 'A 90 5-02 4'
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
Class B Reduce Vertical Separation ❑ 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 material may be attached.):
REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY : •
CLASS B WAIVER CHECKLIST
4 RECORDED DECLARATION OF ATTENUATION ZONE kg I ZZQl-?(U
4 (er-11) p�APPlicant Si � Date: a 5� 3a 49
9nature:
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 2
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 !✓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 fi Environmental Health Manager'
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN ZtOira
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local policy has been submitted. 57 /ZO?S
Staff Signature:
Date:
PART 4: Determination of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect public
i 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:
I
Health Official Signature: Date: C/ Y -f
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
4.
MASON COUNTY MASON COUNTY PUBLIC HEALTH
0 COMMUNITY SERVICES
&L411rg,Planning
Envir
onmental ComntrY 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:360-275-4467,EXT.400
ELMA:360-482-6269,EXT.400- FAX:380-427-7798
APPLICANT NAME /tQ r k I/`9 A id�r WAIVER PERMIT NUMBER WAI 2oVi3-0 0 0 Lf
MAILING ADDRESS a $✓ L7 N E �_ , B 1 , //�
CITY ArC m4Q,Jr/ aIL. /i �t (��/ J �J STATE 14 A ZP 1 $ I V
SITE ADDRESS V / ` E. na��5!,; �(4/, R7 I 1 / I l . A 1/yn, WA 9 8519
TAX PARCEL NUMBER I d(2 3 a w 2)_06 O3 O PROPOSED DRAINFIELD TYPE IX CONVEXTIONAL GROTTY 0 CONVENTIONAL PRESSURE
1.SOIL SERIES: 5.VERTICAL SEPARATION:
The soil series must be Akierwood,Harstlne,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._.__._ l Greater than 12'_...._......_._..__..._.._ .._...w ❑
Harstine Gravelly Sandy Loam....... _....._._.__._._. 0N Greater than 18'_____________...._.W.._..___-_.._ IN
Hoodsport Gravelly Sandy Loam .__ ..._............_.._ 0 ❑ -Determined by:
Shelton Gravelly Sandy Loam _.._._.._.........._0 ❑ Depth to hardpan..........._._____________...._
is 1
Sinclair Gravelly Sandy Loam.........._ _......._......_...._.0 .❑ Depth to mottling ___._.. .... 0
Other ----❑ 0 Both.. __.._.».._ ... __ .._....... 0 0
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 _.._..._.._._._... 0 0 Z -Evidence of seasonal water table:
nft
Loamy Sand ❑ a Yes 0 CI x
/ ' ro
Sandy Loam ............_...._.__S1 0 $ _ ._No.. _......... _.._..__.......
.. C
Percent Gravel: -Curtain Drain required:
-Less than or equal to 35%......_......_...__ ._ IL ❑ 1-.) Yes _......_............ ..._....___.._... _... .. _. ...._.... ❑ ❑( to
-Greater than 35% _..._._..._.._._..__...__.0 ❑ 3
3.SOIL DRAINAGE: ?f 7.HORIZONTAL SETBACKS: ro
Soils must be moderately well drained to well drained. 0 Primary Drainfield must maintain 200'from down-gradi- fb
ent marine shorelines,surface waters,and wells. 0
Well Drained _._... 0 0
Moderately Well Drained _._-_.a IS -Are increased horizontal setbacks met:
Other . _._ ❑ ❑ Yes
JSI
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
Pressure is allowed on 3%to 30%. down-gradient of the primary drainfield.
♦
Less than 3% ❑ 0 -Is there 50 ft or greater between the down
3%to 15%.............................................. E3 , I gradient side of primary drainfield and
16%to 3096 _.. _... 0 0 property boundary:
Greater than 30%.........._..............._..._. .......__._. 0 0 Yes
No _ 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 contraction of roads,decks,patios, AFN: 6 ZQ IQ
parking areas,vehicular traffic.or other similar such uses.The owner must agree to all these conditions. Proof of Recording
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE updated 3/2I20T7
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) �r 111� p Local Health Department/District (2)
/'/ p (see instructions)
Address: oz 90 / �/E i/+,e/4i-, B A t*d Ifl a m (a/0y/
Brr�..er�vr., hI� �f.31D _.._ /
Telephone: 10 7 7„ / f Q r ~—
Signature:
Property Identification: (3)
fitted ' /A4230.-a2- 0O010
Section IL I (completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A— 0230 24"OF V/C FAR-PfCC,SURE (OR) 12" OF V/3 FOR PRESSURE 033 (OR)
Subsection: TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS
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: ZZU? TIC
Section m. l (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
i
Comments/Conditions: (10) S�/ C(gss 8 t4i'tt ,"
Type of Waiver: (11) [ ]Class A Aclass B I ]Class C—Request DOH review before granting? Yes_ No 1
Neighbor Notification: (12) Required? Yes_ No ?C 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 [Q'9-Approved/Gran —Subj all comments,conditions and requirements no in S ctions II and III.
Local Health Officer (13) Date: C l 2"3
DOH 337-021
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A ma, D6-tai i Septic Site Plan Name: Hightower Tax Parcel: 12232-22-00030 f —T: •-
ill _ too/ Address: 391E Hardings Hill Rd, Allyn
This is not a survey,all property lines/boundaries have been demonstrated by the Owner(s)and/or their Agent(s).
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Septic Site Plan Name: Hightower Tax Parcel: 12232-22-00030
::(11111,. --.. ALLIE13 Scale = 1" = 50' Address: 391E Hardings Hill Rd, Allyn
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lor4 0 tic os„ This is not a survey.all property lines/boundaries have been demonstrated by the(1vmer(s)and/or their Agent(s).
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