Loading...
HomeMy WebLinkAboutWAI2023-00108 - WAI Health Waiver - 10/23/2023 415 N 6TH STREET,SHELTON,WA985M ON MASON COUNTY SHELT :3604274467-0467,EXT400 BELON:360-275 ,EXT400 Public Health & Human Services ELMA.360482-5269,EXT400 40 FAX 360-427-7787 ENVIRONMENTAL HEALTH REVIEW OF OSS APPLICATION Jim Zimny -Advantage Perc & Design 7178 WINDFLOWER PL NW SEABECK, WA 98380 Applicant: HOLMAN RYAN a 1 Parcel Owner: HOLMAN RYAN -` Site Address: 451 E North Bay Rd Primary Parcel Number: 122174400040 OSS Permit Number: SWG2023-00454 Permit Description: 2-bedroom gravity system Permit Submitted Date: 1012312023 Permit Review Date: 11114/2023 The above mentioned Onsite Sewage System Application was reviewed by Environmental Health and found more information is required. Parcel tag "SEPTIC- Belfair/Allyn UGA: NO INDIVIDUAL OR COMMUNITY ON-SITE SEPTIC SYSTEM ALLOWED for new development or redevelopment on existing lots, except as noted in MCC 17.03.030(2)(a)(ii). Sewer Connection may be available and required." In order to determine whether the proposed residence will be required to connect to the sewer system, please submit an updated site plan that shows the distance, in feet, from all proposed facilities to the property line, To include proposed SFR, outbuildings, well, septic system, reserve area, and all other structures. Thank you. If you have questions or concerns let us know. Sincerely, 1 I Z�l wz3 jt cGri rwre- David Anderson I / danderson@masonceuntywa.gov N IO SN I SN I S w w � v EWA3 m w � 3 � a a o. 606' m < ICI fl N rl m G � m N 0 0 a' v ZO � m o o N 4 m 3a LOn V � 2 N O 01 F N 3 N N N � 00LO � w N i A 00 N � R � N Z Ln q O O < ^'orttft \ w O � w o 3kDAAp D � � D � O vi V > Z o O N pDr73 0 o s w o o w 3 3 0 n z o � � O -IW O � N IO SNW I SN I S 2 � wT EWA3 CL a °- 6p6 A o m f") N m N O p o cN.a O O y O � ar� a O N V 1 Ol N I lA w N 1 I A OR 00 V N H N to '\ N �. _ t0 Z N < N�nheay RO `\\'• \ w 0 y O # y 4 FF 3 Na C m-4 _ ^ R KT ' v� V > 0 O D z o A 3 E � 3 o zn C Ol O m \ Y L N \'\ ul ♦ N ♦ N Z _ \ 00 O '-I ♦ N # vi � 00 n 00. � 1 N N � k d W �NN LD E O O y E 0 O 0 O a uj r, w z 9p9 ro b N y� rn E a+ E VM 3 ob O o c a s v C a s c 'ac a c lL iy -O LL b N r N =N N =4 N 2 # M a L Nt M NF O M O MF CD m OFFICIAL ^USE ONLY MASON COUNTY Ol g COMMUNITY SERVICES "� • R m01� Nf[IWM(Cnm„wniryH YLM1InimnnvPJHiWIN �.` m m� SWG1 — 0 z rA ON-SITE SEWAGE SYSTEM APPLICATION 3 z FWLICAN! RUNE m m Ryan Holman 17 z c MAILING ACIX1E55-SRiEEf CT",SfNF,DPLGOE 3 4301 Forest Beach Dr G c q Y 335 m A yTEAOORE$$.$IREEI,GTV,21P000E 451 E NORTHBAY RD, Allen WA98528 (— NAME OF GN4R R10NE Jim Zimny 360-516-7287 N NAMEOFIN$lN RIWIE — I(A PERMITTYPE(mbcf DRIIA(ING WATER 9JlIRCE 2w I� V' F RESIDENTIALOSS FcoLMl Mm Fic ERan = ffs PRAIATEINgNOINL EFF wTEmv RLmvw z I 1 TYPEOFMFR (e ) 17 PlIBl1C NNlER sYSTEM I L ff NEWCO LICTIONIUPGRI S t7 REFYUR/REPLACEMEM OTNGt OETNLS fabdrMafplllyJ DIABLE IXREPNR I� GUBMITTALN O sU NOSEM/LC£RFACI 0 EJUSTING FAILURE El sHOR uw LY DESIGN FORM(REWIRED) FsEFmc OESIC>ti(iSQARED) ®Naas LOT s1f I, �w,IVERrs)oF,aPur•w r) 2 6.53 Acres n 1 � ICwREcrloNSTO sITEANO sTEcamnloMs fm A laalpeb) From Allen Travel east turning Rt on E Northbay Rd. Site is .5 miles on the left. Marked with Pink Ribbons.Go through gated rdd and follow ribbons to test les. 5/IE4YST6EMaaF➢fROY MApROAO ANO i6TNIXF5Y/SfBEFLt(WFD MIIH lF3TIp1EMMIBHC' I IG OFFICIAL USE ONLY BELOW THIS LINE U W RPDE I FNLURE 9JURCE 11tt�aNLM pry�l OMOLUNTAw OMAINTENANCE/PL mw [IMU)INGFERMT GNOMES 1[3 M NT OOI IER: INWEC OIISMLLOGS COIMIBRSIa]NM%]NS 7H7 0-�3"OL M ed 5 Rtst of 33" b✓/ +rn Q 111"' 111 vakr. Ifft;o-3Z A (� 1 wdS W/ aPitI of (R"CA'M a�-25 ' n sI I��rl ki Q4- 3f l./ f%II 11 S'�GYblrh9 tva/t4G. �� �` ✓✓ 7 T ©2 3 Z023 iN?- 0 32`a lac olds / f"I fI So�M Res�- F 3 Z' SaLCWE3: pEGMIO pRMMY'IIOINSIN1AT10NRBORF V=V Y G=GRM1LLY G=SAND L=WM1 3=ULT C=CLAY E=EMRENELY R=RJ015 REaMIiED FOR RNMARNONIL. SIGNANRE wAtE N4LIGTNJN WARATIa1 MTE AfPUfAI1LNAYAph➢'L991ED BY DATE (l lSllrL� TNIS FORM IMY EE M:ANREDANDAM\IIAEIE IORF11EU0VM.ION III MAMMi GOIIiYYIAUMTE REN�MORt! DESIGN FORM—PAGE ONE Assessors Parcel Number. 122174400040. A design will be reviewed when 3 mnin of each of the following are submitted: Completed design form that has been signed and dated. Scaled layout sk ack including all applicable items on checklist Scaled plot plan including all applicable heats on checklist Cmss-section sketch including all applicable items on checklist. This form maybe s®aned and agiagef>public view on the Mason County Web sib,. 1=unum papersue. 11"X/7" '1 PARCEL IDENTIFICATION Permit Number: SWG 'W13' Designer's Name: Jim Zmny Applicant's Name: Ryan Holman Designer's Phone Number: 360-516-7287 Mailing Address: 4301 Forest Reed)Dr Designers Address: 717 WINDFLOWER PL NW ® Oia Hama WA 9gi.'a SMSEpr WA9939U city state city SM4 Zip DESIGN PARAMETERS Treatment Device ❑GleadmmBiori ter ❑Sad Filter 0 Mound ❑Sand Lmed Dmmfwld ❑Recirculating Filter,Type' ❑Aerobic Unit MaketModel O Ihsmfectian Unit MakrlModel Drainfield Type gGmvity O Pressure MrTxmh O Bed ❑Sub Surface Drip Septic Taole/Drainfield Specifications / Laterals Number of Bedrooms 2 / Schedtde/Class j 3034 Daily Flow:Operating Capacity 180 gpif Length �/` 45 ft Daily Flow:Design Flow 240 gpd" Diameter f 4 in' Septic Tank Capacity(working) 1200 gal/ Number 3 Receiving Soil Type(1-6) 4 — Se on 5 CTC it Receiving Soil Appl.Rate 0.6 gd/W Orifices Required Primary Atca 400 Rc oW Number fires N/A Designed Primary Am 400 ftt—� Diameter in Designed Reserve Area 400 ftz Spacing 4� in TrenrWBed Width 3 ` 'e '`:. Manifold Treoch/Bed Length 134 8 Sc IeFtSgat����a N/A Elevation Measurements Leng(1I" _. m fl Original Dminheld Arcs Slope 5 % . Diameter in New Slope,If Arrorcd % _ ➢reremd rroWeld wMgumi.need? M Ycs O No Depth of Excavat ionaw 2 m Transport Pipe fmm Original Gra .,laq, 10 in— Schedule/Class 3034 Designed Vertical n 18 in— Length 25Graveness Clambretl7 ❑Yea ❑No �Optiolat Diameter 4 in Pump Acqired? ❑Yen O No Dosing and Pump Chamber Pho Specifications Number of dosearday Diff.le Elevation p&Uppennos[Orifice_fl Dose quantity gal DmieldSquirtHlected Residual(trail) fl Chamber Capacity(Good) gal Uppermost Orificer 0 Lower than Pump Shutoff Pump commis:Please check those requirrdCapacity A Total ead gpm OTiner OElapse Meter ❑Event Counter CakWmed Total Pead R If Timer. Pump on ,Pump off Contends DESIGN FORM-PAGE TWO Assessor's Parcel Number. 122174400040- ___ - Permit Number SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch A Test hole locations Iff Drainfield orientation and layout Reference depth from original grade: • Soil logs N! Trench/bed dimensions and Of $epgc tank • Property lines critical distances within layout B Drainfield cover 16 Existingro wd wells 9 D-BoxfValve box locations and p po Reference depth from original grade within 100 It of property 1121 Septic tank/pump chamber and restrictive strata: 0 Measurements to cuts,banks,and locations B Laterals,trench bed,to d surface water and critical areas IE Observation port location bottom H Location and orientation of fH Clean-out location ❑ Curtain drain cull r curtain drain and all absorption ❑ Manifold placement ❑ Sand augmen components ❑ Orifice placement Other cross-section 9 Location and dimension of Ef If Obsery ' ports/cleanouts primary system and reserve area Lamm!placement with distance to edge of bed Other In anon 14 Buildings ❑ Audible/visual alarm referenced Yes No m Direction of slope indicator 11 Scale of drawing shown on scale ❑ esign staked out 9 Waterlines bar ❑ Recorded Notices attached Id Roads,easements,driveways, ❑Waiver(s)attached pang ❑Pump curve attached 9 North avow and scale drawing ❑ ❑Evaluation of failure shown on scale bar Non-residential justification s@ ❑ ❑Waste strength Ju E� E oesicu ❑ ❑Flow rttr EsIGN APP VAL The anderogned designer must be notified tall at ti of installation IT Yes ❑ No i6 -ir-23 Signature si Date The undersigned has reviewed this design on be f of Mason County Public Health and determined it to be in compliance with state and local on-site regular s: Environ oral Health Specialist Date CAUTION: DESIGN APPROV IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped "App ed"by Mason County Public Health. ✓ The Onsite Sewage Permit not expired,the Permit Expiration Date is: ✓ Drainfield site conditio ave not been altered to adversely affect conditions of design approval. Please Note: he system must be installed by a certified installer, unless prio uthorization is obtained from Mason County Public Health. An Ins lation Fee is re uired. This fo maybe scanned and available for public view on the Mason County Web site. Updated Date: 12/7/2015 � ) k ƒ } ) to / \ \ T.�� / �y \ � = r6 [ / /\ } ( I \ % ƒ a 0fz ® ! ` \ ) . � 2 £ / § ; to Z m 3 Wmo 0 n m 0 N - D o O N m 3 c — � I o I a' I a N w f0 \ I 1 \ I I \ t__-- _____. \\ u, o �\ D ` o \ p O N O N NOrthbay Rd 62g� N - d ' A N ADO � � o s o $ ' 0 n B Z Advantage Perc & Design I -- -. •-)c .iscinable•30 Years of Local Experience Construction Notes for Gravity 2 Bedroom System: Equal Distribution w/graveless chambers(Rock and pipe may be substituted) Install 3—45' Laterals w/4 hole d-box. Install on 5'foot centers. Install 12"deep on low side of trench maintain 18"of vertical separation Install level and along contours. Install in dry weather only. Use 1200-Gallon septic System designed for typical residential waste strength sewage only. System designed for 240 Gallons Per Day AW17/ Advantage Perc&design APDdeslensPi cloud.com (360)516-7287 < < ti , 1 0 g z Fi 1� � i 1 d � � s y� f - OWANO 1� 3Z06pRoai pE51tiNER EnP�e°'Wel 1' 1 3 1 415 N.6u STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360427-9670,eat 400 COMMUNITY SERVICES aELFAIR:360.27s-4467,M.400 ELMA:360-482-5269,a 400 FA%:360-427-7798 "��p on for Waiver or`A peal Amount Paid: � i Receipt Number An WAI J(---ftA-0—% Instructions: 1. Complete Parts 1 and 2.No determination can be made until these parts are fully completed. 2. Fees maybe 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 -{-o�rh K.� Telephone Mailing Address <T/' U) ff 5� y JIAc.C. 0K. City 6-' �mrbar U State (A a- zip / Parcel No. 2 2. 1 I ! - - C) U d y Site Address 14 Y Subdivision Name and Lot PART 2: Nature of Waiver/Appeal l // Class 0 Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Lomtion,WAC 246-272A-0210 ❑ Water AdV cyR ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelin ' ❑ Mason County Onsite Standards ❑ Departmental Detarm d,S)ions ❑ Contractor Certification Requirements ❑ Other 1u, Obi L3 Ll�C3 (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,add'Rional material may be attached. BY REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY CLASS B WAIVER CHECKLIST RECORDED DECLARATIO F ATTENUATION ZONE Applicant Signature: Date: -2.-3 R.Awd B2l/2017 This form may be scanned and available for public view on the Mason County Web Site. Page 1 ofi PART 3: Public Health Evaluation (Staff Use Only) f. Type of Determination Required: Type of Onsite Waiver(if applicable) Appeal VWaiver ❑ None required ❑Class A s/Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/Standard revision): WAC246272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY6fi PREBBHRE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ CenNied 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 ) 6. 1 have received this waiver/appeal request. It Is complete and mitigation required by the state and local policyh7as been submitted. I ) Staff Signature: < / ✓ Date: I! G V?- J 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 dented. This decision is based on the following findings and conditions: Health Official Signature: `il✓ Date: `f Z 2? Revised 9/21/2017 This form may be scanned and available for public view on the Mason County Web site. Nat 2of2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC EBectNe Date: July 1,2007 Revised April 2017 On-Site Sewage Systems(Chapter 246-272A WAC) Request for Waiver from State Regulations Section 1. (evowksadby applicant) Nano: (1) ` Local Health Department/District (2) 0.n see inshuctimu Address: a� V"Ps, qg3 s Telephone: Signature: "city T eation: (3) `Z 06 G O Section IL (�pla/ed byappGema) WAC Notation. (4) WACRequiamrnl: (5) Waiver Sought: (6) 246-272A— 6230 R) ) snbseenom TABLE VI 38"OF V/S FOR GRAVITY 18-OF YLS FOR GRAVITY O lusfifieafion(mitigation measures m e COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATI-N. ZONE AFN: Section 111. (canipletedby health officer) Review Crucria: (8) Mitigation Measure fur addition to chine proposed): (9) Comments/Conditions: (/9) Type of Waiver: (11) [ ]Class A CIm B ) ]Class C—Request DOH review before granting? Yea No_ Neighbor Notification: (12) Required? Yes_ No_ lfneeded,are agremasna,conascats,etc.properlyfiled? Yea _ No Section tv. I (--plead by health affreer) — "is Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC OnShe Sewage Systems. The review criteria applied,and the rmligation measures proposed aMiorrequhed,have been evaluated for their ability to provide public heal'thh protection st least equal In that provided by this chapter WAC. [ ]Denied 6 pproved/Granted— bjcer to ormrents,conditions and requirements noted in Sections II and DI. Lail Health Officer (13) _.. Date: DOH 337-021 Page 26 of 32 MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH ....x a .a.. r CLASS B WAIVER WORKSHEET tisxe.xsnux-r.eimasretrarvumsr (Stateandlom/swiver/omssiequi/edl srcvac amanestp.m too-e¢rurt amarsarar,sn tao Burr:oaamaxau.sxr.too.srx am-to-Here WAI .o«ss&ic. �os-�: taa w gd'33s� u.».asaueaa f ? 2 / `7- 44-/ oo6 yD nowooMxaanmr $l aMnnlox.twvn Dcaoarwuswss- I.SOIL SERIES: S.VERTICAL SEPARATION: TiesausMesmunrbe.Ideraoo4 wmine HoaMWR up+IWe�WrNWrarbn msf be9luRrtlan l8' 5hdmry«Sattldr(ra.MySaMyLwm fur9aMbab 9ie*hr Man 13'lprpreauz Alcl.dGravely Sandy Learn--137 la Gmater Man l2' — ❑ ❑ Hardin Gravelly Sandy Loam ❑ ❑ Greater Manlr _ U Iff Hoclgp Gravelly Sandy loam — ❑ ❑ -0aterrYtNbyr. Shelton Granel"ndly leans ❑ ❑ Depth m hardpan Sinclair Gavely Sandy L.wm ❑ ❑ DryMWnvlttlNg ❑ ❑ other —❑ ❑ BoM____ . ❑ ❑ 2.SOIL TYPE: 6.WATERTABLE LEVEL loll typesmustx6rwwnsan4 wmysaa«lardy rtmtl�almwealae,..e.ta:eaww anarmle Lnan.Gra:el penmtrtxnt bale Man«ryudm35% abaseruaactlselayer,aartdn bM mryberaqulrtd Medlum Sand_— y1T ❑ S -Evidarradsaaaaealaa rbble: Loamy SarW _19 ❑ !Jo _.el W a Sandy loam___..—. Percent Grand: {r�talr UaaYngebal! -1essthan«equdm35 19 ❑ Yes ❑ 0 -Greater Man35%_ ❑ ❑ 3 Ho $ 17A' 3.SOIL DRAINAGE: '- 7.HORIZONTAL SETBACKS: w c Drained nutletalely wNl Malretlro nee d'ahed H1n�sY Dadnaadmuine%,a feeea fm anc, T retll- n S rm nwbesharearleRsvbre viatessaMvdi 3 Well Drained_._._-- ❑ ❑ lrv�ModeratelyWNl Drdrod._____ — -Mbraeuad trtrrmastYSMasI¢rrw: me ❑ ❑ Yes. — Ho ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE slops mist x beLwem 3%m 3a% GmmylsonbdbwedonsloPesrrom 3%rots% Asormthwnmmatre+naron rare mrequaea P�mne Calbwedm3%m 30% Joxtr9rai td Mep«^arYtraM1�field Less than 3%____. —� ❑ HSIMn Wftorg brbdxewrtbedam grtlWR.W.dpaloaydrakA ldawd 16%m303a ❑ pamper"boMoW Greater Man 3r% ❑ ❑ ❑j b ❑ The 50 foot twrizondl atMwdpn sane h reeuhed m be reterdd pn tlse deed err the pspperly a url W Ytlabk prlormdesgnappmval.ilia an«ruatlanzarearotm be usedfar MeoonCuctlondmads,decl¢patlas. AFtl Psmnrareas Mtlaslr trdfic«otlerdmlarwch yea llseoanarvssayeemdlMesarrarbm n==rax�ava iX6ff0A M.YE5GXIEDPID.WYRE(ORNa1KYFM«IM.MYMmW1YMta11E �aYYtOn