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Home My WebLink AboutWAI2024-00038 - WAI Health Waiver - 5/14/2024 415 N.6'STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-96-10,ezt 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,en.400 aui I9�q.P4ina,g Fmironmmd Healu,ranmwry Ikwm FAX:360-427-7798 AgtltlFtltldpplli�``c''aation for Waiver or Appeal Amount Paid: � Receipt Number: 9QXA- ()I QOS wAi r)0)-4 - uoo 3i1 Instructions: 1. Complete Parts 1 and 2. No determination can be made until these parts are fully comoletetl. 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 Telephone 3 Ce, 1;-6`i - o ?1 b�A MailingAdddress — city t ^r�— State W Zip Ce-- Parcel No. � z. 2— o _-7 3 y _ CS c> O Site Address 30\ Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 51 Class 8 Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ 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) 4 Description df 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#EENUATION ZONE Applicant Signature: Date: Revised 8/212M7 This form may be scanned and available for oublic view on the Mason County Web site. Page 1 of 2 Granting Waivers from State Oo-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revisal April 2017 On-Site Sewage Systems(Chapter 246-272A WAC) R uest for Waiver from State Regulations Section (completed by appliamt) Name: (1) local Heahh Department/District (2) see instructions) Address. �I SZ Co C U�Gr C 5 Telephore: ('� _ G-✓, rG4 Signature: property Ide on: 13) 3 O ( rz V r�•,- 11,,•� �-Z. l r w sa Ct 5' 5 2 4 ly 12`LG '7 SH oucioU Section IL le—pleted by appli-1) WAC Number: (,0 WAC Requirement: IS) Waiver Sought: (6) 146-272A— 0230 24"OF V/S FOR PRESSURE (OR) 12"OF V/S FOR PRESSURE OSS (OR) Subsection: TABLE VI 36"OF V/S FOR GRAVITY 18'OF V/S FOR GRAVITY OSS Sustifiration(mitlgahon measures robe prov COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE(AFN: 'Z�Z J 06 ,1 ) Section llL (completed by health oJficw) Review Criteria: (8) Mitigation Measures rm addition m those proposed): (9) Comments/Cordi ions: (10) Type of Waiver. (11) [ ]Class A (U Class B [ ]Class C—Request DOH review before gracing? Yes No Neighbor Noulluabon: (l2) Required? Yes_ No_ Ifneeded ore agreements,easements,etc properly filed? Yes _ No_ Section IV. I (cmmplered 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 mltlgation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by thus chapter WAC. [ ] Denied Pq Approved/Gran —Subject to all comments.conditions and requirements naled in Septions It and III. local health Officer (13) DOH 337-021 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 ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board &( Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN &-Li 1 Q 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. Staff Signature:�YK� Date: 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 grarrted. 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 deGsion is based on the following findings and conditions: Health Official Signature: Date: A,4 i ly Revised 8212017 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 COMMUNITY SERVICES a�ra.Nae e u see a moth wu CLASS B WAIVER WORKSHEET NS N.9IH SrflffT,BIDG 9.SIIEITONYM9ft5N (State and local ivaimr forms requiredf WaTON.YDJZT-W]0,FM KO-t¢tFIlR.9nZ]vMal.fat ELMA YWB]5."9,W Kb. ruX 3pIP // ,J4LIUNTN,JAF A �t1 5"A. ,WNFRrfiM,.rala®, WAI �t`j "' `^/b✓ V ,,Mro mrsl1l`i S-otD Cu��nti r,,,_ go, W'a Tnxvuanxuvam I -Z G t N p masnloxx Nasysa 1.SOIL SERIES: S.VERTICAL SEPARATION: The sal series must be Alderwood Harstine,Ha qor; Up-sbWvertiralzepralianmus grenterdwnl8' Shelton,«SimlairGmvelly5ardyLoam. —/ for grwityard gmahrthan l]'for pressure. Aldervrood Gravelly Sandy Loam____.—_.__._� Ild Greater than lY—._._—.___—.__._._. ❑ ,,❑-✓ HarsdneGravelly Sandy Loam. ❑ ❑ Greaterthan l8' —�_— � IN Hoodsport Gravelly Sandy Loam_ ❑ ❑ -0Nxmined by: Shelton Gravelly Sandy Loam____❑ ❑ Depth to hardpan CJ Sinclair Gravelly Sandy Loam ❑ ❑ Depth to matting ❑ ❑ Other ❑ ❑ Both._._.—_.___.__.—_._—.__.__.— ❑ ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL' Soil typesmustbe Medium Sand Loamy Sard,«SeMy If tert holes slwwevidenceofaseasondwrtertabk Loam.Gravel permn[must bless than«equalm35%. above resaicdue layer,anmsn drain maybe required Medium Sand._ ❑ ❑ -Evidara ofswonalwabrtablr. Loamy Sand.—_—.__ _❑ yes.— —. ❑ ❑❑/�_ Sandy Loam—__.____—._.____—_E9 No_ __ Er YQ Percent Gravel: -curtain Drain requkud: O -Less than or equal to ........ ❑ Y. -Greater than 35%—_— _❑ NO3^ 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: M c Primary Rdrdeld mum maintain 208'hom dovmgradi- Sails must be maderatelywelidnir NmwNl drained. O w me marine siarNmes,wdam waeers,aM wells � Well Drained.__--._—___ ❑ ,❑�,/ Moderately Well Drained ory 'A bsreasalhaeb ntlsNbacks rrsat Other — ❑ ❑ yes No .—❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes muse b between 3%m 30%. Gravity m.n1yallowed on slopes ham 3%m 15K A 50 toot honmrsml attenuadan mne h required Pressure is allowed on 3%to 3o%. dow+rgradiwtofthepnmmydrainfiNd. Less than 3%.._.—__._.__.-------_._.— ❑ —❑/ 4stlwre50Roegr*abrbtwaanthadown 3%to 15%--____—_— � {d gradient sWeof primary draMfield and 16%to3o%—.—.-- ❑ ❑ Vp� _—� /property � Greater than 30%�__ _. ❑ ❑ 9l No . ❑ ❑ ThaSOfoothMmnW attenuadon rasa isrparedrobrtmded on lM deed of the as unWidabb // ` / p prior to logo.appewL Thoamnwtlammne it not to be used Mebeontruetlanofro ded;Mtim, AFW zzI ` O b 1 parldrgarx;vehku1wtmfM1G woi*w spnibr such use;The gwrermwtagreeto Nltbseearditlosn nearawswaq rnsvamruarrawrsouoswarauvarwawwwmsMuoNmum�aaww, w+awwasv