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HomeMy WebLinkAboutWAI2023-00001 - WAI Health Waiver - 1/7/2023 ptsOri- Public: Health Always working for a safer i healthier Mason County PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 Be!fair: 275-446756 ext 400 ❖ Elma: (360)482-5269 ext 400 FAX Application for Waiver/Appeal Amount Paid: Receipt Number: �' ` cc© WAI al- 0 p p o\ Instructions I. 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. y 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant S-PePhen & FeIiC +a ButteI -;eid Telephone 757 S$O 1550 Mailing Address of Applicant p0 BO k l 'i 7 Cf City e4qir State WA Zip 9g52Sj 12-digit Tax Parcel No. 3 2. 0 I I -- I y -- 0 0 0 c) 0 Site Address 2 2 30 E 14 a+e R c , She Ito In WA 61 8 5 5 Name 9 SU VE q ►15 Subdivision ame and Lot �1Z O F SE. N E S E jI ' PART 2: Nature of Waiver/Appeal Class B Reduction in Vertical Separation Cl Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Require t-=- ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determina • ❑ Contractor Certification Requirements 0 Other I(' JAN 0 7 2023 (Installer,Pumper,O&M Specialists) U Description of Waiver/Appeal (include justification,additional material may be attached.): By ( � n,- G - "--C ' cam, C, "-�-- ) 61-1'6-` 14- C CaC.a- l� t))c� - 0 n Applicant Signature: `1 C 4 —/� Date: 1 _ 'Z3 t.�i Ct „ �_ �, _f-c•� �+ `✓Lc/t Revised 1/22/2015 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) C Appeal 4aiver ❑None required 0 Class A y(CClass B ❑ Class C 2. Identification of Specific Code/ Standard/Determination (include date of determination or latest Code/Standard revision): -2>-C6 7i 3. Nature of Appeal: 4. Hearing Official: ❑ Board of Health 0 Health Officer O Pollution Control hearing Board Public Health Director • ❑ Certified Contractor Review Board Environments Health Manager 5. Mitigating Factors: Y CAA!,3 S ‘Afal 'V VeQ (1— '''e4 N,'(S 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and Iocal policy has been submitted. Staff Signature: 45 1 Date: (I (/ (7v 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: Hearing Official Signature: Date: LA/Lj Revised 1222015 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 • -- .. � . L.7'2'� MASON COUNTY PUBLIC HEALTH ° Health CLASS B WAIVER WORKSHEET Public . (State and Local wciverrorms recuired) Always working fo-a safer healthier Mason County PO Sox 1666,415 N 6th Street.(3id9 8)-Shelton WA,98584 Shelton:360-427.9670 ex:400 Selfair..i60-275-4 67 ex:400 /n D ''') I JV {r i WAVER PSWIT NUMBER WAI Z V .. ��O APPUCAM NAME SR�(•�1 t C I /1 MAILING ADDRESS ?0 IJ0 I 7 q ZIP I Yl C Y & Ia v' STA 22 ( E Ajar Ra C-Y Skeli0h sr.E ADDRESS /;/^ 2 0 _ l Li- GOC D PROPOSE:',ORA:NP'E•O�PE rajCO�N'VEAT1ONAL GRAM" ❑ C0`NENTCNALPRESSURE TAX PARCEL NO ASS l� J 1.SOIL SERIES: 5.VERTICAL SEPARATION: Up-slope vertical separation must be greater than 18' 1 The soil series must be Aide wood,Harsrne,Hoodsport, for gravity and greater than 12"for pressure. Shelton,or Sinclair Gravelly Sandy Loarn. 1� Alderwood Gravelly Sandy Loam vaL Greater than 12" -6 t Harstine Gravelly Sandy Loam ❑ CI Greater than 18" uuu oodsport Gravelly Sandy Loam ❑ ❑ -Determined by: ❑ ❑ Shelton Gravelly Sandy Loam 0 0 Depth to hardpan ____.••••••- 0 Er Other 0 ❑ 0 Depth to mottling _.....•-... Sinclair Gravelly Sandy Loam 0 ElBoth El 2.SOIL TYPE: 6.WATER TABLE LEVEL: If test holes show evidence of a seasonal water table Soil types must be Medium Sand,Loamy equal l or Sandy 1 above restrictive layer,a curtain drain may be required Loam.Gravel percent must be less than or equal to 35%. I Medium Sand 0 ❑ -Evidence of seasonal water table: —{ 0 _ 0 0 1 Yes -- �0' 0 ,- Loamy Sand No Sandy Loam t Percent Gravel: -Curtain Drain required: ❑ 0 Less than or equal to 35% 0 0 Yes _ �( a -Greater than 35% ❑ ❑ g No (�• sz 3.SOIL DRAINAGE: rt 7.HORIZONTAL SETBACKS: Primary Drainfield must maintain 200'from down gradi- O Solis most be moderately well drained to well drained. 1 2_ ent marine shorelines,surface waters,and wells. /{Well Drained -Are increased horizontal setbacks met: Moderately Well Drained 0 0 ❑ 0 0 Yes _ w..,_.._.._............. IDOther No CI 4. DRAIN FIELD 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%. dow gradient of the primary drainfield. Pressure is allowed on 3%to 30%. 0 El- -Is there 50 ft or greater between the down Less% to 13 300%than 3% ' gradient side of primary drainfield and 16% - 0 0 property boundary: n 0 Yes _._.._......_ Greater than 30% -- No ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 2-‘4 -2-t.1 Ct� prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios,traffic, A=N: Proof � \ Recording 1 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions.T �� i7v2o:s ii5 PORN.MAY 3E SCANNED AND AVAILABLE FOR PUBLiC VIEW ON THE MASON COUNTY wtssrrE On-Site Sewage Systems (Chapter 246-272A WAC) R• $uest for Waiver From State R• . lations Section L (completed by applicant) ent;District (2) Local Health Departrn Name: (1) (see instructions S+t?4c h. k Fd i C i a _B o -t r i c i d. -- Address: ._-12 30 E 3ot-kRd -- ShtltOr► WA 6H : (.1 Telephone: (757 ) cb(i 0 .. 9 55 0 Signature: "" .. _ Property Id- : `cation: (3) 1-• 0 S L ` 5_. 1171 k5 5 5 l Section II. (completed by applicant) WAC Requirement: (S) � Waiver Sought: (6) 1 WAC Number: (4) �, - V.s-� " 3-,' 246-272A— H •-'4 Subsection: Justification(mitigation measures to be provided): (7) 0 z},� 52 t CY'.�eZ .t �t o- �� Iils� _ • � Gv�e-a �'J -�. 'J Ia .I.r_� � 0 �� ��L� , se, - 'on TEL (complete• by health officer) AI Mitigation Measures(in addition to those proposed): (9) Review Criteria: (8) - Comments/Conditions: (10) — � ] Type of Waiver. al) B Class A [ ]Class Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes No_ If needed are agreements, easements, etc.properly filed? Yes _ No— Section IV. (completed by health ofzcer) 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 protection at least equal to that provided by this chapter WAC. to provide public health noted in Sections II and III. [ ] Denied 4 Approved/Granted—S ect to all comments,conditions and requirements2, Date: LocalHealth Officer (13) 19