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Home My WebLink AboutWAI2022-00120 - WAI Health Waiver - 10/20/2022 01111111111166 Wp. lbe2 2- C)C) ) • i. MASON COUNTY ill"f `~ COMMUNITY SERVICES , Building,Planning,Environmental Health,Community Health err, .,' 4 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360) 427-9670 ext 400 •: Belfair: (360) 275-4467 ext 400 •:• Elma: (360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/ ppeal Amount Paid' 21 Receipt Number: Z0 2Z o S3 Sci Instructions Zo7,Z� 0 2( I LI F1.^ Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 1 i 2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule. 1 3. Submit completed application with attachments to Mason County Public Health for review. L PART 1. Applicant/Parcel Identification Name of Applicant - i ,.- ,. !A Lw[2 Le Telephone 3(:so SO`j l 2 6,,`I Mailing Address of Applicant P 6 it3c) - l'-/sr,3 j City 71,y.-,, & .rt:n State (-4.. Zip 9. 6,s-( 12-digit Tax Parcel No. 2-. 2— C2 I C( -- 3 3 -- 0 3 v CL) Site Address '--( L--( t LL.3 lira j- i L/Z Li{-A) 5==mi MI Subdivision Name and Lot N 0 PART 2: Nature of Waiver/Appeal 1:=3 ❑ Contractor Certification Requirements cam' ,Er. Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation 0 Food Sanitation Requirements o ❑ Building Permit Review Policies 0 Group B Water System Regulations o , m ❑ Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines O Mason County Onsite Standards 0 Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): l E. v C. . li2f,. L.c-4 S P Ajav4,.Tie..0 F.(4.0; Z q '' t7r 4.c:i, ?rG it/, raC,y s.sua, ,Q 16S ii 4 a,„i,.. 1 7-1 0w i sS tr i? i i`;,2 Y .50 i LS 6 Prm. L.a-NT S Lr>f l 4 U i /�/ G(L:A.i :S LCG A r-i i ,v 4N -r',,-,A 1 Ztr � Applicant Signature: 3_,- Date: i -i i -,,,,, J:1E1I Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ei Appeal -Naiver u None required i i Class A illieass B Class C 2. Identification/of Specific Code/ Standard/ Determination (include date of determination or latest Code/ Standard revision) \A/ G-7,---7Z/k.ZZ70o 3. Nature of Appeal: V n e � '�,.�t _ -i1 4-(7-r^ p SS - To i Z t y\Ci —S 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: Mk-PAS C V 5 6 --e-7 c4,04-v V`B 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: ( ,(Z PART 4: Determination of the Hearing Official 4- 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: 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: Hearing Official Signature: Date: 140-3 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 • N 'ON CO S, .? MASON COUNTY PUBLIC HEALTH Public ,:Health CLASS B WAIVER WORKSHEET Always working for a Safer 6 healthier Mason County (State and Local waiver forms required) PO Box 1666,415 N 6th Street,(Bldg 81 Shelton WA,98584 Shelton:360 427 9670 ext 400 I. B -elfa:r:360275 4467 ext 400 /1 ^� APPLICANT NAME �I r� 1.-t_g APO Q V/ WAIVER PERMIT MJMSER ••AI v_ " ` --0 D I��/ MAILING ADDRESS PO L3ci> I CIlc j i C+IY ,r CI/"-k- LW LT&2 STATE titi# iY q e t I SITE-ADDRESS E LI Li( L) L.O 'c-cu.AriA 4.-4 Or' S"L.1r=C.T A TAX PARCEL NUMBER 2 7..0 II 9 1 133— V J .0 PROPOSED DRA+thIELD TYPE ❑ CONVENTIONAL GRAVITY WCONVEN I IONA!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 M. R Greater than 12" ❑ UP Harstine Gravelly Sandy Loam 0 0 Greater than 18" IS 0 Hoodsport Gravelly Sandy Loam __.... 0 0 -Determined by: Shelton Gravelly Sandy Loam ❑ 0 Depth to hardpan El Sinclair Gravelly Sandy Loam 0 0 Depth to mottling ❑ Other 0 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 't 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: Loamy Sand ❑ 0 p Yes 0 0 m Sandy Loam I:: 3. No )� RP tz St Percent Gravel: -Curtain Drain required: Less than or equal to 35% . ._._ E o Yes 0 0 o -Greater than 35% 0 m No Ig R 3 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: c Soils must be moderately well drained to well drained. 0 Primary Drainfield must maintain 200'from down-grads- m ent marine shorelines,surface waters.and wells. 0 Well Drained Moderately Well Drained 0 0 -Are increased horizontal setbacks met: Other ❑ ❑ Yes lg. ISM No 0 0 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 S0 ft or greater between the down 3%to 15% 123, gradient side of primary drainfield and 16%to 30% ❑ K property boundary: Greater than 30% 0 0 Yes I. ge No ❑ ❑ 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 contruction of roads,decks,patios, AFN: parking areas,vehicular traffic,or other similar such uses.ED The owner must agree to all these conditions. Poor of Recording. THIS FORM MAY B:SCA NNW AND AVAILABLE FOR PUBLIC VIEW (MASON COUNTY IYFRVTE. — vodeed J::i/OI5 • 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. (completed by applicant) Name: (1) Local Health Department/District (2) fee Address: I L)r3( r Telephone: ( ) 3tOU ci"C Signature: 7.` Property I ntification: (3) 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) 12" OF V/S FOR PRESSURE OSS (. ) Subsection: TABLE VI 36" OF WS FOR GRAVI 1-811-OF-VIS FOR CRIVITY OSS Justification(mitigation measures to he provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: Z 1 1 f ) Section III. (completed by health offices) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) • Type of Waiver: (11) [ ] Class A j4Ciass B [ ]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 offices) 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 ,Approved / Granted— bject to all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) Date: Or/14 DOH 337-021