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HomeMy WebLinkAboutWAI2023-00029 - WAI Health Waiver - 3/28/2023 415 N 6TH STREET,SHELTON,WA 98584 ira MASON COUNTY SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 • Public Health & Human Services ELMA: 360-482-5269,EXT 400 FAX:360-427-7787 WISS TERESA MARTHA 373 SE MORGAN RD SHELTON, WA 98584 Applicant: WISS TERESA MARTHA Parcel Owner: WISS TERESA MARTHA Site Address: 373 SE Morgan Rd Primary Parcel Number: 320245100013 Waiver Request Number: WAI2023-00029 Waiver Description: Onsite: Class A Waiver Waiver Submitted Date: 03/28/2023 Waiver Review Date: y/41/Z4 7 3 (gjti Waiver Status: f( If you have questions or concerns let us know. Sinc y, David Anderson Danderson@masoncountywa.gov er 7I 35-- . 1 415 N. 6'STREET,SHELTON WA 98584 egre MASON COUNTY SHELTON: 360-427-9670,ext 400 ['!:'i COMMUNITY SERVICES BELFAIR: 360-275-4467,ext.400 j Building,Planning Environmental health,Community Health ELMA:360 482 5269,ext.400 FAX:360-427-7798 for Waiver or Appeal Amount Paid: Receipt Number: it O )-�� 11nOTIE .1.1 aWAI - ���� MAR 2 8 2023 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 Information A-ltev\ ‘c1.-ow`c4-.s Name of Applicant Teresa Wiss Telephone (360) 427-1281 Mailing Address 373 SE Morgan Rd City Shelton, State WA Zip 98584 Parcel No. 3 2 0 2 4 5 1 -- 0 0 0 1 3 Site Address same Subdivision Name and Lot Skookum Point Tracts, Lot 13 & T.L. PART 2: Nature of Waiver/Appeal Onsite: Class A Waiver 0 Food Sanitation Requirements ❑ Onsite: Class B Waiver 0 Group B Water System Regulations ❑ Onsite: Class C Waiver 0 Water Adequacy Requirements • Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies ❑ Onsite: Holding Tank, WAC246-272A- 0 Appeal: Enforcement Timelines 0240 0 Appeal:Departmental Determinations ❑ Onsite: Contractor Certification 0 Other Requirements Description of Waiver/Appeal (include justification. additional material may be attached.): Reduce setback from pressurized sewer transport line from 50' down to 25' minimum from Owner's well. See Mitigation Attached. Applicant Signature: Date: 3 2-1-Z3 ey�ai Ice cSe- c- e ©l J"- Rcviscd 8/13/2018 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 )( Waiver None required ,Class A Class B Class C 2. Identification of Specific Code/ Standard/ Determination include date of determination or latest Code/Standard revision): 2.IE-Z LA -o•iio i) iclbic : Pr t,ve cpve1/l1t'0 {al ficim ncl1-Pt6Vc a.ei1 cc 50Ctit✓► Jerk 3. Nat re of Appeal: iejiite f . 5c,�re cc/Ay-0' fr f,--Ac1c��t h e )-1? O(ic 'km 5o, 40 �5 .frrn well. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director O Certified Contractor Review Board 15k Environmental Health Manage( 5. Mitigating Factors: AEX(a1 n fc kr-tic 6 0 41 fi,1y' c4 tire, \ili 1�`11 r -Feo c kCl Crfcrtn ll Ce, 4-ci1 dii ilYi, ;t:4(17liAklf)611 6{ Q.t t)(61- ic, (oti f\(,t1l` 6l €0S(1'erif s -.r mcir)1crin its a jrmil i CG4 i 1 a - y r� 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. i Staff Signature: A Date: y//3/20 Z3 PART 4: Determination of the Hearing Official 11—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: Health Official Signature: i-\-7- Date: �`���Revised 8;13/2018 This form may be scanned and available for public view on the Mason County Web site. Page 2of2 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver From State Regulations Section I. I (completed by applicant) Name: (1) Local Health Department/District (2) -1'e N-SCL W S (see instructions) Address: J l 3 S E --- --- .. , `1 1 t ss Otf, - Telephone: Gino) cf 2 7 (2'8 Signature: 3-Z�-tS Pro y I entiiori` ) Zo2`�" -S[-coo Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— O 2 l o vac's j�r.5pc -. C� n S e \o a - Subsection: ore•. T t � 7 � VkAN Justification(mitigation measures to be provided): (7) 3 e .e__ Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) j4 Class A [ ] Class 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 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 K4Approved/Granted—Subject to all comments,conditions and requirements n ed in Sections II and III. Local Health Officer (13) Date: _J� 2 19 Application for Waiver/Appeal Mitigation 3-23-23 Owner: Teresa Wiss Phone: (360)427-1281 —contractor Allan Homes Mailing Address: 373 SE Morgan Rd, Shelton, WA 98584 Site Address: same Parcel Number: 32024-51-00013 Property Description: Skookum Point Tracts, Lot 13 &T.L. 1) State DOH Waiver Sought: Reduce horizontal separation between owner's well and pressurized transport line from 50' to no less than 25'. 1) State DOH Mitigation Measures: la)Transport line installed in a casing of at least Schedule 40 PVC within 50 feet of well. Transport line uniformly supported by pressure-grouting annular space with sand-cement grout or bentonite, or casing spacers or skids installed consistent with AWWA PVC Pipe Design and Installation Manual M23. Underground installation of line consistent with ASTM D 2774. 2a)Transport line leakage test consistent with ASTM D 2774, except line should be pressurized to 150% of the system's design operating pressure, but not less than 70 psi,and pressure must hold for 1 hour. 3a)Notify well owner of proposed encroachment if there are no existing covenants or easements establishing a control area.— **Only the Owner's own well is affected, neighbor wells are over 50' from the pressurized transport line