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Home My WebLink AboutWAI2023-00035 - WAI Health Waiver - 4/26/2023 • Public --_; Health Always working for a safer 4. healthier Mason County • PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 Belfair:(364 75-4478 ext 400 -:• Elma: (360)482-5269 ext Q, FAX (360) . • ?atioLl for Waiver/Appeal APB 0 W Amount Paid: Receipt Number: e 6 ?a? wAI •Z= ODD y 3 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 Identification Name of Applicant J OS M Lc'Pz p_ Telephone( )0)3461-Q%1 e el . Mailing Address of Applicant D E odod d yeh P City 51(1 , [by) State W Zip gg5e4 O l 2-digit Tax Parcel No. 4 2 C 2 5 -- 2 J� -- Q Site Address w 0 0 a '�' Skr\e l -0V\ \\O A g e i Subdivision Name and Lot-1-T\ cl 0 F V�� v 01- PART 2: Nature of waiver/Appeal l Class B Reduction in Vertical Separation 0 Food Sanitation Requirements 0 Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements Cl Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements 0 Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): O✓--e (* L `kt Len '- ° ems c c�c - ) ct Applicant Signature: at..,Q.(1. t"---\H-17\ Date: Le..25'Z3 r,P� e_ � e�n rA.C^ +Y1. ,rvtrt Revised 1/22/2015 This form may be scanned and available for public view on the Mason County Web site. Page 1 oft PART 3: Public Health Evaluation (Staff Use Only) T e of Onsite Waiver(if applicable) 1. Type of Determination Required: Class A �.Class B ❑ Class C p Appeal Waiver G None required 2. Identification of Specific Code/ Standard/Determination (include date of determination or latest Code/Standard revision): 3. Nature of Appeal: R&uO, ve✓+"i Cu l 5epear'ior1 -fir pre5svre. .sysfe#7 -from 4. Hearing Official: ❑ Board of Health 0 Health Officer 0 Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board l Environmental Health Manager I 5. Mitigating Factors: 501 6 we(1 dre el fypr, 3 loamy And, Vat SaoK i befiweern 3% % and a so' oef eic/o r4 fir. ui deli nafcd dwrl c -,rad�f 01 Ike r'a dr(am-ree!d• f}FN= zff6t3o y 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 7-)‘rStaff Signature: Date: 111 Z 3/1 o 2.j PART 4: Determination of the Hearing Official t7t,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: HearingOfficial Signature: Date: -S/j2I Revised 122R015 This form may be scanned and available for public view on the Mason County Web site. Page 2 oft N li�5� � './-'2t, MASON COUNTY PUBLIC HEALTH Public -4,Health CLASS B WAIVER WORKSHEET Always working for a safer healthier Mason County (State and Local waiver forms required; po gar 1666,415 N eth Street,(Bldg 8)-Shelton WA 98584 Shelton:360-427-9670 ext 400 8elfa,r:360-275.4467 ext 400 p Z.c�--oz. — WANEi:PEFLMr NUMBER WAI MA INGADORas 40 Ranod a �P 5�4 m, he l D r e 1�>2__ w TAX ADDRESS 0 0 0 g o A 5— ❑ cawErrIonu oannvrrT cor,�NroNAI PRESSURE TAX PARCEL nUMBER K��J aAOP05ED D./AIRFIELD S.VERTICAL SEPARATION: 1.SOIL SERIES: Up-slope vertical separation must be greater than i 8" The soil series must be Alderwood,Hars ne,Hoodsport i or gravityand greater than 12'for pressure. Shelton,or Sinclair Gravelly Sandy Loam. ......—i.m„ I El 0 Greater than.12" ❑ ❑ iia Alderwood Gravelly Sandy Loam —•••••••--••—•-••""'"""""""" Harstine Gravelly Sandy Loam.....»",.....-.--....--••••- 0 ElGre-Deaerminter than 18"d 8y El Hoodsport Gravelly Sandy Loam ....-_._ Depth hardpan w Shelton Gravelly Sandy Loam —••--............-••-- El El Depth to mottling — - --•---•-"- 0 0 Sinclair Gravelly Sandy Loam El ❑ Both ""•'"•"'-"' Other 2.SOIL TYPE: 6.WATER TABLE LEVEL: If test holes show evidence of a seasonal water table I Soil types must be nt must Sand,Loamy ,or Sandy % above restrictive layer,a curtain drain may be required 1 Loam.Gravel percent must be less than or equal to 35%. ` ❑ 0 Evidence of seasonal water table: ❑ Medium Sand --__— -- Yes .._—..._....--. E a ._ -- S O sandy erce Loam Gra e.........».. _ .-- CD -Curtain Drain required: ❑ r, Percent Gravel: � v� � -Less than or equal to 35%...".-.._ 0 Q 3 No .---' TOL I Greater than 35%._._ — is 7.HORIZONTAL SETBACKS: z 3.SOIL DRAINAGE: c I rt O Primary Drainfield must maintain 200'from down-grddl ISoils must be moderately well drained to well drained. a ent marine shorelines,surface waters,and wells. Well Drained...._ _.............._.__. ❑ -Are increased horizontal setbacks met: Moderately Well Drained 0 El Yes.........— 0 CI Other No 4.DRAINFIELD 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%. down gradient of the primary drainfieid. Pressure is allowed on 3%to 30%. -Is there 50 ft or greater between the down Less than 3%.._».._..__ -_ »_.._.._....__.................... rima drainfield and _ gradient side of p rY 16%t 13%_._.._..»__._ _ —.— --.._— property boundary: lg 16%to 30%_......»_-_.....—.—._....___.. ❑ ❑ Yes __._.....__.........._..._.»._. ��—► Greater than 30%..._._�__ ._._. No_" r_._....__._.__-.77-,^,--- The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable ZI 6 ZN cI prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, A �Recorcirtsc parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. updated vzrzois TMS FORM MAY BE SCANNW AND AYMLABa FOR PUBLIC VIEW ON THE MASON COUNTY WE85rrE. On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver From State Regulations Section L I-(completed by applicant) Local Health Department/District (2) Name: (1) (see instructions) _ J 1 Address: 40 E ?1, She She «ov-tV.7A 9e5p)4 - Telephone: ( )3 _ c" Signature: cniNS i4e. S••4- e.5 _ay ; -- property I.:..1:.cation: (3)J - R q OF' so 2U�� V o L._5 b- Z- `PoJece.k # 02.5- 5- OVO90 l��v ziy6i3�}. fl e#1 Va horn zone cccrd o) ; Section IL I (completed by applicant) � WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) cs 246-272A— o•�A. -64- a� n 4 subsection: v:.d��-� ms; .6147`111 7--4 A l z Justification(mitigation measures to be provided): (7) c,�,�s-i A ,IZ -�� °t , � �,�� dfN: zty6z3o 5'1 0 o Q„ Q,ec 1^-a-�- a''�� iL L 1 (comma health officer) proposed): (9) Review Criteria: (8) Mitigation Measures(in addition to those p ro p SeC C lG S _. lcal --- Comments/Conditions: (10) Type of Waiver: (II) [ ]Class A 44.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. 1 (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 [.Approved/Granted—Subject to all comments,conditions and requirements JJJ oted in �II and III. Local Health Officer (13) Date: /i/ 19