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Home My WebLink AboutWAI2022-00128 - WAI Health Waiver - 11/20/2022 t '1•01aior ao t Z� .;e4;11 ..,-, MASON COUNTY COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health `)•I11.NV' 415 N 61h Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 s Belfair: (360) 275-4467 ext 400 Elma: (360) 482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: Z, IP Receipt Number: ZZer 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 GREGG JARCZNSK Telephone Mailing Address of Applicant PO BOX 1303 City NORTH BEND State WA Zip 98045 12-digit Tax Parcel No. 2 2 2 2 2 - -- 2 3 -= 9 0 1 3 2 Site Address 14751 SR 106 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timeline pj� a ❑ Mason County Onsite Standards ❑ Departmental Determi :r I'lJ IJ Va Other N0\i ' 022 Description of Waiver/Appeal (include justification, additional material may be attached.) CLASS A WAIVER,SEE ATTACHED —�— Applicant Signatur �t A/1,'"+ JT /�j'r� €y,// Date: i ( ?- I7 z J:\EH 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) Appeal Waiver None required lass A L. Class B . I Class C 2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/ Standard revision) \fv uo-kb-21 Z A-bZ ?- u1 (3)(b) 3. Nature of Appeal: \sc\-( Z I r okol -fit t( (''/I 3t-J vi^C / I, ri/ 4. Hearing Official: ❑ Board of Health 0 Health Officer O Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: - -1--(A fi 2 -1 H H v 5 - o IA yY\ (Cori - Li1�` I 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: ICW-) Date: l q 12 7-- PART 4: Determination of the Hearing Official 6—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: 0Z:/ Date: / Z// ,-'27-- J:1EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 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. I (completed by applicant) Name: (1) GREGG JARCZNSK Local Health Department/District (2) (see instructions) Address: PO BOX 1303 NORTH BEND, WA 98045 Telephone: ( ) Signamr ot f4Pe3 l Property Identification: (3) 22222-23-9 132 Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0234(3)(b) DF 6" into original soil DF installed in old fill Subsection: 0234(4)(b) Justification(mitigation measures to be provided): (7) See attached, proposal meets Class A mitigation requirements outlined by state 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) Wass 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. I (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 VI Approved/Granted—Subject to all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) Iler / Date: /V/°r/Z L DOH 337-021 Page 26 of 32 PIONEER DIGGING INC. Robert H. Paysse 3083 E Mason Benson Road Grapeview WA 98546 11/10/2022 Mason Co. Health Dept. Re: Gregg Jarcznsk Reference Requirement Request Mitigation WAC246-272A Drainfield must have Install drainfield in 1) Enhanced Treatment. 0234(3)(b) a min. of six inches unoriginal soil (fill) Drainfield will meet TLB of sidewall located in and have 24"+ of vertical original undisturbed separation. Pressure soil. distribution and timed dosing utilized. WAC246-272A The sidewall below Install drainfield in 0234(4)(b) the invert of unoriginal soil (fill) 2) System will require distribution pipe is annual O/M inspections. located in original, undisturbed soil. 3) Soil in drainfield area appears well established and consistent in type and depth making it suitable for hydraulic conductivity.