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Home My WebLink AboutWAI2023-00105 - WAI Health Waiver - 10/17/2023 415 N.6th STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 =: COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,ext.400 FAX:360-427-7798 Application for Waiver or Appeal 1 Amount Paid: d. � Receipt Number: 020 - U H L )U wAl oL023 _ 0 0 \0 5 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 Name of Applicant �f '(JU f y Telephone 70 2 ^ NC/- 7222_ Mailing Address� _-�C rb 2 Per r'� ASS• / -- City 1/n7(C.V"I State W 2 Zip IK -3/0Parcel No. 2- 2 3 7 -- 7 s-- 7 4 C) (o I Site Address .._ 9 '�3y/17�I11, Subdivision Name and Lot II��II PART 2: Nature of Waiver/Appeal --- NI Class B Reduce Vertical 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 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.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS CLASS B WAIVER CHECKLIST (/ per. RECORDED DECLARATION OF ATTENUATION ZONE Aft-Lid f OD)Applicant Signature: Date: 9- Revised RS212017 This form may be scanned and available for public view on the Mason County Web site. Page I aft PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal '/Waiver L None required Class A %/Class B - Class C 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/ Standard revision): WAC246-272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official'. . ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board M' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 120tInS ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. �y� 7 Staff Signature: c Date: lotp IVG j 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: 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. Health Official Signature: atitiV Date: /4//,_ Revised 8R 12017 This form may be scanned and available for public view on the Mason County Web site. Paget oft tr. MASON COUNTY �" ; C MMUN SITYERVICES MASON COUNTY PUBLIC HEALTH ,,, „„.,„w.,,r..ea._.a—.----„— CLASS B WAIVER WORKSHEET (State and Local waiver fares required) s1ELTON6360427 900 EEL 400 -(11FL FAR 3-27SM67.Ever NA EWE 35Ose2-5369.EC 400 - Fail.38W[].7798 APPLIANT„NOk...-EsTii h (a.'a/-.v bu rv. WATER.w...,,w«. WAI HALING ADDRESS Z sore 'pry c r� A'�- cm \(�Jrtrettr „E,E (.94-n HT 413/t OUADDTE% r'L 'T1•,hu l 4.- C t..tks ra Jtt RL airy 11st hh.l G. IMPASSES HUMUS 2Z b( e) - ) C• yas to I Pn««rD w.wrem TUE .I aN10N.L GRAVITY ❑E«PEN,mNAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Mderwood Harstine,Hoodsrort Upslpe Vertical separation must be greater than 18' Shelton,orSlndar Gravelly Sandy Loam- f«gravity and greater than 1rfor pressure — Mderwood Gravelly Sandy Loam__..._.._..__o• ® Greater than 13'.__ .._—_._._....__ 0 ❑ Harstine Gravelly Sandy Loam.—__. --- ❑ CI Greater than 184.___.._____...-----..._. St RI Hoodsport Gravelly Sandy Loam 0 ❑ -Determined by: ry Shelton Gravelly Sandy Loam_—._--❑ ❑ Depth to hardpan _—._____--.._. a µr Sinclair Gravelly Sandy Loam_ ____—_❑ CI Depth to rrattlirg__—_.—_.___--. 0 ❑ Other . .__._❑ 0 Both __._._._..............._....____. ❑ 0 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy Sand«Sa dy It test holes show evidence of a seasonal wafer table Loam.Gravel percent must be less than or equal to 35% above reso-lcwe Nyer,a curtain drain may be required Medium Sand _..._.._...__❑ CI 2 -Evidenced seasonal water table:Loamy Sand ❑ _D o Yes. . 0 ❑ a Sandy Loam.._................................_.__.._....__.._cr No__ _ _ _ _ _ B z Percent Gravel: V -Curtain Dab required: O -Less than or equal to 35%..._..__._—__._ Yes_.__..___._._._._.___..___.__._.. 0 0 -Greater than 35% _❑ [ 1 No.__....___._..___...—__._____._.._..__._._ ( 3 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: 1 Soils must he moderately well drained to well trained I t1 I Primary Dralnfield must maintain 2001rom down-gadi- rak -2t nanase shorelines.surface waters.and wells. Well Drained . _..__..__. _..._...____ 0 0 Moderately Well Drainetl._....__.___......_.._..._.a" ® Are lactated taarlreatalsesbaaa ate Other Yes- "- o.___......._______...____.._._.._. ❑ N 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 309h Gravity is only showed on slopeshorn 3%to 1s% A SO Foot E00ZOElal attenuation zone h required Pressure Is allowed on 3%to 30%. down-gradient or the primary dranfel. Less than 3% _.._..__..._..__..._ ❑ t❑n �tta 1a SO ft a dorm between t d 3%to 15%......_.._.___.__..__..___.._.—_ W gradient side d primary dnlnneld and 16%to30°u.._..._........_..._.___._—.—._ 0 0 PraParly tt4Y11dary' Lb Greater than 30?(.._...._.._._._. ❑ ❑ Yes_ .R TLr,+ The 50 foot hodtontal attenuation zone Is required to be recorded on the deed of the property as urbullable ).�(�1 Q� prior to design approval. The attenuannnzone h net to be used for the conbuctIon of roads decks,patios. ARM 2ZOtig' J parking area;vehicular traffic of other simile such homes.The owner must agree to all these c«Nitlom Now d ikmdM: msuaw.MAY BE SCANNED AND AVuusLr Von PuaiclEW ONTE MASON«Ywnwtrxrt. Tvf.ea vvx017 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July I,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) hCll t n (,-r al-vSo fln • (see instructions) Address: Z 5 Z Qtrr� FAx- e(Cevl Lik. ( W a qS a Telephone: (7 7s�� 22'7_ Signature: Property Went' c ion: (3) 7 2 3 ] -i 7 S_ R eo Le/ Section 11. ' (completed by appliranp WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A 0230 R) _ ) Subsection: TABLE VI "OF V/S FOR GRAVITY � 8 OF V/S FOR GRAVITY OSS Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL9 ^ REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: ZZQIgpa) ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures lin addition to r/mee proposed): (9) Comments/Conditions: (18) cn /7 }� (,it fh CI(as'5 9 W(t ever Work f�,� Type of Waiver: (II) I ]Class ACC i4 Class B I ]Class C Request DOH review before granting? Yes No X Neighbor Notification: (12) Required? Yes No If needed are agreements. easements.err 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,hame been evaluated for their ability to provide public heal) protection at least equal to that provided by this chapter WAC. l ] Denied l pproved/Granted /J Subject to all comments,conditions and requirements noted in S lions 11 and III. Local Health Officer (13) _/[/a/_ _ Date: i� / Z� DOH 337-021 V—_