The URL can be used to link to this page

Home My WebLink AboutWAI2024-00006 - WAI Health Waiver - 1/17/2024 i �+ �r 415 N.6a'STREET,SHELTON WA 98584 MASONCOUN`rY SHELTON:360-427-9670,ext 400 COMMUNM SERVICES BELFAIR:360-2754"7,ext.400 ELMA:360-482-5269,ext 400 FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: O�L.S Receipt Number. a L( ' WAI . �- WOP (2 Instructions: 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees maybe billed for waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submk completed application with attachments to Mason County Public Health for review. PART 1. Applicant& Parcel Information JAN 19 Zp24 Name of Applicant S +W4— Mole, Telephone Mailing Address I&Olq l..alC� Kalhlesn Rd S1EI City &J�4-w r State Zip "!$ Parcel No. d 4- 3 � � — 3 -- — v TO D o2 3 Site Address�I bj E o 11 1'j A l,- I)IC I A k"'k Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 9' Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group 8 Water System Regulations ❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other. (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal(include justification, additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE 11 Applicant Signature: Date: /2 �4R �lUCy Rcvmd 821=7 This form may be scanned and available for public view on the Mason County Web site. Page 1 pf2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(rf applicable) ❑ Appeal K(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): WAC246-272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL 6ZITAR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board Environmental Health Manage 5. Mitigating Factors: CLASS B WANER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. Staff Signature: Date: PART 4: Deterrmtn 'on a 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: ❑ 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: Date: This form may be scanned and available for public view on the Mason County Web site. Page 2 of2 MASON COUNTY 0 COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH CLASS B WAIVER WORKSHEET .15 N.mxSMEET.e :.SHELroNMME6%a (State and Local waiver forms required) sxF1TCN:ae6I37-u]n E%i VA- Ea aaoo ..E%t aro E.3eD1@S.T9.EX!10]-FAl:xoxx7-1iW vnrrrvrxuae . i Vr w.wa.awnn,ww WAI M p,a,a 13o19 L.ak, 1W-Wowt �d an YlcvVAWK aore Wa or 9%059 sm.mea 1z70 NE ce[IIA-S LAXL on,j ?at hy,, ra .,neees AA 3M' 51 - on o A 3 ❑mrwmn,wa— 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soilsedesmust be Alciamood,Narstine,Hwdsport, Up-slopevertkal separation mart be greaer Manl6 Shelton,or5lnclair Gre,elly Sandy Lwm. fagrevityand greater Man 1]'forpreszure. Alderwood Gravelly Sandy Loam.....................❑ ❑ Greaterthan l2"_____.—._______.___.._. ❑ ❑ Harstlne Gravelly Sandy Loam.....__.........._..____: ❑ ❑ Greaterthan l8".__.____.-____----- � ❑ Hoodsport Gravelly Sandy Loam....._..._..__..___ III Cl -Determined by: J Shelton Gravelly Sandy Loam___._._..__.._.__.❑ ❑ Depth M hardpan___..-____.___---.__._-- L] ❑ Sinclair Gravelly Sandy Loam._._._._..._...__._.V ❑ Depth to mantling......... ❑ ❑ Other ....—.❑ ❑ BoM.______.______..--________ ❑ ❑. 2.SOIL TYPE: 6.WATER TABLE LEVEL- Shctypezmu#be Medium Saint,Loamy Sand,r Sa�Wy arert M1ole dww evitlence ofaseasonalzMtt[able Loam.Gravdpttcentmurt be less Phan or equal to 35%. above reamRlve layer,a curbin drain may be required Medium Sand__.__________..--_—...___....._. ❑ ❑ x -Evidence of seasonal emtertable: Loamy Sand--------------------- � o Sandy Loam No.._............ _.._.__._._____._____._____ d ❑ o Percent Gravel -Curtain Drain required: A -Less than or equal to 3S%___._______ ❑'.o Yes__._.._.._....._._______.___.._..______ ❑/ ❑.o -Greaterthan 35%_.—___._______.___.❑ ❑ 3: No LFf ❑ �. re 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: c Solhmunce MWeMMlywNldmi-7-11aralnea o erb:mz nfiele murtmalmm�larfrsaral yadi- O 3 emmaMe Morelirres,sudacewaatts,aik wdts � t Wells mined................._.__._.._._._.___.__ d ❑ Moderately WNlDrainetl.—._._— ❑ ❑ -Are increased horizontal setbacks met: Other _.__ ❑ ❑. Yes_.__.__.._..______._,___._..__..__._.___ ❑ No_..____._._._.___---------------................._...._.. ❑ ❑. 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 3M Gravity b only allowee on slopes hem 3%to 15%. A5of:rffio eonralartenuadonzoneis required Pressure is allowed on 3%M 30W dowmgredient ofone primary dnin6eld. Less than 3%—___._.__..__.._—__-_—. ❑ ❑ -Is there 5a ft or greater between the down 3%to 15%_.--____--__—.-- V ❑ gradient side of primary drainfield and 16%to 30%_._._._______—_—_—..-.----- ❑ ❑ property boundary: Greater than 30%._..________.__...__ ❑ ❑ yes_..._._..__..._ ...... -----..----..__._._.R ❑ El No---------.___....._....__.._..._..______._. ❑ The sob.mmordal atfenuatlwmne,is requhad M be recorded on the deed of Me propertyae untondable peorto design approval.iheatrenuatb.tune is roar,be used for the contruction otroads dedd,patios AFN' parking areas,vehiculertraffic or ether dmilarsuds uses,The owner nest.gree to all these cwdions, e,oMaurwaae ree PoM Ko aesGIfED INo avM.191E roe nauc E MTha MAN.N NJ.. ees9R ,ow.aya7mn Gmntiug 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) LhIL 1'0 2 _(see Enslruchoav) Address:l o Z.aV� -- asO& - - Telephone: (ri^C) _ —_— Signature: �'Ihs !AW Property Identification. 3) Section II. -EVI = ( mletedbalicarn) WACNurnber: (4) ent. (3), Waiver Sought: (6) 246-272A— 023 Subsection: TABLOR GRAVITY 18" OF V/S FOR GRAVITY OSS Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: Section III. -.- (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) q.(Cl CD -- 4- r,C,/6IRrt4� j�aN " fY r t( Commends/Conditions: (10) Type of Waiver: (11) [ ]Class A [40ass B [ ]Class C—Request DOH review before granting? Yes_ No Neighbor Notification: (12) Required? Yes_ No_ Ifneeded are agreements, easements,etc.properly filed? Yes _ No_ Section IV. I (completed by health officer) This Request For Waiver From State Regulations bas 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 heaaqlta�h protection at least equal to that provided by this chapter WAC. [ ]Denied Y Approved/Granted—Subj 1 comment;,conditions and requirements noted in Sections H and M. Local Health Officer (13) Date: k DOH 337-021 Page 26 of 32