HomeMy WebLinkAboutWAI2024-00065 - WAI Health Waiver - 7/11/2024 �OcON COUN�
Public Health
Always wmldn9 for a safer healthier Mason homy
PO Box 1666,415 N so Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 'P Belfair:(360)275-4467 ext 400 p Elma:(360)432-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal P E M � 0 d �D
Amount Paid: a-4S�—`"R�cceiptNumber: _ JUL 11 2024
WAI 0 k pI
Instructions By
1. Complete Parts 1 and 2.No determination can be made until these parts arc Ativ comole+_M.
2. Fees may be billed led for waivers and appeals,based on the Environmental Health Fee Sohedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1.ApplieanUParcel Identification
Name of Applicant Fwt p t-e ){» Cam'^ Telephone bD S— 2
Mailing Address of Applicant 'F- 0 ' c,
City �\e1�,o State wA Zip 9862(0
12-digit Tax Parcel No. 4 -L D 5 -- 2 2 -- D L O 'S O
Site Address AO 11.1 AV-feG ;O-h Da-i S1iel�o� WA 9B594
Subdivision Name and Lot E 2 N W N l) AJ W E A 5 2 D r E X
PART 2: Nature of Waiver/Appeal
Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Fnforcement Timelines
❑ Mason Coumy Owns,Standards '❑ Departmental Determinations
❑ Contractor Certification Requirements ❑ Other
(Installer,Pumper,O&M Specialists)
Description of Waiver/Appeal(include justification,additional material may be attached)
(actc SOt
Applicant Signature: Date: -1-1,2-
0✓\,p:txC 4,ja:x� et1'.4se('1. ,- , tr."r " Re m d 1=015
This forth may be sunned and available for public view on the Mason County Web site.
Page 1 of
PART 3: Public Health Evaluation (Staff'Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
o Appeal tWaiver ❑None required ❑ Class A XClassB ❑ Class C
2. Identification of Specific Code/Standard/Determination(include date of determination or
latest Code/Standard revision):
3. Nature of Appeal:
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r WA/
4. Hearing Official:
❑ Board of Health ❑ Healthoffiicer
❑ Pollution Control hearing Board lic Health Director
❑ Certified Contractor Review Board Ermronmental Health Manager
5. Mitigating Factors:
C SS Ci ( 1,e dgi, 5
tL w a
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has been submitted.
Staff Signal=: 4 ( - I 4
Date:
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:
❑ 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 Sigh e: Date:
Thb/arrrr maybe sonnetl and available for public Weld on the Mason County Web site. 1222015
Page 2 of2
SON COUNr�
MASON COUNTY PUBLIC HEALTH
Public Health CLASS B WAIVER WORKSHEET
Awaysymrking far a safer he
Mason County (Some and Local waterer forms required)
foeta,laaa,at5 NMh SannM Mae al-ShdtenwA,SaSe<
SMh<n:lW<D-W>O+nmO atllalr.YF1>Ss<e)ef[<00
m W E .,g;re Herne Con�Jruc t,ul »wwhW Nw. WAI
Wauq,mm, . o
f 6194 Z
]M,gptlt Ian W
.,fNf�,MWa.41GD5- 22 -0005o ssgq+.xngt.+r ❑ (hNGmpxatgaAM, ��awmaWt.+r=w+f
1.SOIL SERIES: 5.VERTICAL SEPARATION:
ThewJ,er;C soon to uderwIXd,wTin+,HwdfpoR UpslopawNulsewradon mutt Eegru'srtM1an le'
SM1Nton,or5lnddr Grawlty Sandy barn fir 9hv:ry and 9raattrthan 13'for preswre.
Altlarvroad GnwllYSandy loam..._._...._:._.._.❑ ❑ Greater than l3"....._...._.._____.._......._.___..... ❑ (�
Harstine Gravelly Sandy Loam.._.._..__—.... ❑ ❑ Greaterthan l8"......_.._..-----__._.__._.. ❑ ❑
Haodsport Gravely Ssndy loom.___........_..... ❑ ❑ -Determinedby:
Shelton Gravelly Sandy Wm.._.._.—.............❑ ❑ Depth to hardpan ❑ ❑
Sincbir Gravel Sandy Loem...._.._......._...._.EN3d ❑ Depth to moRlin9 - - __.._._—._.
Other%N 11, _......W ❑ Boot,......__...................._.__._...._..__.......__
0,13
2.SOILTYPE: 1oOi"'t 6.WATERTABLE LEVEL
Sgiltypn moat be Metlum SaM.Lbamy5an4 or5antly lttM1101es show nideMf oi+vaaond waarraWe
Iaam.GraW pernMmwt belessthanoregwl b 35K above rcfvihive leyenacuaain drain maybe raqubM
Medium Sand. ❑ [viderw of uawtulwmrdbic
Loamy Sand.._._....__._ yes...._..................................
._..___....__........._. ❑ ❑
Sandyloam. _.. ..._....... _ S N----_..... ------ ----------....................
Percent Gravel: cui oaln required p
-Less than or equal tp 35%...__.._.__.... �`�S�y-'2 Yes........._.__........___........_..._._._.__.._... ❑ In
-Greater than 3S%.__...._............_....._........._......❑ IFI 3 Na............._.................__......
...._...__.._...�
3.SOIL DRAINAGE: �
7.HORIZONTAL SETBACKS:
ShcsmuRGmaGhWYwdltl2ined tq welltlhined. O Primary DnlnM1eld mute maintain 3IXyham dowmgrtlh
..dd ern mennunorelme aueM1a w+rcrsand wNly I 5
WNI Drained............................
_._..._....__.. IN �
ely WellDnined................................... ❑ -Are inaeafed hgrcoffal wtbecks nfeb
OtherOther ............ ❑ ❑ Yes.._..___.........._..__._.....__.__._._......
4.DRAINFIELD SLOPE:
B.ATTENUATION ZONE
Slopes malt be between 3%to 3a%.
3K[o Gavhy is only allowetl on slopef Rom 15%. A50(cot M1orizbnul atttnwdon zone bhquizd
Reswmis albwetl on 3%to 30% dowmgratlient of the prim+ry draiM�Nd.
Leff an.A. .. .. ..................._................. ❑ Je Gery fOhor9ea Ater GarwNn Nf tlom
3%to 15%......_ ._._..�._..____............._... 9MifrR side of primarydrainfiftd and
16%to 30%...._.._..--------_........_.._......_...... prol»rty bountlery:
Greater than 3a%.._..__._...._....................._....., ❑ ❑ Yes__.................
........._....._...._......._.._...___.__.._
No_---_._-------------_..............
Lhiorsod n,ap,ioathnwmeriumon tqulMte Ee rs[ txon Nedeedof NepmpeM1yuvwbvio% azI 1/
priortadesas appmwl.Theanenuaysmm�e ium mg.ro euebkrthecw stream
elraadzdaclttoms. x AGN' wG L
pv4inq araM wbi<uarbalfiporotNaimilariu[R llsei TnebMnh Tort agrNto dltMXcondl[lenf. neYer+ca
MfrdY WYRXAYN®Y9AWILWErO+NIKwW Wn1EMXOM6UW wSYtn. R uOYW)nMef
On-Site Sewage Systems (Chapter 246-272A WAC)
R uest for Waiver From State R ations
.QeetiOR L (conrp78ted by IWIcara)
Nth (7) Local Health Depertrnent/District (2)
_ �"nr(1q.1�.�',R.__ S8?. trU '�o•s see hursucL
\<f- 5o WA 9B(PZ(v
Telephone: (744bQ1 JC I�r'to/.r/
rpshi.;
16 t0 L rI-Zr4 rarty 7 ' atim: (s) 1 'L 14 ktj N W
41 'Q 22-00050
Section EL (compleredbyapp(icanQ
WACNumbar (4) WAC Requirement (5) Waiver Sought: (6)
246-272A— O��D J 1-115 j �, -
Subsecdoo: 24' a 2°
lustifiaum(m/nganon meattues to be provided): () - SD/ ft'�Aet.
Se6tion III. (cwnple by heabh officer)
Review Crtlena: (8) Mitigation Meaatrres(m addition to these p posed): (9)
2213 U
commaots/coamdwe: QO
Type of Waiver. (ll) [ ]Class A learn [ ]Class C—Request DOH review before granting? Yes_ No_
NeighborNotification: (12)
Requhed? Yes_ No_ If needet(are agreemer6s, easements,etc.properly filed? Yes _ No_
Section IV. I (completed by health oJjicer)
This Request For Waiver Fruen State Regulaboas has been reviewed according to the provisions of Chapter 246-272A WAC On-Site
Se vase syateme. The re.. odreria applied,and she mhiaation musnrca Imposed and/or requaed,have been evalumed for their ability
to provide public health protection at least equal W that provided by this chapter WAC.
l ] Denied (IVApprov / Sub pg to all commenss,conditions and requiremen s owd'u Scctiwrs 11 and M.
Local Health Officer (15) /"^/✓ D.W. �(
19