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Home My WebLink AboutWAI2024-00074 - WAI Health Waiver - 7/24/2024 415 N.6'STREET,SHELTON WA 98594 MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,est.400 ELMA:360-482-5269,et.400 smm'nq n+^^^e.[�.o-o� mai ee.nn,emmm�mry H.,¢n FAX:360427-7798 Application for Waiver or Appeal Amount Paid: _ Receipt Number: 0 1k-M2-\S WAI 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. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant& Parcel Information Name of Applicant DALE ARNOLD Telephone Mailing Address 260 E WILLOW BLUE LN City SHELTON State WA Zip 98584 Parcel No. 2 2 1 3—2 1 1 -_9 0 3 1 3 Site Address 30 E PINE TREE PT Subdivision Name and Lot PART 2: Nature of Waiver/Appeal M' Class B Reduce 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 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer, Pumper, 08M 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 RECORDED DECLARATION OF ATTENUATION ZONE W �7 1 J � Applicant Signature: fJ4AO L 149±L- 7 Date: Y Revised MI/2017 This form may be scanned and available for public view on the Mason County Web dte. Page 1 o0 PART 3: Public Health Evaluation (Staff Use Only) t. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal I/Waiver ❑ None required ❑ Class A V'Class B ❑ Class C 2. Identification of Spec 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 ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board 12' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WTHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN ZL -r 1 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. i Staff Signature: R -�/I v 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: Health Official Signature- A Date: Z"6/ / Revised 9/212017 This form may be scanned and available for public view on the Mason County Web site. Page 2of2 Gmrifing Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section L (completedbyapplicant) Name: (1) Local Health Department/District (2) DALE ARNOLD 0 i qaqns�.. .-.................. .................... Address: 260E WILLOW BLUE LN .......................... .... .......... SHELTON, WA 98584 ..................... .................................................... Telephone: ........... .......... ................................. ...........- ..... ... S' fjMy Property Identification: (-7' ............. 22132-11-90313, 30 E PINE TREE PT section H. fed by applic") WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 7 .......... 244-272A— 0230 24" OF V/S FOR PRESSURE (OR) 1 Z'OF V/S FOR PRESSURE OSS .............. ................ 36"OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS Subsection: TABLE V17M Justification(mitigation measures to beprovided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED,,.,,..,,, (OUTLINING ADDITIONAL REQUIREMENTS MET), RECORDED DECLARATION OF COVENANT FOR AT .......... ZONE (AFN: Section Ell. (completed by health office,) Review Criteria: (8) Mitigation Measures(in audition to those proposed): (9) ........................- ........... ............. Comments Conditions: (10) ......................... ............ ......... ............... .......... . ......... . ............ Type of Waiver. (11) [ ]Class A Aclass B cbm c—Request DOH review before grinning? Yes NO Neighbor Notification: (12) Required? Yes_ No lfnecde,4 are agreements, easements. etc.ProperlYfiled? Yes — NO Section IV. I (Completed by health officer) This Request For Waiver From State Regulations has been reviewed according in 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 protection at least equal to that provided by this chapter WAC. [ ]Denied heal Approved /Granted—Sub a all comments,conditions and requirements noted in Sec 'ons 11 and 111. Local Health Officer (13) Date: 2- dt'� DOH 337-021 MASON COUNTY 0 COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH �g,n m ,l a .L . .•� CLASS B WAIVER WORKSHEET 415 N.6TH 3TIPI aLLC &W e,SHELTON MMa (State and Local woiwer forms required) SHELTON.6ma27-%]D,e%r Rao-aE1FNIP 30Y3764su EX /T EIMA aW 492uess EM 4D]-FPX'.X6i17-D� mMijo rwwE DALE AHNOLD sanaluesn Moss WAI WJuxcADCREss 260E WILLOW BLUE LN <m BHELTON so, WA 20 96564 Mrs uwscss W E PINE TREE PT,SHELTON cm TaXEM3LN11 Rso n'U-11-W313 YWiMEDpWHiIxOME ❑ [tll'hHIRIrULGRRMY ❑ 6MEMEN1RLmE5W4 1.SOIL SERIES: S.VERTICAL SEPARATION: The soil series mustbe Aberwggd,Harstine,HOodspon. Up-sbpe vertical BeWrad.munbegmaterthanl8" SM1elmn,or 5bdak GraMly Sandy Loam. mrgraWty and greater than 12-for pressure Aldelwood Gravelly Sandy Loam..................__._.❑ ❑ Greater than l2-------------------------_._.__.___.. I[3" Harstine Gravelly Sandy Loam......................_._ ❑ ❑ Greaterthan l8'------_..____.._..,...._.____.... ❑ Hoodsport Gravelly Sandy Loam.......................... ❑ ❑ -Determined by. Shelton Gnswily Sandy Loam.......... Depth to hardpan...........................__..._ ❑ ❑ Sinclair Gravelly Sandy Loam................................ ❑ Depth to mottling-.-.-..--.._..___._.___._.._. Other ._._,...❑ ❑ Both.......................----,.__.__,._.,___._._,_,..._... 4d 2.SOIL TYPE: 6.WATER TABLE LEVEL $oil types moil be Metlium Sand,Loamy Sand or Sandy If ren M1ales sM1ow evidence ofaseasorelwa[er ible Wmn.Gravd percent muslbe Nn1hanor NBalto35%, above resWctlre laye6awrtain tlraln maybe requiretl Medlum Sand................. ❑/ ,❑.,/2 -EWdenn of seasonal water table•. _ Loamy Sand__.___........................_...______..W Id Yes._..........._.............................._.................._....._....... _... ,❑�/ ❑ ea Sandy Loam......_..........___.._.....___._.......,.❑ ❑ 3 No ...................._.................._......... ____�..._._.....N ®/@ Percent Gravel; ,g -Curtain Drain nNitilred: -Less than or equal to 35%.._................._._ ❑ ❑ Yes......................................_....__....._..._..____.._....� b✓ -Greaterthan 35%._.___.___ No..................................................___..___.........3.SOIL DRAINAGE: N 7.HORIZONTAL SETBACKS: , w Primary Doinfield must maintain 20ofrom Eowny7edi- m SOIB must be modera[ey.11 dminetl to well drtilced. mtmadneshomlines,sudame wryaMw II& r✓ t2 Well Drained.—.... W -llralnwaeedbodmrdal setbacks met Moderately Well Drained..........................__. ❑ J Yes..................................................._...._._...,_.._....._.... Other -.......... ❑ ❑ D7 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must to b6tvreen 3%to 30%. Gravity is only allowed on slopes from 3%to 15%. A5afmthorimnfalattenuatbn cone is required Pressure Is Billowed on 3%to 309a. downgradient o/the primary dralnfield. Lessthan 3%...._........___.._......_.................__. ❑, ❑/ -Is there 5o k or greater between the down 3%to 15%.._..._..___________..._......._..........._. E( B gradient side of primary drainfield and 16%to 30%,._..__,_...... .... .____..__.._...___ ❑ ❑ property boundary: Greaterthan 30%...-----___,._,...___..._.,_---------- ❑ ❑ Yes................................._......................._.................... Ikl Na_.__...._____.._.___._...___......................... ❑ ❑ The50kWhoriawnalanenuadommnehr"uiredmberewdedonthedeedofinepmpertyasunbuIWl a pdato design approval.lheattenuabon2 isnotmbeuwdfortheconimttlonofroads,d ,popos, AFN; parking areas,vehicular traffic or other similar such uses.The owner must agree to all these conditions. rmrelwaae: THSFOR.Ruv BE suxxEDANDAvuuALE FOR wwcNEw Mne ossoN couw Rmum. gem 3a 17