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Home My WebLink AboutWAI2024-00064 - WAI Health Waiver - 7/11/2024 415 N.61°STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-027-9670,ect 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ect.400 ELMA:360d82-5269,ext.400 e�nemy.w�my.r�.,nMme�ui aeanh. FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: a�.5 _ Receipt Number: 9q - WAI CYGI-1- GOU04 Jut 1 12024 Instructions: RfCfIVED 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 / Nameof Applicant PAL„ S�{tr[v1 S _ Telephone �r6az4r� Mailing yyAddress 2 City ��-1-� r` State '^7 Zip Parcel No. _2- 2 J— Z 3 - 2 2 -- 37 O O 7 8 Site Address "Oy\ W (T vt_ t '��J Subdivision Name and Lot ) u � '7 U P h,LS 4 Z'i -d I PART 2: Nature of Waiver/Appeal 15( 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, 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 RECORDED DECLARATION OF ATTENUATION ZONE - t- Applicant Signature: Date: Reviled 8/2 V2017 This form may be scanned 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) ❑ Appeal VWaiver ❑ None required ❑ Class A s/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. Heating Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control heating Board ❑ Public Health Director ❑ Certified Contractor Review Board 9( Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN �GZI3�I ) B. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been`submitted. 1 ' Staff Signature: l� O 7a�' Date: -7IF7 (2y PART 4: Determination of the Hearing Official dL 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 heating 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: `�f/ Date: / Z-Vs Revised 8212017 This form may be scanned and available for public view on the Mason County Web site. Paget oft Graraing Waivers from State Ut-Site Sewage Sys 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 L (completed by applicant) Name: 0) Local Health DcpaNnen[/District (2) p,✓i z 54,e vcM ssee insltvdions Address: 7UZ1,, `J 1 ry r ,n R y�6-t8 Telephoue: (jtr $ _ C. Signature: Property[ (3) ) 01 a F LL k" 7 - o 6.. rk'.••+ t VeW T H- Z2123-2'L- 00 -70 Section II. (completed by applirnnt) WAC Number, (4) 1 WAC Requirement: (S) Waiver Sought (6) 246-272A— 0230 24"OF V/S FOR PRESSURE (OR) 12"OF V/S FOR PRESSURE OSS (OR) Subsection TABLE VI CT 36"OF V/S FOR GRAVITY r 1W OF V/S FOR GRAVITY OSS Justification(mitigaaoa measures to be provided): (71 COMPLETED CLASS 8 WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: IM5 Section 11L I (completedby health officer) Review Criteria: (8) Mitigation Measures rin addition to dense proposed): M Comrrems/Conditions: (10) Type of Waiver (11) [ ]Class A 14Class B [ I Class C—Request DOH review ore graabW Yes_ No_ Neighbor Notification: (12) Requimd? Yes_ No_ Ifneeded.are agreemenh;easements,etc.properlyfiled? Yes _ No Section IV. I (completed by healOr officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC Ou-Sile Sewage Systems. The review crdena applied,and the mitigation rrc oures proposed and/or required,have been evaluated for their ability to provide public bealth pwwfion at least equal to that provided by chapter WAC. [ ] Denied t Vpproved/Granted—Subject to comments,conditions and requirements led in ctions I1 and HJ. Local Health Officer (13) Dale: 7 1 u L DOH 337-021 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES CLASS B WAIVER WORKSHEET Nwv ns N.a"sRF ,,BLDG 9,s aMNwnm5%a (State and Local na"rforms required] MH TON 3BJ-a27-m7u,E NO- � R.�275 ..4W 6Ma a3:l IB a.,.LDJ- FAX.-7 renscvsrxaws b y"A ^ t S4-w r(, vMasreaarraaem WAI MwNCADpaxys�F�.`e. 0 1' 9 D7 6 mY \IV�.F (-' SIIEAIYIIESS L-a l, -7 I�cYay.' w 0.1 arcyr-s.�Yt U l'• sJ nvcrumxrlm Z 21 Z 3 - 2 2 — S u u 7 u mon7sa,Fnraaeu7tR m mNsarantuauMrc ❑mN.RrnaNxrracMaa 1.SOIL SERIES: S.VERTICAL SEPARATION: The sdlsliesmShdton.ust be AMnvm eod.Hlstex,Hoodspart. Up-slope vertiW sepaanon muss begreater than l8" or Smdair Gravelly Sandy Loam. —/ br grariryard graater Man ll'for pressure. Alderwood Grove#y Sandy Loam Yd Greater than 12"—_—_--___._.__._ ❑ ❑ Harsdne Gravelly Sandy Loam— ❑ ❑ Greater than I Hoodsport Gravelly Sandy Loam _ ❑ ❑ -0etamined by: Shelton Gravelly Sandy Loam_. —.—❑ ❑ Depth to hardpan Tzl' I0� Sinclair Gravelly Sandy loam—.----❑ ❑ Depth to mowing— —.—.—. E2 I� Other '--_❑ ❑ eoM.------------'----- ❑ ❑ 2.SOIL TYPE: 6.WATER TABLE LEVEL* $oil types must be Medium Sand,Loamy Sand,or Sandy If tenhdes dsow eviderceofa seawml weir hble Loam.Gra+eu=nt must be less than or equal w 35% abwerestrktive layer, drain be negated Medium Sand . _❑ ❑ _ -E.1deno fseuondlatertaWac Loamy Sand_._—__— ❑ ❑ 'n y� — Sandy to. 19 Lr�f No.--- .-- E 3 Percent Gravel: ty 41 -curmin Drain required: O -LessMan or equal to 35%.--____.__.____ 62yo Yes__.—.—.—_.__._____._--_._.—._ ❑ Greater than 35%_. ❑ ❑ 9ND 3.SOIL DRAINAGE: R 7.HORIZONTAL SETBACKS: i C SOils must be moderately welldraimdrowell drimd. p Pdmary Drain6eW mart mainein 3OD'fromdownyredi � ent marine shorelines,wAam wain,asd welix _ Well Drained ❑ ❑ ModelatelyWe -lire in'lesed horizontal setbacks mat —_ ❑ ❑ Yes— ---_— Other -- —❑ ❑ 4.DRAINFIELD SLOPE: B.ATTENUATION ZONE Sbpes must slopes, l 30%. Gravity is only allowee on oped an skpesfrom 3%ro15% ASO Owe Medimtntal attheprimmm�eisreld. red Pressure is alowed on 3%to 3aK. dormyadientaf the pdmlydrainfieN. Less than 3%___—__--- _ ❑ ❑ Hs tlnore SORar greapr brtween tlsadotm 3%to is%-.-------- 19 53" gradient skin of primary drainfeld and 16%to 30%___—_--- ❑ ❑ Property : Greater Man 30%—_._ ❑ ❑ yes No ❑ ❑ The So foot hodsontal attmum.zone israqumd to be recorded onthe deed oftha property lunbuldable �VI 3S� f prior w design approval.The attenuatlonmrt isrnt to be used for the contructlon ofr*W%dedulsado AFN: SCJ parkingareas,vehicull trafic w oMl similar such uses The ovmer must agree to dlMese corAitbnx xeeret c MaFgLMM/a!%NfeDaIOI.VMIIEfGenmKMLVrDMMMAS0N6V11tY'MLeMR. ytlMa.,