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Home My WebLink AboutWAI2024-00083 - WAI Health Waiver - 8/22/2024 415 N.6�"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 ApplDpiLrc_ation for Waiver or Appeal Amount Paid: —`7 I' Receipt Number: �L • 3bldF' WAIII-L _ Qois�� 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 MAXA/ICKI OMDAHL Telephone 360-490-0274 Mailing Address 2061 E CRESTVIEW OR City SHELTON State WA Zip 98584 Parcel No. 3 2 0 2 4 1 2 9 0 0 0 4 Site Address 50 E EMILY LANE, SHELTON, WA. 98584 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 249-272A-0210 ❑ Water Adequacy R ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Time M ❑ Mason County Onsite Standards ❑ DepartmentalDate❑ Contractor Certification Requirements ❑ Other(Installer, Pumper, O&M Specialists)Description of Waiver/Appeal(include justification, additional material may be attac REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: lr—./an,It �Pl Date: _ S 1 2.o4 rV Rt ,i,d 8'21/2017 This form may be scanned and available for public view on the Mason County Web site. I'w Iof, PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) - Appeal ✓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 GRAVITY 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 WAIVER CHECKLIST lMEETS 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: klL� Date: 1��2 PART 4: Determination of the Hearing Official 6—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: V7�// Date: Z/7 L / Rc,iwd ll/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of Granting 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 1. (completed by appllcam) Name: CKI OMDAHL Local Health Department/District (2) (see indractinns) Address. .. 2081 E CRESMEW OR SHELTON,WA 9868/ _... _. ........ _. Telephone: (390 )a80-027a a ............... Signture: - ..._... _. ......... ............. [. Property ldentific on: (3) 32024-12-90004 --- Section EL Icrompleted by applicant) WAC Number: (4) WAC Requirement: (A Waiver Sought: (6) ........ ......_. zab-z7zA- ..0230 Subsection TABLE VI 38" OF V/S FOR 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: '�Z� L06 Section 111. (completed by health gfcert Review Criteria: (8) Mitigation Measures tin addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) [ ]Class A 1 k]Class B [ ]Class C--Request DOH review before granting? Yes— No—X Neighbor Notification: (12) Required? Yes__ No x IJneeded, tire agreements, easements, etc.properlyfiled' 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,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. [ ] Denied [4Approved/Granted—Su ' ct to all comments,conditions and requirements no din Sections 11 and 111. 2'T Local Health Officer /!3) Date: 7 DOH 337-021 Page 26 of 32 MASON COUNTY COMMUNITY SERVI M SERVICES ASON COUNTY PUBLIC HEALTH BURan,NMsiriz `Pwr'sNPRINC ,,,, I'SN", CLASS B WAIVER WORKSHEET 415N,EN STREET SLOG:,SHELTON N AERSER (Stare and Local waiver forms SHELTON:3NH2 70,"T NO- aELFAIR:O&F2]SMW.EST iW required) EIAN 9BD4RSZaa.EST 4m FA%.36D42]�TBB PPPLIUM game MAWCKI OMDAHL WgVERPERNE NUMBER WAI MAILING ADDRESS Son E LRESTVIEW OR OE,SHELTON STATE wP LP 941E81 BDEADDRrsS 50 E EMILY LANE ",SHELTON,WA BSaS4 TAYMRCELNO ER 32024-12-000N PROPOSED DNAIHFIELY TYPE ❑ CONVEMICMPLGPAVRY ❑ CgeEmscew.PRES'.RE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The sollserlesmustbeP RFyn)od,Harstine,Hoodsport, Up-slope vertical separation must be greater than I Shelton,or Sincblr Gravelly Sandy Loam, �/ far gravityand greater than 12"for pressure. Alderwood Gravelly Sandy Loam........._..................0I YO Greaterthanl2"......_...................._.._......................_.. ❑ ❑ Harstine Gravelly Sandy Loam.........._..................... ❑ ❑ Greater than l8'......_..............._._.............._.._........... Hoodsport Gravelly Sandy Loa m_.............._._........ ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam ....._..._................._.._❑ ❑ Depth W hardpan....._......................._._...................� ❑ ❑ ❑Sinclair Gravelly Sandy Loam-------_......_............. Depth to mottling...._......._......................._......_.... ❑ Other .........❑ ❑ Both................................................_.._....................... ❑ 2� 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil typesmust be Medlum S. Lpamy SaM,or Sandy Iftestholesshowevidence ofa seasonalwatertable Loam.Gravel peRE must be less than orequalro35%. above restrictive layer,a Curtain drain may be required Medium Sand..................................._..................._......... ❑ ❑ _ -Evidence of seasonal water table.. LoamySand..._.............._.................._.._................._...❑ ❑ _ Yes...._..............................................._.............................. ❑ El Sandy Loam..._........._........................_........._.._..._..� �'s No..........................__....._....._........_......_................. ..._....r[] (a Percent Gravel: -Cur min Drain required: O -Less than or equal to 35%........................._...... ❑ EE4 Yes...._.............................................................._._........... ❑ ❑ o' -Greater than 35%....................................._............._❑ ❑ No............................._...................................................._.p er 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: ' Spitsmuubemoderztelywelldminedtowelldmined. O Primary Drainfield must maintain 200'fromtlowmgradi- A ent marine shorelines,surface waters,and wells. O Well Drained...................._._.__........................... Q `I Moderately Well Drained_.__........................_._....... ❑ -Are increased horizontal setbacks met: Other .............. ❑ ❑ Yes.............._..........................................._............I......._..... 4. DRAINFIELD SLOPE: No............._.............................._._.........._........................ El 8.ATTENUATION ZONE Slopes must W between 3%ro 3096. Gravity is only allowed on slopes from 3%to 15%. A 50loot horizontal attenuation mne is required Pressure is allowed on 3%ro 3091, down-gadknto the primarydrainfield. Less than 3%........................................._...................... ❑ ❑`/ As there SO it or greater between the down 395to15%..................__.._...................I.................. gradient side of primary drainfield and 16%to 30%............._.._................................................. ❑ property boundary: Greater than 30%..........._......_..........__............... ❑ ❑ Yes...................................-................_............................... ....❑ No......................_..._................_............_................. ❑ ❑ The 50foot hodmntal anenustlon zone is required to be recorded on the deed of the Property as unburkable 2-1 �7 prior To design approval. The attenuationTOec zone is not be used for thontruction of roads,decks,patios, AFN: (/VV.� 606 Parking areas,vehlculartraffigor other similar such uses.The owner must agree to all thesecondidem. 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