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Home My WebLink AboutWAI2024-00080 - WAI Health Waiver N WA98594 MASON COUNTY 415 NSHELTON:3650429670,ert 0 COMMUNITY SERVICES BELFAIR:360-275-4467,ext 400 �. awmaosa mmm.�v�ewu,,�nunurHdm ELMA:360482-5269,ert.400 FAX:360-427-7798 ATplication for Waiver or Appeal Amount Paid: Receipt Number: ppZ�T — 3 S W WAI ZoZ�_ QV� Du 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& ParcelInformation 1 Name of Applicant f 1 a Kp.ry� 1t Telephone Mailing Address Ic KO•awS lA1a.1 city Fo4 State Wh Zip q OsS.3 Parcel No. 1 2 2 1 — -1 1— -- Q --!2 Q 3 O Site Address 3s1 Cr. Qick4e4o[Soft RoL_ Qe 4,r Subdivision Name and Lot l�r� PART 2: Nature of Waiver/Appeal AUG 1 6 20�� Class B Reduce Vertical Separation ❑ Food Sanitation Requir ments 1� ❑ Building Permit Review Policies ❑ Group B Water Syste �'pulatioT ❑ Location, WAC 246-272A-0210 ❑ Water Adequacy Requiremen�� ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsile 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 Applicant Signature: _ �fi Date: Revised 8/2120❑ This form may be scanned and available for public view on the Mason County Web site. Poge 1 of2 PART 3: Public Health Evaluation (Staff Use Only) f. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal V Waiver ❑ None required ❑ Class A VClass B ❑ Class C 2. Identification of Speck 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. ry/ 22 4. Hearing Official: U LS ❑ Board of Health ❑ Health Officer AUG 161014 ❑ Pollution Control hearing Board ❑ Public Health Director ElCertified Contractor Review Board Environmental Health nage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 'LZ` L. 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 1 , Staff Signature: ^nOLYtly`�^ - 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: iz Date: q � If Revised SMM17 This form may be scanned and available for public view on the Mason County Web site. Pege 2 of2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Re uest for Waiver from State Regulations (completed by applicant) Name: (I) 1 1 1- ' Local Health Department/District (2) A t• _ {We mstruetions Address: . ......... ... -- - - Telephone: (3w ) Ool 7.760 Signature: —� CAf Property Identification: (3) ' • b - a3v Section 11.c'. (completed by app(icanQ WAC Number: (4) WACRequirement: (5) Waiver Sought: (6) 246-272A— 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: (completed by health officer) Review Criteria: (8) Mitigation Measures(in addiii e Comments/Conditions: (10) Type of Waiver: (11) ) ]Class A Wlm B [ ]Class C—Request DOH review before granting? Yes No_ Neighbor Notification: (12) Required? Yes_ No Ijneeded are agreements,easements,etc.properlyfiled? Yes _ No Section TV. (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the previsions 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. I ] Denied h4Approved/Granted—Sub' Wall comments,conditions and requiremen noted in Sections ll and Ell.p Local Health Officer (13) Date: / '1- DOH 337-021 Page 26 of 32 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES a44eroahminaBn6mmM.l .Cmmrettes R B WAIVER WORKSHEET au N.MN STREET ELM a.SHELTCNvesasaG and Local waiver forms required) SHELTCN.9POORi 6670,EXT aW-BELFNR'.aapniTseo E.#64B].SRa9,ECT 4D-FA%'..1-779a 6 2024 APNXhNtN.1 0, N� WAI DDR e.DDND .(' B —= ND F � " gen 1 ilR' � � /a�P 9� % 33,3 am NmaaS �55.�ee1��Aa �'.�..aQ�c_�.udso.. .1. / ISGL4Ar ovessaLMIMYa 1(��$ I�� E y J�1�O M'JYOSFDMWriFlDlYl£ E�CIXM1EMIIC1VLrAaVrry ❑athaonIXULmE55nRE 1.SOIL SERIES: 5.VERTICAL SEPARATION: lne-11 series must be AWemmod HaMine,Hoodspor, Up-slope vertical separation mug be greater than ta' SM1elton,or Sinclair GravNly Santly Imm. forgraviryaro greater Man ti`forpressure. Alderwood Gravelly Sandy Loam.......................❑ ❑ Greater than iP_..........._..._.._.___.._..__...._.._....._. El El Harstine Gravelly Sandy 1.soon_..._........................_.... ❑ ❑ Greater than l9'........................_._....._....._....._ Hoodsport Gravelly Sandy Loam..................._._..... ❑ ❑ -Determined by: / Shelton Gravelly Sandy Loam_......................._.-❑ ❑ Depth to hardpan........................................._____..__... Lir ❑ Sinclair Gravelly Sandy Loam...................................LV {lY Depth to mottling..........._................................_..._ ❑ FI l Other ....__...❑ ❑ Both........._................................_.......____.._..... ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL: Swltypes murt be Metlium Sand Loamy$aM,or Santly Htestealesshow evitlencits, re noalwatertable l Inam.GravN percentmust be less Manor equal to 35%. above regrotivelayer.a curtain drain maybe required V h MediumSand.......____....._......_....................... ❑ ❑ .2 -Evidence of seasonal water table: O 2 LoamySand_......................_.._..____._....._.._._...._.___.❑ ❑ a YES...._..................._..................._.._....._.......__...._..._......... SandyLoam........................................... �3No..._.............................._-......................_...._....._.....❑ I?r Y o s Percent Gravel: s {unpin Drain required: p - Lessthan or equal to 35%......................__.. l:l p Yes.........................................................___._______.... ❑ ❑ c R -Grearerthan 35%...._..._._._..___..............__._..__.❑ ❑ 3 No................._...._........................................____.._._. 3.SOILDRAINAGE: c 7.HORIZONTAL SETBACKS: q c: sons mud be--densely well drained ss efl. Ined o R7-Drainfidd must malmsm 2001mmduw"nedl gF emmadm shoreline,surfacemters,and wens. Well Drained......................................................... aLaY Moderately Well Drained.—...._........................❑ ❑ -Are increased horlmMal setbacks met Other ........... ❑ ❑ Yes................................................................................. N( No........................_............_.........................._...._........._...... ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes most be between 3%to 30% Gravity is only Aloved on slopes from 3%To 15%. A 50 foot horimntal attenuation zone is required Pressure is al loved on 3%to 3016. down-gmdlent of the primary dralnfield. Less than 3%................................................................. ❑J ,❑�,/ -Is there 50 ft or greater between the down 3%W15%............................................................_.. LNS Ls] 9milient side of Primary drainfield and 15%to30%.............................................................. ❑ ❑ property boundary: —/ Greater than 30%.........._........................................ ❑ ❑ Yes......................................................................_.............. ....Q LY No.................................................___..........__.__.. ❑ ❑ The 50 foot horlmntal attenuation none is reguhedm berecorded on the deed ofthe property as unbulldable pfimtodeslgnappr LTheattenuAommneismtwo usetlfortMwntrudionofmad,deh,patloa, AFN: parking anon,vehkularmficor otherslmllarsuch uses.The owner mug agree to all these conditions rmmmuwMns: TMsrCNM1A\ KR NNMM'DFvu Erp MSMAEwoNine1M50NCWMYMEa Rrub dvea.,, Mason County WA GIS Web Map I r i r secllon T 18 i / i g 5x1 r u �\ I 7123/2024, 1:10:00 PM 1:3,061 0 003 0.05 0.1 mi C1 County Boundary 0 0,04 0.0e 0.15 km El No Filled O Tax Parcels (Zoom in to 1:30,000) E, J.W. HERE, Gamin, USGS. ,,H, E INCREMENT P, NRCeq ❑ Esl Je , MET, Evl Cl,re 1Hwp K«M�, Een U.C Eml c� NM1aIeM), Sections NGCL,� OpanStrmWytonlndAwa uCNe GIS Usa anmuniry -' Townships Mm cwmr MMGISNWMaMdimm Mm CWMda ime aW"..mlWlb.«r"H—dw IMu,Mlv fX'Fl89W Imn,el'ww M 9,l :Mx'x.mB9tn`cn"a ewaletlaY r"