HomeMy WebLinkAboutWAI2024-00090 - WAI Health Waiver - 10/29/2024 ON CouI,4
publicH�th
Por a sMc hUlthlar Masan county
po Box 1666,415 N 6e street,Bids 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 + Belfai (360)
360)42�87 4 xt 400 Elma:(360)482-5269 eet 400
FAX p
A plication for Waiver/A peal
Amount Paid: Receipt Number:
/
WAI
Instructions
t. Fees may
bPartae billed
i and 2.No determination can be made until these pans are
r,t1 mvleted.
Health Fee
2. Fen maybe billed furwaiverS and
with cep hR based�m m°n ft won County Public Health for reviow�e.
3. Submit completed application
PART 1.Applicaut(Parcel Identification SHMLNod Ple10"50
Name of Applicant T)0 t1 e M w KEN —
Telephone( 205: 0
Mailing Address of Applicant —1 i I O Ft G 4W W 5
city M t< T a State _ zip 9 B_ 5
12-digit Tax Parcel No. 2 O4�- -- 4 - -�-Z D O a 0
Site Address —ZU L pX�Llsot4 91D6E- LD C, otEu)� 1a49®5% _
Subdivision Name and 3 oFu si LR otAG 2L16oR3 PrN OF: NP 61E +
NW SF 5 31 J z 48" 6 q-1/150
PART 2: Nature of Watver/Appeal
-)i Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policin ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requrements
❑ Holding Tauk WAC 246-272A-0240 ❑ Evforcement Timelines
❑ Mason County Onaite Standards ❑ Departmental Determimmons
❑ Contractor Certification Requ cements ❑ Other
ansmller,Pumper,O&M SPecislists)
Description of Waiver/Appeal(includejustification,additional material may be attached.):
" SOS
-a nn p
Applicant Signature: Date:
(• awe. elba;q� s^ �e r o �"`°^ Raised la2na15
This form may be scanned and available for public view on the Mason County Web site. page I oft
PART 3: Public Health Evaluation(Staff Use Only) Type of Onslte Waiver(if applicable)
I. Type of Dete��*rm///ination Required: o Class A cyass B ❑ Class C
c Appeal Waiver ❑None required
2. Identification Of Specific Code/Standard/D rmmatlon(include date Q�e ion or
latest Code/Standard revision):
3. Nature ofApPea�On
4. Hearing Official:
❑ Health Officer
❑ BoardofHealth Public Healthl Halth
❑ C dl1on Control hearing Board Environmental Health Manager
❑ Certified Contractor Review Baard
6. Mitigating Factors:
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:�I' " Date:
PART 4: Determination of the Hearing Official
21-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:
Hearing Official Signature: Y Date: /d/j ,,,
Revisd 1222015
This form nay be scanned and&"liable for public view on the Mason County Web site. Page 2 of 2
On-Site Sewage Systems (chapter 246-272A WAQ
R nest for Waiver From State R tions
Barron L (completed by appliam") Local Health Dapattmem/District (2)
see instntc
Nettle: ry)DCNhLD MlhlrKEp1— _—. --_ .
Andreas: fluFlc I+w _
— MIL,-oa VQA
Telephone: (Zs3)Zo9-e64o S N'T ere
S;r�anue° a E SE t NW.
�11bo4�.PrN
Property - (3) L� DG LLC-A -vI AF
—sue
P GEC-# Z?a o 4 - SOD3o
Section IL (oomp/eted by applicant/ Waiv«Sought: (d)
WACNumber: (Q wncxwai "� (s)
246272A— 02aD
Subsaxion.
Jtutifiea5�(ndtlgada"measures to be
5P -
lIL ( by heahh officer)
Mitigation Measures(m addition to thaw proposed): (9)
Review Criteria: (g)
_. _..—.. C1ass C—Request IIOH review f to ga"ong'. yes_ No_
Type of waiver. (11) [ ]Class A Class E I
NeighborNoriSotioo, (12) Yes _ No_
_ I needed are agreeme+as,easemerm',etc.properlyfded?
Requited? Yes No_ .(
$eCUon IV. (completed by health offer) sioro of Chapter 246-272A WAC Oo-Shc
Th:e Re9neat Yx waive r>rom State Resulati—bay been tevion vrmsprpa prop% a P
M and/or required,nave been cvalaaae for tlw"v a iliry
'a8e g]'¢e�. Tlae mnew criteria applied,and the miriptr "C.
m Provide public health
i pmtec¢on at least equal m that provided M m;s el"pra n din Secnoru II atM M.
I l Denied ,Approved/Granted�Subift m aR wm`oaon,wndidons and rwtdrero° J t
Hato:
Lac,l geanE offer (13)
19
�aSpN CO(7NrP MASON COUNTY PUBLIC HEALTH
Public Health CLASS B WANER WORKSHEET
ired)
NwaYs workin5 tnr a inter healthier Mason CCUnty (Scare and Locaf waiverlarms required)
ro etatee4a13 Hash Streer.11ad987-SM1elm^W0.9a%°
pw.mx:amaztzemmaoo s.v+iraao-z>s«sz.naaa
wwareWnxuwP WAI
eauixa.00aed �1 I I 44C 1 G I C tFw E sm+l \N A
MIL.Tm , n anp —
Z O E E 0r1 DGE RD m mP ,x waa
vrtancesss na 41 r-aFlt7� wpupoaru«so"'t
-
5.VERTICAL SEPARATION:
1.SOIL SERIES: dun ta•
Xarsdne,Htpdsport. UpamMxerdml xparadon mun be ---
fotOraMYand 9reamrthan tYfor INaSur¢
Thesdlxdes m+atbe Ndowood• _..-K
3hym^.¢r pndJ¢Gravelly SanN loam
— 0
Nd.wood GmvylY Sandy gym--"—"-. GxatertMn
ru,ow, eGravellySandY� `o --- .� dined or. J❑ ❑
HdddsPort Gmllel"IdY Wm Depth W hardpan.._-. --' ❑
Shelton Gwei1Y5andytwm--'-- —❑ Depthtomotding...—•--•
Sincbir Gravelly Sandy loam.-_—'..._._—___❑
OMer
5.WATERTABLE LEVEL
2501LTWE HLe RTA JwweEVEL ota se*+<^•I+at«m°le
Soiltypes must beMWum SaM,lnamy Sand.or Andy above repncdve byecamrtain drain mayv¢reQui+ed
Inam Gravy percent must be WstNn orquJm 33%
.❑ ❑ T -Evidesxa Mseuprsal WrternWe: _._. _. ❑ ❑ _
Medium$antl. —•- Yes_.._._._._ --.--_
Wm Sand No
Santlyloam---__.__- _•- —❑ o -c nWn Drainx uim* _ ❑ ❑
PeK¢MGx[4: ..sa{{ Yes.___. -_-
-less than
-6rearerthan 3s%__--- - ---❑ 7.HORIZONTAL SETBACKS:
c
3.SOIL DRAINAGE E R
Primary DninRytl must melrwna00'Irom down9rad'.
etas munbe mexreWywelldnimd mwyldNned em marine shoMna swM1«wein.anewyk
Well Drained_—� ..� -,reinaaasadhorhentalsetbadtssnet
MatlerrtyY W¢IlDnined ❑ Yes-...._.__---
—____—.._._._.W IF❑}
❑ ❑ No__—_—.__.—..____..._—____- ❑
4.DRAINFIELD SLOPE B.ATTENUATION ZONE
Slopes must d be[weP+3%m 30% A So(oo[herbonnl attenuation iMelS W.hedl
Gamy ismlY Jlw.ed on slopeshom 3%m15% downyradim[ottM PrimaNdralr+aekl
Pressurt's Jbw¢d on 3%m 3o16 sew+.
p .umerexx«erree•b.a,.,,....x.
less tron sw. —'---'__—'� 9tedun<tlde ae PrtmarydnlrsMld eras
pmperglboUMd -
Yes
Greatertnan30%..----- --'—' ❑ ❑ No_- --.—
mesoaothoriuna.mnuado^m^ebmwr.amwnco,aeewme a..d,enepmwmuuwuilaede 7?a6Z�f�__
lheattenwtionaMebrotm be uredM die mnnu.-mn of madxdedw panes
Priorm tleJSn sppmv+l °rmnezruxms
pvldiq artM vahiabr M1fIC or oMer Jmilar such user The ow^er must agree eo all Nex candldons.
naSKwwr KfGIMFD 119 Nuun£sCdrunlCY4w W nIEKV(Ixmuxnw951R.