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HomeMy WebLinkAboutWAI2024-00097 - WAI Health Waiver - 10/4/2024 415 N.6"STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360,427-9670,ert 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5 ,ent.400 amia�na vidumna rmua�m<noi aeam,<ammumry seam FAX: 60- -498 Ap lication for Waiver or Appeal / o Amount Paid: 5 Receipt Number: �Z'�- �'/ 2 l� 4,4 WAI ZOZ4 - DOC)97 Instructions: 1. Complete Parts 1 and 2. No determination can be made until these pans 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 7r-c yo r /n�If �\� , Telephone 3 ter Mailing Address (o l'L i-�L cw--f- City i7/'c+^'i-v"�'`� State i.J Zip 9 k-3 12 Parcel No. 2 �21 m.,� L�� 7r) U — � U 4 Site Address 61/ Af� f•yVn iom VIew Pr146VyQ ttfr7d Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 5( Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Peril Review Policies ❑ Group B Water System ❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requi ❑ Holding Tank WAC 248-272A-0240 ❑ Enforcement Timelines —� ❑ Mason County Onshe Standards El Departmental Deterin m� El Contractor Certification Requirements ❑ Other za (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 TTENUATION ZONE • 7,7I Applicant Signature: ll� Date: el Revised 8212017 This form may be scanned and available for public view on the Mason County Web site. Pagel of 2 PART 3: Public Health Evaluation (Staff Use Only) t. Type of Determination Required: Type of Onsite Waiver(if applicable) u Appeal s/Waiver c None required ❑ Class A VClass B ❑ Class C 2. Identification of Specific Code/Standard/ Determination (include date of determination or t 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 Environmental Health Manage/' 5. Mitigating Factors: CLASS B WAIVER CHECKLIST MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN NI kO f 1 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: A /�Date: 'Vlfl Q1 PART 4: Determination of the Hearing Official RX 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: Date: Revised&212017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of2 MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH CLASS B WAIVER WORKSHEET ass N.eTH srRM,&W b.SH MN wnaesea (State andlocal waiverforms required) SHATON:596 -OffTa,FM MO- iJE R:9912)SMa7,fJR Idl F1Mrt 3aO<e35]W.IXL M]- FN 3401])-TTea ...ANF.5nn5 mr &r-f.rvi C/"�'a,� I ' son f-�M. n, sm nnoxs Lp0 yJ I�y�}+.i� t/J L.,-/ QQ. my ovmamnxnea C G , 0!4 waeos®cR.vaatoTwE 7TC .amorutuuxsr ❑carmnaNusrtssua 1.SOIL SERIES: 5.VERTICAL SEPARATION: The sollsedesmust be Alderwood,Hannine,Iloodspvt Upslopeverscal separation muse be greater Man la' Shelton,or Sinclair Gravely Sally Loam. ram- rorwv=yandgreater Manl2'fprpressure. Alderwood Gravely Sandy Loam-.--.----Iw IN Greater than 12'-.._._.-...__.-.__.__._._._._. ❑ ❑ Harsdne Gravelly Sandy Loam.._................... ❑ ❑ Greater than 18'._.__._.—_-._._.__.-.__._.... g ❑ Hoodsport Gravelly Sandy Loam............_..... ❑ ❑ -Datermlrred by: Shelton Gravelly Sandy Loam............._._.......❑ ❑ Depth to hardpan..........._.-.._._._._...------- � 91 Sinclair Gravely Sandy Loam.._.---.-........❑ ❑ Depth to mottling.......----._..._........_... Other _.__❑ ❑ Both_____—.___.-.—_-__._—._._.__._. ❑ ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL: Sell types must be Medium San,Loamy San,or Sally If[ert hdez show evidenceofesmsonelwatermble Loam.Grind percent mart be less Man orequalb= above resnicsve laye,a cumin dnin may be required Medium Sand ❑ -Welonce of seasonal wate table _ Loamy Sand__�.�__-._._❑ ❑ p Yes.._____.__-_.__-.__._____.—___._ ❑ ❑ Sandy Loam ®' ® �: Percent Gravel: O -Curtain Drain required: -Less than or equal to 35%__—...-. ® I� B Yes._.___.-.-.______.__.____._._-.__ ❑ ❑ -Greater than 35%_........._...__-------------------❑ ❑ 3 No................__....................-......._._............ Q� 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: d Iz c Soils muse be moderately well drain ecitowelldrained. O Primary DrinOeld must maintaln 200'from down-g me marine shoreline,surface water,en wells. c Z Well Drained____._.__..._._.__.__.__._.___.__ ❑ ❑ Moderately Well Drained__--_-.-__._.__L5i' -Ara increased harlsontai saWads msen Other .___.. ❑ yes..................................._-_._....____.. 19 No._.-.--._.-__._.--.__.--_.__.___-.-.. ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%W 30%. Gravity is onlyallowed on slopesfrom 3%to 15%. A 50 foot horiaontal attenuMion zone is squired Pressure is allowed on 3%to 30%. down ymdien[of the primary dreinfield. Less than 3%._-.___.__._.-.__._.._.._._._._._._ ❑ ❑ -is them 50 ft or greater benowen the down 396to 15%_-.__..._-__._--.—._. L9' n gradient side of primary drairefiald and 16%to ❑ ❑ prop"boundary: ..f G2atethan 30%.__-._-.___---._. ❑ ❑ Yes No__.--._�.-__.____.____ ❑ ❑ The%foot hosaontsl attenuation nine is required tote recorded on the deed of Me property as unWildable pdor todesign approval.Theattenuation min is roe W be used for the contruttion ofroadx decks,poses, AFN: 11 ! l perking ereaxvehi ular traffic,orother similar wch uses The owner must agreetoail erase oonibmn rsodaa,m,a�p: MSFgMMMBESCANEDNO AVIA/aLEFQIPAVCNEW pITa MAspImIMYMEB9IE. upAbd JRR01) Granting Waivers frromDState are� On-Site Sewage System Reg Revoins Chapterpril 246-272A WAC Effec uly On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (aompleted by applicant) Name: (7) Local Health Department/District (2) f LJ'O r (see instructions) Address: (p1'L Telephone: C; O ( 3 Signature: Property Idemiff 'on: (3) - SA — W O Section IL (completed by applicant) WAC Number. (4) WAC Requirement: (3) Waiver Sought: (6) 246-272A— 0230 24" URE (OR) RE OSS (OR) Subsection TABLE VI 36" OF V/S FOR GRAVITY 18"OF V/S FOR GRAVITY OSS Justification(mi0gatim measures to b 'de ): COMPLE S B WANER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: ZZ I Section I11. (completed by health gficer) Review Criteria: (g) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: 00) 8Pi W1,W, WI Type of Waiver. (11) ( ]Class A Pd Class B [ ]Class C-Request DOH review below gaming! Yes_ No Neighbor Notification: (12) Required? Yes_ No X Ifneeded,are agreements,easements, etc.properlyfiled? Yes _ No Section Iv. (completed by health o cery This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246.2?2A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for then ability in provide public health protection at least equal to that provided by this chapter WAC. [ ]Denied V4 Approved/Granted—Subject to as comments,conditions and requirements noted in Sect as lI and HI. Local Health Officer (13) Date: f G 2 DOH 337-021 2217401 MASON CO WA 1©t]v7024 lot 51 Pn oECL VELLRY, TREVHHOR 020283a Pee Fee $204 50�Pages 2 IIII II� I�III�I � I� II�II � I ayll Rehm TO 61 For Ave, wA q_9 3 RF jZ 20 CFy�FO Grantor(s): (1)f rzNyr yeIto y (2) /u / 11 Grantee(s): (1) PUBLIC Legal Description (1) I,Jor?�tn �ti�5 I r4Glr S (Abbrevisfed krm:i.e.lot,block,par or section, townabO range) Assessors Tax Parcel: (1) z. � q _ a3 - '- DECLARATION OF COVENANT FOR ON-SITE SEWAGE ATTENUATION ZONE I (We) the grantor(s)herein, am (are)the owners in fee simple of(an interest in)the described real estate situated in Mason County, State of Washington: hereby declare this covenant&place the same on record', to wit the described real estate on which the grentor(s) owns and operates an ort-site sewage disposal system which has been granted a Class B State Waiver to reduce the Minimum Vertical Separation requirements and grantor(s) is (are) required to maintain a 50-foot horizontal attenuation zone down gradient of the on-site sewage system to facilitate treatment of the sewage efNuant. It is the purpose of these grants and covenants to prevent certain practices hereinafter enumerated In the use of the grarnor(s) tend which might encumber the lend set aside for further sewage treatment and disposal. NOW, THEREFORE, the grantor(s)agree(s) and covenants) Oust said grantor(s), his(her) (their) theirs, successors and assigns will not construct or instaft any trench, channel, ditch, road cut, utility chase, or other structure of excavation what would intercept or serve as a conduit for migrating ground water. Dated on this q�'-Pj day of 06400e(- , 201±. Page 1 of 2 Signature of Grantor(s): (1) � . (2) State of Wasnmgton County of Mason ) I,the undersigned, a Notary Public In and for the above named County and State, do hereby certify that on this gd't day of IT mbe r . 20J�L , C �j Personalty appeared berme me,who is known to be signer 0 the bave instrument, and acknowledged that he(she) (they)signed it. GIVEN under my hand and official seal the day and year last strove written. Notary Public in and for the State of Washington, L N N HESSONresiding at 4�w: All;PUBLIC 023031123 ,OF WASHINGTON My Commission expires:SSION EXPIRESMBER 14,2027 Page 2 of 2