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Home My WebLink AboutWAI2024-00086 - WAI Health Waiver - 8/28/2024 415 N.a STREET,SHELTON WA98584 MASON COUNTY SHELTON:360-427-9670,ext 400 1 COMMUNITY SERVICES BELFAIR:360-2754467,ext.400 ELMA:360-482-5269,ext.400 sundinsmwi q,a,wmmunw Haw communirrHcaiN FAX:360-427-7798 A pIVIion for Waiver or Ap eal Amount Paid: q Receipt Number: WAI 10Zq— daoSit0 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 '-A w"- W2CdGl� Telephone Mailing Addreess' P,O, got IZI City C2f�Ai( State We ZIP 9OSo1$ Parcel No. a- 3 - Z - Q -Q -0- .Q Site Address a81 E S �.n•c R,;.tg, �'� �zlP-0.`r Wfl 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 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 I .. PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: Date: D'2`6•ep r/2017 This form may be scanned and available for public view on the MasA Q[)� 2 9 2024 1 of2 By PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onslte Waiver(d applicable) ❑Appeal VWaiver ❑ 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. 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 I M-IA I ) 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has nbeen submitted. li q I Staff Signature:�� Date: PART 4: Determination of the Hearing Official J�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: L RevLNd 8212017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES a. ,m.x,am OlRe,aAcm ..a,Hwah CLASS B WAIVER WORKSHEET 41s R.eTH STREET 8LIXi8.SHELTORMNSW (State and Local waiver forms required) SHELToR 36G427 K70 ECr.aoG-9El R,aeo27a4ae7,EsT aao Et1 :fGG4ab53W.FM 4W-FA%:3e>4]7-71a8 rsnraxrruaE 3�Q a�tAA W ccick wII wu b,ma,RNu eSS WAI nuRRcwousa P-0. 8ofi IAT or, Pgj9.;( stare w? 98 $ a Abram W1eerMNma 2aa\3--77 - 00040 wroeosEnowxEEmmE ❑ CCNYEmpRLLGRavm powwxiuRuvussuaE 1.SOIL SERIES: S.VERTICAL SEPARATION: ThesoilsedeSMUStbe Alder .WH.,sb.,H.dtlWM Up-slopeverticalseparadonmurtbegMa r%anlr Shelton,or Sinclair Gravelly Sandy Loam. I for gravity and greater Man 12-for pressure. � AIderwood Gravelly Sandy Loam.._._.............._❑ ElGreaterthan t2'..-_--.---_---.._................_._.... E/ Bp I-Inmine Gravelly Sandy Loam.-......................... ❑ ❑ Greaterthan l8'..-_--.---_--___-.._..__._...--.... ❑ ❑ Hoodsport Gravelly Sandy Loam....................__-.- ❑ ❑ -Determined by: Shelton Gravelly Sandy Loom........................._....❑ El Depth to hardpan........................_.............. E� M' Sinclair Gravelly Sandy Loam.....-......................-.� L7. Depth to mottling..........-....._........._...__---.-. ❑ ❑ Other ........ ❑ BuM.............._...........................-_.._-_-..- ❑ ❑ 2.SOILTYPE 6.WATER TABLE LEVEL: Shctypes murtbe Medium yard,Loamy Sard,or5andy 0testhdes show evidenceofa seasonal watertable tnam.Gravel percent mustbe less Manorequal to 35%. above resMmive layeca cattalo drain may be requlretl Medium Sand............._.....-........... ...................❑ ❑-2 -Evidence of seasonal water table: '° Yes................................-............-.........-.-..-..-..._....-....... ❑ ElLoamy Sand-.--..._._-.--- -_---._.............._-.❑ yes................................ J � Sandy Loam.-_---._.-...-.-----..--..._._._..............'-� y � Na........--....-.....................................-..-...._.............. L] PercentG.eel: {urtain Drain required: o ^A -Less than or equal to 35%......................._...-. � : Yes.....................................-....--........................ ❑,/ .❑��c+ -Greeterthan35%.........._..-.-__..__--...-.._-_..❑ El '3. No..............-.._..__...-._.............._-_.....___.__.I]1 :K 3 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: c ole.Relyerelldralned[o.weldain.s. , p Pdmeanr mDamrinfield murtmxelhtalne2warrom Shm re ryaMlgzr. ael ............ .. .. .. .. .Well Drained.........._...-_.................. O t Moderamy Well Drained................__---.--....-_.❑ ❑ -Are Immased horizontal setbadss met: Other _.. . ❑ ❑ .Yes.......-..............................................--...._..... d 4.DRAINFIELD SLOPE: B.ATTENUATION ZONE Slopes must be between 3%to 30%. Gravity is onlyallI on slopesfiom 396to 15%. A50foothodzomal attenuatlonaone is required Pressure Isallowed on 3%to 30%. I downgradientofMe pdmary dralnfield Less than 3%.........................-.................... ❑r ❑ -Is there 50 ft or greater between the down 3%to 15%................._........................................_. LN gradient side of primary drainfield and 16%to30%.......... ...... ...... ........ ._..-.-_..- ❑ ❑ property boundary: NJ (IX Greaterthan 30%..._..--...--_--.._.._................. ❑ ❑ ,. YES....-........_--................._......_.._.................._..-. No..............._.-.-..-..-.-._._......._............-......... ❑ ❑ The 50foot horlmmal attenuation zone is required to be recorded on the deed of the property as unbuildable �/2 '�7 prior to design approval.Theattenuation zone is not M be Used for Me contruction of road;deck;patios,deck AM ZZ1 '4 parking arsur%whlculartraffi4 or.thersimilarsuch uses.The owner mustagmeto all these conditions e,ennarmmix >rwsawmsrxsonrrnarro4wnwswnweunmvoRrrewaoxcauxnvasxrc umm�e3nnon 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) Re uest:. for Waiver from State Regulations :;',-�� xtlan l'.`a. ''. (campfetedby apP(icant) Name: (1) Local Health Department District (2) ES�uo. Wt(dwll see instructions) Address: P.o. 801c iag QelLb.tr WA 9ssaa Telephone: ($60 ) gol- 3b3 3 Signature: Property ldenification: (3) I Eklahnwn td c- � lgo�t(_ con- 9gsag Section H. ' (completed by aMhcanf) WAC Number: (4) WACRequirement: (5) Waiver Sought (6) 246-272A— 0230 24"OF V/S FOR PRESSURE 12,OF VS FOR PRESSURE OSS (OR) Subsection: TABLE VI Justification(mitigation measures to be provide4: (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: �L _°.Section M. (completed by healthoffrcer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: 01) [ ]Clsss A [PC}Chrss B [ ] Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes No If needed, are agreements, easemenu,, etc.properlyfi(ed? Yes No Section IV. (completed by health officer) This Request For Waiver From State Regulations has been reviewed according in 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 then ability to provide public health protection at least equal to ti t provided by this chapter WAC. [ ] Denied [.Approved/Grant e subject to all comments,conditions and requirements noted in Sections U and III. Local Health Officer (13) Date: DOH 337-021 Page 26 of 32