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Home My WebLink AboutWAI2024-00098 - WAI Health Waiver - 10/8/2024 415 N.6'STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360427-9670,eat 400 COMMUNITY SERVICES 6ELFAIR:360-275-4467,ert.400 ELMA:360d82-5269,ext.400 amm�nyn.�nvy.rmasiawm.camnu�nyawa F Application for Waiver or Appeal Ilil Amount Paid: Z 95 Receipt Number: 6y797 OCT 0 0 2026 wAl o24 -_fd209R By Instructions: 1. Complete Parts 1 and 2.No determination can be made until these parts am 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 C � rxrc�v'rN Telephone 3 m Mailing Address city Yl�\qq\Or State ^ Zip rl� Parcel No. d3 Z_ 3- Site Address Subdivision Name and Lot Cl PART 2: Nature of Waiver/Appeal CFip OI6 Class B Reduce Vertical Separation ❑ Food Sanitation Requirements F� ❑ 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 Onstte Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal(include justification, additional matedal may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY .E OSS CLASS B WAIVER CHECKLIST RECORDED DE\\CLARtA�TION OF ATTENUATION ZONE Applicant Signature �T-' \ Air Date: Reviad8212017 This form may be scanned and available for public view on the Mason CoarLty Web site. Page 1 pf2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal VWaiver ❑ None required ❑ Class A VClass 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)QvlTy R PRESSURE OSS. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board 9' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN Z)1 h tit 3 ) 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. y Staff Signature: -� Date: /0'2 4 '� 1 PART 4: Determine ton 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: 4-n ni Date: �O L L Revised WI2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES CLASS B WAIVER WORKSHEET ass w.arx smEsc esno a eneuox wAeases (State and Local waiver forms required) aHRttN:3 27A gam.E ,IW.KtAsFi:aaa I saer,ENI.a00 ELM M0.18adaPH.IXiaW-fAC a%9-P9e arrLevnxua wwnwwrwasew WAI 20 QOC? «nac annals \ vnamasx q /�x�a� *a..umrxwaa ��—'!.\��CX�f�x� enor.�oaraemases �oawvanuuLwuar 0 oawennruinassua 1.SOIL SERIES: 5.VERTICAL SEPARATION: Thesollurlesmuslbe Mdenvoat Harstirw,Noodsport, u"lope.enlnlsepara4onnesit' greanathan1w Shelton,or SinclairGnvely SaMytoam, for gravity and greater Man 12'forprezwre. Alderwood Gravelly Sandy Loam_....................__,kX ❑ Greaterthan l2'___�._._._..__._._.._._. ❑ ❑ Harralne Gravelly Sandy Loam..... ..................__ ❑ ❑ Gneaterthan ln'._..____—� ❑ Hoodspom Graveloandy Loam............ ❑ -Dalanstmed by: Shelton Gravelly Sandy Loam_..__...__..____-❑ ❑ Depth to hardpan_..______—_—�. ❑ Sinclair GureallY Sandy Loam---------__❑ ❑ Depth to Mottling.___.___.._--_-- ❑ ❑ Other -..___❑ ❑ Both..___.__...............-------------__.___.__.._. ❑ ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL: Sall types mustbe Medium Sand,Losmy Snid,or Sandy k[eAhoks show eMtlericedaseawml walla table Loam.GnvN percemmurt be less Man wequalto 35%. above nsmlMve layegacurUin dnin mrybe required Medium Sand.._.._............................_.._.___❑ ❑ = Evidence Mseawnal wale table: a Yes........_____._.....__..._........__.._........................ ❑ ❑ m Loamy Sand..___..______.._.____�__.___.❑ ❑ q� ❑ t No—_____.__. ........_ ._—._.�._.._ Sandy Loam...__.._.__...._._._..__._______..�, ❑ OS ................ . Y'e s Percent Gravel: �,,r n -Osrtaln Drain n��1 -Less than or equal to 35%_._...----------- d ❑ � Yes...... _.._..___..._.___�.____....... ❑ ❑ -Greater than 35%........_..._ ___ ❑ ❑ a No_________._.__.__.___.._.._..._.___._.......� ❑ 3 3.SOIL DRAINAGE: '^c 7.HORIZONTAL SETBACKS: c Soikmust be moderateyvrelldralned roweH dnlnLd. is nsmary prinked mui insinuin 2a0'kom wellxdow odi- 0 � mtmarMe shorelines,swfxe waters,and . � Well Drained....................._...._._........................... ❑ ❑ Moderately Well Drained ❑ -itre increased hodmntal selWs me skt Other ---- ❑ ❑ Yes___.__.__._..._._....................... _._.—._._.. ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%ro 3%t Gravity Is only allowed an sb from m 3%ro15%. A50foot lgilranGl attenuation mne is required Pressure is albwed on 3%to 3096. down9ndieM of Me primary dralnfieW. Less than 3%....................._.._.._.___.___.._.._.._ ❑ ❑ Asthere50korgreatir betweenthedown 3%to 15%.........__..................._...___._.....__.____*9 ❑ gradient side of primary drainheid and i6%to311%..........._............_..........._.._.__._ ❑ ❑ Property boundary: y� Greaterthan 30%--------_..____._._.__.__ ❑ ❑ yes___......_.........._..__.._.___..._........._______..._.....yJ ❑ No_—_..........__....__.______. ❑ 10 nesO ofhorlmnblmenuadmmneisrequiredtobemcade mo dmddfi pmpp tymmbuiklade prurtodedgnappmval.Theettenwtlon.misrwltobeusMfrMeco alon droadtdecks,patio% UK o S parkirgareaswMicubrtraficardhersimilarsuclluses Theownermurtagreetualldexecondleom. aaiwrmry. trusrawwvasswxmawoavniueurwwuv¢woxnaxnsaucwwsrxasm. exeud3uoi 7 Granting Waivers from State Oo-Site Sewage System Regulations Chapter 246-272A WAC Effusive Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (completed by applicant) Name: (7) Local Health Department/District (2) 0. see inrduerione er 0 Telephone: �) Sigaabue: vC Property Identification: (3) X • \ -It — -- Section H. (completed by applicmU) WACNumber. (4) WAC Requiremeut (3) Waiver Sought (6) 246-272A— 0230 2 ' ) ) Subsechou: TABLE VI 38' OF V/S FOR - VI 18' OF V/S FO GRAVI OSS Justification(mifigofian measures to be provided): (7) CO ETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE(AFN: Section III. leompletad by health ggicer) Review Criteria: (8) Mitigation Measurea in,addition to those proposed): (9) v U Commeuts/Conditions: (10) Type of Waiver: (11) [ )Class A Wass IS [ ]Class C—Request DOH review before granting? Yes_ No_ Neighbor Notification: (12) Required? Yee_ No_ )fneeded,are agreements,easementr,etc.properly filed? Yea _ No_ Section IV. I (completed by health ofrcer) This Request For Waiver From State Regulations has been reviewed according m 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 [Approved/Granted dub' o all comments,conditions and requireorients t oled in Sections It and Ill. Local Health Officer (13) Date: O L Z DOH 337-021