HomeMy WebLinkAboutWAI2024-00109 - WAI Health Waiver - 12/12/2024 Public Health
AJW1Ys ,odong for a safer haalm[or Maven county
Po Box 1665,415 N e Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 +' BelmA ((36 2767-467 eat 400 4 Elms:(360)48 E D
PAX (360)427-7787
A lication for Waiver/Appeal DEC 1 2;024
Amount Paid: W L 9 Receip2Number: �' 00% ! f/'\Q
WAI Z004 - 00/09 BY
Instructions
I. Complete Parts I and 2.No determination can be made until these Pafb are
fi Ilv emmplemd.
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 t.Applicant(Parcel Identification
Name of Applicant M %Ctkh?L PFAR50A Telephone �'�O�J
Mailing Address of Applicant AS 11 5 e LY N GN R D
city state W R zip q18 tj
12-digit Tax Parcel No. �-
SiteAddress SPdAE
Subdivision Name and LotTR 4 OF LL903-05 f'TN NvJ SE. EX 5 2�l/�`ll
PART 2:
2: Nature of Waiver/Appeal
pl Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A•0210 ❑ Water Adequacy Requvemems
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Owite Standards -❑ Departmental Detennitmtu us
❑ Contractor Certification Requirements ❑ Other
(Irowler,Pumper,O&M Specialists) Z(8
/ AfN zzz0
Description of Waiver/Appeal(include justification,additional material may be attached.):
Applicant Signature: Date: 12- 1 Z,-ZaF
U '0—'y'or-- C�y4.i.m'.s,n .-�-u�l a acT�la.n Revised IR2.2015
This form maybe scanned and available for public view on the Mason County Web site. Page I oft
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver ('If applicable)
❑ Appeal &(Waiver ❑ None required ❑ Class A &(Class 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 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 1UVZl1 )
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: Date:
Z p t7OZ
PART 4: Determination of the Hearing Official
9-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: t_ 0
area anlnon
This form may be scanned and available for public view on the Mason County Web site. Page 2 oft
0P'SpN COp
� MASON COUNTY PUBLIC HEALTH
public Health CLASS B WAIVER WORKSHEET
Always working far a Safer halLhler Maven Coumv ;Srate and Local waiveryorms requiredi
5n�eltw�=tiw�<naaaoma�oo la�eaa�r. sp-aeaAi axt� q�I
.rww+w� M ILV�f�~ wuawwr.vaea yv— I
.wuwwue3 3'll 0 sa,t yJR —
�{EI.TO
an
sm.ouess �� MWYodWamam'^s ❑mrea"no"..rsu'nr �m.+n+ru+a[.aeswm
b»a.�anw.r. 22oZ9 �9-s�a4o -
5.VERTICAL SEPARATION:
1.SOIL SERIES: _
lhewi Shtlmn,wairde GbvNy Sa ay LwoodsGarG
V br9m+M antl 9reatertlbn�lYfwpressubn ta'
Aldernvod Gravelly Andy Loam_--- '�
Naas[ine dGav Sandy Loam_. ❑ GreatnWnlB'_------ ❑ ❑
-o~mhmdbys .❑ ❑
Hwclsport Gravely Sandy iCam- -.- ❑ ❑ Wthtohardpan...
Shelton Gravely Andy Loam-
❑ DepMro moMin9.._�------ - d
Slncbir Gravely Andy Loam.__.._..._._.--❑ ❑ Darn
OMe
6.WATERTABLE LEVEL
2.SOILTYPE:
M test oohs show maa+m a a sbwnal wear mhk
Shctypes mustbe Medium Seto.Loamy Sena,or Santo above rtsniNYa isyenamrbindrain maY aebae eied
W am Gravtl par<ant mmt be kM Man or peal m 35%
.gvidasce efsxaorsaiwabrbble: A
Medium Sand._------- - —�} JZ Yes.___..__.__-.---_-__. ❑� ❑q
Loamy Sand_—_—_��❑9 ❑ No_—._--_._._--._.--__.-.__."_"_-_.
Sandy loam..__-__—_— — o -Corbin 0aai.m.ked:
pennintG2vN: .—.--_q❑ IR
❑ o
-Less than, sal to 35%.-_--
7,HORIZONTAL SETBACKS:
3.SOIL DRAINAGE: e c
R
ad= welldnhwd mwMldni- Primary Dninfidd munmainbin 300'lrom dawrDbtl: O
anf lPanllrcssurface watas.aM wNls.
❑ -pra abash hW..W sass man �,( rrpp
Moderately Well Drained
OMer ---_ ❑ ❑ No.—_.--.—_—_-_--___...❑ ❑
4.DRAINFIELD SLOPE S.ATTENUATION ZONE
Skpesmus[a Oetween 3%to 30%. ASprpa[he%enbl asbniani mmne is bquned
GbvhyisoNY allowed Dollopesfrom3%m15%. dm.�nyndim[Mtne Wimary tlninfiel6
Press�ae'salbwed on 3%m 3Qi
-ISMere Sahor 9reatar aeawwn Metlnwn
Less Man 3%.._._-----'-'--'-""--'"'_' ❑ ❑ gndiemsitle of pdmarydrain(dd and
3%b15%-- ----' E2 proparrybeundiry. ��..dd AA.w
--� ❑ ❑❑ ❑ No -- -'_. ❑
Thesosee[neruonblaaenu.eon mnebreyuiredmee,eaorded,n Mad«darMepropero+f unbwlmbe Z2 �V
pderm dnien apwmal.Theatbnusdonzonan rotor beusM forthtconnuctian oymatlx tlahx padex AGN: L �a�ro
parldnparaxs+M1icuhrinlacaroMardmilarfuch user Thaowmer mart a5reem YI thasamMNons +Wr�w/se',s
TufPowwra[XIM'ID uallwwaRMvaK`RW fN rva w.WamNm'wSWe
On-Site Sewage Systems (Chapter 246-272A WAC)
R nest for Waiver From State Regulations
Section L I (completed by appl-aw) Distia (2)
Local Realm Depamnent
lgma O)- 1(�IGNf�E�-. P���°N--- — --- see imtrucirons
&A rl-A411
stkei-T-clo wA 98591
relephoire: (3bO)3'�-3�TJ
Stgnanue.
+ " r # 05 4TK NVJ SE EX `� 2 ]`t7_
wopatyi �: (3� "`'R4 of LLS 03-
pRRGFL# 22 J2q — 8' S0090
Section 11 (completed by applicant waiva Sought (6) yy nn
WACNumba: (Q WAC Requirement (J) Js' '
246-272A— 0?,1 D
Subsection: TO to
J,sbficaow(rnidgatfon mea+mes to baPrPV&W: M bSe6t
5 o/e
=�gmonM�(waddlfiofixth�prvPowd): zit'On III. (temple by health oReview Ctifaie: (8) oposed): (9)Comments/Conditions: (10) _.. _.
Type of Waives: (I]) [ ]Clan A Class B [ ]Class C—Regnca DOH review before granting? Yes— No
Neigbb allod51•anon: (72)
Required? Yes_ No Ifineded are oSo a,,ns,easemernt,etc.properlyfi/ed? Yes _ No_
Section IV. (completed by health officer)
This Regoen For Waive From State Regulations bM been reviewed accmdine m the Provisions of Chapter 241r272A WAC Ou-Site
Sewage SyataPta. The review criteria Vplicd,and the mitigatou measures PmP�and/or required,Lave been evaluated frn theb ability
m provide Public heath protanon at least equal m thm provided by this chapter WAC.
[ ]Denied �] Approved/Granted w all wmments,condthons and requirement aed m 5 cLons II and RI.
Local Health Officer (13) Dace: '[•a 2
19