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Home My WebLink AboutWAI2024-00111 - WAI Health Waiver - 12/27/2024 415 N.6'STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360d82-5269,ext.400 Building,Phnnms,cnmmnmemai H -M 17-11e. . FAX:360-427-7798 A plp ication for Waiver Appeal U I�fry f2 f1 Vi f2 Amount Paid: �Fft�x-3�-5--- Receipt Number:r: Z0Z7 • OJ�2.3,3 L41t7 f5 J V LS I DEC 27Z 4 WAI C1 - 0011/ u Instructions: Ey 1. Complete Parts 1 and 2. No determination can be made unfit these parts are fully wmolefed. 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 ( )y, ,, S �j ej s h as e- Telephone '3LrU • S `7 a -7--f u S- Mailing Address 1 B-72 A!W V p A P—`- City l \stiu State W (A Zip j S 37 0 Parcel No. 2- 2 5 u 5 - 7 is -- ° 0 1 7 0 Site Address N@ rhxtj S cn CT Ra-\'�'-• r L'r r- l g S 2 4 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 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, 08M 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 ATTENUATION ZONE Applicant Signature: Date: 1 Z-2 4-2 4 Revised 8212017 This form may be scanned and available for public view on the Mason County Web site. Page f of PART 3: Public Health Evaluation (Staff Use Only) t. 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-023q TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Heafth ❑ Heath 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 7Z7pLr(4 I ) 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: t' -7 I�� PART 4: Determination of the Hearing Official Mi 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 dented. This decision is based on the following findings and conditions: Health Official Signature: Date: Revised 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 0 COMMUNITY SERVICES CLASS B WAIVER WORKSHEET ns N.STH IYT.},,BLou a,BNBLTaN Weeeeea (State and Local waiver forms required) $ ,TcN aso R-aym F W]- arUAR-.30oVS-s n.FC!400 ct"atl aa35X , aW .soo-an-M,6 KnICINTNMIE LV^r s ` 'e1:s hHa r- „nraeaRr�R�.nrawa� WAI ?�Z`1- 00 I I 1 MNUNGRLde55 I Qj7 Z 'y W VaA 21 a1v �Sba sarB tr A aP q y 37U slnescress NC_ vru s — �'T mr K.,l•Cl..r Tra wamuaaw ? 2 'so i-7 0O 17U _ Rwro�vlwamrwB �.carorNnoxuauurr ❑ touvTrnroxurlessua 1.SOIL SERIES: S.VERTICAL SEPARATION: The sdlseriesmust be Alderwaad,Harsfine,rl dspwt, Up9ope vertical seweres,must be greater then tY Shelton,or Sncbir Gravelly Sally Loam. ,../ forgrainy and greater than l2'for pressure. Alderwood Gravelly Sandy Loam_--.._—� IO Greatatnan Tr-.--------.--__._._._.-. ❑ ❑ Harstine Gravelly Sandy Loam El ❑ Greater than l8•........... -.-......-___._.•._..._. Hoodsport Gravelly Sandy Loam ❑ -Dearrminod by: Shelton Gravelly Sandy Loam...... ❑ ❑ Depth to hardpan.......--....................... (� Sinclair Gravelly Sandy Lam-------_-----_...._._._.-.❑ ❑ Depth to mottling -------•------•_-. ❑ Other _.__❑ ❑ Ilotn_------.--.__.—__.___._..._._. ❑ ❑ 2.SOIL TYPE 6.WATERTABLE LEVEL: Sell types must be Medium Sall,Loamy Sard,or Sally If hst holes showevidence ofa seasonal water,table Loam.GravelpenomtmusAelezihonoreyualm35%. ebo+e resfdctivelayer,acurtain drain may be required Medium Sand_. __— ❑ ❑ = i3d4�ef sens-W waMbMm - ❑ ❑ _ Loamy Sand .❑ 13te2 Yes-- _.-.-_..._.__._.-...-_ Sandy Loam_----_ __10 IO 3 No._—.__-.-�_�_.__._-__. percent Gravel: -Curtain Drain required: ❑ El-Less than or equal to 35%__-.-.-_ Yes.--__-.-_--.__---.-. 3 -Greater than 35%_...........__.-.__----------------❑ ❑ 3 No._._.__.__._--------- -------_-..._._ 3.SOIL DRAINAGE: it c 7.HORIZONTAL SETBACKS: c Soils must be moderately well drained to well drained. O primary Drainfield must maintain 200'from downyradi- O `< ant marine shorelines,surface waters,and wells. p Z Well Drained-----------____..—..• ❑ ❑ -pre]....ad horimMal selbadcs met: ❑ Moderata ll Drained_.-._.-..._-_._.-.-® �' OtherYes-------_.------------------------_..._........... ® IO -_. ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. Gravity is only allowed on slopes from 3%to 15%. A 50 foot horimmal attenuation zone is required Pressure is allowed on 3%to 3096. down-gradient of the primary dminfleld. Less than 3%..........................._................... ❑ ❑ -Is there 50 ff or greater Warrants the down 0radlent sidoof primary dreidield and 3%to 75%_._.__.__...__.u.—__..__-__-.. boundary: Greater than ❑ ❑ .---._._�._-_® 4Y No.----.- -___._ ❑ ❑ The W foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuddahle priortodesignapp,oval.Theattenuahonzo isls wt usedfarthecom ionof roads,dells.paths, APN: parking areaz,vehiularteffic,orothwvmilar such uses The oemer must agree to all these conditions. froddxa,e,v. MSFgMMp BESC.VIeD ND.rVOLAYFFpIRA1CNEW ONTa MASQI RIMYMTBSm. Wdretl3R 017 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) ReQuest for Waiver from State Regulations Section (rompleted by applicant) Name: (7) Local Health Depamnent/District R1 C\r`rrS WC%G4wai see insiructions) Address: A Pw.,`sbv o- 98 39d Telephone: (3 -3 tip_ 2 y o S" Signature: Property Ids quoDn: (3) I re t u \Z 3 y f b O O Section IL (completed by applicant) WAC Number. (4) WACRequirement: (5) Waiver Sought: (6) 2A -272A— 0230 RESSURE (OR) 12" OF V/S FOR PRESSURE OSS (OR) Subsection: TABLE VI 36"OF V/S FOR GRAVI 18" OF V/S FOR GRAVITY OSS Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: Section IIL (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) CommeNs/Conditions: (16) Type of Waiver. (11) [ ]Class A Class B [ ]Class C—Request DOH review before granting? Yes_ No_ Neighbor Notification: 02) Required? Yes_ No_ lfneeded, are agreements, easements, etc.properly filed? Yes _ No Section IV. (completed byhealth officer) This Request For Waiver From State Regulations but been reviewed according to the provisions of Chapter 246.272A WAC On-Site Sewage Systerns. 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 M Approved/Granted S to all connmenCs,conditions and requirements noted in Sections H and M. Local Health Officer (13) Date: ` � 2 DOH 337-021 SP12024-00115 �5 s 445 403 Assumed stream path" Wetland edge' Stream setback' a3s Wetland setback' D f p p AO^h SP U w O b VO i P o *All locations approximate 11/26/2024,7:25:13 AM 1:1,528 0 0.01 0.03 0.05 ml ElTax Parcels(loom in l01:30,000) — CityFEMA FIRM Map A. 0 0.02 0.04 0.08 km Railroads(Zoom to 1:200,000) — Private AE, Road. — Green Diamond — Federal AE,FLOODWAV US Forest Service a Saw .Fan wuv Eema.Gwii Wsy GI9 WaCaaw-" — State AO, Contours 5 it — County OPEN WATER, Me.00 V^Glsweeuapaaq'r Mayon County alxiumm aau,xv.eiueuM.a of not facie b MaeaM1 rtllancennn.nape IMwa.mawwuMWaawMaclelmer.pcp