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Home My WebLink AboutWAI2024-00085 - WAI Health Waiver - 1/21/2025 MASON COUNTY 415N.6`h STREET,SHELTON WA98584 SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,ext.400 FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: 8-0 P�7Q — (Receipt Number: WAI 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 NORMAN WALSH Telephone 360-701-0205 Mailing Address 80 E PICKERING LANE City SHELTON State WA Z;p 98584 Parcel No. 3 2 3 1 5 7 5 0 0 0 8 0 Site Address 50 E EMILY LANE, SHELTON, WA. 98584 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ty 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 CONVENTIONAL GRAVITY CLASS B WAIVER CHECKLIST RECORDED DECLARATION/OF ATTENUATION ZONE Applicant Signature: �� nlG•s�i Date: lo),2r/2o2ry Il Ned 82I2017 This form may be scanned and available for public view on the Mason County Web site. Val I or2 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 ✓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 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board EY Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST MEETS ADDITIONAL REQUIREMENTS OUTLINED WIT RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AF ]/1HIN 0LC I 6. 1 have received this w .ver/appeal request. It is complete and mitigation required by the state and local polio, h • been submitted, Staff Signature: W. Date: ("2 t—ZS PART 4: Determination fit Hearing Official 14 The hearing official has etermined that approval of this request will not adversely affect public health and is hereby g nfed. 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: Z�Vu Ro iwd W21/2017 This form may be scanned and available for public view on the Mason County Web site. Ngb 2of2 MASON COUNTY 0 COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH ,N ^ Lm°w m„„�I^rmm^^B,I.^B^ CLASS 8 WAIVER WORKSHEET Sts N.6TH STRESW T SLDO e,SHELTON MA NW (State end Local waiver forms required) BMELTON.361I 7-ea)0. EST N -6ELFAIR.350.2)SM6).EXT<W €LMA.3yk<R2.Sag,[XT<W. FM 3 27-770e APPULwT NAME NORMAN WALSH MIARPEMTNUMBER WAI AUIUNGMBPFss a]a FICNERwc LANE my SHELTOry tiAR WA ZIV Y9`Ai SREAIIHS.RUN E CAPSTON ROCK RD -Tv TAHUYA,M. 96588 W ARCELNUMnR 32315-75.00080 PROPOSEDURAwnELOTIGE 0 CONVFNTCMALtiFi ❑ COMEMONALPRESSUE 1.SOIL SERIES: S.VERTICAL SEPARATION: The loll series rnus[be Alderwood.HBntlne,Hoodsport, Up in vertical Separation must he greater Te" Shelton,or Sinclair Gravelly Sandy Loam. for gravity and greater than 12'for pressure. Alderwood Gravelly Sandy Loam................................❑ ❑ Greater than l2"............................................................... ❑ ❑ Hassling Gravelly Sandy Loam......................-.-.......... ❑ ❑ Greater than l8"................................................................ ❑ Hoodsport Gravelly Sandy Loam..............................- ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam.............. ................... ❑ Depth to hardpan...,........................................................ � ❑ Sinclair Gravelly Sandy Loam........................................❑p� ❑ Depth to mottling......................................................... CI _ .. . .. ...........'4 ❑ Both............................................................_......................... ❑ ❑ 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy 5and,or Sandy Ikcs1i aShow evidence o/a seasonal water table Loam.Gravel percent must be less than or equal to 35%. above res[ricdve layece curtain drain muy be requlretl Medium Sand.................................................................... ❑ ❑ _ -Evidence of seasonal water table; LoamySand.........................................................................❑ ❑ 2 YES-........................................................ .............................. ❑ ❑ � Sandy Loam.........................................................................Ia ❑ i No........................... ...... ❑ ........ .................................................. Percent Gravel: R -Curtain Drain required: -Less than or equal to 35%....................................... ❑ g yes......._...............................__..............,.............................. . ❑ ❑ g -Greater than 35%...................................................� ❑ 3 No........_.................................................................._.............� ❑ R n 3.SOIL DRAINAGE: c 7.HORIZONTAL SETBACKS: B M Soils must be moderately well drained[o well drained. O Primary Grainfield mug maintain]00'from down-gradi- n ant marine shorelines,surface waters,andwells. WellDrained...................................................................... ❑ Z Moderately Well Drained............................................... ❑ -Are Increased horizontal setbacks met: Other— — . .. .............. ❑ ❑ Yes................................................................_........................RI ❑ 4.DRAINFIELD SLOPE: No.......................................................................................... ❑ 8.ATTENUATION ZONE Slopes must be between 3%to 3046. Gravity Is only allowed on slopes from 3%to 15%, A 50 foot horizontal attenuation zone is required Pressure is allowed on 3%to 30%. dowrryruikn[o/the prlmarydralnfield. Less than 3%...................................................................... ❑ ❑ -Is there 50 It or greater between the down 3%to15%.......................................................................... in ❑ gradient side of primary chminfield and 16%to 30%........................................................................ ❑ ❑ property boundary: Greater than 30%............................................................. ❑ ❑ Yes........ ..'I'.t.!1.sx....a .....RO'Egau.a...............Z ❑ No.......................................................................................... ❑ 10 The 50 foot horizontal attenuation zone is required to be recorded on the deed ofthe property as unbuildable O`D� prior to design approval.The attenuation zone a not in be used for the contruction of roads,decks,patios, III T parldngaai vehicular traffic,or other similar such uses.The owner must agree TO all these conditions. o,�,rt, " my THIS FORM MAY BE SCANNED AND awala E FOR VAaLIC VIEW ONdE MPSON LOTION Wai u'NF"'AaV C=G7mtingWaivcnom State On-Sire Sewage System Regulations Chapter 246-272A WAve Date: July 12007 Re ised April 2017 Sewage Systems (Chapter 246-272A WAC) uest for Waiver from State Regulations Section I. /completed by applicant/ Name:N69MAN WALSH Local I lealth Department/District (2) (see instructions) Addrer: _.. . . 80 PICKERIN LANE SHELTON,WA 9858I Telephone: (360 )7614&65 ___ _ . . __ . -.......... Signature: - I I _.. -.... -... _. Property Identifrc on: (3) 32315-I5.00080 _.... ___.... Section 11. (completed by applicant) WAC Number: (4) WAC Requirement: (3) Waiver Sought: (6) 246-272A-- 0230 24"OF SSURE (OR) F V/S FOR PRESSURE OSS (OR) subsection: TABLE VI 36" OF V/S FOR ORAVI 18" /S FOR GRAVI SS Justification(mitigation measurer to COMPLETED CLAS AIVERC ACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE AFN: 22ZOM Section 111. (completed by health officer) Review Criteria (8) Mitigation Measures(in addition to those proposed): (9) ......... .... ... .... /0r! .10 I16t/+ C S y>tidAJ Art-11- a'4/SAY d Comments/Conditions: (10) . ................ Type of Waiver: (11) ] Class A ()Q Class B ] ]Class C---Request DOH review before granting? Yes_— No Neighbor Notification: (12) Required? Yes _. No x lj neeaed. are agreements. easements, etc.pr•aperlrfrled? Yes No Section IV. (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions or 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 this chapter WAC. ( ] Denied i Approved/Granted—Subjec all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) T_ Date: 3`.1 DOH 337.021 Page 26 of 32 i