HomeMy WebLinkAboutWAI2024-00037 - WAI Health Waiver - 5/2/2024 MASON COUNTY 3 APR 23 2024 D
COMMUNITY SERVICES,
Buildin%Planning EmiranmeM l HaItK Community Health
415 N e Street, Bldg 8, Shelton WA 98584,
Shelton:(360)427-9670 ext 400 4 Belfair: (360)2754467 ext 400 G Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid:
Receipt Number: Z
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 Identification
Name of Applicant NATHAN SHAFFER Telephone
Mailing Address of Applicant 15950 S LORA CT
City OREGON CITY State OR Zip 97045
12-digit Tax Parcel No. 3 2 1 2_7=_ 5 1 _ 0_0 2 7 2
Site Address 570 ST.ANDREWS DRIVE,SHELTON
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
V Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal(include justification, additional material may be attached.):
CLASS A WAIVER TO REDUCE SETBACK FROM DRAINFIELD TO DOWNSLOPE FOUNDATION DRAIN.
25FT DOWN TO 15FT+
MEETS CLASS A WAIVER REQUIREMENTS.TLB W/DISINFECTION a W OF VERTICAL SEPARATION 8 ANNUAL O/M.
Applicant Signature. Date: �
1:\EH Forms\Waiver-Appcal Mason County Local Revised 1/20/2017
Page 1 of
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onslte Waiver(if applicable)
-Appeal Iver ❑ None required lass A ❑ Class B ❑Class C
2. Identificatio of Specific Code/Standard/Determination(include date of determination or latest Code/
Standard revision)3. Nature of Appeal: ,,Vr-d`y(-'4J D ar� 715
Fy
4. Hearing Official: A
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
5. Mitigating Factors:
6. 1 have received this w iver/>i peal request. It is complete and mitigation required by the state and
local policy has bee submit ed.
Staff Signature: Date:
PART 4: Determinatio f 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:
Th hearing official has determined t�sppmval �requeat �Patenflally�sdverselyct publiclth and is hereby denied.This da
II A
Hearing Official Signature: Date: 2.. LO L2yL
IF
J:\EH Forms\Waiver-Appeal Meson Cowty Local Revised 1/20/2017
Page 2 of 2
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 (completed by apphcam)
Name: (p NATHAN SHAFFER Local Health Department;District (2)
(see instructronr) .
Address: 15950 S LORA CT
OREGON OR 97045
Propertyldentification: (3) 321 -51-00272, 570 ST. ANDREWS DRIVE, SHELTON
Section Q. (completed by applicanr)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A 246-272A-0210 Soil dispersal component 30 feet Down to 15 feet, except not in
... ......... ____. _from-interceptor/-curtain drains/........ Soil-Type..} ......... ............ ...
subsection: TABLE IV I drainage ditches down-gradient
Justification(mitigation measures to be provided): (7) MEETS CLASS A WAIVER REQUIREMENTS
IA)OSCAR X02 OS50 MEETS TUB W/OUT DISINFECTION, SOILS PROVIDE FOR 24"+OF VERTICAL SEPARATION
2A)SYSTEM WILL REQUIRE ANNUAL MAINTENANCE,COUNTY MANAGEMENT PROGRAM W/ONLINE RME
Section II[- (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Commems/Conditions: 00)
Type of Waiver: (lf) lass A [ ]Class B [ ]Class C—Request DOH review before granting? Yes_ No_
Neighbor Notification: (72) Required? Yes_ No_ IJneeded, are agreements,easements,etc.properly flied? Yes No
Section IV. (completed by health officer)
This Request For Waiver From Some Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site
sewasi*aterns.. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability
VDeni
blic health protection at least equal m that provided by s chapter WAC.
[ ] Approved/Granted—Subject comments,conditions and requirements n ted in ections 11 and Ill.
Officer (13) Date: 1— Lo V f
DOH 337-021 Page 26 of 32