HomeMy WebLinkAboutWAI2024-00047 - WAI Health Waiver - 6/13/2024 \ 415 N.6'STREET,SHELTON WA 98584
MASON COUNTY
SHELTON:360-427-9670,ext 400
COMMUNITY SERVICES BELFAIR:360-275 4467,ext.400
emimng.mammny Enm—mn*auh,Comm„mn Hiam ELMA:360-482-5269,ext.400
FAX:360-427-7798
Application for Waiver or Appeal
Amount Paid: Receipt Number:
WAI aoau - (-.-
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 TRAVIS ROWLAND Telephone 360-870-1287
Mailing Address_1 r1Q 1 S f ru;En Qd
City_ sw-lial, State (Gjjj Zip clpsp /
Parcel No. 3 1 9 0 5 _ 2 1 -- 9 0 0 0 1
Site Address 1130 SE CRAIG RD SHELTON, WA 98587
Subdivision Name and Lot LOT: 1 OF SP#2997 AF 41880072
6�t
r'Di�1 PART 2: Nature of Waiver/Appeal
�. 151' Class B Reduce Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAG 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAG 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 eRANrrPDR PRESSURE OSS
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE Applicant Signature: Date: 0 �3 — 2 It/
Revised 8212017
This form may scanned and available for public view on the Mason County Web site.
Page 1 of2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal V`Waiver ❑ 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 ORAV77'6R'
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 ZZlzacog )
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: /'iav Date:
PART 4: Determination of the Hearing Official
6-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:
Revised 8@I/2017
This form may be scanned and available for public view on the Mason County Web site.
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{
MASON COUNTY 0 COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH
.Ia �ry E M�mam remm,n,H d. CLASS B WAIVER WORKSHEET
nay.aNv smEe7,erw e.sn[vory wnsasx (State and Local waiver forms required)
SHEMN:360d3]6810,EM.Am-BELEwn:3E62]5407,EM AM
FLMh]NMa I tana..ENt W-.,aBDA]7-110a /�,5
APPpGNrNAMt TpRAAVIS RROWLAND ArvBR PERMnn1.11 WAI C 77 OZ (c/�t.(.ii q;z
comer Aperess to f t jrr Rd
sa�/t
an 1L/n sru, will ne WTI
,in A... 1130 SE CRAIG RD ars SHELTON
ru,marnvuMen, 31905-21-90001 W_ersan.nsale7YDE 0 cONwmI0XAr0RAY11V ®cgNMEMERNAL PREssure
1.SOIL SERIES: 5.VERTICAL SEPARATION:
The soil series mu9beAldervrood,Hantlne,Hoodsport, Up-slope vertithe separation mustbe greaterthan l 8"
Shelton,
or Sindair GravNly Sandy Loam, for gravity and greater 12'for pressure.
Alderwood Gravelly Sandy Loam..........-..............0 ® Greater than 12........................................................... ® Iffi
Harstine Gravelly Sandy Loam........-.._.................- ❑ ❑ Greater than 18.......................................................
❑ ❑
Hoodsport Gravelly Sandy Loam............................ ❑ ❑ -Determinedby: ,:
Shelton Gravelly Sandy Loam...........................--....❑ ❑ Depth to hardpan;...................................... ® ❑
Sinclair Gravelly Sandy Loam_.........................-.-.-....❑ ❑ Depth to mottling .............-..._......._.................. ❑ ❑_
Other ..._.....❑ ❑ Both...............................--............--.......................... ❑ Ana'(
2.SOIL TYPE: 6.WATER TABLE LEVEL:
Shctypez must be Medium Sand,Loamy Sandor sandy Iftest holes show evidence&&seasonal water table
Laam.Gravel percent mu9be less than arequal[o 35%. above resbittive layer,a curtain drain mayberegmred
Medium Send................._......_..--...-........................... ❑ ❑ _ -Evldernee of seasonal water table:
LoamySand............._..-. .. . .. ...._.........❑ ❑ e Yes..........................................................................-...-........ ® _..........-.........-. -.-. -. o
SandyLoam.........................-.................--.._............-.....91 ® a No.......................-............................................... ................. El ❑
Percent Grovel: -Curtain Drain required: p
nn m
-Less than or equal to 35%................_._............... ® ® o Ves.__........._-._................---...................._.........................
❑ ❑ o
-Greater than 35%........................ ..................--......❑ ❑ No............................................. .........-..-.-..-..............
....._® 3'
As
3.SOIL DRAINAGE: '^� 7.HORIZONTAL SETBACKS:
N
sml:mu:memMeratelvwallartm¢drowell a.aln<a. o Pnmaryoralne¢Id must
on,surface
]OD•Eromddwells. A
� ent madne shorelines,sudace waten,and wells.
Well Drained................ ❑ ❑ `<
Moderately Well Drained............................................® -Are increased horiamrmal setbacks met: ��t1
Other .............. ❑ ❑
yes................-........................................................................ ® W
4.DRAINFIELD SLOPE: No.................................................................................... ❑ ❑
8.ATTENUATION ZONE
Slopes must be between 3%to 30%.
Gravity is only allowed on slopes from 3%to 15% ASo foot horizontal attenuation zone is required
Pressure Is aII.ed on 3%to 30% df=,,radient of Me primary drainfieId.
Less than 3%.................................-...----...-.......-.....-. ❑ ❑ -is there s0 ft or greater between the down
3%to 15%..............-....._..._...................-..............-...... In HI gradient side of primary dralnfield and
16%to30%..................-..................................-..-...... ❑ ❑ Property boundary: M
Greater than 30%.........................................................-- ❑ ❑ Yes...........................................................-...................
..........® W
No...........-.......................--...-..-....--...-....-...................... ❑ ❑
The 50 foot horizontal attenuationzone is required to IN,recorded on the reed ofthe pmpertyas unbuildable �� 1 N/O�
prlorto design approval.Theattenuation z pati one is not to be usedfor the contruction ofmads,peaks, os, AFN:
parking areas,vehicular traffic or other similar such uses.The owner mustagme to ail these conditions. noaoffEne.r.,
n1anau MAYBE SCANNED AND AVAILABLE MR runicanvom E MASON rnI1N1YKFByTE UAdwdAora17
Granting Waivem 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)
Re uest for Waiver from State Regulations
Section I. (completed by applicant)
Name: (I) TRAVIS ROWLAND Local Health Department/District (2)
- ...... ',y....... - see..Instructions)
Address ....-/6* t 59 ✓ ..
54
_......._
Telephone: (360)870-1287
. .....
Signature: __...._.................
Prsfdiy Identification: (3)
......................... _.. ____.. ..... .._... . . ..............
1130 SE CRAIG RD, SHELTON
_........ ... ...........--
TAX PARCEL 31905-21-90001
Section R. (completed by applicant)
WAC Number: (4) WAC Require en"'
(5) Waiver Sought: (6)
_ ... _ —.._......_..
246-272A— 0230 24' OF V/S FOR PRESSURE (OR) 12 OF V/S FOR PRESSURE OSS (OR)
... _.. ....._ __. _... ____. .— ... — ..'-.._Subsection: TABLE VI
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: L )
Section III. (completed by health officer)
Review Criteria: (8) Mitigation Measures tin addition to those proposed): (9)
......... .. .............
Comments/Conditions: (79J S/n �!/Yt t�� _Wp /1 -
------
Type of Waiver: (11) [ ]Class A lass B [ ]Class C—Request DOH review before granting?nLg??�TYes_ No_
Neighbor Notification: (12) Required? Yes_ No_ Ifneeded,are agreements,easements,etc.property filed? Yes _ No_
Section IV. (completed by health officer)
This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Sire
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 [Vg Approved/Granted t to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13) Date: 7-
DOH 337-021
2212008 MASON CO WA
• 06N3/3039 031.03 PM 19 8484 DELL
11113 3
1111
Retum To
TRAVIS ROWLAND
ldq( f eki t aA
Granter(s): (1)11 4m Rn4/faj , (2)
Grantee(s): (1)PUBLIC
Legal Description (1) LOT: 1 OF SP#2997 AF#1880072
(Abbreviated form:i.e.lot, block,plat or section, township, range)
Assessor's Tax Parcel: (1) 3 1 9 0 5 - 2 1 - 9 0 0 0 1
DECLARATION OF COVENANT FOR ON-SITE SEWAGE ATTENUATION ZONE
I (We)the grantor(s) herein, am (are)the owners in fee simple of(an interest in)the
described real estate situated in Mason County, State of Washington; hereby declare this
covenant&place the same on record;
to wit the described real estate on which the grantor(s)owns and operates an on-site sewage
disposal system which has been granted a Class B State Waiver to reduce the Minimum
Vertical Separation requirements and grantor(s) is (are)required to maintain a 50-foot
horizontal attenuation zone down gradient of the on-site sewage system to facilitate
treatment of the sewage effluent.
It is the purpose of these grants and covenants to prevent certain practices hereinafter
enumerated In the use of the grantor(s) land which might encumber the land set aside for
further sewage treatment and disposal.
NOW,THEREFORE,the grantor(s)agree(s)and covenant(s)that said grantor(s), his (her)
(their) heirs, successors and assigns will not construct or install any trench, channel, ditch,
road cut, utility chase, or other structure of excavation what would intercept or serve as a
conduit for migrating ground water.
Dated on this day of SUnp- 20ZY.
�D Pagel oft
JUN 13�
Signature of Grantor(s):
(1)� . (2)
State of Washington )
County of Mason )
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this )3 day of .,rd✓12 , 20 2r ,,
'r^{ p —personally appeared before me,who is known to be
signer of the above instrument, and acknowledged that he(she)(they)signed it.
GIVEN under my hand and official seal the day(nand year last above written.
Joa�lY unu�,i, Y YX/I/u (il[AA/�
••• q�F''., Notary PubAc in and for the State of Washington,
�•g \sa)on 9t:,�
.o p'yxt-zo�ej. residing at526
?v pOTARy °Y i S My commission expires: q t2l tZD27
�Na� PUBLIC bj=`
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