HomeMy WebLinkAboutWAI2025-00006 - WAI Health Waiver - 1/28/2025 Public VPFAW
Health
Alrrays warlon9 fora safer haitltier Mason Lawny
PO Box 1666,415 N C Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427.9670 ext 400 4 Belfai�( 60) 42�87 xt 400 4 Elms:(360)482-5269'relyxxtt1400 M
Application for Waiver/Appeal
Amou Paid: 5 ReceiptNumlom ZO5 Z '00507
m JAN �25
WAI Za'S -
Instrections
F22.
Complete Parts I and 2.Node -.nation can be made until these parts are 6 tl Como'
e[ed.
Fees rosy be billed for waivers and appeals,based on the EnvvonroentslHealth Fee Schedule.Submit completed application with attachmen s to Mason County Public Health for review.
PART 1.Applicant/Parcel Identification
Name of Applicant A,M Hmpvp l E Telephoneo!eo4o-3952
Mailing Address of Applicant r g 8 SE M t" C R-V-E K R D pp
City -s yke I Te r1 State W) \ Zip
12-digit Tax Parcel No. Z 2 2 -- �L- 3 - o ,- Q
Site Address `I DO SE Mll-L ceFEK RD SFteLT-Cm uy} �1�584
Subdivision Name and Lott-R \O o F 5\0 -5 E PC L. 4 0 F BLa r 00-3-1
PAT/2: Nature of Waiver/Appeal
pl Class B Reduction in Vertical Separation ❑ Food Saturation Requaremems
❑ 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 Onsim Standards ❑ Departmental Determinations
❑ Contractor Certification Requirements ❑ Other
(Installer,Pumper,O&M Specialists)
Description of Waiver/Appeal(includejustification,additional material may be attached):
SO
Applicant Signature: Date:
U elda�a� Revised 1222015
This form may be scanned and eves able for public view on the Mason County Web site. Page I of2
PART 3: Public Health Evaluation (Staff Use Only)
1. 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-0230,TABLE VI
3. Nature of Appeal:
REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY Oft•
rRECSU w
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board Environmental Health Manager
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN ZZ11020 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: 4� Date: Z wf
PART 4: Determination of the Hearing Official
d& 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: 1{t / Date:
Revised aatnon
This form may be scanned and available for public view on the Mason County Web site. Page 2 oft
+NSON COUNrP
MASON COUNTY PUBLIC HEALTH
Public Health CLA55 ,aWAIVERWORKSHEer
AlwayaworWM bra w hea Nlx Mason County (Stateond Local wolYal fOlJna IPQUMed)
ro Bm tafiaa15 N6M SMq Rld9al.anNtanw0.sas9a
SMF:36'J-R)-0690mtlJ aeryir.YblJasM)araW /
� IA/AI W
DIE awve�rnw.ruaar.
wuixo.mms lo9G Sk ILL G2E
atJ S N E� t 6 N S{{E Lro of
Both
m 100 SE MILL C REEFZ F-b Nr�
'2o2`I-4�-oo Ioo _ ra,w� - [�n,�Naaom. ❑
5.VERTICAL SEPARATION:
1.SOIL SERIES: tmn t�
Upsbpe uerdol separodon must he gioaam
The soil udnmustae Altlerwaod.Hats6irt,HeotlspeR krSrawNandgrtamr WnlYfor preswrt
Shalmn,orsind(aGmrtllYyndyLwm
Alderwood Gravelly Sandy Loam -
❑
Grearerthan 12'_-.-_-_._..__.._._.__..- ❑
Harstine GravelNSandy loam_----- ❑ ❑ Greaterthan l8'---------_•."---•�
HondWn Gmwty Sandy Loam --_ ❑ ❑ -pesarmirred er. Tg[ ❑
13 Depth m hardpan....-...._.--- C' ❑
ShehonGtave1iYSandYLmm.__.—.—._—. ❑ Depth to mottlingLJ
SincllairGravNiy Sandylnam..._..-....--__-_._LJ ❑ ._..-._.._- ___.______.-..—__ ❑ Y'
Other
_..--❑
6.WATERTABLE LEVEL:
2.SOILTYPE:
N test holes snow e+meax a seawm wear mda
Soatypn mart to Medium than
Sand,1than ane.er Sandy alwveteamttleelayenaarrain drain may h¢sequiid
Loam.GrnN Portent must be less w qua!m 35%
-HManre of seasortY water ObM: _
Metlium _.,❑JJ(( 7{�❑+� Yes._..___--_..-_--_____-_.__—. ❑ 4
LJ tom' n
loamy Sand......_..-_____.___..___--..__p i No..._--___-_-_-.._-_.__Yl 3
Sandy Loam_.-.._._-___.__..-_.._—L7 R -Cnrt&in D.1nr-W1r-&
❑3 ❑
O
Yt
-Lessth eq an or ual to35%...-__..__-.____. No..._..__.._-....__-_..____._.—.—�s
❑ 7.HORIZONTAL SETBACKS:
c
3.SOIL DRAINAGE: n
xalltlznedm.wlldninetl. D primary GrslnfiNd tle
muRmaimm�2W(mm xn9rWF
SeJsmust GemaOrMY �Js Tss( � ent mminesnonaric,wrfm�'+vers.a^d`reib' �
p -,,e horeonbl setbadss nsaK
Motlencelyw'eil Drained— ❑ x
-- ❑ ❑ Yes.__ —. .
Other No .._-❑ ❑
a.DRAINFIELD SLOPE B.ATTENUATION ZONE
51PpnmuIIbe belwren 3%maffla. PSafoc[horea al t mm�e isrtquned
Gravity isadY Nlawd onsbpesfrom 3%m t5%. dwm9rtdient nt of thhee Pdmarydrain`Nd
puvirt¢albw.M on 3%m 3016
-Isthen Sift of 9saMfIrd wan Med°xn
Laos than 3%____._.__.__._..._-..._. ❑ yndMrc d side PrimarydrairsRaldaM was
Property boundary 1s5 W
t6%to 3(Y%__-------__-_- ❑ yes__.-...._______.�_ LLI^
Greem than ❑ ❑ No___.__...____-___.-_._.._—.
TheSpbo[harimnbl atxnuadon moth rtquiretlm be�ecoNedenecorr oyTearopertYuunhuildaWe =�/Q
prbrortnemnmdonofmadadetlaWLVios.
paABig s,ya,srtrycWarosific or othersimiW sacra usn The pvner must a9rtem NllhuemMitions � s
tNSRMIsu+&e[MVtF0a1ID fiM+L41Ef.P' gaa2YYMCNTIEvwtCMOWmeaLan-
on-Site Sewage Systems (Chapter 246-272A WAC)
R nest for Waiver From State R tions
Section L (compleaedby Local Heehh Depart/District (a)
Name: (1) we inta'uCfion4
Address: (oq SE MILL CREF11, fZD _..
$t%L:TO N A 6J 85S
Telephony c3eo ) AV -315 2
Ste: I-zs
r<
pmpe,ty wrion: (i1 -c•o nc CW SE Pcl.. 4 Df BWZ---
PpgcE� �32v29 - 43- ooioo -- _ -_
Section IL (eampleredli!'appjloara) waiver Sought (6)
WACNumben (9 wncxw°i�� (51
246-22A— o
18-
Subsection:
justification(nftatroa atemtves to he provided): (7) - SD' a
kh
° zQ. by heats,g8tcer)
• (
Review Crrt (5) hLtigatiw b.{�urn(m addition to those propose: (9)
Coom�/cooddana: po, -_ See. G 95S- &.►1 Wc-at —
P�lu��iora _znnt �eriL�y AFty z2zlozo_ _ __
_.— —
Type of Waivr. (11) [ ]Chu A Cla B Yon— No
NeighborNot&CWI : (12)
Requhed? Yea_No x Ijaeeded are agreenew,eatemeras,eon.properlyfiled? Yes _ No_
section (aampiered 6Y healtl,fir) provisions ofChepta 7A6-22AWACoo•Sd-
This Requen For Waiver Ftom Sme gegtdadom has been reviewed accond'mg „wo..ewnee,nave bem evamacW ror nKh anu.a
sy.e�s. xn�.r:meae;.wvuaa,.sa+na.e:a�oe.em..«vgvea.e
to
provide Public heahh Pautm at least equal m that pro-dedby this chaps WAC. Yd
Approved/Gran --subiect to all comments,boas and r qubmeuis Yd'° o
Z ns B and M.
[ ]Denied �QAPP Date• t
Local Health Officer (/9)
19