HomeMy WebLinkAboutWAI2024-00024 - WAI Health Waiver - 3/11/2024 ON COUA,,
public�Health
Allays wo"for a safe heaahler Mason County
PO Box 1666,415 N C Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 eu 400 O Belfair..(`360)42
600) 7 7787 M 4004 Elma:(360)482-5269 ext 400
FAX
Applica ' n for W aiver/Ap �^ 131 t
Amount Paid: '�l, Re iptNumber:
WAI600�-
Instructions
1. Complex Potts 1 and 2.No determination can be made omit tMse Peru 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 t.Applicant(Psrcel Identification (3to0)
Name of Applicant !��l \P>Qn c�t� Telephone
�SOh
Mailing Address of Applicant r13o3 55-�44 }eve SE
City 0 VVt a _ State wA zip 98513
12-di9it Tax Parcel No.
Site Address -21 S�'leyyJ000� t"[ 11` S S� I���VV1 �f't �05Z�
Subdivision Name and Lot 'C"R IL OG- SUftyEy Z / FOR -- -
i 2 2024
PART(2: Nature of Waiver/Appeal
pl Class B Reduction in Vertical Separation ❑ Food Sanitarion Requirements
❑ Building Permit RevieW Policies ❑ Group B Water System Regulations
❑ Location,WAC 246.272A-0210 ❑ Water Adequacy Requirement
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards O Departmental Determinations
❑ Contractor Certification Requirements
(installer,Pumper,O&M Specialist)
Description of Waiver/Appeal(imludejustificatimn,additional materiel may be attached.):
12
Applicant Signature: Date.
U f�' e z �C o, —U- Revised 1=015
This/ortn may be conned and avai able for public view on the Mason County Web site. Pa1;<1 oft
PART 3: Public Health Evaluation(Staff Use Only) Type of Onsite Waiver >f a licable)
1. Type of Determination Required: W
PP C
❑ Appeal Waiver ❑None required ❑ Class A s�Class B ❑ Class C
1 Identification of Specific Code/Standard/Determmattog(include✓date\ of determination or
latest Code/Standard revision): INB �, 4 b 27LA -U7,-";
3. Nature of Appeal:
W.lI SSt/r`e tn '
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board [3 Public Health Director
❑ Certified Convector Review Board EX Environmental Health Manager
5. Mitigating Factors:
Vi. (�i�(�SS � ✓'CA - ��� � �GlfiG'e-
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: �Q/ Date:
PART 4: Determination of 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:
❑ 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:
Hearing Official Signature: Date: lF LJ
aevlsed lamois
This fen"may be scanned and available for public view on the Mason County Web site. Page 2 of
ll�NSON. COU,yrP MASON COUNTY PUBLIC HEALTH
Public CLASS B WAIVER WORKSHEET
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POBa taa6at5 ncn t pNM1lera6YPPS+aalAartaas
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.warar[wrtrMivau WAI
r LIW oas 83 5S"F`' m as
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.aapmmwax I22�I `n
S.VERTICAL SEPARATION:
1.SOIL SERIES: n mwt be,aana Nan te'
Up-Nape vertical uwntb
Thexilxdesmus[be Akervmad Xatnim.Hoodwm {orgndryand9timrtNntYfor Prasv"a
ShNmn.or5lrvLirGnvellYLndy barn la
yIGM11thanl2'.-_Nderwood Gravelly Sandy twm_._-_---- fWnnne GraldiOandy Loam.----- L.I ❑ -Dwmywdbr.
Hoodsiwrt Gravely Sand team__ Depth mhardpan_.__
El
Shelton Gravelly SandYL -._.____..._.�-O ❑ Dappim matdin r,r5
SincUir Gravely Sand LOzm..__.....__.__._. 9...�-J—_�..._ P
-❑ ❑
Oche
6.WATERTABLE LEVEL:
2.SOILTYPE:
Itxathde5 mcw .". naasWcoalwmQ9de
Soilrypemustbe Medium SaM,Lwmy Sander Sandy above restd Ih..N r.aartaf drain mayberpWrad
W m.Gael pempt must De Im Nan or pwi m 35%
-Evidence of sesasarvlwrtarbblK �,./ i
MedWrn Sand........_.._.._. ❑ Yes..__._ __._.______._....__.__.Jb�
Loamy Sand__�____._-____�._._._ s No__._._.��._��___�.___❑ 5
Sand Lwm.__._---------^-••'-- O {Mrbin Drain sa wed: O
Percent Gravel: $' vas _— — _.❑ 1❑�$
-Less than aregwl m 35%__--- -
-GrcaterNan 3s%__._..._._._._...___.❑ ❑ 7.HORIZONTAL SETBACKS:
3.SOIL DRAINAGE: c c
primary paiaiNd mustmainoin 200'from dpyrrerad4
n
SNlsmurt GemMotte'Y wailCNnedrowalianlrcC. tmMnesHonlinenmrmwawatwLNdwNia
an <
Well Drained_-._._._--.-...- ❑ 0 -Ana inmasad hetaa-tall xtWd'a men -t
Moderately Well Dmb*d- -_I� i❑p Yes._._ .._...____.____--___$❑I ❑
Gther ❑ No
4.DRAINFIELD SLOPE - B.ATTENUATION ZONE
$byes munbe beNwen 3%m30%. A50 faothertmntal atttnuadomm�e ureYulxd
Graviyuonly Nlowed on sbpmhom 3%rot5% dwmyradimtad,e primarydrabdab.
Pressure a a0owed on 3%m 301E
-la Herefe aaetieear aaawan a
Less Nan 3%.___.____-.-__._.... ❑ gr,d�„idaof primary drairtfialdandd
3%m 15%_-_-----------_ ppgertY ochry: 16
Yea_..__------- �-.-
❑ ❑ No
Tu50toat iwnmmN awnwNomm�a brpuM1etlm be rtoNed antM1atlwd aNep ee wbWlda
raada ble
piormdesyn approval.The agpwdon mne lsr�mto be�aMfor Necw+ouNona ,,d ded%Patiex
pvldngan+a vehindartMac or oNer NmOarfuch usea liw ewer must a9reem Nl NeseceMidom. ��,
tws rauwressca:wrnwoavuuva wpweucv�twaaru wvw uHannxnv'c
On-Site Sewage Systems (Chapter 246-272A WAC)
R uest for Waiver From State R tions
Section L (completed by ePPlicmrt) Local Health Departman l District (2)
Name: (7) see instruction
Address:
Telephone: (?jw q
property cation: (3) ----
[2230- 15 - Got M ----- — - -
Section IL rcongkied by appliaard)
( WAC�imultnt: (5m ) ..r_ • _. Waiver Sought: (6)
WAC Numb
er. Q
Subsection ` -
2—
Justification(atiagawbon mfnsmas to be prm9dz4:
s III. (c by heal*officer) '
Review Criteria: (8) — — Mmgabon Measures(m addition ro those propou�: (9)
Cow/Conditions: (70)
_....—.. Clans A aM,�Class B [ ]Class C—Request DOH review 1>eforo 6rantng7 Yee_ No_
Type of Waiver: (11) [ ] lH
Neighbor Notification (72)
Roq.,V Yes_ No_ If r soled.are agteemeras,easementa,etc.property fikd2 Yes _ No
Section rv. (compkttdby health qf—r)
on has hem reviewed actcedin8 m the Provision of Chapter 246-272A WAC Oa Site
Iris Requcat Fa Waiver From State Reguhhti envoy cmattee.rave nem e.atnated for then Ility
Scwege Sy 1Le review eciteria applied,tma the miti�p n v ssnres C+nPaaed
m prm'ide Public health protecdon at least equal to that by this chapter WAC.
[ ]Denied MPproved/G —S lect to all con otaim conditions and an /o
in Section n and III.
anentanoleli
Dew. A Y
Local Heath ofcer (73)
19