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Home My WebLink AboutWAI2025-00015 - WAI Health Waiver - 3/10/2025 415 N.a STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-2754467,M.400 ELMA:360-482-5269,eat.400 summa manning.am,a,mmW H 111h.c—WO weauh FAX:360-427-7798 Application for Waiver or Appeal rrr��1 MOWED r� Amount Paid: 3 5 Receipt Number. zoz-5 -h1,07 Ip1171'OWED WAI 2075- M616 I'llJll^JII{J)IL�MAR 102025LS Instructions: 1. Complete Parts 1 and 2. No determination can be made until these parts are fully comp 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 TAD SMITH Telephone Mailing Address 1540 E SHELTON SPRINGS RD City SHELTON State WA Zip 98584 Parcel No. 3 1 9 0 4 = 1 4 __9_0 0 2 0 — — — h.. Site Address 201 BE ELLIS ROAD, SHELTON ti Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 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 just cation, additional material me be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONA GRAVITY R PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARA TIO N OFFF ATTENUATION ZONE � Fu:LZ ZZ 3 Applicant Signatur �M,.dsV.I� � +^'f- Date: }� hp Lf U Revised 8/21/2017, This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 dh 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 N/Class B ❑ Class C 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/Standard revision): WAC246-272A-0230,TABLE A 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY eR+ 7AE66HREe66. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board &I' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 22133;r? ) 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 7 Staff Signature: 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: Health Official Signature: Date: 31 � 10 Reviud 9/212017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES CLASS B WAIVER WORKSHEET a x.aTHsrnEET eLnae.sND.ToxwAsesu (state and Local waiver forms required) SHELTP M"T.W EM b a ro. 0. M`LodR'. 27S 7.EXT 400 EIAN MD-197�51ae,FM aCO-FAX'..27-. /��/��(� ♦veLrRlrt NWE TAD SMITH wuh.....ar wAI 2O 2�-VW LJ „NOXGALOR51 taa0 E SHELTON SPRINGS RD cm SHELTON 'sn WA or WSBa Sm AODRE%MI SE ELLIS ROAD.SHELTON or, }AYMKFLNUNBF„319M-1A-9W311 PROPOWEDM1YlFIEWME 12 dalWN11e1NLGRAV ❑tlRVIEN CxALFRESSORE 1.SOIL SERIES: S.VERTICAL SEPARATION: The sail sedesmux[be Altlerwood,Harstine,Hoodspory Up-slope venal separation must be greater Man 1r SM1eltan,or Sinclair Gravelly Sandy Loan fmgraveyand greater Man tYforpressure. Alderumod Gravelly Sandy Loam...........................❑ ❑ Greaterthan 12............................................... ❑ ❑ Harstine Gravelly Sandy Loam..............._.......... ❑ ❑ Greater than lB".......................................... Hoodsport Gravelly Sandy Loam........................ ❑ ❑ -Dewrmined him. Shelton Gravelly Sandy loam._..._.........................❑ ❑ Depth to hardpan........................ _...._......._.... ❑J ❑ Sinclair Gravelly Sandy Loam._......._.....................,❑-,/ ❑ Depth to mottling..-.._................................ DB ❑ OtherC 8 ..........qd L` Both.............._._........................................... ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL• Shctypes ma9 be Medium Sand,Loamy Sand,or Sandy WmRt M1des show;Z—eofa—`dhalwadntadle team.Gravelperd.ummurtbelessthormequalto35%. above resMttive layer,a cunaindalnmaybereri Medium Sand....__...._......_...................... ❑ ❑ _ -Evidence of aaasonal water table-. Ye ..............................................................._............. ❑ ❑ Loamy Sand.........................._.....-......_..-....... SandyWam............... s.....--......_._..-........._..__.❑ No_......................................._..............-................-.........u� Lp Percent Gravel: tD -Curtain Drainrequinch O -Less than or equal to 35%......................------ I$ $ Yes...............................................................I......._.... 91 W p -Greaterthan 35%................. - ............. . ❑ ❑ n No.............................................................._.......... 3 3.SOIL DRAINAGE: ' 7.HORIZONTAL SETBACKS: c c Shcsmunbemotlerstenyonlarai Nto welltlrelrretl. O Nlmary Ominfield must maintnln MfYfivmdowmgrzdi- T N en[m-t nMorelirles,suglh w:en,antlwelis. �_ Well Drained..............................................._. ❑ ❑ Moderately Well Drained._._._.._....._._--.-.._..� -Ara Increased hodmrdal setbacks met: s_/` Other .. ❑ Yes............................................................................. __. 4.DRAINFIELD SLOPE: B.ATTENUATAON Z Slopes must be between 3%W than Gravnyis:;tddawetlonsbp %.f 30W r5ya. ASOfomhodwntalattenuabonaonelsrequird Pressure isallowed en 3%to than down-gradient of the primary dralnfieltl. 3%toLess 5 3%................._................................... ❑JJ ❑ -is there SD ft or greater between the down 3%co 15%......_........._.-_..-.................._........ m gradient side o(Primary drainfield and 16%to than.... ._....._.................._.._....... ❑ property boundary: Greaterthan 30%A6............._........._....... Yes................................................................................ G The Spfaot hot iaontal anenuadapaasw is required to be recorded on the deed of Me property as unbulldable aZz33 / L ptlor to deuin approval Z.ce .HwmnelsnaWbeusedforthecontmalonofroadsdecks,paUta, AFN parking areas,vehicular ttaMq or other similar such uses.The net mustagree to all these tonditionz vawawRaleRN: tars FWA NAY M XANNm ANDMILA.LE FOR PUnKNEWONTHE NAWN COIMYWERSnE. upLNJ323m7 Granting Waivers from State On-Site Sewage System Regulations Chapter 246.272AWAC Effective Date: July I,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Seetion I. (completed by applicant) Name: (1) Local Health Department/District (2) TAD SMITH J,�/�ff� (see instructions)............. _ Addre — ss 1540 E SHELTON SPRINGS RD SHELTON, WA 98584 .._._ ............. Telephone: ( ) ...... ...._ ............ ........... property Identification: (3) 31904- 4-90020, 201 SE ELLIS ROAD, SHELTON Section II. (completed 6y applicant) WAC Number: (4) WAC Requirement: (5) waiver Sought: (6) 246-272A 0230 R) ..... ........... 11 11 Subse 11 ction: TABLE VI 36" OF V/S FOR GRAVITY 18 OF V/S FOR GRAVITY OSS Justification(mitigatimmeat lobeprovided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, ..................... ................................_......... (OUTLINING ADDITIONAL REQUIREMENTS MET) RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN ZZf,3 ....._. .. .. _. Section In. (completed by health officer) Review Criteria: (8) Mutgansm Measures(m addition to tho11 se proposed) (9) Commems/Conditions: (10) Ifpy(4s(,4l� .. Ser�9_�k1 ( $ .kit. Type of Waiver: (11) [ ]Class A Class B [ ]Class C—Request DOH review before graming? Yes_ No Neighbor Notification: (12) Required? Yes_ No lfneeded, are agreements,easements,etc.properly filed? Yes _ No Section IV. I (completed by healthoffmr) This Request For Waiver From State Regulations has been reviewed according to the provisions of 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 by this chapter WAC. [ ]Denied pUppmved /Grante — ject to all comments,conditions and requirements noted in Sections II and 111. Local Health Officer (13) Al Date: DOH 337-021