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Home My WebLink AboutWAI2025-00022 - WAI Health Waiver - 3/18/2025 • • 415 N.6"'STREET,SHELTON WA 98584 ift . ''.‘v..7MASON COUNTY SHELTON:360-427-9670,ext 400 /RI '; COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 Building.Planning.Environmental Health.Community Health `_LMA:360-482-5269,ext.400 `. FAX:360-427-7798 Tplication for Waiver or Appeal Amount Paid: /rJ �� Receipt Number: WAI 2 $ I'OZZ 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 /? -I./N 6416,fe Telephone Mailing Address 83 91 t. S f 3 City $,,z L Ti.v State 4,'A Zip 9S s-Sy Parcel No. 2. "2- (57 0 7 - 2 z — clfo O 2, Site Address //7' ,C /3'"�)--- e—s eAj fe-‘244 Subdivision Name and Lot LGS /9—ca.�, Lor z : )4F 44e 2/2 3 rs-e PART 2: Nature of Waiver/Appeal S(4(6y zczc-oao 9 IV/ Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines 14 0 Mason County Onsite Standards 0 Departmental Determinations 0 Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE / FIf/1 2 Z Z 4 gL Applicant Signature: ,12.2.-k - 6 Date: 3 1 e -.S-- Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) c Appeal u'Waiver Li None required ❑ Class A VCIass B u 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 OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 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 a7-gAny ) 6. i have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 7 Staff Signature: 92-- Date: /(Zil ac PART 4: Determination of the Hearing Official 9 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: `T/ZP/b"f Revised 3/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 ` A ; MASON COUNTY y. ,i COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH ' „'' FrAding.PlannlMj.EmioomootJHoskn.Ca.unw.yHJih CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLDG e.SHELTON WA 96584 (State and Local waiver forms required) SHELTON.380-427-9870.EXT.400-BELFAIR 380-275.446r.EXT.40e i ELMA./82-52;9/ EXT.<00-FAX:360-427-7798 APPLICANT NAME p it! V C^a/'L/� WAPIEH PERMIT LUMBER V�'AI 7j DG 5 _�C MAILING.ADDRESS 839/ ,4 Si 3 ��///VVV rim S/i<X4-7?)/t! srVIE 14/.A zp 98're 4/ SITE ADDRESS I170 . .`. ,,6E/e TE7e'SrcN /.5:3429 CITY J./44EG.%Z'4 TM PAP.CEL NUMBER 22 7 -2..2 - ,raj Z..Q PROPOSE/DRAINFIELD TYPE 0 CONVENTIONAL GRAVITY CONVEMIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood.Harstine,Hoodsport. Up-slope vertical separation must be greater than I B' Shelton,or Sinclair Gravelly Sandy Loam. 2" �+ for gravity and greater than 1for pressure. / f Alderwood Gravelly Sandy Loam E Lt1 Greater than l 2"........,_... El (jf Harstine Gravelly Sandy Loam........_................_........ ❑ 0 Greater than 18 0 0 Hood sport Gravelly Sandy Loam 0 0 -Determined by: Shelton Gravelly Sandy Loam 0 0 Depth to hardpan. ..._.........,M_,.,........_-_,,......_......... ❑ ❑ Sinclair Gravelly Sandy Loam 0 ❑ Depth to mottling.._.._...._............._................_,..,_-... E 0 Other ❑ ❑ Both 13/ 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy Sand,or Sandy If test holes show evidence of a seasonal water table Loam.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand 0 ❑ _ -Evidence of seasonal water table: LoamySand __............ ..__,...,.,-, ........_ ❑ ❑ 2 Yes.._.._..-.�.........._.__...._......._ - Sandy Loam............................_,..,__..,_._-._......_..._.,....._I� Er-.., l� I�No — Percent Gravel: -Curtain Drain required: O -Less than or equal to 35%...._._.._.._......_._........... ❑ 0 a Yes —..-.,_,,._._.,_...._.....__......................___._..,., Er-0 Greater than 35% ❑ ❑ SNo.....................___........_..............__.........__._.._.__ ....._. 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: o C Soils must be moderately well drained to well drained. 0 Primary Drainfield must maintain 200'from down-gradi ro - ent marine shorelines,surface waters,and wells. 0 Well Drained ❑ El '< Moderately Well Drained j.' !Y -Are increased horizontal setbacks met: �� Other ❑ 0 Yes......._..........__._.-.__ No..,.._....._..__.._......_..........._..................._ _ . __»..0 0 4. DRAINFIELD SLOPE: 8.ATTENUATION ZONE slopes must be between 3%to 30%. Gravity is only allowed on slopes from 3%to 15%. A 50 foot horizontal attenuation zone Is required Pressure Is allowed on 3%to 30%. down-gradient of the primary drainfield. Less than 3% ❑/ ❑,/ Is there 50 ft or greater between the down 3%to 15%....__......__.._._..._.. ..._.. _...._....._..___..... 11Y L7 gradient side of primary drainfield and 16%to30%........._..._........__._...._..__......_..— ❑ ❑ property boundary: ,�,/ Greater than 30%........_.„......... ...._......_...____ 0 ❑ Yes — .. - - .. . -B 11d No.............._..__.._..............____......._._..___.._.._..__......, ❑ ❑ The 50 toot horizontal attenuation zone Is required to be recorded on the deed of the property as unbuildablc �� c) prior to design approval.The attenuation zone Is not co be used for the contraction Of roads,decks,patios, AFN: 7Vt parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording ITHIS FORM WAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON rHE MASON COUNTY WEBSRt. updated 3/22017 1 „_.,-..,_....__________. . _ • r — Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July I,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (completed by applicant) Name: (1) Local Health Department/District (2) • Y//✓ N6.4;2 __.__.. _. __._._...(see instructions) ...___....._.. . Address: • . , . .._SR___ Telephone: ( ) Signatttre: Property Identification: (3)._._.._Ga 7!`2..:_. . /yes7.,; _2/.2 3S58...._ _._.... Section II. (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 24'OF V/S FOR PRESSURE (OR) 12"OF V/S FOR PRESSURE OSS (OR1 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:�,Z Z 4 j ) Section Ill. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/ ns:Conditio (I D) ( t __._.._....._..._._.......__..._ ___._._...........se� a�a�... ....___CLG�S � art.. .._I4,Q /.c swee,�.______....._..._.._____._., Type of Waiver: (//) ( ]Class A /4 Class B [ ]Class C—Request DOH review befQrg granting? Yes No x Neighbor Notification: (I2) Required. Yes No If needed.are agreements.easements,etc.properly 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-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 t is chapter WAC. I ] Denied Approved/Grant -Subject t comments.conditions and requirements n ed in Se ions II and III. Local Health Officer (13) _ Date: 2_J DOH 337-021