The URL can be used to link to this page

Home My WebLink AboutWAI2025-00032 - WAI Health Waiver - 5/12/2025 00N, . CO1Tt !*. Pub1ic- = 7 Health Always working for a safer a healthier Mason County PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 Belfair:(360)275�677 ext 400 Elma: (360)482-5269 ext 400 ECEHWEirli Appliction for Waiver/Appeal - MAY 1 2 2025 Amount Paid: if 3645 Receipt Number: Zce . 6?'frf o - WAI 262.6 - C OQ 32 By Instructions 1. Complete Parts 1 and 2.No determination can be made until these parts are fully complcted. 2. Fees may be billed for waivers and appeals,based or.the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1.Applicant/Parcel Identification Name of Applicant L_.e.512 Telephone(S01) 5—(oD?O Mailing Address of Applicant 2.42 23 e-' S E City C}\es-Ver State 1`A IJ Zip 5g04 l 2-digit Tax Parcel No. 2 2 2 3 3 -- *b 2 -- 9 0 0 go Site Address 42 IS Mcx v, Lake Dr w, Gra.pev i ewLvA %5* Subdivision Name and Lot-PIS 5 6 F G o\-T LOT 5 TR 3 o f S p lc 43 SEE S1 RvEy ii f l 2(0 PART 2: Nature of Waiver/Appeal _7 In Class B Reduction in Vertical Separation 0 Food Sanitation Requirements O Building Permit Review Policies ❑ Group B Water System Regulations O Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contactor Certification Requirements 0 Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal (include justification,additional material may be attached.): ) G.s,,. •r -cp ) tS.�..� .�.�.:�--, a C�� ' _ d i Applicant Signature: C Date: S(2 2.,5' /3.13. • Revised 1/22/20 i 5 This form may be 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 Determin ation Required: Type of Onsite Waiver(if applicable) 0 Appeal Waiver = None required 0 Class A lass B ❑ Class C 2. Identification of Specific Code/ Standard/Determination (include �e of determination or i latest Code/Standard revision): \\I Pit Zfl1 ? 3. Nature of Appeal: n n v \ AA Ca` %&)(2 CDNI tVAA 5 J t \Z A n . 4. Hearing Official: 0 Board of Health 0 Health Officer 0 Pollution Control hearing Board 0 Public Health Director 0 Certified Contractor Review Board 74 Environmental Health Manager 5. Mitigating Factors: (Y V.11i) r J lJl.a. CS UVa° kh ZZZSi- 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. Staff Signature: 1 Date: b Z7t-CS/ PART 4: Determination of the Hearing Official ti—The hearing official his 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: j 'A r/ram Revised 1/222015 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) R:a uest for Waiver From State R• lations Section L (completed by applicant) !District (2) Local Health Department Name: (1) (see instructions) Le,s\e� 1<.ex1 8 - _ Address: 2 Q,2 -- -- — 3 Sa`� s} ‘2\o6(k es*e>r) MN 5561ci Telephone: (S01) Ci q 3 -(00 p Signature: Pla.45\S2-,417\--, 5--tZ-7.S Property Ide cation: (3)�- 5 p� Lcrf 5 1"R Pf sc 1043_ SEA V y gtZ(o 1:; 2 2233-32- 'ic-5 Section II. I (completed by applicant) (5) Waiver Sought: (6) WAC Requirement: �y WAC Number: (4) 246-272A— o AAAA.141 -b e- 0-1-1 t` t `��C`� ,.1c✓1r1.�ZQ, %•� Subsection: 1 � Justification(mitigation measures to be provided): (7) t) C( a' et 2 qfAa-t) td Section III. [(completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) -.. Type of Waiver: (11) [ ]Class A [I class B [ ]Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes_ No_ If needed, are agreements, easements,etc.properly filed? Yes _ No_ Section IV. { (completed by health officer) of Chapter 246-272A WAC On-Site the This Request For Waiver From State Regulations has been reviewed according to provisionshave been evaluated for their ability Sewage Systems. The review criteria applied,and the mitigation measures proposedA and/or required, to provide public health protection at least equal to that provided by this chapter C. [ ] Denied &Approved/Granted—Subject to all comments,conditions and requirements noted in Z ctons II and III. Date: [� Ips Local Health Officer (13) �� 19 • � �'S0N COLT, MASON COUNTY PUBLIC HEALTH Public - Health CLASS B WAIVER WORKSHEET Always working fcr a safer,.,healthier Mason Count' (State and Local waiver forms required) PO Box 1666,415 N Sth Steet(Bldg 8)-Shelton WA,98584 Shelton:360-427-e670 ext 400 Setfain 360-275-4467 ex:400 Ap„.'AhNAME L eS 1e; K v‘r• wAvERPERMTNUMBER WAI MA;:,NGADRESS 2.(D'L3 ..)-1 a ry SA S S . 55904 R ockveb-her I sA-: MN �P s..,,, s LV2.1,5 E. t-itexco Lake -br Vi e'► �� e-"' ^/22��' ✓'32 � �- O 50 D>R PROPOSE AIN;1ELD'YRE 7 :�'Yc\:10NA GSAZTT CCNYENT.ONA:PRESSURE TA%PARCEL NUMBER �+ r 1.SOIL SERIES: S.VERTICAL SEPARATION: Up-slope vertical separation must be greater than 18 The soil series mustbe Alde ravel) eia Stine,Hoodsport, for gravity and greater than 12-for pressure. Sheton,or Sinclair Gravelly Sandy Loam. Alderwood Gravelly Sandy Loam_.. _-__.:_....__!L Greater than 12"__...._._...-..__.—..— —_-- 5Z 21/ Harstine Gravelly Sandy Loam_____.•__-----•—••- ❑ Greater than 18'_ ...._--..•- ------ ❑ 0 Hoodsport Gravelly Sandy Loam...._.__._....._.... 0 ❑ -Determined by: Shelton Gravelly Sandy Loam.._.._..____..__.............❑ ❑ Depth to hardpan _ _.—...—.--- 0 ❑ Sinclair Gravelly Sandy Loam_______......_..........-.❑ 0 Depth to mottling_ ______.----- 0 -- Other0 0 Both._._—..._......___...._.... ___._.._.___._.... i lir 2.SOIL TYPE: 6.WATERTABLE LEVEL: If test holes show evidence of a seasonal water table ILoa types must e Medium Sand,Loamy Sand,qu l or Sandy 1 I above restrictive layer,a cl roin drain.may be required Loam.Gravel percent must be less than or equal to 35%. Medium Sand_......_..____..__ .._. 0 El -Evidence of seasonal water table: Loamy Sand.. __._.. _.....___..__....._..pt ❑ _ Yes _..__ ___- �( �' a ¢ No.._.._..__............__..__._.__..__......__.__.._ Sandy Loam.....___ _ __......_._ ...._ .._......_.XI v a Percent Gravel: -Curtain Drain required: '� -Less than or equal to 35% a es...__.__.._____.... ______..__.___.__._ --. ❑ 7.1 Greater than.35%_______ —••❑ o3 No...._....__........._...._._.__ __ —• 3.SOIL DRAINAGE: c 7. HORIZONTAL SETBACKS: c t` rD Primary Drainfield must main ain 200'frorn down.-gradi- rs 1 So is mus be moderately welt drained to well d aired. O O 11 ent marine shorelines,surface waters,and wells. 0_ Well Drained ....._._»._.__._......._......__.. . Moderately well Drained_______..-__.___. _...._.0 0 Are increased horizontal setbacks met Other ...,... ❑ ❑ Yes._..__ _..._.___—_____.__._._..._. Z1 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 drainfeld. -Is there Softer greater between the doom Less than 3%..__..__.__..___—...__..-- 0 gradient side of primary drainfreld and property boundary: Greater than 30%....___......_.___..._ ....__.. ._...... ❑ 0 Yes 0 No_.._._.._.._..................._-.__._._.__.....__.___. The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable �� prior to design approval.The attenuation zone is not to be used for the contucton of roads,decks,patios, parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. AFN: PruolF`Remd Vp0eIec 3/2/2075 Ti4S FORM MAYBE SCANNED AND AYTJ:Aa:i FOR PUa.;C VSW ON me MASON COUNTY VFBYr=