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Home My WebLink AboutWAI2025-00036 - WAI Health Waiver - 5/20/2025 . i ��: .c-ix:-0,_� 415 N.6th STREET,SHELTON WA 98584 /,< • MASON COUNTY SHELTON:360-427-9670, ext 400 fR t COMMUNITY SERVICES � � • �� BELFAIR:360-275-4467,ext.400 '"4 -fir: ELMA:360-482-5269,ext.400 \'''ry Building,Planning.Environmental Health,Community Health K ,t's.,,.�' FAX,360-427-7798 Applicationli^ for Waiver or Appeal Amount Paid: 3 S Receipt Number: -ZS • e Ufl ‘ p ?I7`lew ic: wAl DGS - C500 (to MAY 2 U 2R2 11 ��t5 Instructions: BY:" . ........ '. 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 C\"-m C..VV-0 8- 2-' < Telephoned 6 (4\ t D \ Mailing Address _) \`�C . , )rC City �\ \ i\ State .:1-') Zips J�JJ`.\ Parcel No. 0 v , - — \ -- 0 ( ! V 0 Site Address �-S\(, � Th 1F '')\-\r\C�\ _ 1 � ' 1 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal IV Class B Reduce Vertical Separation 0 Food Sanitation Requirements O Building Permit Review Policies 0 Group B Water System Regulations O Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ 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 R FU 2 2 Z V 6I ?. r --C--.,, ) Applicant Signature: _.\ . �;�� Date: \C\- C:A�� Revised 8/21/2017 ii 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) Li Appeal 'Waiver Li None required Class A 'Class B r 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 PRE4SLIEIELZ. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board 62' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 2 2Z-661s~ ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. 027- 6/10075"— 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: 0 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: C/v/ kr Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 0 MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES Buding,Plannm¢Endronmen:alHealth.Community Health CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 (State and Local waiver forms required) SHELTON:360.427-9670,EXT.400 - BELFAIR:360-275-4467,EXT.400 ELMA:360-4825269,EXT.400 - FAX:360-427-7798 APPLKANTNAMME \ •.h �\' f c�� t WNVER PERMIT NUMBER WAI 1.�75 - 000 36 MAILING ADDRESS �1 A c� 1 � CITY �` • STATE \�) ZIP • SITE ADDRESS `l-1') �v E:Z� _ - CITY . \ \� <" ` \cC,3`/ \\p.,/ TAX PARCEL NUMBER�r�.s�)�,.-� �� PROPOSED DRAINFIELD TYPE Qy CONVENTIONAL GRAVITY ❑ CONVENTIONAL PRESSURE 1. SOIL SERIES: S.VERTICAL SEPARATION: The soil series must be Alderwood,Harstine,Hoodsport, Up-slope vertical separation must be greater than 18" Shelton,or Sinclair Gravelly Sandy Loam. for gravity and greater than 12"for pressure. Alderwood Gravelly Sandy Loam 0 ❑ Greater than 12" ❑ ❑ Harstine Gravelly Sandy Loam 0 ❑ Greater than 18" Hoodsport Gravelly Sandy Loam 0 ❑ -Determined by: Shelton Gravelly Sandy Loam tt Depth to hardpan lig ❑ Sinclair Gravelly Sandy Loam 0 ❑ Depth to mottling 0 ❑ Other ❑ 0 Both 0 tir 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 0❑ - -Evidence of seasonal water table: Yes 0 _ Loamy Sand ty1 No . . 3 Sandy LoamIi4 'f q Percent Gravel: -Curtain Drain required: p -Less than or equal to 35% NO Q Yes �❑p�( :'0 43 -Greater than 35% ❑ u 7. HORIZONTAL SETBACKS:No 1�{ L� 3.SOIL DRAINAGE: c c ` SoPrimary Drainfield must maintain 200'from down-gradi- ro Sods must be moderately well drained to well drained. 1 ent marine shorelines,surface waters,and wells. Well Drained Moderately Well Drained El -Are increased horizontal setbacks met: OtherM 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% 0 0 -Is there 50 ft or greater between the down • 3%to 15% 1:21gradient side of primary drainfield and 16%to 30% ❑ 0 property boundary: \Er Greater than 30% ❑ 0 Yes g No ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable ZZ C 6 Z prior to design approvaL The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: Z parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proorof Record Ing THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. updated 312,2017 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section j. J (completed by applicant) �y �� p Local Health Department/District (2) Name. (i)c cN' \c \ > . o (see instructions) .._ Address: <�--c, 1 ,,,:k‘c_k\)A. \ F'� ` r _.._.... __..._..— .. car Vii- c) i.7)\ -1 , . Telephone: ( — - '. / (• r Signature: \ 1 Property Identification: (3) C\ — 6 Section 11. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) _ 246-272A— 0230 (OR) 12" or V/S roR PRESSURE OSS (OR) Subsection: TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, 1 (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE(AFN: ZZZ 66 _ Section IIL (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) C(deba vow v WOrk$Lt a itgch(, Type of Waiver: (11) [ ]Class A [.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 W. l (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 this chapter WAC. [ ] Denied 4 Approved I Granted—Subject to all comments,conditions and requirements noted in Sections II and III. Local Health Officer (13) Dater O(/' DOH 337-021