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HomeMy WebLinkAboutWAI2025-00069 - WAI Health Waiver - 10/1/2025 `'oQ'c'r 11 \` MASON COUNTY NITY SERVICES COMMUNITY Building,Planning,Environmental Health,Community Health • 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 + Belfair: (360) 275-4467 ext 400 Elma: (360) 482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal \, Amount Paid: � D �L/ 1171 Receipt Number: ac S OLi g(og O Instructions W 4r,20-'S - 6y 7?, 1. Complete Parts 1 and 2. No determination can be made until these parts are full com 2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedu . 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant JESS MOSLEY Telephone Mailing Address of Applicant 163 HAWTHORNE City SHELTON State W4 Zip 98584 12-digit Tax Parcel No. 3 2 1 2 7 --- 5 2 --- 0 0 0 1 7 Site Address 290 SHAMROCK DR,SHELTON WA Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) ❑ Separation 0 Food Sanitation Requirements S ❑, Building Permit Review Policies 0 Group B Regulations Water System X Location, WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations 0 Other 1.)Water line installed in casing of at least Schedule 40 PVC within 10 feet of the dispersal Description of Waiver/Appeal (include justifi component.Water lines are uniformly supported by pressure-grouting annular space with sand- cement grout or bentonite,or casing spacers or skids installed consistent with AWWA PVC Pipe REDUCE SETBACK FROM DRAIN FIELD Design and Installation Manual M23. TO WATERLINE FROM 10FT DOWN TO 5FT. 2a)Water line leakage tests consistent with WSDOT 7-09.3(23)Hydrostatic Pressure Test. 3a)Adequate protective site-specific conditions exist,such as physical settings with low hydrogeologic susceptibility from contaminant infiltration,i.e.deep,well-drained soils or down- gradient contaminant source. Applicant Signature:akAit,P /AH7171 /1/#441-111( Date. 1117 t 1 1 Z� J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 miy\ lot- ci 319dl , P` r• w01i' yip/pc' LI Soli , rt,N rS o,S178 far- ) S PART 3: Public Health Evaluation (Staff Use Only) I i1 37,6 S1..F-t- So R., 1. Type of Determination Required: Type of Onsite Waiver(if applicable) S}mot Wct1 et-t,S AppealIVaiver None required ) lass A Class B Class C 4010 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/ Standard revision) Vi Z`C�, -2:-/ ZA--0ZA Q 3. Nature of Appeal: Wok+ 42‘c t/r1.-ke, 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board gl.s. Environmental Health Manager 5. Mitigating Factors: SC,t1 ,c t 0 •Artn,Thff ael- 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. LAlcArNe\,9(C(trI Staff Signature: Date: `_ 1Lc 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: /6/7/2<1 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 � r � • 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 I. I (completed by applicant) Name: (1) Local Health Department/District (2) JESS MOSLEY (see instructions) Address: 163 HAWTHORNE SHELTON, WA 98584 • Telephone: ( ) Mture: PropertyIdentificatio : (3) 32127_52-00017, 290 SHAMROCK DR Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0210 10' DF TO WATERLINE 5' DF TO WATERLINE Subsection: TABLE IV la)Water line installed In casing of at least Schedule 40 PVC within 10 feet of the dispersal component.Water lines are uniformly supported by pressure-grouting annular space with sand- Justification(mitigation measures to be provided): (7) cement grout or bentonite,or casing spacers or skids installed consistent with AWWA PVC Pipe Design and Installation Manual M23. MEETSCLASS A MITIGATION. 2a)Water line leakage tests consistent with WSDOT 09.3(23)Hydrostatic Pressure Test. 3a)Adequate protective site-specific conditions exist,such as physical settings with low hydrogeologic susceptibility from contaminant infiltration,i.e.deep,well-drained soils or down- gradient contaminant source. Section III. I (completed by health ofcer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) 4 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 IV. I (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 [Approved /Gran —Subject to all comments,conditions and requirements noted i Sections II and III. Local Health Officer (13) Date: �b/ 2,1 DOH 337-021 Page 26 of 32 Rhonda Thompson From: Bob Paysse <pioneerdigging@yahoo.com> Sent: Friday, October 3, 2025 10:13 AM To: Rhonda Thompson Subject: Re: SWG2025-00355 Caution: External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Rhonda, can you please attach this to our waiver request. 3a) The site in question has low hydrogeologic susceptibility due to the hardpan layers found 28-30" deep. While the drainfield itself has 0% slope, the site in general has a subtle slope towards the back of the lot (away from the waterline). Should the pre-treated (TLB2) effluent pass thru the 18-20" of vertical separation (only 12" required/further treatment) and reach the hardpan layers, its more likely to horizontally move away from waterlines location based on the general topography. The site conditions align with past practice and county approvals based on my 30+ years in this industry. Bob Paysse Pioneer Digging Inc. 360-426-1803 PIONEERDIGGING <D Prrit►.ve On Thursday, October 2, 2025 at 10:40:08 AM PDT, Rhonda Thompson <rthompson©masoncountywa.gov> wrote: Hi Bob, We got the extra waiver fee on this and the state forms, but I don't see how you are meeting #3. It is not evident from your submittals. You will need to describe or argue how you are meeting that mitigation measure before I can bring it before management. Thanks, Rhonda Thompson, RS Senior Environmental Health Specialist