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Home My WebLink AboutWAI2024-00096 - WAI General - 9/24/2024 ' 415 N.6a STREET,SHELTON WA 99584 MASON COUNTY SHELTON:360427-9670,ext 400 COMMUNITY SERVICES 6EIFAIR:360-27SA467,ext 400 ELMA:360-482-5269,ext.4W wu %Pk Emba,mmel Heal&.CannanlbM IIM1 FAX:360-427-7798 Application for Waiver or Appeal Amount Paid: 295 Receipt Number: wan 2024 _ 00 oq(e Instructions: 1. Complete Parts land 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 appication with attachments In,Mason County Public Health for review. PART 1.Applicant& Parcel Information Name of Applicant- Cg_fphlyQGLq LYGZ Telephone Mailing Address �• IJ ^ 0 g City Vaa2hh I WA State WA zip 9T3Qy Parcel No. 1 1 2 0 S _ 7 % _ q 0 0 `Q 3 Site Address f1-01 F- bra2ir✓ L1V BelFv,✓, WA 9852� Subdivision Name and Lot PART 2: Nature of WalvedAppeal N( Class B Reduce Vertical Separation ❑ Food SerdaliOn RwArlmnrants ❑ Building Permtt Review Poieles ❑ Group B WaYrSyalem Regulations ❑ Location,WAG 246-272A-0210 ❑ Water Adeglwq Requirements ❑ Holding Tank WAG 246-272A-0240 ❑ EnrorcerneMTineines — . --❑_—Mason County Onsits Standards--_ ___ __ __--❑—Departmental Determination ❑ Contractor Codification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Desodplion of WaK%dAppeal(0nclude)ustlfication,additional material may be avedred.r. REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS (LASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE i Appicant Signature:. .- _14" Date:A02 t Radud 8Y6120I7 This form may be conned and avaOabis for public view an the Moron Cane Web On. hoe I oft PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal V Waiver ❑ None required ❑ Class A &(Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/Standard revision): WAC246i272A-0230,TABLE VI 3. Nature of Appeal: REDUCE VERTICAL SEPARATION REQUIREMENTS FOR CONVENTIONAL GRAVITY OR PRESSURE 055. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board li� Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN A(je2of e2 1 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has bbeee�n,submitted. � � y� Staff Signature: V. �" ' �"' ' `r/ '6 v v 1 Date: PART 4: Determination of the Hearing Official Pi 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: Q / Date: lL 2 ' Revised Sk I2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of Cumming Wadvma from State OnSim sewage system Regulations Claptm 246-272A WAC Effective Dsto: July 1,2007 Revisad Apr U 2017 On-Site Sewage Systems(Chapter 246-272A WAC) Request for Waiver from State Regulations 8"don1. (—.Wks--dbyappHenn) Name: (1) _t Q e 9 L r(ty Local Deelth Depmtmon �//Die [ f2) G Ate: P.a 130k 1106 _ a WA q a Telapboaa ( ) - 3iga�ax WV.ty Mend (3) Serdoall. (ensapresodbyaPPH—r) WACNumber: (4) WACRegrmmme (d) Waiver Sought (q 2i&272A— 0230 24.OF V/S FOR PRESSURE (OR)l 12"OF WS FOR PRESSURE OSS OR "com" TABLE VI I 3W OF V/S FOR GRAVITY lir OF V/S FOR GRAVITY OSS htstifi`III—(i"W9a6m`m"a `0'ePv'04' M COMPLEfED CLASS BWANERCHE(7(LI.4TATTACHED, (OUR ININGADDIT7011ALREQUIREMENTSMET[. RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE AFN: �� Sectlas . I (mmplcwby heahh gBleer) Revkwt7iiOwa (g) MdSutamhfc%emea(taaddWoaro Dwvep vpo;4: M TypeofWaiva: (71) [ ]CI—A [64,QamB [ )class C—Request DOH mvbwp$1MSamug? Y._ No NeigbborNotilication: (72) RcWimW Yes_ No_ .jf'needed are agreewatr eawwarte,h.praps(yflfed7 Yea _No_ S"flonIV. I (emaplstedbyheabhofker) 7bia Request For Waiver From State Rgalatioas has been mviawed according to aeprovisteu of Chapter 246-272A WAC Ov-Site Smeage Systme. 'lbe roview mdteaa appbdl,mod thomitigation meaemespsopoxd anNormgwed,beve been ev"W fortear ability to provide public heahb protection at least equal to that provided bytbla chapW WAC. I )Denied "proved/Gr<,nted to all e000ucats,conditions and regeeameda noW in Sections H and M. Loch Been O®eer 01) �/ now DOH 337-021 MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH CLASS B WAIVER WORKSHEET ns x.am arxasrewoe,sxetrox wavesN (State and Local waiver forms required) TO axes aW,tv.,EM iW-eF1FNP:300,27 1,,.tlo EIMA SOiaRBBi..WJ-.YW3r.11Pa unsunxvaa Caii,� Oe La C uy areaamN,maw WAI Ma.MpaCra6f P o. l�oK 1lo�b ,1 p on' a ` sere WA n�3 a `70 �9y ,reanterso rm Re[ F4r`r1, 14A glds2_6 mxwaca Mxea 12.2D S -a- =�oc.G 3 ,m..n.e e'm�x,tos. ❑�„a MtasUM 1.SOIL SERIES: 5.VERTICAL SEPARATION: The eoilserlesmustbeudemmd,Hantine,NoodspoM up-dapewnial sepaauon most begreaterthan 1r SM1dtery or 9ntlalrGn vNly Sandy loam. fwgravityandgreaterthan Irforprefsurs, Alderwood Gravelly Sandy loam___.____ ❑ Greater than lY_.__________._ ❑ ❑ Harstine Gravelly Sandy loam_.._..__..__.___. ❑ ❑ Greaterthan Hoodsport Gravelly Sandy loam___..___.___ ❑ ❑ -Determinedby: Shelton Gravelly Sandy Loam________._❑ ❑ Depth to hardpan.._.�_._�__.._.__. ❑ ❑ Sinclair Gravelly Sandy Loam__._____------❑ ❑ Depth to mottling_.__________ ❑❑/ ,❑,/ Other ___..❑ 01 Both_._____________.__._.__. D7 IN 2.SOIL TIDE: SMATERTABLE LEVEL Soil types must be Medium Sand Loamy Sand or Sandy 9rest holes show evidence da seasonal water table Loam Gm4perceMmustbe less Man orequalm 35%—, / abeverennctivelayenaartaindminmayberequimd Medium Sand.___..__.___.__-- bd ❑❑� -Essldencaofsersonalrabrbillr. N E��hp:jsv Loartry ❑ L c yes__._........_............_._.................._.._.__ya ❑/a p �."AVVX Sandy Loam________.____—_._❑ ❑ S No............._.________.__.❑ L7 z ,r�i• PercentGavel: {urtaln Drain required: O -Less than orepial to 3S%___—____ Yes_.________---- ❑J ❑ e -Greater than 35%_____.__❑ ❑ 3.SOIL DRAINAGE: '^c 7.HORIZONTAL SETBACKS: c Shcsmurtbe nwderMebvrelldalnedmwell drained. � Nimary Daldleld mart malnGln lOo'ham downgadi- � ant marine shoreliney surface water,andwells. � Well Drained Pf NlgdeateiyWell Drained __—❑ ❑ 'Are Mcnawd hodmntal setbacks met Other __. ❑ ❑ Yes._.__._______.._..___..__.._.._._._._..._ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE only alSlopes mustbe between 3%to A t Gravity Nesoarelowedenslopesimm 3%roIS% A50 kot horkurtiltenua[ien mrrel,required Prnwre lsalloxed on 3%to3o96, dowmgradientdthe pdmarydrelidield. Lessthan3%__--_____ ❑' �/ -is there Soft or greater between the the down 3%tol5%.._ __ LY gradient side of primary drainfieid and 16%to30%__ ❑ ❑ Property boundary: ,../ Greater than 30%. ____ ❑ ❑ Yes______ _..__.__...._..L7 No_ _..__... ❑ ❑ The50 foot horlmntalatrenuMbn zonal,iooredto be reartedonthe deed o/the propertyse unbulldoble ZZ� 6 �CR pdoito design approval.Theatrenusoon rare b rwttobe usedfweheconwRlon dreads dedss wdos AFN: (7 —` p Mngamssvehlculartra orothersimilarsuchu Theownermunagreetoallthesemrl Mws, rMMaaaaie nmroauxnssruxmuorvswlEwawnxxswari>wwsoxwusrrwmsrtc es+avumn