HomeMy WebLinkAboutWAI2023-00111 - WAI Health Waiver - 11/9/2023 e
MASON COUNTY 415 N. 6th STREET,SHELTON WA 98584
"`l M1 I ? COMMUNITY SHELTON:360-427-9670, ext 400
=, T_ SERVICES BELFAIR:360-275-4467,ext.400
-41, Hmithim.Planning.Environmental Health.Community Health/ ELMA:360-482-5269,ext.400
I•III IvS,,,.
FAX: 360-427-7798
Application for Waiver or Appeal
Amount Paid: aZ95S Receipt Number: Z 3
WAl ao i. _ cc) (
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 JOHN SHARP Telephone 206-354-5346
Mailing Address 3531 W SHELTON VALLEY RD
City SHELTON
State WA Zip 98584
Parcel No. _4_ I 9 0 _2 -- 2 1 9 0 0 2 1
Site Address SAME fn n' ( I` f w.1 p
I;
Subdivision Name and Lot
NOV 0 9 Z023 '
u U _J
PART 2: Nature of Waiver/Appeal
By--
EY Class B Reduce Vertical Separation
❑ Building Permit Review Policies 0 Food Sanitation Requirements
0 Location, WAC 246-272A-0210 0 Group B Water System Regulations
❑ Holding Tank WAC 246-272A-0240 0 Water Adequacy Requirements
❑ Enforcement Timelines
❑ Mason County Onsite Standards
❑ Contractor Certification RequirementsDepartmental Determinations
(Installer, Pumper, O&M Specialists) 0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY
-3S
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE
Applicant Signature: (---.
2; Zu
_ ,P
'�'� Date: // 2ri
Rev
This form may be scanned and available for public view on the Mason County Web site.lsed 8/2I/20I7
Page I of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. 'Type of Determination Required:
Type of Onsite Waiver (if applicable)
Appeal ✓Waiver None required Li Class A ✓Class B 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 CONVENTIONA GRAVITY
4. Hearing Official:
❑ Board of Health 0 Health Officer
0 Pollution Control hearing Board
0 Certified Contractor Review Board 0 Public Health Director
Environmental Health Manage
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local policy has been submitted.
i
Staff Signature: ,G " V 1�`) - Date: �-
l _
PART 4: Determinati n 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:
Health Official Signature: Date: ( L/
// ' ?,—
Rev
This form may be scanned and available for public view on the Mason County Web site.ised 8i21/2o17
Page 2 of 2
MASON COUNTY MASON COUNTY PUBLIC HEALTH
- COMMUNITY SERVICES
Building.Planning,Environmental Health,Community I leallh CLASS B WA I V E R W O R K S H E E T
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:360-482-5269.EXT.400 - FAX:360-427-7798
APPLICANT NAME JOHN SHARP WAVER PERMIT NUMBER VI/AI
MAILING ADDRESS 3531 W SHELTON VALLEY RD
cry SHELTON
STATE WA ZIP 98584
SITE ADDRESS SAME
CITY
TAX PARCEL NUMBER 41902-21-90021 PROPOSED DRAINFIELD TYPE ® CONVENTIONAL GRAVITY
❑ CONVENTIONAL I'I,,',.,)4r
1.SOIL SERIES: 5,VERTICAL SEPARATION:
The soil series must be Alderwood,Harstine,Hoodsport, I
Shelton,or Sinclair Gravelly Sandy Loam. Up-slope vertical separation must be greater than 18"
for gravity and greater than 12"for pressure.
Alderwood Gravelly Sandy Loam 0 ❑ Greater than 12" 0 ❑Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" ZII5
Hoodsport Gravelly Sandy Loam 0 ❑ -Determined by: ""
Shelton Gravelly Sandy Loam ® W Depth to hardpan ( ❑
Sinclair Gravelly Sandy Loam ❑ Depth to mottling ❑ ❑
Other ❑ ❑ Both ❑
rcir
2.SOIL TYPE: 6.WATER TABLE LEVEL:
Soil types must be Medium Sand,Loamy Sand,or Sandy Loam.Gravel percent must be less than or equal to 35%. If test holes show evidence of a seasonal water table
above restrictive layer,a curtain drain may he required
Medium Sand ❑ 0 Z -Evidence of seasonal water table:
Loamy Sand ❑ ❑ o Yes
O Elz
Sandy Loam In .0 S. No 12] 1L o
Percent Gravel: p '
-Curtain Drain required:
-Less than or equal to 35% I Eo Yes ❑ ❑
co
Greater than 35% ❑ a. No 0tjc
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ro
3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS:
ISoils must be moderately well drained to well drained. I p Primary Drainfield must maintain 200'from down-gradi- o
ent marine shorelines,surface waters,and wells. 0
Well Drained ® WI
Moderately Well Drained 0 0 -Are increased horizontal setbacks met:
Other_ — ❑ ❑ Yes
3
4. DRAINFIELD SLOPE: NO ❑
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 ❑ -Is there 50 ft or greater between the down
3%to 15% a] gradient side of primary drainfield and
16%to 30% 0 [l property boundary:
Greater than 30% ❑ 0 Yes ❑
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 contruction of roads,decks,patios,
parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. AFN:
Proof of Recording:
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIFW ON THE MASON COUNTYIVFIhITF 1 [y
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• I 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. I (completed by applicant)
Name: (1) Local Health Department i District (2)
JOHN SHARP (see instructions)
. . . .
Address:
... . .... ... . .
3531 W SHELTON VALLEY RD
SHELTON, WA. 98584
.. ..........................
Telephone: ( 206) 354-5346
Signature: - - -
em4 ( F.0-74) li 0 7_4.0
Property Identifi ion: (3)
............. . .. ... ... . ..........
.
Section II. I (completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A —
0230
Subsection:
TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY OSS
Justification(mitigation measures to he provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED,
(OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN.
ZONE (AFN: _)
Section III. I (completed by health queer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
... ...........
.
Comments;Conditions: (10)
Type of Waiver: (11) [ ] Class A [x] Class B [ ] Class C----Request DOH review before granting? Yes No_ x
Neighbor Notification: (12) Required? Yes. No X 11 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 2
provisions of Chapter 46-272
applied,and the mitigation p A WAC r their
Sewage Systems. The review criteria
measures proposed and/or required,have been evaluated for the ability
to provide public health protection at least equal to that provided by this chapter WAC.
I ] Denied RI Approved/Granted---Subject to all comments. conditions and requirements noted in Sec ions II and III.
Local Health Officer (13) 1°N 4 14 y
--- - Date:-- ---------
DOH 337-021
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