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Home My WebLink AboutWAI2025-00050 - WAI Health Waiver - 7/1/2025 415 N.C STREET,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,ext 400 0. • COMMUNITY SERVICES 6ELPAtR:360-275.9467,ext.400 sana'�ag..ni.Miw rrAimmenulHnaARrmnmwpyHeMin ELMA:360-0s2-5269,ext.400 FAX:36o-427-7798 Application for Waiver or Appeal �p cap f�1(� D )t1 Amount Paid: ' 1 Receipt 2016 03311 D EUD V WAl 2075 - 000� JUL 0 1 2025 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 en 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 Knulzen Telephone_360-850-2421_ Mailing Address 1826 NE Tee Lake RD City Tahuya State WA Zip 98588 Parcel No. 32335-31-90041 Site Address_1826 NE Tee Lake RD Tahuya,WA 98588 Subdivision Name and Lot. LOT: 1 OF SF'#2939 PTN G.L.3&NW SW PART 2: Nature of WaiverlAppeal Mr Class B Reduce Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group 8 Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Description of Waiver!Appeai(include justification,additional material may be a REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY O PRESSU O88 CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE `r1 �,E.,-, Applicant Signature: .m KA'61A ails, Date: 3 1 VA O�o''S V U Rev la18/2 our This form may be scanned and available for public view on the Mason County Web site. Page I of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) I:i Appeal s/Waiver ❑ None required a Class A s/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 CONVENTIONAL GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board 6f Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFNty. 7 ) coa-c Sku d 2- o bhp 4 , uS(C, lest ve� 7jl f!/r.ft uvat44r 20c .Et Ca ki}7 Ca iv 6. I have received this waiver/appeal3ivll request. It is complete and mitigation required by the state and local policy h c een61.4) ,, submitted. ,,h Staff Signature: /�/ ,!�-1, )I1�F1� Date: 7 30 -25 PART 4: Determination q the Hearing Official i -The hearing official has determinedd 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: 7/2/Alf Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 < r." MASON COUNTY =• COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building.Planr,Fn9.En,i,n,me,.ta;Health,Community health CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLDG 6,SHELTON WA98584 (State and Local waiver forms required) SHELTON.360427-85/0,EXT 400 - BELFAIR.3660754467,EXT 400 ELMA.38-482 5269,EXT 4D0 - FAX 360-427-7IS8 APPLICANT NAME lnhn Kmlben WAIVER PERMIT NUMBER WAI MAIura ADDRESS 1X76 NF Tee lake RD cm Tahuva STATE WA 71P9RSRR SITE ADDRESS 1 RDR NF Tee lake RD are TAhriya TAM PARCEL NUMgFR 3233S-31-40041 PROPOSEDDPAINFIELDTYPE ❑ CONVENTIONAL GRAVED. "CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.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. ,,J/ for gravity and greater than 12for pressure. Alderwood Gravelly Sandy Loam IN TKL, Greater than 12" Harstine Gravelly Sandy Loam ❑ 0 Greater than 18" . 0 Sig Hoodsport Gravelly Sandy Loam ❑ 0 -Determined by: Shelton Gravelly Sandy Loam ❑ 0 Depth to hardpan Sinclair Gravelly Sandy Loam - ❑ ❑ Depth to mottling Other 0 0 Both ilg ❑ 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 V 0 _ -Evidence of seasonal water table: Loamy Sand 0 $ Yes [,/ ❑�I n� Sandy Loam 'S—c No E. 't3 Percent Gravel: o -Curtain Drain required: O rtt -Less than or equal to 35% 0 0 o Yes NJ 0 a -Greater than35% 0 0 3 No . o 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: � '_ m PrimaryDrainfield must maintain 700'boo down- n Soils must be moderately well drained to well drained. I/ O ls.adi- EwWiy F ent marine shorelines,surface waters,and wells. Well Drained . `� Moderately Weil Drained ❑ 17 \ -Are Increased horizontal setbacks met: NJ Other ❑ 0 NoYes ❑ gV 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 3096, 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 primarydralnfieid. Less than 3% ❑ ❑ -Is there S0 ft or greater between the down 3%to 15% gradient side of primary drainfield and 16%to 30% ❑ ❑ property boundary: Greater than 30% ❑ 0 Yes 1 0 No . . ❑ 0 The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 'T-T�1 gag �7 prlor to design approval.The attenuation zone is not to be used for thecontruction of roads,decks,patios, AFN: 2e12--_1_{ 'L parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions, Pinola,Recording, THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW OXIDE MASON CONrtvWFBSIE. updated 1ry207 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)John Knuizen Local Health Department/District (2) (See instructions) Address: 1826 NE Tee Lake RD Tahuya, WA 98588 Telephone: ( 360) 850-2421 Signature: Property Identification: (3) Section II. I (completed by applicant) WAC Number: (4) Re uir mexY.-(T/ Waiver Sought: (6) 246-272A— 0230 24" OF V/S FOR PRESSURE (O 12" OF V/S FOR PRESSU OSS (OR) Subsection: TABLE VI 36" OF V/S FOR GRAVITY ClInF V/S FOR G TY OSS Justification(mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: 2 Z-2-S'l C ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) 24°9-gd---rc_.�utsxr�__�s4 --c�stgarl to 'tiyr}trc. 1:. .un,inesdestc Comments/Conditions: (l0) Type of Waiver: (l1) [ ] Class A KClass B [ ]Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes No lfneeded, are agreements, easements, etc prover/yfiled? Yes No Section IV. (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 lytApproved/Granted 5 bject all comments,conditions and requirements oted in,ections 11 and II. Local Health Officer (13) Date: / Y, Z DOH 337-021