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Home My WebLink AboutWAI2025-00062 - WAI Health Waiver - 8/22/2025011111110/. 415 N.6th STREET,SHELTON WA 98584 MASON COUNTY SHELTON: 360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR: 360-275-4467,ext.400 ELMA:360-482-5269,ext.400 Building.Planning,Environmental Health,Community Health FAX: 360-427-7798 Application for Waiver or Appeal Pc7(1.q.,W1 --irg � Ll� Amount Paid: $-,306 Receipt Number: O�� " OL/Q° I �^ � WAI o n9�J - CX)0(P t G 10?5 8/ 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 ULEOTSO, LLC Telephone Mailing Address 403 16TH AVE E F City SEATTLE State WA Zip 98112 Parcel No. 1 2 1 0 7 - 24 - 9 0 0 5 2 Site Address 581 E MURRAY RD, GRAPEVIEW Subdivision Name and Lot PART 2: Nature of Waiver/Appeal 63/ 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 O Holding Tank WAC 246-272A-0240 0 Enforcement Timelines O 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 OSS CLASS B WAIVER CHECKLIST /� RECORDED DECLARATION OF ATTENUATION ZONE ftFi/'2z3(S?l Applicant Signature: QJ44AAT ('1"�t Date: ' /2 pp 9Revised 8/21/2017 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) Appeal ✓Waiver None required Class A v/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 erft- PitnSeRbE OSS. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board ' Environmental Health Manager' 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN Z1307Z 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy ha een submitted. g Staff Signature: Date: V v" PART 4: Determination of the Hearing Official t! - 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: Official Signature: Date: /Z-1 Zf Health g Reoiscd 8'21.'2(117 This form may be scanned and available for public view on the Mason County Web site. Page 2012 MASON COUNTY MASON COUNTY PUBLIC HEALTH 01457 COMMUNITY SERVICES CLASS B WAIVER WORKSHEET Building.Planning,Environmental Health Community Health 415 N.6TH STREET,BLDG 8,SHELTON WA98584 (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 /�. WANER PERMIT NUMBER ••AI � L Z ra Xo APPLICANT NAME ULEOTSO,LLC MAIUNGADOREss 403 16TH AVE E F STATE WA ZIP 96112 CITY SEATTLE SITE ADDRESS 581 E MURRAY RD,GRAPEVIEW city GRAPEVIEW TAX PARCEL NUMBER 12107-24-90052 PROPOSED DRAINFIELD TYPE ® CONVENTIONAL GRAVITY ❑ CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood,Harstine,Hoodsport,I 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 ❑ ❑ Greater than 12" 0 0 Harstine Gravelly Sandy Loam El Greater than 18" Hoodsport Gravelly Sandy Loam 0 ❑ -Determined by: 0 0 Shelton Gravelly Sandy Loam ❑ 0 Depth to hardpan Sinclair Gravelly Sandy Loam ❑, 0 Depth to mottling ❑, 0 Other 'I Both NI [JJA 2.SOIL TYPE: 6.WATER TABLE LEVEL: If test holes show evidence of a seasonal water table Soiltypes must berc Medium Sand,Loamy orS equal,or Sandy35%. above restrictive layer,a curtain drain may be required Loam.Gravel percent must be less than to 35%. I Medium Sand 0 0 _ -Evidence of seasonal water table: El 0 o ro Loamy Sandlir No o-3- Sandy Loam ? Percent Gravel: -Curtain Drain required: 0 `O Less than or equal to 35% . 0 0 Yes Lam" Greater than 35% 0 0 • m No - 3. SOIL DRAINAGE: F, 7.HORIZONTAL SETBACKS: c l Soils must be moderately well drained to well drained. I cO Primary Drainfield must maintain 200'from down-gradi- ro 0 ent marine shorelines,surface waters,and wells. Well DrainedISr -Are increased horizontal setbacks met: Moderately Well Drained 0 � Yes 121 1:17 Other No LI ❑ 4. DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. A 50 foot horizontal attenuation zone is required Gravity is only allowed on slopes from 3%to 15%. down-gradient of the primary drainfield. Pressure is allowed on 3%to 30%. Less than 3% 0 L0/^ -Is there 50 ft or greater between the down 3%to 15% m g gradient side of primary drainfield and VEl '16%to 30% ❑ ❑ property boundary:Greater than 30% El ❑ Yes ❑VI No The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable t C�� prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: Froor of Recording: parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. updated 3/1/2017 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE. • Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC I Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (completed by applicant) Name: (1) Local Health Department/District (2) ULEOTSO, LLC (see instructions) Address: fitt5at 403 16TH AVE E F ....Cavil I y t� SEATTLE, WA 98112 w. Telephone: ( ) Si. .at t e: / ertkniffifi-g-ri, gi(LZ( Property Identification: 581 E MURRAY RD, GRAPEVIEW/ 12107-24-90052 Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 02304"'O RFSSURF-.(OR) ) Subsection: TABLE VI 6d7: OF V/S FOR GRAVIly..--) 18" OF V/S FOR GRAVI Justification(mitigation measures to be provided): ( COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: 213(S.?Z ) Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) ('n n C(455 8 Lwo,L 11/0,1(5 .,f CGfa(,1 ) Type of Waiver: (11) [ ]Class A Class B I ]Class C—Request DOH review before granting? Yes— No)( 1 needed, are agreements, easements, etc.properly filed? Yes — No Neighbor Notification: (12) Required. Yes No X f 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 /Granted—Subject to all comments,conditions and requiremen noted Sections II and III. Local Health Officer (13) QI/Y Date: DOH 337-021