HomeMy WebLinkAboutWAI2025-04457 - WAI Health Waiver - 9/8/2025 415 N. th 6 STREET,SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,ext 400
- COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
' ELMA:360-48 .400
v j Building.Planning.Fnvuonmt,ntal R,alth•Comnwnity H•alth F
8 (-'67-geo
Application for Waiver or Appeal L,
�1 �1 'L r
Amount Paid: 305 Receipt Number: o�Qd�� -N4q 61 SEp 082025
By
WAI - bbi 0
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 MIKE/BARB MINNER Telephone 360-507-0534
Mailing Address PO BOX 636
City SEQUIM State WA Zip 98382
Parcel No. 3 2 0 1 0 -- 3 1 -- 5 0 1 2 0
Site Address XXX E LONE FIR DR
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
IS( Class B Reduce Vertical Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
O Location, WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
O Mason County Onsite Standards ❑ Departmental Determinations
O 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 a sg
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE
Applicant Signature: � w 1, e.9A . Date: 9 f 1 /•
Revised 8/21/2017
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)
Appeal s'Waiver r None required 7 Class A s/Class B i 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 ;p5 5'
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
O Certified Contractor Review Board Et' Environmental Health Manage
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN)
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN ZZyJ
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local policy has been submitted.
Staff Signature: b Date:
PART 4: Determination of the Hearing Official
0-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:
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: ! VY2,f
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
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. , (completed by applicant)
Name: IKE/BARB MINNER Local Health Department/District (2)
(see instructions)
Address: PO BOX 636
SEQUIM, WA 98382
Telephone: (360 ) 507-0534
9 -Signature:C. t
Property Identification: (3)
32010-31-50120
Section II. I (completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A— 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR PRESSURE OSS (OR)
Subsection: TABLE VI 36" OF V/S FOR GRAVITY 18" OF V/S FOR GRAVITY 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: Z,v5?i )
Section III. I (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Comments/Conditions: (10)
Type of Waiver: (11) [ ] Class A Class B [ ]Class C—Request DOH review before granting? Yes No f`
Neighbor Notification: (12) Required? Yes_ No x 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 pr. ded by this chapter WAC.
[ ] Denied ti Approved /Gra i ed—. bject to all comments,conditions and requirements noted in Sections 11 and III.
'.ocal Health Officer (13)
. Date: /0�1�Z U
OH 337-021
MASON COUNTY MASON COUNTY PUBLIC HEALTH
•II• COMMUNITY SERVICES
r
Building,Planning,Environmental Health,Community Health CLASS B WAIVER WORKSHEET
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,EX .
ELMA:360-482-5269,EXT.400 - FAX.360-427-7798
APPLICANT NAME MIKE/BARB MINNER \)� WAIVER PERMIT NUMBER
'
MAILING ADDRESS PO BOX 636 C
� . ACITY SEQUIM STATE WA ZIP 98382
SITE ADDRESS XXX E LONE FIR DR �\�� are SHELTON,WA 98584
TAX PARCEL NUMBER 32010-31-50120 PROPOSED DRAINFIELD TYPE ® CONVENTIONAL GRAVITY El 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. for gravity and greater than 12"for pressure.
Alderwood Gravelly Sandy Loam g ❑ Greater than 12" 0 0
Harstine Gravelly Sandy Loam
❑ 0 Greater than 18" g IX
Hoodsport Gravelly Sandy Loam 0 ❑ -Determined by:
Shelton Gravelly Sandy Loam 0 0 Depth to hardpan 0 R
Sinclair Gravelly Sandy Loam 0 Depth to mottling
Other ❑ Both ❑ 0
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 0 0 ro -Evidence of seasonal water table:
Loamy Sand
� J Yes 0 D a
Sandy Loam 0 CINo '�
Percent Gravel: -Curtain Drain required: C)
-Less than or equal to 35%Yo 0 ❑ a Yes 0
0
-Greater than 35% 0 0 q No
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3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS:
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ro di-
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I Soils must be moderately well drained to well drained. Primary Drainfield must maintain 200'from down-gra
ent marine shorelines,surface waters,and wells. 0
Well Drained 0
Moderately Well Drained El -Are increased horizontal setbacks met:
Other 0 0 Yes
:11S ega--/r--1
No LJ
4. DRAINFIELD SLOPE: 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 0 -Is there 50 ft or greater between the down
3%to 15% NI igl gradient side of primary drainfield and
16%to 30% 0 ❑ property boundary: i✓ill"-
Greater than 30% 0 ❑ Yes .vi,......... • oittog
No }tea,zei
y �� El
4
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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, AFN: 2
parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording:
updated 3/2/2017
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSRE.
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