HomeMy WebLinkAboutWAI2025-00082 - WAI Health Waiver - 10/24/2025 �AgON Cott
Public Health
Always working for a safer i healthier Mason County
415 N 6th Street, Bldg 8,Shelton WA 98584,
Shelton: (360)427-9670 ext 400 ❖ Belfair:(360) 275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400
FAX (360)427-7787
Application for W iver/Appeal
Amount Paid: 5
Receipt Number: tITCrS- 0,
Instructions .13\ o b
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 Identification
Name of Applicant BRUCE BORK Telephone 3605561984
Mailing Address of Applicant 120 STATE AVE NE #209
City OLYMPIA State WA Zip 98501
12-digit Tax Parcel No. 3 2 1 2 7 5 4 0 0 0 8 2
Site Address 41 E KILMARNOCK RD, SHELTON, WA 98584
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑✓ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ 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.):
REDUCED SETBACK TO ROADSIDE DITCH (15FT) WITH 24" OF VERTICAL
SEPARATION AND MEETING TREATMENT LEVEL B WITH NUWATER BNR600
Applicant Signature: Date: 10/22/2025
J:1EH Forms\Waiver-Appeal Mason County • i01
Revised 12/1/15
Page 1 of 2
110
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑ Appeal Waiver 0 None required )(Class A ❑ Class B 0 Class C
2. Identification of Specific Code/ Standard/Determination (include date of determination or
latest Code/Standard revision) (9-L7211-'p'T,-{ 0 k°
3. Nature of Appeal
q,- IruM I S�Gtc�- -Cum ofAwrc ,adrrvr4—
okv .. �`�-Cr\ to t`5- 1-
4. Hearing Official: OR le 114(.'
o Board of Health 0 Health Officer VOA i�� (�__vb
0 Pollution Control hearing Board 0 Public Health Director wk1,"�W 111. 11 VS
❑ Certified Contractor Review BoardSZ. Environmental Health Manager `i 33 z sT.N.
1 h (o+ is t 3,SD3 5M-7
5. Mitigating Factors: 't"h.v1/4.5
TLC VA i4' v-e Lot,( rV`n ei'ds,nk&
— ik1M1 WO p r (Al re t _coo e✓s
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: 'r ' Date: I I7G1 1 /S----
PART 4: Determination of the Hearing Official
Is--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:
O 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:
V
Hearing Official Signature: Date: it/i ?r
J:\EH Forms\Waiver-Appeal Mason County Local Revised 12/1/15
Page 2 of 2
al
On-Site Sewage Systems (Chapter 246-272A WAC) in W""'"0""State
C p rtment
Request for Waiver from State Regu
lations ,• H E A LT H
Section I. I (Completed by applicant)
Name: (1) BRUCE BORK Local Health Jurisdiction Received (2)
(See instructions)
Address: 120 STATE AVE NE #209
OLY.MPIAT.WA_98501 _.
.......................
Telephone: (360) 556-1984
.....-_........................... . .... . -..........
Signature:
Property Identification: (3)
32127-54-00082-41 E KILMARNOCK RD, SHELTON-v WA 98584
Section II. I (Completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A- 0210 1 SOIL DISPERSAL COMPONENT 30 FT DOWN TO 15 FT
� � FROM INTERCEPTOR/CURTAINQRAINS/
Subsection: TABLE IV DRAINAGE DITCHES DOWN-GRADIENT
Justification (Proposed mitigation measures): (7)
DISPERSAL COMPONENT MEETS TL B (NUWATER BNR600) WITHOUT DISINFECTION. THE SOIL DISPERSAL
COMPONENT-1+AS-24"-OF-VERTiCAL SEPARATIONS OWNER REQUIRED-TO-HAVE A MAINTENANCEISERVICE
CONTRACT.
Section III. I (Completed by local health officer)
Review Criteria: (8) Additional Mitigation Measures: (9)
Comments/Conditions: (10)
Type of Waiver: (11)E1Class A n Class B nClass C— Request DOH review before granting? Yes n Non
Neighbor Notification: (12) Required?YesnNo I I If needed, are agreements, easements, etc.filed? Yes n Non
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 east equal to that provided by this chapter WAC.
nDenied 7 Approved/Granted — Srtiject to all comments, conditions and requirements noted in Sections II and III.
Local Health Officer(13) ' It/
/ Date: l IAA"
DOH 337-175 February 2024 1
-ell w
m 0 3 0 .°J•
v, a c a, v
c
v) ++ > +' C C 4M C 0 0 C — tv
`� m
N '3eV .0 O_ v 3 0 0 0 m 'v i, C • •0 u N c
Q y Q F- o a •c. a m c c a) o `° `^ N o
v m 3 s ° w o • ° +- o ° > s v a o
• L Q 0/ 3 al m m aJ Q_ N a/ a .. 01 a m a
r- m L VI C i C °• a m v, m > 0 C > .c L 0
�«cu- co C :° v1 ar > v m u O •� > m O y a) m 2
o� C o r0 3 J 'o v a�, a c s d N a F`- E a) w a
c 3 v, -0 •7,, a c ^ �' > aY H `- w c °n 0 m c c
O 0 = >. o a) , ° y E •• m — 'p c +L. no Fr' •O
., o`ou a0 EF- ,v r 0 > . o as o vcu _c cv
U •- al N al `l Ti, > N O M v +L., E m 0 O
G 4.1
>, vo) .m-, Ol U C 0a a 0 CO t C Q! m .0 L m O 'C .0 0
C) L.a) C O N ° 5 C w °� " +- +. c a) Yn w E E 'c v,
an
.y d vl p N C aL-. N m a) C 'p m U O C `l ,/,
U O O C 'O N m 17 _C U w m C t v .O 0 v7�i .mC
N O VI m U a) 0 •O v_ 7 U 7 al U
4) a) '0 CO o^ a 3 0 ( a, �_ 0 U - v c »a-) ^ >•Cr
+•+ >' c U �' ++ •p a C 0 N 0,1
C a) al •0 •0 a)
c m w 0 0 ,_E c C 3 �, E c 0 -0 c N
O m 0 o " a) E Q Ea) u E .0 0 .n a) .CI cu o > 7 3 O
0 E C U m 00 v) O vl 0 0 v+'i L O y v0i VI .> '+ L v O va+i +>+
Lo
O) Ql O C N > u L0 'O m a`. al • O N a) _ O U a O al
c y m N 7 L u c wt E E c u y a E E : L E E :n
N •, am. a) 07 0 m O 'C ►m+ Ql 0 L m r ✓ C != ar m :% c° a)
'C W 0 C > vt C U r y oa > C •a) vl > OD >... ' C 3 '� bO >. u,
'Q N C ++ O 00 a ''' O0.vm- 7 O v) •O CL .L-. .fl 2 ut a) O a ..+ '� 0 VI v 0)
+' > +m `w a f0 °�' 41 c E t _n w a E > a a aL. 0 E aci a t o
C CL
O C L m 01 0 7 • U �+ • C O a) L C N o 0 0 ym• C ++ in
O 11 m 0 .-, a h E .U. co 'O a v 0 �+ L '= WO O a+ C a WO O
O.
▪ 3 yo' = ca o c ac) r >, coE U w m 3 o y U U a .c 0 _, a aE) U a,
•L c L "0 L 7 0 E u v, a to c E $ c c m e c E O u m e c
N a) c °,,° 0 :: 0 y m m a) v c co o 0 c -. o C C .D •io '; m o v0i C C -o
_O m Oa aci m o v ° a 3 m a) w N a m °) > d m u m a; >
Q F- o C 0 c F= 7 •0 m . C w F- c Q m` C u)
_ «�
Q m O U N to f0 > m m H •" p m )6 •-i O O (CO O.
la'el E m •m - '" Q.
> la E la
rl U U N m .c Oo eti 7 3 ..._ N E rim .C U ut 1g N E en .-, p 'O ut > N E m
ce
LU 0 C C 7 c 7
(I) oo C E c m U c m u
d c 7 E E E o ar ° E o J O O C •N ut v) Y E vt Y
I__. O O L .m+ u )O m m m v, C m m •N 1/1 CU C
Z '= u o u p ; u v>i ; U VI a ; U in a
4! al C +, w a-
0 3 CO v a. c m aci v c `o m d o Em aci a
D V y 0_ o E a) oo 2• c f0 E E c '° E E - c fO E
CC 2 w 'c 0 a m E ° o m E . o .o m E ° o :o
_ L.
'C N O w aa, 0 > V c 0 a `! C 0 a) v .., C O a) `l +•
C 2 y W L a .. W 0_ .- V) .- Cl. .. V)
Z ' U ti _ N 3 Kf vai . a N 0 rl a N 0 en el a N O en
W
Z „.,, 4...4
O. N O
N G�J
a r X V) • X V7 + X V)
2 C . > C C N C W C N
O 3 +' 3 a 3 a 3 a
O W0s ow cow c FT cl .:'. c FT 0 15H
J
Q _ _
0= d co c c •, Y - a)
LJJ a) >, N d C 0 a) a)
`- 0. p -0 .��. _0 — O L 0 > )I)
i/') O a m -0 m V) L CO V) 0 +' U N
p D N c c oo eV. o 'm C w 0
J 4.> c w c Y 3 ac) 7 0 `.) c 7u _ a N
0 7 C w >
O p o m
a u 0 0 0 m O. C m m .i
a
cn ? 3 E -° a c a, E .4) .0 al a
E o v o o a E v of z 0 ° N o Q
U u aL $ u u v, a
Q m m v .. m 40 ,, m no ar m
N a) y v v• • c a v �, c o N
N Cl a) N O .. al a) 3 Ol a 3 • O
Q ° a v, c m a-o m ,� -00 3 m i
-41
U v '8 c v 1O 0/ v '^ E L
V d — E a) - E ',� — E o - E c 'm d CO
m N N ... C v0) aL- "O v0) .- 3 CO V)) .L- d 0 m CO
a =
C N N ,--1 > N ,--) > N ~ > 0
O N p a N p Qt N D a) N p Ql
V :... N ri .0 eti n .-i
< U lO N m VD IN m 1D N m t0 N m
N O F- N O F- N O F- N O F-
ah