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Home My WebLink Aboutwai2025-00085 - WAI Health Waiver - 11/10/2025IOW s�` "''t,i 415 N. 6th STREET,SHELTON WA 98584 eiPleriT ,\ MASON COUNTY SHELTON: 360-427-9670,ext 400 I 'I I' COMMUNITY SERVICES BELFAIR: 360-275-4467,ext. 400 V.---- ;l ELMA: 360-482-5269,ext.400 Building,Planning,Environmental Health,Community Health , FAX: 360-427-7798 Appli tion for Waiver or Appeal 71� Amount Pai Receipt Number: �Z 5� 0 <b 6 S WA! /9a1/� - O ° Y 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 BRAD HAGSETH Telephone 3607483471 Mailing Address 1051 BUNKER CREEK RD City CHEHALIS State WA Zip 98532 Parcel No. 320103150130 Site Address XX E LONE FIR DR Subdivision Name and Lot SWINDLER'S COVE ESTATES LOT 3 OF LLS#21-04 PART 2: Nature of Waiver/Appeal IV 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 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 OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTE ATION ZONE Applicant Signature: (1."-#7-- Date: 11/10/25 Revised 8/21/2017 This form may be scanned and ava table 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 s/Waiver n None required n Class A vClass 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 O Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board ' Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST (MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN /if/i4.2 a1 10 o I 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: '" ' Date: �4 I�S/ PART 4: Determination of the Hearing Official AI/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: 411/ Date: Wd 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY MASON COUNTY PUBLIC HEALTH ` -I . ' COMMUNITY SERVICES --� CLASS B WAIVER WORKSHEET i�r • Building,Planning,Environmental Heahh,Community Health 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 BRAD HAGSETH WAIVER PERMIT NUMBER WAI MAILING ADDRESS 1051 BUNKER CREEK RD CM, STATE STATE WA ZIP 98532 SITE ADDRESS XX E LONE FIR DR cm TAX PARCEL NUMBER 320103150130 PROPOSED DRAINFIELD TIDE 0 CONVENTIONAL GRAVITY ❑ 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 El E Greater than 12" 0 El---- Harstine Gravelly Sandy Loam ❑ ❑ Greater than 18" ❑ ❑ Hoodsport Gravelly Sandy Loam ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam 0 ❑ Depth to hardpan 0 ❑ Sinclair Gravelly Sandy Loam ❑ ❑ Depth to mottling 0 0 Other ❑ ❑ Both ❑ 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 -Evidence of seasonal water table: Loamy Sand ❑✓ ,❑�/t,0 Yes ❑ 0 Sandy Loam ❑ LI No s. Percent Gravel: ,{� -Curtain Drain required: 0 -Less than or equal to 35% 0 L(Y a Yes 0 0 -Greater than 35% ❑ ❑ - No I(2' ro 3. SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: z c rt di- r0 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. O Well Drained El Moderately Well Drained 0 ❑ -Are increased horizontal setbacks met:Other 0 CI YestT No ❑ ❑ 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% ❑ ❑/ -Is there 50 ft or greater between the down 3%to 15% 0 �' gradient side of primary drainfield and 16%to 30% ❑ ❑ property boundary: ElGreater than 30% ❑ CI Yes No 0 ❑ 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: ZQ� Re- 1 O parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof o cording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE updated 3;2/2017 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) Local Health Department/District (2) BRAD HAGSETH (see instructions) Address: 1051 BUNKER CREEK RD CHEHALIS WA 98532 Telephone: ( ) 3607483471 ..__- .. Signature: Property Identification: (3) XX E LONE FIR DR 320103150130 Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 24" OF V/S F PRESSURE R) 12" OF V/S FO RESSURE 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�I REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: 2/V S W I ) Section III. I (completed by health office?) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (Il) [ ]Class Alass B [ ]Class C—Request DOH review before granting? Yes_ No Neighbor Notification: (12) Required? Yes_ No_ If needed, are agreements, easements, etc.properly filed? Yes _ No Section IV. (completed by health office?) 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 healt protection at least equal to that provided by this chapter WAC. [ ] Denied [ pproved/Grante —Subj to all comments,conditions and requiremen noted i Sections TI and III. Local Health Officer (13) Date: IL /f DOH 337-021 Page 26 of 32