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Home My WebLink AboutWAI2025-00083 - WAI Health Waiver - 10/27/2025 415 N.6`n STREET,SHELTON WA 98584 c \ 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 • •I'c 4:•n for Waiver or Appeal Amount Paid $��.� `! Receipt Number: 50 i;also.„� wAl �96 - 000�'3 de 0 -� T?� �a �' 20�s 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 Don & Sally Root Telephone (360) 580-2570 Mailing Address 36 Westview Drive City Hoquiam, State WA Zip 98546 Parcel No. 2 2 1 0 8 -- 5 0 -- 0 0 0 0 4 Site Address 8331 E Mason Lake Rd, Grapeview, WA 98546 Subdivision Name and Lot Manzanita Tracts (Unrecorded) TR 4 & S.L. S 28/8 PART 2: Nature of WaiverlAppeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements ❑ Onsite: Class B Waiver ❑ Group B Water System Regulations ❑ Onsite: Class C Waiver 0 Water Adequacy Requirements JS' Onsite: Location,WAC246-272A-0210 0 Building Permit: EH Review Policies El Onsite: Holding Tank, WAC246-272A- 0 Appeal:Enforcement Timelines 0240 0 Appeal:Departmental Determinations ❑ Onsite: Contractor Certification ❑ Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): See attached for State Waiver Requests & Mitigation: 1) Reduce setback from septic tank to Mason Lake from 50'to a minimum of 25' 2) Reduce setback from sewage transport line to private wells from 50'to a minimum of 25' 1 Applicant Signature: PDate: " Z("f.2./� C>NS -(3 �c , -11-£s`� -k . -01,3,/,-V--- Revised 8;13/2018 This form may be scanned and available for paolic view on the Mason County Web site. Page 1 oft tin*, tvi- 511e_ -6 cfhd, i L3 Soi 1 T-N and pm volt. w a}e,- i S 609 WA. (dt i S PART 3: Public Health Evaluation (Staff Use Only) ' Z,j5'1 SR A- So y('b(4- -' vroti 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal Waiver None required Class A Class B Class C 2. Identification of Specific Code/ Standard/ Deteminati n (include date of determination or latest Code/ Standard revision): A6-1,12_ -01A 0 3. Nature of Appeal: Q-4-kkC , hOci 1J2nir4 Se a ` '"(1 -krW5 -111, a-ce warty lv 7,5- -. Qedl,v c e, hag tvelf-c ( S�(7f-toc.k,t-�r�--0 f V 1 v C v'.e l LS 4. Hearing Official: SWAY-- '�l"-' ' ` 4-• ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board Environmental Health Manage► 5. Mitigating Factors: v-11 -P( 49 €-- ifv hhe-+' y vv T S C Gt,S l r —f-vmti S p04 - 7- _ vfl j rY' SD - The-- weGI l e t(C � �4-� �- I rr 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: it //(1(-7 -. 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: Health Official Signature: (10 Date: L `) / 1 Revised 8/13/2018 This form may be scanned and available for public view on the Mason County Web site. Page 2of2 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver From State Regulations Section I. I (completed by applicant) Local Health Department/District (2) Name: (1) (see instructions) Address: Telephone: (3. 0) -go- 2570 Signature: cg§:^.. i\,6).- - Property Identification: (3) wx✓\. KIA.,,l, eks csiv,r ,e0.1'd- ) T(. & L s z,8j 8 lab- So-D000`f �SE�-c- 08, N, R A Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0 Zl.O A h,c-E-t. - 50 1 •-�`" �o l� 2 ZS NcAv Subsection: -�Y�,�b f. �-�^t 4-0 V_Teit..lS S\ • TocrSf Justification(mitigation measures to be provided): (7) 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) [1(],Class A [ ]Class 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. 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. [ ] Deniedpproved /Granted—Subject to all comments,conditions and requirements noted in S ions II and III. Local Health Officer (13) Date: 12- 19 Application for Waiver/Appeal Mitigation updated 12-18-25 Owner: Don& Sally Root Phone: (360) 580-2570 Mailing Address: 36 Westview Dr, Hoquiam, WA 98550 Site Address: 8331 E Mason Lake Rd, Grapeview, WA 98546 Parcel Number: 22108-50-00004 Property Description: Manzanita Tracts(Unrecorded)TR 4& S.L. S 28/8 **Property meets minimum lot size requirements for Class A State Waiver with .74 acres(32,234 s.f.),Nitrogen Treatment and Private Water.** State Class A Waiver Sought: 246-272A0210(1)Table IV: Reduce horizontal separation between septic tank(s)and surface water from 50' to no less than 25'. la)Waterproof surface barrier applied to concrete tank consistent with Manual of Concrete Practice ACI 515.1 R. Flexible rubber boots or compression seals meeting ASTM C 1644,or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to provide flexibility in case of tank settlement while still maintaining a watertight seal. 2a)Concrete tank tested for water-tightness consistent with ASTM C 1227. 3a)Access openings at or above finished grade with lockable lids or secured to prevent unauthorized entry. **Note: The installer plans to use a coated concrete Hagerman precast tank in this location.** State Class A Waiver Sought: 246-272A0210(1)Table IV: Reduce horizontal separation between sewage transport line and non-public wells from 50' to no less than 25'. This affects the Owner's well and the Northern neighbor's well. la)Transport line installed in a casing of at least Schedule 40 PVC within 50 feet of well. Transport line uniformly supported by pressure-grouting annular space with sand-cement grout or bentonite,or casing spacers or skids installed consistent with AWWA PVC Pipe Design and Installation Manual M23. Underground installation of line consistent with ASTM D 2774. 2a)Transport line leakage tests consistent with ASTM D 2774, except line should be pressurized to 150% of the system's design operating pressure, but not less than 70 psi,and pressure must hold for 1 hour. 3a)Notify the well owner of the proposed encroachment if there are no existing covenants or easements establishing a control area. Owner is aware of his own well setback and a certified letter has been mailed to the northern neighbor with a return receipt request. Arrow Septic Designs 171 E.Vuecrest Dr. Union, WA 98592 Snure Family LLC 612 S 227th St Des Moines,WA 98198 October 24,2025 RE:Don& Sally Root, 8331 E Mason Lake LLC-New Septic with Well Waiver Dear Snure Family, This letter is to inform you that we are currently working on a septic design on the property next door to yours for Don& Sally Root located at 8331 E Mason Lake Rd,Grapeview,WA 98546. The proposed waiver is to place the sewage transport line as close as 25 feet from the Root's well and your well on Parcel#22108-50-00003 located at 8341 E Mason Lake Rd, Grapeview, WA 98546. The standard setback is 50 feet,but the state and local health code allows us to lessen this distance down to 25 feet. To mitigate the setback reduction on this project,extra protective measures are required during installation including encasing the 2"Sched 40 transport line inside of another larger Sched 40 pipe, uniformly supporting the transport line and performing a pressure/leak test on the line. The septic tanks on this project are more than the standard 50 feet from your well and the septic drainfield is more than the standard 100 feet from your well with no waivers required. You do not need to respond to this letter,it is for notification only,but you can feel free to contact the local Health Department or myself if you have any questions. The Mason County Health Department regulator's contact information is as follows: Mason County Department of Health Services 415 N 6th St Shelton, WA 98584 (360)427-9670 ext.400 If you need further information,please contact my office at paulaj@hctc.com or(360) 898-2255. Sincerely, O pu, Paula J.Johnson Licensed Onsite Wastewater Treatment System Designer n,n.q.J Lo1Z41z.5 U.S. Postal Service"' CERTIFIED MAIL° RECEIPT O Domestic Mail Only n j- For delivery information. visit our website at www.usps.com . e 1 ''; • IAL Ti USE Certified Mail Fee Sr.31.I 0460 $ $4-4U 02 Extra Services&Fees(check box,add fee ppgvgate) ❑Return Receipt(hardcopy) $ u'vy ❑Return Receipt(electronic) $ so■IJU Postmark J D Certified Mail Restricted Delivery $ $U-UU Here Adult Signature Required $ $U, }{ Adult Signature Restricted Delivery $ Postage $i1.78 7- $ 10/24/2025 L T �Lrorgge and Fees $ !-''■■11.0 Sent To 5NA,rc, `l` Vvv `' LA—C.) Street and Apt. No.,or PCB Box O.Z � ------------- City, State, ljP+4® w5 44\2 W, `� t.s PS Form 3800, April 2015 PSN 7530-02-000-90047 See Reverse for lnstructio