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Home My WebLink AboutWAI2025-00079 - WAI Health Waiver - 1/2/2026 t 9 t , 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 A lication for Waiver or Appeal ' Amount Paid: Receipt Number: ZdZS `09(t�l / J WAI 20 7 5 - 000 '7? q'V 04 2026 Instructions: RCF 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 Pamela Yates Telephone 360.789.3234 Mailing Address 563 W Golden Pheasant Road City Shelton State WA Zip 98584 Parcel No. 2 2 0 1 7 -- 5 0 -- 0 0 0 8 2 Site Address 310 E Lakeshore Drive E, Shelton Subdivision Name and Lot Timberlake PART 2: Nature of Waiver/Appeal ® Onsite: Class A Waiver O Food Sanitation Requirements ❑ Onsite: Class B Waiver O Group B Water System Regulations ® Onsite: Class C Waiver O Water Adequacy Requirements ❑ Onsite: Location, WAC246-272A-0210 O Building Permit: EH Review Policies O Onsite: Holding Tank, WAC246-272A- O Appeal:Enforcement Timelines 0240 ❑ Appeal:Departmental Determinations ❑ Onsite: Contractor Certification O Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): See attached-multiple waivers • Applicant Signature: 2cey 4 U Date: 11.17.2025 Revised 8/13/2018 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: T pe of Onsite Waiver (if applicable) Appeal Waiver None required Class A Class B Class C a- x t 2. Identificatio of Specific Code/Standard/ Determmination include date of determination or latest Code/ Standard revision): lifRL 7c(6• Z 17 it -0ZtO 3. Nature of Appeal: cfas5A Waty 1: Palm,.tnktAvir hdr►totla( scparufibvi betfwee -loot 540456 lcrctwOfee Cron C ff-fo2Sff. c 1455 A tvai vow Z: Peke P if irno n hiOr nf+tl f ta(tier?bofvewl 'dro il'et and prime:id kva*I'IMef►UM left 6050 c(at5 C vat'oe=(lecka.inin;inon hvr rmiaiseeppggra cmi 14f$v4' 40wfcela( oKdSrrrlara✓t•afeflit i!Doff to r . wtT less fkan 1,* of tretli'cal Sefara41. 4. Hearing Official: ❑ Board of Health O Health Officer ❑ Pollution Control hearing Board O Public Health Director ❑ Certified Contractor Review Board a Environmental Health Manager 5. Mi atina Factors: %A VOW/i: IvciffL jlo SceFocGhtimkcon (Wtics kFs'cakgTwKc 10 Reuss.i5r4E& Class 4 ;: Povvte gad(enc. ) Prrhsv✓'e felt-() I'riW ne Hof downy Wt f-af d,AmPe(d G(agG tvoultA `: Esrhav! -tmil< f (elver/ ter TL-,l/841 and M•®malafeor40 Prayr1tn, ttttity A d eat (t ce 441" m cot ` far e7 ducts PI alf verfafibn 4(rca ) c1 rep,. esici- deMen dn�ndtis cLt is 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: k Date: i7! - (101-6.• 4: Determination of the Hearing Official Et. 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: Date: //30/45Z6 Revised 8/13/2018 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) , Washington as " on5tatPDepam °' q Re uest for Waiver from State Regulations �, HEALTH Section I. I (Completed by applicant) Name: (1) Becky Rieger - Environmental Design Local Health Jurisdiction Received (2) (See instructions) Address: 2041 Little Hanaford Road iliacwi (Don /7 Centralia, WA 98531 Telephone: (360) 219-3343 Signature: 6 e U Property Identifi ation: (3) .......................... 310 E Lakeshore Drive E, Shelton TPN: 22017-50-00082 S-T-R: 17-20N-02W ......................................................... Section II. (Completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A- See Attached .9TonkS fe Aefacc va14/ Of} 2.1Ditthe 1)Taiiks fvfv4ace'afer' ZSff 7)1410 (d f. Subsection: ie tn0(1.6Vi8:lc ,?)Ptr la'*C(44. fti&nt;$f+.) 3)01110f WI4e Sufov 4.afcr Justification (Proposed mitigation measures): (7) 1"'"1-e4 IdUff. Soft, Seel cr.-Hocked PV q'fitrl /WS Section III. I (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures: (9) Comments/Conditions: (10) ceeq`f...,f...q.c n 'qa> ........► ke/o .....v.....r. -- .........._.........___ ...._.. ._.._....__._. .._..__...._.....__._............_._.__ _.- ..._ Type of Waiver: (11) X Class A Class B Class C— Request DOH review before granting? YesX No Neighbor Notification: (12) Required?Yes No If needed, are agreements, easements, etc.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. Denied Approved/Granted — Subject t comments, conditions and requirements noted in Sections/ II and III. Local Health Officer(13) Date: 1 / 3o/ ZO Cam' DOH 337-175 February 2024 1 WAI 2025-00079: Class A Waivers: i WAC 246-272A-0210 Table IV Requirements: Sewage tanks for be 50 feet from surface water Waiver Sought: Reduce the distance from sewage tanks from surface water from 50 to 25 feet Justification (Proposed Mitigation Measures): 1) Waterproof surface barrier applied to the concrete tanks consistent with the Manual of Concrete Practice ACl 515.1 R. Flexible rubber boots or compression seals meetingASTM C 1644, or flexible couplings meetingASTM C1173 used for inlet and outlet connections to provide flexibility in case of tank settlement while still maintaining a water tight seal. 2) Concrete tank tested for water-tightness consistent with the ASTM C 1227 -3) Access openings at or above finished grade with lockable lids or secured to prevent unauthorized entry. 0 WAC 246-272A-0210 Table IV Requirements: Drainfield to be 10 feet from water line Waiver Sought: Reduce the distance from sewage disposal to water line from 10 feet to 5 feet Justification (Proposed Mitigation Measures): 1) Water line to be cased or have extra protection 2) Water line to be tested to make sure it can not be contaminated 3) Water line is not located down-gradient of drainfield Class C Waiver: WAC 246-272A-0210(4) Requirements: Soil dispersal component to be 100 feet from open water. Waiver Sought: Reduce the distance from soil dispersal component from 100 to 50 and a 2 foot vertical separation can not be met due to soil profile and site constraints. Justification (Proposed Mitigation Measures): 1) Treatment component or sequence listed as meeting Treatment Level A, BL 1 & N with a pressure distribution to a Bio-Microbics Bio-Barrier MBR-0.5-N system. This treatment does not have UV light disinfection. 2) Treatment component located as far away from the body of water to the northwest Of the lot and drainage buffers are disrupted by housing, driveways and not a direct flow to the wetland water area. 3) The body of water is isolated and does not flow to other waters 14) The body of water does not impose a health risk to the public or environment as it is to the east of the septic drainfield and the site is to be planted with vegetation to further protect the water from contamination. 5) Septic system will have an operation and maintenance contract that will be maintained to keep the system from causing contamination. 6) Site will be replanted with native vegetation which will aid in filtrating surface water and protecting the drainfield from extra water intrusion as the vegetation will absorb the water in its root system. 04 c i`0 WAIVER NOTES. Environmental Design, LLC.- Y7S Cl 1) DRAINFIELD MUST BE 50 FT Septic Design •Wetlands•Mapping FROM SURFACE WATER 2041 Little Hanaford Road r C l�css A2 2) DRAINFIELD MUST BE 5 FT FROM Centralia,Wa. 98531 see. ,4e,,,;o WATER LINE (Icisc A 1 3) TANKS MUST BE 25 FT FROM (360)219-3343 SURFACE WATER r t�yt LEGEND N E e,,,,,, ,�� . HUB , 1 C(4 :#7, HUB C kg ve(C ® TM KT VICINITY MAP / #0 Ew EMU.Mil / S[l'R Mal '"50 FT WETLAND Pwa,aED NELL / n a BUFFER/WATER _ / 14 C lass /1 waiver Z ( SETBACK >.s. STUMP 100.00' # / 25 FT WATER 0 20 40 / 5 • �.�� lug SETBACK � ��--- 1" = 20 FT / / w 3 __ _ ioo:5' Ulm l/ FIELD STAKING OF DRAINFIELD IS _ /J FOR PERMITTING PURPOSES ONLY. I 0 __. ��— . DRAINFIELD LOCATION TO BE I w • ■ „--® .�` I / VERIFIED BY INSTALLER. I o0.D 3 co T ._2 w a ✓ (04 min O O / PROPERTY LINES SHOWN AS PER •4, .LM y� ` /' 3 E f#�h RECORDED DOCUMENT AFN:3037023 \ • I �•` ��i�1 I t i Y I ��\\N`\`"\`\\`\N\ I• q1/ THE PROPERTY LINES IN THIS MAP ARE 30 f+ S Aj �6e jx n Ft� , C�Q$ �� APPROXIMATE AND ARE NOT INTENDED v�$ft d0 duo(( Wye /w y w hl4lWet TO BE USED AS A SURVEY. Or u+19 tt t� / T�'o1 ks W w v . v • `L W i `k . ti W y ti o- ERTY LINE g9.66 ` ` W ` v ''w s PROP w v w r''Betty J. ROPOSED 2-BEDROOM v v :1vti r '' c... " -- I PROPOSED DRIVEWAY R'•IDENCE 4 .E 12.31.2025 I w W CLIENT NAME:PAMELA YATES 4. ,A 4.. MAILING ADDRESS:563 W GOLDEN PHEASANT ROAD SHELTON.WA 98584 * Z` rJ PHONE NUMBER: 360789.3234 r ♦ �O /•/fe� •�� [J, f� yy X�. 51TE ADDRESS: 310E LAKESHORE DRIVE E,SHELTON AJov a(I `lass i "class C f'(�Qf•�1 � 4SV as ate( Pay PARCEL NUMBER:22017.50-00082 5.T-6:17-20N-02W c(ose uffci11kin eta SGffoodc5 and ex('fra� dep(itS PERMIT NUMBER: fopre ANA 2 files `/ ,t/ �,/yy �,y DRAFTED BY: BJR JOB NUMBER:2024-161 PAGE 1 OF 4 P I- (o r \ V 43e awls y unaevelopa)l e. REVIEWED BY:BJR DATE:12.31.2025