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Home My WebLink AboutWAI2026-00002 - WAI Health Waiver - 2/3/2026 t y , t'1:\ MAS N COUNTY 415 N.6t"STREET,SHELTON WA 98584 ,J SHELTON:360-427-9670,ext 400 I' ':T) COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ` � Ti e''�;, `;j Building,Planning,Environmental Health,Community Health ELMA:360-482-5269,ext.400 ti .1_11 F X:360-427-7798 Application for Waiver or Appeal D Eig$nAmount Paid: # 3l 0 Receipt Number: • Da. . ^ 0 r� PE JAN WAI pC.Ca(Q - 0000 e � T zU26 y Instructions: 1. Complete Parts 1 and . No determination can be made until these parts are fully completed. 2. Fees may be billed fo' Waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submit completed aplijcation with attachments to Mason County Public Health for review. Ells PART 1. Applicant & Paricel Information Name of Applicant ADAM TATE Telephone 360-517-3383 Mailing Address 380 E BUCKTAIL VIEW City BELFAIR State WA Zip 98528 Parcel No. 2 2 2 1 2 -- -- 5 3 0 9 0 0 1 Site Address 600 E OLYMPIC VIEW ST, BELFAIR, WA. 98528 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal Ig/ Class B Reduce Vertical Separation O Food Sanitation Requirements ❑ Building Permit Review Policies O Group B Water System Regulations ❑ Location, WAC 246-272A-0210 O Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 O Enforcement Timelines ❑ Mason County Onsite Standards O Departmental Determinations ❑ Contractor Certification Requirements O Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY CLASS B WAIVER CHEtLIST RECORDED DECLARAIIIQN OF ATTENUATION ZONE\C L I /2.t-C.4., 4 t-iihpni ia-ekla ew t CvYhpleJr) &FV'-11.36Set Applicant Signature: � , td&J, 02 ,) Date: 1 7v2-b Revised 8/21/2017 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: Type of Onsite Waiver (if applicable) ❑ Appeal r 'Waiver ❑ None required ❑ Class A MClass 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 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board 2' Environmental Health Manager 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 2. 236 9 L ) 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: Z l.�/00 Z‘ PART 4: Determination p the Hearing Official 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: Z Revised 8/21/2017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 i,-(07 -'� MASON COUNTY C MASON COUNTY PUBLIC ,� OMMUNIT SERVICES HEALTH N <j 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,EXT.400 ELMA:360-482-5269,EXT 400 - FAX:360-427-7798 APPLICANT NAME ADAM TATS WAIVER PERMIT NUMBER WAI W Z6 '00001 MAILING ADDRESS 380 E BUCKTAIL VIEW CITY BELFAIR STATE WA ZIP 98528 SITE ADDRESS 600 E OLYMPIC VIEW ST CITY BELFAIR,WA. 98528 TAX PARCEL NUMBER 22212-53-09001 PROPOSED DRAINFIELD TYPE ® CONVENTIONAL GRAVITY 0 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 ❑ ❑RI Greater than 12" O O Harstine Gravelly Sandy Loam Greater than 18" % IF Hoodsport Gravelly Sandy Loam O O -Determined by: Shelton Gravelly Sandy Loam i ' O O Depth to hardpan X O Sinclair Gravelly Sandy Loam O O Depth to mottling O Other I- O O Both O 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy S0-1d,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 O O 2 -Evidence of seasonal water table: .,{ Loamy Sand ❑ ❑ a Yes ❑ LOCI ro Sandy Loam a ® No J ❑ Percent Gravel: r -Curtain Drain required: -Less than or equal to 35% Er o Yes O ❑ -Greater than 35% El 0 No o 3.SOIL DRAINAGE: c 7. HORIZONTAL SETBACKS: co c Soils must be moderately well drained to well drained. p Primary Drainfield must maintain 200'from down-gradi- m �� ent marine shorelines,surface waters,and wells. 0 Well Drained W `:.-- Moderately Well Drained ❑ O -Are increased horizontal setbacks met: Other ❑ O Yes No ❑ O 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% ❑ O -Is there 50 ft or greater between the down 3%to 15% gradient side of primary drainfield and 16%to 30% O NI property boundary: Greater than 30% ❑ O Yes L4P ( itch-e%,:el 4 ,,O' .S3 No .4c.42e 4 ❑ C J A G% 1i� The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable (J/ prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: 77.36 6 Z. parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording: THIS FORM MAYBE 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. j (completed by applicant) NameA( sA A TATS Local Health Department/District (2) (see instructions) Address: 38.0....E...B.U.C.KT.AI.L.L VI.EV. Then n CC4i..l.. BELFAIR, WA. 98528 I. Telephone: (360a5173383 Signature Lettz Property Identifi tion: (3) 22212-53-09001 600 E OLYMP C VIEW ST • Section II. (completed bj applicant) WAC Number: (4) W 'C Requirement: (5) Waiver Sought: (6) 246-272A— 0230 -! .__ _. 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 REQUI EMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: 2136 %? ' Section III. I (completed by health officer) Review Criteria: (8) f Mitigation Measures(in addition to those proposed): (9) I Comments/Conditions: (10) c (q t) „twee- Type of Waiver: (11) [ ] Class A Keamli h °{e,]Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? ''es_ 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 appfied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at leastlequal to that provided by this chapter WAC. [ ] Denied plApproved/GI-anted—Subject t 11 comments,conditions and requirements noted' Sections II and III. 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