HomeMy WebLinkAboutWAI2026-00012 - WAI Health Waiver - 2/23/2026 i
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T,SHELT0N WA 98584
pi 7�\ MASON COUNTY 415 NSHELT0NE360-427-9670,ext 400
�;�� -. COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
/ ELMA:360-482-5269,ext.400
Building,Planning,Environmental Health,Community Health
ai FAX:360-427-7798
p Iication for Waiver or Appeal J�
Amount Paid: Receipt Number: ao — 0 v 7 64
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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 e,2_-. . G-..rc', Telephone
Mailing Address C. O . &o x 3(O'1
City Gr4 Mier,-) State L-t Zip q V
Parcel No. k 2 l O a -- Z 2-. -- d / O 0
Site Address
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
se Class B Reduce Vertical Separation O Food Sanitation Requirements mr- ric-E❑ Building Permit Review Policies ❑ Group B Water System Regulat Mrj
❑ Location, WAC 246-272A-0210 O Water Adequacy Requirements
O Holding Tank WAC 246-272A-0240 O Enforcement Timelines FEB 2 3 2026
O Mason County Onsite Standards O Departmental Determinations
O 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 OR PRESSURE OSS
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION A NUATION ZONE
Applicant Signature: Date: Z- 2 a-2Co
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 2
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MASON COUNTY
/' COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH
�..! &MingMronNgEMtrarnmWRedhCortmuH9'Health CLASS B WAIVER WORKSHEET
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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 ee: /C -r cs`o, ,NAI�IPB�4rNwA�A WAI
MA NGADDRESSS P.O . Y O Q> 7 co y cm( C,"- c-eA V/e (.‘,J STATE C/4 A ZIP q r. /u
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RIE ADDRESS Ir. &" ms-s. U t.v.J I vu Ie a-e- an ( —v-s- -t/I-e.,fr.)
TAX PARCEL NUMBER IZt(5 —2 2_— re I UC--) PROPOSED oaAwriLDTIRE tig COMIENnoNALGRAVEY ❑CONVENTIONAL PRESSURE
1.SOIL SERIES: 5.VERTICAL SEPARATION:
The soli 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 V P. Greater than 1 Y 0 0�
Harstine Gravelly Sandy Loam_ ___ 1 Greater than 1 r» »_ . IS ,,R`I—�
Hoodsport Gravelly Sandy Loam U ( -Determined by:
Shelton Gravelly Sandy Loam 0 0 Depth to hardpan 0 0
Sinclair Gravelly Sandy Loam 0 0 Depth to mottling __.__ ® 0
Other -0 0 floth_».»__» »»..___..__...».... .».._».._»»» . ... ❑
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 maybe required
Medium Sand, , ,.,.,, ._,,. __.,.,,.,.,.,..0 0 _ -Evidence of seasonal water table:
LoamySand »...._..» ».»».. .._.» .. __».». _ ❑ ❑ o Yes .» . .»»» ........»»»....»...».»».».. 0 0 m
Sandy Loam Id S No. » _.....»..__»»....... »....»__»._.»... i22
Percent Gravel: • / rKo -Curtain Drain required: p
-Less than or equal to 35% El tici Yes— .__,____.___,..,,,,».»._»_._.»»_..»» 0 El 10,
-Greater than 35%„».,,,,.».».»,,,»,,,»,,,»..,»_,_..»._»....0.,»..»..,»»» »_.»,», »»..».....»»..»»»».. .»»».., t.F�a
3.SOIL DRAINAGE: c 7.HORIZONTAL SETBACKS: c
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Soils must be moderately well drained to well drained. O Primary Drainfieid must maintain 200'from down-gradl- to
ent marine shorelines,surface waters,and wells. 0
WellDrained. ..._. .._................_......».....,.,»,,.»»,» O 0 •c
Moderately Well Drained......__,,.,»..__.,»......__..,..,.g tip -Are Increased horizontal setbacks met:
Other ,_ ,_ _ ❑ Yes------ ».....»»..».. »...»_.»..».»._»»» Or . 1'
4.DRAINFIELD SLOPE: No__ »»..».» »»»»_».._ »»0 (❑
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% _» 0 -Is there 50 ft or greater between the down
3%to 15% gradient side of primary drainfield and
16%to 30% _.._.. El property boundary:
Greater than 30%_..»,»,» 0 Yes— » "a
No_» »_ _»w» .» »» ❑ b
•
The 50 foot hortontal attenuation zone is required to be recorded on the deed of the property as unbuildabie prior to design approval.The attenuation zone is not to be used for the contraction of roads,decks,patios, �3��AFN: 1.
parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. ProofurRamrdMg:
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBUC VIEW ONTHE MASON COUNTY'MATE. updated 3/2/2017