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Home My WebLink AboutWAI2026-00021 - WAI Health Waiver - 3/31/2026 S415 N.Vh STREET,SHELTON WA 98584 -9670,ext 400 BELFACIR:360 254467,ext.400 ' � . Public Health & Human Services Application for Waiver or Appeal Amount Paid: i () Receipt Number: r?Q (O -��0 Llq WAI 7 - ^�y 1 Please note all approved Onsite Waivers have the same expiration date as their OSS Permits. 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 David Ashby Telephone (808) 740-3690 Mailing Address 30 E Main Street City Union, State WA Zip 98592 Parcel No. 3 2 2 3 2 _ 5 0 _ 0 6 0 0 4 Site Address XX E Main Street, Union, WA 98592 Subdivision Name and Lot UNION HOOD CANAL LAND & IMP CO BLK: 6 W 1/2 LOT: 3 LOT:4 PART 2: Nature of Waiver/Appeal 0 Onsite: Class A Waiver ❑ Food Sanitation Requirements ❑ Onsite: Class B Waiver ❑ Group B Water System Regulations ❑ Onsite:Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite:Location, WAC246-272A-021 0 O Building Permit: EH Review Policies ❑ Onsite: Holding Tank;WAC246-272A- ❑ Appeal:Enforcement Timelines 0240 ❑ Appeal:Departmental Determinations ❑ Onsite: Contractor Certification ❑ Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): Reduce horizontal separation between Reserve Drainfield and down-gradient drainage ditch from 30' down to 15' minimum. See Attached Mitigation. Applicant Signature: Date: 'l\ , Q '� �` r r Revised 03/03/2026 This form may be scanned and available`for public view on the Mason County Web site. Page I of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) ❑Appeal Waiver %Class A O Class B ❑Class C ❑ Local State Waiver C iteria Number of Bedr oms: J Nitrogen Treatment: Yes ❑ No Soil Type: Minimum Lot Size: sq.ft. Water Source: Public ❑Priva₹e This Lot Size: tO, DI t sq.ft. Is This Lot Eligible for State Waivers: Yes ❑ No ❑ N/A Hearing Official: Environmental Health Manager ❑ Public Health Director ❑ Other: 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/Standard revision): 'L? (o' ?_-17 A-.-O74 D 3. Nature of Appeal: Qw -!- I Ntln1 . 5. Mitigating Factors: fl-r ) i ( So r 0 7c1 trnn &at 0 YYI i-ego 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local polio has been submitted. r� Staff Signature: c ' Date: /3 f PART 4: Determination of the Hearing Official PLThe 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: Revised 03/03/2026 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) ingtaostrtapnpcttmrntn( Request for Waiver from State Regulations Tie l• E LT H Section I. (Completed by applicant) Name:(1) David Ashby Local Health Jurisdiction Received(2) (See instructions) Address: 30 E Main St- Union, WA 98592 Telephone: (808) 740-3690 Signature: Property Identification:(3) UNION HOOD CANAL LAND & IMP CO BLK: 6 W 1/2 LOT: 3 LOT: 4, Parcel #32232-50-06004 Section H. (Completed by applicant) WAC Number:(4) WAC Requirement: (5) Waiver Sought: (6) 246-272A 0210(1) Soil dispersal component 30' from Reduce setback to 15' Subsection: down-gradient drainage ditch - Justification (Proposed mitigation measures): (7) See Attached Mitigation Section Iii. (Completed by local health officer) Review Criteria:(8) Additional Mitigation Measures:(9) Comments/Conditions:(10) Type of Waiver:(11) Class ALu Class B Class C—Request DOH review before granting? Yes❑No Lii Neighbor Notification:(12) Required?Yes❑No❑ If needed,are agreements,easements,etc.filed? Yes ❑ NoIIJ • Section IV.. (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 to a omments, conditions and requirements noted in Sections 11 and III. Local Health Officer(13) Date: 2,"2//"z_ ( DOH 337-175 February 2024 1 a . Application for Waiver/Appeal Mitigation 3-25-26 Owner: David Ashby Phone: (808) 740-3690 Mailing: 30 E Main Street, Union, WA 98592 Site Address: XX E Main Street,Union, WA 98592 Parcel Number: 32232-50-06004 The following requested waiver is for the construction of a 3-bedroom home with public water hookup,type 4 soil with a 0.6 gpolft2 application rate, and an onsite septic system on a sloping lot sized at 0.23 acres (or 10,018 s.f.). A Geotech report has been completed. In order to be eligible for a State Waiver,the property must be a minimum of 9,508 s.f. with 3-bedrooms, Treatment Level N (nitrogen), Type 4 soil and public water. This site meets the minimum lot size requirements. 1) State Class A Waiver Sought: Reduce horizontal separation between Reserve Drainfield and down-gradient drainage ditch from 30' down to 15' minimum. The Primary Drainfield meets the required 30' setback. 2) Mitigation Measures: Treatment component or sequence listed as meeting Treatment Level B. Disinfection is not used to achieve the fecal coliform limit of the treatment level. The soil dispersal component with pressure distribution and maintaining at least 2 feet vertical separation. The reserve drainfield area septic system proposed is a NuWater BNR-500 to subsurface drip system with 24"+of vertical separation, which meets the following Treatment Levels: TLB, TLC,BL2, BL3, TLE and TLN without disinfection. The system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance.