HomeMy WebLinkAboutWAI2026-00015 - WAI Health Waiver - 4/10/2026 G4
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415 N.6th STREET,SHELTON WA 98584
MASON COUNTY 1
COMMUNITY SERVICES BELFAIR:
N:360-427-9670,ext 400
BELFAI 360-275-4467,ext.400
Building,Planning,Environmental Health.Community Health ELMA:360-482- , 400
FAX �f
Application for Waiver or Appeal
Amount Paid: 1 O Receipt Number: ? a
WAI o - 00015 1 �/
Instructions: J+
1. Complete Part 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 PATRICK PARADISE Telephone 360-349-7685
Mailing Address 2150;E MASON LAKE RD
City SHELTON State WA Zip 98584
Parcel No. 3 2 1 .3 4 2 3 __ 9 0 0 4 0
Site Address 1640 E MASON LAKE RD
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal.
' Class B Reduce Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements
0 Holding Tank WAC 246-272A-0240 O Enforcement Timelines
❑ Mason County.Onsite Standards ❑ Departmental Determinations
❑ Contractor Certification Requirements ❑ Other
(Installer, Pumper, O&M Specialists)
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE VERTICAL SEPARATION PRESSURE OSS
CLASS B WAIVER CHECKLIST
RECORDED DECLARATION OF ATTENUATION ZONE 4FIU: 123 v?
Applicant Signature: figr
pp 9 W Date:
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 2
ti
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
❑Appeal V'Waiver ❑ None required ❑ Class A sClass B o 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
PRESSURE OSS.
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board 6d' Environmental Health Manage/`
5. Mitigating Factors:
CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN
RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN ZZ
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: ` ( z6
PART 4: Determination of the Hearing Official
lL 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:
O 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: vf6 0016
Revised 8/21/2017
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH
Building;Planning,Environmental Health,Community Health C LASS 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 PATRICK PARADISE WAIVER PERMIT NUMBER WAI 7p6 OOQ t
MAILINGADDRESS 2150 E MASON LAKE RD -
clry SHELTON STATE WA ZIP 98584
SITE ADDRESS 1640 E MASON',LAKE RD
CITY
TAX PARCEL NUMBER 321.34-23-9001 0 PROPOSED DRAINFIELDTYPE [ CONVENTIONAL GRAVITY ® CONVENTIONAL PRESSURE
t �
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................................ ':;Lh Greater than 12"................ �I'................................................ LI
❑ ❑
Harstine Gravelly Sandy Loam..................................... � Greater than 18"
Hoodsport Gravelly Sandy Loam ''
❑ In -Determined by:
Shelton Gravelly Sandy Loam ❑ Dr Depth to hardpan ry D
Sinclair Gravelly Sandy Loam........................................❑ '❑ Depth to mottling ❑
Other ❑ 0 Both ❑.
............................................ .............. ❑ ;
....................... ..
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 may be required
Medium Sand..................................................................... ❑ 0 -Evidence of seasonal water table:
LoamySand.........................................................................❑ ❑ a, Yes... ................................................................................. ❑
SandyLoam......................................................................... No............................. ......... a 1
Percent Gravel: O -Curtain
Drain required:
r
Less than or equal to 35%....................................... a ' Yes..........................................................................................
❑ ❑
-Greater than 35%....................................................... ❑ QNo........................................................................................... a 3.SOIL DRAINAGE: _ 7. HORIZONTAL SETBACKS: - ,
N:
Soils must be moderately well drained to well drained. I Primary Drainfield must maintain 200'from down-gradi-
--'N` ent marine shorelines,surface waters,and wells.
�.
WellDrained...................................................................... . �c ;
Moderately Well Drained............................................... ❑ 0 -Are increased horizontal setbacks met:
Other ........... ❑ 0 Yes.........................................................................................
4.DRAINFIELD SLOPE: No........................................................................................... ❑ ''
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%...................................................................... ❑,...,r ❑ -Is there 50 ft or greater between the down
3%to 15%.......................................................................... Uv gradient side of primary drainfield and
16%to 30%........................................................................ ❑ ❑: property boundary: -(.`
Greater than 30%............................................................. ❑ 0- Yes rc,1:......r.. '.:i✓....°.f P14.........................
No............................................ ......... ......................... ❑ ❑,
The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable w h
prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN:
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. (completed by applicant)
Name: (1) Local Health Department/District (2)
Add...................................................................................................................................................................................... ..........................I................ I'see instructions)
ress: rn 'See.i..........................s).............................................................................
.� 1/
PATRICK PARADISE Il OM C0� t f
2150 E MASON LAKE RD
............................ .........................................................................................................................................................................................................
SHELTON, WA 98584
..............................................................................................................................................................................................
Telephone: ) .......................................................................................................................................................................................................
(360 349-7685
.............................. ............................................................................................................................................
Signature:C ( ) j __________________________
Property Identifi tion: (3)
.........................................................................................................................................................................................................................................................................................................................................................................
32134-23-90040
.. ....................................................................................................................................................................................................................
Section II. I (completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
24
...................................................................................:.................................................................................... . . . . .
.......................................................:.....................................................................................................................................................
. .........-272A- 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR PRESSURE OSS (OR).................................... .. ............................................ ............................................................................................................ ..............................................................................................
Subsection:
TABLE VI Justification(mitigation measures to be 7
provided): () COMPLETED CLASS B WAIVER CHECKLIST ATTACHED
..........................................................................................................................................................................................................................................................................................................
(OUTLINING ADDITIONAL REQUIREMENTS RECORDED DECLARATION OF COVENANT FOR ATTN.MET).
..................................................................... .............................................................................................................................................................................................................
ZONE (AFN: Z -3 9T6 '
.Section III. I (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
.........................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................
...............................................................................................................................-.......................................................................................................................
Comments/Conditions: (10)
.................................................................................................._ P•Pi.........G� 5S...... .......U1 A.1. ........ ... S ...................................................................................................,............
Type of Waiver: (11) [ ]Class A [VI Class B [ ]Class C—Request DOH review before granting? Yes No
Neighbor Notification: (12) Required? Yes_ No J !f needed, are agreements, easements, etc.properly filed? Yes _ No
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 [4'Approved/Grante Subject to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13) Date:
DOH 337-021
4 r
This is one of a set of maps prepared by the Soil Conservation Service' U. S. Department of Agriculture, for a soil survey report of this area. For Infor- s,
motion regarding the complete soil survey report, write the Soil Conservation Service, U. S. Department of Agriculture. Washington 25, D. C. This map
compiled from aerial photographs flown in 1951 and 1953.
Range, township, and section corners shown on this map are indefinite.
(Joins sheet 7 4)
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