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Home My WebLink AboutWAI2026-00013 - WAI Health Waiver - 2/25/2026 415 N.6`h STREET,SHELT0N WA 98584 SHELTON:360-427-9670,ext 400 MAS,r�xr OJ:11 COUNTY BELFAIR:3 '0- 7 ext.400 COMMU yITY SEi VICES Bulldt4g;Planning,EtwimmentalHealth;communityHealt 1} L � � FEB 2 4 2026 Application for Waiver or Appeal 1 wy, Amount Paid: Receipt Number: p0 (o o G 0(� WAl aoa(e - DW Please note,all approved Onsite Waivers have the same expiration date as their OSS Permits. Instructions: 1. ..:Complete Parts 1 and 2 No:deternainatton can be made.until these parts are fully completed. 2 :Fees may be billed for waivers arid based can 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 @'ç Teiephon =`' Mailing Address \ \ c City State Zip J Parcel No. dam- \ -- Site Address \� . cs \ � . Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Onsite:Class A Waiver ❑ Food Sanitation Requirements ® Onsite: Class B Waiver O Group B Water System Regulations ❑ Onsite:Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location,WAC246-272A-0210 ❑ 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 Vertical Separation for Pressure OSS Class B Waiver Checklist Recorded Declaration of Attenuation Zone Applicant Signature: ._• _ Date: Revised 9/29/2025 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 'Waiver o None required ❑ Class A (Class 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 GRAVITY OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health O Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board ' Environmental Health Manager 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE(AFN 23' 3j ) - c ax - I crr- C 3ieMc I O4sT- ') 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'J7.3177 PART 4: Determination of the Hearing Official l .. 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: �- Z C Revised 9/29/2025 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 M � MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building,Plannrng,EnNronmental Health,Community Heath 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 APPLICANT NAME *` ^. WAIVER PERMIT NUMBER WAI ?/0 O Z.-- -' 00 IS MAILWGADDRESS SD` \`�J )„J r�� ,�y STATE ZIP SITE ADDRESS a� \ a C�1 1 CnY TAX PARCEL NUMBER - PROPOSED DRAINFIELDTIPE O CONVENTIONAL GRAVITY .CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: tVV 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................................❑ Greater than 12"............................................................... Harstine Gravelly Sandy Loam.....................................Q Greater than 18"............................................................... ❑ O Hoodsport Gravelly Sandy Loam ❑ -Determined by: Y Shelton Gravelly Sandy Loam.....................................❑ El Depth to hardpan.............................................................❑ e Sinclair Gravelly Sandy Loam........................................❑ Depth to mottling.......................................................... E Other ❑ J 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.....................................................................❑ -Evidence of seasonal water table: LoamySand...................................................................... .❑ Yes..............................................._...................................... ❑ Sandy Loam..........................................................................� No ,l? Percent Gravel: -Curtain Drain required: -Less than or equal to 35%....................................... Yes............................ ..................... . -Greater than 35%.........................................................❑ xl . No..........................................................................................Jr.� 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: }► Soils must be moderately well drained towell drained. C]; Primary Drainfield must maintain 200'from down-grad) 4 ent marine shorelines,surface waters,and wells. WellDrained.................................................................... ❑ Moderately Well Drained............................................... f r -Are increased horizontal setbacks met: Other ______________ 0 Yes..........................................................................................� No................................ ... _............ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 30%. ', 5 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. s.. Less than 3%............................. ❑ O Is there 50 ft or greater between the down 3%to 15%.................„. .................................-.-......... ❑ r gradient side of primary drainfield and 16%to 30%....................................................................... ( property boundary: Greaterthan30%............................................................. ❑ Q Yes.................................. ................................................ xr. No...................................._.................................................... ❑ } - The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 2 prior to design approval The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: Zz313 H'1 parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof ofRecording. THIS FORM MAY BESCANNED AND AVAILABLE FORPUBUC VIEW ONTHE MASON COUNTY WEBSITE. updated 3/2/2017 On-Site Sewage Systems (Chapter 246-272A WAC) Washfn�fanSrare.Uaparrmont'roF. Request for Waiver from State Regulations H . T q g H Se Wart:a 1 (Completed by applicant) Name: (1) ,—. Local Health Jury dict►on Received(2) Ad ess. 1 \ ` 11 Sori ourrfy Telephone /_ Si nature. Property Identification: (3) Section I1 J (Completed by applicant) WAC Number:(4) WAC Requirement: (5) Waiver Sought:(6) 246-272A O23O 24"of v%S for Pressure(or) 12"of V%S-for-Pressure OSS (or Subsection: Table VI � Justification (Proposed Completed Class B Waiver Checklist Attached,(Outlining Additional Requirements Met). Recorded Declaration of Covenant for ATTN. Zone (AFN: 2Z- I' '1'i ) Section UI I (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures:(9) Comments/Conditions:(10) Type of Waiver (11) Class A W/Jj Class B Class C— Request DOH review before granting? Yes No!I ?Il 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. LIDenied Approved/Granted— ubject II comments,conditions and requirements not d in Sections 11 and III. Local Health O icer(13) Date: Z DOH 337-175 February 2024 1