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Home My WebLink AboutWAI2026-00040 - WAI Health Waiver - 5/28/2026 HELTON: 360-427-9670, ext 400 415 N. 6`"STREET,SHELTON WA 98584 MASON COUNTY S BELFAIR: 360-275-4467,ext.400 Public Health & Human Services MAY 1 2 7.026 Application for Waiver or Appeal By Amount Paid: Receipt Number: - �L WAI _ a� 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 SHANNON ALATALO Telephone Mailing Address 1690 TREASURE IS DR City ALLYN State WA Zip 98524 Parcel No. 1 2 3 3 0 __ 7 6 __ 0 0 0 1 0 Site Address XXX NE MAST RD - BELFAIR Subdivision Name and Lot PART 2: Nature of Waiver/Appeal El Onsite: Class A Waiver El Food Sanitation Requirements El Onsite: Class B Waiver El Group B Water System Regulations ❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location, WAC246-272A-021 0 ❑ Building Permit: EH Review Policies ❑ Onsite: Holding Tank, WAC246-272A- El Appeal: Enforcement Timelines 0240 El Appeal: Departmental Determinations ❑ Onsite: Contractor Certification El Other Requirements Description of Waiver/Appeal (include justification, a?Gravitv aterial may be attached.): Reduce Vertical Separation for Conventi o Pressure OSS Class B Waiver Checklist Recorded Declaration of Attenuation Zone Applicant Signature: Gt J Date: 3 Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page I of'2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal Iii Waiver ❑ Class A I]Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedro s: 9 ` Nitrogen Treatment: Yes 1 No Soil Type: �Y ` Minimum Lot Size: - Water Source:❑Public Private This Lot Size: Is This Lot Eligible for State Waivers: 'es ❑ 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): WAC246-272A-0230,Table VI 3. Nature of Appeal: Reduce Vertical Separation Requirements for Conventional Gravity or Pressure OSS 5. Mitigating Factors: Class B Waiver Checklist (Meets additional requirements outlined within) Recorded Declaration Covenant for OSS Attenuation Zone (AFN ) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted.y►� Staff Signature: `6 Date: PART 4: Determination of the Hearing Official W-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: ❑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: 2-a Zf Revised 03/03/2026 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 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./4, A A r. A .+A1 Y Y I p WAIVER PERMIT NUMBER A I MAILINGADDRESS f(- K (O 6 / j-J/�Q (S DL CITY 4 y n STATE ll)�{ ZIP SITE ADDRESS )c/C) f �r , CIT V Y TAX PARCEL NUMBER 1��J — -7 Ig — oiO f' PROPOSED DRAINFIELD TYPErCONV-ENTIONALIGRADVITY ❑ 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................................❑ ❑ Greater than 12.................................................................. ❑ ❑ Harstine Gravelly Sandy Loam..................................... ❑ ❑ Greater than 18"................................................................ E( I Hoodsport Gravelly Sandy Loam................................ ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam.......................................❑ ❑ Depth to hardpan............................................................. ❑ ❑ Sinclair Gravelly Sandy Loam........................................❑ ❑ r Depth to mottling.......................................................... Other ........... 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:Q LoamySand.........................................................................❑ ❑ r° Yes......................................................................................... L7 9 SandyLoam......................................................................... 1LY1- No........................................................................................... ❑ ❑ Percent Gravel: �� -Curtain Drain required: Lessthan or equal to 35%....................................... o Yes.......................................................................................... ❑ 0J Greaterthan 35%.........................................................❑ ❑ No........................................................................................... Lfa 3.SOIL DRAINAGE: 7.HORIZONTAL SETBACKS: n c ro Soils must be moderately well drained to well drained. p Primary Drainfield must maintain 2OO'from down-gradi- ent marine shorelines,surface waters,and wells. 0 WellDrained...................................................................... Moderately Well Drained............................................... ❑ ❑ -Are increased horizontal setbacks met: Other .............. ❑ ❑ Yes.......................................................................................... tfd' No........................................................................................... ❑ ❑ 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%...................................................................... ❑ U❑� -Is there SO ft or greater between the down 3%to 15%.......................................................................... . gradient side of primary drainfield and 16%t030%........................................................................ ❑ ❑ property boundary: ✓ Greaterthan 30%............................................................. ❑ ❑ Yes.......................................................................................... Lwl No.......................................................................................... ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable ^ 1 A prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: aZ0,L ` L 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 On-Site Sewage Systems (Chapter 246-272A WAC) Waahny,.nSbt.U.pz,m.ntut Request for Waiver from State Regulations 1192")F H E ALT H Section I. (Completed by applicant) Name: (1) SHANNON ALATALO Local Health Jurisdiction Received (2) .__.._ (See instructions) Address: 1690 E TREASURE IS DR Mason County .................. .. ......._ .......... .................................................. ALLYN, WA 98524 ........ _... . ... . . ....... ..... ........_ ........ . ...__.. ...... . ............ .................. ... ........_ .._ Telephone: ..._... ......._ ........... ..__.._.......... _ Signature: Property Identification: ) _..._. .._...... _ ......_.. ....__ _. .... ......... ...-----_. ...... _......... ...............__._.. .. _............._..__._......._..._..._.... 12330-76-00010, XXX MAST RD - BELFAIR Section II. (Completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) . -.............. ..............................................._................ 246-272A- 0230 24"of V/S for Pressure (or) 12"of V/S for Pressure OSS(or) .._......__... . Subsection: Table VI6"o V/S for Gravity "of V/S for Gravit .y OSS Justification (Proposed mitig re {3 Completed Class B Waiver Checklist Attached,(Outlining Additional Requirements Met). Recorded Declaration of Covenant for ATTN. Zone (AFN:��(2 7 ) Section III. (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures: (9) ...._......_._.._..._................_ ..................................................._..................................................................................._.............................._ ._...._..................._....._ _._.._......._...._................ ._.._-..........................._........_...._._...... ............ . . ..... .... ....... ..........._ ._ .............................................. ..... .......................... . .__...._..............._..__.---_.. .... Comments/Conditions: (10) _..----._......._...__........._.._..-.._......-...---...._.._..- — —. ._......_..__..._.. .........._._.. --._.._._..__..... See Class B Waiver Worksheet ........ . __ ._._..... ..............-—— ---._.._.............___ ........ Type of Waiver: (11)LI Class A Class B Class C— Request DOH review before granting? Yes No Neighbor Notification: (12) Required?Yes No❑ If needed, are agreements, easements, etc.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 Approved/Granted — Subject II comments, conditions and requirements notedyl Seecti ns II and III. Local Health Officer(13) Date: L-`^ DOH 337-175 February 2024 1 5/26/26,8:35 AM Mason County WA GIS Mason County WA GIS 1' 123307600010 X Q 29n Show search results for 12330... •a _11 .T—. _ ti :f C • w. SwF �. 4'7 O . 100ft https://gis.masoncounta.gov/mason/ 2241292 MASON CO WA I 06/0112026 02:50 PM DELL I RLATRLO 11222543 Rao Fee: $304.50 Pages: 2 1111111111111III 1111 Ii1illllllllllI1 DI llllllll 11111110111111111llll Return To -- _. HPt Po qm( 52 1 ELFRI IJ JUN 0 1 2026 By Grantor(s): (1) V1A W, AulA+-ra L-O , (2) �tUST1I CJ�STC.eL Grantee(s):,(1)'PUBLIC Legal Description (1) T L DF 3\)Rwr U / -7 3 55/ '2.''2- (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 1 2 3 3 C) -7 - _. ?D CSO - 23 , 0 1 ) DECLARATION OF COVENANT FOR ON-SITE SEWAGE ATTENUATION ZONE I (We)the grantor(s) herein, am (are)the owners in fee simple of(an interest in)the described real estate situated in Mason County, State of Washington; hereby declare this covenant & place.the same on record; to wit the described real estate on which the grantor(s) owns and operates an on-site sewage disposal system which has been granted a Class B State Waiver to reduce the Minimum Vertical Separation requirements and grantor(s) is (are) required to maintain a 50-foot horizontal attenuation zone down gradient of the on-site sewage system to facilitate treatment of the sewage effluent. It is the purpose of these grants and covenants to prevent certain practices hereinafter enumerated in the use of the grantor(s) land which might encumber the land set aside for further sewage treatment and disposal. NOW, THEREFORE, the grantor(s)agree(s),and covenant(s)that said grantor(s), his (her) (their) heirs, successors and assigns will not construct or install any trench, channel, ditch, road cut, utility chase, or other structure of excavation what would intercept or serve as a conduit for migrating ground water. Dated on this__�day of , 20'2. '. Page 1 of 2 Signature of Grantor(s): (1)3j _ , (2) State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this _day of dl4a�. , 20%' , S n on 14(c4-°'t(o 4' ( - V t,e4e4 rsonally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed It. GIVEN under my hand and official seal the day and year last above written. ,,;.•,'\\''��KRUGF��.,,�, Notary Public in and for the State of Washington, •:��. F residing at K t i r NOTARY . My commission expires: j ,7 2- 20112949 `: PUBLIC '2 Page 2 of 2