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Home My WebLink AboutWAI2026-00034 - WAI Health Waiver - 5/28/2026 A MASON 415 N.6th STREET,SHELTON WA 98584 COUNTY S . -9670,ext 400 BELFAIR:360-277-4467,ext.400 ublic Health & Human Services Application for Waiver or Appeal Amoun Paid: IO Receipt Number:MCP — 0t/ WAI� oo O 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 full com eted. 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 BENSON RIDGE FORTE/B-LINE Telephone 360-426-4221 Mailing Address 690 E BENSON RIDGE RD city GRAPEVIEW State WA Zip 98546 Parcel No. 2 2 1 0 4 _ 4 1 _ 5 0 0 2 0 Site Address 711 E BENSON RIDGE RD Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Onsite:Class A Waiver O Food Sanitation Requirements D Onsite:Class B Waiver ❑ Group B Water System Regulations ❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location,WAC246-272A-0210 0 Building Permit: EH Review Policies ❑ Onsite: Holding Tank,WAC246-272A- Appeal:Enforcement Timelines 0240 0 Appeal:Departmental Determinations ❑ Onsite:Contractor Certification ❑ Other Requirements Description of Waiver/Appeal(include justification, additional material may be attached.): Reduce Vertical Se aration for Conventional Gravi Class B Waiver Checklist Recorded Declaration of Attenuation Zone ii Applicant Signature: LakT4pp g Date: Revised 03/03/2026 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: Ty pe of Onsite Waiver(if applicable) ❑Appeal El Waiver ❑Class A 0 Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedroor4: y Nitrogen Treatment: ❑Yes l 'No Soil Type: T Minimum Lot Size: Water Source: ublic ❑Private sq.ft. This Lot Size: �,h �� sq.ft. Is This Lot Eligible for State Waivers: �+ la'S'es O No ❑ N/A Hearing Official: 0 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 Gravitwor-2resserecan 5. Mitigating Factors: Class B Waiver Checklist Meets additional re uirements outlined within) Recorded Declaration Covenant for OSS Attenuation Zone (AFN._ C 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local polic s been sub fitted. Staff Signature: 24 2, Date: PART 4: Deter ina on of the Hearing Official he 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: s Z 2Z Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) Wahlpfon Stun fl�putm�ar of Request for Waiver from State Regulations V141rHEALTH Section I. (Completed by applicant) Name:(1) BENSON RIDGE FORTE/B-LINE CONST Local Health Jurisdiction Received(2) Address: (See Instructions) 690 E BENSON RIDGE RD Mason - GRAPEVIEW, WA. 98548 Telephone: 360-426-4221 Signature: f ) Q Property Identifica ion:(3) 22.1..04-41-50020 Sectional. I (Completed by applicant) WAC Number:(4) WAC Requirement:(5) Waiver Sought:(6) 246-272 A- 0230 ,e fessuri(or) . ,; ... . .... . . ... .. . Subsection: 36"of V/S for Grav' 18" Table VI of V/S for Gravity OSS Justification(Proposed mitigation measures):(7) Completed Class B Waiver Checklist Attached,(Outlining Additional Requirements Met). Recorded ...... ... Declaration of Covenant for ATTN. Zone (AFN: 2 D.L/((i5 ( ) _ Section111. I (Completed by local health officer) Review Criteria:(8) Additional Mitigation Measures:(9) 10 fie,re I o —/ tm SJ C Fa ct a h 1W Comments/Conditions:(10) See.Ciass B'Waiver Worksheet . Type of Waiver:(11) Class A R/ Class B Class C—Request DOH review before granting? YesEJ No Neighbor Notification:(12) Required?Yesallo J If needed,are agreements,easements,etc.filed? Yes j NoIJ 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 lea ual to that provided by this chapter WAC. EJDenied IN Approved/Granted—Subj to all comments,conditions and requirements noted in Sect nns II and Ill. Local Health Officer(13) Date: DOH 337-175 February 2024 1 MASON COUNTY COMMUNITY SERVICES MASON COUNTY PUBLIC HEALTH Building,Planning,EnHronmental Health,CommunityHealth CLASS B WAIVER WORKSHEET 415 N.6TH STREET,BLDG 8,SHELTON WA 98684 .400 (State and Local waiver forms required) SHELTON:360.427.9870,EXT.400'-BELFAIR:360.276.4467,EXT APPUCANTNAME_ 9.eavrr�f OR 4 €l tf WAIVER PERMITNUMBER WAI MAILING ADDRESS L( ttJ J D PU S'a'e rl`t CITY �26C417o // Aej f�sl STATE ZIP SITE ADDRESS �7( � ' 8C yy.,.••+. nn TAX PARCEL NUMBER_ L©Lf_ w tJ'�tfJ PROPOSED DRAINFIELDTYPE CONVENTIONAL GRAVITY 0 CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood,Harstine,Hoodsport, Shelton,or Sinclair Gravelly Sandy Loam. �p-slope vertical separation must be greater than 18" for gravity and greater than 12"for pressure. Alderwood Gravelly Sandy Loam. r^, Greaterthan 12"..................................................-,.......... Gravelly Sandy Loam. ..........................„. ❑ ❑ Harstine °- s Hoodsport Gravelly Sandy Loam............ O❑ Greater than 18".,...,,,-....,,.,„,,..,,,,. .,,................... .. -Determined by: Shelton Gravelly Sandy Loam.......................................❑ Depth to hardpan................ ...... ......-............ af0 Sinclair Gravelly Sandy Loam............................... Other ® Depth to mottling..................„...........................,......... ❑ Both.................... ^..,..„.........................„' ❑ 2.SOIL TYPE: 6.WATER TABLE LEVEL: Sall 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............................................ o❑ :w Loam Sand,.-,,.„...,...„ -Evidence of seasonal water table: Y .....................„-............. .❑ V. ,a` Yes. Sandy Loam. Ia „........................ ,� „......,.............,......,.,....,„,.....„.....„.......„.....................„, ❑ ro Percent Gravel: .`O„ No............................. .................,...,,-........,..........,.............. "a „•ro , -Curtain Drain required: `1 Less than or equal to 35%.................... ❑ ; rOK Yes............................... Greater than 35%.............••"-...,..............-.........,.......,.❑ ;0`1,x• No,.............,...,........... ..............,,.....,,......,.........-....,.......,... .�� .................................................„...... .❑ 3.SOIL DRAINAGE 7.HORIZONTAL SETBACKS: [_Soils must be moderately well drained to well drained. = ____,________—I ;p± imary Drainfield must maintain 200 f- ;�o a . ent marine shorelines,surface waters,and wells. f =,•:O` WellDrained.....,............ ,........................,,................- Moderately Well Drained.............................................. ❑ fl -Are Increased horizontal setbacks ❑ .„ met. Other Yes. ! ............................... .ar J' p•' 4.DRAINFIELD SLOPE: No.................... 0❑ FD 8.ATTENUATION ZONE Slopes must be between 3%to 30%. , ' I, Gravity is only allowed on slopes from 3%to 15%. A 50 foot horizontal attenuation zone Is required �µ Pressure is allowed on 3%to 30%. down-gradient of the primary drainfieid _ Less than 3% >-.`. ........................................................ r.>:a ............. _�:_ -Is there 50 ft or greater between the down ,, • �• 3%to 15%............._. ...............„....................................... � :. gradient side of primary drainfleld and property boundary: Greater than 30%..........................................„..........-.„. ❑ ,: Yes...........................,..............,.,...........................................❑ kJ No..................................................„ ................. ... .. ❑ =50footontal attenuation zone is required to be recorded on the deed of the property as unbuildable , L� pproval.The attenuation zone Is not to be used for the contruction of roadsdocks,pathos. AFN;hicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of Recording: THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE, updated 3/2/2017 abF ew '�'t 41 vC Qp III1rvr/.