HomeMy WebLinkAboutWAI2026-00041 - WAI Health Waiver - 7/9/2026 415 N.6th STREET,SHELTON WA 98584
4I IIASO N COUNTY S ext 400
ELFAIIR:360-2 5HELTON: ?44670 ext.400
Public Health & Human Services
Application i, Li
pp atlon for Waiver or Appeal �� ,
Amount Paid: l Receipt Number: al �Q
WAI aO p - C0 O L4
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 Robert Ben Pocius Telephone 360-621-6437
Mailing Address 16923 Olympic view Dr NW
City Silverdale State WA Zip 98312
Parcel No. 2 2 0 0 5 -- --
5 2 0 0 0 5 7
Site Address 2820 E Phillips Lake Loop Rd; Shelton, WA 98584
Subdivision Name and Lot Phillips Lake Div 3 Lot 57
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-0210 ❑ Building Permit: EH Review Policies
0 Onsite: Holding Tank, WAC246-272A- U Appeal: Enforcement Timelines
0240 O Appeal:Departmental Determinations
❑ Onsite: Contractor Certification ❑ Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.):
Horizontal Separation of Septic tanks to non-public well from 50' down to 25'
WAC 246-272A-0210(1) Ta e IV
Installer to complete Items 1 through of tate approved mitigation measures see
attached.
Item 4 is mute as well and septic both belong to Robert Pocius
n po-q i A/,f/L� c-//, v p u/ a . 2S
Applicant Signature: Date: 05/18/2026
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: Type of Onsite Waiver (if applicable)
❑Appeal *aiver 'Class A ❑Class B 0 Class C ❑ Local
State Waiver Criteria
Number of Bedrooms: Nitrogen Treatment: L 6(es No
Soil Type: Minimum Lot Size: (V�-( S sq.ft.
Water Source:❑Public "Private This Lot Size: I sq.ft.
Is This Lot Eligible/for State Waivers: ales 0 No 0 N/A
Hearing Official: cl
Environmental Health Manager ❑ Public Health Director ❑ Other:
2. Identification of Specific Code/Standard/Determination (include date of determination or latest
Code/Standard revision): v\f " ,y►��fLV7I-A'-O .i O
3. Nature of Appeal:
5. Mitigating Factors: /^ r, "�."
v�iack, wv F �Y �GWy C'V 0p. Cau).Gk t)1 IB S
— G I��e du1�' 1opr ) r(AT1 ttcSVt \ (o((.
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: �t Date: '716 1 i�
PART 4: Determination of the Hearing Official
JThe 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: K
Date:-E f#8f2A�8'
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
Page2of2
I•
On-Site Sewage Systems (Chapter 246-272A WAC) ®rNEALTI
wishIo®'u"Statecop.rionn
Request for Waiver from State Regulations '
S.e tj n l j (Completed by applicant)
Name: (1) Robert Ben Pocius LocalHehlth`Jun diet on Rece,vecl '/ ¢
( eearnstuctons)y' ss
Address: 16923 Olympic View Dr NW ' �
._.._.___.....__..___._....._._.._.—..-_.._.. r .... ..,...a.,. 4 5�`L .Z..1 _ul n£ •. 4Vit`s*�G
Silverdale �. � �
r WA 98383
__.._.__.._._._.__.__- .._._....._........ '
Telephone: (360) 621-6437
Sign
Property Identification: (3)
2820 E Phillips Lake Loop Rd;Shelton, WA 98584 ___.___...._._.-_.._....-....__......._.........._..._._. _.
---._._.__._._._....-... ..___...__._......._._.__—__..__—....-..........._---_.___.__._._----•—__._....._—._........__._...—_.._._�.___.__.._...__._..-----._-------_______....�_______.
22005-52-00057
Section ii (Completed by applicant)
WAC Number: (4) LC Requirement: (5) Waiver Sought: (6)
246-272A-
021 0(1) Pressure sewer transport line 50' 25' set back
Subsection: from Non-Public well • �— —
V
tification (Proposed mitigation measures):(7) t .
il�rv(? SM'�C+ Pin - x�b( c0i ir 'E l�acal.
Well owner is encroachment person notificaon is not required. See attached complete pounds
ns ort line sleeved in Sch 40 PVC casing uniform) su orted per state - Leakage test at 70 ounds
q hed for complete requirements
Sect onRIii ...,` (Completed by local health officer)
Review Criteria: (8) Additional Mitigation Measures:(9)
Comments/Conditions: (10)
Type of Waiver: (11J Class A Class B IIIClass C— Request DOH review before granting? Yes No
Neighbor Notification: (12) Required?Yes❑No❑ If needed, are agreements, easements, etc.filed? Yes fj NoE
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 f[Approved/Grant —Subj 'to all comments, conditions and requirements n ted in Sections II and Ill.
Local Health Officer(13) Date: 7/'
DOH 337-175 February 2024
C
Table 2. CLASS A - SEWAGE TANK HORIZONTAL SEPARATIONS
WAC Specific Item Extent or Minimum Issues/Criteria to Approved Mitigation Measures'
Section Waived Degree Consider
Waived
246-272A- Sewage tank 50 Down to 25 feet 1)Extra protection of integrity of tank la)Waterproof surface barrier applied to concrete tank consistent with Manual of
0210(1) feet from surface and joints Concrete Practice ACI 515.1R.Flexible rubber boots or compression seals meeting ASTM C
Table IV water 1644,or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to
provide flexibility in case of tank settlement while still maintaining a watertight seal.
2)Performance testing of tank 2a)Concrete tank tested for water-tightness consistent with ASTM C 1227.
3)Accessibility of tank for ease of 3a)Access openings at or above finished grade with lockable lids or secured to prevent
operation and maintenance unauthorized entry
246-272A- Sewage tank 50 Down to 25 feet 1)Extra protection of integrity of tank a Waterproof surface barrier applied to concrete tank consistent with Manual of
0210(1) feet from non- and joints Concrete Practice ACI 515.1R.
Table IV public well or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to
suction line provide flexibility in case of tank settlement while still maintaining a watertight seal.
2)Performance testing of tank 2a)Concrete tank tested for water-tightness consistent with ASTM C 1227.
3)Accessibility of tank for ease of 3a)Access openings at or above finished grade with lockable lids or secured to prevent
operation and maintenance unauthorized entry.
4)Determination of any existing 4a)Notification of proposed encroachment to the well owner if there are no existing
covenants or easements for covenants or easements establishing a control area. /k o T /11 ,Lhf
maintaining a sanitary control area O✓ I2' Est/ (. 'i(A1 .LL
246-272A- Sewage tank 10 Down to 2 feet 1)Extra protection of integrity of tan la)Waterproof surface barrier applied to concrete tank consistent with Manua o
0210(1) feet from and joints Concrete Practice ACI 515.1R.Flexible rubber boots or compression seals meeting ASTM C
Table IV pressured water 1644,or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to
supply line provide flexibility in case of tank settlement while still maintaining a watertight seal.
2)Performance testing of tank 2a)Concrete tank tested for water-tightness consistent with ASTM C 1227.
3)Accessibility of tank for ease of 3a)Access openings at or above finished grade with lockable lids or secured to prevent
operation and maintenance unauthorized entry.
4)Extra protection of integrity of 4a)Water line installed in casing of at least Schedule 40 PVC within 10 feet of the tank.
water line Water lines are uniformly supported by pressure-grouting annular space with sand-cement
grout or bentonite,or casing spacers or skids installed consistent with AWWA PVC Pipe
Design and Installation Manual M23-7-2.
•The local health officer may require additional site-specific Issues and criteria to consider,and mitigation measures.
Table 1. CLASS A—NONPERFORATED DISTRIBUTION LINE HORIZONTAL SEPARATIONS (6/07) (cont.)
EiNr�1 �Clr�e IlAlrttit�i�rra�)` � }yy�� pb �p �p pq Sodôn .
'sue :,«,a .,�' H : : ' Ileast
�
246-272A- Pressure sewer transport line 50 Down to 25 feet 1)Extra protection of in -y J ^
0210(1) feet from non-public well or qty of line in)Transport line Installed In a casing of at Schedule 40 PVC within
Table IV suction line
within 50 feet of well 50 feet of well.Transport line uniform
�_. b supported by
ng spacers
os installed consistent with AWWA PVC Pipe Design and
Installation Manual M23.Underground installation of line consistent
with ASTM D 2774.
2)Performance testing of line 2a)Transport line leakage tests consistent with ASTM D 2774,except
line should be pressurized to 150%of the system's design operating
pressure,but not less than 70 psi,and pressure must hold for 1 hour.
3)Determination of any existing 3a)Notify the well owner of the proposed encroachment if there are no
covenants or easements for maintaining existing covenants or easements establishing a control area.
—__ a sanitary control area
Rhonda Thompson
From: Thomas Weaver <tweaver1431 @gmail.com>
Sent: Monday,July 6, 2026 8:55 AM
To: Rhonda Thompson
Subject: Re: Pocius 2820 E Phillips Lake Loop Rd
The actual distance from the well we intend to use is 35' or more from the well.
The issue that is not obvious from the site plan is a dispute with the neighbor.
There is a very large stump that if removed would allow for the 50' setback.
The stump is unfortunately intertwined with the stump of another very large tree just over the line on the
neighbors property.
This became a significant issue with the neighbor.
Tom Weaver
Allied Design Inc
On Jul 6, 2026, at 8:24 AM, Rhonda Thompson <RThompson@masoncountywa.gov>wrote:
Thanks, I will forward this over to Wendy Mathews who does the well construction
inspections.
When I look at the new site plan, it seems like the new tanks could be placed outside of the
50ft well radius. Is there a reason they need to be inside? Can't they be shifted outside?
Thanks,
Rhonda Thompson, RS
Senior Environmental Health Specialist
Mason County Public Health
415 N 6th St. Shelton,WA 98584
360-427-9670 ext. 581
Rthompson masoncountywa.gov
To register for an upcoming homeowner septic workshop, please
visit: https://extension.wsu.edu/mason/event/septic-summer/2026-06-18/
From:Thomas Weaver<tweaver1431@gmail.com>
Sent: Monday,July 6, 2026 8:02 AM
To: Rhonda Thompson<RThompson@masoncountywa.gov>
Subject: Pocius 2820 E Phillips Lake Loop Rd
I believe this should meet the corrections you requested.
Upon hearing back from you I will resubmit the BSA with the new site plan.
Tom Weaver
1