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Home My WebLink AboutWAI2026-00047 - WAI Health Waiver - 6/25/2026 • 415 N.6'.STREET,SHELT0N WA 98584 M AS O O U N SHELT0N:360-427-9670,ext 400 Public Health & Human Services J4Rt5L6 JJ Application for Waiver or Appeal I I9Y 3L1J.QAmount Paid: �I Receipt Number: WAl a0a P C� '-17 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 Empire Home Construction Telephone (360) 751-8062 Mailing Address PO Box 241 City Kelso State WA zip 98626 Parcel No. 3 2 0 2 1 5 3 -- 0 4 0 3 5 Site Address 210 E Bridger Ln, Shelton, WA 98584 Subdivision Name and Lot SHORECREST ADD REPLAT BLK: 4 LOT: 35 PART 2: Nature of Waiver/Appeal ✓❑ 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 Pohicies ❑ 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.): See Attached Mitigation Applicant Signature: Date: 6-10-26 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 Waiver [Class A ❑Class B ❑Class C I Local State Waiver Criteria Number of Bedrooms: 3 Nitrogen Treatment: NYes ❑ No Soil Type: Li Minimum Lot Size: I 0a D sq.ft. Water Source: Public ❑Private This Lot Size: (Or O((S-Y _sq.ft. Is This Lot Eligible for State Waivers: Yes O No ❑ N/A W(fk ToN 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): w'AG7Y(-Z fl4 ` 2(00) Tc (CIV 3. Nature of Appeal: C Sr Wr1�Uhl' I(e4sceMtr my kc"tto'*i cqxvi1 ,i 6eweci o ntIee.i - C +' iL of vr( rv�e e.^ a - dicron 2Sff+o( . Lacs( w c1vcp Min,'s ,P k,I4r,vi c as '7 bit fat -rvda#oMlfiDOh Sffto Z -. 5. Mitigating Factors: Gton aid S44o iz 7L t71 U 3L' ev i'lu aru ce : &(/'he 7Thp(Qin e t t t fsse$5me4 f 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy be submitted.Staff Signature: Date: G yy oza. PART 4: Determination of the Hearing Official IIQThe 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: 0 The hearing official has determined that approval o₹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: r� �Gly� y'�� "� Date:6-10-26 R� ised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 or2 Waa,i"' 2", O.P✓tmrnt ai On-Site Sewage Systems (Chapter 246-272A WAC) lH Request for Waiver from State Regulations Section 1. I (Completed by applicant) Name: (IJ Local Health Jurisdiction Received (2) Empire Home Construction See instructions Address: PO Box 241 __ihcøtCav4i Kelso, WA 98626 Telephone: (360) 751-8062 Signature: ti Property Identification: (3) SHORECREST ADD REPEAT BLK.4 LOT:35- SEC21,TWP 20N, R3W Parcel#32021-53-04035 Section II. j (Completed by applicant) WAC Number:(4) WAC Requirement: (5) Waiver Sought: (6) -_._......_........ __-......_..—__.. - -246-272A- 0210(1) Drainfield 25' min from down- Reduce drainfield to down-slope cut subsection: Table IV slope cut bank (over 5'soil) -...-_. ank setback to-,C2' minimum --- Justification (Proposed mitigation measures): (7) See Attached Mitigation Section III. j (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures:(9) Comments/Conditions: (10) a.4q W frcV^p(d.&4 Type of Waiver: (11) Class A Class B Class C— Request DOH review before granting? Yes No Neighbor Notification.(1Z) Required?Yes❑No If needed, are agreements, easements, etc.filed? Yes No❑ Section IV. (Completed by health officer) This ncqucst for waiver from Statc Regulation hos 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 p ovide public health protection at least equal to that provided by this chapter WAC. ❑Denied Approved/ranted —Subject to all comments, conditions and requirements noted in Sections II and III. Local Health Officer(13) '�Gt�rl�Jt T. /1 Date: 6 _IER DOH 337-175 February 2024 Instructions for Completion Sections I and II are to be completed by the Applicant and must be submitted to the local health jurisdiction. Sections III and IV are to be completed by the local health officer or their authorized representative. Most items in each section above are followed by a number in ( ). Here are the instructions for each: (1) Individual requesting waiver(presumed to be property owner; indicate if not): Include the mailing address and phone number. (2) Local Health Jurisdiction:Jurisdiction with the authority to approve OSS permits in the system's county. County staff typically complete this field using a county stamp. (3) Property Identification: Provide the address, parcel number, permit application number or other identifying description of the property for which a waiver is being requested. A full legal description is not required. (4) WAC Number:Specify the particular WAC number from Chapter 246-272A WAC for which a waiver is being sought, such as "WAC 246-272A-0210(1)." (5) WAC Requirement:State the requirement in the specified WAC for which a waiver is being sought, such as "100-foot setback from soil dispersal component to a well." (6) Waiver Sought: Briefly describe the waiver sought, such as "reduction of setback to 70 feet." (7) Justification: Provide the rationale for the waiver request.What site conditions, system design characteristics, etc. mitigate the deviation to satisfy the WAC's intent? Justification should include supporting technical data, plat plans, device or treatment methodology proposed, possible mitigating site characteristics,gross land area, other options explored, and any other pertinent data. Possible mitigation measures may include system design, site requirements, or administrative approaches. Attach additional pages, if necessary,to provide the local health officer with adequate information upon which to make an informed decision. (8) Review Criteria: Indicate specific criteria used in the review of the proposed waiver and mitigation measures. (9) Additional Mitigation Measures: Indicate any mitigation measures required in addition to those proposed by the applicant. (10) Comments/Conditions: Briefly describe concerns regarding the waiver request, mitigation measures, or related issues. (11) Type of Waiver: Indicate which category of waivers this particular request falls under. For Class C, indicate if DOH review is requested before a decision is made to grant the request. (12) Neighbor Notification:Are there any aspects of this waiver request for which notification to and/or permission by, adjoining or nearby property owners/dwellers would be appropriate? (13) Local Health Officer/Authorized Representative:The local health officer must check the appropriate box and ign,grant or deny the waiver request. Assistance for applicants requesting a"Waiver from Local Health Department/District Health Officers may obtain assistance State Regulations"may be obtained from the Local from the Wanhin8twn Steto Deportment of He Ith in their Health Department or District. proposed "Waiver from State Regulations"by contacting WastewaterMgmt@doh.wa.gov. To request this document in another format,call 1-800-525-0127.Deaf or hard of hearing customers, please call 711(Washington Relay) or email doh.information@doh.wa.gov. DOH 337-175 February 2024 2 Application for Waiver/Appeal Mitigation 6-10-26 Owner: Empire Home Construction Phone: (360) 751-1745 Mailing: PO Box 241, Kelso, WA 98626 Site Address: 210 E Bridger Ln, Shelton, WA 98584 Parcel Number: 32021-53-04035 1) State Class A Waiver Sought: Reduce horizontal separation between drainfield and down-gradient cut bank with more than 5 ft of native soil from 25 ft to a minimum of 12 ft. 2) Mitigation Measures: The septic system proposed is a NuWater BNR-500 to shallow pressure trench system which meets Treatment Level B without disinfection. The new system will also be on a timer, counter and elapse meter to prevent overuse and facilitate future operation and maintenance. The drainfield area has total usable soil depths of 63 to 65 inches,with trench depth not exceeding 15", leaving over 36"to the restrictive layer. The drainfield is in Type 4 Soil. With pressure distribution, the entire drainfield will be utilized equally allowing for consistent distribution and absorption of the septic effluent, thereby protecting the water quality and reducing hydraulic susceptibility. Trees/vegetation on the slope and at the top of the slope have been retained in order to maintain slope stability. 1) Local/County Waiver Sought: Reduce horizontal separation between house and septic tanks from 5 ft to a minimum of 2 ft. 2) Mitigation Measures: The tank is at a lower elevation than the foundation, and the land slopes away from the foundation.