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Home My WebLink AboutWAI2026-02531 - WAI Health Waiver - 6/17/2026 415 N. 6th STREET, SHELTON WA 98584 M ASO N CO U N TY SBELFAOR:36O4279670,e}t 44OO OO Public Health & Human Services Q � � JUN 0 4 2026 Application for Waiver or Appeal �Y Amount Paid: V Receipt Number: h .'S3 I WAI : -(47 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 Daniel Ford Telephone (360) 981-0064 Mailing Address 131 E Olympic Ct City Allyn State WA zip 98524 Parcel No. 3 2 1 3 4 -- 7 5 -- 0 0 0 5 0 Site Address 260 E Catfish Lake Rd, Shelton Subdivision Name and Lot _ PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements D Onsite: Class B Waiver ❑ Group B Water System Regulations ❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location, WAC246-272A-O21O ❑ Building Permit: EH Review Policies ❑ Onsite: Holding Tank, WAC246-272A- ❑ Appeal: Enforcement Timelines 0240 O Appeal: Departmental Determinations ❑ Onsite: Contractor Certification ❑ Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): Reduce Vertical Separation for Conventional Gravity Recorded Declaration olAttenualion Zone �= z1y26nr� Applicant Signature: Date: �'3ao'l6 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 []Waiver ❑ Class A El Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedrooms: Nitrogen Treatment: ❑Yes 01 No Soil Type: L( Minimum Lot Size: ) sq.ft. Water Source:❑PublicPrivate This Lot Size: 4 sq.ft. Is This Lot Eligible for State Waivers: 'Yes ❑ No ❑ N/A Hearing Official: 21 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 5. Mitigating Factors: Class B Waiver Checklist (Meets additional requirements outlined within) Recorded Declaration Covenant for OSS Attenuation Zone (AFN 2'j y-16'OO _) 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy ha en submitted. Staff Signature: Date: V 0 V PART 4: Determination of the Hearing Official 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:_________________________________cam Date:_____________ 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 pAh I-I Po rd WAIVER PERMIT NUMBER WAI W. Z6 _ d O O'' L1 MAILING ADDRESS ` OttfbYt(✓ C4 1./4 Q fYI� �Y All y t STATE VV 1 ` C I ZIP U � l SITE ADDRESS a6 E Cc is k LkLq, Rw CITY TAX PARCEL NUMBER 3a 13`t L S PROPOSED DRAINFIELD TYPE CONVENTIONAL GRAVrrY ❑ 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"................................................................ �( Hoodsport Gravelly Sandy Loam................................ ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam.......................................V 0 Depth to hardpan....................................................... ❑ Sinclair Gravelly Sandy Loam........................................❑ ❑ Depth to mottling.......................................................... ❑ Other ...........0 0 Both................................................................... ....... ❑ 2.SOILTYPE: 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..................................................................... ❑ 0 -Evidence of seasonal water table: p1 2 LoamySand......................................................................... �N s, Yes.......................................................................................... � � r« SandyLoam.........................................................................❑ ❑ z No......................................................................................,.... Percent Gravel: -Curtain Drain required: -Less than or equal to 35%....................................... Yes.......................................................................................,.. ❑ -Greater than 35%.........................................................❑ 0 No........................................................................................... D 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: c Soils must be moderately well drained to well drained. O Primary Drainfield must maintain 200'from down-gradi- ent marine shorelines,surface waters,and wells. WellDrained...................................................................... . .1jJ Moderately Well Drained ............... ❑ -Are increased horizontal setbacks met: ( rn Other ❑ ❑ Yes.......................................................................................... bGi .............. 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%.. ... .. ❑ -Is there 50 ft or greater between the down .................................................... ......... . 3%to 15%.......................................................................... gradient side of primary drainfield and 16%to 30%........................................................................ ❑ ❑ property boundary: Greaterthan 30%............................................................. ❑ 0 Yes.......................................................................................... No.......................................................................................... ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios, AFN: l• o 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) w..hinq,an,,.,.Deportmentof Request for Waiver from State Regulations ,g r H E A LT H Section I. (Completed by applicant) Name: (1) Daniel Ford Local Health Jurisdiction Received (2) _ (See instructions) Address: 131 E Olympic Ct Mason County Allyn, WA 98524 Telephone: (360) 981-0064 Signature: `� - -�--�_—_� — -----�---------�__-._—._—_ Property Identification: (3) rd ess:260-E-C-a1fish 1_a ct—e Rd-S"elton Parcel Number: 32134-75-00050 Section ll. I (Completed by applicant) WAC Number:(4) WAC Requirement: (5) Waiver Sought: (6) 246-272A- 0230— - - Subsection: Table VI 36"of V/S for Gravity 18" 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: 2291 2(Q(, ) Section III. I (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures:(9) Comments/Conditions: (10) See Class B Waiver Worksheet Type of Waiver:(11) Class A V/ Class B IliClass C— Request DOH review before granting? Yes No Neighbor Notification: (12) Required?Yes❑No fJ If needed, are agreements, easements, etc.filed? YesEli 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 f Approved ranted —Subject to all comments,conditions and requirements noted in Sections II and III. Local Health Officer(13) � �i l�G � of 7 Date: 461/2 ��6 DOH 337-175 February 2024 1