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Home My WebLink AboutWAI2026-00043 - WAI Health Waiver - 6/24/2026 '�!j�,Q'( �/q�,`p�p �/q@, C }� { 415 N.6th STREET,SHELTON WA 98584 `reAE++'T� COUI ITY 5EHELTON:360-427-9670 ext 400 LFAIIR:360-25-467,ext.400 Public Health & Human Services ��, Application for Waiver or Appeal \\ �St Paid: E t Receipt Number: - 7Ac O7-1 k (. wAl - Dc 014 3 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 KYLE KIMBLE/ALLIE HOWE Telephone (360) 4264221 Mailing Address o1 O € I/Y1eA 1yezv— LQkA_ QJv . City SHELTON State WA Zip 98584 Parcel No. 3 1 9 0 3. _ 7 5 _ 9 0 (� 2 0 Site Address 101 SE DUSTY LANE Subdivision Name and Lot PART 2: Nature of Waiver/Appeal El 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 ❑ Onsite: Holding Tank, WAC246-272A- ❑ Appeal:Enforcement Timelines 0240 El 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 rGO6 Class B Waiver Checklist Recorded Declaration of Attenuation Zone Applicant Signature: L ' ' • ,I Date: _ / i.. 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 0 Local State Waiver Criteria Number of Bedrooms:3 Nitrogen Treatment: ❑Yes O No Soil Type: 4 Minimum Lot Size: I ".._ i- rV - sg3tr Water Source:❑Public ❑Private `- . This Lot Size: �, 2: . . sgit- Is This Lot Eligible for State V(faivers: ❑+ Yes ❑ No ❑ N/A Hearing Official: Rl Environmental Health Manager ❑ Public Health Director ❑ Other: 2. Identification of Specific Code/ Standard/Determination (include date of determination or latest Code/ Standard revision): WAc2as-292A-023o.Tabu vi 3. Nature of Appeal: Reduce Vertical Separation Requirements for Conventional Gravity ^ wf 5. Mitigating Factors: Class B Waiver Checklist (Meets additional requirements outlined within Recorded Declaration Covenant for OSS Attenuation Zone (AFN "/tAk5zO I ) 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: Date: b(2 I 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: Date: rll 6 Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY SERVICES Building,P°°.',P EnvironmtaiH ItK.COminjty Itaith CLASS B WAIVER WORKSHEET 411 N.6TH STREET BLDG 8.SHELTON WASSSS4 (State and Local waiver forms required) SHEL_DN.s8D427.0870.EXT 400- 6ELFnla:ved27-4467.Ear 40 4 c_MA'.36O4a2-5263,EXT 400 FAX.360-427.7708 APPLCANT NAME KYLE KIMBALL/ALLI HOWE WAIVERPERMiNUMBER WAI 2-Oz-(c IDOL)`4( 240E MEYER LAKE DR HANG ADDRESS cry SHELTON, WA 98584 TATS ZIP SITEADDRESS 107 SE DUSTY LANE CmT1 TA.PARCEL NUMBER 31902-755-90020 PROPOSED DMMINFIELDNPE ® CONVENTIONALGRAVRV D CONVENTIONAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood,Harstine,Hoodsport Up-slope vertical separation must be greater than i8" Shelton,or Sinclair Gravelly Sandy Loam, for gravity and greaser than 12"for pressure. Alder pod y easy Sandy Sandy Loam .....................,..� Greater than 1P'............................................................ C ❑Harst e Loam............ ... ❑ ❑ Greater than 18"............................................................... ❑ Hoodsport Grave!Iy Sandy Loam................................ ❑ 0 -Determined by: Shelton Gravelly Sandy Loam.........................._...........❑ 0 Depth to hardpan............................................................. 7 Sinclair Gravelly Sandy Loam........................................ ❑ 0 Depth to mottling ....................... ........ ......... . 0❑ ❑ Other ...........❑ ❑ Both.......................................................................... 2.SOILTYPE:TYPE: 6.WATER TABLE LEVEL: Soil types mast be.Meciom Sand,Loamy Sand,or Sandy If test holes show evidence of a seasonal water table Loam.Gravel percent mist be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand.... _......__ ❑ ❑ -Evidence of seasonal water table: Loamy Sand . ....... . ....❑ ❑ o Yes ...... ...... ........ ..... ❑ ❑� Sandy Loam. ...... ......... .. . .....[A]' No ...... ....... _...... ..._ ❑1 Percent Gravel: Curtain Drain required: -Less than orequal Lo 35s ..... ..... ... ❑ rs-,/q Yes -Greater than35%-------------------------------------------------------0 ❑ m No .......'yam 3.SOIL DRAINAGE ^ 7.HORIZONTAL SETBACKS: Soils must be moderately F Pnmentmarrineshorel'Ines,suraiclaters,adown-gradEui �a wen drained drained p r 1 p ,-./ �/ surface Wdte6,and wells Well Drained...._.. 1 IQ '- `c Moderately Well Drained......._...................................... ❑ ❑ -Are increased horizontal setbacks met: Other .............. ❑ ❑ Yes...............,................ ..._.............................. 0 �� No............ ...... _.. ............. n ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes mist be between 3%to 30%. Gravity is only a'lowed 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%............................................................. 0 ❑ Is there 50ft or greater between the down 3%to 15% .... ......... .. ... ..... I gradient side of primary drainfield and 16%to 30%.......... ....... ........ ❑ ❑ property boundary: Greater tnan3u3E ....... .....__. ❑ ❑ Ves_.1.+J 'ft...�.:.a.!:5� ;G.�V .....0' [� ✓ No._....................................................................................... ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuGdablez,r,Z`}—'] priorto design approval.The attenuation zone is not to be used for the contuctlon of roads,cecks Fe dos, AFiy: ` parking areas,vehicular traffic or other similar such uses.The owner must ac rep to all these copolticrs e-om 13raer„dint TNISEDMM4 AnnEb.. .H.Uei' N. rNemnm+ wees.r pd :e432]OT7 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date. July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section 1. (completed by applicant) �.7n Kl'L KIMBALUALLI HOWE Local Health Department/District (2) Ate MEYER LAKE DR SHELTON, WA 98584 _... Telephone: ( 36C) 426-4221 Signature: Property 1dentifi' tion: (3) Section D. (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A 0230 24 OF V/S FGRFRESSURE-{OR) 1ZLOF-WS FOR PRESSURE OSS (OR) Subsection: TABLE VI 6" OF V/S FOR GRAVITY " OF V/S FOR GRAVIT Justification(mit.gation mrasures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE(AFN: // -�� ) _... Section 111. (completed by health officer) Review Criteria: (8) Mitigation Measures (in addition to thaw proposed; (9) Comments/Conditions: (10) Type of Waiver: (i1 j 1 Class A MClass B [ ] Class C—Request DOH review before gram:fig? Yes No Neighbor Notification: (12) Required? Yes No Ifneeded, are agreements, easements, etc properly pled.' Yes No Section IV. I (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A \W?C On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or regrired Hen evsi.:ared for their ability to provide public health protection at least equal to that provided by this chapter WAC. i ] Denied W Approved/Granted—Subject to all comments,conditions and requirements noted in Sections II and ❑1. Local Health Officer ( >) Date: // 'jZ226 1 1 i DOH 337-111 it c - ^ `� s a ]" . ` n a ww µ+ ,,. :. T- - - N DNIHSVM 'A1Nf1C0 NI C: M6= Cindy E. Waite � 80 E Pickering Lane Shelton, Wa. 98584 360-426-2113 360-701-0205 cindyewaitea.msn.com 5/21/2026 fk Parcel # 31902-75-90020 101 SE Dusty Lane This was originally approved as a pressure. Their project has changed. The shop/garage is not going to be built. This allows for a gravity with a Class B waiver. Drainfield is going in the same place as originally designed. I used your soil logs. I submitted the waiver fee($370.00) and design resubmittal($170.00) Respectfully submitted; CA Cindy E. Waite Mason County WA GIS Web Map L. tom+ �4 CIP tr 1 uo I _ III'`�, y� ^\ %l v2-fl(- q0 n o t a� � 1 314u2 Qov3 ° F A \. 61412026, 11:19:14 AM 11,537 6 >0 0.01 0.03 0.05 mi u County Boundary '. ✓Nr( a caU, ct �ffu 0 OM 0.04 008 km No Filled tU K r 4/f 7 IO . ° Site Address (Zoom in to 1:3O00`) Evi, MERE, Gamer. (c) Opanbveomp mn4lWbrs, and be 012 uam Tax Parcels (Zoonn in to 1:30,000) ü / Contours 5 ft rnnmcoumYWAGIS Web Map Ain mvon county dieasims& A!SOY.r.we+1N,o bww..a of wwe,w,no.not liable me aaxs Iron Mi.,c on n.flhlptY .m.sjaw.gov/im.rp