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Home My WebLink AboutWAI2026-00050 - WAI Health Waiver - 8/11/2026 ooccs'gn Envelope ID:79232FC6-635^_-8B2F-8035-BBD4E7B981 ED MASON 415 N.C STREET,SHELT0pL�A98584 C COUNTY SHELTON.369-az7! OMMUNITY SERVICES BELFAIR:360-27S n (q°°/'/ r - -- ELMA. 360-FAX! 2x1 fy 8 ' l r Building.Planning,Env mrmemai nealm.mmmnn naealm FAX- 427x7 8 > /1 �U 2 292E Application for Waiver or Appeal Amount Paid: , J Receipt Number: 2c O 31U WAI Instructions: 1. Complete Parts I 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 KC Home Services Inc. Telephone 360-620-9960 Mailing Address 12271 Orchard Ave SE City Olalla State WA Zip 98359 Parcel No. 2 2 2 2 3 -- 7 7 -- 9 0 0 2 1 Site Address xxxx E Rasor Rd West, Dollar WA 98529 Subdivision Name and Lot No.2623 - NE 1/4, NE 1/4, Section 23,TWP.22N., R.2 West,W M. Lot 1 PART 2: Nature of Waiver/Appeal Y Class B Reduce Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location, WAC 246-272A-021 0 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements 0 Other (Installer, Pumper, O&M Specialists) Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE VERTICAL SEPARATION FOR CONVENTIONAL GRAVITY OR PRESSURE OSS CLASS B WAIVER CHECKLIST RECORDED DECLARATION OF ATTENUATION ZONE IISigned by 1 �� Applicant Signature�l�RI& (nj/L Date. 6/9/2026 I EIsmcr ure.. Revised X.21 2017 This form may be scanned and available for public view on the Mason County Web site. Page I oft Docuslgn Envelope ID:79232F06-0350-882F-8@36-BBD4E7a981 ED i' 415 N, 61°STREET,SHELTON WA 98584 \\ MASON COUNTY SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES eELFAIR. 360-276-4467,ext.400 � ELMA:360-482-5269,ext.400 \ Building.Planning,enviroomenral Health.Community Health FAX:360-427-7798 Onsite Class B State Waiver Request Packet Description: WAC246-272A-0230, Table VI outlines the vertical separation requirements for types of Onsite Sewage Systems (OSS). Mason County has received State Department of Health approval to reduce these vertical separation requirements if specific conditions are met. Forms Required (attached): 1. Mason County Waiver Form 2. Washington State DOH Waiver Form 3. Class B Waiver Checklist 4. Copy of Recorded Declaration of Covenant for OSS Attenuation Zone (Property owners must sign with notary, Record with Mason County Auditor, Supply copy of recorded document) Septic Design Requirements: 1. Lateral trenches only, no bed layouts. 2. 50ft downslope Attenuation Zone (from lowest primary lateral) shown 3. All wells within 200ft of drainfield anchored and shown 4. All surface waters within 300ft of drainfield anchored and shown. Fees Required: Please see the Mason County Environmental Health Fee Schedule for current fees. 1. WaiverNariance, DOH fee (State Waiver) Revised 8.11:2017 This form may be scanned and available for public view on the Mason County Web site. Pngc I n12 Docuslgn Envelope ID:79232FO6-0350-882F-8036-BBn4E]B981 ED PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) -. Appeal VWaiver - None required Class A sClass B T Class C 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 CONVENTIONA GRAVI OR PRESSURE OSS. 4. Hearing Official: ❑ Board of Health O Health Officer ❑ Pollution Control hearing Board O Public Health Director ❑ Certified Contractor Review Board i Environmental Health Manage 5. Mitigating Factors: CLASS B WAIVER CHECKLIST(MEETS ADDITIONAL REQUIREMENTS OUTLINED WITHIN) RECORDED DECLARATION COVENANT FOR OSS ATTENUATION ZONE (AFN 6. I have received this waiveriappeal request. It is complete and mitigation required by the state and local polic r s been submitted. Staff Signature: *¼J'22.. Date: _/G -oZQ/ PART 4: Determinatio of the Hearing Official 81 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: f'9Qofv`4e_ t4 t Date: Revised K'?I l?017 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Cronus'on Enveope ID-79232FCG-03508821L-8036-BBD4E7B9B1 ED MASON COUNTY MASON COUNTY PUBLIC HEALTH COMMUNITY LOAA mm..N.HI Lh CLASS B WAIVER WORKSHEET 415 N SI H STREEr BLDG SHELTON WA 90M4 (State and Local waiver farms required) SHELTON:360.427-9670,Ett 100 -BELFAIR.360.276-046].ENT 400 ELMA 360-4025269.El 400 -FAX 360.427-7791 APPLICANT NAME KC Home Services Inc aArEH PERMIT NUM ER WAI MAILING ADDRESS I 22[ Orchard Ave SE CITY Olalla STATE WA ZIP 98359 SITE ADDRESS xx E Rasor Rd West CITY Better TAB PARCEL NUMSEP 2222371-900n rsnposm DRAINFIELD I'll M CmVENTONALCR"M ❑ CONS/EN noNAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alderwood Harstine,Hoodsport, Up-slope vertical sepa ration mustbe greater than 18- Shelton,Dr Sinclair Gravelly Sandy Loam_ for gravity and greater than 12 for pressure. Alderwood Gravelly Sandy Loam. -_.® Greater than 12 ..................................................... 0 D Harstine Gravelly Sandy Loam............................... 0❑ ❑ Greater than 18 ....................................................... E Hoodsport Gravelly Sandy Loam .... ❑ ❑ -Determined by: Shelton Gravelly Sandy L am ...... -_. ❑ ❑ Depth to hardpan.................................... .......... Sinclair Gravelly Sandy Loam..... ....................... 0 ❑ Depth to mottling _... ..... ❑ Other ...........❑ ❑ Both............................................................ 0_........ ❑ ❑ 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium n Sand,Loamy Sand,or Sandy If est holes show evidence of a seasonal water table Loam.Gravel percent mue:be less than or equal to 35%. above restrictive layer,a curtain drain may be required Medium Sand.................... . ............................ ❑ -Evidence of seasonal water table: LoamySand -_........................................................0 ❑ o Yes ........ _. ........... ❑ ❑ S 5 dyLoa ... .....® yyz N ....._ .... -. ® z Percent Gravel. / O -Curtain Drain required: IC Less than or equal to 35% .... ...._ ® Yes ...... .... ...... ® o Greater than 35 _ .........❑ ❑ No ...... "- _... . 3.SOIL DRAINAGE: '^a 7.HORIZONTAL SETBACKS: Sots must be moderately well drained to well domed_ O Primary Drainfield must maintain 200 from down-pradi em marine shorelines,surface waters,and wells. t t Well Drained.. ....... ... ❑ Moderately rdtely Well Drained -Are Increased horizontal setbacks met: Other .... ❑ ❑ Yes -.......... ............. ...._._ ® No _....... ............_. __. ......... ❑ 4.DRAINFIELD SLOPE: B.ATTENUATION ZONE Slopes must be between 3%to 30% only . Gravity is 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 Isg6.... . .. ... ® gradient side of primary drainfield and 16%to 30%........................................ .................. ... C❑ property boundary: Greater than 3090 ❑ ❑ Yes............. ..... -. ......._..._® ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as Cromol able i prior to design approval.The attenuation zone is not to be used for the contruction of reads,decks,patios, AEN: parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. THIS PRESS MAY BE SCANNED AND AVAILABLE FOP PUBLIC view ON mE MASON murvty weesnE Age"d"°� Docusign Enve'ope ID:79232FC6-0350-882F-8036-BBD4E7B981 ED Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July I.2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section 1. (completed hP applicant) Name. (I) Local Health Department/District (2) KC Home Services Inc. (see instructions) Address: _--. . 12271 Orchard Ave SE _--_ ---- ""'--_-- -- Olalla WA 98359 Telephone ( 360 ) 690 S960 Signature Property I t�tlbf$0F(IJ9 Parcel No. 22223-77.90021 xxxx E Rasor Rd West Blefa r Wa 98528 Section II. (completed In applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-27'A 0230 24" OF V/S FOR PRESSURE (OR) 12" OF V/S FOR P URE OSS (OR)_- Subsection TABLE VI 36" OF VISFO CAVITY 18" OF V/S FOR AVIT OSS justification (mitigation measures to be provided): (7) COMPLETED CLASS B WAIVER CHECKLIS ACHED (OUTLINING ADDITIONAL REQUIREMENTS MET). RECORDED DECLARATION OF COVENANT FOR ATTN. ZONE (AFN: Section III. (eompteted hi health offuer) Review Criteria: (N) Mitigation Measures(m adduiml to dense proposed) (9) Comments/Conditions: (10) Type of Waiver. (11) [ ]Class A bd Class B ) ] Class C— Request DOH review before granting.? Yes No Neighbor Notification: (12) Required'! Yes No 1/needed, are agreements, easementy, etc-property fled? Yes _ No__ Section 1V. I (completed In,health ofliee,-) 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 p4.Approved/Granted—Subject to all comments,conditions and requirement'noted in Sections II and Ill. LocalHealth Officer (13) 6fl fl //� ��'�i!!J Date: ��✓r DOH 337-021 page 26 of32