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Home My WebLink AboutWAI2026-00061 - WAI Health Waiver - 8/10/2026 415 N.6"STREET,SHELTON WA 18584 MASON COUNTY 5EEFAIR36o 725446,E 400 Public Health & Human Services Application for Waiver or Appeal / 21 Amount Paid: il kD Receipt Number: WAI ___ - 1 Please note,all approved Onsite Waivers have the same expiration date as their 055 Permits. Instructions: 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees maybe 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 Rod & Sherry Bracken Telephone 360-490-7887 Mailing Address 50 W. White Rd City Shelton State Wa Zip 98584 Parcel No. 4 2 0 3 6 4 1 -- 0 0 0 6 0 Site Address same as mailing Subdivision Name and Lot TR6 of NE SE TR E of Survey 1/224 PART 2: Nature of Waiver/Appeal 0 Onsite: Class A Waiver ❑ Food Sanitation Requirements ❑' Onsite: Class B Waiver 0 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 ❑ 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 or Pressure OSS Class B Waiver Checklist Recorded Declaration of Attenuation Zone 7-Z 1 Hl6C Applicant Signature: /(oZ"" f"2 Date: 7 // ` a 6 Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page ' of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) ❑Appeal p Waiver ❑ Class A ID Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedrooms: y Nitrogen Treatment: ❑Yes No Soil Type: r.( Minimum Lot Size: Qi 3I f(6 sq.ft. sq.ft. Water Source:❑Public I2Private This Lot Size: hr� Is This Lot Eligible for State Waivers: 'Yes ❑ No ❑ N/A Hearing Official: I] 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.Tame Vi 3. Nature of Appeal: Reduce Vertical Separation Requirements for Conventional Gravity erPressarg6S6 5. Mitigating Factors: Class B Waiver Checklist (Meets additional requirements outlined within) Recorded Declaration Covenant for OSS Attenuation Zone (AFN ZI44 ZJ1 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy been been submitted. /' Staff Signature: /f� Date: Z �d PART 4: Determination of the Hearing Official Y '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: 8/it/_t/ Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of2 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations I*r H.EA LT H Section 1. (Completed by applicant) Name: (1) Rod & Sherry Bracken Locai Health Jurisdiction Received (2) (See instructions) Maso Address: 50 W White Rd n Count y Shelton We 98584 Telephone: 360-490-7887 Signature: ✓6` _- __. _-. _---_. Property Identification (3) r .c ,U I_ TI I- 0 .... .,a.i 3h.. r. TO 'S171A 2fiw IZae...c -. . Section II. (Completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A- __. . .0230 24" of 1LL4fa'P� rr) 1•i" e 'fie f _.]___ re nec( ) _--. 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: Z?, 71f 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 ✓ Class B flclass C— Request DOH review before granting? Yes flNo ✓ Neighbor Notification: (12) Required?Yes❑No If needed, are agreements, easements, etc.filed? 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 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 i J(l Appro,v/e�f �ranted — Subject to all comments, conditions and requirements noted in Sections II and III. Local Health Officer(13) ✓ KNiyL/"#" ta>/U' Date: d/�a Al DOH 337-175 February 2024 1 • MASON COUNTY VICES MASON COUNTY PUBLIC HEALTH COMMUNITY SER 4,n9,P„,, , E,.,'o,mrnraIH.,. .Com.una,H.a,h CLASS B WAIVER WORKSHEET 415 N.SETH STREET,Hmc 9,SKELTDN WA 9esea (State and Local waiver forms required) SHELTON 3360427-96TO,E%T,4W -BELFAIR.3360-275-4457.EXT.400 1 APvuuNTNAME Ibn �& S1L W� 1,f� ��y WAIVER PERMITNHMbER WAIWZ _COQt 1 e flMA]]INU ADDRESS t_ W1„ I- CIY sk \_) STATE VV 4r' 2,P �05�21 SITE ADDRESS SC L [_ qS ' l.N� CN TAX PARCEL NVMEER 4'L0 Sb -41 ' in f`rL L (2 PROPOSED DRAIN IELD TYPE amNV5NTONAU GRAVITY ❑ 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.... ................ O ❑ Greater than 12 .... ............. ............................... 0 0 Harstine Gravelly Sandy Loam............. . .........._. ❑ ❑ Greater than l8 ........................................... ................ y' N Hoodsport Gravelly Sandy Loam....... ...._....... ❑ ❑ -Determined by 60 Shelton Gravelly Sandy Loam................................... .12 H Depth to hardpan...................................................... Sinclair Gravelly Sandy Loam....- . ... ❑ ❑ Depth to mottling ,........ .. ........ ❑ ❑ Other ..........❑ O Both............. ....._ .................. ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand Loamy Sand,or Sandy If test holes show evidence ofa seasonal water table Loam.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain maybe required Mediu0 O -Evidence of seasonal water table Loamy S nd.......... _...... .....,,, ❑ ' ❑ ❑ Yes ...... LoamySand........................................................ . O..._ �pin — Sandy Loam _._... ....LFa y S No _..... ... ._ .__. .. . �, Percent Gravel: m0 -Curtain Drain required: r.� O .... - ❑ O n -Less than or equal to 35% Yes ................ ....... lH ..... ............ ssy�, No ............... ® W -Greaser than 35%...................._..................................❑ � ,.,..... 3.SOIL DRAINAGE: c 7, HORIZONTAL SETBACKS: Primary DrainfieId must maintain 200 from downgrade- r� ealsmusI bemoderate moderately well drained to well drained. ent marine shorelines,surface waters,and wells. `< M M WellDrained......................................................... ...... W Moderately Well Drained ,_... ❑ O -Are Increased horizontal setbacksmer ....... Yes.... ......... ............... ......................................_ ........ Other_ ........... ❑ ❑ ....._ ❑ .a 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 soft or greater between the down 3%to 15% .... .................... ................................ ........ O O gradient side of primary drainfield and 16%to 30% ,,,,,.,. property boundary: .... _.. .......... ... _ ......... Greaterthan 3040................... ........ ............. 0 ❑ Yes................. .............................................. . N The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuildable 2244 Z6S prior to design approval.The attenuation zone is not to be used for the contruction of roads,decks,patios. AFM . parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proofof [^re.^y, Revival 3/2/2017THIS FORM MAY BE SCANNED ANUAVAMfiIE FOR PUBLICVILW ON THE MASON COVNIY WEa5nf