HomeMy WebLinkAboutWAI2026-02027 - WAI Health Waiver - 8/11/2026 5th STRET SHELToN WA 98584
MASON COUNTY 415 NSf1ELTONE36O-4279670,ext 400
Public Health & Human Services 6ELFAIR:360-275. 67,ext.400
Application for Waiver or Appeal
Amount Paid: I
Receipt Number:
Please note off a WAJ
ved Onsife Webers hew IOShI1C[IOna; the same ex ntlon deb as fhs/r OSS Permits.
1. Complete Parts 1 and 2. No determination can be made until these parts are fully comdetetl.
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 JOHN DITZLER
Mailing Address 16525 SE 30th Street Telephone (425) 623-6816
City Bellevue
State Wash_ i^9ton- zip 9808
Parcel No. 2 2 2 0 9 _ 5 0 _ 0 0001
Site Address 7151 NE Shore Road / B Belfair, Washington 98528
Subdivision Name and Lot Lot 1, of CADY'S PEBBLE BEACH TRACTS
PART 2: Nature of Waiver/Appeal
El Onsite: Class A Waiver
0 Food Sanitation Requirem
❑ Onsite:Class S Waiverents
0 Group B Water System Regulations
❑ Onsite:Class C Waiver
❑ Onsite: Location, WAC246-272q_0210 ❑ Water Adequacy Requirements
❑ Onsite: Holding Tank, WAC246-272A- 0 Building Permit: EH Review policies
0240 Appeal:Enforcement Timelines
❑ Onsite; Contractor Certification ❑ Appeal:Departmental Defermineflons Requirements 0 Other
Description of Waiver/Appeal(include Justification, additional material may be attached.):
WAIVER to allow the SEPTIC TANK, AEROBIC TREATMENT TANK $ PUMP
Applicant Signature: 4 't 1 1& ",G
Date: 7/15/2026
This form may be scanned and available for public view on the Mason Court Rmv 03/03/2026
tv Web site,
Page I oft
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal Waiver Class A 0 Class B 0 Class C ❑ Local
State Waiver C Iterla
Number of Bedroo s: 2 Nitrogen Treatment: Yes 0 No
Soil Type: Minimum Lot Size: 3'tK sq.ft.
Water Source:lPublic ❑Private This Lot Size: sq.ft.
Is This Lot Eligible for State Waivers: tYes 0 No ❑ N/A
Hearing Official:
PEnvironmental Health Manager ❑ Public Health Director ❑ Other.
2. Identification of Specific Code/Standard!Determination (include date of determination or latest
Code/Standard revision): IA/ 7 5. L-Z7Z;--O2-(O
3. Nature of Appeal: ,- ,L, 1/
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5. Mitigating Factors: ��--
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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:
PART 4: Determination of the Hearing Official
1$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:1i4 1�/UC"� - � Date e26"
Revised 033/03/2026
This form may be scanned and available for public view on the Mason County Web site.
Page?oft
On-Site Sewage Systems (Chapter 246-272AWAC) ,' HEALTH
Request for Waiver from State Regulations
Section I I (Completed by applicant)
Name:(])
Local Health Jurisdiction Received (2)
JOHN DITZLER (see instructions
Address:
16525 SE 30TH STREET
BELLEVUE WASHI NGT
Telephone:
(425) 623-6816
signature,/ 12, FOR
Property Identification: (3) —_�----
7151 NE SHORE ROAD PARCEL # 22209-50-00001
BELFAIR , WASHINGTON 98528
Section It. (Completed by applicant) Waiver Sought: (6)
WAC Requirement: (5)
WAC Number:(4)
EDUCTION TO 25 FEET FROM SHORELINE
246-272A- 021 0(1) SEWAGE TANK 50 FEET FROM SURFACE — REDUC
TABLE ( _— WAT '-
Subsection:
Justification(Proposed mitigation measures): (7) _.
ATTACHED
Section III. (Completed by local health officer) Additional Mitigation Measures: (9)
Review Criteria: (8) __
Comments/Conditions: (10) —�—
Ij
Type of Waiver:(]I) Class A Class 8 Class C —Request DOH review before granting? Yes No
Neighbor Notification: (12) Required?Yes❑No fl If needed,are agreement,easements,etc.filed? Yes ❑M0
Section IV. (Completed by health a icer)
g have been evaluated for
This Request for Waiver from State Regulations has been reviewed according to the provisions of Chapter 2afi-272A WAc on-
Sewage Systems.The review criteria applied,and the mitigation measures proposed and/or required,
y this their ability to provide public health protectione bjedt to al east equal
to that menu,provided
conditions and requirtement Cnoted In Sections II and II.
Denied Ig Approved/
ILA K bj
Local Health Officer(]3)
DOH 337-175 February 2024
• CHARLES H. POLLMAR & ASSOCIATES
JOHN DITZLER - SEPTIC TANK WAIVER
JUSTIFICATION (REVISED):
t.) There is insufficient Area for placement of the Tanks between the R/W of North Shore Road.
Specifically, the Tanks could not coexist with the Disposal Component, which is between the
Residence and the Road: could not maintain a 5 foot Setback to the Property Lines; the
R/W; the Disposal Component; and the Residence.
2.) There is insufficient Area on the East or West (Side yards)for the Tanks for BOTH the
Existing Residence&the Proposed Residence without eliminating the Setbacks from the
House foundation &the Property lines.
3.) If the Septic Tanks were installed between the Proposed Septic System Disposal Component
&the Road, (which may be possible with Waivers to reduce the Setback to the R/W), there
would be absolutely NO area remaining for Reserve Area purposes. Placing the Tanks
between Residence&the Shoreline, however, allows for a Reserve Area adjacent to the R/W
of North Shore Drive.
4.) The Tanks are to be Coated w/appropriate asphalt or Plastic emulsions specified for this
Purpose, and consistent to the waiver mitigation specified in the WAC Guidelines.
5.) The water tightness of the Tanks is to be tested as per ASTM C 1227 with Inlets&Outlets
Capped &water retention up into the Risers for a minimum of 24 Hours with no sign of
leakage.
6.) Connections to and between Tanks are to consist of flexible couplings, as specified in the
Waiver Guidelines&Watertight Risers w/Bolt Down lids are to extend up to final grade.
7.) The Tanks are to be installed on a level bed of gravel and the Tanks are to be Backfilled
w/Gravel (7/8' Washed Gravel) up to the Top of the'tanks — to prevent ANY uneven
settling,that will occur w/Native Soil Backfill.
8.) The Risers are to extend at least 1"ABOVE final grade&equipped w/Fiberglass Bolt Down
lids.
N 'dl a�ee �