HomeMy WebLinkAboutSWG2008-00026 Application for Waiver/Appeal - VAR Application - 3/5/2012 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC
Effective Date: July 1,2007 Revised September 1,2009
On-Site Sewage Systems (Chapter 246-272A WAC)
Request for Waiver from State Regulations
Section I. (completed by applicant)
Name: (1) Local Health Department/District (2)
may,f �C see tnstrucfions
Address:
lid �Ir .Pad ---- ----- . ---- ------ ------- ---- -------—
O!? .rsrdf uJ4 185 ------ ----- --------------------
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Telephone: C60
Signatu ---------------------
Property Identification: (3)
32-33Co5 ------------ — --- -------
Section IL (completed by applicant)
WAC Number: (4) WAC Requirement: (S) Waiver Sought: (6)
246-272A—
Subsection:
Justification(mitigation measures to be provided): (7)
Section III. (completed by healiA officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
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Comments/Conditions: (10)
Type of Waiver: (11) [ ]Class A [ ] Class B Class C—Request DOH review before granting? Yes_ No Ll_�
Neighbor Notification: (12) Required? Yes_ No_ 1f needed, are agreements, easements, etc.properly filed? Yes — 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 tection at least equal to that provided by this chapter WAC.
[ ] Denied [ ppcQved /Granted—Subject to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13 \ Date: y
DOH Publication 4337-021 Page 26 of 32
c MASON COUNTY
PUBLIC HEALTH
PO BOX 1666 SHELTON,WA 98584
SHELTON (360) 427-9670
FAX (360)427-8442
ELMA (360)482-5269
BELFAIR (360) 275-4467
Application for /Waiver/Appeal
Amount Paid:
Receipt Number:
Instructions
1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Submit completed application,with attachments to the health department for review.
3. Submit Waiver fee of$113.00
PART 1: Applicant/Parcel Identification
Name of Applicant o/� �` �P ✓ Date /�-
Mailing Address /S3 Gr1� ,e I 'D Telephone 360—
04w.on"4 4/4 9ff 5770
Assessor's Parcel Number 3Z93051nVao ?L
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
51 On-Site Sewage Requirements ❑ Food Sanitation Requirements
❑ Building permit review policies ❑ Solid Waste Requirements
❑ Location, WAC 246-272-09501 ❑ Group B Water System Requirements
❑ Holding tank WAC 246-272-12501 ❑ Water Adequacy Requirements
❑ On-Site Standards ❑ Enforcement Timelines
W, Contractor certification requirements ❑ Departmental Determinations
(Installer,Pumper, O&MSpecialist) ❑ Other
Description of Waiver/Appeal(include justification,additional material may be attache ):
st C.-MA,CAA_
.c 3
Applicant Signature !�/ �— Date:
Page I oft / Updated:01-9-2008
PART 3: Health Department Evaluation (Staff Use Only)
IA. Type of Determination Required: 113. Type of On-Site Waiver(if applicable):
❑ Appeal ),�Waiver ❑None required A ❑ Class B xClass C
2. Identification of Specific Code/Standard/Determination(include date of determination or latest code/standard
revision): tn3 P',C Z?iA h _2-77 Z _ CD 2-5 O
3. Nature of Appeal:
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control Hearing Board W[] ealth Services Director
❑ Certified Contractor Review Board �Environmental Health Manager
5 �ft ating Factors:
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6. I have reviewed this waiver/variance request. It is complete, and mitigation required by state and local policy
has been submitted.
Staff: l� Q� t / Date:
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 have an adversely affect
public health and is hereby denied. This decision is based on the following findings:
Hearing Official` Date:_'7 "7
Page 2 of 2 Updated:01.9-2008
Ferguson Land Services & Development, Inc.
P.O. Box 940
Onalaska, Wa. 98570
LIC# FERGULS945NZ
To whom it may concern,
I was a licensed septic installer in Lewis County from 2007 to 2010 . At that time Mike McGraw worked
for me. We installed several styles of systems, ranging from a simple gravity system to a Sand filter with
a mound system. Mike had previous experience which was very helpful. It was nice to be able to go to
look at other jobs,and know Mike could handle the job and get it done properly.
Due to the bad economy I had to close down my company in 2010, and let all my guys go.
J.C. Ferguson