HomeMy WebLinkAboutWAI2022-00119 - WAI Health Waiver - 10/19/2022 -• „SpN COU,v
Public .;--e Health
Always working for a safer healthier Mason County
415 N 6th Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 ❖ Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid:
Receipt Number: O� `1
Instructions \ P\2°2, 11
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 Identification
•
Name of Applicant DAMES GLENN Telephone 4259412269
Mailing Address of Applicant 22119 NE 78TH ST
City REDMOND State WA Zip 98053
12-digit Tax Parcel No. 3 2 1 2 2 -- 5 0 -- 0 0 3 2 1
Site Address 170 E BALMORAL WAY, SHELTON, WA 98584
Subdivision Name and Lot LAKE LIMERICK 3, LOT 321
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation 0 Food Sanitation Requirements
O Building Permit Review Policies 0 Group B Water System Regulations
❑✓ Location, WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
O Mason County Onsite Standards 0 Departmental Determinations
O Contractor Certification Requirements 0 Other
(Installer,Pumper,O&M Specialists)
Description of Waiver/Appeal(include justification,additional material may be attached.):
REDUCTION IN SETBACK TO 2FT FROM AN UPSLOPE SLAB ON GRADE FOUNDATION
Applicant Signature: Date: 10/19/22
J:\EH Forms\Waiver-Appeal Mason County .. al Revised 12/1/15
Page 1 of 2
47 ♦
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑ Appeal [Waiver ❑ None required ❑ Class A ❑ Class B 0 Class C
2. Identification of Specific Code/Standard/Determination(include date of determination or
latest Code/ Standard revision) (p _
3. Nature of Appeal: e�.,
�,tk Ce 7106 3txt 1 S�=�1►o c - -Fri VY\ DVJ F
co-a- -to dl r,ih.-6 e +O 2
4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board Environmental Health Manager
5. Mitigating :Facto ��
V tiA�-A�(c � -
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: (o(2d1�-Z
PART 4: Determination of the Hearing Official
8"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:
0 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:
Hearing Official Signature: Date: l(2/ /x
J:\EH Forms\Waiver-Appeal Mason County Local Revised 12/1/15
Page 2 of 2
G�
,/
OP-
SCALE-1"=30'-0"
DECK
2 BDRM RES
-TUBOUT/CLEANOUT
SHED
AtSHED
SEPTIC TANK
10FT,
OWDY'SDRAINFI D(LOCATED N119 ` I
SLEEVE WITHIN 10FT OF SEPTIC COMPONENTS)
HOWDY'S DOODY ON 10 19/22 J
50FT2 DRIP R/A L-- PROPOSED STUBOUT/CLEANOUT
\-ROPOSED GARAGE /
CONVENIENCE RESTR 1OM
(SLAB ON GRADE)
W._.
10FT
(~560FT2 DRIP R/A
(TYPE 4 SOIL) �I
L' ., ,''
JIM HUNTER&ASSOC. CONTRACTOR
P.O. BOX 162,OLY,WA 98507 LOCAL
753-1226
1HANDASSOCIATESOHOTMAIL.COM INSTALL DATE- 1971
RECORD DRAWING SITE ADDRESS/LEGAL
170 E BALMORAL WAY
OWNER- JAMES GLENN FINAL DATE-
10/19/22
TP# 321225000321 SITE# 2328