HomeMy WebLinkAboutWAI2023-00007 - WAI Health Waiver - 1/24/2023 ) S l ao 2-3 _(IOO
7, MASON COUNTY
l 1.
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
.)•rIL1Y'��,
415 N 6'h 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*I d• Si--
Receipt Number: �-�� 51
Instructions
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 JOHN & BRENDA LEECH Telephone
Mailing Address of Applicant 1311 STARLING STREET
City STEILACOOM State WA Zip 98388
12-digit Tax Parcel No. 2 2 2 12 = __ 5 6 __ 0 0 0 1 0
Site Address 40 E ROSE POINT LANE
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
l ' Location, WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM TANKS/DRAINFIELD TO BUILDING/DECK FOOTINGS
FOOTINGS ARE UPGRADIENT AND ACTUAL HOME FOUNDATION MEETS SETBACKS.SEE ATTACHED.
Applicant Signature: jC��\. JDate: 2Li ( 2-3
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
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 Class C
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision) / r' n ,Zi'h-..0 0
3. Nature of peal: `V u�
a&8. 4,-eL/3, S ! u-Nat ct=rwi -f-ra -Zcl
4. Hearing Official:
O Board of Health ❑ Health Officer
O Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board Environmental Health Manager
5. Mitigating Factors: -�rI
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: 13o 1z 3
PART 4: Determination of the Hearing Official
VC 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: sCkYit
Date: /ZA.7
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
., ,
\
//7
/ X
PROPOSED DRAINFIELD AS PER
/i/%/�/// IN
PERMIT SWG2O21-00073
// / / / // /
///�/�////�///// / / PROPOSED FOOTINGS
// ///// // ///// //////// ♦ ♦ AS PER BUILDING PLANS
//// / ////// / /////////////////
/ / // / / // / / // / / // / / ♦
// //////////// //// //////////// //// / \
/ / / / / / / / / / / / / / / X
/// / //// / //// / //// / //// / /
// ////%/ ////%/ / ///// ///1/ /// // ♦ ♦
/ /// // /// // /// / / /// // /// N
/ ////// ////// ////// ////// ///// ,, N
///// ////// ////// ///// / ////// // V \
/ ////// /// //// ///////////////// ///
/ //// / //// / //// / //// / / N
//// //////// ///////// /////// T3
/// // / //// //////////////
//// / //// / //// /
♦ ////%• // ///%/////
N // / / // / /
/ ///// // // • NEW RESIDENCE
S. \ / / / /
/ / AS PER BUILDING
N / . y PLANS
\ \ Q/ o
♦
'b�
♦ O
PROPOSED TANKS ♦ ♦ O
AS PER S WG2012-00073
N s�
S. O,oc<-
♦
Ot. N
ie.' tq , (A), \
• r''
ROBERT T I MYSEE 1�;
0 .?: ••• • o'' r.1F'-'" '' N N
,,,,,
EXPIRES
\
PIONEER DIGGING INC. CUSTOMER: JOHN LEECH SEE ATTACHED WAIVER REQUEST APPLICATION
PARCEL# 22212 56-00010 FORMS AND PREVIOUS PERMITS ON FILE
SEPTIC DESIGNS ADDRESS: 40 E ROSE PT LANE
DED
PLATS OR SURVEY.FIE LLD MEEASOT A �L RREME NTS AND COUNTYY.REFERENCES `GIS UDE DESIGN INTENDED FOUCANTICOUNTY R SSEEPTiC
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFICE-360-426-1803 FAX-360-427-2353 0' PURPOSES ONLYEPROPOSEDS DEVELOPMENT MAY BE SUBJECTACKSRG OTHER
SHEET: WAI PLAN SCALE 1"=1V 5 P�COMPONENTS.REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO