HomeMy WebLinkAboutWAI2023-00016 - WAI Health Waiver - 2/15/2023 f
415 N.6th STREET,SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,ext 400
. COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
\ . i ELMA:360-482-5269,ext.400
•„: / Building,Planning,Env,ronmental Health,Community Health
�; •,,;;,ti:•,; FAX:360-427-7798
Application for Waiver or Appeal
Amount Paid: Receipt Number: )67
WAI -Lol 3 ocogot6
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 Information
Name of Applicant Patrick Moran Telephone (206)403-3365
Mailing Address 310 E Libby Rd W
City Shelton State WA Zip 98584
Parcel No. 3 2. O 1 k __ 5 q -- O i m I
Site Address 200 E Soundview Dr, Shelton, WA 98584
Subdivision Name and Lot SHORECREST BEACH ESTATES #2 BLK: 1 LOT: 12
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver ❑ Group B Water System Regulations
❑ Onsite: Class C Waiver 0 Water Adequacy Requirements
181, Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Revie
❑ Onsite: Holding Tank,WAC246-272A- D Appeal:Enforcement Time �5
0240 0 Appeal:Departmental Deter Ions ions
O Onsite: Contractor Certification 0 Other FEB 1
Requirements 5 2023 U
Description of Waiver/Appeal (include justification, additional material may be attached.): By
Reduce horizontal separation between house foundation and drainfield from 10'to a minimum of2':-
Mitigation:Land slopes away from foundation. Drainfield effluent will drain away from foundation,not toward it.
--i)
Applicant Signature: � Date: Z- ( S-23
�,`s c_ 5.e(()'�C 8 N 1—" Revised 8/13/2018
This form may be scanned and available for public view on the Mason County Web site.
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PART 3: Public Health Evaluation (Staff Use Only) ( rt ot/(
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
F. Appeal H Waiver None required Class A Class B : 1 Class C
2. Identification of Specific Code/ Standard/ Determination (include date of determination or
latest Code/ Standard revision): - 10)46 (,96 461-7.A- '(i
3. Nature of Appeal: 6ov,vol-al 1 a ---2 0-P IC) -f-
4. Hearing Official:
0 Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
0 Certified Contractor Review Board 0 Environmental Health Manage
6
5. Mitigating Factors:
no,r6t-f-i-6,1 cyloic)-1- — Irf-4--
. ,
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: "V .., Date: 2 ->-7 `-J
PART 4: Determination of the Hearing Official
gr-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:
El 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: 4....*/
Date: 7A/1-3
Revised 8/13/2018
This form may be scanned and available for public view on the Mason County Web site.
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