HomeMy WebLinkAboutWAI2023-00022 - WAI Health Waiver - 3/16/2023 1
�--„ 415 N.6th STREET,SHELTON WA 98584
MASON COUNTY SHELTON: 360-427-9670,ext 400
COMMUNITY SERVICES
BELFAIR: 360-275-4467,ext.400
�� _/ ELMA: 360-482-5269,ext.400
`� Building Planning,Enviranmer t i Health.Community Health FAX:360-427-7798
&p.pllcatio,n for Waiver or A eal [ M IE
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Amount Paid: .'. Receipt Number: sul I MAR 16 2023 11
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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
RJ Peabody, Inc Telephone 253-514-3915
Mailing Address P.O. Box 565
City Burley, State WA Zip 98322
Parcel No. 2 2 3 3 6 -- 5 4 - 0 0 0 6 5
Site Address 50 NE Katherine Ct, Belfair, WA
Subdivision Name and Lot Beards Cove/ Div 4/ Lot 65
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver 0 Food Sanitation Requirements
❑ Onsite: Class B Waiver 0 Group B Water System Regulations
❑ Onsite: Class C Waiver 0 Water Adequacy Requirements
% Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies
❑ Onsite: Holding Tank,WAC246-272A- 0 Appeal' Enforcement Timelines
0240 0 Appeal: Departmental Determinations
❑ Onsite: Contractor Certification 0 Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.):
Reduce horizontal separation between house foundation and drainfield from 10' to a minimum of 2'.
Mitigation Land slopes away from foundation. Drainfield effluent will drain away from foundation, not toward it.
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Date: 3—tS- 23
Applicant Signature: Revised 8113/2018
This form may scanned and available for public view on the Mason County Web site. Page I of2
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PART 3: Public Health Evaluation (Staff Use Only) LCic c7 I
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 late of determination or
latest Code/ Standard revision): Uj/1G Zt« 1-7711 ,Z(
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3. Nature of Appeal: n
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4. Hearing Official:
❑ Board of Health El Health Officer
❑ Pollution Control hearing Board '❑ Public Health Director
O Certified Contractor Review Board )S. Environmental Health Manage
5. Mitigating Factors:.-1 / SC f 1 dif in TiVG l� ckt,t / teal
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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: J/2 2/ 20r75
PART 4: Determination of the Hearing Official
it-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:
Date: 2/2 12—
Revised 8113!2018
This form may be scanned and available for public view on the Mason County Web site. Page of 2