HomeMy WebLinkAboutWAI2023-00021 - WAI Health Waiver - 2/10/2023 .Jr o r�N kkE:2023—000aA
��' tiw°L MASON COUNTY
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#1 COMMUNITY SERVICES
gp Building,Planning,Environmental Health,Community Health
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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: `Ci0
Receipt Number: . ..(-1,23--•0\\G1i3
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 Stephanie Thanem Telephone (602) 575-1399
Mailing Address of Applicant 81 NE Lennie's Loop Rd
City Belfair State WA Zip 98528
12-digit Tax Parcel No. 22336-56-00014 -- --
Site Address 81 NE Lennie's Loop Rd and 60 NE Lennie's Loop Rd
Subdivision Name and Lot Lynch Cove Heights, Lots 14 and 20
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
14 Separation 0 Food Sanitation Requirements
❑ 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 ❑ Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
Request reduction of setback from primary and reserve drainfield to bldg foundation
from 10 ' to 7.5' for primary, and to 5' for reserve. Bldg foundation is slab on grade,
SFR does not have footing d.ains. and Lot is level. Drainfiglds will meet TL B
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Applicant Signature1. a, `( / for Stephanie Thanem Date: 2/10/23
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
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PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
_: Appeal Waiver None required i Class A : Class B -- Class C L 0 7
2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal: �.�-i -Q
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4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board X Environmental Health Manager
5. Mitigating Factors: �� _ 1 n
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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: 'v S Date: (� (2
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 adversely effect public
health and is hereby denied. This decision is based on the following findings and conditions:
Hearing Official Signature: Date: /Z/
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2