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HomeMy WebLinkAboutWAI2023-00067 - WAI Health Waiver - 6/23/2023 z. /; =: 415N. 6"STREET,SHELTONWA98584 7,_ . - \ MASON COUNTY SHELTON: 360-427-9670,ext 400 ( r COMMUNITY SERVICES BELFAIR:360-275-4467, ext.400 �, `J ELMA: 360-482-5269,ext.400 Building,Planning,Environmental Health,Community Health FAX:360-427-7798 A.,t pl . a i.n for Waiver or Appeal I 1 LE 0 \ IE � Pp Amount Paid: 1. �-tj:'• >i: Receipt Number: - b IJu 232023 WAI .oa3 - DDC)b-- - By 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 Stuart Simpson Telephone (253) 853-2165 Mailing Address 13405 138th Ave NW City Gig Harbor, State WA Zip 98329 Parcel No. 3 2 0 2 1 -- 5 6 -- 0 1 0 3 7 Site Address 480 E Panorama Dr, Shelton, WA 98584 Subdivision Name and Lot Shorecrest Terrace 3rd Add/ BIk 1/ Lot 37 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 NC Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies O Onsite: Holding Tank, WAC246-272A- 0 Appeal:Enforcement Timelines 0240 0 Appeal: Departmental Determinations O 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. --) Applicant Signature: 1� Y Date: (0- t Z- - ?..3VYD _ (-� .-bN Dw'l-J Revised 8/13/2018 This form may be scanned and available for pu tic view on the Mason County Web site. 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 LO 2. Identification of Specific Code/ Standard/ Determination include date of determination or latest Code/Standard revision): wn�7�-t3 —7---7 Z - —O -a- 3. Nature of Appeal: 4'lSti`wb ac,, --Ftwr\ DP- to -•`wt to Z-Feo_-i-. 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director O Certified Contractor Review Board \K Environmental Health Manage 5. Mitigating Factors: I ( \-t%r\-4;ti-e_ka i r-e-3.e--vv-Q 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: 1ZVA5 V vY- Date: g(2-7 /25 PART 4: Determination of the Hearing Official C_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: Health Official Signature: Date: (/L 7/1-2 Revised 8/13/2018 This form may be scanned and available or public view on the Mason County Web site. Page 2of2 • --- f ?ctr1orar1c* Dry , • qr. Z 0' ��'{ • . 13( n201- 01yN3 / c ) Park �h� /• / g . • 12 „mow li.17-_.: - .:',5,14-7.- • ,7) r ;; '�� ..!It i v i k - /- 711.74IC. �� 20' w 0 I ' _. = naii A ...„ • sz' 9y 5i ' liar-- 475 SF f Dri 5 i rf sfrvt . w►.. L / IONS/ "..---..' ..*-. " .'""j : J0 za 40 (4) 3'X 3$' primal PIN- Plan D.F. enc4s Sfhact Sirnpgah 5' Oc, NU( 32mi-Sb-ol o37 xx Parkway Blvd lien ciN w S�4 Audio-Visual Alum Ogamout d'Tts1-}iQit 3 500 Gallon Pm-Trash tank l ' 3 0 r., 1 Oa Myy Saha O NuWater BNR-500 ATU + roots -to +�t 11 © 1,000 Gallia Pump F 2 4 21" loamy n umber � dt �0 0'{'S .}� O Valve Control Box ,I..,.")i% +11I APPROVED ••�P^L AJ, • ti a` q JUL 2 1 2020 .Printed From Mas h 9hialoy. 6, Printed from Mason County DMSLYC