HomeMy WebLinkAboutWAI2023-00072 - WAI Health Waiver - 7/20/2023 `.'" 'C,; \ 415 N. 6th STREET,SHELTON WA 98584
� \s MASON COUNTY SHELTON: 360-427-9670,ext 400
COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
-•1 .f ELMA:360-482-5269, ext.400
\_ j Building,Planning,Enrrcximentel Health,Community Health FAX:360-427-7798
Aoolication for Waiver or meal
Amount Paid: Receipt Number:
WAI 13 ..
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 Scott Barnard Telephone (360) 490-0155
Mailing Address P.O. Box 417
City Shelton, State WA Zip 98584
Parcel No. 3 2 2 3 4 5 1 - 0 0 0 1 5
Site Address 401 E Olympic Vista Dr, Union, WA 98592
Subdivision Name and Lot Olympic Vista, TR 15 & VAC Olympic Vista Dr
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver 0 Food Sanitation Requirements
O Onsite: Class B Waiver 0 Group B Water System Regulations
❑ Onsite: Class C Waiver 0 Water Adequacy Requirements
g Onsite: Location, WAC246-272A-0210 ❑ Building Permit: EH Revie (: ties iC . 1 1 11t
❑ Onsite: Holding Tank, WAC246-272A- 0 Appeal:Enforcement Tim $ Iti
0240 0 Appeal:Departmental Dot
illations II
O Onsite: Contractor Certification Other �RA. 't' 0 Lt�2.3 4,
El
W
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Description of Waiver/Appeal (include justification. additional material may be attached.): E•,i
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.
iN
Applicant Signature: Date: 1— ( g-2 5
crr _ a Q,s6f6V 7 Spd` o u.> - - ' Rev iscd 81 13/2018
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only) L 61'
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/ DeterrSi�ation include date ofdeerminati or
latest Code!Standard revision): �-�' �G�,�+ j
3. Nature of Appeal: (�
4. Hearing Official:
❑ Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board 0 Environmental Health Manage
5. Mitigating Factors:
ootil/d e9ri (100-F6(11 5 up5lope,
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local pol' as been submitted.
Staff Signature: t /1 v �J Date:
PART 4: Determinati n 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:
Health Official Signature: Date: 7/e/
!!!! 1,7
Revised 8/13/2018
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2