HomeMy WebLinkAboutWAI2023-00098 - WAI Health Waiver - 10/3/2023 7Lo23 - Oocflq
MASON COUNTY
COMMUNITY SERVICES
Building,Planning Environmental Health,Community Health
415 N 6th Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 e Belfair: (360) 275-4467 ext 400 e Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid. Vqo •- '(
Receipt Number -1-2.
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Instructions •
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1. Complete Parts 1 and 2. No determination can be made until these parts are full cohi ed
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 TIMOTHY THADEN Telephone
Mailing Address of Applicant 90 E OLD RANCH RD
City ALLYN State WA Zip 98524
12-digit Tax Parcel No. 2 2 2 3 3 _ s -- o 0 0 4 s
Site Address 4940 E MASON LAKE DRIVE WEST-GRAPEVIEW
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
O Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ 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 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM SOLIDS HANDLING PUMP BASIN TO FOUNDATION FROM 5FT DOWN TO 2FT
FOUNDATION IS UPGRADIECNTTI AT
HIGHER ELEVATION. BASEMENT IS ALSO SLAB ON GRADE(NO CRAWL)
Applicant Signature:/�b • �� 1 Date: i o(L I L3
11EI I Forms'.N'uncr-Appeal Mason Count). Local Rea isud I/2012017
Page I oft
PART 3: Public Health Evaluation (Staff Use Only)
1 Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal If4vaiver : None required r Class A Class B i Class C CO
2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/
Standard revision) V`�' ,t it Zl5�
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3. Nature of Appeal:
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4 Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board 9( Environmental Health Manager
5. Mitigating Factors: Oatn J O cQ 1y _ - 1
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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. C I r�n v f Date: t (" /L 3
PART 4: Determination of the Hearing Official
et- 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: $*Ai Date: /0// 2- 1
J:\EFI Forms\Waiver-Appal Mason County Local Revised I20/2012
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