HomeMy WebLinkAboutWAI2023-00095 - WAI Health Waiver - 9/24/2023 W6)(2, &Oaf - oacg5
"Z MASON COUNTY
r f� '_.! COMMUNITY SERVICES
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`Hy M1+,7 Building,Planning,Environmental l leallh,Community Health
415 N 61" 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 W$Iver/Appeal
Amount Paid: ,R (goedo
Receipt Number.
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 THOMAS WALSH Telephone 206-660-7634
Mailing Address of Applicant 5001 SUNRISE VISTA
City SEATTLE State WA Zip salts
12-digit Tax Parcel No. 3 2 0 2 3 - 3 2 - 0 0 1 4 0
Site Address 372 S E MELL RD, SHELTON, WA. 98584
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
0 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
0 Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE HORIZONTAL DISTANCE FOR DRAINFIELD TO SURFACE WATER(MARINE) FROM 100' TO 75'
Applicant Signature. 5 ( A-ii.“ .0( p a,lJal ) Date. f{I ZY! Zr712
1211II Farms\ Bainro r-Appeal Mason('nunh I.neal I
Retivad I'20/2017
Nu: I nl2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver Of applicable)
Appeal N Waiver None required Class A Class B Class C LOU/
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. NatureofA- 27ze &Zyo T<.6ie J7
12e r1io 1 cL 1ah,4 /c c_trea.rrvj:e 1 2 4. CW1 I. . W 2h/
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4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board
9/� ® Environmental Health Manager
5. Mitigating Factors: Af_f"
MEETS TREATMENT LEVEL E(WITHOUT DISINFECTION.
6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been �ssubb//7mitted. (/ /I X�J/
Staff Signature: /��/ Date: fy Il V L Z8/2
PART 4: Determination of the Hearing Official
lJ, 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: V Date: /V�7. f
JAE'I Forms\Waiver-Appeal Mason county Local lies'mal 1:20.2017
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