HomeMy WebLinkAboutWAI2024-00013 - WAI Health Waiver - 2/29/2024 •
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° MASON COUNTY
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COMMUNITY SERVICES
,h ,\yv� Building,Planning,Environmental Nealth,Community Health
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: 21.5 _ \ 94
Receipt Number. ZO C�Q�4 S
Instructions t' O
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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 GAVIN LAYTON Telephone
Mailing Address of Applicant 17913 W INTERURBAN BLVD
City SNOHOMISH State WA Zip 98296
12-digit Tax Parcel No. 3 1 9 1 0 -__ 1 4 0 0 0 2 1
Site Address 231 SE MABLE TAYLOR LANE, SHELTON FEe 1
24
Subdivision Name and Lot F 4 20
PART 2: Nature of Waiver/Appeal C�/v��
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
O Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
Location, WAC 246-272A-0210 0 Water Adequacy Requirements
O 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 100FT DOWN TO 75FT BETWEEN DRAINFIELD AND A SEASONAL RUNOFF
SURFACE WATER IS SEASONAL ONLY AND NOT DIRECTLY DOWNSLOPE OF DRAINFIELD.
SYSTEM WILL MEET TREATMENT LEVEL B W/OUT DISINFECTION USING A NUWATER AND SUBSURFACE DRIP.
SYSTEM WILL REQUIRE ANNUAL MAINTENANCE W/COUNTY TRACKING IN ONLINE RME.
SYSTEM WILL BE HELD HIGH TO MAXIMIZE V TICAL SEPARATION INCREASING TREATMENT BEYOND TLB
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Applicant Signature: V 0�` "t" *.• ate:o?( 7`
J:1EH Fonns\Waiver-Appeal Mason County Local Revised 1/20/2017
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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 Class A Class B Class C C-0
2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal: / 1
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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 4 Environmental Health Manager
5. Mitigating Fac rs: Y\si,t 04 a avc1
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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. C���
Staff Signature: D�r Date: Z--/Z�17i�
PART 4: Determination of the Hearing Official
VA-- 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:
Hearing Official Signature: Date: 4- 2- 0- V
J:1Fll Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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