HomeMy WebLinkAboutWAI2024-00014 - WAI Health Waiver - 2/12/2024 mom&
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Always working for a safer • healthier Mason County FB
415 N 6th Street, Bldg 8,Shelton WA 98584, RCA• Z�Z�
Shelton: (360)427-9670 ext 400 °.• Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400 /frFD
FAX (360)427-7787
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Application for Waiver/Appeal
Amount Paid: FEB ?t;L4 Li
Receipt Number: c ck e
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 Ronald Poole Telephone 7c3-740-1677
Mailing Address of Applicant 38215 42nd ave South; Auburn, WA 98001
City Auburn State WA Zip 98001
12-digit Tax Parcel No. Z 7 n 7 -- 5 0 -- 0 0 n _J__ 9
Site Address 360 E Lakeshore Rd E; Shelton 98584
Subdivision Name and Lot Timberlake #2 Lot 79
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
j l 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
❑ Contractor Certification Requirements 0 Other
(Installer, Pumper,O&M Specialists)
Description of Waiver/Appeal (include justification,additional material may be attached.):
5' property line down to 2' Parcel nest door is greenbelt will never be built on and side slope
10' from building foundation down to 3' - foundation is side slope+Treatment level B and pressure beds
Over old drainfield - Old drainfield was installed deep over hardpan. New pressure bed over small portion
Vertical separation c19" type 4 soil and treatment level R t. in" Table IX
Applicant Signature: Date: 02/12/24
J:\EH Forms\Waiver-Appeal Mason County local Revised 12/1/15
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PART 3: Public Health Evaluation (Staff Use Only) L6) C a(
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal Waiver Li None required r- Class A r- Class B _ Class C
2. Identificatio of Specific Code/ Standard/Determination (include date of determination or
latest Code/ Standard revision)
3. Nature of Appeal: 2F-f 690,4141-1 drJ 6-. p-E) ,cles logo
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4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board 0 Environmental Health Manager
5. Mitigating Factors:
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. iV1� � Date: 2.2. tf
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PART 4: Determinati I 1 oft • Hearing Official
;i'' 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: L-- Date: Z-/� °�L6Z
J:\EH Forms\Waiver-Appeal Mason County Local Revised 12/1/15
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