HomeMy WebLinkAboutWAI2024-00020 - WAI Health Waiver - 3/7/2024 �\ MASON COUNTY
COMMUNITY SERVICES
Building,Planning EnvironmentalHeilth Community Health
415 N 6''Street, Bldg 8, Shelton WA 98584,
Shelton:(360)427-9670 ext 400 * Belfai360)2 427 67 ext 400 4 Elma: (360)482-5269 ext 400
FAX
Application for Waiver/Appeal
Amount Paid: lql� q g
Receipt Number: a�
Instructions
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� 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Fees maybe 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 t. ApplicanVParcel Identification
Nameof Applicant ?-\(31-AAbIA +kPTFlFLD Telephone C55 n552-5�92
Mailing Address of Applicant [• C)• Boy, \`T � r, ACity �IDctIUVA State) Zip g9588 (1
12-digit Tax Parcel No. Z 2 1 - -5— 1 — k -L Q Y
Site,Address C� 1 NF S?AR `TREE D R T'A t1UV A
Subdivision Name and Lot Sit r'I=RKooK 'C'KAO , S 41 / 42
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in vertical (installer, Pumper, O&M Specialists)
Cl Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
0
Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246.272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification,additional material may be attached.):
SEE AITA�tl -n
Applicant Signature: Date:
J:\EH Fonns\Waiver-Appwl Mason C C7 Local C- Revised 11202017
Page J of 2
PART 3: Public Health Evaluation (Staff Use Only)
f. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal ❑Waiver ❑ None required ❑ Class A ❑ Class B � Class C
2. Identification of Speck Code/Standard/Determination (include date Of determination or latest Code/
Standard revision) / L� J�,/
3. Nature of Appeal: (O C 'Iy 7�! S��r NGE. C4f�"(
4. Hearing Official:
❑ Board of Health + ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
6. Mitigating Factors:
6. 1 have received this waiver/appeal request It is complete and mitigation required by the state and
local policy has en ubmitted.
Staff Signature: e Date:
PART 4: Determin tI a Hearing Official
�. The hearing offici 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: — Q-A Date:
J:\EH Fo.ms\WaivmAppeal Mason County Local Reviwd 1/202017
Page 2 of 2
Application for Waiver/Appeal Mitigation 2-28-24
Owner: Romana Hatfield
Phone: (360) 552-5192—Justin Macomber
Mailing Address: PO Box 14,Tahuya, WA 98588
Site Address: 91 NE Spar Tree Dr, Tahuya, WA 98588
Parcel Number, 32227-54-00040
Property Description: Shorebrook TR 40. S 47/112
Local Waiver Sought: Reduce horizontal separation between drainfield and surface water from
100'to no less than 75'.
Mitigation:
A) Drainfield meets Treatment Level B without disinfection using a NuWater BNR-500 and
shallow pressure drainfield whh timed dosing.Vertical separation is 12"+, no restrictive layer
encountered.
B) Proposed House is in between the drainfield and the creek which further reduces the
hydrogeologic susceptibility.
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