HomeMy WebLinkAboutWAI2024-00050 - WAI Health Waiver - 5/22/2024 r�T�r� 415 N. 5-STREET,SHELTON WA 98584
MASON CO*T N y Y SHELTON:360-427-9670,ert 400
COMMUNITY SERVICES BELFAIR:360-275-4467,ezt.400
ELMA:360482-5269,ii< .400
wero,e>umin% FAX:360-427-7798
for Waiver or��Appeal I
Amount Paid: Receipt Number: d-lML4' ��1zgy
WAI .�-J..m/ D
Instructions:
1. Complete Parts 1 and 2. No determination can be made until these parts are fuliv 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 Information
Name of Applicant Zenith Group NW, LLC Telephone 253-225-2808
Mailing Address 3190 Harris Rd SE
City Port Orchard State WA Zip 98366
Parcel No. 3 1 9 0 4 _ 5 4 _ 0 0 0 1 5
Site Address 30 SE Fuchsia Ave, Shelton, WA 98584
Subdivision Name and Lot Fawn Lake #5, TR 15
PART 2: Nature of Waiver/Appeal U R ! T Q U T
❑ Onsite: Class A Waiver M v 2 2 ,174Dlater
od Sanitation Requirements
❑ Orate: Class El �' t - ❑ oup B Water System Regulations
❑ Onslte: Class C Waiver ❑ Adequacy Requirements
0 Onsde: Location,WAC246-27 0 ❑ ilding Permit: EH Review Policies
❑ Onsite: Holding Tank,WAC24B- peal:En/orcement Timelines
0240 ❑ Appeal. Departmental Determinations
❑ Onslte: Contractor Certification ❑ Other
Requirements
Description of Waiver/Appeal(include justification, additional material may be attached.):
See mitigation attached.
Applicant Signature: Date:
4c� LlJ,—. Q,(� Rena 8113RU13
This fain ilry�be 3canribd-and a ro la for pubik view on the Mason County Web site.
Inge 1 of 2
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 qqw Class C to
2. Identification of Specific Code/Standard/ Determination (include date of determination or
latest Code/Standard revision): IAO 7 149 —77Z A-02( O
3. Nature of Appeal:
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4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board �' Environmental Health Manage✓'
5. Mitigating Factors:
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the
state and local policy rh-tass been submitted.
`\Staff Signature: Li r lf/P Date:
PART 4: Determination of the 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:
Health Official Signature: Date: j
a,�„� snvz rs
This form may be scanned and available for public view on the Mason County Web site.
Page 2 or2
Application for Waiver/Appeal Mitigation 5-16-24
Owner: Zenith Group NW,LLC
Phone: Derek Johnson(253)225-2808
Mailing Address: 3190 Harris Rd SE,Port Orchard,WA 98366
Site Address: 30 SE Fuchsia Ave, Shelton, WA 98584
Parcel Number: 31904-54-00015
Property Description: Fawn Lake#51 TR 15
1)Local Waiver Sought:
Reduce horizontal separation between house foundation and reserve drainfield from 10'
to a minimum of 2'.
1)Mitigation Measures:
Land slopes away from foundation. Drainfield effluent will drain away from foundation,
not toward it.
APPROVED
MAY 2 3 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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