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Home My WebLink AboutWAI2024-00041 - WAI Health Waiver - 5/7/2024 MASON COUNTY COMMUNITY SERVICES Building Planning EnvlronmeMal Health Community Health 415 N 6"Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 O Belfair: (360)2754467 exl 400 J Elms: (360)482-5269 ext 400 FAX (360)427-7787 n Application for W;iT.l Amount Paid: , I`�Jlla`1fl MAY 07 2024 Receipt Number Instructions a �� Y 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 LYNN MURDY Telephone Mailing Address of Applicant 1181 E MASON IAKE DRIVE EAST City GRAPEVIEW State WA Zip 98546 12-digit Tax Parcel No. 2 2 1 0 4=-- 5 2 =_0 0 0 5 1 Site Address 1180 E MASON LAKE DRIVE EAST Subdivision Name and Lot PART 2: Nature of Waiver/Appeal O ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper,O&M Specialists) ❑ Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations V 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.): REDUCE SETBACK FROM WELL TO DRAINFIELD DOWN TO 75FT. DRAINFIELD IS DOWNGRADIENT OF WELL AND WELL IS OUTSIDE ZONE OF INFLUENCE. TREATMENT LEVEL B&24"VERTICAL SEPARATION PROPOSED. SYSTEM TIMED AND ANNUAL O/M WELL LOG ATTACHED FOR REVIEW. Applicant Signature: ate: ''�,r 30�2•/ T 1:TH Fonns\Waiver-Appeal Mason County Laval Revised 1/202017 Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) Laa 1 1. Type of Determination Required: Type of Onslte Waiver(if applicable) ❑Appeal XWaiver ❑ None required O Class A ❑Class B ❑ Class C 2. Identification of Specific Code/Standard/Detenninatiopp�I elude dale of determination or latest Code/ Standard revision) G/k,ZCj6_2�Z�-zI�C1r 3. Nature of Appeal: Rrdr.cr, ham zo�fu/ Spie�ufitrt d-ft,,ePif oil drine✓5r 1 �emam of ana( CL1 4h 11WsOfLGI 4.ALer IL I/ J-MM lV57 fri na+ fPsS' 1yjLHl '1�'f� 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: C4xfQ*t,,,1e44- - dnCfii fk, weod M ro - will a /a X f 6 dPoo wiMa orn fm n- Jni fL 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been�ssuuubbm/ittedd.. 7� Staff Signature: //' / Date: &—yz7 zy. PART 4: Determination of the Hearing Official 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: Cl 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: S Z L 1:\EH Forms\Waiver-Appeal Mason County Local Revised 1202017 Page 2 of2 WATER WELL REPORT MDEPARTMENTOF NosceormtmtNo. we54M Type orwxb ECOLOGY Uviqua FidpO.WeI1IDTgg Na BNme, .Stare M Wes:Mngmn ® Cmmstion gke Wdl Name(ifomm Wev aoewat9: ❑IxePamiNbap Otimmllavlktlpa NOptla Waa Right PwnWCmkfimle Nw Nappm4UW eOmm:k UfWew UNmtlpd Property Owoa Name LYNN MURDY D 4wmup ❑hliv4 ❑TaawN ❑Opy_ , - Wdi Soad Add ma 1170E MASON LAID:RD E B 1JW weD ❑.1lvesm ❑plwa U3 ❑11WeT Chy GRAPEVIEW Om w, MASON o Oepaa Oolm U1A6 e.vr- OMW4 , Tn Pawl No. 2210452000SO OpPe�leee 1NaWpr(Igbq k k.b toe R DgkatePNPkte4we810g R Wuavaivaappmvcd forlhiewdlT ❑Yu MN, Ortevnru:br wA lfloa,whmwu tM vmkucetm? 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