HomeMy WebLinkAboutWAI2024-00023 - WAI Health Waiver - 3/12/2024 MASON COUNTY
COMMUNITY SERVICES
Buildng,Planning,Environmental Health,Community Health
415 N 6"Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 le Belfair: (360)275-4467 ext 400 f Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: I q _
Receipt Number: /1
Instructions (��/_
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. Applicant/Parcel Identification
Name of Applicant NATHAN/SERENA PEARSON Telephone 253-651-e226
Mailing Address of Applicant 6118 189TH AVE CT E
City LAKE TAPPS State WA Zip 98391
12-digit Tax Parcel No. 2 2 1 2 7 - 7 6 _ 9 0 0 3 3
Site Address 102 E PASSAGE POINT LANE
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ 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
X 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 HORIZONTAL DISTANCE FROM DRAINFIELD TO SHORELINE.
Applicant Signature: Date: ®..
_�
J:1EH Fonns1 Waiver-Appeal Mason County Local Revised 1/202017
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/ PART 3: Public Health Evaluation (Staff Use only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)p,❑Appeal Waiver ❑ None required ❑ Class A c Class B ❑ Class C
2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/
Standard revision) WAC246-272A-0210 TABLE IV
3. Nature of Appeal:
REDUCE HORIZONTAL DISTANCE BETWEEN DRAINFIELD AND SHORELINE FROM 100'TO go'
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board Environmental Health Manager
6. Mitlggatin Factors:
1.TIMD DOSING
9 RAr1CT I F\/FI ARFA f1N THE SITr
A ARFA W14FRF ADEOI IATF SO" S FOO A (`fl /FNTIC) IAI PRESSI IRE SYSTEM
OWNER FELT THAT HIGH WATER MARK WAS 10' FURTHER THAN BANK
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted.
Staff Signature: Date:
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:
tli� 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: 3 v 2
MEH Forms\Waiver-Appeal Meson County Local Revised 120/2017
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