The URL can be used to link to this page

Home My WebLink AboutWAI2024-00056 - WAI Health Waiver - 6/17/2024 415 N. 6 STREET, SHELTON WA 98534 MASON COUNTY SHELTON: 360-427 9670,est 400 COMMUNITY SERVICES BELFAIR: 360-275-4467,e.t 400 ELMA 360-482-5269, vxt,400 a�uema vizmm�p s�wo�meoui msm-co=,m:,w 4�un FAX:360 427-7798 A icatlon for Waiver or Appeal Z024A t Paid Receipt Number / ( WAI '19 BY ions: FComplete Parts 1 and 2 No determination can be made until these parts are fully completed.Fees may be billed for waivers and appeals. based on the Environmental Health Fee Schedule.Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant& Parcel Information P Name of Applicant Steve Fors Telephone (253) 225-0813 Mailing Address PO Box 3287 City Belfair, State WA zip 98528 Parcel No 2 2 2 1 2 __ 5 6 Site Address 18331 E State Rte 106, Belfair, WA 98528 Subdivision Name and Lot Rose Point Tracts, Eddys (unrecorded)TR 32 &T.L., Pcl 3 of BLA#01-12 PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements ❑ Onsile. Class B Waiver ❑ Group B Water System Regulations ❑ Onsite: Class C Waiver ❑ Wafer Adequacy Requirements 52� Onsite: Location.WAC246-272A-0210 ❑ Building Permit'. EH Review Policies ❑ Onsite: Holding Tank.WAC246-272A- ❑ Appeal.Enforcement Timelines 0440 ❑ Appeal:Departmental Defemiinalions ❑ Onslte. Contractor Certification ❑ Other Requirements Description of Waiver/Appeal (Include justification, additional material may be attached.): See Attached Mitigation Applicant Signature: ` rr�VJ' " l��- Date: 6-13-24 Cull c"t.oJ x:13r>am This form may be scanned and available for ublic view on the Mason County Web site. I'we.t of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) _. Appeal yvvaiver None required _. Class A Class B Class C 2. Identification of Specific Code/Standardl Determination (include date of determination or latest Codel Standard revision). I- 3- Nature of Appeal " r � l 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 has been submitted. {-, Staff Signature: Dat-L., /(L'L_ PART 4: Determination of the Hearing Official EL 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. s Z This form may be scanned and available for public view on the Mason County Web site. Application for Waiver/Appeal Mitigation 6-13-24 Owner: Steve Fors Phone: (253) 225-0813 Mailing Address: PO Box 3287, Belfair, WA 98528 Site Address: 18331 E State Rte 106, Belfair, WA 98528 Parcel Number: 22212-56-00032 Property Description: Rose Point Tracts, Eddys (Unrecorded) TR 32 &T.L., Pcl 3 of BLA#01-12 1) Local Waiver Sought: Reduce horizontal separation between drainfield and south property line from 5' to a minimum of 2'. 1) Mitigation Measures: Land slopes away from property line. Drainfield effluent will drain away from foundation, not toward it.