HomeMy WebLinkAboutWAI2024-00057 - WAI Health Waiver - 7/8/2024 MASON COUNTY D
COMMUNITY SERVIC JUL 08 p024
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Building,Planning,Environmental Health,Community Health BY
415 N 60 Street, Bldg 8, Shelton WA 98594,
Shelton: (360)427-9670 ext 400 v Belfair: (360)2754467 ext 400 G Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal "24
Amount Paid: 0 Receipt Number: W —Instructions
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 Randy & Kerrie Rugg Telephone 360-606-8819
Mailing Address of Applicant 200 W Arrowhead Drive
City Elms State WA zip 98541
12-digit Tax Parcel No. 5 1 9 1 7 _ 5 0 _ 0 0 0 1 3
Site Address 200 W Arrowhead Drive, Elma, WA 98541
Subdivision Name and Lot Lots 13, 14, 15, Lake Arrowhead plat
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
19 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 WaiverlAppeal (include justification, additional material may be attached.):
100' horizontal separation to surface water requirement cannot be met. Waiver
a lination is for reduced se aration of 75' to surface water. To support this
waiver applicat opre
the on-site septic esign Inclu es a tendon Biotilter meeting
Treatment Level A. Additionally, this design includes 34" of vertical separation.
Applicant Signature: Date:
JaEH Forms\Waiver-Appee n County I Revised 1/20/2017
Page 1 of 2
• PART 3: Public Health Evaluation (Staff Use Only) f(3c wl W Natr
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal ❑Waiver ❑ None required c Class A ❑ Class B ❑ Class C
2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal: '� (j -�-a �i17�6a2 Z. �Jp1..(-Q„� ��
1 t
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: f J rl Al A S 2 �•.rL f�
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the stale and
local policy has been s bmitted.
Staff Signature: Date: /
PART 4: Determin ion*ofe Hearing Official 1
8[ 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:
Hearing Official Signature: Date. 7 / z-
]:\EH Forms\Waiver-Appeal Mason County Local Revised 1202017
Page 2 of 2