HomeMy WebLinkAboutWAI2024-00053 - WAI Health Waiver - 6/11/2024 415 N.6t6 STREET,SHELTON WA 98584
MASON COUNTY SHELTON.36OA27-9670,ext 400
COMMUNITY SERVICES BELEAIR:360-275-4467,exn 400
ELMA: 360-482-5269,ext.400
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FAX 360-427-7798
Aooli tlon for Waiver or Appeal
Amount Paid c,-:: Receipt Number
WAI )-() - OCb53 "I 11 M,
Instructions: KLk/
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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 Information
Name of Applicant Ronald & Kimberly Preston Telephone (206) 250-8170
Mailing Address PO Box 3032
City Belfair State WA zip 98528
Parcel No. 2 2 2 0 9 3 4 0 0 1 9 0
Site Address 7070 NE North Shore Rd
Subdivision Name and Lot TR 19 OF GOVT LOT 3 S 53/37
PART 2: Nature of Waiver/Appeal
❑ Onsite'. Class Waiver ❑ Food Sanitation Requirements
❑ Orate: Class B Waiver ❑ Group B Water System Regulations
❑ Onsite Class C Waiver ❑ Water Adequacy Requirements
■ Onsite: Location, WAC246-272A-0210 ❑ Building Permit: EH Review Policies
❑ Orate' Holding Tank,WAC246-272A- ❑ Appeal' Enforcement Timelines
0240 ❑ Appeal:Departmental Determinations
❑ Onsite. Contractor Certification ❑ Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.)'.
,r See attached mitigation.x
Applicant Signature: Date "L(_Z"
Re.ised8l13/2018
This form may be scanned and available fo public view on the Mason County Web site.
Pagc 1 of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable) �-
Appeal y.vvaiver _ None required r. Class A Class B = Class C
2. Identification of Specific Code/Standard/ Determination (include date of tletermination or
latest Code/Standard revision): �y r M Zt-fE-Z-�> ^CZI J
3. Nature of Appeal:
A fa
Vrmavy G Mi �I; f�.
�mgva Ifr�l Y�Sca ✓P �+o Wlttinfa , lu �uWr.l5�f.
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board V_ Environmental Health Manager/
5. Mitigating Factors:
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6. 1 have received this waiver/appeal request. It is complete and mitigation required by the
state and local
npolicy
nhas
�vnbeen submitted. r
Staff Signature:`i,gN`" � Date: I I
PART 4: Determination of the Hearing Official
A- 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: zz Jy1Se
d 8"]32018
This form may be scanned and availa Z e for public view on the Mason County Web site.
Page 2 of
Application for Waiver/Appeal Mitigation June 4,2024
Owner Ron & Kimberly Preston
Phone: (206) 250-8170
Mailing Address: PO Box 3032, Belfair, WA 98528
Site Address: 7070 NE North Shore Rd, Belfair, WA 98528
Parcel Number: 22209-34-00190
Property Description: TR 19 of Govt Lot 3 S 53/37
1) Local Waiver Sought:
Reduce horizontal separation between house foundation and primary drainfield from 10'
to a minimum of2`.
1) Mitigation Measures:
Land slopes away from foundation. Drainfield effluent will drain away from foundation,
not toward it.
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