HomeMy WebLinkAboutWAI2024-00062 - WAI Health Waiver - 7/8/2024 r �
MASON COUNTY
COMMUNITY SERVICES RF�F/V
auildk g.Plannkig,Emironmental Hmlth,C...ty Health
415 N 6 Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 O Belfair: (360)275-4467 ext 400 O Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for WalverlA peal
Amount Paid: �nQ
ReceiptgN�um�bberr: -qZ-q A 0,).Q) to-
Instructions W f 1 d-�-oa o��C�_
1. Complete Parts 1 and 2. No determination can be made until these�rts are fully comple[ed.
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.ApplicantlParcel Identification
Name of Applicant Andrew Spear Construction
Telephone 360-490-0324
Mailing Address of Applicant
2000 w Shelton Vallev Rd
City Shelton State WA Zip 98584
12-digit Tax Parcel No. 42135MO55
Site Address
901 W Clear Lake Dr
PART 2: Nature of WaiverlAppeal
tF, X Location, WAC 246-272A-0210
Description of Waiver/Appeal(include justification, additional material may be attached.):
We would like the setback from the reserve drainfield to be a minimum of 5' from the proposed garage.
This is just in one corner. The reserve drainfield is also downhill from the garage.
The location of the RV Garage was chosen because of the topography, needs of the owner, and existing
system. This very large lot has plenty of room to use a different reserve driainfeld location, if the need to
use the reserve ever arises.
Applicant Signature: Date: —
L EH Forms\Waiver-Appeal Mason ounty Local Revised IJ2012010
Page 1 of
PART 3: Public Health Evaluation(Staff Use Only)
I. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal 'Waiver ❑ None required ❑Class A ❑Class B ❑Class C IAL7rZ-
2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/
Standard revision)
3. Nature of Appeal:
lJ1 RO�/lu-Pyl�a Jl- �I'cA- yvf Sear4n �-��-il�y1'l�iC.�C, �1 '1'-TT.
4. Hearing Official:
o Board of Health o Health Officer
❑ Pollution Control hearing Board o Public Health Director
o Certified Contractor Review Board V�_ Environmental Health Manager
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: tit '!CJ" Dater
PART 4: Determination of the Hearing Official
k 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 denled.This decision is based on the following findings and conditions:
G
Hearing Official Signature: Date:
J:\EH Pons\Waiver-Appeal Mason County Local Revised 1202017 Page 2 of 2
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