HomeMy WebLinkAboutWAI2024-00068 - WAI Health Waiver - 7/17/2024 1�114� 10 60 68
On
JUL 1� 202�
MASON COUNTY ,,,�
COMMUNITY SERVICE By_�----
� ® Building,Planning Environmental Health Community Health
415 N 61"Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 8 Beffair (360)275-4467 ext 400 d Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount (
Receipt Number: Z
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 Becky Rieger Telephone 360.2193343
Mailing Address of Applicant 901 L street
city Centralia State WA Zip 9e531
12-digit Tax Parcel No.
Site Address 760 E Wood Lane, Shelton
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certffication Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
K Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal(include justification, additional material may be attached.):
Reduction of setbael,from a manufactured home from 10 feet to 2 feetwith the drainfield down gradient.Draifoeld arx1 hone
location are restrained by site corstraints in the t000araoM.
Applicant Signature: 6 Date: 07.01.024
1:\EH Forms\Waiver-Appeal Mason County Local Revised 1202017
Page 1 of
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsre Waiver(if applicable)
o Appeal arver ❑ None required o 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:
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 Aowmy2xa�1t-
YW
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted.
. -^[n� l ,�
Staff Signature: Y�_+'"�'V' �M' i Yv 1 Date: (Let � —1
PART 4: Determination of the Hearing Official
It 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:
J:1EH Forms\Waiver-Appeal Mason County Local Revised 120/2017
Page 2 of 2