HomeMy WebLinkAboutWAI2024-00048 - WAI Health Waiver - 5/20/2024 415 N.6' STREET,SHELTON WA 98594
MASON COUNTY SHELTON:360-427-9670,ext 400
COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
ELMA:36OA82-5269,ext 400
eu�un4riaanmy,eimmnme�m ueaiu.<mammine.+xx FAX:360-427-7798
Application for Waiver or Appeal
AmcuntPaid lol : Receipt Number: �2t{' 022
WAI _ OODt lQ,_
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 Information
Name of Applicant Empire Home Construction Telephone 360-751-8062
Mailing Address PO BOX 241
city Kelso State WA Zip 98626
Parcel No. 3 2 0 2 1 __ 5 8 _ 0 4 0 6 1
Site Address 90 E Kingston Way, Shelton, WA 98584
Subdivision Name and Lot Shorecrestt Beach
l�Estates #1, Blk 4, Lot 61
PART 2: Nature of WalverlAppeal IUJ � �^ 0 U t6
❑ Onsae: Class A Waiver �If��fl MAY 21 2024 d Sanitation Requirements
❑ Onsite: Class B Waiver ❑ up B Water System Regulations
❑ Onsite: Class C Waiver ❑ W ter Adequacy Requirements
]W Onsite: Location,WAC246-272A- Iding Permit: EH Review Policies
❑ Orate: Holding Tank,WAC248-272A- aC Enlorcement Timelines
0240 ❑ Appeal:Departmental Determinations
❑ Onsae: Contractor Cert�cation ❑ Other
Requirements
Description of Waiver/Appeal(include justification, additional material may be attached.):
See Attached Mitigation
Applicant Signature: Date:
uyy,o r. Revised 8113aOl8
This form may be�sca scanned anda vallable lr+ori .blic view on the Mason County Web site.
Page 1 of2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑ Appeal (1C���'�aver None required ❑ Class A 3 Class B Class C OCA-L--
2. Ident cetiori of Spec Code/Standard/Determination (include date of determination or
latest Codel Standard revision): «MA� /1 -07-1 0
3. Nature of Appeal:
mn vtu I'M' �1
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board C3 Public Health Director
❑ Certified Contractor Review Board Environmental Health Manage
5. Mitigating Factors: O
1' Al
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: � � t t1✓�v t Date: I v`
PART 4: Determination of the Hearing Official
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: �i i Date: Z
Heviu-0 8/1�2018
This lomt maybe scanned and available for public view on the Mason County Web site. rage^_or2
Application for Waiver/Appeal Mitigation 5-16-24
Owner: Empire Home Construction
Phone: (360) 751-8062
Mailing Address: PO Box 241,Kelso,WA 98626
Site Address: 90 E Kingston Way, Shelton,WA 98584
Parcel Number: 32021-58-04061
Property Description: Shotecrest Beach Estates#1,Blk 4,Lot 61
1)Local Waiver Sought:
Reduce horizontal separation between house foundation and primary drainfield from 10'
to a minimum of 2'.
1)Mitigation Measures:
Land slopes away from foundation. Drainfield effluent will drain away from foundation,
not toward it.