HomeMy WebLinkAboutWAI2024-00095 - WAI Health Waiver - 10/4/2024 o 0 o Cl
MASON COUNTY
COMMUNITY SERVICES
Building Planning,Environmental Health,Community Health
415 N 6'"Street, Bldg 8, Shelton WA 98584,
Shelton:(360)427.9670 ext 400 4 Betair: (360)275-4467 ext 400 J Elms: (360)4825269 ext 400
FAX (360)427-7787
Application foyryWaiver eal
Amount Paid
Receipt Number
Instructions
1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Fees maybe billed for waivers and appeals, based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Heath for review.
PART 1. Applicant/Parcel Identification
Name of Applicant Mark Tansey Telephone 816-728-2560
Mailing Address of Applicant 410 NE 103rd St Apt 6B
city Kansas, City state MO zip 64155
12-digit Tax Parcel No. 321245200031_
Site Address 251 E Emerald Lake DR W Graoeview WA 98546
Subdivision Name and Lot Emerald Lake DIV 3
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertcal (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
❑ Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal(include justification, additional material may be attached.):
Reduce setback from deck to septic tank to 2'.
Applicant Signature: 04"4#4.11 Date: 1 010 4120 24
]AEH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable) Co❑Appeal aiver ❑ None required ❑ Class A ❑ Class B ❑ Class C
2. Identification of Code/Standard/Determination (include date of determination or latest Code/
Standard revision) 5 „f,fry -L ,'Z-'�'Z .--o-?-C 0
3. Nature of Appeal: Y�.L-O..N Prn1C rrf,'ro, n
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: ,\
_ -1-r,� n tre�rf—
e�
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:���w� Date:
PART 4: Determination of the Hearing Official
CThe 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:_ 0,/�— Date: I d/r'1r�Z e7,
1:TH Forms\Waiver-Appeal Mason County Local Revised 1/202017
Page 2 of
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