HomeMy WebLinkAboutWAI2024-00002 - WAI Health Waiver - 1/7/2025 �CL't o,
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 0 Belfair: (360)275-4467 ext 400 p Elms: (360)4825269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: o-5c
Receipt Number:QQ,;lS • (36 Ci75
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 Health for review.
PART 1. Applicant/Parcel Identification
Name of Applicant S)?ft / 'Telephone 3�'ZZS-O�OS
Mailing Address
of Applicant �.
� 7i$� ��J hOLJ 5L q �• p o
City 1d State v p Zip
12-digh Tax Parcel No.
Site Address Sa•tr"�'�
Subdivision Name and Lot
PART 2: Nature of Walver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, 08M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
X Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsfte Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal (Include justification, additional material may be attached,):
r
Applicant Signature: Date:
J:ViH Forms\Waiver-Appal Mason County LoW � Revised 12020 V
Page 102
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal `'Waiver ❑ None required ❑ 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: n� f 04-5 14?
'tom --- �✓ T° � e /
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:
Lre i s
e ti a f = rl e0Q
6. 1 have received this waiver/appeal request. It is complete and mitigation required bythe state and
local policy has n submitted.Staff Signature IPL4 I Date: 1- 2-5
PART 4: Determin tion of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect public health and
is hereby granter!.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 dented.This decision is based on the following findings and conditions:
Hearing Official Signature: � �/ Date: L �J
r:\EH Forms\Waiver-Appeal Mason Cowry Local Revised 1202017
Paget oft
Application for Waiver/Appeal Mitigation 1-6-25
Owner: Jeffrey& Stephanie Logan
Phone: (360)275-0105
Mailing Address: 281 E Snow Cap Dr, Belfair, WA 98528
Site Address: same
Parcel Number: 22221-53-00041
Property Description: Twanoh Falls Add#1,Lot 41
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,toward back yard. Drainfield effluent will drain
away from foundation, not toward it.
2)Local Waiver Sought:
Reduce horizontal separation between edge of road easement and and primary drainfield
from 5' to a minimum of 2'.
2)Mitigation Measures:
Property line is up-slope of drainfield. Drainfield effluent will drain away from
easement, not toward it.