HomeMy WebLinkAboutWAI2025-00008 - WAI Health Waiver - 1/30/2025 MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health Community Health
415 N e Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 4 Belfair: (360)275-4467 ext 400 4 Elms: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal I
Amount Paid: 4JO5upu, JAN 0 2
Receipt Number: MZ - co`�9
Instructions 20z5 - 00002 BY
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. 1
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant/Parcel Identification ?
Name of Applicant M)hN H&-m av Telephone
Mailing Address of Applicant 3-)33 4l&6 L-Va Lr AAA)
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City aarlG'/l�II / ��''11 Stale Zip 'I U3 )e�
12-digit Tax Parcel No. t1(' of a D— - L 2 - 3 � o o l
Site Address ;91 E Sulu ym sf Ally. `✓,r,r_y�st y
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer,Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies X 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.):
SEC: ATtgcNco Le-cto12
Applicant Signature: Dale:
J9EH Fomrs\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
1
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal pf Waiver ❑ None required ❑ Class A ❑Class B ❑ Class C
2. Identification of Specific Code/Standard/Determination(include date eto`f"determination or latest Code/ �..n
Standard revision) N*" �l<y pef�t 9(045j 15W �teet&I'd '�M' �tp�a WWJ� fw.
Siam' hiriv. 2-For �4f jySveil
3. N ure of Appeal:
v m r 6 Rv um
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4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board X Public Health Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
5. Miti sling Factors:
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f- We zbz& - o
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted, 7
Staff Signature: // /� Date: Zd
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:
�9 L /
Hearing Official Signature: Date: / >
J:/EH Forms\Waiver-Appeal Mason County Lacal Revised 1/20/20ll
Page 2 of 2
Tom Herstad Building Design, Inc.
296 Tremont St.
Port Orchard, WA 98366
360-876-6893
office(a)tom he rstad.com
To: Mason County Environmental Health
RE: WEL2024-00049
We are writing this in order to get a waiver for use of a two party well on two
pieces of property that are under 1.0 acre. The lots affected are listed below.
371 E Sullivan St— 12220-50-39003 - .11 acre
381 E Sullivan St— 12220-50-39004 - .11 acre
Both of these lots would like to be served by a two-party well already installed on
371 E Sullivan St,Allyn, WA. The lots do not have an onsite drain field and are hooked
up to the sewer system in the area. The builder built the two neighboring homes 3
years ago and they are both served by a two party well (351 &361) E Sullivan St. We
feel that letting these two houses be served by a two-party well would not be detrimental
to the neighborhood development or cause any issues since there are no onsite septic
systems.
Please contact me if there are any questions or concerns. Thanks.
Michael Fortman
360-876-6893