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HomeMy WebLinkAboutSCANNING ONLY NO FEES NO PERMIT NO REVIEW - WAI Health Waiver - 1/3/2022 (.tJctc�ao a�, • boon l no 7 ✓IASON COUNTY J10 ?Arm; , :OMMUNITY SERVICES '/� f� �{�I ,� �) ilding,Planning,Environmental Health,Community Health �" , v • — v' � I' N 6'Street, Bldg 8,Shelton WA 98584, 4• Belfair. (360)276-4467 and 400 O Elma: (360)482-5269 wit 400 FAX for 427-778 1 pplication for Wai/v/\\eC/Appeal Amount Paid: v Receipt Numbs, 0 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 �n l� Nameof Applicant Ac,,,an rCorn tSh 1L Teellephonez,�3- - 7""— IS37 Mailing Address of Applicant 32,7 kegevt-& ULV o Owl- city Fr'rrresf state WA zip IM& 12-digit Tax Parcel No. 2 I �' - -E L - a 0 d f Z Site Address 1S'21 E Mason rLk k EI Gro1�'e yieyLd WA' 9.f�OYb Subdivision Name and Lot 0. IAgs S flny J/IOrP RrAA I��p4 fr'I Lot /7 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 ❑ 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 IWI /Iaiverl/App/�aI(inclu/de just cation, additional material may be attached.): SPe GT+ h!U M0.7C✓rti �, Applicant Signature: ceufii Date: 0 1 JAEH Fame\Waivar-Appwl Mason County Local Revised 120=7 Age 1 af2 ! g■ pf d k\��` ® \\\ � 9 t© * > m | m ) E � � jn % [ � » ` �. Ei! aAE i ' 1 v , 'bA A ppgg9g A /� J iai 59 N rbrt 3 �� S pa tlR6R6R6R6 g ,�' m = 1 H $ � rri aeaA �OI1 � ia ee ° . `o I aaeiee �,��� � ea EE as Es i i pa ini IiaEaE°$ ;EE6fsi i -0 ;g !� 55s .pp $E'Ai s§ $E ss i �a�ibii�i �� �I°i�a alAi�E's i§�}abja�l gi�i $a is '9 Esaii 9� iE �!° s be 4gs �i� E?e9b�E, 6§E !E As _ it i i a b a §' 9A 9 § 3$i"s�ge 1 29bs3 �EEiEi bs ia�Bi 3z+ bI-Ml g ,;�a� Is3 S1 1g�EaE°1A aaia ,�iE;� + ! p� ER6f IWffi1lN(E IXfRE e�gaµ CgMWI �� sitts ill pn -- (aq Brian Cornish Phone#: (253)720-4537 Property Address: 1521 E Mason Lk Dr. E Grapeview WA 98546 Parcel#: 22104-51-00017 I'm asking for a WAC 246-272A-0230 (Line 3)waiver for the existing drain field which is downgradient from the slab garage that was permitted and finalized in 2016. Also attached is a current survey obtained from Sitts&Hill (#253-474-9449),the closest corner to the uphill garage is 5.4' away while the next closest is 10.5' away. All 4 corners of the drain field were exposed at the time of the survey in order to get an exact location.The septic system was pumped and inspected by B-Line Construction late June 2021 and should be in the health departments records.Apex Septic Design (#253-509-9922) Have also been to the site to verify no issues with the drain field location along with plenty of room for reserve if needed. 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. Identficabon 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: 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: Date: 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: Hearing Official Signature: Date: ]:tEH Forms\Wnivc,Appeol Mason C000ry Local Reviud 1202017 Page 2 of 2