HomeMy WebLinkAboutWAI2025-00014 - WAI Health Waiver - 3/7/2025 415 N.6`"STREET.SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,ekt 400
COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400
ELMA:360 482-5269,ext.400
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for Waiver r: Appeal I
f2 frv�E � DAmount Paid: Receipt Number: .'COZS- 072�I0 LSS ll��ll
MAR 0 7 2025
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Instructions: aY
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Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule.
Submit It application with attachments to Mason County Public Health for review.
PART 1. Applicant& Parcel Information
Name of Applicant Tho Nguyen Telephone 253-332-0086
Mailing Address 3335 43rd PI NE
City Tacoma, state WA Zip 98422
Parcel No. 3 2 0 2 1 _ 5 3 _ 0 4 0 3 8
Site Address 180 E Bridger Ln, Shelton
Subdivision Name and Lot Shorecrest Add Replat, Blk 4, Lot 38
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver ❑ Group B Water System Regulations
❑ Onsle: Class C Waiver ❑ Water Adequacy Requirements
19 Onsae: Location,WAC246-272A-0210 ❑ Building Permit: EH Review Policies
❑ Onsite: Holding Tank,WAC246-272A- ❑ Appeal:Enromement Timelines
0240 ❑ Appeal:Departmental Determinations
❑ Onsite: Contractor Certification ❑ Other
Requirements
Description of Waiver/Appeal(include justification, additional material may be attached.):
Reduce setback from proposed retaining wall and/or house foundation to Septic
Dralnfield from 10'to a minimum of T and to the septic tanks from 6 to a minimum of 2'.
Mitigation Is that drainnew and tanks are downolope of Ilse proposed retaining well and the foundation.
Applicant Signature: Date: S- S—ZE
Rcvix d 811312018
This form may be scanned and available for public view on the Mason County Web site.
PaEm I of 2
PART 3: Public Health Evaluation (Staff Use Only) Local
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
❑Appeal a1 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): WAG 246-272A-0210(3)
3. Nature of Appeal:
Reduce the minimum horizontal separation between the retaining wall and the septic tank from 5 ff
to not less than 2 fi and between the retaining wall and the drainneld from 10 fi to not less than 2 R.
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control Hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board 14 Environmental Health Manager
5. Mitigating Factors:
The retaining wall is up-gradient from the septic tank and dreinfield.
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submsubmitted.`Yl�suu /
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:
Condition(s): No drain will be installed as pan of the retaining wall.
No drain will be installed within 10 tt up-gradient of the dminfield.
❑ 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: V
1:\EH Forms\Waiver-Appeal Mason Comty Local Revised 1/202017
Page 2 of2
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