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Home My WebLink AboutWAI2025-00011 - WAI Health Waiver - 3/5/2025 MASON COUNTY COMMUNITY SERVICES Building Planning,Enviranmerdal Health Community Health 415 N 6" Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 -% Belfair. (360)2754467 ext 400 4 Elms: (360)482-5269 ext 400 FAX (360)427-7787 Application for Wpaive�r�/A peal Amount Paid: 1 g Receipt Number:QQQr 'VI,li1A7J s Instructions M NT aba5— 0 0011 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 2. Fees may be 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 DWIGHT & MARY WHITING Telephone Mailing Address of Applicant 71 NE SUNDSTROM RD City BELFAIR State WA Zip 98528 12-digit Tax Parcel No. 2 2 2 0_2 5 1 —_0 0 0 0 2 Site Address 71 NE SUNDSTROM RD - BELFAIR Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) LEI Separation ❑ Food Sanitation Requirements 13 Building Permit Review Policies ❑ Group B Water System Regulations 1a 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 APPLICANTS WELL TO TRANSPORT LINE FROM SOFT DOWN TO 25FT. MEETS CLASS A MITIGATION REQUIREMENTS. Applicant Signature: q Date: 1:\EH Forms\Waiver-Appeal Maven County Local Revised 1202017 Page 1 of2 it PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(d applicable) -Appeal Waiver ❑ None required MClass A n Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/ Standard revision) IpK2y6.272Q•QZIO(1) T4UCW 3. Nature of Appeal: Aa[tl!G Klh'ewrr �M+2olnk/ f fkn I'N!/1 !r//rr, trwJµtlitlCGrr� rtAh /� UG/l aCM SlFFt dr Mn /e th ZSCf. 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board CF Environmental Health Manager 5. Mitigating Factors: i c of kK um4lif jroff r U 1 11 P o 2 L ( e a.+• t r F fmvh S 7.17.3&ld er 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: !Lam/ /� Date: l z�4 2OZ 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: 3 .f 2 1:\EH Forms\Waiver-Appcal Mason County Local Revised 1/20/2017 Page 2 of2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section L (completed by applicant) DWIGHT & MARY WHITING Local Health Department District (2) M (see rnetruchons) Address: 71 NE SUNDSTR0M RD e/! BELFAIR, WA 98528 Telephone: ( ) Signahrre Properly ldemrfication: (3) 22202-51-00002 ......71 NE SUNDSTROMRD Section H. (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246 272^— 0210 50' WELL TO T - LINE 25'+ WELL TO T-LINE subsemion: TABLE IV Justification(mitigation measures to be provided): (7) MEETS CLASS A REQUIREMENTS_OUTLINED Section III. (completed by health gfcer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) .................................................... Comments/Conditions (10) T-il;4 tir*t 216•7711-_02(0(l) TM LV ......... ____. _. Type of Waiver: (11) ffClassA [ ]Class B [ ]Class C—Request DOH review before granting? Yes_ No_)[ Neighbor Notification: (72) Required? Yes_ No_C /jneeded,are agreements,easements, etc.properlyJiled? Yes _ No Section IV. (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. I ] Denied Ipd Approved/Granted—Subj/e$�o all comments,conditions and requirements noted in Sections It and III. Local Health Officer �/ Date: .T DOH 337-021 Page 26 of 32 u � 3 3 U o ❑._ > °o' ,a`1 y of O �gi v 8 o ' m '° > `m u@ a E _ F •a`_ W u3 3 $ d O z z� o9� s e E 5 a F FU = W M 8