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HomeMy WebLinkAboutWAI2025-02113 - WAI Health Waiver - 4/3/2025 f /i .\\ MASON COUNTY '� . ll ,; COMMUNITY SERVICES •�y % Building,Planning,Environmental Health,Community Health • `Hlltia% 415 N 6th Street,Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 ❖ Belfair: (360)275-4467 ext 400 ❖ Elma: (360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid:4 7,,0U Receipt Number.2A Z�' Out 3 Instructions t�V�� OGQZ I 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 l&eD(247 4,�r LLe—Telephone o(5 • 3� r J��,:;.4, Mailing Address of Applicant L27,2- City ( /I l State // Zip 91%0, 12-digit Tax Parcel No. ,? 7 -� /J (� - til ��� I) Site Address �57 it" F 1 f M zit �� `-� 2&i, /d4- 9157/ Subdivision Name and Lot 4/Ammoto „v3 PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper,O&M Specialists) ❑ Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification,additional material may be attached.): We are looking for a waiver regarding the setback from the Drain Field form 14' to 8' setback to the home or 4' setback to the side porch as shown on the site plan. l � !G Applicant Signature: A 96a1Date: 7 � )3 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 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 i Class B : Class C2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/ Standard revision) v\I � �,( (�; Z—1 2. _r7Zt 1�L1/ 3. Nature of Appeal: GQ- NA:4 -ti a� -: Ola n ik- thi Yl U Ype r vv� .To d ir- i o/Crfie KC.4-0 Z +-m n . 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board 0 Public Health Director O Certified Contractor Review Board ] Environmental Health Manager 5. Mitigating Factors: 3e- v€e 91 .dt 't- 0-P- ►t- t1 r 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. (--t Staff Signature: IrleS(Vn Date: 1 7i PART 4: Determination of the Hearing Official f/ - The hearing official has determined that approval of this request will not adversely affect public health and is hereby ranted This decii ion is based o the following finings and ccondiiltiioons: f• Q`o/i�1f L ✓G► ✓�� ,Z(✓ /�l, ` f'f� U of r'0. p`n 3 c 2L q^q / i e4v I • c/ El 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: /2.1/2f J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 , I . . 1-4 8 to d, $ _ R_ uat d � $ 00ao 0 X m § o � a2 = - II ® § % u ƒ 2w / K2 § . -o /6./I k k /\ \ \ } \ a — rj) 0. 0 2 0. 4.4 . § E 7 0 _ ] \ k ....00.0$ _� ■ A \ \ O 2 §/......... - ` j 5 ©— ) } / � � � � —CC 0 ° 4.1\� 3 = / < � , � � . / § 1--(..-- k\ � ` 0 et • . eek a2 _ V A ik ` I. � / 2 ) LP a, j § ; 0 � j i .0 // / § § V) g - ; S § / / V co V \ © bi 2 £ W j\19‘6 C § A Id o V _ , a\ 2 � 1 I o Fs to .5 / & Q - o § a 0 § ° 222t2 Q e d . 145 ° 2 = 0 CLI ) r r k