HomeMy WebLinkAboutWAI2025-00026 - WAI Health Waiver - 5/2/2025 „.„0„,-,-,,,--,
�\``,``:.,,.,r MASON COUNTY
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2,,, ,y, Building,Planning,Environmental Health,Community Health
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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:Receipt Number: U ['S-0-- 01 9 r�U 5
Instructions
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 JEFF ROGERS Telephone
Mailing Address of Applicant 5255 E MERCER WAY
City MERCER ISLAND State WA Zip 98040
12-digit Tax Parcel No. 4 2 3 1 8 -__ 5 0 _= 0 0 0 1 0
Site Address 220 N POTLATCH DR, HOODSPORT
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal p t - o
❑ Contractor Certification Requirements -:<
❑ Class B Reduction in Vertical (Installer. Pumper, O&M Specialists) r
❑ Separation 0 Food Sanitation Requirements 1 -<�
❑ Building Permit Review Policies 0 Group B Water System Regulations i oWil
`( ' Location, WAC 246 272A 0210 0 Water Adequacy Requirements i • ry b
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines 1 o 4
❑ Mason County Onsite Standards 0 Departmental Determinations 1 . i
❑ Other
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Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM DRAINFIELD TO LAKE FROM 100FT DOWN TO 75FT
INCREASED VERTICAL SEPARATION FROM 24”(MIN.)TO 36" FOR INCREASED TREATMENT.
NUWATER BNR500 PRETREATMENT. SYSTEM WILL BE TIMED DOSED AND RECEIVE ANNUAL O/M
SYSTEM REPLACES OLDER GRAVITY SEEPAGE PIT THAT IS ALSO LESS THAN 100FT TO LAKE.
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Applicant Signature:��l�'""l; 41 !
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) Lv LfiL
Appeal °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) 6.fcC 6--rZ/{-- 0 Z-( 0
3. Nature of Appeal: 1171
Its
Wafer
4. Hearing Official: \A,51N) Go f vrnr 6 -(-(4,- Sr 1 I ovl boa
❑ Board of Health 0 Health Officer Y �y2_ifk,L
O Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board ja., Environmental Health Manager
5. Mitigating Factors: , LQ .if v
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: b\l r -VV\if Date: cI `0 0,c"
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:
0 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: S 6/
J:1EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2