HomeMy WebLinkAboutWAI2025-00030 - WAI Health Waiver - 5/2/2025 Lae ADS - c3oc�
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,-. 4`�\ MASON COUNTY
COMMUNITY SERVICES
;, 1,4 Building,Planning,Environmental Health,Community Health
415 N 6"' 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: c S-a3(3 )
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 RICK SEATON Telephone
Mailing Address of Applicant 15310 35TH AVE E
City TACOMA State WA Zip 98446
12-digit Tax Parcel No. 1 2 1 0 8 --- 5 3 --- 0 5 0 0 9
Site Address 151 E BAHAMA DR, GRAPEVIEW
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
O Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
O Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
Mi 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.):
REDUCE SETBACK FROM DECK FOOTINGS TO DRAINFIELD AREAS FROM 10' DOWN TO 2'+ PER
WAC 246-272A-0210(3)
DECK FOOTINGS WILL BE UPGRADIENT. DECK FOOTINGS ONLY. HOME FOUNDATION WILL BE 10'+
Applicant Signature: 01l 1 1 J g ate: S`/ 2( 2.S
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J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal fAVaiver None required Class A Class B Class C �c-1
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal:
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4. Hearing Official:
O Board of Health 0 Health Officer
O Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board Environmental Health Manager
5. Mitigating Factors:
6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted.
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Staff Signature: � h�� - Date:
PART 4: Determination of the Hearing Official
l The hearing official has determined that approval of this request will not adversely affect public health and
4 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: 512-01
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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