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HomeMy WebLinkAboutWAI2025-00033 - WAI Health Waiver - 5/13/2025 �<,,,�` ..G MASON COUNTY Y 1 h 'j ° COMMUNITY SERVICES N. Building,Planning,Environmental Health,Community Health 415 N 6th Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 s• Belfair: (360) 275-4467 ext 400 Elma: (360)482-5269 ext 400 FAX (360)427-7787 ipt-Epw3r Application for Waiver/Appeal Amount Paid: 'UZ S ��Ss �, MAY 1 3 2025 6 Receipt Number: Instructions WA LOZS- cx7c7 33 By_____94,-e -/ 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 1 Name of Applicant ( 7 -CO:70E Telephone 3W "Z&)`c /y-" G cr �--(e_ L=C Mailing Address of Applicant /O P.ID. 13�,c_ 72-9 City State U• Zip 4 8>i 12-digit Tax Parcel No. 3 Z 0 C G -- 5 0 -- 41 c e 2— Site Address j-D6f--- �r1�2���51��1� Nt 7 {J f. _L 9 , • ✓' 2. : u Subdivision Name and Lot T 0 ( kJS- ( ��,✓ 2-- Ow Q = `'^j-2 I 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 )( 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.): —r e- `rtNl•o s/-Tf 5 T+- T NAM t— e .5 C� -T-Af . 1TUNL� �{STF�M )�6Q1CiNQ� L t � RJe b¢- -rwo 4PPS S-c� S+ tk AR- ��u✓ 5L).- v 10_ 0E- Ac 2 -_ �� r A A P-�S,->cT— cs F4-- et-a. - Applicant Signature: L7. Date: ;~- �� a 5 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1of2 PART 3: Public Health Evaluation (Staff Use Only) [Keg Croup & Merl!2-Paf/ leio 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal )(Waiver I None required ii. Class A Class B - Class C 2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/ Standard revision) %Wm a+*f y 9614 old corvvek''I f'l orOrS fir p 6 �itrgfr ex 3. Nature of Appeal: (( - ROM', Aiatenvint [of Size fir pate! 32006 s0 Dyovt from 1.144 0.t'1 are - fedic,G w4+ilisvol 4y t S?tZ ler pone/ 32tre6 j00k003 from 1 acm id 0.77 ar, e, 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board / Public Health Director ❑ Certified Contractor Review Board 0 Environmental Health Manager 5. Mitigating Factors: t-4,1- t?z¢S lifforce4 i , Mti 9C11 2OZ3-0003? . 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted.Staff Si nature: �� / Date: -( /l�/(�?/ '' 9 ART 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: 13aAA44 Hearing Official Signature: Wier► ivrYi Date: 5-V ).26 \EH Fornis\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 DR LAND SURVEYING PLLC EXHIBIT PROFESSIONAL LAND SURVEYING EXHIBIT FOR WELL AND DRAINFIELD LOCATIONS 222 SE SNIDER RD SHELTON,WA.98584 5 7 2025 (360)427-8392 drsurveying@yahoo.com 400.72' S 88°39'55"W \ 41145 SqFt \a 0.94 Acres !,:q" ‘73r).‘;4'; \ ,goo 9.593 c'(�NG� DRAIN FIELD 424.31' 5g 5° �X\,' 158.4' N 88°51'43" E 1 I 1 38014 SqFt 0.87 Acres • • N 88°52'53" E • 322.63' I,,.. sAYMoN O \ -of w"SH� 'Q �Ii cr yo b NOTE:THIS IS NOT A SURVEY ©� co ,Tr 2 FOR ILUSTRATIVE b a PURPOSES ONLY �o 0 4) :46454,o .6 s CSTER # S10A'A L L' 9 Id 0 50' ••••• JOB:2025.024 = MI BASE-$$SURVEYNAME MMI INDEX:NE1/4 SE 1/4 AND SE1/4 SE1/4 AT FULL SCALE,IF NOT ONE INCH SEC. 01,T2ON,R4W,W.M. 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