HomeMy WebLinkAboutWAI2025-00075 - WAI Health Waiver - 6/9/2025 (' -:;14(1"
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1 MASON COUNTY
COMMUNITY SERVICES
% Building.Planning,Environmental Health,Community Health
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: ;{a,5.000 -5
Receipt Number:945• ( fI
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 SO HYUN MI/NICK PARISI Telephone 360-490-3839
Mailing Address of Applicant 1252 SW ORCHARD ST
City SEATTLE State WA Zip 98106
12-digit Tax Parcel No. 4 2 0 2 1 3 3 0 0 0 0 0
Site Address 1021 W CARMEN RD S
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
p 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 HORIZONTAL DISTANCE BETWEEN DRAINFIELD AND FOUNDATION TO 4'
Applicant Signature: C 4 (g.<0, Date: ( 4 Z02 Y
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 Class B - Class C
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision) WAC246-272A-0210 TABLE IV
3. Nature of Appeal:
REDUCE HORIZONTAL DISTANCE BETWEEN DRAINFIELD AND FOUNDATION TO 4'
4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board ES Environmental Health Manager
5. Mitigating Factors:
FOUNDATION UPGRADIENT OF PRIMARY DRAINFIELD.
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6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted.
Staff Signature: Date: W €1
PART 4: Determination of the Hearing Official
tig- 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: OK Date: 7Z.f Lf
J:\fi11 Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
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