HomeMy WebLinkAboutWAI2025-00061 - WAI Health Waiver - 8/20/2025 415 N.6t"STREET,SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,ext 400
} {I' COMMUNITY SERVICES BELFAIR: 360-275-4467,ext.400
ELMA:360-482-5269, ext.400
Building,Planning,Environmental Health.Community Health FAX:360-427-7798
Applica0i99 for Waiver or Appeal
Receipt Number: OCt)�' > V"I
Amount Paid °-�. � p
1 C V/
WAI 0 5- OaDLP 1 AUG 2 0 2025 J
Instructions:
By
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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 Information
Name of Applicant
Cannel) Investments LLC Telephone (253)777-7294
Mailing Address P.O. Box 448
City Spanaway State WA Zip 98387
Parcel No. 3 2 0 2 1 -- 5 6 -- 0 2 0 1 4
Site Address E Panorama Dr, Shelton, WA 98584
Subdivision Name and Lot SHORECREST TERRACE 3RD ADD BLK: 2 LOT: 14
5 IA zoi5 oco
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver 0 Group B Water System Regulations
❑ Onsite: Class C Waiver 0 Water Adequacy Requirements
Cu Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies
❑ Onsite: Holding Tank,WAC246-272A- 0 Appeal: Enforcement Timelines
0240 0 Appeal: Departmental Determinations
❑ Onsite: Contractor Certification 0 Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.):
Reduce setback from foundation to septic tanks from 5 feet to a minimum of 2 feet and drainfield
from 10 feet to a minimum of 2 feet. Mitigation is that septic tanks and drainfield are both downslope of
house/foundation. Effluent will drain away from house.
Applicant Signature: - Date 3'"(5l " Z-C
O`c�S 4e 5 �� `I V,x.` o" I:.\i,c.18I 2018
This form may be scanned and available for public view on `the Mason County Web site. Page 1 of
PART 3: Public Health Evaluation (Staff Use Only) CoCa1
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
Appeal 'Waiver None required L Class A Li Class B Class C
2. Identification of Specific Code/ Standard/ Determination (include date of determination or
latest Code/ Standard revision): w►4 G ZY6 ' 7 ft# 'GZ l0 0)
3. Nature of Appeal ZOr1�tf t�(/CP���It'nvM ��l ' Gireib l 6efuee►i hvl iiti 'I^oo4da� 7i d doWea
y
-From toff to not toss th 7i 4+c/ k t- ef? bfi►'ld h9 , idat-,17� mil
1-4 fk$ froni S f i- 'fn kW- l i'{1ic.i Z -il
4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board 0 Public Health Director
0 Certified Contractor Review Board Environmental Health Manage
5. Mitigatin. Factors:
Oa i i?Ufl.a ' CP ' a i°M
Z • o Z tr'�"!u a , '•�f.
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local poli as been submitted.
Staff Signature: Date: ra/Zell
PART 4: Determination of the Hearing Official
[ji- The hearing official has determined that approval of this request will not adversely affect public
health and i/$j hereby gra fed. This/decision is based o e f lowing findin/jQ.�$ and conddiittiioons:
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:
Health Official Signature: V7 Date: 0-72--1Re3/2018
This form may be scanned and available for public view on the Mason County Web site.
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