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HomeMy WebLinkAboutWAI2025-00064 - WAI Health Waiver - 8/27/2025 - E MASON COv,?' tl Public Health Always working for a safer healthier Mason County 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 PP � S\13 Amount Paid: t 305 t3 Receipt Number: aJ P��j 1. Instructions WO l a095- O00 (pq toyi . 1. Complete Parts 1 and 2.No determination can be made until these parts are full co • --1. 2. Fees may be billed for waivers and appeals,based on the Environmental Health Fee Sch... e. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant DOUG DEVLIN Telephone 3607904807 Mailing Address of Applicant PO BOX 367 City LILLIWAUP State WA Zip 98555 12-digit Tax Parcel No. 3 2 3 0 3 -- -- 5 0 0 1 0 2 7 Site Address 80 N AYOCK BEACH DR Subdivision Name and Lot AYOCK BEACH BLK 1 LOT 27 PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical 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 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): REDUCED HORIZONTAL SEPARATION FROM CREEK TO DRAINFIELD (50FT) JUSTIFIED THROUGH MEETING TREATMENT LEVEL B(NUWATER BNR600)IN ADDITION TO 24"OF VERTICAL SEPARATION IN DRAINFIELD. (SEE ATTACHED) Applicant Signature: I Date: 8/29/25 ill J:\EH Forms\Waiver-Appeal Mason County . . I Revised 12/1/15 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 0 None required ' Class A 0 Class B 0 Class C 2. Identification of Specific Code/Standard!Determination(include date of determination or latest Code/Standard revision) J 71 6-rnA---o Q 3. Nature ofnAppeal: VLb A L, 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board ,14k Environmental Health Manager Zh d i pvall L 5. Mitigating Factors: /If �o{tiY' 4-T(il`f-r t - 4NteS .. ram + 'TUN "MS 9,ii7-50 ▪ '1;1 " v\e, -Ga d T r\ Type, Li Ityn rtwoica ounnitt.cdtx 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: 41°0 1 ZC 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: /4/ Date: /0 f"Al J:\EH Forms\Waiver-Appeal Mason County Local Revised 12/1/15 Page 2 of 2 On-Site Sewage Systems (Chapter 246-272A WAC) • WashWashingtonw "'"9 °S" LTH"°'p•rtn..t f , A Request for Waiver from State Regulations HE Section I. (Completed by applicant) Name: (1) DOUG DEVLIN Local Health Jurisdiction Received (2) (See instructions) Address: PO BOX 367 LILLIWAUP, WA 98555 Telephone: 60) 790-4807 Illp _ Signature: ( 1 Property [den A;c. '•n: (3) 80 N AYOCK BEACH DR, LILLIWAUP, WA 98555 323035001027 AYOCK BEACH BLK1 LOT 27 Section II. (Completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A- 02101(1) SOIL DISPERSAL COMPONENT REDUCE SOIL DISPERSAL SETBACKS — DOWN—T6-50FT-FROM _--- -Tfl-50FT Subsection: _ SURFACE WATER Justification (Proposed mitigation measures): (7) 1 >a{ .1.' ` 6 ._ Af.4. ,? "� vS Section III. (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures: (9) Comments/Conditions: (10) ..........................._ Type of Waiver: (11)MClass A n Class B nClass C — Request DOH review before granting? Yes n Non Neighbor Notification: (12) Required?YesnNo n If needed, are agreements, easements, etc.filed? Yes n Non Section IV. (Completed by health officer) This Request for Waiver from State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems.The review criteria applied, and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at lea qual to that provided by this chapter WAC. Denied n Approved/Granted Sub' to all comments,conditions and requirements n ted i Sections II and Ill. Local Health Officer(13) Date: / 0 /0 L_.J DOH 337-175 February 2024 1