HomeMy WebLinkAboutWAI2025-00074 - WAI Health Waiver - 10/6/2025 �J`
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J•FF1'1v?A Building,Planning,Environmental Health,Community Health
415 N 6`h Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 •:• Belfair: (360) 275-4467 ext 400 •3 Elma: (368}4�2.52fi9-eXt 400
FAX (360)427-7787 12 C�� n VII Application for Waiver/Appeal I ,,S L� �' IT))
Amount Paid: coilla SEP 1 2025 ''
Receipt Number: k -04(e3
By ,
Instructions W'4 I a6a5-o00-7 4
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 r1
Name of Applicant MPM VENTURE GROUP LLC Telephone p.6:3 - a - GZ JO.
Mailing Address of Applicant 110 W K ST. SUITE C
City SHELTON State WA Zip 98584
12-digit Tax Parcel No. 2 2 2 2 3 _._ 5 0 __- 0 1 0 0 1
Site Address 401 E TRAILS END DR
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
0 Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation 0 Food Sanitation Requirements
❑, Building Permit Review Policies 0 Group B Water System Regulations
Vli Location, WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM DRAINFIELD TO LAKE/WETLAND FROM 100FT DOWN TO 75FT
X02 SYSTEM MEETS TL-A W/OUT DISINFECTION AND HAS 24"OF V/S FOR"ENHANCED"TREATMENT
BEYOND THAT REQUIRED IN TABLE VI. PER WAC246-272A-0210(4)
Applicant Signature:ccava l ipa, Pi O 1 Irk 25 Date:
J:1EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal Waiver None required F Class A Class B Class C
2. Identification of Specific Code/Standard/Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal:
17.-/ & t)
4. Hearing Official:
❑ Board of Health 0 Health Officer
0 Pollution Control hearing Board 0 Public Health Director
0 Certified Contractor Review Board 0 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 submitted66, .
Staff Signature: PV l �,}
Date:
PART 4: Determinati n 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: Date: l0 1- I `a►f
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2