HomeMy WebLinkAboutWAI2025-00063 - WAI Health Waiver• ' On-Site Sewage Systems (Chapter 246-272A WAC) • Washington 511 Dopartment
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Waiver from State Regulations i H E A LT H
Request for g
Section I. I (Completed by applicant)
Name: (1) MICHAEL J DAVIS Local Health Jurisdiction Received (2)
(See instructions)
Address: 5129 NASSAU CT NE
TACOMA, WA 98422
Telephone: (253) 820-5950
Signature:
Property den f. atio : (
3070 E MASON LAKE R W, GRAPEVIEW, WA 98546
224055400087 - -
MADINGS SUNNY SHORE ADD #3 TR 87
Section II. (Completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A- 0210(4) SEWAGE TANK AND BUILDING DOWN TO 25FT
_
—._._._._.._ SEWER 50-FT.FROM NON
Subsection: PUBLIC WELL / SUCTION LINE
Justification (Proposed mitigation measures): (7)
MEETS STATE TABLE 1 WAIVER CRITERIA, SEE ATTACHED DOCUMENTATION
......_..._..............
Section III. (Completed by local health officer)
Review Criteria: (8) Additional Mitigation Measures: (9)
F(o Nv 5&' 444,,
Comments/Conditions: (10)
Type of Waiver: (11) Class A nClass 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 piNon
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 least equal to that provided by this chapter WAC.
riDenied Approved/Granted — Su ect to all comments, conditions and requirements noted i Sections II and Ill.
Local,Health Officer 13 Date: It 1-LZf
DOH 337-175 February 2024 I
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