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HomeMy WebLinkAboutWAI2025-00088 - WAI Health Waiver - 12/2/2025 4 w c`` MASON COUNTY ww ti Gy` 'f COMMUNITY SERVICES 9,y� d Building,Planning,Environmental Health,Community Health tbJ• FIJ1VaN^ 415 N 6m Street, Bldg 8, Shelton WA 98584, Shelton: (360) 427-9670 ext 400 •: Belfair: (360) 275-4467 ext 400 •: Elma: (360) 482-5269 exfi FAX (360) 427-7787 /F9 l�' .0)rq I/1 i - ....4-3 E Application for Waiver/Appeal i ii Amount Paid: # oZw j i ti Ai 2 p Receipt Number: a- S - � 5 ' y, ?425 � Instructions #}-I 3-pa�j - OCDOF Y ~w - 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 J.Rocky Easter Telephone 360-470-1311 Mailing Address of Applicant P.O Box 261 City Mccleary State_WA Zip 98541 12-digit Tax Parcel No. _3_ _2 _1_ _0_ 4 -- 5 1 -- 0 0 0_ _1_ _6_ Site Address 201E Country Club Dr E,Union Subdivision Name and Lot Alderbrook Properties PART 2: Nature of Waiver/Appeal ❑ Contractor Certification Requirements ❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists) Separation ❑ Food Sanitation Requirements -- Rf� e i tees ❑ Group B Water System Regulations A Location, WAC 246-272A-0210 ❑ 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.): Deck is being built near the edge of a hill so in all likelihood the actual distance to the reserve drainline is well over 5' Applicant Signature: Q". 47.6A. Date: 11/2C/2025 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 of 2 o- ii II 11 il I ` II II 11 II PA I ill R II T 3: Public HeaiIlth E ill valuatio III n (Staff Use Only) 0(41 1. Type of Determination Required: Type of Onsite Waiver (if applicable) Appeal 1 Waiver ❑ None required Class A 1 Class B ❑ Class C 2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/ Standard revision) wVG2 y 6 •Z 7Z ii-vzoo 3. Nature of Appeal: 4. Hearing Official: ❑ Board of Health 0 Health Officer O Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board lg Environmental Health Manager 5. Mitigating Fa tors: Ira( WOOf5 Get vp)Iadf•enF f ciann_r4 _ 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: iii Date: /L il/?a 7r PART 4: Determination of the Hearing Official i§' 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 4 health and is hereby denied. This decision is based on the following findings and conditions: Hearing Official Signature: Y/ Date: 1--/1/ 1 - J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2 J . r t55' Iii pRg••a3 ti :1Tr71 t �tl � I�'Wrn I i : i *- 17 To , `� 1' � � � H OOOO © pi I w 3" , • , , 11.f ••,_ 0;.%., [ 1 i - i i 4 r 7-6 i 1 u \\,. a t ?(} a lc �,Y 1 E * 3i i 4