HomeMy WebLinkAboutWAI2026-00004 - WAI Health Waiver - 1/9/2026 rtY'�hYtn
MASON COUNTY
Y _ COMMUNITY SERVICES
4:Y Building,Planning,Environmental Health,Community Health
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 [Eli
Application for Waiver/Appeal Q I :�� f ,
Amount Foie 05.
JAN 0 9 202E II
Receipt Number: r2Oa(O- o6oT`1?
Instructions --( BY.44. I
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 MICHAEL BRUEMMER Telephone
Mailing Address of Applicant 2224 11TH AVE E
City SEATTLE State WA Zip 98102
12-digit Tax Parcel No. 1 2 1 0 5 5 2 --- 0 0 0 9 8
Site Address 770 E TREASURE ISLAND DR. - ALLYN
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
O Separation O Food Sanitation Requirements
❑ Building Permit Review Policies O Group B Water System Regulations
cl Location, WAC 246-272A-0210 O Water Adequacy Requirements
O Holding Tank WAC 246-272A-0240 O Enforcement Timelines
O Mason County Onsite Standards O Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM DRAINFIELD TO AN UPGRADIENT FUTURE FOUNDATION.
FOUNDATION IS LOCATED UPHILL OF DRAINFIELD.
FOUNDATION IS FOR A GARAGE.
Applicant Signature: Ve-'6 f D611.61-P--)liertkae: I Z(.3
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable) -,
Appeal ,Waiver None required Class A L Class B Class C (0 +,r L___.
2. Identification
of Specific Code/Standard/Determination (include date of determination or latest Code/
Standard revision) W ,Z` , '777 9 -0 Z/�
3. Nature of Appeal:/e_ t 'I� o "—��--y,"eiT
rnie-A-1-e- 4151"-hul,4-7--col 417 t e tc-r h-P r rth(I W tfi L.MEI--
4. Hearing Official:
O Board of Health O Health Officer
O Pollution Control hearing Board O Public Health Director
O Certified Contractor Review Board Environmental Health Manager
5. Mitigating Factors: 0 tail m4 n` ^ (s cLow v v-I-- 0-(—
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6. I have received this waiver/appeal request. It is complete and mitigation r fired by the state and '26
local policy has been submitted.
Staff Signature: Kjy\SLAY\faC - ,V" ' Date: `Iia C
PART 4: Determination of the Hearing Official
IA- 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:
O 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: /2/7/2-4
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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