HomeMy WebLinkAboutWAI2026-00010 - WAI Health Waiver - 2/12/2026 tic, - a G�
/ ,, MASON COUNTY
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COMMUNITY SERVICES
\ a. ^� 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
Application for W�iiver/Appeal
Amount Paid: C7
Receipt Number:
Instructions
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 44(,
FEB
Name of Applicant CADE ROLER Telephone 360-359-8312 12 2Oy
R -9
Mailing Address of Applicant 2238 W RAILROAD �c�'fr&,
City SHELTON State WA Zip 98584
12-digit Tax Parcel No. 4 I2 0 2 4 Q-- O1 3 0 0 2 9 0
Site Address z. 738 ✓V railI�VQrc/ Ave,
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation O Food Sanitation Requirements
❑ Building Permit Review Policies O Group B Water System Regulations
❑ Location, WAC 246-272A-0210 O Water Adequacy Requirements
O Holding Tank WAC 246-272A-0240 O Enforcement Timelines
I Mason County Onsite Standards O Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
EXTEND WET SEASON OBSERVATION FROM FEBRUARY TO APRIL
1.1 hay r/ bceI1 Mont'follnq th€Se two Sod( to,1; tk c& and heuCnof5ee1 chip makei n K e 42otiowt Ole Sat(1 or Lectf✓' Cun en on
Z• i have roof Seer( caw ��i oven o f c%lw titffy
3. t Will perfrArni er -pc •( f �`nv encon5.
Applicant Signature: `—'17 C lam/ et../0 Date: gya,
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
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 ❑ None required ❑ Class A ❑ Class B ❑ Class C 'Local
2. Identification of Specific Code/Standard/ Determination (include date of determination or
latest Code/ Standard revision): 01615001 t,A•fy PabilY Uealfh On-Pie Slalickedc,
3. Nature of Appeal:
5h,'( - fix. W"11-e,' obseivaleon per,bc( from Targioir Iv Math +o
Feb tocay fo i3 pit/.
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board pS Public Health Director
❑ Certified Contractor Review Board O 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 submitted.
Staff Signature: Date:
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:
❑ 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:
Health Official Signature: Date: ?oLf
g amolf411
3�
Revised 9/29/2025
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
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 Class B Class C
2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Appeal:
EXTEND WET SEASON OBSERVATION FROM FEBRUARY TO APRIL
4. Hearing Official:
❑ Board of Health O Health Officer
❑ Pollution Control hearing Board O Public Health Director
O Certified Contractor Review Board O Environmental Health Manager
Lowne.,1 1- frcoucetijed to Part 2 oin pgye 1. we f h o(lsi y d er
5. Mitigating Factors: Cf d t� tvai'le'S OPr0Vi(
1. I HAVE BEEN MONITORING THESE TWO SOIL LOGS TWICE A WEEK AND HAVE NOT SEEN ANY WATER IN THE
BOTTOM OF SOIL LOG OR WATER COMING IN ON THE SIDES
9 I HA\/F NC T SFFN ANY INfICATInN o f WATFR INTRI ISInN
T
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:
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:
❑ 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:
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2