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Home My WebLink AboutWAI2026-00014 - WAI Health Waiver - 2/26/2026 `., �{, OC°1 Lf � 4 H MASON COUNTY s COMMUNITY SERVICES " F 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 Waiver/Appeal ROME WI Amount Paid: F O D 1 f_u L Receipt Number CO Instructions1 1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed. 12. 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 JEFF ROGERS Telephone Mailing Address of Applicant 5255 E MERCER WAY City MERCER ISLAND State WA Zip 98040 12-digit Tax Parcel No. 4 2 3 1 8 5 0 0 0 0 1 0 Site Address 220 N POTLATCH DR,HOODSPORT 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 ❑ Holding Tank WAC 246-272A-0240 O Enforcement Timelines ❑ Mason County Onsite Standards O Departmental Determinations ❑ Other Description of Waiver/Appeal (include justification, additional material may be attached.): REDUCE SETBACK DRAINFIELD TO PROPERTY LINE DOWN TO 2'. PROPERTY LINE IS UPGRADIENT REDUCE SETBACK TANKS TO DECK FOOTINGS DOWN TO 2'. FOOTINGS ARE UPGRADIENT,DECK ONLY. Applicant Signature: 4427 /47.1""." (AGENT) Date: 2/22/2026 J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 1 oft '.* 4 . PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ,q._, ❑Appeal ' Waiver ❑ None required ❑ Class A ❑ Class B ❑ Class C (-a("ft_ L_ 2. Identification// ff of Specific Code/Standard/Determination (include date of determination or latest Code/ Standard revision) r‘rp„7 c--'Mirrv21 O 3. Nature of Appeal h^A A 1 sdome_ e`-_ r b I i - (r2 Art, ( 5feka.a. -E'h a( x- 4. Hearing Official: 'cart 40 2 -f ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board 5t. Environmental Health Manager 5. Mitigating Factors: I� l,� a� d,e. � 4' tom_ a i C �� om 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: f11- 10n/1/1 Date: 21 PART 4: Determination of the Hearing Official AThe 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: V Date: 00- J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017 Page 2 of 2