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HomeMy WebLinkAboutWAI2026-00018 - WAI Health Waiver - 3/13/2026 415 N.6th STREET,SHELTON WA 98584 ( -� 'SHSHELTON:360-427-9670, ext 400 MASON COUNTY BELFAIR:360-275-4467, , "' COMMUNITY SERVICES ext.400 N ;/ Budding,Planning,EnvircnrnenIan-Wilk Community Health Application for Waiver or Appeal i Amount Paid: 2.057 Receipt Number: Z 0 Z 6—6 la 61O WAI 2U 2-6 - 000. i 8 Please note, all approved Onsite Waivers have the same expiration date as their OSS Permits. 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 Information Name of Applicant 7 Ct.0 '5 RC-LA.3 l ct Telephone ? ICJ b 70 1 ? 7 Mailing Address / O 9 I 51 C re,f j A City _,.'YG`'t State Zip gP5-bC/ Parcel No. 1- ) , C • d \ -- 5- 3 -- a O a . ( 5-- Site Address /OF- kr [05 (4 ke fe. A- G 1- 5 k_J'h -i Subdivision Name and Lot UE'5+zl I re el 77- ( 5'— PART 2: Nature of Waiver/Appeal . ❑ Onsite: Class A Waiver - O Food Sanitation Requirements ❑ Onsite: Class B Waiver O Group B Water System Regulations O Onsite: Class C Waiver O Water Adequacy Requirements ,��Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies • O Onsite: Holding Tank, WAC246-272A- 0 Appeal:Enforcement Timelines 0240 O Appeal:Departmental Determinations ❑ Onsite: Contractor Certification O Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached,): S-J L .* /ire *VIA IC era p05)---k z rl--- prop-{-" t5 F-14 it— Applicant Signature: .~ ~� Date: 3//27" 5 2 Revised 9/29/2025 This form may b canned and available for public view on the Mason County Web site. Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal Npaiver ❑ None required ❑ Class A ❑ Class B ❑ Class C XLocal 2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/ Standard revision): ki)1'(,, ( C-Z72A-r(:)-- ( 0 3. Nature of Appeal: Igs-OtNee S Cot- +eh Cu P a rmA t' 4 Y UC- 1 rte'?;� 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board A Environmental Health Manager 5. Mitigating Factors: nl— i S YAfi /N -oar- ►4- o-- oof-'r'- S 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: ;W U, PART 4: Determination of the Hearing Official 0..,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: 3/72-1( Revised 9/29/2025 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 LOST LAKE �/ A RBM IS GOUND ELEVATION AT THE WATER METER. RBM EL=488.5 0 EXISTING HOME STUBOUT EL=488 . \ 20 PROPOSED NEW STUBOUT/CLEANOUT EL=487.8 115'TO SURFACE WATER 03 EXISTING 1000-GAL 2-COMPARTMENT SEPTIC TANK,ADD OUTLET FILTER WITH 1/16TH MESH INLET EL=487 OUTLET EL=486.7 EXISTING SHOP ® PROPOSED 1000-GAL PUMP CHAMBER,PUMP EL=483 TIMER, DOSE COUNTER,AND ELAPSE TIME METER REQUIRED 0 120 FT OF 1.5-INCH PCV TIGHTLINE, SCHEDULE 40 SHALL BE DOUBLE SLEEVED UNDER ROADWAY 7.5 FT OF 1.5-INCH PVC MANIFOLD,SCHEDULE 40 -"t-10.6' © PRESSURE TRANSPORT LINE SHALL CROSS 18 INCHES UNDER THE WATER LINE 07 EXISTING HOME FOOTPRINT w / � ® PROPOSED ADDITION a 09 EXISTING WATER METER / / /1 RESERVE AREA MAY REQUIRE PRETREATMENT DUE TO PROXIMITY TO SURFACE WATER 491.25 -1-1- I / NO WELLS WITHIN 200 FEET OF PROPOSED DRAINFIELD KNOWN TO DESIGNER. �Q IIII / / o w oil- F I I /_ 490.5�_ -\ / / • � 6 490 _ ' e 5 w� 11"x-4_, • � \ • 0 STl,1,(z,p N q,P4-OT N N TO-}/SiiN / N I9 G e.4-4.27 �k'vc \� ��BA4Noo F/F�o i.. ? f'';' ::: • � ' 10.2' 488.5 Q /--�:1,PROP. �4�,, 4 2 ADDITION _ h cd SITE PLAN 65, EXISTING '.;";;'. 35' CABIN - DIRECTIONS: FOXHEAD CONSTRUCTION FROM CLOQUALLUM RD AND LOST LAKE RD,N ON LOST LAKE, eUCKh'% '' ` ' 1 ADDRESS LOST LAKE PARK DR,L ON LOST LAKE PARK CT,TO SITE EFT DECK CUSTOMER: PROPERTY SIZE: 42.3' _ W.LOST LAKE TP#: I WHORTON, NOEL& KAREN 0.09 ACRES . 0 30' PARK DRIVE HOME/TANKS 51901-53-00015 PROJECT NUMBER: DRAINFIELD DRAINFIELD 519015300010 LOST LAKE , _;EMI; € IMMI LOST LAKE III. '11111111 0 ROAD SITE ADDRESS: 105 LOST LAKE PARK CT W DOC LOST LAKE LEGAL: VISTA KNOLL HOME/TANKS TR 15 HOME PARK CT DRAINFIELD TR 10