HomeMy WebLinkAboutWAI2026-00025 - WAI Health Waiver - 4/3/2026 415 N.6`"STREET,SHELTON WA 98584
SHELTON:360-427-9670,ext 400
jrj 1AO N 0 L N ivBELFAIR:360-275-4467,ext.400
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Public Health & Human Se °vices %
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Application folr @waver orr Appeal
Amount Paid: — 8-15 Receipt Number: �, 1 n ' I ` f
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 tie made until these parts are fully completed
2. Fees maybe 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
Fred & Nancy Kreienkamp Telephone (303) 478-4654
Mailing Address 61 E Weymouth Place
Shelton State WA zip 98584
city
2 2 5 ® 6 6 1 2 4
Parcel No. 3 2 1 --- -- -- --- -- -- -- —' — —
Site Address same
Subdivision Name and Lot
Lake Limerick #3, Lot 124
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver ❑ Group B Water System Regulations
❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements
❑✓ Onsite: Location, WAC246-272A-0210 ❑ Building Permit: EH Review Policies
❑ Onsite: Holding Tank,WAC246-272A- ❑ Appeal.Enforcement Timelines
0240 ❑ Appeal:Departmental Determinations
❑ Onsite: Contractor Certification ❑ Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.):
Reduce setback from drainfield to porch footings from 10'to a minimum of 2'.
Mitigation is that drainfield is down-slope of foundation and effluent will drain away
from house and porch. See revised septic plot plan attached.
Applicant Signature:
Date:
— Revised 03/03/2026
This form may be s a �scanned and available for pub!ic view on the Mason County Web site.
Page 1 of 2
PART 3: Public Health Evaluation (Staff'use Only)
of Determination Required: Type of Onsite Waiver(if applicable)
1. Type Lacal
0Appeal Waiver ❑Class A ❑Class B ❑Class C
State Waiver Criteria
Nitrogen Treatment: ❑Yes O sq.ft.
Number of Bedrooms: __ Minimum Lot Size:
Soil Type; This Lot Size: sq.ft.
Water Source:[]Public ❑Private N!A
is This Lot Eligible for State Waivers: ❑Yes O No
Hearing Official: Other:
Environmental Health.Manager ❑
Public Health Director ❑
2. identifiic ation of Specific Code!Standard!Determination (include date of etermination or latest
Code/Standard revision):
3. Nature of Appeal:
5. Mitigating Factors:
t
6. I have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has been submitted. t A
Date: "t
Staff Signature:
PART 4: Determination of the Hearing Official
.The hearing official has determined that approval of this requestlof finadvs and conditions:
affect
blic
health and is hereby granted. This decision is based on the following
®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:
Date:
Health Official Signature: z�uvisea o3ia312o26
This form may be scanned and available for public view on the Mason County Web site. -Page 2 of 2