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HomeMy WebLinkAboutWAI2025-00077 - WAI Health Waiver - 10/9/2025 A T����/ 415 N.6th STREET,SHELT0N,WA 98584 MASON COU ,i 1 SHELTON:360-427-9670,ext 400 COMMUNITY SERVICES BELFAIR:360-275-4467,ext.400 ELMA:360-482-5269,ext.400 Building,Planning,Environmental Health,Community Health FAX:360-427-7798 �olCato for Waiver or Appeal WAI - 25 - 000 -4 T 0CT 5.9 225 Instructions: \ _ __ 1 Complete:Parts 1=and 2 No determination can be made until these gaits are fully comp! 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 David Ashby Telephone (808)740-3690 Mailing Address 30 E Main Street city Union State WA Zip 98592 Parcel No. 3 2 2 3 2 5 0 -- 0 6 0 0 4 Site Address XX E Main Street, Union, WA 98592 UNION HOOD CANAL LAND& IMP CO BLK: 6 W 1/2 LOT: 3 LOT:4 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Onsite:Class A Waiver O Food Sanitation Requirements ❑ Onsite:Class B Waiver O Group B Water System Regulations ❑ Onsite:Class C Waiver O Water Adequacy Requirements Onsite: Location,WAC246-272A-0210 ❑ Building Permit: EH Review Policies ❑ Onsite:Holding Tank,WAC246-272A- O Appeal:Enforcement Timelines 0240 .O Appeal. Departmental Determinations ❑ Onsite:Contractor Certification ❑ Other Requirements Description of Waiver/Appeal(include justification, additional material may be attached.): Reduce setback from foundation to septic tanks from 5 feet to a minimum of 2 feet and drainfield from 10 feet to a minimum of 2 feet.Mitigation is that septic tanks and drainfield are both downslope of house/foundation.Effluent will drain away from house. Applicant Signature: Date: t O - - Revised 8/13/2018 This form may be scanned and available for public view on the Mason County Web site. Page 1 oft PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) o Appeal Naiver ❑ None required o Class A o Class B o Class C L(7�JrZ 2. Identification of Specific Code/Standard/Determination (include to of determination or latest Code/Standard revision): A 3. Nature of Appeal: 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: -S (FYI h. 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: 1T_aA11f\fh1'h1 Date: �I38 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: Q/ Date: ? __ evised 8/13/2018 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2