Loading...
HomeMy WebLinkAboutWAI2026-00022 - WAI Health Waiver - 3/31/2026 415 N.6th STREET,SHELTON WA 98584 • MASON COUNTY HELTON:360-427-9670,ext 400 BELFAIR:360-275-4467,ext.400 Public Health & Human Services Des' Amount Paid: A lication for Waiver or A eal ��S pp Receipt Number: ��,� WAI _s - OO 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..rr3rL 4 i-W-U Telephone 6-7$D -??ycf Mailing Address (.It \.iJ S k cu t._. City_____ a a State i iA Zip Parcel No. 2ZOL -- O7 Site Address l ,,,, t JIQ V- 5�o Subdivision Name and Lot L4 (.0 &o V71 t_O. (07 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-021 0 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.): JILl- 4-i 'ive1df .� •r ar-&4-4.,-,L 1 D Applicant Signature: Date: 33'1( Ui Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal Waiver ❑Class A ❑Class B O Class C Local State Waiver Criteria Number of Bedrooms: Nitrogen Treatment: ❑Yes ❑ No Soil Type: Minimum Lot Size: sq.ft. Water Source:❑Public ❑Private This Lot Size: sq.ft. Is This Lot Eligible for State Waivers: ❑Yes ❑ No �VNIA Hearing Official: Environmental Health Manager ❑ Public Health Director ❑ Other: 2. fff Identification of Specific Code/ Standard/Determination fnclude dato-determination or latest Code/Standard revision): \fV- 72-(6—Z, ZP1-- C 3. Nature of Appeal: c.� htth ( S - vu i U Z 5. Mitigating Factors: — 0 1 PZZ o f i c) riot- UD g t-e '- Gy C) a let/ 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. -7 Staff Signature: Date: 't `- PART 4: Determination of the Hearing Official 1.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: 2-b Revi d 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 1 � � I. a s. l: �";r� ;ar k�*»�+ i�,`;'A• � '�" ( s y � u"f' �;,, \ a ,) '/�: r r to 0�; F .° jJ ty gs4 h z • - � yr{ ..'� "�� •" �� ��,.� '�v -�� " �,i '' ', �• ' : - i4d.�i `I'I,,� , r t a 'r e R X J%�+, • ,, yww • - ,1 fS © t "•°1r�'w i 4 4•r r 'r rs '. 5^�.-'r, 4 w ;- "'`S a . d `�' rr.. .ti 4 if n � � C 4 S .:.� ' µms o,• '� � .�+ :r;�� r-'t'' �i��k r fe-- x,�ti•= 1•�--. r j ;{ t `'nFa'vy �:" � � .i° � — r °o °oeet�„ s ,;s_ �i♦ oioOI'' .i ;, .cx = s .:• _ _,r,;" �!. 3" vt +•; .4♦ ♦•- s '`'-e-'r a; M10 ® .,, oei♦000♦i♦a t♦ .�..� . • .• _ ;^:j X� Y Di '♦� a .�o♦♦♦e♦♦ _s z'� t • i T � � 'y'�''� Y "`a.� `Y •il• �� � a .v ode©ooh ••°e�♦�� ��ow��''1 :Q°i°♦ i I � a� i''�°� • 5: d M a i •°•� i�i�°�°�i°i�i�°e: �o7♦ ee®�.e I!St • • • ,' / ,ZW +bf .. ` •�%oosi©►o°♦o:ve♦Aos!♦oe♦oo♦o° ® � 9e "k ,Y • • ,�,¢ _ ,, f 1 "i ,t•:.- .,.... 1 - ,r '� dioi°i°e°i°$°ope°i°e°♦`�R�O.�� �i�J + ,` • _* n t < 2 > ..7 i0 �° lAO e040.p,p0♦t' 1"`- .1•.n, ,y 1 • t+'f a. su 0 , i.`t 1�� `°oQo�o� o�♦°!a!°°o! 8 rn { ' 8" �f.ao�t p°e°a°Ooh.!°oa• aL5 n • f y `,,z �, r A t a5 r a 3 •Ooioi°!oo°aC'i s! t • \ T St _ '�4 v r;� '�: J •` ri. °i�♦�ee♦el�v o .,� 1 ♦ tt* ,✓( ;��-' �,�.���:..� � .-�}'a�$�',fe�-c ��,. Ol o ' X006 • ^� '"� t �j +l 1 yet ^rte a4 .,/_ �`F^" .• • • ' •• .• . I________' ____ 'J :.;!_' 11 s f• y• ,� 4` +a'1fc�'$ f ;v :p., "•'4 ^y ..