HomeMy WebLinkAboutWAI2026-00029 - WAI Health Waiver - 4/24/2026 415 N.6`"STREET,SHELTON WA 98584
SHELTON:360-427-9670,ext 400
o , U N BELFAIR:360-275-4467,ext.400
Public Health & Human Services Lll
4PR 2 4. 2026
Application for Waiver or Appeal
Amount Paid: Receipt Number: By
WA [ U
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 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 AB Fine Homes (for Brad Pfeifer) Telephone 360-898-0055
Mailing Address 871 E Beach Dr
City Union State WA zip 98592
Parcel No. 3 2 1 0 9 _ 5 0 __ 0 0 0 4 0
Site Address 71 E Hemlock Ct, Union, WA 98592
ALDERBROOK G&Y#5 LOTS:39&40 PCL 39 OF BLA#02-53 AF#2180731
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
O Onsite: Class B Waiver ❑ Group B Water System Regulations
❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements
Q 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.):
Requesting reduced setback from new proposed garage foundation to reserve
drainfield area from 10 feet down to a minimum of 2 feet. Mitigation is that drainfield
area is down slope of the garage so effluent will drain away from foundation, not
towards it. Primary septic drainfield and tanks meet all standard setbacks.
**See Updated/Revised Plot Plan Attached.**
Applicant Signature: Date: —
5— Revised 03/03/2026
This form may be scanned a d available for biic view on the Mason County Web sine. Page 1 of2
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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 ❑Class C X Local
I 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 0 No N/A
Hearing Official:
Environmental Health Manager ❑ Public Health Director ❑ Other:
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest
Code/Standard revision): \niy`'l��Z�ZQ�07i i0
3. Nature of Appeal:
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5. Mitigating Factors:. -c ) `n 4k
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6. I have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has been submitted.
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Staff Signature: l o Date: V`2c
PART 4: Determination of the Hearing Official
6-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: l
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2
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