HomeMy WebLinkAboutREVISED WAI2026-00030 - WAI Health Waiver - 5/7/2026 ,
415 N.6th STREET,SHELTON WA 98584
MASON COUNTY SHELTON:
• I ext 400
BELFAIIR:360-275-4467,,e ext.400
Public Health & Human Services
Application for Waiver or Appeal
Amount Paid: Receipt Number:
WAI _l 1Q- OO O
Please note,all approved Onsite Waivers have the same expiration date as their OSS Permits.
Instructions:
1. Complete Parts I and 2. No determination can be made until these parts are full completed.
2. Fees may be billed for waivers and appeals, based on the Environmental Healt c
3. Submit completed application with attachments to Mason County Public Healt r /Tfl 17
'
PART 1. Applicant& Parcel Information MAY 07 2026
Name of Applicant RON COVAL Telephone B
Mailing Address 312 CLEVELAND ST
City HOQUIM State WA Zip 98550
Parcel No. 1 2 1 0 8 -- 5 0 -- 0 1 0 2 3
Site Address 90 E BAHAMA DR
Subdivision Name and Lot
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 O 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 PROPERTY LINE
PROPERTY LINE IS UPGRADIENT
Applicant Signature: ,627/ Date: 5/7/26
Revised 03/03/2026
This form may be scanned 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 [Waiver ❑ Class A ❑Class B ❑Class C ,Local
` State Waiver Criteria
Number of Bedrooms: Z Nitrogen Treatment: ❑Yes [ No
Soil Type: ' Minimum Lot Size: 6 Yi sq.ft.
Water Source: Public ❑Private This Lot Size: 0•�( sq.ft.
Is This Lot Eligible for State Waivers: ❑Yes ❑ No l 'N/A
Hearing Official:
19 Environmental Health Manager ❑ Public Health Director ❑ Other:
2. Identification of Specific Code/Standard/ De ermin tion (include date of determination or latest
Code/Standard revision): IV 4C l V6- Z F Z OZ(O
3. Nature of Appeal:
Red c.&- ln+'l'I rrn um h organ fq( Separufeon oft ee popeliv fie
and fold fcr Sct to q
5. Mitigating Factors:
Q1�9DCI1ty << PS '?ol Wn G ('di ,,,t dr4,i 1d_
6. I have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has n submitted.Staff Signature: Date:
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: Date:5s 5t / o26
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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�L. ROBERT H A1YISE /
EXPIRES
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RECORD DIAWING /
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CUSTOMER: RON COVAL TEST HOLE!: TEST HOLE 2.
PIONEER DIGGING, INC. 0-14 SI LOAM 0-15 SI LOAM
PARCEL#.12108-50-01023 14+MOTT.CLAY 15+MOTI.CLAY
SEPTIC DESIGNS ADDRESS: 90 E BAHAMA DR
3083 E MASON BENSON RD. GRSPEVIEW,WA 98546 DESIGNER ROBERT H.PAYSSE DIScLAIMES INCLUDE:APPLICANT/COUNTY PRO/SEED
PLAYSRE SURVEYR:THIS S. NETA SURVEY. DESIGN INTENDED FOR SEPTIC
PURPOSES ONLY. PSOPOSEE DEVELOPMENT MAY BE TO OTHER
OFFICE-360-426-1803 F.&\-360-427-2353 SHEET: ASBUILT SCALE I"=30' DEPARTMENTAGENCY REV W DESIGNER NOT RESPONSIBLE FOR SEBACEKSTUNRELATED TO
SEPTIC COMPONENTS.