HomeMy WebLinkAboutCANCELED WAI2026-00028 - WAI Health Waiver - 4/20/2026 q" l c 9 l I e V` 415 N. 6`h STREET,SH ELT0N WA 98584
M A SO N CO U N TY SBELFAIR:360-27SA44b:Z,-�x#-40
Public Health & Human Services
APR 2 0) 2026
Application for Waiver or Appeal /� pr By
Amount Paid: $205 Receipt Number: ��Z l)( 0
WAI - M(7
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 Sandra Fred Telephone 206.488.3818
Mailing Address 9304 23rd Ave NW
city Seattle State WA Zip 98117
2 2 2 0 2 5 4 0 2 0 1 1
Parcel No. -- --
Site Address 31 NE Wagon Wheel, Belfair, WA 98528
Subdivision Name and Lot Wagon Wheel EStateS
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver ❑ Group B Water System Regulations
❑ 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.):
Existing water line does not meet the required 10' setback to sewage tanks and
transport line. is waiver reques a e se ac a re uce . o zero ee
design for additional details.
Applicant Signature: - Date.
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
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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 O Class A ❑Class B O Class C O Local
State Waiver Criteria
Number of Bedrooms: Nitrogen Treatment: ❑Yes O 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 ❑ 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):
3. Nature of Appeal:
5. Mitigating Factors:
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: 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:04/19/2026
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
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