HomeMy WebLinkAboutWAI2026-00042 - WAI Health Waiver - 6/2/2026 415 N.6th STREET,SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,
ext.400
Public Health & Human Services
Application for Waiver or nAppeal
Amount Paid: S Receipt Number: (�17i10` Z 7125
WAI -()00'f2,
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 Jason Campbell (Agent) Telephone 564-546-0742
Mailing Address 406 108th St S
City Tacoma State WA Zip 98444
Parcel No. 2 2 2 2 3 -- 5 0 -- 0 1 0 0 9
Site Address 521 E Trails End 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 ❑ Water Adequacy Requirements
Onsite: Location,WAC246-272A-0210 ❑ Building Permit: EH Review Policies
O 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.):
Due to the small constraints of this lot we are requesting a varience to crowd the
foundation. Thc drainficld i down hill from thc ctructurc. Also the decks are free
standing and will utilize pier blocks not poured in place footings
Applicant Signature: J ' Date: 5/22/26
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)
ElAppeal 'Naiver ❑ Class A ❑Class B ❑Class C Local
II 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 "A/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): \4'\f c.7Al '7 --n2.'(a
3. Nature of Appeal:
5. Mitigating Factors:
- .y tr'M t I f -ci:4i( t' e. -E-
S Ofl
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
lThe 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:
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
Page 2of2
14.c N
uj
W
Primary D/f
Existing Shed to Be Removed
Existing Shed `
e�ecle 6 404 Deck Free Standing no permanent footings
.t Existing Shop W/Eaves
X62
4x4 Deck
8,
o 1r
i le,
�ii 1b'-
0 40 80
Scale 1"=40'
REVISIONS
Karl&Marie Heilborn 5IM/OD/Y I aenw xs
521 East Trails End Drive
Belfair,WA 9852B x
Parcel:222235001009 Drawn By:Jason Campbell + __/_ /__ ...