HomeMy WebLinkAboutWAI2026-00035 - WAI Health Waiver - 7/31/2026 MASON COUNTY
COMMUNITY SERVICES
® Building,Planning,Environmental Health,Community Health
415 N 61° Street, Bldg 8, Shelton WA 98584,
Shelton: (360) 427-9670 ext 400 4 Belfair: (360)275-4467 ext 400 4 Elma: (360)482-5269 ext 400
FAX (360) 427-7787 Application for Waiver/Appeal n if L f F [ 1`'�(�7 Amount Paid: 9 205 Ic.
LOI4/Rase nt pl«rn era: QO) 5 H MAY 0 6 2026
Instructions IQeca -(Q CItfs �Q
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 Identification
Name of Applicant Franklin Clark Telephone 360.830.4765
Mailing Address of Applicant R.O. Box 1954
City Silverdale State WA Zip 98383
12-digit Tax Parcel No. 2 3 3 6 -- i. 5 -- 0 0 0 0 5
Site Address XXX NE GLADWIN RD, BELFAIR WA 98528
Subdivision Name and Lot BEARDS COVE DIV I TB 5
PART 2: Nature of Waiver/Appeal
O Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation O Food Sanitation Requirements
❑ Building Permit Review Policies O Group B Water System Regulations
Location, WAC 246-272A-0210 O Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 O Enforcement Timelines
❑ Mason County Onsite Standards ❑ Departmental Determinations
0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.).
Drain Field to Building foundation/in-ground swimming pool does not meet local
juristiction's and Washington State 10 foot required setback. Request Reduced setback
from Drain Field to MFH Building foundation setback to 5'The MFH has a 4'elevation
chanwe between the MFH and the drain field and the MFH will be installed on grade not
duo in around }� 1 q
Applicant Signature: '�"-x-�%-x.1 \ �NPd Date: 02May2026
fVHH I or ns\Waiver-Appeal Mason Counts Local Revisal 1/20/2017
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PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
DAppeal E Waiver ❑ Class A ❑Class B ❑Class C 0 Local
State Waiver Criteria
Number of Bedrooms:2 Nitrogen Treatment: 0p Yes O No
Soil Type: + Minimum Lot Size: 21750 sq.ft.
Water Source:❑Public ❑Private This Lot Size: 7840 sq.ft.
Is This Lot Eligible for State Waivers: ❑Yes0 No O N/A
Hearing Official:
0 Environmental Health Manager ❑ Public Health Director O Other:
2. Identification of Specific Code/Standard/Determination (include date of determination or latest
Code/Standard revision): WAG 246d)2A-olio
3. Nature of Appeal:
Reduce horizontal separation between the building foundation and the drainfield from
10 feet to five feet.
5. Mitigating Factors:
The building foundation is up-gradient.
6. I have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has a submitted.
Staff Signature: � Date:7/3V2026
PART 4: Determination of the Hearing Official
NThe 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:______________
Re'ised 03,03 2026
This form may be scanned and available for public view on the Mason County Web site.
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