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HomeMy WebLinkAboutWAI2022-00075 - WAI General - 6/2/2022 c©N CO j 01111111 ^ ti Public Health © w`O� L�� , Always working for a safer ;" healthier Mason County w � .•�'� PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584, IV; 427-9670 ext 400 ❖ Belfair: (360)275-4467 ext 400 ❖ Elma: (360)482-5269 ext 400 V��ii; FAX (360)427-7787 Application for Waiver/Anneal Amount Paid a -1r5.. k..., c Receipt Number: 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 Identification Name of Applicant /32ta.ofF'Ace6 c ' 7`. Telephone .74o - VIPs-- fdz-.c Mailing Address of Applicant PGA eo,e Sao City d zvk-�v State w/4 Zip rJP 1-2 n 12-digit Tax Parcel No. S- / ? / 7 -- S 7 __ o o cD / y Site Address 4/49 w• [.a La ,"2 Subdivision Name and Lot GA,rr• ' ie,zo.✓hSrrdo id/v. 8 • Go /r PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation 0 Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements 0 Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): Install Holding Tank for Recreational/ Part-time Use (RV) Meets RSnGs for Holding Tank Design and is on state approved list. Tracking of maintenance through Mason County maintenance database, Carmody Inc. Applicant Signature: / Date: 4' / - Revised 12/12/2014 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 c'Waiver ❑ None required ®'Class A E Class B ❑ Class C 2. Identification of Specific Code/ Standard/Determination (include date of determination or latest Code/ Standard revision) WAC246-272A-0240(2) 3. Nature of Appeal: ALLOW HOLDING TANK FOR RECREATIONAL (RV) - PART-TIME USE 4. Hearing Official: ❑ Board of Health 0 Health Officer ❑ Pollution Control hearing Board 0 Public Health Director ❑ Certified Contractor Review Board ®' Environmental Health Manager 5. Mitigating Factors: 1. 1200 GALLON TANK, ON WASHINGTON STATE APPROVED LIST OF SEWAGE TANKS 2. INSTALLATION BY A MASON COUNTY CERTIFIED INSTALLER 3. LETTER FROM OWNER AGREEING TO REGULAR PUMP OUTS 4. NOTIFICATION TO FUTURE OWNERS RECORDED ON PROPERTY/PARCEL 5. HIGH WATER AUDIONISUAL ALARM, RISERS TO SURFACE, WATER-TIGHT FITTINGS 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: 'RjiDate(?/ (, / Z PART 4: Determination of the Hearing Official la[. 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: HearingOfficial Signature: _ Date: (/Z Ø - � �� Revised 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 nt)G ring Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date. July 1,2007 Revised April 2017 .00 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (1) Local Health Department/District (2) ze G G (see instructions) --- --------------- Address: 30 �C ' e.v. '4 - - .e."2-41,Q, A.9 f_8S '/ _ - Telephone: ( ,) €19 7 %3% 7 3 - ems` - ��L,G Signature:'��C Property Identification: (3) /Vr,,,o 4 1 4.,-74 -- —----- Tr At5 't/7 - s-7- O ao Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0240(2) holding tank used for pemament holding tank used for part-time recreational use Subsection: commercial uses for RV Justification(mitigation measures to be provided): (7) see local waiver form for full outline of mitigation measures: 1. Design criteria consistent with RSnGs for Holding Tank Sewage Systems 2. Tracking through Online RME (Mason County OSS maintenance database) Section III. J(completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) ['Class A [ ]Class B [ ] Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes No If needed, are agreements, easements,etc.properly filed? Yes No Section IV. I (completed by health officer) This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. [ ] Denied VI-Approved I Granted—Subject all comments,conditions and requirements noted iinn�Sec�ti ns II and III. G2 7/ ` Local Health Officer (13) Date: 2- DOH 337-021 Page 26 of 32 5-13-2022 Mason County Environmental Healtr Lower Level Building i" 415 N 6th Street Shelton,WA 98584 RE: Lake Arrowhead Division 8 Tract 14: Sewage Holding Tank To Mason County Health Department, I, David M Rugg agree to properly maintain and pump out proposed sewage holding tank at least once annually. Sincerely---, 1 TERESA L WAY j Notary Public State of Washington David M. RuggLicense Number 135501 My Commission Expires May 15, 2024 SCO State c;Washington,County o^ 20 �(� day of . 1.� J OV personally appearedred before7I whose identity I verified on the basis of-y��.+�-�' whose identity I verified on the oathleff+rtnation of a credible witness,to tah s signer Fnee d A f tho foregoing document,and heishe acknowledged that 1---6 Zji a. et tan µY Notary pubtie to and for the State of W .. David Rugg 253-495-7939 twin oaks@live.com Mailing address: 30 W LoLo Place Elma.WA 9854: Site address: 40 W Lolo Place Elma,WA 98541 Lake Arrowhead Div 8 Tr 14 Parcel# 51917 57 00014 Thank You Dave 2183623 MASON CO WA 06/2412022 11.40 AM NOTCE RUGG 4176621 Rea Fee: $204.50 Pages: 2 1111111111111111111111IIIIIII11111II1111111111 1111111IIi11111111I0IIll III Return To Doc v/S otI5J ya fir. La Im�, c.,,9 4'1el-1/ Grantor(:):(1) Sicv, L R4413 ,(21 Grantee(s):(1)PUBLIC Legal Description(1) Gt*e. ,O/v,ryr A.. I d - (Abbreviated form:i.e.lot,block,plat or section,township,range) Assessor's Tax Parcel:(1) s' / ,.L - s Z- L L. NOTICE TO FUTURE PROPERTY OWNERS OF RECREATIONAL_USE OF HOLDING TANK (We),the undersigned grantor,hereby place this notice on record that the described real estate situated In Mason County,State of Washington;to wit the described real estate has a holding tank installed on this lot for sewage disposal for recreational use only. The approval and permits of the holding tank was conditional to the mitigation required by the state and county waiver process.Failure to maintain the holding tank In the manner required by Mason County Public Health is a violation of these conditions under which the holding tank permit was issued.This could result in abandonment of the holding tank and vacating the property until such time another suitable method of sewage disposal is approve°. Dated on this 1i day of /VA 42E'r Signature of r{� ✓ .i ,(2) State of Washington County of Mason Age 1of2 J 0 ` 0- 3 2 £ , R ° k �� / X 2 im 5 R • , � 2 § V © as . $ 7 k . B 0 ƒ / c a\ - 2 . op 2 CO § a *I-0un S & 2 , �,k 2 E k c4 a . 5 Q ■ V 2 2 to 2 A/ Z 1- 7 k To a) RI acE oE @ U k o c To '4 ` V c% § y� r. E etgm%Lu# 2 ' § 2 8 ,a- ck ■ . . o2 a/ 220CD -g 2 0 . « >322J xi ' �Szk >. . § c o ° 2 -1 2222o2 . C 0 0 > a) .. I �7 c ; —` .5 ) )