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Home My WebLink AboutWAI2023-00024 - WAI Health Waiver - 3/17/2023 415 N 6TH STREET,SHELTON,WA 98584 f t 1 MASON COUNTY SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 ,�1`' Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 MAN EMAN ET AL GREGORY D & ROBIN L TYLER JAMES ADAMS & BRIANN LEE ADAMS OLYMPIA, WA 98502 Applicant: MANEMAN ET AL GREGORY D & ROBIN L Parcel Owner: MANEMAN ET AL GREGORY D & ROBIN L Site Address: 131 W LOST LAKE VIEW DR Primary Parcel Number: 519015201004 Waiver Request Number: WAI2023-00024 Waiver Description: Onsite: Holding Tank, WAC246-272A- 0240 Waiver Submitted Date: 03/17/2023 Waiver Review Date: L//y non Waiver Status: fl ppiOVPcf If you have questions or concerns let us know. Sincerely, David Anderson Danderson@masoncountywa.gov • Public Health MAR 17 2023 Always working for a safer healthier Mason County PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584, By Shelton:(360)427-9670 ext 400 :• Belfair:(360)275-4467 ext 400 4. Elma: (360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: - 72' c� Receipt Number: Instructions \ N ) 02_ _ D oo Lk 1. Complete Parts l 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 BRIAN N ADAMS Telephone 360-580-1042 Mailing Address of Applicant 407 FIRE WILLOW ST NW City OLYMPIA State WA zip 98502 12-digit Tax Parcel No. . r / 9' V Site Address 131 W LOST LAKE VIEW DR, SHELTON Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies 0 Group B Water System Regulations ❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements ISe 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 he 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: L.,1,1LCC fir Date: 1 1 I 2t)Zj 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) Li Appeal Waiver Li None required 1/4/Class A Li Class B L Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or L 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 2' 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: Date: 3/7(1/70a3 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: Hearing Official Signature: Date: /`?6A-O 21 Revised 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (1) BRIANN ADAMS Local Health Department/District (2) (see instructions) Address: 407 FIRE WILLOW ST NW OLYMPIA, WA. 98502 Telephone: ( ) 360-580-1042 • Signature: C/# /() . 4 Property Identification: (3) 51901-52-01004 . .......................................................................................... ....................................................... Section II. I (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0240(2) holding tank used for pernament holding tank used for part-time recreational use Subsection: commercial uses for RV Justification(mitigation measures to he 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. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) IXI Class A [ ]Class B [ ] Class C—Request DOH review before granting? Yes No Neighbor Notification: (12) Required? Yes_ No X 1/'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 -Approved/Gran d---Subject to all comments,conditions and requirements n ted i Sections II and III./ Local Health Officer (13) Date: / 17c DOH 337-021 Page 26 of 32 2195353 MASON CO WA 03/29/2023 01:27 PM NOTCE Return To A0 1S 4185479 Rec Fee: $204.50 Pages: 2 El? , w A/ aNia ms I Ili,ll I III 11 IIII III I Dli III 11111111111111111111111111111 I111111 • L1 eri F'r x Y �✓1 11 o w - N (t1 O l `gyp 4) G��. Grantor(s): (1) g2fc) ivN ClJ n r" , (2) Grantee(s): (1) PUBLIC / /7 Legal Description (1) L US/ C qk-t I/rcW 7'L4�.1 v 1 ick (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1)S ( ' G ( - -5 Z - O, ( 00 . LI NOTICE TO FUTURE PROPERTY OWNERS OF RECREATIONAL USE OF HOLDING TANK I (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 approved. Dated on this ! day of PActi2 , 20 a93. Signature of Grantor(s): (1) , (2) State of Washington ) County of-A4 set'11 -sh-15 - Page 1 of 2 • I, the undersigned, . Nary Publi in and f r the above named County and State, do hereby ce ify that on t 's I day of �6 r(� , 20 Z�j , "ri;Q,�l ry) m /ar personally appeared ere me, who is known to be signer of the above instrument, and acknowledged that N (tiey) signed it. GIVEN under my hand and official seal the day an. year la .•ove written. ... , D EF,?,!)„ �I . . .I i 1� _� �� w�„R��C%,,� IF Public -n an for •- :tate of Washington, s0 ♦ 4:0 �4, �n/f G re sing at 5 s u 96i10 My commission expir s: " l 'I • ?� icn 'ti ,4 "0tieoc -z % 'k ',,,f•15.2?J i 9 = /�III, OF WASH\-' .�� Page 2 of 2