HomeMy WebLinkAboutWAI2023-00036 - WAI Health Waiver - 4/26/2023 cONt: �,
Public Health
Always working for a safer ,<healthier Mason County
PO Box 1666,415 N 6th Street, Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 ❖ Belfair: (360)275-4467 ext 400 + Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid:
Receipt Number:
Instructions
I. 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 JOHN BOWMAN Telephone 360-999-7156
Mailing Address of Applicant 7420 STATE HIGHWAY 3 SW TRAILER 31
City BREMERTON State WA _ Zip 98312
12-digit Tax Parcel No. 2 z 2 =? -- .5— / -- D120 (
Site Address 1170 E TRAILS END DR, BELFAIR, WA. 98528
Subdivision Name and Lot
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
0 Location,WAC 246-272A-0210 0 Water Adequacy Requirem n 133/ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines 11 (� L 71
❑ Mason County Onsite Standards 0 Departmental Determinati yU
❑ Contractor Certification Requirements 0 Other u APR 2 6 i l
(Installer,Pumper,O&M Specialists) 2�L i
i
Description of Waiver/Appeal(include justification,additional material may be attached.): By (C )'
l
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:
Revised 12/12/2014
This form may be scanned and available for public view on the Mason County Web site.
Page I of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal i,VWaiver None required ~/Class A ❑ Class B .I 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 Controllhearing Board 0 Public Health Director
❑ Certified Contractor Review Board E' Environmental Health Manager
5. Mjtigating Factors:
4 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 IWDIONISUAL ALARM, RISERS TO SURFACE,WATER-TIGHT FITTINGS
6. I have received tlis waiver/appeal request. It is complete and mitigation required by the state
and local policy L as been submitted.
� `�(27(2 3
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:
111 0 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: S L,Z
Revised 12/12/2014
1 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 I,2007 Revised April 2017
On-Site Sewage Systems (Chapter 246-272A WAC)
Request for Waiver from State Regulations
Section I. I (comp eted by applicant)
Name: (1)J O H N BOWMAN Local Health Department/District (2)
(see instructions)
Address: 7420 STATE HIGHWAY 3 SW TRAILER 31
BREMERTON, WA. 98312
Telephone: ( ) 360-999-7156
Signature:
I
,312023
Property Identification: (3) \ 22223-51-06025
1
Section II. I (competed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A— 0240(2)O holding tank used for pernament holding tank used for part-time recreational use
Subsection: commercial uses for RV
Justification(mitigation measures 4 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. I (completed by health officer)
Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9)
Comments/Conditions: (10)
Type of Waiver: (11) Class A I ]Class B [ ]Class C—Request DOH review before granting? Yes No
Neighbor Notification: (12) Requyred? Yes_ No If needed, are agreements, easements, etc.properly filed? Yes No _
M -
Section IV. I (completed by health officer)
This Request For Waiver From Static Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site
Sewage Systems. The review critedia applied,and the mitigation measures proposed and/or required,have been evaluated for their ability
to provide public health protection alt least equal to that provided by this chapter WAC.
[ ] Denied Approved/Granted--Subject to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13) / Date: _P/1/2 3
DOH 337-021 Page 26 of 32