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Home My WebLink AboutWAI2023-00054 - WAI Health Waiver - 5/24/2023 Co w A t ..Ez)o ` 'a' Public !. Health Always working for a safer : healthier Mason County PO Box 1666,415 N 6'h 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: 1ft Receipt Number: Instructions Complete Parts I 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 Dot} . ,- DeJ(in/ Telephone 360 796 - YSOT Mailing Address of Applicant P.a 8O 36 City ; State c,3Y1 Zip e18555 12-digit Tax Parcel No. - _3_ ( -- d Site Address i'Lta�oJe L0Aie Subdivision Name and Lot S e_ t ,z3 1•1 - Z 3 a) (A-1 -1, PART PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation ❑ Building Permit Review Policies 0 Food Sanitation Requirements 0 Group B Water System Regulations ❑ Location, WAC 246-272A-0210olicie IV Holding Tank WAC 246-272A-0240 0 Water Adequacy Requirements ❑ Enforcement Timelines-_ - ❑ Mason County Onsite Standards 0 Departmental Dete❑ Contractor Certification Requirementsrrniila 'c v((� (� n 0 Other L, U (Installer,Pumper,O&M Specialists) (j MAY 2 4 10 (.I Description of Waiver/Appeal(include justification,additional material may be attached.): 23 Install Holding Tank for Recreational/ Part-time Use (RV) By Meets RSnGs for Holdin Tank Des; n and is on state ap roved list. Tracking of maintenance through Mason County maintenance database, Carmody Inc. Applicant Signature: Date: Z This form may be scanned and available for public view on the Mason County Web sitev eSed 12/12/2014 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal i/Waiver 0 None required I'Class A _i 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 Er 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: r22 �� 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: 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: �z2�,j�/ 4/Z' Date: f Revi This form may be scanned and available for public view on the Mason County Web sitesed 12/12/2014 Page 2 of 2 ' I 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: (I) Local Health Department/District (2) Address: Wit./ 'i (see instructions) PO Sox Al c,2liu)ocip WA. °p8°55 5 Teleph e: (.360 ) -pia- '{go 7 "'" Signatux A, 1 fr( L'S -4—) Property Identification: ) `- J f _...._....Sc.e. 16 t�1J/;23A) /?Su). (4-K, C a-/ Lz Section H. (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) w� Section III. I (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (Il) ..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. I ] Denied 0-Approved/Granted—Subject to all comments,conditions and requiremen oted in Sections II and III. Local Health Officer (13) 4, Date: 6 Z/Z DOH 337-021 Page 26 of 32 2197472 MASON CO WA 05l24/2023 1106 AM NTFCL Return To !'HII IIIINI1l114iIiIINIIm1111!INN mRi''IDPIRun /icemow -De✓ :7 Pe fk.r367 L.,'/( u iadp c.k, 9 11:555 Grantor(s): (1) � k co Li 1 (2) Grantee(s): (1) PUBLIC Legal Description (1) $,4 i -/-zA 07-3 R 514). Lot L.0} 22 (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 3 Z. 3 1 6 _ 5 _C? - Q �� _ 2 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 23 day of 1Y1 A7" , 20 2• nature of Grant (1) c , (2) State of Washington County of Mason ) Page 1 of 2 I, the undersigned, a Notary Public 'n and for the above named County and State, do hereby c lrtify that on this �2)(6day of , 200 Q 41 . ,bry I 1.K.1 pe onally appeared before me, who is known to be signer Y the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. •,...4-a . _ \PG'.yssD/C,t_'�,�� Notary Public n and or the State of Washington, ,`Qo�o_07_.2 E,f�?i residing at Sh c( NoryR`'a'... = My commission expires: 0 '((G'""''t' ''.,peA,umbece.••: '1 • /��i��wA S11-i`NG\�`�� Page 2 of 2 May 30, 2023 Mason County Community Services Shelton,WA 98584 RE: Septic Holding Tanks Parcel#32316-50-00022 & Parcel#32316-50-00023 To Whom it May Concern: I am writing this letter to confirm that I am placing two septic holding tanks one per parcel on the above mentioned lots. I am agreeing to have them regularly pumped according to the design and use recommendations. This agreement has also been registered for future property owners as recorded with Mason County Auditor #2197472&#2197473 on May 23, 2023. Sincerely, Mr. Doug Devlin �. y