HomeMy WebLinkAboutWAI2021-00125 - WAI Health Waiver - 7/15/2023 r
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�� MASON COUNTY
r.r i COMMUNITY SERVICES
%J, c- Building,Planning,Environmental Health,Community Health
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: ho. —
Receipt Number: 2 L'-
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 Michael Rechnitz Telephone 805-585-0546
Mailing Address of Applicant 15548 SE 175th CT
City Renton State WA Zip 98058
12-digit Tax Parcel No. 2 2 0 1 8 -- 5 0 -- 0 0 0 2 1
Site Address 530 E. Lakeshore Drive W., Shelton, WA 98584
Subdivision Name and Lot Timber Lakes, Division #1, Lot #21
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation El Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements
® Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
110 0 !i2'J vY E 4 Y --time re_c-r i fi anal ct .
Applicant Signature: Date: 7/15/2023
.I: Ell Forms\\Vancr-Appeal Mason County Local Revised 1/2p/2017
Page I oft
1 ,
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
L Appeal V Waiver L None required eiClass A u 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 Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board Lir Environmental Health Manager
600
5. Mitig/ng Factors:
1. f2fila.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 Rf,U:Z(6$75O
5. HIGH WATER AUDIOVISUAL 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: riPA1 Date: o(1151"L
PART 4: Determination of the Hearing Official
rileThe 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:
41 Hearing Official Signature: Date: 7/Le�i.�?
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) Jamie Workman (see
Health Department/District (2)
(see instructions)
Address: 120 E. Timberlake Dr.
Shelton, WA 98584
Telephone: ( ) 360-463-9573
Signature: 04Z-0,
Property Identification: (3) Assessor's Parcel Number: 22018-50-00021
Subdivision Name:Timber Lakes, Division 1, Lot 21
Section 11. I (completed by applicant)
WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6)
246-272A 0240 holding tank used for permanent holding tank used for part-time recreational use
uses, limited to controlled part-time for RV
Subsection: use
Justification(mitigation measures to be provided): (?) see local waiver form for full outline of mitigation measures:
1. Design criteria consistent with RSnGs for Holding Tank Sewage Systems
2. Tracking through Carmody Inc (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: (II IX] Class A 1 ] Class B ( ] Class C—Request DOH review before granting? Yes_ No X
Neighbor Notification: (12) Required? Yes No X 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 44Approved /Granted—Subject to all comments,conditions and requirements noted in Sections 11 and Ill.
Local Health Officer (13)
Date: 7/ 0/4.J
DOH 337-021 Page 26 of 32