HomeMy WebLinkAboutWAI2023-00078 - WAI Health Waiver - 8/4/2023 ,,�K ,t•, n f'�I�J I
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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 giver/Appeal
Amount Paid: 2c35
Receipt Number: 9.013-
Instructions viNaxa13 _poo LBy
I. 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 ofApplicant DAVID CARROLL 512-5177493
--- -- ------- --- Telephone--
Mailing Address of Applicant 41 W QUINAULT TRAIL
City ELMA State WA zip 98594 — —`
12-digit Tax Parcel No. 5 1 _ 9 1 7 -- 5 2 -- 0 0 0 3
Site Address 41 W AUINAULT TRAIL
Subdivision Name and Lot LAKE ARROW HEAD #3 TRACT 38
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location, WAC 246-272A-0210 0 Water Adequacy Requirements
112/ Holding Tank WAC 246-272A-0240 0 Entorcement Timelines
❑ Mason County Onsite Standards ❑ 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: f; __._cj_
_( Da __i_b1P221
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 VWaiver None required /Class A ' 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
0 Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board l ' 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 been submitted.
Staff Signature: �� 4U �'—r -23
III
Date:
PART-t: I)eterminatio of the Hearing Official
[ l-''l'hc 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:
1-fearing Official Signature: _ __ tr-VDate: F/-r/13
Rev
This form may be scanned and available for public view on the Mason County Web site.ed I2/I2no1 t
I'age 2 of 2
1 Granting Waivers from State On-Site Sewage S stem 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. L/c nutple1ed by amilk cn7l/
N`'m`. tl) DAVID CARROLL Local Health Department 'District (2)
(seeinstructions)
. Address:
41 W QUINAULT TRAIL
ELMA. WA. 98541
Telephone: ( 512-517-7493
Signature: iL----
4._)4,1/4-el
� 2
Property !deltaic n: (3) 51917- 2-00038 —T�
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()Ulcer)
Review Criteria: (8) Mitigation Measures tin addition n,those proposed/: (9)
, Tu u 5c 0.0%f
Comments 'Conditions: WO - -
"type of Waiver: (11) baf..71ass A I ] Class 13 I ] Class C--- Request DOI I review before granting? Yes No
Neighbor Notification: (12) Required? Yes __ No l/needed, are agreements. easements. etc. properly filed! Yes No
Section IV. , (completed hr health()Wert
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 v] Approved /Granted - Subject to all c mmcnts,conditions and requirements noted it Sections II and III.
Local Health Officer (/3)
/4t / �� �
. . .. , Date: V/17
1)01-I 337-021 Page 26 of 32