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Home My WebLink AboutWAI2023-00053 - WAI Health Waiver - 5/24/2023 (2) L&DIA t ')l.,o 1 S 5-3 • 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: A' 1%S , Receipt Number: ¢ 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 Veil f- t-I Telephone 50 T 4v (1607 Mailing Address of Applicant P. D i3ok 367 City L% I l; wb cip State 64-)fq , Zip 1 s55 12-digit Tax Parcel No. ,3 3 1 6 -- S a -- 0 6 Q 2. 3 Site Address • tap/a Lo,ve___ . Subdivision Name and Lot Sex— fly 77.211.10231.1. R, 3 LA.), LJM, /61. 02,3 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 2/ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements ❑ 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: Date: S This form may be scanned and available for public view on the Mason County Web sitesed 12/12/2014 Page 1 of2 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 ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board air 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: 1( L Date: � 12 2 ! Z'T3 PART 4: Determination of the Hearing Official L.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: El 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: AW/Z Date: CA Z'J Re This form may be scanned and available for public view on the Mason County Web sitesed 12/12/2014 Page 2 of 2 iminnommumer 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: (l) Local Health Department/District (2) 1' e v(IV (see instructions) Address: P a Box 31)7 L.kl.l.;.kaa.p.....Wa.., 9 g 555 Telephone: (360 ) 7g a- Hg Signature: _..._........._......_........_..._._................. �3 ? Property Identification: ( Section II. I (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) 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) b[]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. ( (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/Granted—Subje o all comments,conditions and requiremen noted in Sections II and III. Local Health Officer (13) Date: 2. 2 3 DOH 337-021 Page 26 of 32 2197473 MASON CO WA 05/24/2023 11:06 AM NTFCL • DOUG DEVLIN *187116 Rec Fee S204 50 Pages: 2 Return To 1#11131111111111 u1111I11FIIlli1ii11I1I 11111 111111/1 Dad% + 7 t3eJIt ?0 Qot' 367 LillkJatlp Ak . 7555 Grantor(s): (1) 13(5 uG L/} c z)J) (2) Grantee(s): (1) PUBLIC v Legal Description (1) Sec_;b .t-ti1J A3'J R �.J LL)N, 1.94- 01.3 (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) 3 0Z. 3 . 16 - 5 d -o d ` a 3 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 2 3 day of 01 4-7/ ignature of Grantors . (1) , (2) State of Washington County of Mason Page 1 of 2 I, the undersigned, a Notary Public in and for the above named County and State, do hereby c rtify that on this rNday of , 20 IQ5 i • V 1 f� rsonaly appeared before me, who is known to be signer o he above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. \`\�oiicii nisi,///, jat et..' j — , ..oc;$ios/0„.. �-.% Notary Public in and r the State of Washington �' ° ?,:o N residing at 511. 1 _ NI:) .-ya' ':p= My commission expires: Ill id0A0 q ''G�` eC 1C 30�ry rri°, tuber�. • . Page 2 of 2 May 30, 2023 Mason County Community Services Shelton,WA 98584 4 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, c Mr. Doug Devlin 1