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Home My WebLink AboutWAI2023-00054 - WAI Health Waiver - 5/24/2023 (2) Catr v, Lxi A t 'La 1.75 4_,Dos-tt ‘, 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: ./C3C Receipt Number: 7-s7.-- 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 Identificatiion Name of Applicant 0,jvy t DeJ(in/ Telephone 36o 79e -Y607 Mailing Address of Applicant 2 840x 36 7 City J,; 11;cJ o op State c,3i2 Zip 90553 12-digit Tax Parcel No. 3 .Z 3 ( -- Jr- d Site Address ilgap/ L0,Je Subdivision Name and Lot Se e_ t -(-,j l g 3 P.1 - R 3 uJ. adN, PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations • ❑ Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements l' Holding Tank WAC 246-272A-0240 0 Enforcement Timeline ❑ Mason County Onsite Standards 0 Departmental Dete I t'1'`r/ ❑ Contractor Certification Requirements ❑ Others (Installer,Pumper,O&M Specialists) ` t °1 . MAY � �, . . 1 �i Description of Waiver/Appeal(include justification,additional material may be attached.): ik Install Holding Tank for Recreational/ Part-time Use (RV) �k�- Meets RSnGs for Holding Tank Design and is on state approved list. Tracking of maintenance through Mason County maintenance database, Carmody Inc. Applicant Signature: y Dater 2 Z This form may be scanned and available for public view on the Mason County Web siteSea 12i12i2014 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal IWaiver ❑None required 'Class A ❑ Class B 0 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 I ' 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: Date: fr2/141:S 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: ❑ 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: (e�` /7� Date: trA -1/2-) This form may be scanned and available for public view on the Mason County Web tesed 12i12/2014 s Page 2 of 2 2197472 MASON CO WA 05/24/2023 11:08 PM NTFCL DOUG DEVLIN *187116 Rec Fee: $204.50 Pages: 2 Return To 11111110111111 1111111+111111 E11111111111,11 1 11 H1 111 1111 weir 'De.tair7 P.. o ,4. 367 !elf;uht)o i, '91,555 Grantor(s): (1) Grantee(s): (1) PUBLIC Legal Description (1) Sc 4x.3 n1 R 3c ). uir-t Lo A- 2 a (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1)3 Z 3 / 6 - 5 v - 0 _ O ,z 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 1Y) i y , 20 2 ' nature of Grant (1) � , (2) State of Washington 4 County of Mason ) 4 Page 1 of 2 0 I, the undersigned, a Notary Public 'n and for the above named County and State, do hereby • c rtify that on this 2(4la of 20 bD 0(�� - • ru pe onally appeared before me, who is known to be signer d#the above instrument, and acknowledged that g he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. ��tt►iluutry `P !s.P/C ./ Notary Public n and for the State of Washington, .�o e-o7-� + ,J, residing at Sh� r�o7;46., N z' My commission expires: R�101, ""t` AUBLIC ry.• •,�O,crWA SI 4-i 0 // 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