HomeMy WebLinkAboutWAI2023-00092 - WAI Health Waiver - 8/16/2023 i ,
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Public Health
Always working for a safer: healthier Mason County
PO Box 1666,415 N 6ch 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 ;aive r/Appeal
•
Amount Paid:
Receipt Number: 1; • *A41 CLEAR FORM
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 KEITH LOVELL Telephone 3604388371
Mailing Address of Applicant 1027 4TH AVE E
City OLYMPIA State WA Zip 98506
12-digit Tax Parcel No. 42329 -- 50 -- 00129
Site Address 61 N DOW CT, HOODSPORT, WA
Subdivision Name and Lot LAKE CUSHMAN #1 LOT 129
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements
9' Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 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: Date: 8/16/23
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 vu'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 0 Public Health Director
❑ Certified Contractor Review Board d 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 ARV 2Z01 6
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 bee submitted.
Staff Signature: Date: 22(ZZZJ
PART 4: Determination of the Hearing Official
III/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: Date: / O/f/
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) CLEAR FORM
Request for Waiver from State Regulations
Section I. I (completed by applicant)
Name: (1) KEITH LOVELL Local Health Department/District (2)
(see instructions)
Address: 1027 4TH AVE E
OLYMPIA, WA 98506
Telephone: ( 3604388371
Signature:
Property Identi cati n: (3) LAKE CUSHMAN #1 TR 129
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 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) [jV]Class A [ ] Class B I ] 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—Subject to all comments,conditions and requirements noted in Sections II and III.
Local Health Officer (13) 3-7 Date: l OA/•
DOH 337-021 Page 26 of 32
Jim Hunter &Associates
LOCATION: 2201 "A" 93RD Avenue SW • Olympia, WA 98512-9195
MAILING: P.O. Box 162 • Olympia, WA 98507
(360) 753-1226 • FAX: (360) 705-1360 • EMAIL: jhandassociates@hotmail.com
SEPTIC SYSTEM DESIGNERS
TO: Mason County Health Department
FROM: Keith Lovell (c/o—Adam Hunter)
REGARDING: Holding Tank pumping acknowledgement
42329-50-00129
DATE: 8/16/23
To Whom it may concern,
4
Mr. Lovell agrees to have the holding tank pumped as needed, a minimum of once annually.
If you have questions please call: 360-753-1226
Keith Lovell
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