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Home My WebLink AboutWAI2023-00097 - WAI Health Waiver - 10/3/2023 w A 1 3,6 t3 — 00094 �ASoN coo,, Public Health Always working for a safer healthier Mason County PO Box 1666,415 N Et°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: ISO , - Receipt Number: 1$ Instructions I. Complete Parts 1 and 2.No determination can be made until these parts arc 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 DAVID ALBERTI Telephone 253-948-2969 on Name of Applicant P Mailing Address of Applicant PO BOX 2506 City POULSBO State WA Zip 98370 12-digit Tax Parcel No. 42216 -- 53 -- 00133 Site Address 81 N WHITE WAY LN, HOODSPORT, WA Subdivision Name and Lot LAKE CUSHMAN #16 TR 133 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 611 Holding Tank WAC 246-272A-0240 0 Enforcement Timelines ❑ Mason County Onsite Standards 0 Departmental Determinations ❑ Contractor Certification Requirements D 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: 7( �,>,,.,,�. ( 91-:-e. ze `(may Date: /O - 3 -, 3 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) n Appeal 'Waiver H None required VClass A - 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 ' 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: l t' (I b/7--5 PART 4: Determination of the Hearing Official 6- 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: v " Date: to //6/2-3 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 I,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. (completed by applicant) Name: (I) DAVID ALBERTI Local Health Department/District (2) (see instructions) Address: PO BOX 2506 POULSBO, WA 98370 Telephone: ( ) 253-948-2969 Signature. Property Iden ficati .• LAKE CUSHMAN#16 TR 133, 81 N WHITE WAY LN Section II. (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. (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (9) Comments/Conditions: (10) Type of Waiver: (11) lass A I ]Class B I ] Class C—Request DOH review before granting? Yes No Neighbor Notification: (I2) 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 healthprotection at(east equal to that provided by this chapter WAC. I ] Denied IlN.Approved / Granted—Subject to all comments,conditions and requirements noted in Sections Il and III. Local Health Officer (13) YA Date: /��6/1 DOH 337-021 `-� Page 26 of32 Jim Hunter &Associates LOCATION: 2201 "A" 93R0 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 environmental health From: David Alberti Regarding: Regular Pump out of holding tank Parcel U: 42216-53-00133 Site Address: 81 N White Way Ln, Hoodsport Date: 9/29/23 To Whom it May Concern, I, David Alberti,agree to have the holding tank at 42216-53-00133 pumped on a regular basis. Best regards, David Alberti