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Home My WebLink AboutWAI2023-00119 - WAI Health Waiver - 12/11/2023 L}.S‘A- ‘ o o 1 19, Public e'Health DEC 11 76�� Always working for a safer i 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 s• Elma:(360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: Receipt Number: Instructions 1. 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 of Applicant Derek McMasters Telephone (253)205-1877 Mailing Address of Applicant 130 E. Hilldale Rd. City Union State WA zip 98592 12-digit Tax Parcel No. IA \ -- -- 0 l/ 9 `` Site Address 61 N. Kings Way S., Hoodsport WA 98548 Subdivision Name and Lot Lake Cushman #12 TR 93 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 Cie 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. -9F \\15\iQ5. � — c Applicant Signature: Date: \kV c Revised 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 4 • PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal KiWaiver ❑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 0 Public Health Director ❑ Certified Contractor Review Board 12' 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: ( I Z 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: OA/ Date: / X i' 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) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (1) Local,Health Department/District (2) Derek McMasters (see instruction Address: 130 E. Hilldale Rd. Union, WA 98592 Telephone: ( ) (253)305-1877• Si nature: " jVIS\Q-\ Property Identification: (3) Tax Parcel 42216-52-00093 Lake Cushman #12 TR 93 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 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: (ll) ACIass 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 d4 Approved/Granted—Sub'ect to all comments,conditions and requirements not dppin Sections II and III. Local Health Officer (13) Date: I I— 11/II DOH 337-021 Page 26 of 32 Mason County Community Services 415 N. 6th St. Shelton, WA 98584 January 25, 2023 Subject: Operational Agreement Parcel #: 42216-52-00093 Address: 61 N. Kingsway S., Hoodsport, WA 98548 The intended use of the Septic Holding Tank located at the above referenced property is for recreational use. The use is low flow, and the pumping service frequency will be "On Call". The system will be routinely monitored and pumped by a Certified Mason County Septic Pumper when needed. At a minimum, the holding tank will be pumped once annually and inspected to ensure proper functioning. Respectfully, ‘,/,-7 ( Derek McMasters (property owner)