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Home My WebLink AboutSWG Inactive Can cell ed OFFICIAL USE ONLY MASON COUNTY W ."MRO13 - IS - 2 a C COMMUNITY SERVICES w m fltlkNWO�CemmuMy�'MMNNEminmmmNl NeaMl 5 y SWG ON-SITE SEWAGE TANK ONLY APPLICATION > z' APNCANI PHONE Ijj Christopher Weeks& Cheryl Weeks 760-519-5595 i MNIUNG ADDRESS-STREET,GIY.STALE.LP CODE - Gl C W O 17615 24th St NW, Lekebay, WA 98349 m BITEA➢EREss-sTREET Cm9PCCOE � ,-�, 40 N Bass Place, Hoodsport, WA 96546 a .EOFOESIGNER PHONE S I N Royal Flush 360-790-3021 WME OF INSTALLER R ONE O I (V Royal Flush 360-790-3021 '< TYPE Cf\10RK(rN-I wp) CgINNNG NMTER SOURCE 4 ■NEW CONSTRUCBON/UPGRADES D REPAIR/REPLACEMENT D FRWATEINORROUALIMELL E PRNATE`IHNC, TYNELL Z CGMFCY.ENrybITO SE REPIAf,Ew INGTAllfD 0 PUSLIC M'R SYSTEM O SEPRC TANK OPUMPTA: ■RVHOLOINGTANK SEDRODM9 LDi EITE � IC.iI D oTHER 1 RV Bedroom e712 Bq h m DMEROETNLS(a IpRRe TAIM(S)SETWK CHEC"T O I W OSURFACINGSEWAGE DEKISTINGFAILURE DSHORELINE n100FT.PUBLIGCOMMUNITY WELLS n BUSxITEAL$ 0 SOFT.PRIVATE NELLS,SLATFACE NMTERS,STRFAM8.RIVERS O ■PLOT PLAN(MOORED) ■TANK CROSS SECTION(REQUIRED) E1K -DRINKING WATER SUPPLY LINES IO ■PUMPOETAILS(IFAPPLICASLE) E WANER(S)(IFAPPUCASLE) E SFT.PROPERWI EASEMENT ONES,FOUgATIONS,FOOTINGS ROT FVN CHEC.. O O ■ PROPERT UNESANOEASEEIENT3 EEXISTINGIPROPOSEDSTRUCTURES EEXISTINGPROP SEDOSSCOMFONLNTSANDUNEB E `AHLS WITHIN 100FT E WATER SUPPLY LINES E ORNEVNY&PARKING TP SURFACE VNTERS,STREAMS.RIVERS,ETC.,. N N W NRECTIONOFSLOPE/CONTOURS OPERMIET CURTAINORAINS .NOWHARROW HSCALEBAR GO gREIIILMBTO 6REINO81TECgID1TICN3 - � � :(Y.E>V�NIPkf 40 N. Bass Place, Hoodsport, WA OFFICIAL USE ONLY BELOW THIS LINE wORIIE/FN LLME BCUICE MN n W�FF9 RKKMq OVOLUNTARY DMABRENANCFiPUMPING [3131AUDIMPERMIT DIIOMESAIE OCOMPLNNT DUTHER: caMExrs/cwxwTwxR SE%kGETAN0 MUSTMLISTEDUNceRw -LISTCFREGISTEREDSEWOf£TAWS',TANKSMIMTMEETCURRENTMIMM SUFREOUIRENm,E PPEDNRH RISERS ANDUMMSLRFACE.WIDIWLUMANEFFLUENTFILTERIIFAPPNLAMEI, REwA'iDCRAWWMDINSTANA REP]XTRE MDF RNKAPRiWAL, INSPECTOR SIGM1NflE MTE APPLCATIQY FXRgATNIN MTE I APPFIONAP IVISSUEDSY DATE THISFORMMAYSE SCANNED ANDAVARABLE FOR PUBUCVIEWON THE MASON COUNT INESSITE REASED070vg1c i-e osz�neosz� „ '�NI `JNIN33NIzJN3 N3 `01t� qFa � 14M e !Pti it a e P S i° ____ �N � � 2 U � Lo !C � � M Q L LL i-d ose�v a xz� 3 'is ose,'s osz, 3NI `JNR133NION3 N3 + a�9� 6SlI ca nfi s 8d 3 9 , !'t % 4 . - gI Etl pp t kill f. ,.d.t 14�%lat 1` i�2 I4 [: I Ill HI !jj MASON CovN t 'IL Publid! Health Always mrldng for a safer "antler M wn Wunty PO Box 1666,415 N 6w Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 O Belfalr:(360)275-4467 eat 400 4 Elms:(360)482-5269 ee 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: IR!� " `7 '-`-4 Receipt Number. ZU _ 1 q 0— fnatreCtidaa - t 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 Christopher Weeks S Cheryl Weeks Telephone 760-519-5595 Mailing Address of Applicant 17615 24th St NW City Lakebay ^ State WA Zip 98349 12-digit Tax Parcel No. d 1 — S — 6 CDC)Zq_v Site Address 40 N Bass Place, Hoodsport, WA 98548 Subdivision Name and Lot 16-28 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 51' Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(includejustification,,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 lief. Tracking of maintenance through Mason County maintenance database,Carmody Inc. Applicant Signature: Date: Revised 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Pagc 142 PART 3: Public Health Evaluation(Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal V Waiver ❑None required VClass A ❑Class B ❑Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or Iffiest Code/Standard revision) WAC246-272A-0240(2) 3. Nature of Appeal: ALLOW HOLDING TANK FOR RECREATIONAL(RV)-PART-TIME USE 4. Hearing Official: ❑ BoardofHealth ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board Environmental Health Manager 5. Mitigating Factors: t. 1200 GALLON TANK,ON WASHINGTON STATE APPROVED UST 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 PROPERTYIPARCEL 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: PART 4: Determination of the Haring 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: Qf. 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: Aacr Hearing Official Signature: _ Date: 7- Revised 12/17R014 This forth may be scanned and available for public view on the Mason County Web site. Page 2 of2 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. (completed by applicant) Name: (1)Christopher Weeks&Cheryl Weeks Local Health Deparm art/District (2) see inrhacttans _ Address` 17615 24th St NW Lakebay, WA 98349 Telephone: ( ) 760-519-5595 Signature: Property Identification: (3) Address-40 N Bass Place, Hoodeport, WA 98548 Parcel Number-42216-53-00028 Section D. (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 mr KV Justification(midgrairm memares to be provided): (7) asses local waiver fbmr for full outline of mitigation measures: 1. Design criteria conaierent 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) Cuwneats/Condidore: (le) Type of Waiver. (11) KClass A [ ]Class B [ ]CI=C—Request DOH review before granting? Yes— No— Neighbor Notification: (12) Required? Yes_ No_ ljneeded,are agreemend,easements,etc.properlyjtled7 Yes _ No_ Section IV. I (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. [P}Deoied [ ] Approved/Granted object to all comments,conditions and requirements noted in Sections 11 and III. Local Health Officer (13) Date: 2 2- DOH 33M21 Page 26 of 32 RV HOLDING TANK SITE PLAN: 14 PROPERTY LINES&EASEMENTS EXISTING&PROPOSED STRUCTURES 10 DRIVEWAYS&ACCESS ROADS M ISTINGWATERLINES EXISTING&PROPOSED WELLS --IJ4 PROPOSED HOLDING TANK LOCATION SURFACE WATER SOURCES(LAKES,SALTWATER) .N-P APPROXIMATE RV LOCACTION CRITICAL AREAS(STEEP SLOPES,CREEKS,WETLANDS) NORTH ARROW&SCALE BAR 41 P� W wrr? PaK ' Pwt!/wIaTE2 5 �, � I - w�v 5 REFERENCED SETBACKS PER WAC246-272A-0210. TANKTO SURFACEWATER AND/OR PRIVATEWELL-SOFT TANK TO BUILDING FOUNDATION-5FT TANK TO COMMUNITY WELL-1OOFT TANK TO PROPERTY OR EASEMENT LINE-SIFT TANK TO CRITICAL AREA-CONTACT PLANNING DEPT TANK TO WATERLINES-LOFT 2208946 MASON CO WA 031251 M24 02 06 PM NOTCE CHRISTOPHER & H,R" "S #ISGOBI Rec Fee E30T 50 Pa9e5. 2 Return To 17 is 29 M SY Jill / Q e i24 t 9A- qky 9 3 Grantor(s): (1 ri 2JAa Pr Tr G rjrs ,(2) ( j� 4t Grantee(s): (1)PUBLIC Gd' Cc Legal Description(1) ?z/ ,& �ir,a,2 d" /6 _ i (Abbreviated krm:i.e.lot, Nock,plat orsedion,township,range) Assessor's Tax Parcel: (1)—q-2-Z1 6 -63-- 2 Q-,?— F 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, Slate 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 thi92 / h day of , 20 ht . Signature of Grantor(s): (1) �> � . lt� , (2) 34 .� .. State of Washington ) County of Maser Page 1 of 2 I,the undersigned, a Notary Public in t and for the above named County and State, do hereby certify that on this zS day of /IA.A2[µ , 207o- , personally appeared before me,who is known to be signer of the above instrument, and acknowledged that he(she)(tbaW signed it. GIVEN under my hand and official seal the day and year last Notary Public in and for the State of Washington, CHARLES B ELLIS residing at Fev r; NOTARY PUBLI C My commission expires: tl STATE OF WAGTON COMMISSIONIRESNOVEMBER ,2025 Page 2 of 2