HomeMy WebLinkAboutWAI2024-00055 - WAI Health Waiver - 6/2/2024 U-n -4-400oss,
MASON COUNTY
Public Health & Human Services
PO Box 1666,415N e Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 4v Belfair:(360)275-4467 ext 400 O Elma:(360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: IRS
Receipt Number:
Instructions
L Complete Parts I and 2.No determination can be made until these parts are filly 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—EA Af1) /Z AQse-A , Telephone !-6A947/-16760
Mailing AdttessofApplicant 123-V, 50) lq5TOA &dreon i.A) 9)?164
City� State C4J11 . Zip_28164
12-digit Tax Parcel N,^o,. '' a _ d Q _ /' o)—
Site Address AV /J
Subdivision Name and Lot J7i1', !y 0!1 d4 8e,-ape— ljO-x IQUn�rS
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
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(include justification,additional material may be attached.):
Install Holding Tank for Recreationall Part-time Use(RV)
Meets RSnGs for Holding Tank Design and is on state approved list
Tratddng of maintenance through Mason County maintenance database, Carmody Inc.
Applicant Si
APP gnanite: -PJaM�.R 130a1°,41 Date: Z 2
Revised 12/122014
This form may be scanned and available for public view on the Mason County Web site.
Page I oft
PART 3: Public Health Evaluation(Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
0 Appeal V Waiver ❑Now required 9'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 ❑ Health Officer
❑ Pollution Control hearing Board ❑ 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
l jDLI 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: T�-(vim"�" Date: a'I3Iz-r'1
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: Date:
Revised 12112R014
This form may be scanned and available for public view on the Mason County Web albs.
Page 2 of
E
Granting Waivers fiom Stet"C 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 L (completed by applicant)
Name: ( e Local Health Department/District (1)
............. . A.. (7 8.05'C1t t _.. (see Instructions)_
Address. ..
_L3` Su� 1 �B �.S�._ - .....
_........
_ _ -_
Telephone (650) qy ..a3a$(��(jJ . .._
........... ..... . ...... _._ ._.. . ... .__.. .... -.1.1................ .._ _.... ....
.....
Signature
A ill],
Property Identification: (3)
Section If. I (completed by applicant)
WACNumber: (4) WAC Requi.mmem: (3) Waiver Sought: (6)
— ... ... ...._... ....__ _....... ...._.. _
246-272w 0240(2) _holding tank used for pemament holding tank used for part-time recreational use
Subsection: COm1118rcial U3ee ..... ... . __.—._.. 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. (completed by health officer)
Review Criteria: (8) 1 Mitigation Measures(in addition tothose proposed): (9)
Comments/Conditions: (10)
Type of Waiver: (11) .Class A [ ]Class IS ( ]Class C—Request DOH review before granting? Yes_ No_
Neighbor Notification: (12) Required? Yes_ No_ Ifneeded, are agreements,easements,etc.properly filed? Yes _ No_
Section IV. (completed by health of'ire)
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—Sub' o all comments,conditions and requirements noted in S ctions It and III.
Local Health Officer 03) Date:
DOH 337-021 Page 26 of 32
RMOLDING TANK SITE PLAN:
PROPERTY LINES&EASEMENTS -EXISTING&PROPOSED STRUCTURES
PI DRIVEWAYS&ACCESS ROADS EXISTING WATERLINES
EXISTING&PROPOSED WELLS PROPOSED HOLDING TANK LOCATION
SURFACE WATER SOURCES(LAKES,SALTWATER) APPROXIMATE RV LOCACTION
CRITICAL AREAS(STEEP SLOPES,CREEKS,WETLANDS) NORTH ARROW&SCALE BAR
sC Al-TAC' llf.CI p10 -} .
AppROVEII.j
IIAEON COUNryEN4RONV ENTAI
RET HEALrrI
REFERENCED SETBACKS PER WAC246-272A-0210:
TANK TO SURFACE WATER AND/OR PRIVATE WELL-50FF TANK TO BUILDING FOUNDATION-5FT
TANK TO COMMUNITY WELL-100FT TANK TO PROPERTY OR EASEMENT LINE-5FT
TANK TO CRITICAL AREA-CONTACT PLANNING DEPT. TAN KTO WATERLINES-LOFT
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