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Home My WebLink AboutWAI2024-00081 - WAI Health Waiver - 7/24/2024 000 g t MASON COUNTY Public Health & Human Services PO Bon 1666,415 N 5u Street,Bldg 8,Shelton WA 98584, Shelton(360)427-9670 ext 400 4 Beealr:(360)27S- 467 ext 400 ? Elma:(360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appealm Amount Paid: V—ve} cJ Receipt Number:C �'-aSLJO9 Instructions 1. Complete Pans I and 2.No determination can be made until time parts are fully cowleted. 2. Fees may be billed for waivers and appeals,based on the Enviromnenta Health Fee Schedule. 3. Submit completed application with attachments on Mason County Public Health for review. PART t.Applicant/Parcel Identification Name of Applicant Phillip Tucker Telephone 360-266 4435 Mailing Address of Applicant 10260 Ramble Dr NW City Bremerton State WA Zip 98311 12-digit Tax Parcel No- 4 Z Z -- S 1 _ D 1 0 g' Site Address 101 N Gadwall PI North, Hoodsport, WA 98584 Subdivision Name and Lot Lake Cushman #18 BILK 1 Lot: 8 PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation ❑ Food Saturation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ L..dn,WAC 2a6-272A-0210 ❑ We=Adequacy Requirements Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Meson County Chance Standards ❑ Deparhnenral Determinations ❑ Contractor Certification Requirement ❑ Other, (randier,Pumper,O&M Specialim) Description of Waiver/Appeal(include junification,-additional material maybe attached.): Install Halting Tank for Recreationall Pan-time use(RV) Meets RSnGs for Holding Tank Design and is on stale approved list. Tracking of maintenance through Mason County maintenance database, Carmody Inc. Applicant Signature: Date: geviwd 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Page 1 af2 PART 3: Public Health Evaluation (Staff Use Only) L Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal V W aiver G None required VClass A ❑ Class B T 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 ART-TIME USE 4, Hearing Official: ❑ Boardof Health ❑ health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board V 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�been submitted. Staff Signature: N Date: PART 4: Determination of the Hearing Official UL 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: nz Date: 0 4. Revised 12,112014 This form may be scanned and available for public view on the Mason County Web site. Page].oft Orating Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Dale: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations (.ompleted by applicant) name: m Phillip Tucker Local Health Departmen^/District a) Address: 10260 Ramble Dr NW Bremerton, WA 98311 Telephone: ( ) 360-265-4�435 Signature Property Idmrificatim: (3) 101 N Gadwall PI North, Hoodsport, WA 98584 Parcel #42205-51-01008 Section II. (completed by applicant) WAC Number. (4) jhldM�g quitement /3) Waiver Sought (b) 246-272A— 0240(2) tank used for perrratnent holding tank used for part-time recreational u . Subsection: rcial uses for RV Justification(mitigation menaces 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(Meson County OSS maintenance database) Section M. (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to thou proposed): (9) Comment/Conditions: (10) Type of Waiver (11) Was A I ]Clans B ( ]Class C—Request DOH review heforo staining? Yes- No Neighbar Notification: (12) Required? Yas_ No_ ffneeded,are agreemaus, eaument.uc.properly filed? Yes No Section IV. I (completed by health officer) — This Request For Waiver From State Regulations has been reviewed according m 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 in provide public health protection at least equal m that provided by this chapter WAC. [ ]Denied MAppraved/Granted comma,conditions and requuerrcm word tions Il and III. Eacal health Officer (13) Daft: DOH 337-021 Page 26 of 32 July 22, 2024 Mason County Public Health Environmental Health Sewage&Septic Program 415 N.6' Street Shelton, WA 98584 RE:STATEMENT FROM PROPERTY OWNER—PROPOSED HOLDING TANK FOR RECREATIONAL USE VEHICLES AT 102 N GADWALL PL NORTH, HOODSPORT,WA 98584 To Whom it May Concern: I Phillip and LindseyTucker,owner of the above referenced property, hereby acknowledge and agree to have the tank pumped and/or inspected by a Mason County certified septic pumper annually and serviced on an as needed basis. For questions,please contact Phillip Tucker at 360-265-4435 or phil.tucker003C@¢mail.com. Sinc ely, Phillip Tucker 10260 Ramble Dr NW Bremerton, WA98311 Sincerely, TI Lindsey Tucker 10260 Ramble Dr NW Bremerton, WA98311 2215482 MASON CO WA 0"061202E ,i 22 an W'CE pHi jjI1P ER {20'305 vc Fa„ 33" 5C gages ] Return To /yZleO ,col-..Ei(F f7�Nul - - $�r.�rri�ryt l �v14 Yez�l Grantor(@): (1) I �L � T✓rG� (2) �n sc✓ �v�kv ✓ Grsntee(s): (1) PUBLIC - -_ F- Legal Description(1) LAiLZ7 GUsKm*✓J AA IX BLX- ( L O-T ' FS (Abbrawaled loan:i.e. tot Nock,plat ar section, township, range) Assessor's Tax Parcel: (1) ' 2 -z-.0 NOTICE TO FUTURE PROPERTY OWNERS OF RECREATIONAL USE OF HOLDING TANK I (We), the undersigoed'grantor;hereby place this notice on record that the described real estate situated in Mason Cgwnty, State of Washington;to wit the described real estate has a holding tank installedo"his 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 hokiing tank and vacating the i property until such time another suitable method of sewage disposal is approved. -- Deted on this y `� day of '--' Sign ure of Gremor s (1) m (2)� State of Washington ) County of Meson Page 1 of 2 I,the undersigned, a Nol ry Public in and for the above named County and State, do hereby certify that on this �da of U l 20-2L, I A Y✓tka ally appeared befalf8 me,who is known to be signer of the above instrument,and acknowledged that he(she)they)signed it. GIVEN under my hand and official seal the day and year,.18s1 above written. Pam a Notary PO im or the State of Washington, IISY�M re9idingat; __bly:ootnlnYsebn expires:=SyuJ�_ IDLY qO" - ii Page 2 of 2 2215482 Page 2 of 2 09/06/2024 11:22:08 AM Mason County, WA