The URL can be used to link to this page

Home My WebLink AboutWAI2025-00010 - WAI Health Waiver - 2/13/2025 MASON COUNTY Public Health & Human Services PO Box 1666,415 N 6'h Street, Bldg 8,Shelton WA 98584, _ Shelton:(360)427-9670 ext 400 4 Belfair:(360)275-4467 ext 400 4 Elms:(360)482-5Fc tt n(f D FAX (360)427-7787 1111 �I Application for Waiver Appeal FEB 1 3 20 Amount Paid: ,3� Receipt Number: Instructions to GUOI O 1. Complete Parts Ind 2.No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals,based on the Envbonmortal Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1.Appneant/Parcel Identification Name of Applicant RENEE MARSHALL Telephone 206-714-3052 Mailing Address of Applicant 9668 N HWY 79 LOT F66 City FLORENCE State WA Zip 85132 12-digit Tax Parcel No. 3 2 1 2 7 5 // 1 -- 0 0 0 4 2 Site Address 151 E DUNOON P(qd_ Q9x;p" Subdivision Name and Lot L!k. T',e YL- 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 Rr 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 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: A Date: 13 20- 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) ❑Appeal V Waiver ❑None required O'Class A ❑Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/Standard revision) WAC245-272A-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 ii� 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: PART 4: Determination of the Hearing Official IL 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: i'� _ Date: 3 � Z- Revised 12/12/2014 This form 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 I,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) R oast for Waiver from State Regulations I, (completedbyopp/ieant) Name` (') RENEE MARSHALL Loral Health Departoent/District (2) ........ (eee.msdmfionsJ....,_. ...... ......._�._.. 'dam` 9668 N HWY 79, LOT F66 _ ......... .........................................................................—....___.-........... __.... -- FLORENCE, AZ 85132 _..........................- . ...... --- ._ . .__............................................_.................__._—_.._...__......_..... Telephone: ( ) 206-714-3052 Signature: C.... ..... ..... ........ . -___ .... a"o5/ Property Identification: (3) Zli,r 32'127-61-00042 ...._ . .. .... .......... _._ _. R. f........... .(M+•irArtw....�_Z'f 4/2. ....._................... Section II. (completed by applicmnt) WAC Number: (4) WAC Requirement (3) Waiver Sough: (6) 246 272w 0240(2) holdln tank used for mament holdln tank used for art-time recreational use Subsa:non......... ......... .................. commert(al uses forRV Justification(mitigation measure,to be provided): (7) see local waiver form for full outline or mitigation measures: ........ ................ ....... ... .._........ .._............ _.._ ......... ............ 1. Design criteria consistent with RSnGs for Holding Tank Sewage Systems -.... ................. ............ ......... ._ ............. ............ 2.Tracking through Online RME (Mason County OSS maintenance database) n m, I (completed by health ofrcer) Review Criteria: (6) Mitigation Measures(in addition to those proposed): (9) _.. ..._ .__.... ............................................_ ......................................................... .............. ........ ................ ............ . ......... ......... .................................__ ... ........ .__... .__...__..........._..___........ Continent/Conditions: 00) Type of Waiver: (11) W Class A [ ]Class B [ ]Class C—Request DOH review before granting? Yes_ No— Neighbor Notification: (72) Required? Yes_ NoY lfneeded.are agreements, easements, etc.properlyfded? Yee _ No_ Xtilte_IV, (completed by health after) 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 Vq Approved/Granted—S bjec In,all comments,conditions and requiromen rot!.Sections It and III. Local Health Officer (13) Date: 3 Zf DOH 337-021 Page 26 of 32 p OEM February 19, 2025 11� FEB 2 5 To whom it may concern at Mason County of Washington State. I, Renee A. Marshall,will have the holding tank at parcel#32127-51-00042, 151 E Dunoon PI, Shelton,WA 98584 pumped outannually or as needed. Thankyou, RJeAMar;shaU 151 E Dunoon Place Shelton,WA 98584