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Home My WebLink AboutWAI2026-00075 - WAI Health Waiver - 9/20/2026 MASON COUNTY sEPoszozs �D Public Health & Human Services , By PO Box 1666,415 N 6u Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 L Belfair:(360)275-4467 ext 400 4 Elms:(360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: fi' 319 ReceiptNumber: 0(4 Instructions Lul(k .A�aJ.P - ccc75 1. Complete Parts I and 2.No determination can be made until these parts are fully completed. 2. Fees maybe 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 Bar[ Evans Telephone 206-669-6360 Mailing Address of Applicant 2226 EASTLAKE AVE E BOX 99 City Seattle State Wa Zip 98102 12-digit Tax Parcel No. 2 2 2 1 4 -- 5 1 - 2 0 0 4 1 Site Address 15641 E STATE ROUTE 106, BELFAIR 98528 Subdivision Name and Lot HAPPY HOLLOW BEACH E 25' OF TR 41 & ALL OF 42 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 O 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 CotmtyplaintenanCe 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. Page I of 2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑ Appeal d Waiver ❑None required M'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) L-Ofr9 ,�2`r'5Z �` -S _ 3. Nature of Appeal: -t 'M_1 11 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 it 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 PROPERTYIPARCEL 5. HIGH WATER AUDIONISUAL ALARM, RISERS TO SURFACE,WATER-TIGHT FITTINGS 6. 1 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 * 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: yt i' V 2C. Date:9 6,26 Revised 12/12/2014 This form may be scanned and available for public view on the Mason County Web site. Page 2 oft Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April On-Site Sewage Systems (Chapter 246-272A WAC) Request for Waiver from State Regulations Section I. I (completed by applicant) Name: (I) Local Health Department/District (2) Bart Evans -- ....... (see ostrucnoru)..,_., ........ ......... Address: 2226 EASTLAKE AVE E BOX 99 ._. .. ........ .........1_.......------_ Seattle WA 98102 Telephone t ..... )....... 206-669-6360 Signature: Property Id oo: (3) HAPPY HOLLOW BEACH E 25' OF TR 41 &ALL OF 42 Section IL I (completed by applicant) WAC Number: (4) a s (3) Wmve Sought: (6)......0240(2) JWAC used for pemament holdin tank used for part-time recreational u246-272A 9 .. .. . ...... —_ ..... ....e uses _. _ ......... for RV ...... Subsection. 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 ofcer) Review Criteria: (8) Mitigation Measures(m addition to those proposed) (9) Comments!Conditions: (10) -.-... ..._......__ Type of Waiver: (11) N Class A I ]Class B I ]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. 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. I ]Denied C>4 Approv /Granted—Sub J�f��to all comments,conditions and requirements noted in Sections II and III. ✓' Local Health Officer (13) _____ Date: _ Page 26 of 32 DOH 337-021