HomeMy WebLinkAbout2014- August JEFFERSON COUNTY BOARD OF HEALTH
August 21, 2014
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA
2:30—4:30 PM
DRAFT AGENDA
I. Approval of Agenda
II. Approval of Minutes of July 17, 2014 Board of Health Meeting
III. Public Comment
IV. Old Business and Informational Items
1. Port Townsend Paper Corporation settlement agreement
2. Correspondence BOH
V. New Business
1. Proposed Revisions to Jefferson County Solid Waste Code
2. EH hourly rate for technical staff
3. Community Health Improvement Plan- activity update
4. SBHC review
5. Communicable disease update
6. Regionalization of Medicaid and Behavioral Health
VI. Activity Update
VII. Public Comment
VIII. Agenda Planning Calendar
IX. Next Scheduled Meeting: September 18, 2014
2:30—4:30 PM
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA
•
• JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, July 17, 2014
Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368
Board Members Staff Members
Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer
David Sullivan, Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir
John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Dir
Sally Aerts,citizen at large Jared Keefer,Env.Health Services Dir
Kris Nelson,Port Townsend City Council Veronica Shaw,Public Health Deputy Dir
Sheila Westerman, Vice-Chair, Citizen at large
Jill Buhler,Hospital Commissioner,District#2
Chair Sullivan called the June 19, 2014 meeting of the Jefferson County Board of Health to order
at 2:32 PM. A quorum was present.
Members Present: Jill Buhler, David Sullivan, John Austin, Kris Nelson, Sheila Westerman,
Phil Johnson, Sally Aerts
Staff Present: Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin
• APPROVAL OF AGENDA
Chair Sullivan called for review and approval of the agenda for the 07/17/2014 meeting.
Member Aerts moved to approve the agenda; the motion was seconded by Member Buhler.
The motion passed unanimously.
APPROVAL OF MINUTES
Chair Sullivan called for review and approval of the minutes of the 6/19/2014 meeting of the
Board of Health.
Chair Sullivan pointed out that it was member Sullivan who recommended removing the
identification of county (Aerts) and city (Westerman) on the member list at the last meeting.
Member Johnson moved to approve the minutes; the motion was seconded by Member
Nelson. No further discussion. The motion passed unanimously.
PUBLIC COMMENT
. No Public Comment.
• OLD BUSINESS AND INFORMATIONAL ITEMS
1. Chronic Diseases Are Main US Public Health Concern
Dr. Thomas Locke, Health Officer, Jefferson County Public Health,presented the Board
with information from the Centers for Disease Control and Prevention(CDC). He
focused on the following four strategies (domains) the CDC uses to try to meet the
chronic diseases burden, which are also of importance to JCPH:
a. Epidemiology and surveillance to monitor trends and inform programs,
b. Environmental approaches that promote health and support healthy behaviors,
c. Health system interventions to improve the effective use of clinical and other
preventive services, and
d. Community resources linked to clinical services that sustain improved
management of chronic conditions.
2. First West Nile Virus Detection in Mosquito Pools for 2014
Dr. Locke informed the Board that the first mosquito pool to test positive for West Nile
Virus in 2014 is in Franklin County. This information was brought to the Board and is
being tracked because it can become a major public health emergency if there are large
scale outbreaks.
NEW BUSINESS
• 1. Port Townsend Paper Corporation Limited Purpose Landfill Permit
Dr. Locke informed the Board that a press release was sent last week and information
posted to the JCPH website. The Port Townsend Paper Corporation is now classified as a
Limited Purpose Landfill. A community open house is scheduled for July 28th at 6:00
p.m. at the Cotton Building in Port Townsend. Representatives from the PTPC and JCPH
will be there to answer questions from the public.
2. Proposed Revisions to Jefferson County Solid Waste Code
Jared Keefer, Director of Environmental Health and Water Quality, JCPH,provided the
Board with the Jefferson County Solid Waste Code. Mr. Keefer made the following
changes:
a. Clarified the permit application process
b. Added hearing procedure guidelines
c. Clarified language and intent regarding the terms "Moderate Risk Waste" and
"Small Quantity Generator Waste."
d. Clarified Definitions for discarded commodity,junk vehicle, and moderate risk
waste
e. Corrected an error in agencies from Puget Sound Clean Air Agency to Olympic
Region Clean Air Agency
Member Westerman pointed out a duplicated section under(c) Denial of Property
Access.
Member Westerman recommended removing the identification of county (Aerts) and city
• (Westerman) on the signature page.
• Member Austin recommended adding language to the Junk Vehicle section to include
any former form of transportation.
Mr. Keefer will review timelines in the Appeal of Administrative Hearing section
Mr. Keefer will incorporate changes, have the code reviewed by Risk and Legal, and
bring it back to the Board for final review.
3. Chimacum Prevention Coalition Strategic Plan
Julia Danskin,Nursing Services Director, JCPH, updated the Board on the Chimacum
Prevention Coalition Strategic Plan and provided the Board with information that is
available to the public on youth marijuana use. Ms. Danskin recommended the University
of Washington website, www.learnaboutmarijuana.com and the DSHS website,
www.dshs.wa.gov/dbhr/dapreventionpub.shtml as good resources for the community.
Ms. Danskin informed the Board the Chimacum Prevention Coalition is always seeking
Board members. Ms. Danskin informed the Board of a town hall meeting that will be
facilitated by Chimacum youth on October 13th at the Chimacum High School.
4. Cascade Pacific Action Alliance Update
Jean Baldwin, Director, JCPH, shared with the Board the 6-month timeline that was
discussed at the last meeting. The next meeting is September 11, 2014.
5. Washington State Health Care Authority's State Innovations Models Grant
Application
Dr. Locke informed the Board of his recommendation on the State Innovation Models
• Initiative (SIM) Grant Narrative, which was to include omitted information from the
State Health Care Innovation Plan(SHCIP)that referenced the challenges faced by the
rural component of Washington's health care system.
6. Community Health Improvement Plan Activity Group Update
Ms. Baldwin and Member Buhler invited Member Aerts to work on the planning
committee. The next committee meeting is July 28, 2014.
ACTIVITY UPDATE
Public Workshop on Port Townsend Paper Corporation Landfill Permit—July 28, 2014, 6:00
PM, Cotton Building, Port Townsend
PUBLIC COMMENT
Dan Toepper of Port Ludlow asked the Board to keep PSAs and other public messages regarding
1-502 short and simple in order to get the message across effectively.
AGENDA PLANNING CALENDAR
No Agenda Planning.
• NEXT SCHEDULED MEETING
r
• Next Board of Health meeting will be held on Thursday, August 21, 2014 from 2:30—4:30 p.m.
at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA.
ADJOURNMENT
Chair Sullivan adjourned the July 17, 2014 Jefferson County Board of Health meeting at
4:22 PM.
JEFFE' SON COUNTY BOARD OF HEALTH
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Sheila Westerman, Vice Chair
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Board of Health
Iv
Old Business & Informational Items
Item 1
Port Townsend Paper Corporation settlement
agreement
•
0 August 21 , 2014
I .
B. Jefferson County Public Health reviewed the permit modification application and has II
investigated whether the modified site and facilities meet all applicable regulations and
laws,the approved comprehensive solid waste handling plan and zoning requirements.
Jefferson County Public Health concluded that the modified facility meets these
standards and issued a permit with a compliance schedule
C. The terms of this modified permit, including the compliance schedule,were negotiated
by the parties and are acceptable to each party.
D. Ecology has reviewed the permit,has determined that the facility conforms to all
applicable laws and regulations and the Jefferson County solid waste management plan,
and will not appeal the issuance of this permit to the PCHB.
E. PTPC has agreed not to appeal this permit.
F. PTPC will dismiss its appeal, PCHB No. 13-014.
G. If there is a third party appeal of the negotiated permit,the three parties to this
agreement will jointly defend the permit.
IV. COUNTERPARTS
This Agreement may be executed in any number of original,copied,or facsimile
counterparts, each of which,when executed and delivered,shall be deemed an original,but all •
of which together shall constitute one instrument
Port Townsend Papersen
d Paper C
By:
Name,Title /2o5 4.r P 14M0-el , Pe.es'a�`''"e.--
Date: /1--A-.).-At 4, 1-0./.9
Department of Ecology
By:
Name,Title
Date:
Jefferson County
By:
Name,Title
Date:
FINAL SETTLEMENT AGREEMENT August 5,2014—Page 3
•
A
• B. Jefferson County Public Health reviewed the permit modification application and has
investigated whether the modified site and facilities meet all applicable regulations and
laws,the approved comprehensive solid waste handling plan and zoning requirements.
Jefferson County Public Health concluded that the modified facility meets these
standards and issued a permit with a compliance schedule
C. The terms of this modified permit, including the compliance schedule,were negotiated
by the parties and are acceptable to each party.
D. Ecology has reviewed the permit, has determined that the facility conforms to all
applicable laws and regulations and the Jefferson County solid waste management plan,
and will not appeal the issuance of this permit to the PCHB.
E. PTPC has agreed not to appeal this permit.
F. PTPC will dismiss its appeal, PCHB No. 13-014.
G. If there is a third party appeal of the negotiated permit, the three parties to this
agreement will jointly defend the permit.
IV. COUNTERPARTS
This Agreement may be executed in any number of original, copied,or facsimile
• counterparts, each of which,when executed and delivered, shall be deemed an original, but all
of which together shall constitute one instrument
Port Townsend Paper Corporation
By:
Name,Title
Date:
Department of Ecology
By:
Name,Title
Date:
Jefferson County
Vairil
/By:
Name,Title`DQU1D (�L�'-A Ck-kiEF CIVIL —0 PR
Date: P,\.)civSY X14
FINAL SETTLEMENT AGREEMENT August 5,2014—Page 3
1111
R. STATEMENT OF FACTS
A. The regulatory history of the landfill is complex. Beginning in approximately 1989,the
facility was regulated as an inert waste landfill; then as a limited purpose landfill;then as
an inert waste landfill.
B. PTPC has consistently operated the landfill in compliance with all state and local
regulations and in compliance with the operations plan approved by the Jefferson County
Health Department.
C. In 2011, Ecology and Jefferson County notified PTPC that they believed the wastes in the
landfill should not be managed as inert wastes and the landfill should be regulated as a
Limited Purpose landfill. PTPC disagreed. The three parties met several times in 2011
and 2012 to discuss how the mill wastes should be regulated.
D. Although the PTPC inert waste landfill permit expired January 31, 2012,Jefferson County
has directed PTPC to operate the facility under the terms of the expired permit pending
the outcome of the PCHB appeal.
E. PTPC requested renewal of its inert waste landfill permit in September 2012.
F. Jefferson County denied the renewal in October 2012.
G. PTPC appealed that denial to the Jefferson County Health Officer who upheld the denial. •
H. PTPC appealed the Health Officer's decision to the Pollution Control Hearings Board.
I. All Parties prepared for a hearing on the merits scheduled for mid-December 2013, but
agreed to postpone the hearing until October 2014, and to meet with Kay Brown, a PCHB
mediator.
J. The Parties met several times with Ms. Brown; exchanged a draft permit application and
a draft permit.
K. Jefferson County has determined that requirements of the State Environmental Policy
Act have been met for the landfill permit modification.
The Parties have reached agreement on the matters set forth below:
W. AGREEMENT
A. PTPC agrees to operate the landfill as a Limited Purpose Landfill and submitted an
Application for Modification of Solid Waste Permit.
FINAL SETTLEMENT AGREEMENT August 5,2014—Page 2
4110
• SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (the "Agreement") is made and entered into by and
among Port Townsend Paper Corporation ("PTPC",)Jefferson County Public Health (Jefferson
County), a political subdivision of the State of Washington, and the Department of Ecology, an
agency of the State of Washington, ("Ecology",)to memorialize certain agreements among the
parties regarding the permit for PTPC's landfill. PTPC, Ecology and Jefferson County are
collectively"the Parties." This Agreement is effective on the date of the last signature below.
I. RECITALS
WHEREAS, PTPC has operated a landfill for disposal of its paper mill wastes on its
property in unincorporated Jefferson County Washington since 1983;
WHEREAS,Jefferson County regulates and permits the landfill;
WHEREAS, Ecology provides technical support to Jefferson County, and has the authority
to appeal to the Pollution Control Hearing Board ("PCHB",)the issuance of any landfill facility
permit issued by Jefferson County;
WHEREAS,Jefferson County has permitted the landfill as an inert waste management
facility since 2004, but denied PTPC's application for permit renewal in October 2012;
• WHEREAS, PTPC appealed the permit denial to the Jefferson County Health Officer and
participated in a hearing on the appeal;
WHEREAS,the Jefferson County Health Officer denied PTPC's appeal and PTPC timely
appealed to the PCHB;
WHEREAS, Ecology moved to intervene in the PCHB proceeding and that motion was
granted;
WHEREAS,the Parties were prepared for a hearing on the PCHB appeal in December,
2013 and mutually agreed to suspend the appeal and to utilize the mediation services offered by
the Environmental Hearings Office and have met with mediator Kay Brown on several occasions;
and
WHEREAS, all Parties desire to avoid the risk of litigation;
NOW THEREFORE, in consideration of and in reliance upon the recitals, promises, covenants,
understandings and obligations set forth in this Agreement, and intending to be legally bound,
PTPC, Ecology and Jefferson County mutually agree as follows:
FINAL SETTLEMENT AGREEMENT August 5,2014—Page 1
11111
* •
• B. Jefferson County Public Health reviewed the permit modification application and has
investigated whether the modified site and facilities meet all applicable regulations and
laws,the approved comprehensive solid waste handling plan and zoning requirements. •
Jefferson County Public Health concluded that the modified facility meets these
standards and Issued a permit with a compliance schedule
C. The terms of this modified permit,including the compliance schedule,were negotiated
by the parties and are acceptable to each party.
D. Ecology has reviewed the permit, has determined that the facility conforms to all
applicable laws and regulations and the Jefferson County solid waste management plan,
and will not appeal the issuance of this permit to the PCHB.
E. PTPC has agreed not to appeal this permit.
F. PTPC will dismiss Its appeal, PCHB No. 13-014.
G. If there is athird party appeal of the negotiated permit,the three parties to this
agreement will Jointly defend the permit.
IV. COUNTERPARTS
This Agreement may be executed in any number of original,copied,or facsimile
411 counterparts,each of which,when executed and delivered,shall be deemed an original,but all
of which together shall constitute one instrument
Port Townsend Paper Corporation
By:
Name,Title
Date:
Departmen of Ecology
By: . 1./J . ✓ .!
Name, Itieaiot a
Date: / -/
Jefferson County
By:
Name,Title
Date:
FINAL SETTLEMENT AGREEMENT August 5,2014—Page 3
s
Board of Health
IV
Old Business and Informational Items
Item 2
0 Correspondence BOH
0 August 21 , 2014
JEFFERSON COUNTY
• BOARD OF HEALTH
August 4, 2014
Sam Markow
Executive Director
Jefferson Mental Health Services
P.O. Box 565
Port Townsend, WA 98368
Dear Sam,
On behalf of the Jefferson County Board of Health, I want to thank you for your many
contributions to the Substance Abuse Advisory Board. Your insights regarding drug and
alcohol issues, as well as your guidance with respect to the schools has been very
helpful. The time and effort you spent participating on this Board is sincerely
appreciated. We will soon begin our efforts to find and interview a suitable replacement.
Thank you again for your service.
Sincerely,
David Sullivan
Chair, Jefferson County Board of Health
Cc: Fran Joswick, Chair Substance Abuse Advisory Board.
Board Members
David Sullivan(Chair),County Commissioner District#2;Sheila Westerman,Citizen(Vice-Chair);
• Phil Johnson,County Commissioner District#1;John Austin,County Commissioner District#3;
Kris Nelson,Port Townsend City Council;Sally AertsCitizen;Jill Buhler,Hospital Commissioner
615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368
(360)385-9400
JEFFERSON COUNTY
• BOARD OF HEALTH
August 11, 2014
Lois Barnett
Dear Ms. Barnett,
On behalf of the Jefferson County Board of Health, I want to thank you for your many
contributions to the Jefferson County Substance Abuse Advisory Board. Your insights
regarding drug and alcohol issues, as well as your guidance with respect to the schools
has been very helpful. The time and effort you spent participating on this Board is
sincerely appreciated. We will soon begin our efforts to find and interview a suitable
replacement.
Thank you again for your service.
Sincerely,
David Sullivan
Chair, Jefferson County Board of Health
Cc: Fran Joswick, Chair Substance Abuse Advisory Board.
Board Members
David Sullivan(Chair),County Commissioner District#2;Sheila Westerman,Citizen(Vice-Chair);
Phil Johnson,County Commissioner District#1;John Austin,County Commissioner District#3;
Kris Nelson,Port Townsend t itv Council;Sally Aerts Citizen;Jill Bidder,Hospital Commissioner
615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368
(360)385-9400
JO
Board of Health
V
New Business Items
Item 1
Proposed Revisions to Jefferson County Solid
• Waste Code
40
August 21 , 2014
•
JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE NUMBER 0402045
SOLID WASTE REGULATIONS
October 20, 2005
•
•
TABLE OF C Ohf TEl\2§ Comment[P1]:Delete manual table of contents
and replace with automated table of contents.
010 AUTHORITY AND PURPOSE 1
015 ADOPTION BY REFERENCE 1
020 APPLICABILITY 1
025 OWNER RESPONSIBILITY FOR SOLID WASTES 2
(1) GENERAL. 2
(2) REMOVAL. 2
(3) DISPOSAL 2
030 EFFECTIVE DATES 3
040 PERFORMANCE STANDARDS 3
100 DEFINITIONS. 3
200 BENEFICIAL USE PERMIT EXEMPTIONS S
210 RECYCLING 8
220 COMPOSTING FACILITIES 3
230 LAND APPLICATION 3 r
240 ENERGY RECOVERY AND INCINERATION 8
•
-. - _ p- • - - - - -
(1) ANIMAL-WASTE. 9
(2) ASBESTOS CONTAINING-WASTE. 9
(3) BIOMEDICAL WASTE. 10
(4) BULKY WASTE. 12
(5) DANGEROUS WASTE. 12
(6) MODERATE RISK WAS'I35 AND USED OIL. 13
(7) PROBLEM WASTE. 1 F
(8) SEPTAGE. 14
(9) CONDITIONALLY EMPT SMALL QUANTITY GENERATOR(CESQG)WASTE. 15
310 INTERMEDIATE SOLID WASTE HANDLING FACILITIES 15
320 PILES USED FOR STORAGE OR TREATMENT 15
330 SURFACE IMPOUNDMENTS AND TANKS 16
350 WASTE TIRE STORAGE AND TRANSPORTATION 16
.1 „ . I v'. r '.. •
- - • }' - - ,
ii
•
S
400 LIMITED PURPOSE LANDFILLS 16
410 INERT WASTE LANDFILLS 16
! " "
I. . . .-1 . I 1 . 11
A .!(1) ONSTRUCTION REQUIREMENTS 16
(2) NOTWICATIONREQUIREMOR OWNERS OF LANDFILLS. 17
490 OTHER METHODS OF SOLID WASTE HANDLING 18
500 GROUND WATER MONITORING 18
700 PERMITS AND LOCAL ORDINANCES 18
710 PERMIT APPLICATION AND ISSUANCE 18
715 GENERAL PERMIT APPLICATION CONTENTS 18
900 CORRECTIVE ACTION 18
950 ADMINISTRATION AND ENFORCEMENT 1F
• LAWS,REGULATIONS AND AGENCY REQUIREMENTS 18((21)) OTR
RC T AUT-140RITY. 19
(3) RIGHT OF ENTRYp19
(4) INERSPECTIONS- ED FACILITIES 20
(5) NOTICVIOLATIONS,0 ETO CORRECT VIOLATION 20
(6) REMEDIES AND PENALTIES 21
29
(8) VARIANCES 30
960 REPEALER 32
970 SEVERABILITY 32
990 CRITERIA FOR INERT WASTE 32
APPENDIX A. REFERENCES 32
A. FEDERAL: 32
C. LOCAL/REGIONAL: 34
S
JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE 09-1020-05
SOLID WASTE REGULATIONS
Comment[P2]:All sections 100,200,etc general
8.10.010 —AUTHORITY AND PURPOSE, format change to Header Style 1tomakeTOC
These solid waste rules and regulations are promulgated under the authority of Chapters 43.20.050,
Powers and Duties of State Board of Health70.05,Local Health Departments,Boards,Officers-
Regulations,and 70.95,Solid Waste Management-Reduction and Recycling,in the Revised Code of
Washington(RCW),and Chapters 246-203,General Sanitation,173-304,Minimum Functional
Standards for Solid Waste Handling,173-350,Solid Waste Handling Standards,and 173-351,Criteria
for Municipal Solid Waste Landfills,in the Washington Administrative Code(WAC),to protect the
public health and the environment,and promote the safety and welfare of the citizens of Jefferson
County. All references to these RCWs and WACs,and all other RCWs,WACs,and other federal,state,
and local regulations,refer to the cited chapters and paragraphs,as amended. The rules and regulations
herein govern the handling,storage,collection,transportation,treatment,utilization,processing and
final disposal of all solid waste within Jefferson County,including the issuance of permits and
enforcement. These regulations shall apply to all persons and in all territory within the boundaries of
Jefferson County,except actions by persons on lands under the jurisdiction of the Federal Government
or recognized Native American Nations and Tribes.
It is expressly the purpose of these rules and regulations to provide for and promote the health of the
general public,and not to create or otherwise establish or designate any particular class or group of
persons who will or should be especially protected or benefited by the terms of these rules and
regulations.
It is the specific intent of these rules and regulations to place the obligation of complying with its
requirements upon waste generators,haulers,and/or operators of solid waste handling sites,and no
provision of,nor term used in these rules and regulations is intended to impose any duty whatsoever
upon Public Health nor any of its officers or employees,for whom the implementation or enforcement
of these rules and regulations shall be discretionary and not mandatory.
Nothing contained in these rules and regulations is intended to be,nor shall be construed to create or
form the basis for any liability on the part of Public Health or its officers,employees or agents,for any
injury or damage resulting from the failure of any person subject to these rules and regulations to
comply with these rules and regulations,or by reason or in consequence of any act or omission in
connection with the implementation or enforcement of these rules and regulations on the part of Public
Health.
8.10.015 —ADOPTION BY REFERENCE
Pursuant to and by the authority of RCW 70.95,Jefferson County Public Health hereby adopts Chapter
173-350,Solid Waste Handling Standards,and Chapter 173-304,Minimum Functional Standards for Solid
Waste Handling. As provided for by RCW 70.95 Public Health makes the following amendments to
Chapter 173-350. To the extent that aim state statute or regulation listed in this section is amended or
revised_subsequent_to.the adoption of this chapter that amendment or_revision_is deemed incorporated into
w .m
this Chapterand inapplicable to_any activity regulated by .i "r+ " 1. Comment[P3]:Added to clarify that any
subsequent changes to the WAC would be adopted
without us having to go through code revision.
4
•
•
8.10. 020-APPLICABILITY
WAC 173-350-020`Applicability",is adopted by reference except that subparagraph(6)is hereby
repealed. Single-family residences and single-family farms disposing of their own solid wastes on their
own property shall be subject to these regulations.
8.10.025 -OWNER RESPONSIBILITY FOR SOLID WASTES
WAC 173-350-025 is revised as follows:
(1) General.
The owner,operator,or occupant of any premise,business,establishment,or industry shall be
responsible for the satisfactory and legal arrangement for the solid waste handling of all solid
waste generated or accumulated by them on the property. An owner is not relieved of the duties
and obligations imposed by this Chapter because the owner has leased the property or premises to
another or permitted others to occupy the premises or operate there.
(2)Removal.
Solid waste shall be removed from the premises where it was generated to a permitted solid
waste handling facility at a frequency that does not create a nuisance or litter problem,or at a
frequency otherwise approved by the Health Officer. The Health Officer may require any
person who does not store,remove,transport,or dispose of solid waste consistent with these
regulations,or who stores solid waste so as to create a nuisance or litter problem,to remove
solid waste from the premises where it was generated,or collected,by that person to a permitted
solid waste handling facility no less frequently than once per week.
(3) Disposal.
(a) Generally. All solid wastes shall be disposed of at an appropriate solid waste handling facility
permitted to receive such waste,or in a manner consistent with these regulations asapproved by the
Health Officer. Should a situation arise where disposal of solid waste is not covered under these
regulations,the Health Officer shall determine acceptability of a method of disposal for the solid
waste on a case-by-case basis
(b) Unlawful Dumping. It shall be unlawful for any person to dump,deposit,bury,or allow the dumping,
depositing or burying of any solid waste onto or under the surface of the ground
or into the waters of this state,except at a solid waste disposal site for which there is a valid permit.
Unlawful dumping shall include unauthorized deposition of solid waste into a container that is owned
or leased by another person.
(c) Name Appearing on Waste Material and Presumption. Whenever solid waste dumped in violation
of this regulation contains three(3)or more items bearing the name of one individual,there shall be
a presumption that the individual whose name appears on such items committed the unlawful act of
dumping.
(d) Identification Presumed. When the Health Officer investigates a case of unlawful dumping and finds
identification in the solid waste as described in Section 025(3)(c),or other evidence,he/she may then
order the person who committed the unlawful dumping to remove and dispose of said solid waste
5
•
according to these regulations. Following the disposal of said solid waste,the Health Officer may
order this person to present to the Health Officer a receipt from the permitted disposal facility as proof
of appropriate disposal.
(e) Lack of Identification. When the Health Officer investigates a case of unlawful dumping and finds no
identification in the solid waste,nor evidence,he/she may then order the property owner to remove
said solid waste from his/her land,and have the solid waste disposed of according to these
regulations. Where this occurs on private land,the property owner or occupant shall be responsible
for removal and disposal. Where this occurs on public land,the appropriate governmental agency
shall be responsible for removal and disposal.
(f) Burning Prohibited. It shall be unlawful for any person to burn solid waste including garbage or
rubbish unless these materials are burned in an appropriate permitted energy recoveryor
incinerator facility. The burning of land clearing debris and the residential burning of natural
vegetative matter is regulated under Chapter 173-425 WAC,Outdoor Burning.
(g) Disposal Service Required. When a person does not dispose of solid wastes in a manner consistent
with these regulations,the Health Officer may order said person to obtain ongoing and regularly
scheduled solid waste collection service if said person does not already have this service and if a
solid waste collection service exists or is offered in the geographic area where the person resides.
Said service shall be from a solid waste_collection service holding a Solid Waste Handling Permit
issued by Jefferson County Public Health and necessary certificates issued by the Washington
Utilities and Transportation Commission. If said person does not have this service and resides in a
geographic area where a single solid waste collection service operates exclusively under covenant
or ordinance as required by local government,and said service is mandatory for persons residing
within the jurisdiction of the local government,the Health Officer may schedule ongoing regularly
scheduled service for said person with this solid waste collection service.If service is cancelled
through nonpayment,it will be deemed a violation of this paragraph.
(h) Disposal Receipts Required. Any person in violation of this paragraph to whom a notice and order to
correct violation has been issued is required to produce receipts from a pernutted solid waste
disposal,recycling and/or reclamation facility or solid waste transporter to demonstrate compliance
with the notice and order to correct violation issued by Jefferson County Public Health.
8.10.030 - EFFECTIVE DATES.
WAC 173-350-030,Effective Dates are hereby adopted by reference. The effective date of these
regulations is October 20,2005.
8.10.040-PERFORMANCE STANDARDS.
WAC 173-350-040,Performance Standards,is hereby adopted by reference.
8.10. 100 - DEFINITIONS.
6
•
Terms used in this regulation shall have the meaning provided in WAC 173-350-100,hereby adopted in
its entirety by reference herein except as revised or altered by the definitions provided below. Terms
related to municipal solid waste landfills are contained in Chapter 173-351 WAC,Criteria for
Municipal Solid Waste Landfills.Terms related to landfills closed pursuant to Chapter 173-304,
Minimum Functional Standards for Solid Waste Handling.
Abandoned Landfills: Those sites not closed in accordance with all applicable regulatory
requirements in place at the time that waste handling/disposal activities ceased.
Abate: Repair,replace,remove,destroy,or otherwise remedy a condition(s)which constitutes a
nuisance or a violation of these regulations by such means,in a manner,and to such an extent as the
Health Officer determines is necessary in the interests of the general health,safety and welfare of the
community.
Abrasive Blasting: A method of surface preparation in which an abrasive aggregate is sprayed under
pressure on to exterior surfaces which include,but are not limited to,boats,ships or other watercraft.
Agricultural Wastes: Non-dangerous wastes on farms resulting from the production of agricultural
products including,but not limited to,crop residues,manures,animal bedding,and carcasses of dead
animals weighing each or collectively in excess of fifteen(15)pounds.
Animal Wastes: Wastes generated on a farm,including manure,pet feces,and dead animals.
Asbestos-Containing Material: Any material containing more than one percent(1%)asbestos as
determined using the method specified in EPA regulations Appendix E,Subpart E,40 CFR Part 763,
01 10 Section 1,Polarized Light Microscopy. _
Asbestos-Containing Waste Material: Any waste that contains or is contaminated with friable
asbestos-containing material.Asbestos-containing waste material includes asbestos waste from control
equipment,materials used to enclose the work area during an asbestos project,asbestos-containing
material collected for disposal,asbestos-contaminated waste,debris,containers,bags,protective
clothing,or HEPA filters.Asbestos-containing waste material does not include samples of asbestos-
containing material taken for testing or enforcement purposes.
Ashes: The residue from combustion or incineration of material including solid wastes and any air
pollution flue dust.
Biomedical Waste: Biomedical waste means,and is limited to,the following types of waste:
1. "Animal waste"is waste animal carcasses,body parts,and bedding of animals that are known to be
infected with,or that have been inoculated with,human pathogenic microorganisms infectious to
humans.
2. "Biosafety level 4 disease waste"is the waste contaminated with blood,excretions,exudates,or
secretions from humans or animals who are isolated to protect others from highly
communicable infectious diseases that are identified as pathogenic organisms assigned to biosafety
level 4 by the Centers for Disease Control,National Institute of Health,and Biosafety in
Microbiological and Biomedical Laboratories,current edition.
3. "Cultures and stocks"are wastes infectious to humans including specimen cultures,cultures and
stocks of etiologic agents,wastes from production of biologicals and serums,discarded live and
attenuated vaccines,and laboratory waste that has come into contact with cultures and stocks of
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etiologic agents or blood specimens. Such waste includes but is not limited to culture dishes,blood
specimen tubes,and devices used to transfer,inoculate,and mix cultures.
4. "Human blood and blood products"are waste human blood and blood components,and materials
containing free-flowing blood and blood products.
5. "Pathological waste"is human source biopsy materials,tissues,and anatomical parts that emanate
from surgery,obstetrical procedures,and autopsy. "Pathological waste"does not include teeth,
human corpses,remains,and anatomical parts that are intended for internment or cremation.
6. "Sharps waste"is all hypodermic needles,syringes with needles attached,intravenous tubing with
needles attached,scalpel blades,and lancets that have been removed from the original sterile
package.
Biomedical Waste Collection Service: Any agency,business,or service operated by a person for the
purpose of biomedical waste collection and transportation.
Biomedical Waste Generator: Any producer of biomedical waste to include without limitation the
following categories: General acute care hospitals,skilled nursing facilities or convalescent hospitals,
intermediate care facilities,in-patient care facilities for the developmentally disabled,chronic dialysis
clinics,community clinics,health maintenance organizations,surgical clinics,urgent care clinics,acute
psychiatric hospitals,laboratories,medical buildings,physicians offices and clinics,veterinary offices
and clinics,dental offices and clinics,funeral homes or other similar facilities.
Biomedical Waste Treatment: Means incineration,sterilization,or other method,technique,or
process that changes the character or composition of a biomedical waste so as to minimize the risk of
transmitting infectious disease.
Board of Health: The Jefferson County Board of Health.
*Buffer Zone: That part of a facility that lies between the active area and the property boundary.Junk
cars are not allowed in a Buffer Zone as defined in Title 18 of Jefferson County Code.
Bulky Waste: Large items of refuse,such as appliances(white goods),furniture,junk vehicles,and
other oversize wastes which would typically not fit into reusable or disposable containers.
Construction Waste: Non-dangerous solid waste,largely inert waste,generated as the result of
construction of buildings,roads,and other man-made structures. Construction waste consists of,but is
not limited to:concrete,asphalt,brick,rock,wood and masonry,composition roofmg and roofing paper,
shakes,shingles,plastic and paper wrappings,plastic pipe,fiberglass insulation,carpeting,floor tile,
glass,steel,and minor amounts of other metals like copper.
Demolition Waste: Non-dangerous solid waste,largely inert waste,resulting from the demolition or
razing of buildings,roads and other man-made structures.Demolition waste consists of,but is not
limited to:concrete,asphalt,brick,rock,wood and masonry,composition roofing and roofing paper,
shakes,shingles,plastic pipe,fiberglass insulation,carpeting,floor tile,glass,steel,minor amounts of
other metals like copper,and incidental amounts of soil associated with these wastes. Plaster(i.e.,sheet
rock or plaster board),yard wastes,stumpage,or any other materials that are likely to produce gases or
leachate during the decomposition process are not considered to be demolition waste for the purposes of
this definition. Bulky wastes,white goods,and asbestos-containing materials are not considered to be
demolition waste for the purpose of this regulation.
8
Discarded Commodity: Products or items that because of damage,misuse,wear,or neglect(left out in
the weather to rot,rust or deteriorate)and because of such neglect are no longer being utilized for its Comment[P4]:Clarifying by providing an
intended purpose. example.
Disposal Site: The location where any final treatment,utilization,processing or deposition of solid
waste occurs. See also the definition of interim solid waste handling site.
Drop Box Facility: A facility used for the placement of a detachable container,including the area
adjacent for necessary entrance and exit roads,unloading and turnaround areas. Drop box facilities
normally serve the general public with loose loads and receive waste from off-site
Ecology: The Washington State Department of Ecology.
Emission: The release of air contaminants from solid waste into the outdoor atmosphere.
*Environmentally Sensitive Areas or"ESA":shall be as defined at RCW 36.70A.030(5)(or as
hereafter amended)to include wetlands,areas with a critical recharging effect on aquifers used for
potable water,fish and wildlife habitat conservation areas,frequently flooded areas and geologically
hazardous areas(and buffers for all such areas)as those terms are defined and described in Title 18 of
the Jefferson County Code in its current form or as it may be in the future,amended,supplemented or
replaced.Junk cars are not allowed in an ESA as defined in Title 18 of Jefferson County Code.
EPA: The United States Environmental Protection Agency.
Hazardous Substance: Any liquid,solid,gas,or sludge,including any material,substance,product,
• commodity,or waste,regardless of quantity,that exhibits any of the physical,chemical or biological
properties described in WAC 173-303-090 or WAC 173-303-100.
Health Officer The Health Officer or the Health Officer's representative,of the Jefferson County
Public Health. Comment[PS]:Included a more detailed
definition to include boats and trailers and other
more specific details.
*--Junk Vehicle: junk ehiele_includes cansperst boatsi- id i_trailers or any other type of vehicle f Formatted:Indent:Left: 0.13'
used for human transportation which may_exhibit am,of the following: f Formatted:Font 11 Double underline
Formatted:List Paragraph,Bulleted+Level:1
liil Build u of debris„m oss or weeds on,in under or around the vehicle_that_obstrutts • +Aligned at: 0.38"+Indent at 0.63"
ix Formatted:Font:11 pt,Double underline
• �?amage to the frame __.. -1 Formatted:Font:11 pt,Double underline
• jvlore,than one missing or shattered window or windshield. _.... Formatted:Font 11 pt,Double underline 1
• More,,than one inoperable or missing headlight or to llight _
♦ Formatted:Font 11 pt,Double underline
_,,�14L��h1.i1_o11�tl�t_S_LT�
• n sing or ino erable engine or r c,,,c� I Formatted:Font 11 pt,Double underline
• ITn
, ssingy' jcense elate driver side mirror,lire,body'panel door,..liood orj3ther obvious 1m
FUral!edC Font:11 pt,Double underline
body part,not i„neludtilg a bumper. 1 Formatted:Font:11 pt,Double underline
• j ii.ving llcensgpinte.,Micensn,plate_t11at has-beeniinva d for ,hai Qw(lsi y -........ (Formatted:Font 11 pt,Double underline 1
• -n- -- lyidenee..Olathe vehicle hasnot beeiunovt<d.in_aileast12Q_days. --- Formatted:Font:11 pt,Double underline
f Formatted:Font:11 pt,Double underline 1
A vehicle certified under RCW 46.55.230 as meeting at least three of following requirements: — — --.1
I Formatted:Font 11 pt,Double underline 11
1. Three(3)years old or older; Formatted:Font:11 pt,Double underline
Formatted:Font:11 pt,Double underline
2. Extensively damaged,such damage including but not limited to the following:a broken window (Formatted:Font:11 pt,Double underline
or windshield,or missing wheels,tires,motor,or transmission; -- _--- -- �
I Formatted:Font:11 pt,Double underline 1
9
3. Apparently inoperable;and/or
4. Has approximate fair market value equal only to the approximate value of the scrap in it.
Comment[P6]:Included a more detailed
definition to include boats and trailers and other
... ��-�:,..••.�y,,.. -.� •,�'.�.'. _. _.""'�' '_- _-" - --- morespecific details.
c>t d 3on,1n,imdtr,.eutrottrid th4 x hlPkth11t ebtht_.
For enforcement purposes,possessing three(3)junk cars on a single property of any size is not allowed
under this regulation.
Minimum Functional Standards(MFS): Chapter 173-304 WAC,Minimum Functional Standards for
Solid Waste Handling.
A UR A • U..: I •1 ... • I •
.11. •1 1 111 '1I.. ...III IS. I .1 •I
••�.- . � • ... - .11 1.1 -II 51. . 11 . .•. • ISI• Al •. S•11-1 ._1 >-S.chapter.. ,_. Comment[P7]:Definition not previously
included.
Nuisance: Consists in unlawfully doing an act,or omitting to perform a duty,which act or omission
either annoys,injures or endangers the,repose,health or safety of others;or unlawfully interferes with,
obstructs or tends to obstruct,any lake or navigable river,bay,stream,canal or basin,or any public
park,square,street or highway;or in any way renders other persons insecure in life,or in the use of
property. To the extent applicable,the County adopts the definitions of nuisance found in Ch.7.48
RCW.
Owner: The person,business entity or partnership that is the title owner of record with the Jefferson
County Auditor for the parcel or parcels where the violation is allegedly occurring.
Person responsible: The owner,lessee,occupant or operator of the premises,business,activity or
action that is allegedly a violation of this Chapter.
Problem Wastes:
1. Any solid material removed during a remedial action,a dangerous waste site closure,other
cleanup efforts,or other actions,which contain hazardous substances,but are not designated
dangerous wastes;
2. Dredge spoils resulting from the dredging of surface waters of the state where contaminants are
present in the dredge spoils at concentrations not suitable for open water disposal and the dredge
spoils are not dangerous wastes and are not regulated by Section 404 of the Federal Clean Water Act
(PL 95-217);or
3. Waste abrasive blasting grit or other material used in abrasive blasting. Common aggregates
include,but are not limited to silica sand,utility slag or copper slag. Waste abrasive blasting grit
does not include blasting grit that will be reused for its intended purpose.
Public Health: Jefferson County Public Health or any person acting on behalf of or employed by
Jefferson County Public Health.
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Remedial Action: Any action to identify,eliminate or minimize any threat posed by hazardous
substances to human health or the environment including any investigative and monitoring activities
with respect to any release or threatened release of a hazardous substance and any health assessment or
health effects studies conducted to determine the risk or potential risk to human health.
Rubbish: All non-putrescible wastes from all public and private establishments and from all
residences.
Solid Waste: All putrescible and non-putrescible solid and semi-solid wastes including,but not limited
to,garbage,rubbish,ashes,industrial wastes,swill,animal wastes,construction and demolition wastes,
land clearing wastes,contaminated soils,contaminated dredged spoils,junk vehicles or parts thereof
(including waste tires),and discarded commodities. This includes all liquid,solid and semi-solid,
materials that are not the primary products of public,private,industrial,commercial,mining and
agricultural operations. Solid waste also includes,but is not limited to,woodwaste,dangerous waste,
yard waste,bulky waste,biomedical waste,animal waste,waste tires,recyclable materials,and problem
wastes. Municipal sewage sludge or septage is a solid waste when placed in a municipal solid waste
landfill subject to the requirements in Chapter 173-351 WAC,Criteria for Municipal Solid Waste
Landfills,Chapter 173-308 WAC,Biosolids Management,and a solid waste handling permit issued by
the Health Officer.
Used Oil:
1. Lubricating fluids that have been removed from an engine crankcase,transmission,gearbox,
hydraulic device,or differential of an automobile,truck,bus,vessel,plane,heavy equipment,or
4111 machinery powered by an internal combustion engine;or
2. Any oil that has been refined from crude oil,used,and as a result of use,has been contaminated
with physical or chemical impurities;or
3. Any oil that has been refined from crude oil and,as a consequence of extended storage,spillage,
or contamination,is no longer useful to the original purchaser;and
4. Used oil does not include oil to which dangerous wastes have been added,or oil that would
otherwise be considered used oil except that it is used as a fuel in an industrial furnace,which
meets the emission standards of the Puget Sound Clean Air Agency.
1 Formatted:Heading 1,Indent:Left: 0",
8.10.200-Beneficial Use Permit Exemptions - l Hanging: 0.5"
WAC 173-350-100 Beneficial Use Permit Exemptions is hereby adopted by reference.
Formatted:Heading 1,Indent:Left: 0",
8.10.210 - Recycling Hanging: 0.5"
WAC 173-350-210,Recycling is hereby adopted by reference.
-- Formatted:Heading 1,Indent:Left: 0",
8.10. 220 - Composting Facilities Hanging: 0.5"
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WAC 173-350-220,Compost Facilities is hereby adopted by reference. Paragraph 220(7)has been
revised as follows:
220(7)Compost Facilities—Financial Assurance requirements.
(a) Financial Assurance may be required for certain compost facilities as determined by Public Health.
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism
in accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds
shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be
present at any time during the operation of the facility and to accomplish closure in accordance with the
facility closure plan.
(c) If required,no owner or operator shall commence or continue to operate any part of the facility until
a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173-
350-600.
Formatted:Heading 1,Indent:Left: 0",
8.10. 230- Land Application Hanging: 0.5"
WAC 173-350-240,Land Application is hereby adopted by reference.
Formatted:Heading 1,Indent:Left: 0",
8.10.240 - Energy Recovery and Incineration Hanging: 0.5"
WAC 173-350-240,Energy Recovery and Incineration is hereby adopted by reference. •
Formatted:Heading 1,Indent:Left: 0",
8.10.300 - On-site Storage,Collection,and Transportation Hanging: 0.5"
Standards
WAC 173-350-300,On-Site Storage,Collection,and Transportation Standard is hereby adopted
by reference and revised with the addition of the following paragraphs.
300(2)(b)(iv) Containers of mixed municipal solid waste,putrescible waste,and rubbish shall be
closed at all times except when waste is being added or removed. Commercial containers
located at public or private collection facilities may be kept open during routine hours of
operation,as long as the container drain plugs remain in place.
300(2)(b)(v) The owner,operator or occupant of any premises,business establishment or industry shall
store all recyclable materials so as not to produce unsafe or unsanitary conditions.
8.10.305 -Solid Waste Handling Standards for Specific Waste
Stream
8.10.305(1) Animal Waste
(a) Animal waste,as defined in Section 100,shall be disposed of in a manner consistent with these
regulations,or other method approved by the Health Officer.
12
(b) Any animal waste that is deemed biomedical waste as defined in Section 100,shall be handled,
treated,and disposed of as required in Section 305(b).
(c) Animal Manure. Animal manure shall not be deposited,or allowed to accumulate,in any ditch,gulch,
ravine,river,stream,lake,pond,marine water,or upon the surface of the ground,or on any highway or
road right of way,where it may become a nuisance or menace to health,as determined by the Health
Officer,through the breeding of flies,harboring of rodents,or pollution of water. Manure shall not be
allowed to accumulate in any place where it can pollute any source of drinking water.
(d) Dead Animals. Except as otherwise provided in Section 305(3),dead animals shall be disposed of in a
manner to protect the public health and the environment. Their disposal shall be consistent with local
codes. Dead animals may be taken to a rendering plant,a veterinary clinic,an animal shelter,pet
cemetery,or can be disposed of directly at permitted operating landfills or transfer stations so as not to
create a nuisance. Property owners may bury dead animals on their property,so long as no nuisance is
created. If the dead animal is buried,it shall be placed so that every part shall be covered by at least
two(2)feet of earth and at a location not less than one-hundred(100)feet from any well,spring,
stream,or other surface waters,and in a place not subject to overflow. In all cases of death from
communicable disease,the dead animal,if disposed of by burial,shall first be thoroughly enveloped in
unslaked lime.
(e) Pet Feces. Pet feces,especially dog droppings,shall be disposed of in a manner,such as burial,or
bagging and placement into containers described in Section 300(2),which does not create a nuisance
or pollute surface waters of the state. Pet feces shall not be disposed of into the sanitary sewer
unless approved by the sewer purveyor. This waste shall not be put into a storm sewer or on-site
sewage system.
• 8.10.305(2) Asbestos-Containing Waste
(a) General. Asbestos-containing waste material(ACWM),as defined in Section 100,shall be handled
and disposed of pursuant to 40 CFR Part 61,National Emission Standards for Hazardous Air
Pollutants,Chapter 173-303 WAC,Dangerous Waste Regulations, {Formatted:Strikethrough
.• • ' - •,• /II. :"•',i ••• t. • ••, : ..• . ,and Chapter 296-65 WAC, ---{Formatted:Not Strikethrough
Asbestos Removal and Encapsulation. {Formatted:Strikethrough
(b) Removal. Persons removing ACWM shall contact the '_._ _ __ •lympic {Formatted:Double underline
Region Clean Air Agency for information and instruction concerning removal and disposal. ACWM
must be wetted down during removal to reduce airborne emissions of particulate matter. ACWM
shall be sealed into leak tight containers or placed in one or more plastic bags with a combined six(6)
mils thickness or greater and identified with the proper warning label.
(c) Disposal. The ACWM shall be disposed of in accordance with 40 CFR Part 61,National Emission
Standards for Hazardous Air Pollutants,at a facility permitted to receive such wastes,in accordance
with an approved operations plan,and covered with at least fifteen centimeters(6 inches)of non-
asbestos containing waste material immediately following disposal.
8.10305(3)BIOMEDICAL WASTE
(a) Applicability. This regulation applies to all persons who generate biomedical waste including,
but not limited to,individuals,hospitals,medical and dental clinics,medical laboratories,nursing
or intermediate care facilities,veterinary facilities and other institutions,which may generate
biomedical wastes as defined in Section 100,without regard to the quantity of biomedical waste
produced per month.
13
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(b) Storage and Handling.
(i) Containment of biomedical waste shall be in a manner and location which affords protection
from animals,rain,and wind and does not provide a breeding place or a food source for
insects or rodents.
(ii)Biomedical wastes shall be segregated from the general medical waste stream at the point of
origin and stored in separate containers. When possible,biomedical wastes should be
rendered non-infectious through chemical or physical treatment procedures as approved by the
facility's site safety officer.
(iii)Biomedical waste,except for sharps,shall be contained in disposable leakproof containers
having strength to prevent ripping,tearing or bursting under normal conditions of use. The
containers shall be secured to prevent leakage or expulsion
of solid or liquid waste during storage,handling or transport. The containers can be of any
color and shall be conspicuously labeled with the international biohazard symbol,and the
words"Biohazardous Waste"or words that clearly denote the presence of biomedical waste.
(iv)All sharps,including home-generated sharps,shall be contained in leak-proof,rigid,puncture
resistant,break resistant containers that are labeled and tightly lidded during storage,handling
and transport. These containers must be capable of maintaining their structural integrity from
the point of storage to deposition at an approved disposal or collection site. The containers
shall be of any color and shall be conspicuously labeled with the international biohazard
symbol,and the words"Biohazardous Waste"or words that clearly denote the presence of
biomedical waste.
(v) Reusable Containers. S
(A) Reusable containers for biomedical waste storage,handling or transport shall be
thoroughly washed and decontaminated by a method approved by the Health Officer
each time they are emptied,unless the surfaces of the containers have been protected
from contamination by disposable liners,bags or other devices removed with the waste.
(B) Approved methods of decontamination are agitation to remove visible solid residue
combined with chemical disinfection. Chemical disinfectants should be used in
accordance with the manufacturer's recommendations or by disinfectant
concentration/contact times approved in writing by the Health Officer. Other
decontamination methods may be approved in writing by the Health Officer.
(C) Reusable pails,drums or bins used for containment of biomedical waste shall not be used
for any other purpose except after being disinfected by procedures as described in this
regulation and after the international biohazard symbol and the words"Biohazardous
Waste"are removed.
(vi)The handling and storage of all biomedical waste must prevent the dissemination of
biomedical waste into the environment.
(vii)Trash chutes shall not be used to transfer biomedical waste.
(viii)Biomedical waste shall not be placed into the general waste stream unless contained and
treated.
(ix)Sharps shall not be placed into the general waste stream.
(cDisposal.
(i) All biomedical waste that has been contained as described in Section 305(3)(b)shall be
disposed of at a solid waste handling facility permitted to receive such waste.
14
1
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4
(ii) All human or animal body parts,fetuses,and other pathological specimens shall be disposed
of either by appropriate interment, incineration or other method approved by the Health
Officer.
(iii)Untreated liquid and liquefied biomedical waste maybe disposed of by release into a sanitary
sewage system,if this practice is approved by the providing sewer utility,provided that the
Health Officer shall have the authority to require the treatment of any biomedical liquid,
according to requirements specified by the Health Officer,prior to release into a sanitary
sewage system if deemed necessary to protect the public health.
(iv)Biomedical waste shall be disposed of on a regular basis to avoid nuisance conditions.
If any nuisance condition exists,the Health Officer shall have the authority to require a
specific disposal or collection frequency.
(v) Sharps must be contained in accordance with Section 305(3)(b)(iv)and prepared for disposal
by a means that protects medical handlers,solid waste workers and the public from injury.
The disposal of sharps shall be limited to the following methods unless prohibited by the
requirements of Chapter 70.95K RCW,Biomedical Wastes:(No longer exempts home-
generated sharps.)
(A) Depositing properly contained sharps at a facility that has agreed to accept home
, ,,: ., --: , , -_ , ,
generated sharps.
(B) Depositing properly contained sharps at a medical facility or pharmacy that provides a
program to dispose of sharps waste and that meets the requirements of these regulations.
(C) Using a permitted biomedical waste collection service.(E) Other methods approved by
the Health Officer.
0 . , , -, ,
(d) Transfer of Biomedical Waste. Any biomedical waste generator,who produces untreated biomedical
waste,shall have said waste collected and transported by a permitted biomedical waste collection
service.
(e) Inspection. The Health Officer shall have the authority to inspect any biomedical waste generator,at
any reasonable time,to determine if the generator's biomedical waste is being handled,stored,and
disposed of in accordance with this regulation,or to determine if the waste generator's solid waste is
being disposed of in accordance with this regulation.
(1) Disposal Service Required. When a person does not dispose of biomedical waste in a manner
consistent with these regulations,the Health Officer may order said person to obtain ongoing and
regularly scheduled biomedical waste collection and disposal service if said person does not have this
service and if commercial biomedical waste collection and
disposal service exists in or is offered in the geographic areas where the person resides. Said
service shall be from a biomedical waste collection and disposal service holding a Solid Waste
Handling Permit issued by Public Health.
(g) Biomedical Waste Collection Services. In addition to the general operation and maintenance
requirements applicable to persons operating a solid waste collection service specified in Section 300,
vehicles used by biomedical waste collection services shall have a leak proof and fully enclosed
vehicle compartment constructed of durable and easily cleanable materials,and shall be identified on
each side of the vehicle with the name or trademark of the biomedical waste collection service.
1 8.10.305(4)BULKY WASTE
Bulky wastes shall be stored and transported in such a manner so as not to create a nuisance or safety
hazard.Recycling of bulky wastes is encouraged where programs have been established to accept
15
all
them. If recycling is not feasible,these wastes shall be taken directly to a disposal site permitted to
accept oversized waste. Land clearing bulky waste such as tree stumps,trees,portions of buildings
and other waste shall be transported directly to a transfer station or landfill designed and permitted to
accept these bulky wastes;provided,that nothing herein shall prevent these wastes from being
salvaged and/or used as firewood.
8.10.305(5)DANGEROUS WASTE-,
(a)All solid waste must be designated as required by WAC 173-303-070 to prevent the disposal of
dangerous waste at a facility not permitted to accept dangerous waste. All solid waste designated as a
dangerous waste must be managed in a manner consistent with these regulations and Chapter 173-303
WAC.
(b) The Health Officer may require the screening of any waste suspected of being a regulated dangerous
waste as defined in Section 100. The screening process may involve analytical testing,a disclosure of
the waste constituents and waste generation process,and other additional information necessary to
determine if the waste is dangerous. The Health Officer may establish a schedule for compliance as
part of the screening process. Based on the results of the required screening,the Health Officer may
require the generator or transporter to direct the waste to a facility permitted to handle such waste.
8.10.305(6) ODERATE RISK WASTEANDUSED OIL- -
_-- - Comment[PS]:Meant to apply to CESQG
'• waste.MRW also means Household Hazardous
(a) Small Quantity Generator(GESQG) Waste and do not believe we want to regulate
households.
_.ApplicabilitY.__This..section....applies....to conditionally exempt small Quantity_generators Comment[P9]:CESQG=Federal language
• ,• .t•, '..� - •,, $1,__ r addition to the requirements of this.sectiion, SQG--State language and more consistent with
- -- -- -- -- -- - Ecology WAC 173-3-3
c.l SQGs must meet the storage urre:ments of Section 305(6)(a)
(bii)_Waste Designation._G SQGs_shal1 deli to sospeeted nr known dangerous wastes
psuant to WAC 173-303-070 through WAC 173-303-109.
Containe_tLabeling C SQGsshall label all containerroflvl _a-nd-used oil with the name
of the waste and identify themaiior risk(s)associated with the waste in the container or tank for
emplotiees,_emergencyx_esponsepersonnell he_..public._Containers oI£MRW.shall
also..be labeled with..thewor "hazardous waste"or_'_'dangerouswaste".. �..
(dive SecondaryConta nnie t__The_leeatthOfftecrmay require an GhSQG to provide secondary .
containmenLfor_liquid MRW_and/or used oil stored_on-siteif_thellealth Offlcersletermines
,', s• • . , •, 5 -. to I-, to i , 1111-, , - I ,- I. ,fthe
wastes being accumulated,the location of accumulation or due to a history of spills or
releases from accumulation containers._When required under this section,aseconslary
containment system must be_durable,compatible withihe.waste it is meant to contain,_and
large enougI to contain a volume_equal tote ( )percent of all containers,or one hundred
and ten percent(110%)of the largest single container,whichever is greater,:
(ye) Hazardous Materials Management Plans.If.a.0-BSQG has violated any part of this {Formatted:Indent:Left: 0.5"
regulation...the Health Officer inay require the C--FSQG_to..prepare_and follow a written
Hazardous_Materials_M.an o • 1.n. gro_tied by Public Health and in a format
prescribed by Public Health.,
(b)Storage Requirements.
(i) . - • :.. • •!' SOG Waste),used oil,and hazardous l: •,$ - shall be stored {Comment[Pio]:This is overly broad and
in containers which are: l includes a multitude of things.
16
(A) Compatible with the waste contained therein;
(B) In good condition and without any leaks,corrosion or other signs of
deterioration;
(C) Securely closed everedlat all times except during the addition or removal of -- Comment[P11]:The appropriate term is closed,
contents;and as you want the container closed,and covered is
(D)
handled in the folio
... - ... '. ..• '. wing paragraph
h
• � �• •' Forma tted•Strikethrough
------ Comment[P12]:Conflicts with a number of
(ii) Containers of MRWS_OG,used oil,and hazardous substances shall be stored on an industries such as Janitorial,hospitals,labs,and
impervious surface and in a location(s)that is covered and controlled to prevent: othersthat have a go°a reason to not use;n heir
original containers.
(A) Container deterioration due to weather exposure;(B) {Formatted:Strikethrough
Surface water run-on and run-off;
(C) Exposure to extreme temperatures;
D) Unintentional discharge to stormwater,soil,or surface water;and
(DE) Any other controllable condition,which may cause or increase the possibility of
container failure.
(c) Accumulation. In addition to the quantity exclusion limits(QELs)for small quantity generators
contained in WAC 173-303-070(8),MRWSQG,used oil,and hazardous substances shall not be
accumulated in quantities that,in the opinion of the Health Officer,present a threat to public health
or the environment.
(d)Transportation. MRW-SOG and used oil shall be transported in accordance with WAC 173-350-
300(3)(d)Section 00 Treatment and Disposal.- p -- comment[P13]:The Full Reference is WAC
l73-35--300(3)(d)
(i) S_QCLWaste. All 1.01R-W-SQG shall be transported to a permitted MRW
collection facility,or picked up by a permitted dangerous waste transporter for treatment or
disposal at a facility permitted to accept such waste. . . .• . . • .: S Comment[P14]:Technically the rules do
• +"a•""-' '-- • - -" •. -:• :• • - ••-• - •'i. allow SQGs to treat waste on-site and Ecology
recently revised their
shall not be deposited in the general municipal solid waste collection system,a public sewerrules to be consistent with
EPA
system,a storm drain,an on-site sewage system,in surface or ground water,or onto or under the
surface of the ground.
(ii)Pesticides. Usable pesticides shall be utilized in accordance with the EPA approved label
requirements,or shall be disposed of,as appropriate,at a permitted hazardous waste treatment,
storage,or disposal facility,the Jefferson County Moderate Risk Waste Collection Facility,or
through an approved Department of Agriculture collection event.(For addition l informs ion it
WSDA at 1-877-301-4555) Empty containers from canceled,suspended,or otherwise unusable
pesticides should be disposed of as a hazardous waste or triple rinsed in accordance with the
requirements under WAC 173-303-160(2)(b). Rinsate from a pesticide container must be reused in
a manner consistent with its original intended purpose or disposed of as a hazardous waste under
Chapter 173-303 WAC.
(iii)Used Oil. Used oil shall be recycled or disposed of at a facility permitted or approved for that
purpose,or as otherwise allowed by Ecology or the Health Officer. Used oil may be taken to
service stations or similar facilities that collect used oil for subsequent reprocessing at a facility
specifically permitted for that purpose.
(e) Mitigation and Control. The person responsible for a spill or non-permitted discharge of MRW_S_QG,
used oil,and/or hazardous substances shall take appropriate and immediate action to protect public
17
health and the environment,including any necessary measure required to prevent the spread of
contamination. In addition,the person responsible for a spill or discharge shall:
(i) Notify Public Health and,when an imminent threat to public health or the environment
exists,call 911;
(ii) Clean up any released hazardous substance,or take such actions as may be required or approved
by federal,state,or local officials;and
(iii)Meet applicable requirements of Section 305(7)as directed by the Health Officer.
8.10.305(7)PROBLEM WASTE
(a) Screening. Persons excavating problem waste as defined in Section 100,which is intended for upland
fill in Jefferson County and which may contain a hazardous substance,endanger the public health,or
adversely impact the environment,shall contact the Health Officer to determine the need for screening
in accordance with Section 305(9)(b)
(b) Management Options.
(i) Beneficial Reuse. Any person intending to beneficially reuse problem wastes must first contact
the Health Officer to determine the appropriate reuse options.
(ii) Treatment. Problem wastes may be treated to remove contaminants and,following treatment,
may be used as upland fill in Jefferson County if the treated waste is determined by the Health
Officer not to be a problem waste.
(iii)Disposal. Problem waste can only be disposed of at a solid waste handling facility permitted to _
receive such waste.
(c) Waste Abrasive Blasting Grit Storage. Waste abrasive blasting grit shall be stored under cover in a
manner that minimizes contact with process water or stormwater. Persons recycling waste abrasive
blasting grit at a facility permitted to recycle such waste are exempt from the provisions of Section
305(7)(b)of these regulations provided that the recycling facility enlists a process and produces a
fmal product that does not endanger human health or the environment as a result of using said
material.
I 8.10.305 (8)SEPTAGE
Septage must be disposed of directly into a sewage treatment works,licensed as such by Ecology,
with the permission of and according to the requirements of the sewage treatment works or disposed
of into an alternative treatment works or other process approved by the Health Officer. Septage of
domestic quality,meeting all applicable requirements for biosolids under Chapter 173-308 WAC,
Biosolids Management,may be beneficially reused by being applied to land as approved by the
Health Officer on a case-by-case basis.
_ _ C 173 303, 100.
18
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emergency ro3pen:t' � e per. Co ;r_4#]tom t'_444141 -
8,10.310-Intermediate Solid Waste Handling Facilities
• WAC 173-350-310,Intermediate Solid Waste Handling Facilities is hereby adopted by reference.
8.10.320 - Piles Used for Storage or Treatment
WAC 173-350-320,Piles Used for Storage or Treatment is hereby adopted by reference. Paragraph
320(7)has been revised as follows:
320(7)Piles used for Storage or Treatment—Financial Assurance requirements.
(a) Financial Assurance may be required for certain piles treating or storing solid waste as determined
by Public Health.
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in
accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds
shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be
present at any time during the operation of the facility and to accomplish closure in accordance with
the facility closure plan.
(c) If required,no owner or operator shall commence or continue to operate any part of the facility until a
suitable financial assurance mechanism has been provided to the MD in accordance with WAC 173-
350-600.
8.10.330-Surface Impoundments and Tanks
WAC 173-350-330,Surface Impoundments and Tanks,is hereby adopted by reference. Paragraph
19
•
•
330(7)has been revised as follows:
330(7)Surface Impoundments and Tanks—Financial Assurance requirements.
(a) Financial Assurance may be required for certain surface impoundments and tanks used for treating or
storing solid waste as determined by Public Health.
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in
accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds
shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be
present at any time during the operation of the facility and to accomplish closure in accordance with
the facility closure plan.
(c) If required,no owner or operator shall commence or continue to operate any part of the facility until a
suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173-
350-600.
8.10.350 -Waste Tire Storage and Transportation
WAC 173-350-350,Waste Tire Storage and Transportation is hereby adopted by reference.
8.10.360 - Moderate Risk Waste Handling
WAC 173-350-360,Moderate Risk Waste Handling is hereby adopted by reference.
8.10.400 - Limited Purpose Landfills
WAC 173-350-400,Limited Purpose Landfills is hereby adopted by reference.
8.10.410 - Inert Waste Landfills
WAC 173-350-410,Inert Waste Landfills is hereby adopted by reference.
8.10.450 - Municipal Solid Waste Landfills
WAC 173-351,Criteria for Municipal Solid Waste Landfills is hereby adopted by reference.
8.10.460 - Construction and Notification Standards Near
Landfills
(1) Construction Requirements.
(a)Methane Protection.
20
•
(i) Any person constructing or developing any area within one-thousand(1,000)feet of the
footprint of an active,closed,or abandoned landfill shall provide documentation that
demonstrates that levels of methane gas within this one-thousand(1,000)foot zone are
below the lower explosive limits(LEL)under all conditions. A description of the
investigation methodology,all analytical data,and conclusions shall be presented in a
report submitted by a licensed professional engineer or professional geologist to the Health
Officer and the local building department for review and approval. Copies of this report
shall also be provided to the Washington Department of Ecology and the Puget Sound
Clean Air Agency;and
(ii) Any person constructing or developing any area within one-thousand(1,000)feet of the
footprint of an active,closed,or abandoned landfill shall provide documentation that
demonstrates that all enclosed structures are protected from potential methane migration.
The method for ensuring a structure's protection from methane shall be addressed in a
report submitted by a licensed professional engineer to the Health Officer and the local
building department for approval. Such a report shall contain
a description of the mitigation measures to prevent the accumulation of explosive
concentrations of methane gas within or under enclosed portions of a building or
structure. At the time of final inspection,the engineer shall furnish a signed statement
attesting that the building or structure has been constructed in accordance with his/her
recommendations for addressing methane gas migration.
(iii)The Health Officer may grant a variance to the requirements in Section 460(1)(a)(ii)
above,based on a review of data submitted pursuant to preceding Section
460(1)(a)(i).
4110 (b) Stormwater. To minimize erosion impacts and leachate generation,no person shall detain
stormwater on a closed or abandoned landfill. Stormwater may be conveyed across a closed
or abandoned landfill if the conveyance system has been engineered to minimize the
percolation of stormwater into the landfill.
(c) Construction within the Footprint of the Landfill. No person shall construct within the
footprint of a closed or abandoned landfill without first having submitted detailed
engineering plans documenting how potential hazards will be controlled. Potential hazards
include,but are not limited to,subsidence,methane,odor problems,hazards associated with
subsurface utility installation,and leachate generation. A qualified,licensed Professional
Engineer(PE)shall sign such plans. These plans must be submitted for review and
approval to the jurisdictional building department and Public Health,or Public Health's
designated representative.
(d) Groundwater Supply Wells. No person shall construct a groundwater supply well within
one-thousand(1,000)feet of an active,closed,or abandoned landfill property boundary
without a formal request for variance as outlined in Chapter 173-160 WAC,Minimum
Standards for the Construction and Maintenance of Wells.
(e) Methane Monitoring. All landfills where methane gas is generated shall provide for
adequate venting,collecting,redirecting,or elimination of gases generated by solid waste.
It shall be the responsibility of the landfill owner/operator to develop a sampling and testing
program to monitor gas production and potential migration.
(2) Notification Requirements for Owners of Landfills.
All owners of active,closed,or abandoned landfills shall:
21
•
(a) File a Notice to Title with the County Auditor's office noting the presence of a landfill on
the tax parcel within one-hundred and eighty(180)days of the effective date of these
regulations.
(b) For any property without notice to title,Public Health may file a notice to title regarding
the presence of a landfill on the property.
(c) Disclose the presence of an active,closed,or abandoned landfill to all prospective
purchasers of the property.
8.10.490 - Other Methods of Solid Waste Handling
WAC 173-350-490,Other Methods of Solid Waste Handling is hereby adopted by reference.
8.10.500 - Ground Water Monitoring
WAC 173-350-500,Ground Water Monitoring is hereby adopted by reference.
8.10.600 - Financial Assurance Requirements
WAC 173-350-600,Financial Assurance Requirements is hereby adopted by reference. Paragraph .
600(1)of the WAC is revised by adding the following subparagraph.
(d) Certain waste piles;certain surface impoundments and tanks;and certain compost facilities as
determined by Public Health.
8.10.700 - Permits and Local Ordinances
WAC 173-350-700,Permits and Local Requirements,is hereby adopted by reference. Section 700(1)of
the WAC is revised by adding the following subparagraph.
(d) Landfills closed pursuant to this Chapter 173-351,Mixed Municipal Solid Waste Landfills or Chapter
173-304 are required to obtain a closure-post closure permit.
(e) Permit holders must comply with all rules and intent of the Jefferson County Comprehensive Solid
Waste Management Plan(JCCSWMP).
8.10.710 - Permit Application and Issuance
WAC 173-350-710,Permit Application and Issuance is hereby adopted by reference.
Appeal of a Permit Denial.Any person aggrieved by the denial of permit denial shall:
22
a. Within 10 days of receiving the written letter denying a permit,the appellant shall request a hearing
in writing. The appellant shall submit specific statements in writing of the reason why error is
assigned to the decision of the health officer.
b. Upon receipt of such request together with hearing fees,the health officer shall notify the person of
the time,date,and place of such hearing,which shall be set at a mutually convenient time not less
than five business days nor more than 30 business days from the date the request was received.
c. Within 30 days.the Health Officer will issue a decision upholding or rTf,eLiiig public health's
action.The health officer may require additional actions as part of the - Comment[P15):Separate to make more reader
friendly.
8.10.715 -General Permit Application Contents
WAC 173-350-715,General Permit Application Contents is hereby adopted by reference.
8.10.900-Corrective Action
WAC 173-350-900,Corrective Action is hereby adopted by reference.
8.10.950 -Administration And Enforcement
(1) Other Laws,Regulations and Agency Requirements
(a) All solid waste management shall be subject to the authority of other laws,regulations or other 4.
agency requirements in addition to these rules and regulations. Nothing in these rules and .„
regulations is intended to abridge or alter the rights of action by the state or by persons,which exist
in equity,common law or other statutes to abate pollution or to abate a nuisance.
(b) Chapter 173-350 WAC,Minimum Functional Standards for Solid Waste Handling,is
hereby adopted by reference.
(c) If a conflict exists in the interpretation of Chapter 173-350 WAC and these regulations,or in the
interpretation of Chapter 173-351 WAC and these regulations,the more stringent regulation
shall apply to better protect public health and the environment. '
8.10.950(2)ENFORCEMENT AUTHORITY
The Health Officer,his or her designee,or any person appointed as an"Enforcement Officer"by the
Jefferson County Board of Health shall have the authority to enforce the provisions of these
regulations equally on all persons. The Health Officer is also authorized to adopt rules consistent with
the provisions of these rules and regulations for the purpose of enforcing and carrying out its
provisions.
8.10.950(3)RIGHT OF ENTRY
(a) Whenever necessary to make an inspection to enforce or determine compliance withthe provisions
of these regulations,and other relevant laws and regulations,or whenever the Health Officer has
cause to believe that a violation of these regulations has or is being committed,the Health Officer or
23
S
his/her duly authorized inspector may,in accordance with federal and state law,seek entry of any
building,structure,property or portion thereof at reasonable times to inspect the same.
(b) Prior to entering any building,structure,property or portion thereof the Health Officer or his/her
duly authorized inspector shall attempt to secure the consent of the owner,occupant or other person
having apparent charge or control of said building,structure,property or portion thereof.
(i)If such building,structure,property or portion thereof is occupied,the inspector shall present
identification credentials,state the reason for the inspection,and request entry.
(ii)In attempting to contact the owner,occupier or other persons having apparent control of said
building,structure,property or portion thereof,the inspector may approach said building or
structure by a recognizable access route,e.g.,a street or driveway,leading to said building
or structure.
(c)Denial of Property Access
t
. . .. _, .. Formatted:Indent:Left: 0.13",
Hanging:
0.25"
the-kieatth-Offeee-er his/ : , d-iris-peer ahathal u e—+ecocuese•to any other..:retnedie:,
(d) If permission to enter said building,structure,property or portion thereof is not obtained from the - (Formatted:Indent:Left: 0.13"
owner,occupier or others persons having apparent control of said building,structure,property or
portion thereof,the Health Officer or his/her duly authorized inspector shall also have recourse
to any other remedies provided by law to secure entry.,including
8.10.950(4)INSPECTIONS—PERMITTED FACILITIES
(a) General.At a minimum,the Health Officer may,to the extent resources permit,perform annual
inspections of all permitted solid waste facilities. Findings shall be noted and kept on file. The
Health Officer shall furnish a copy of the inspection report,or annual summary,to the site operator.
(b)Pre-Operational Inspection.Whenever plans and specifications are required by these regulations to
be submitted to the Health Officer,the Health Officer may inspect the proposed solid waste
disposal site,solid waste handling facility,or solid waste collection service prior to the start of the
operations to verify compliance with approved plans and specifications.
8.10.950(5)NOTICE AND ORDER TO CORRECT VIOLATION
(a) Issuance. Whenever the Health Officer determines that a violation of these regulations has occurred
or is occurring,he/she may issue a written notice and order to correct violation to the property owner
or to any person causing,allowing or participating in the violation.
(b) Content. The notice and order to correct violation shall contain:
(i) The name and address of the property owner or other persons to whom the notice and order
to correct violation is directed;
24
4111
(ii) The street address or description sufficient for identification of the building,structure,
premises,or land upon or within which the violation has occurred or is occurring;
(iii)A description of the violation and a reference to that provision of the regulation,which has
been violated;
(iv)A statement of the action required to be taken to correct the violation and a date or time by
which correction is to be completed;
(v) A statement that each violation of this regulation shall be a separate and distinct offense and
in the case of a continuing violation,each day's continuance shall be a separate and distinct
violation;
(vi)A statement that the person,to whom the Notice and Order is directed,can appeal the Order
to the Health Officer,in accordance with the terms of this Chapter,and that any such appeal
must be presented to the Health Officer with ten days;
(vii)A statement that the failure to obey this notice may result in the issuance of a notice of civil
infraction,and/or the assessment of an administrative remedy,and/or,if applicable,the
imposition of criminal penalties.
Comment[P16]:Space sous to not interfere
with
(c) Disposal Receipts. The notice and order to correct violation may also include a statement requiring he footer.
the person to whom the notice and order to correct violation is directed to produce receipts from a Formatted:Indent:Left: 1.04",Hanging:
permitted solid waste disposal facility, facility, spaRight: 0.1",Space Before: opt,Line
p permitted hazardous waste or the local household spacing: single
hazardous waste facility(moderate risk waste facility)-or of-transporter to demonstrate compliance
with an order issued by the Health Officer.
(d) Service of Order. The notice and order to correct violation shall be served upon the person to whom it
is directed,either personally or by mailing a copy of the order to correct violations by first class and/
or certified mail postage prepaid,return receipt requested,to such person at his/her last known
address. The notice and order to correct violation shall also be served via certified mail/return receipt
requested to the owner of the parcel or parcels where the alleged violations are occurring to the
owner's last known address.
(e) Extension. Upon written request received prior to the correction date or time,the Health Officer may
extend the date set for corrections for good cause. The Health Officer may consider substantial
completion of the necessary correction or unforeseeable circumstances that render completion
impossible by the date established as a good cause.
(f) Supplemental Order to Correct Violation. The Health Officer may at any time add to,rescind in
part,or otherwise modify a notice and order to correct violation. The supplemental order shall be
governed by the same procedures applicable to all notice and order to correct violations procedures
contained in these regulations.
(g) Enforcement of Order. If, after any order is duly issued by the Health Officer,the person to whom
such order is directed fails,neglects,or refuses to obey such order,the Health Officer may:
(i) Utilize any remedy or penalty under Section 950(6)of these regulations;and/or
(ii)Abate the health violation using the procedures of these regulations;and/or
(iii)Pursue any other appropriate remedy at law or equity.
(h) Written Assurance of Discontinuance.The Health Officer may accept a written assurance of
discontinuance of any act in violation of this regulation from any person who has engaged
25
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•
in such act. Failure to comply with the assurance of discontinuance shall be a further violation
of this regulation.
8.10.950(6)VIOLATIONS,REMEDIES AND PENALTIES
I 8.10.950(6)(a) Violations.
(i) Violations of these regulations may be addressed through the remedies and penalties
provided in this section.
(ii)Each violation of these regulations shall be a separate and distinct offense and in the case
of a continuing violation,each day's continuance shall be considered a separate and
distinct violation.
(iii)The Health Officer may investigate alleged or apparent violations of these regulations. Upon
request of the Health Officer,the person allegedly or apparently in violation of these
regulations shall provide information identifying themselves.
(iv)Violations,apparent or alleged,that occurred or are occurring in environmentally sensitive
areas,as that term is defined in this Chapter,of Jefferson County will have the highest priority
for investigation by those persons charged in this Chapter with investigating such violations
and enforcing this Chapter and such violations will be subject to a'zero tolerance'policy.
18.10.950(6)(b)Civil Remedies.
(i) Except as provided in Section 950(6)(b)(ii),the violation of any provision of these regulations is
designated as a Class 1 civil infraction pursuant to Chapter 7.80
RCW,Civil Infractions. 111
(ii) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)or waste in an
amount greater than one(1)cubic foot has committed a Class 1 civil infraction pursuant to
Chapter 7.80 RCW,Civil Infractions. Any person who unlawfully dumps solid waste in an
amount less than or equal to one(1)cubic foot has committed a Class 3 civil infraction pursuant to
Chapter 7.80 RCW. The court may also impose restitution for any violation.
(iii)The Health Officer may issue a notice of civil infraction pursuant to Chapter 7.80
RCW if the Health Officer has reasonable cause to believe that the person has violated any
provision of these regulations or has not corrected the violation as required by a written notice and
order to correct violation. Civil infractions shall be issued,heard and determined as described in
Chapter 7.80 RCW,and any
applicable court rules.
(iv)All other legal and equitable remedies are also deemed available to Public Health or its Health
Officer and may be invoked,utilized or sought at any time regardless of whether other remedies
have or have not been undertaken or sought.
18.10.950(6)(c) Criminal Penalties.
(i) Any person who unlawfully dumps biomedical waste as described in Section 025(3)(b)shall
be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than
$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both. The court
may also impose restitution.
(ii) Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or
RCW 70.105.010(5)in violation of RCW 70.105.090 shall be,upon conviction,guilty of a
misdemeanor. The court may also impose restitution.
26
S
(iii) Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or
RCW 70.105.010(5)in violation of RCW 70.105.085 shall be,upon conviction,guilty of a
felony. The court may also impose restitution.
(iv) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)and in an
amount less than one(1)cubic yard,but greater than(1)cubic foot,shall be,upon conviction,
guilty of a misdemeanor,and shall be subject to a fine of not more than$1,000,or
imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also
impose restitution as stated in Chapter 70.95 RCW,Solid Waste Management-Reduction and
Recycling.
(v) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)of these
regulations and in an amount greater than(1)cubic yard,shall be,upon conviction,guilty of a
gross misdemeanor,and shall be subject to a fine of not more than$5,000,or imprisonment in
the county jail not to exceed one(1)year,or both. The court may also impose restitution as
stated in Chapter 70.95 RCW,Solid Waste Management-Reduction and Recycling.
(vi) Any person who fails,neglects,or refuses to obey an order of the Health Officer to correct
a violation as set forth in Section 950(5)(g)above shall be,upon conviction,guilty of a
misdemeanor and shall be subject to a fine of not more than$100,or imprisonment in the
county jail not to exceed ninety(90)days,or both. The court may also impose restitution.
(vii) Any person who fails,neglects,or refuses to comply with a written assurance of
discontinuance pursuant to Section 950(5)(h)above shall be,upon conviction,guilty of a
misdemeanor and shall be subject to a fine of not more than$100,or imprisonment in the
• county jail not to exceed ninety(90)days,or both. The court may also impose restitution.
(viii) Any person who operates a solid waste facility or collection service without a permit shall
be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more
than$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both.
The court may also impose restitution.
(ix) Any person who operates a solid waste facility or collection service after a permit has been
revoked shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine
of not more than$1,000,or imprisonment in the county jail not
to exceed ninety(90)days,or both. The court may also impose restitution.
8.10.950(6)(d) Noncompliance Fees.
(i) Pursuant to the most current Public Health fee schedule adopted by the Board of Health,
Public Health may assess a noncompliance fee to a permittee-permittee or small quantity
generator for the following:
(A) Public Health oversight and review required as a result of the Health Officer's
determination that a permitted facility or small quantity generator is not in compliance
with its permit and/or applicable regulations and has not met the compliance dates
specified in a notice and order to correct violation;or
(B) Amendments to an existing Public Health permit required as a result of the permitted
facility not being in compliance with its permit and/or applicable regulations.
(C) Second and subsequent re-inspections conducted by Public Health in response to the
permittee-permittee or small quantity generator not complying with their permit and/or
27
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•
J.C.C.code or the permittee not meeting the requirements outlined in a notice and order
to correct violation.
(ii)Whenever a re-inspection noncomplianee-fee is assessed by Public Health,the fee shall be
due and payable thirty(30)days after receipt of the invoice by the permittee.
(iii)The noncompliance fee shall not be assessed in addition to the permit fee for permitted
facilities where permit fees,as described in the most recent Public Health fee schedule,
specifically include those Public Health activities described in Section
950(6)(d)(i).
I 8.10.950(6)(e) Stop-Work Orders.The Health Officer may cause a Stop-Work order to be issued
whenever the Health Officer has reason to believe that a violation of this regulation is occurring. The
effect of the Stop-Work order shall be to require the immediate cessation of such work or activity that
has contributed to the violation until authorized by the Health Officer to proceed.
(i)Content. A Stop-Work Order shall include the following:
(A)The name and address for the person responsible for the alleged violation;
(B)The street address or description sufficient for identification of the building,
structure or premises,or land upon or within which the alleged violation has
occurred or is occurring.
(C)A description of the violation and reference to the provision of the Jefferson County
Board of Health Ordinance,which has been allegedly violated;(D)The required
corrective action;
(E)A statement that a failure to comply with the order may lead to issuance of a
civil infraction to the person named in the order; 4110
(F)A statement that the person to whom the Stop Work Order is directed can appeal
the Order to the Health Officer in accordance with the§950(7)of this Chapter
and that any such appeal must be presented to the Health Officer with ten days.
(ii)Service of Notice. The Health Officer shall serve the Stop Work Order upon the
owner of the property where the alleged violation occurred or is occurring and the
person,firm or business entity that has allegedly violated this Chapter,either
personally or by mailing a copy of the notice by regular and certified or registered
mail,within a five-day return receipt requested,to the owner at his or her last
known address. A copy of the Order shall also be posted on the property where the
alleged violation occurred or is occurring.
(iii)Posting of Notice. In addition to service of the notice listed above,an additional
notice shall be posted on the property in substantially the following form:
Under the authority of Jefferson County Public Health Ordinance 09-1020-05,Solid Waste Regulations
you are hereby required to immediately
STOP WORK
This order is in effect at this property for all work and activities that relate to violations of Jefferson
County Public Health Ordinance 09-1020-05,Solid Waste Regulations,and remains in effect until
removed by Public Health. It is a violation of these regulations to remove,deface,destroy,or conceal a
posted Stop Work Order. FAILURE TO COMPLY WITH THIS ORDER MAY RESULT IN THE
ISSUANCE OF A CIVIL INFRACTION.
8.10.950(6)(f)Voluntary Correction. When the Health Officer determines that a violation has occurred
or is occurring,he or she shall attempt to secure voluntary correction by contacting the person
28
I
responsible for the alleged violation and,where possible,explaining the violation and requesting
correction.
(i) Voluntary Correction Agreement. The person responsible for the alleged violation may enter
into a voluntary correction agreement with Public Health. The voluntary correction
agreement is a contract between Public Health and the person responsible for the violation in
which such person agrees to abate the alleged violation within a specified time and according
to specified conditions.The voluntary correction agreement will be in lieu of the issuance of
further citations or the abatement of the property pursuant to RCW 7.48 or§950(6)(g)of this
Chapter.The voluntary correction agreement shall include the following:
(A)The name and address of the person responsible for the alleged violation;
(B)The street address or other description sufficient for identification of the building,
structure,premises,or land upon or within which the alleged violation has occurred
or is occurring;
(C)A description of the alleged violation and a reference to the regulation,which has
been violated;
(D)The necessary corrective action to be taken,and a date or time by which correction
must be completed;
(E)An agreement by the person responsible for the alleged violation that Public Health may
enter the property and inspect the premises as may be necessary to determine compliance
with the voluntary correction agreement;
(F)An agreement by the person responsible for the alleged violation that Public Health may
enter the property to abate the violation and recover its costs and expenses(including
administrative,hearing and removal costs)from the person responsible for the alleged
violation if the terms of the voluntary correction agreement are not satisfied;and
(G)An agreement that by entering into the voluntary correction agreement,the person
responsible for the alleged violation waives the right to a hearing before the Health
Officer under these regulations or otherwise,regarding the matter of the alleged
violation and/or the required corrective action.
(i)Right to a Hearing Waived.By entering into a voluntary correction agreement,the
person responsible for the alleged violation waives the right to a hearing before the
Health Officer under these regulations or otherwise,regarding the matter of the
violation and/or the required corrective action. The person responsible for the
alleged violation may,by through written documentation provided to the Health
Officer,state his or her decision to reject and nullify the voluntary correction
agreement,at which time that person is entitled to an appeal to the Health Officer
pursuant to§950(7)of this Chapter.
(ii)Extension and Modification.The Health Officer may,at his or her discretion,grant
an extension of the time limit for correction or a modification of the required
corrective action if the person responsible for the alleged violation has shown due
diligence and/or substantial progress in correcting the violation,but unforeseen
circumstances have delayed correction under the original conditions.
(iii)Abatement by Public Health.The county may abate the alleged violation in
accordance with Section 950(6)(g)if all terms of the voluntary correction
agreement are not met,except that the person responsible for the alleged violation
shall not have a right to appeal the Abatement Order.
29
•
(iv)Collection of Costs.If all terms of the voluntary correction agreement are not met,
the person responsible for the alleged violation shall be assessed all costs and
expenses of abatement,as set forth in Jefferson County Public Health Ordinance
09-1020-05,§950(6)(g).
8.10.950(6)(g)Abatement Orders.Where the Health Officer has determined that a violation of these
regulations has occurred or is occurring,he or she may issue and Abatement Order to the person
responsible for the alleged violation requiring that the unlawful condition be abated within a
reasonable time period as determined by the Health Officer.
(i)Prerequisite to Abatement Order. Absent conditions which pose an immediate threat to the
public health,safety or welfare of the environment,the procedures for abatement of conditions
constituting a violation of these regulations should only be utilized by Public Health only after
corrections of such conditions have been attempted through the use of the civil infractions
process. Once it has been determined by Public Health that there is no immediate threat to the
public health's safety or welfare and that correction of such conditions has not been
adequately achieved through use of the civil infraction process,then Public Health is
authorized to proceed with abatement of such conditions pursuant to these regulations. Public
Health shall also attempt to enter into a voluntary corrections agreement prior to issuing an
Abatement Order.
(ii)Content. An Abatement Order shall include the following:
(A)The name and address for the person responsible for the alleged violation;(B) The
street address or description sufficient for identification of the building,structure or
premises,or land upon or within which the alleged violation has occurred or is
occurring;
(C)A description of the violation and reference to the provision of the Jefferson County Board
of Health Ordinance,which has been allegedly violated;
(D)The required corrective action and a date and time by which the correction must be
completed and after which,the Health Officer may abate the unlawful condition in
accordance with§950(6)(g)of this Chapter.
(E) A statement that the costs and expenses incurred by Public Health pursuant to
§950(6)(g)of this Chapter,including any amount expended on staff time to oversee the
abatement,may be assessed against a person to whom the Abatement Order is directed
in a manner consistent with this Chapter;and
(F) A statement that the person to whom the Abatement Order is directed can appeal the
Order to the Health Officer in accordance with§950(7)of this Chapter.
(iii)Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the
property where the alleged violation occurred or is occurring,either personally or by mailing a
copy of the notice by regular and certified or registered mail,a five-day return receipt
requested,tof the owner at his or her last known address. The Order shall also be served on
each of the following if known to the Health Officer or disclosed from official public records:
the holder of any mortgage or deed of trust or other lien or encumbrance of record;the owner
or holder of any lease of record and the holder of any other estate or legal interest of record in
or to the property or any structures on the property. The failure of the Health Officer to serve
any person required herein to be served,shall not invalidate any proceedings hereunder as to
any other person duly or relieve any such person from any duty or obligation imposed by the
30
I
provisions of this section. A copy of the Order shall_also be posted on the property where the
alleged violation occurred or is occurring.
(iv)Authorized Action by Public Health. Using any lawful means,Public Health may enter the
subject property and may remove or correct the condition that is subject to abatement.
(v) Recovery of Costs and Expense. The costs of correcting a condition which constitutes a
violation of these regulations,including all incidental expenses,shall be billed to the owner
of the property upon which the alleged violation occurred or is occurring,and shall become
due within fifteen calendar days of the date of mailing the billing for abatement. The term
"incidental expenses"includes,but is not limited to,personnel costs,both direct and indirect
and including attorney's fees;costs incurred in documenting the violation;towing/hauling,
storage and removal/disposal expenses;and actual expenses and costs to Public Health in
preparing notices,specifications and contracts associated with the abatement,and in
accomplishing and/or contracting and inspecting the work;and the costs of any required
printing and mailing.
(vi)Collection of Costs and Expenses. The costs and expenses of correcting a condition,which
constitutes a violation of these regulations,shall constitute a personal obligation of the person
to whom the Abatement Order is directed. Within fifteen days of abating any violation,the
Health Officer shall send the person_named in the Abatement Order a bill that details the work
performed,materials removed,labor used and the costs and expenses related to those tasks as
well as any other costs and expenses incurred in abating the violation.
I 8.10.950(6)(h)Notice to Vacate. When a condition constitutes a violation of these regulations and poses
an immediate threat to life,limb,property or safety of the public or persons residing on the property,
the Health Officer may issue a Notice to Vacate.
(i)Content. A Notice to Vacate shall include the following:
(A)The name and address for the person responsible for the alleged violation;(B) The
street address or description sufficient for identification of the building,structure or
premises,or land upon or within which the alleged violation has occurred or is
occurring;
(C)A description of the violation constituting an emergency and reference to the provisions
of the Jefferson County Board of Health regulations,which has been allegedly violated;
(D)A date,as determined by the severity of the emergency,by which any persons must
vacate the premises. 1asaseIn case of extreme danger to persons or property immediate
compliance shall be required;
(E) The required corrective action;
(F) A statement that the person to whom the Notice to Vacate is directed can appeal the
order to the Health Officer in accordance with§950(7)of this Chapter and that any such
appeal must be presented to the Health Officer with ten days.
(ii)Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the
property where the alleged violation occurred or is occurring,either personally or by mailing a
copy of the notice by regular and certified or registered mail,within a five-day return receipt
requested,to the owner at his or her last known address. A copy of the Order shall also be
posted on the property where the alleged violation occurred or is occurring.
(iii)Posting the Notice. In addition to providing service as states above,an additional notice shall
be posted on the property in substantially the following form:
31
•
•
410
DO NOT ENTER
UNSAFE TO OCCUPY
It is a violation of the Jefferson County Board of Health Ordinance 09-1020-05 to occupy this building,or
to remove or deface this notice.
,Health Officer
Jefferson County Public Health
a
32
a
S
(iv)Compliance. No person shall remain in or enter any building,structure,or property which has
been so posted,except that entry may be made to repair or correct any conditions causing or
contributing to the threat to life,limb,property,or safety of the public or persons residing on
the property. No person shall remove or deface any such notice after it is posted until the
required corrective action has been completed and approved.
I 8.10.950(6)(i)-Permit Violations,Suspension-,and -'Revocation : '.:
� • a.a== '._, - Comment[P17]:Delete appeal and incorporate
into new section to avoid confusion.Add in Permit
mer Vieleitei Appeal section that use to refer to 950(7).
(i) n. Any violation of a permit requirement issued pursuant to these ;
regulations shall be a violation of these regulations. (Formatted:Indent:Left: 0" )
(ii) Suspension of Permits.
(A) The Health Officer may temporarily suspend any permit issued under these
regulations for:
(1) Failure of the holder to comply with the requirements of the permit;
(2) Failure to comply with any notice and order to correct violation issued pursuant
to these regulations related to the permitted activity;
(3) Failure to comply with a stop-work or abatement order issued pursuant to
Section 950(6)(e)and(g)of these regulations;or
(4) The non-payment or dishonor of any check or draft used by the permit holder to
pay any Public Health fees associated with the permit.
• (B) Permit suspension shall be carried out through the notice and order to correct violation
provisions specified in Section 950(5),and the suspension shall be effective upon
service of the notice and order to correct violation upon the holder or operator. The
holder or operator may appeal such suspension as provided in Section 950(7)and
Section 950(6)(i)(iv)of these regulations.
(C) Notwithstanding any other provision of this regulation,whenever the Health Officer
finds that a violation of this regulation has created or is creating an unsanitary,
dangerous or other condition which,in his/her judgment,constitutes an immediate and
irreparable hazard,he/she may,without service of a written notice and order to correct
violation,suspend and terminate operations under the permit immediately.
(iii)Revocation of Permits.
(A) The Health Officer may permanently revoke any permit issued by him/her for:(1)
Failure of the holder to comply with the requirements of the permit;
(2) Failure of the holder to comply with any notice and order to correct violation
issued pursuant to these regulations related to the permitted activity;
(3) Failure to comply with a stop-work or abatement order issued pursuant to
Section 950(6)(e)and(g);
(4) Interference with the Health Officer in the performance of his/her duties;
(5) Discovery by the Health Officer that a permit was issued in error or on the basis of
incorrect information supplied to him/her;or
(6) The non-payment or dishonor of any check or draft used by the holder to pay any
Public Health fees associated with the permit.
33
•
(B) Such permit revocation shall be carried out through the notice and order to correct
violation provisions specified in Section 950(5)and the revocation
shall be effective upon service of the notice and order to correct violation upon the holder
or operator. The holder or operator may appeal such revocation,as provided in Section
950(7)and Section 950(6)(i)(iv)of these regulations.
(C) A permit may be suspended pending its revocation or a hearing relative to
revocation pursuant to the provisions of Section 950(6Xi)(iii)(B).above.
(iv)Permit Appeal.
(A) Subject to Appeal. Any denial,suspension or revocation of a solid waste
permit by the Health Officer may be appealed.
(B) Appellant Defined. The appellant shall be the applicant for a solid waste
permit or holder of a solid waste permit who appeals a decision denying,
suspending or revoking a solid waste permit.
(C) Appeal Procedure. .:: . • . - - :. .. -1 . .
. = .:. -
• • • i.. ,•- ' ,- • p" • - + , - - + +. Comment[P18]:This section was added to
• ••r`.--' .. •++ — - -- clarify the process between general NOCV that are
denial of1imit denial shall: not permit related that do not get heard by the
---------- PCHB.Since the permit denial section already
1. Within 10 d ys of receiving the written lette d ying apermit,the appellant shall existed,I deleted the reference to 950(7)that added
request a he. g in writing. The appellant shall submit specific statements in writing to the confusion.
of the reason why error is assigned to the decision of the health officer
2. •.i - -'+ • • -I - •'-.i- i I •-e1+'_ I- I-.. + •i y I. 1• .1k
the personof the time,date and place of suchhe. ___g,which shall_be set_at a-mutually
convenient time not less than five business days nor more than 30 business_days from
the_date the..request was re eived. •
3. Within_30...days.,_theHealth_Officer.will_issue_a_decision..upholdingoLreversirig_public
health's action The health officer may require additional actions as part of the decision
4• . Within 30 days of receiving_the Health Officers decision,the appellant,may file an
• • • i. -- Comment[P19]:Added the RCW regarding the
appeal W • ! • !+ •+, •- • 1-• '•' • t PCI-LB filing process.34.05 RCA is the PCHB
4-5.The Hearing will be conducted as specified in JCC 8.10.950(7) procedure if we want to include.
Comment[PM]:This section added to be line
with other codes and hearing processes already
.
8.10.950 6 Si+" •• • I • ` \•►./ + ,+ +• I y• • • .5 • I• adopted by other programs such as the on-site code.
n`• +- . + •i y +•. • • '0 , - - • ••'•'• ,• • • actives or abate
any conditions that constitute or will constitute a violation of this ordinance,or rules and regulations
adopted under it,or any state health law or regulation,or that otherwise
threatens public health.
8.10.950(6)(k) Imminent and Substantial Dangers. Notwithstanding any provisions of this regulation the
Health Officer may take immediate action to prevent an imminent and substantial danger to the public
health by the improper management of any waste irrespective of quantity or concentration.
8.10.950(7)APPEALS
Appeal—of an NOCV Enforcement Action or other Public Health Action 4 - I Formatted:Line spacing: single
a) Appeal of Public Health Action-HealIth..Officer AdministrativeHearing.Any_person_aggrieved by
.i t t f f r A order to correct. olation issued under this relation v nv
inspection,permit issuance or enforcement action conducted by_public health under this regulation,
maysequest,_in writing,_a hearingbefore_the_health_o oar or his otter_designee.
34
•
•
III
1 (i) The appellant shall submit specific statements in writing of the reason why error is assigned-to
the decision of public health.Such request shall be presented to the health officer within 10
'1- ,. • i- 's i .ppealec except in the_ease of asuspension the request for a
hearing mustbe made within_fve_business days.
• Formatted:Indent:Left: 0.75",Line spacing:
(ii) :WW ire eipt of such-request together with hearing fees_thellealthofficer shallnotifythesingle, No bullets or numbering
person of.the time-date.and place of such hearing—which shall be set at a mutually convenient Formatted:List Paragraph,Indent:Left: 0.5",
time...notiess...than—five business.days-nor more than--30 business days-from...the date the request Space After: 12 pt,Font Alignment:Baseline
was received.
(UN-leafing Procedures.Hearings shall be open to the public and presided over by the health „ --f Formatted:Font 11 pt
officer.Such hearings shall be recorded.Hearings shall be opened with a recording of the time. - Formatted:List Paragraph,Indent:Left: 0.5",
date and place of the hearing,and a statement of the cause for the hearing.The health officer Font Alignment:Baseline
shall then swear in all potential witnesses.The case shall be presented in the order directed by Formatted:Font:11 pt,Double underline,
the health officer.The appellant may present rebuttal.The health officer may ask questions. Underline color:Background 2
The health officer may allow the opportunity for a closing statement or summation.GeneralFormatted:Font:(Default)Times New
rights include` ' Roman,11 pt
a Zo be represented by an attorney __. ____. ... .---...-.. Formatted:Indent:Left 1 Space After 0
b. To present witnesses; pt,Line spacing: single,Numbered+Level:4
C. To cross-examine witnesses' +Numbering Style:a,b,c,...+Start at:1+
d. To object to evidence for specific grounds. Alignment:Left+Aligned at: 2.5"+Indent at:
2.75"
In the conduct of the proceeding,the health officer may consider any evidence,including Formatted:p3,Indent:Left: 1",Numbered+
hearsay evidence that a reasonably prudentperson would rely upon in the conduct of his or her f , at:1l:4 li Numbering L +Al a,b,a,...+Start
p `, at:1+Alignment:Left+Aligned at: 2.5"+
affairs Evidence is not admissible if it is excludable,on constitutional or statutory grounds or Indent at 2.75"
0 on the basis of evidentiary privilege recognized in the courts of this state.The health officerFonn,atted:p3,Indent:Left: 0.75^, No
shall decide rulings on the admissibility of evidence.and the Washington rules of evidence bullets or numbering
shall serve as guidelines for those rulings. Formatted:Font:(Default)Times New
.. Roman,11 pt,Font color:Auto
inasmuch as any appeal to the board of health from a health officer decision is a review on the Formatted:p3,Indent:Left: 0.5",Hanging:
record,the health officer shall ensure that the record generated contains testimonial and 0.25", No bullets or numbering
documentary evidence supporting the health officer's determination, 1 Formatted:Font:11 pt
Formatted:Font:(Default)Times New
The health officer may continue the hearing to another mutually acceptable date to allow for Roman,11 pt,Font color:Auto
additional submission of information or to allow for additional consideration.Prior to closing Formatted:Font:(Default)Times New
of the hearing,the health officer shall issue its oral ruling unless the health officer determines Roman,11 pt,Font color:Auto
that the matter should be taken under advisement.Written findings of fact,conclusions of law • Formatted:Font:(Default)Times New
and orders shall he served on the appellant within 14 days of the oral ruling.If the matter is Roman,11 pt,Font color:Auto
taken under advisement,written findings.conclusions and orders shall be mailed to the Formatted:Font:(Default)Times New
appellant within 21 days of the close of the hearing. Roman,11 pt,Font color:Auto
,{ Formatted:Indent:Left: 0.75",Line spacing:
The appgllant shall bear the burdenofgtroofand may_overcome the permit revocation order by , ' single, No bullets or numbering
a preponderance of the evidence. {Formatted:Line spacing: single
Comment[P21]:Separate to make more reader
- - Formatted:Font:11 pt,Double underline,
Font color:Black
,r Formatted:List Paragraph,Indent:Left: 0.5",
84-079,54)47+42h) p_peal of Administrative H ' g to,the Board_of.-health. ," Line spacing: single,Numbered+Level:5+
Numbering Style:i,ii,iii,...+Start at:1+
. Alignment:Left+Aligned at: 2.76"+Indent
r .„ :1r. si .•=n- -, , _l- 1a i. .conclusions r •r _•• , _sl • 1 S4rl •4 • •'
-- - .-- . _ at: 3.01”
hearing shall haree the richt to appeal the matter. ry requesting_a..1earing_before the board of Formatted:Font:11 pt,Double underline,
health.Such notice of appeal shallbe in_writing and resented to_the_health officer within five Font color:Black
35 ___ ..._...__._,
III
•
thirty(30k days of the health officers_decision. The appellant shall subm?t.specft _ Formatted:Font:11 pt,Double underline,
zr
statements in writing of the reason.,1,1-w error is assigned to the decision of the health.officer. Font color Black _
;;;;,;;,;„,.,,d,,,.„:„.,:,;;,„...;,..,;.1,_„,...,.......,,.;...#,,,,,,,,,. ..s,,.,.:._ ,a a a, a.- . r n r.i•-1 a , ee as -- Formatted:Font:11 pt,Double underline,
established in the current public-health fee schedule. -------:----;;::----;-1--s-"---- Font color:Black
The appellant and the health_officer may submit additional information to-theboard of health
for review _ - ----- _..–.::-
--{ Formatted:Font:11 pt,Double underline,
-.-: I Font color:Black
(ii) £• -The_notice_and order to correct violation shall remain in effect during th pp al Any - Formatted:List Paragraph,Indent First line:
personaffected by_the-nctice and order to correct violation may make_a written request fora 0",Line spacing: single
stay_of the._decision_to the health officer..within five business_days._of the heahkofflkees Formatted:List Paragraph,Indent:Left: 0.5",
decision The health officer will grant or deny the request within five business dave- Line spacing: single,Numbered+Level:5+
Numbering Style:i,ii,iii,...+Start at:1+
. Alignment Left+Aligned at 2.76"+Indent
(iii){E• -Unon receiptof a timely written notice of anneal lo-get henn
wi h he g fee the health \
officer shall seta time,date,and pl f th quested hearinbefore the board of health and s. at: 3.01^
shall v_the ppellant written notice thereof_Such shall be set ata mutually Formatoed Font:11 pt,Double underline,
----�-g p Font color.Black
- color:
.a -i -r n- 1. - r., fteen l5 . . r .. . n. - r rthirtv I 1_ r- 'y -
Formatted:List Paragraph,Indent First line:
days$ollx the daleShe appoe_al.was-receiyed by the health officer, o',Line spacing: single
Formatted:List Paragraph,Indent:Left: 0.5",
(iv)j3oard of health hearings shall be open to the public and presided over by the chair of the board Line spacing: single,Numbered+Level:5+
of health.Such hearings shall be recorded.Board of health hearings shall be opened with a Numbering Style:i,ii,iii,...+Start at:1+
recording of the time,date and place of the hearing,and a statement of the cause for the Alignment Left+Aligned at 2.76"+Indent
hearing.The hearing shall be limited to argument of the parties and no additional evidence at: 3.01"
shall be taken unless,in the judgment of the chair.such evidence could not have reasonablyFormatted:Font:11 pt,Double underline,
been obtained through the exercise of due diligence in time for the hearing before the health Font color:Black
officer.Argument shall be limited to the record generated before the health officer unless the Formatted:Font:11 pt,Double underline,
chair admits additional evidence hereunder- Font color:Black___________
• Formatted:
`---
Font color:Black 11 pt,Double underline,
(v) (E0-Any decision of the board of health shall be final and may be reviewed by an action filed in
superior court.Any action to review the board's decision must be filed within 30 business days Formatted:Font:11 pt,Double underline,
of th da a of rhe decision.. Font color:Black _ _ _
Formatted:Indent:Left: 0.5",Space After: 0
pt, No bullets or numbering,Font Alignment:
8.10.950(7)(3c)Allreyocation hearings_shallbeconducted_b-y.the_boariLofhealth. ,, Auto
Formatted:Font:11 pt,Double underline,
8.10.950(7)(4d II,- . .. r• x 11 •r- .., . .. . r-.i,• ..r ...-. 111 '1 . 1" .... m 1 ''', Underline color:Background 2,Font color:
health pursuant to_this section: FormattFormatted1...f 1l 1
•:.f Formatted 1••• 211
(i) Appeals_shall he made in writingand shall be signed and datedby the petitioning-party,_ 'i Formatted1...131-1
• ',. I Formatted — 1-.-1411
ii) lb)-Appeals shall include a brief and concise statement of the law and facts,which '''I Formatted NEM
affirmatively establish that the health officerhas committed an error1 Formatted
(Formatted --_j
(iii)„, :Ir., r 8- r i_ tr r-. a a- •., . m t t . . 111A r' : • r r.fr 1" I Formatted (-.1811
1
rZetltionurgparty together with all relevant_material associated with-thehealthofficer°s action,. ,-Fo-- �!matted _.—_..— —___f...1911
including but notlimited to.applications.,_reports,soil logs.photographs.staffanalysis and % ,,lFormatted _--... ..__ 1...1101)
recommendations. ','I Formatted (,..1111)
• I Formatted 1...1121
(iv) ..r - ••. a _r- .a..... m , -rials transmitted by JCPH,the board of health shall conduct 1 Formatted (---r131)
a_hearing._to_determine...the_correctness._of-tile slecision_by._the..health officer_within��ays.._.T11e .,`I`Formatted .__.-.-._ _ _......_...___ism
'f-
I Formatted IMO
36
•
S
petitionershall be_given five_days'notice by_certitled_mail of the.purpose,time,date and place
of saidlearing.Further.if the petitioning party is_a_person other than the permit applicant or a
en noticenftlieamtp_o_se.time,date_and_Place_of saidlearing shall likewise_be
mailed by certified mail to the permit applicant or permitholder.
Formatted:Font:11 pt,Double underline,
• Font color:Black
(v) tei-Any hearing conducted pursuant to this section.shall_be a Public hearing and_thc_cliairpers_on',
Fonnatted:List Paragraph,Indent:First line:
of the_board of health shall open the hearing and.take testimonv_from_any interested_persons;
provided,that testimony in suspension or revocation hearinp,s shall he limited to that presentedFNouninnatted_:tLeisvtzr5an+raNpuni„nlizngnt:stetylfte::
by_the healthffi
_ocer the certificate holder and any witness callcd..1?yfficrp;_provided further, +Start at:1+Alignment:Left+Aligned
that the chairperson my limit the length of the testimony to a specific amount of time to be at: 2.75"+Indent at: 3"
A• 0.01 I 0-0 II
hearings where the board of health is authorized to use its discretion.
C-Formatted:Font:11 pt,Double underline,
' I
Font color:Black
Ivi')The procedure to be utilized during any hearing conducted pursuant to this section shall be as ' - - -
Formatted:List Paragraph,Indent:First line:
follows: - o"a. The petitioning party.permit applicant,or permit holder and the health officer,if not ‘.
the petitioning party,shall be given an opportunity to present evidence,analysis and
recommendations.
b. Members of the board of health may direct questions to the petitioning_party.permit
applicant or permit holder and health officer. . .
-- - -
4110 c. The chairperson of the board of health shall permit the presentation of testimony by
any interested person as set forth in this chapter.
, 22.
d. Following presentation of evidence and testimony,the chairperson of the board
health shall close the hearingand initiate discussion with other board members on the -- r-
matters presented.
e. Following discussion.the board of health shall make J .ruling,pithe appeal.
Under no circumstances shall cross-examination of persons making presentations at the
hearing be permitted.notwithstanding that the board of health may ask questions as set
forth above.
Should_thebnard_of health requireAdditimaltestiniony,..itinaicontintie..the_p01ic• Formatted:Font:11 pt,Double underline,
Font color:Black
hearingto__a date and_time not to exceed 35 days following_the date of_the_initiaLpublic hearinp„;
Formatted:List Paragraph,Indent:Left: 0.5",
provided_that_atthe_close of the_secondpublic hearing the board of health may_contin_ue_ils Numb:rectia+rt tani:+5A-igNnumemtb,LjilLlegitstiy.
a
flea- . 'it .o.-. I .is 'fi' • d date not to exceed 3da_y_s_followingthe close r 2.75"+Indent at: 3"
Aligned
•
of the second public_hearing conducted to receiye additionaLlestin=v—In_all_othersases_the
boar, • - m, 00 '0 deliberations on die_aPPeal_to_another_slate and time not to
exceed 35 days following_the close of the_public_he.aring.
Formatted:Font:11 pt,Double underline,
Font color:Black
(viii) th) Relevant evidence is admissible,if m the onmion of the board of health it is the
best evidence reasonably obtainable having due_regarcl for itspecessity,availabilityand
trustworthinessi_provided that_in passing ttpni the_admissibility_of evidence the Jefferson
Cgty board of health may give consideration to but shall not be bound to follow.the rules of
evidence ' civ'l proceedings in matters not involvingalibyji_nthesiperior court
of the state of Washington. - -
37
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(ix)iii--A•-full_and complete rec_orsl-shall be keptof_all proceedings and all testimony shall be
rec11rded•_The record_t•f testimony and exhibits together with all papers and requests filed in the
proceedings shall constitute the exclusive record forthe decision in accordance with the law.
(x) {fit—All decisions shall become a part of the record and_shallinclude a statement of fmdines_and
conclusions.
(xi)£-1 -Notice..ofthe_decisionnf-the...board_of.health_shall be_provided__otlater_th_an 10 days
following the date_of its decision.
(xii} The petitioning party-permit pplicant-permit holder-or designated agent and
JCPH shall be notified of the decision of the board of health together with the findings and
conclusions.[Ord.6-121 --I Formatted:Font:11 pt,Double underline i
-•' ' _ .. _ - Deleted this section and added
• .. .. .. ... Comment[P22]:
the language from the On-site code.
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38
•
Formatted:Indent:Left: 0.61",Line spacing:
single
(8) Variances Formatted:Indent:Left: 0.61",Right: 0",
Line spacing: single
.
39
Hcal41�caih r review.
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le
8.10.950(8)VARIANCES
(a) Applicability.Any person who owns or operates a solid waste facility may apply to the {Formatted:Indent:Left: 0.5"
Health Officer for a variance from any paragraph of these regulations except as provided in
Section 950(8)(b)(iv)of these regulations. 411/1
(b) Granting Requirements.
(i) The Health Officer may grant such variance if it finds that:
(A) The solid waste handling practices or site location do not endanger public
health,safety or the environment and
(B) Compliance with the regulation from which variance is sought would produce
hardship on the applicant without equal or greater benefits to the public;and
(C) No other practicable or reasonable alternative exists. A practicable alternative • Formatted:Indent:Hanging: 0.31",Right:
is one that is available and capable of being carried out after taking into 0.12",Space Before: 0 pt
consideration cost,existing technology,and logistics in light of overall project
purposes,and better reducing or eliminating impacts to health and the
environment. It may include equipment or facilities not owned by the
applicant that could have reasonably been or be obtained,utilized,expanded,or
managed in order to manage,reduce,or eliminate impacts to health and the
environment. A reasonable alternative is one that could feasibly attain or
approximate compliance,but would better reduce or eliminate impacts to
health and the environment.
(ii) No variance shall be granted pursuant to this paragraph until the Health Officer has
considered the relative interests of the applicant,other owners of property likely to
be affected by the waste handling practices,and the general public.
(iii)Any variance or renewal shall be granted within the requirements of this paragraph
and for time period and conditions consistent with the reasons therefore,and within
the following limitations:
40
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(A) If the variance is granted on the grounds that there is no practicable means
known or available for the adequate prevention,abatement or control of
pollution involved,it shall be only until the necessary means for prevention,
abatement or control become known and available and subject to the taking of
any substitute or alternative measures that the Health Officer may prescribe.
(B) The Health Officer may grant a variance conditioned by a timetable if:
(1) Compliance with this regulation will require spreading of costs over a
considerable time period;and
(2) The timetable is for a period that is needed to comply with this regulation.
(iv)No variance from Chapters 173-350 WAC,Minimum Functional Standards for
Solid Waste Handling,and 173-351 WAC,Criteria for Municipal Solid Waste
Landfills,shall be granted by the Health Officer except with the approval and
written concurrence of Ecology prior to action on the variance by the Health
Officer.
(v) The Health Officer may grant variances from these regulations for standards that are
more stringent than the standards of Chapters 173-350 and 173-351 WAC,or from
provisions in these regulations that are not contained in Chapters 173-350 and
173-351 WAC,without Ecology approval.
(c) Application.
(i) The application shall be accompanied by such information as the Health Officer r
• may require.
(ii)An application for a variance,or for the renewal thereof,submitted to the Health
Officer shall be approved or disapproved by the Health Officer within ninety(90)
calendar days of receipt unless the applicant and the Health Officer agree to a
continuance.
shall be given bymailinga notice of the variance application to persons who
(iii)Notice PP�
have written to the Health Officer asking to be notified of all variance requests.
(d) Renewal. The Health Officer may renew any variance granted pursuant to this paragraph
on terms and conditions and for periods that would be appropriate on initial granting of a
variance. No renewal shall be granted except on written application. Any such application
shall be made at least sixty(60)calendar days prior to the expiration of the variance.
960 - REPEALER
Jefferson County Board of Health Solid Waste Regulations,Ordinance#09-0715-04,dated July 15,
2004 and Ordinance#08-0919-02,dated September 19,2002,are hereby repealed. In addition,if any
resolution,code,words,rules or regulations of Jefferson County Public Health is in conflict with this
regulation,they are hereby repealed to the extent necessary to give these regulations full force and
effect.
41
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--- Formatted:Heading 1,Indent:Left: 0",
970 - SEVERABILITY Hanging: 0.5"
�- - Formatted:Heading 1,Indent:Left: 0",
Hanging: 0.5",Space Before: 0 pt,Line
Should any paragraph,phrase,sentence or clause of these regulations be declared invalid or spacing: single
unconstitutional for any reason,the remainder of these regulations shall not be affected thereby.
Formatted:Heading 1,Indent:Left: 0",
990-CRITERIA FOR INERT WASTE Hanging: 0.5"
WAC 173-350-990,Inert Waste Criteria,is hereby adopted by reference,,
APPENDIX A. REFERENCES
The following is a list of Federal,State,and local laws,regulations,and documents referenced in
Jefferson County Board of Health Ordinance 09-1020-05,Solid Waste Regulations. Copies of these
documents may be found at the Port Townsend office of Jefferson County Public Health,the Jefferson
County Courthouse,or through your local library.
A. Federal:
1. United States Code(USC):
33 USC 1344 PARAGRAPH 404 OF THE FEDERAL CLEAN WATER ACT(PL 95-
217),PERMITS FOR DREDGED OR FILL MATERIAL
42 USC 300 SAFE DRINKING WATER ACT(PL 95-523)
42 USC 2011 ATOMIC ENERGY ACT OF 1954
42 USC 6901 RESOURCE CONSERVATION AND RECOVERY ACT OF 1976
(RCRA)
42 USC 9601 COMPREHENSIVE ENVIRONMENTAL RESPONSE
COMPENSATION AND LIABILITY ACT OF 1980(CERCLA)
2. Code of Federal Regulations(CFR):
10 CFR Part 20 STANDARDS FOR PROTECTION AGAINST RADIATION
40 CFR Part 61 NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR
POLLUTANTS
40 CFR Part 258 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS
40 CFR Part 503 STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE
3. Environmental Protection Agency:
SW-846 TEST METHODS FOR EVALUATING SOLID WASTE,PHYSICAL/
CHEMICAL METHODS
42
S
s
B. State:
1. Revised Code of Washington(RCW),Chapters:
7.80 CIVIL INFRACTIONS
42.17 DISCLOSURE-CAMPAIGN FINANCES-LOBBYING—RECORDS
43.21A DEPARTMENT OF ECOLOGY
46.37 VEHICLE LIGHTING AND OTHER EQUIPMENT
46.55 TOWING AND IMPOUNDMENT
70.05 LOCAL HEALTH DEPARTMENTS,BOARDS,OFFICERS-
REGULATIONS
70.93 WASTE REDUCTION,RECYCLING,AND MODEL LITTER
CONTROL ACT
70.94WASHINGTON CLEAN AIR ACT
70.95 SOLID WASTE MANAGEMENT-REDUCTION AND RECYCLING
70.95K BIOMEDICAL WASTE
76.04 FOREST PROTECTION
90.48 WATER POLLUTION CONTROL
2. Washington Administrative Code(WAC),Chapters:
173-160 MINIMUM STANDARDS FOR CONSTRUCTION AND
MAINTENANCE OF WELLS
173-200 WATER QUALITY STANDARDS FOR GROUND WATERS OF THE
STATE OF WASHINGTON
• 173-201A WATER QUALITY WASHINGSTANDARD
STATE OF TON
S FOR SURFACE WATERS OF THE
173-218 UNDERGROUND INJECTION CONTROL PROGRAM
173-240 SUBMISSION OF PLANS AND REPORTS FOR CONSTRUCTION
OF WASTEWATER FACILITIES
173-303 DANGEROUS WASTE REGULATIONS
173-304 MINIMUM FUNCTIONAL STANDARDS FOR SOLID WASTE
HANDLING
173-308 BIOSOLIDS MANAGEMENT
173-314 WASTE TIRE CARRIER AND STORAGE SITE LICENSES
173-350 STANDARDS FOR SOLID WASTE HANDLING
173-351 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS
173-425 OUTDOOR BURNING
197-11 SEPA RULES
246-203 GENERAL SANITATION
246-220 RADIATION PROTECTION-GENERAL PROVISIONS
246-232 RADIOACTIVE MATERIALS-LICENSING APPLICABILITY
296-24 GENERAL SAFETY AND HEALTH STANDARDS
296-62 OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR
CARCINOGENS
296-65 ASBESTOS REMOVAL AND ENCAPSULATION
480-70 SOLID WASTE AND/OR REFUSE COLLECTION COMPANIES
3. Washington State Department of Ecology(Ecology):
Ecology document 80-12,Biological Testing Methods
43
III
Ecology document 91-30: Guidance for Remediation of Petroleum Contaminated Soils
(revised November 1995)
Ecology document 93-51,Chemical Testing for Complying with the Dangerous Waste
Regulations
C. Local/Regional:
1. Jefferson County Public Health:
Jefferson County Comprehensive Solid Waste Management Plan(JCCSWMP)
JEFFERSON COUNTY BOARD OF HEALTH
David Sullivan.Chairm County Commissioner District#2 Jill Buhler,Hospital Commissioner {Formatted:Indent:Left: 0"
Formatted:Font:11 pt
Sheila Westerman,Citizen/City`(Vi r Kris Nelson,Port Townsend City Council {Formatted:Indent:Left: 0"
A. _1'Formatted:Font:11 pt
Phil Johnson,County Commissioner.District#1 Sally Aerts,Citizen County
John Austin,County Commissioner.District#3
GeoffMaaci,Me Jill Buhler,Member
David Sullivan,Chairman Sheila Westerman,Member
Roberta Frissell,Member Phil Johnson,Member
44
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JEFFERSON COUNTY BOARD OF HEALTH
• ' •
IFormatted:None,Indent:Left: 1.73",Right:
SOLIDANik-STE 1.73",Space Before: 3.9 pt,Line spacing:
'‘.sMgle
REGULATIONS
Dale
* Re executed by the Board of Health upon
meeting of the Board of Health held on June-14,,
2006.Date
•
• . .
„ -
- ,
County-Commisaionef District 1f2
Sheila Westerman,klemberCitizeniCity(\'ice
Chair) Kris Nelson,Port
45
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Phil Johnson,Counts/Commissioner.District i`1
Sally Aerts.Citizen County
.tr'rxfverrlable for gt ure
Junutxy 18,2007June 13.2014
46
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JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE NUMBER
SOLID WASTE REGULATIONS
JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE 09-1020-05
SOLID WASTE REGULATIONS
8.10.010 - AUTHORITY AND PURPOSE
These solid waste rules and regulations are promulgated under the authority of Chapters 43.20.050,
Powers and Duties of State Board of Health70.05,Local Health Departments,Boards, Officers-
Regulations,and 70.95,Solid Waste Management-Reduction and Recycling,in the Revised Code of
Washington(RCW),and Chapters 246-203,General Sanitation, 173-304,Minimum Functional
Standards for Solid Waste Handling, 173-350,Solid Waste Handling Standards,and 173-351,Criteria
for Municipal Solid Waste Landfills,in the Washington Administrative Code(WAC),to protect the
public health and the environment,and promote the safety and welfare of the citizens of Jefferson
County. All references to these RCWs and WACs,and all other RCWs,WACs,and other federal,state,
and local regulations,refer to the cited chapters and paragraphs,as amended. The rules and regulations
herein govern the handling,storage,collection,transportation,treatment,utilization,processing and final
disposal of all solid waste within Jefferson County,including the issuance of permits and enforcement.
These regulations shall apply to all persons and in all territory within the boundaries of Jefferson County,
except actions by persons on lands under the jurisdiction of the Federal Government or recognized
Native American Nations and Tribes.
It is expressly the purpose of these rules and regulations to provide for and promote the health of the •
general public,and not to create or otherwise establish or designate any particular class or group of
persons who will or should be especially protected or benefited by the terms of these rules and
regulations.
It is the specific intent of these rules and regulations to place the obligation of complying with its
requirements upon waste generators,haulers,and/or operators of solid waste handling sites,and no
provision of,nor term used in these rules and regulations is intended to impose any duty whatsoever
upon Public Health nor any of its officers or employees,for whom the implementation or enforcement
of these rules and regulations shall be discretionary and not mandatory.
Nothing contained in these rules and regulations is intended to be,nor shall be construed to create or
form the basis for any liability on the part of Public Health or its officers,employees or agents,for any
injury or damage resulting from the failure of any person subject to these rules and regulations to
comply with these rules and regulations,or by reason or in consequence of any act or omission in
connection with the implementation or enforcement of these rules and regulations on the part of Public
Health.
8.10.015 - ADOPTION BY REFERENCE
Pursuant to and by the authority of RCW 70.95,Jefferson County Public Health hereby adopts Chapter
173-350,Solid Waste Handling Standards,and Chapter 173-304,Minimum Functional Standards for Solid
Waste Handling. As provided for by RCW 70.95 Public Health makes the following amendments to
Chapter 173-350. To the extent that any state statute or regulation listed in this section is amended or
revised subsequent to the adoption of this chapter that amendment or revision is deemed incorporated into •
this Chapter and is applicable to any activity regulated by this Chapter.
2
S 8.10. 020 - APPLICABILITY
WAC 173-350-020 "Applicability", is adopted by reference except that subparagraph(6)is hereby
repealed. Single-family residences and single-family farms disposing of their own solid wastes on their
own property shall be subject to these regulations.
8.10.025 - OWNER RESPONSIBILITY FOR SOLID WASTES
WAC 173-350-025 is revised as follows:
1. General.
The owner,operator,or occupant of any premise,business,establishment,or industry shall be
responsible for the satisfactory and legal arrangement for the solid waste handling of all solid
waste generated or accumulated by them on the property. An owner is not relieved of the duties
and obligations imposed by this Chapter because the owner has leased the property or premises to
another or permitted others to occupy the premises or operate there.
2. Removal.
Solid waste shall be removed from the premises where it was generated to a permitted solid
waste handling facility at a frequency that does not create a nuisance or litter problem,or at a
• frequency otherwise approved by the Health Officer. The Health Officer may require any
person who does not store,remove,transport,or dispose of solid waste consistent with these
regulations,or who stores solid waste so as to create a nuisance or litter problem,to remove
solid waste from the premises where it was generated,or collected,by that person to a permitted
solid waste handling facility no less frequently than once per week.
3. Disposal.
(a) Generally. All solid wastes shall be disposed of at an appropriate solid waste handling facility
permitted to receive such waste,or in a manner consistent with these regulations as approved by
the Health Officer. Should a situation arise where disposal of solid waste is not covered under
these regulations,the Health Officer shall determine acceptability of a method of disposal for the
solid waste on a case-by-case basis
(b) Unlawful Dumping. It shall be unlawful for any person to dump,deposit,bury,or allow the
dumping,depositing or burying of any solid waste onto or under the surface of the ground or into
the waters of this state,except at a solid waste disposal site for which there is a valid permit.
Unlawful dumping shall include unauthorized deposition of solid waste into a container that is
owned or leased by another person.
(c) Name Appearing on Waste Material and Presumption. Whenever solid waste dumped in
violation of this regulation contains three(3)or more items bearing the name of one individual,
there shall be a presumption that the individual whose name appears on such items committed
the unlawful act of dumping.
(d) Identification Presumed. When the Health Officer investigates a case of unlawful dumping and
finds identification in the solid waste as described in Section 025(3)(c),or other evidence,he/she
may then order the person who committed the unlawful dumping to remove and dispose of said
3
solid waste according to these regulations. Following the disposal of said solid waste,the Health
Officer may order this person to present to the Health Officer a receipt from the permitted
disposal facility as proof of appropriate disposal.
(e) Lack of Identification. When the Health Officer investigates a case of unlawful dumping and
finds no identification in the solid waste,nor evidence,he/she may then order the property owner
to remove said solid waste from his/her land,and have the solid waste disposed of according to
these regulations. Where this occurs on private land,the property owner or occupant shall be
responsible for removal and disposal. Where this occurs on public land,the appropriate
governmental agency shall be responsible for removal and disposal.
(f) Burning Prohibited. It shall be unlawful for any person to burn solid waste including garbage
or rubbish unless these materials are burned in an appropriate permitted energy recovery or
incinerator facility. The burning of land clearing debris and the residential burning of natural
vegetative matter is regulated under Chapter 173-425 WAC,Outdoor Burning.
(g) Disposal Service Required. When a person does not dispose of solid wastes in a manner
consistent with these regulations,the Health Officer may order said person to obtain ongoing
and regularly scheduled solid waste collection service if said person does not already have this
service and if a solid waste collection service exists or is offered in the geographic area where
the person resides. Said service shall be from a solid waste collection service holding a Solid
Waste Handling Permit issued by Jefferson County Public Health and necessary certificates
issued by the Washington Utilities and Transportation Commission. If said person does not
have this service and resides in a geographic area where a single solid waste collection service
operates exclusively under covenant or ordinance as required by local government,and said
service is mandatory for persons residing within the jurisdiction of the local government,the
Health Officer may schedule ongoing regularly scheduled service for said person with this
solid waste collection service.If service is cancelled through nonpayment,it will be deemed a
violation of this paragraph.
(h) Disposal Receipts Required. Any person in violation of this paragraph to whom a notice and
order to correct violation has been issued is required to produce receipts from a permitted solid
waste disposal,recycling and/or reclamation facility or solid waste transporter to demonstrate
compliance with the notice and order to correct violation issued by Jefferson County Public
Health.
8.10.030 - EFFECTIVE DATES.
WAC 173-350-030,Effective Dates are hereby adopted by reference. The effective date of these
regulations is October 151,2014.
8.10.040 - PERFORMANCE STANDARDS.
WAC 173-350-040,Performance Standards,is hereby adopted by reference.
8.10. 100 - DEFINITIONS. 110
4
0 Terms used in this regulation shall have the meaning provided in WAC 173-350-100,hereby adopted in
its entirety by reference herein except as revised or altered by the definitions provided below. Terms
related to municipal solid waste landfills are contained in Chapter 173-351 WAC,Criteria for Municipal
Solid Waste Landfills.Terms related to landfills closed pursuant to Chapter 173-304,Minimum
Functional Standards for Solid Waste Handling.
Abandoned Landfills: Those sites not closed in accordance with all applicable regulatory
requirements in place at the time that waste handling/disposal activities ceased.
Abate: Repair,replace,remove,destroy,or otherwise remedy a condition(s)which constitutes a
nuisance or a violation of these regulations by such means,in a manner,and to such an extent as the
Health Officer determines is necessary in the interests of the general health,safety and welfare of the
community.
Abrasive Blasting: A method of surface preparation in which an abrasive aggregate is sprayed under
pressure on to exterior surfaces which include,but are not limited to,boats,ships or other watercraft.
Agricultural Wastes: Non-dangerous wastes on farms resulting from the production of agricultural
products including,but not limited to, crop residues,manures,animal bedding, and carcasses of dead
animals weighing each or collectively in excess of fifteen(15)pounds.
Animal Wastes: Wastes generated on a farm,including manure,pet feces,and dead animals.
Asbestos-Containing Material: Any material containing more than one percent(1%)asbestos as
determined using the method specified in EPA regulations Appendix E, Subpart E,40 CFR Part 763,
. Section 1,Polarized Light Microscopy.
Asbestos-Containing Waste Material: Any waste that contains or is contaminated with friable
asbestos-containing material. Asbestos-containing waste material includes asbestos waste from control
equipment,materials used to enclose the work area during an asbestos project,asbestos-containing
material collected for disposal,asbestos-contaminated waste,debris,containers,bags,protective
clothing,or HEPA filters.Asbestos-containing waste material does not include samples of asbestos-
containing material taken for testing or enforcement purposes.
Ashes: The residue from combustion or incineration of material including solid wastes and any air
pollution flue dust.
Biomedical Waste: Biomedical waste means,and is limited to,the following types of waste:
1. "Animal waste" is waste animal carcasses,body parts,and bedding of animals that are known to be
infected with,or that have been inoculated with,human pathogenic microorganisms infectious to
humans.
2. "Biosafety level 4 disease waste"is the waste contaminated with blood,excretions,exudates,or
secretions from humans or animals who are isolated to protect others from highly communicable
infectious diseases that are identified as pathogenic organisms assigned to biosafety level 4 by the
Centers for Disease Control,National Institute of Health,and Biosafety in Microbiological and
Biomedical Laboratories,current edition.
3. "Cultures and stocks"are wastes infectious to humans including specimen cultures,cultures and
III stocks of etiologic agents,wastes from production of biologicals and serums,discarded live and
attenuated vaccines,and laboratory waste that has come into contact with cultures and stocks of
5
etiologic agents or blood specimens. Such waste includes but is not limited to culture dishes,blood
specimen tubes,and devices used to transfer,inoculate,and mix cultures.
4. "Human blood and blood products"are waste human blood and blood components,and materials
containing free-flowing blood and blood products.
5. "Pathological waste"is human source biopsy materials,tissues,and anatomical parts that emanate
from surgery,obstetrical procedures,and autopsy. "Pathological waste"does not include teeth,
human corpses,remains,and anatomical parts that are intended for internment or cremation.
6. "Sharps waste"is all hypodermic needles,syringes with needles attached,intravenous tubing with
needles attached,scalpel blades,and lancets that have been removed from the original sterile
package.
Biomedical Waste Collection Service: Any agency,business,or service operated by a person for the
purpose of biomedical waste collection and transportation.
Biomedical Waste Generator: Any producer of biomedical waste to include without limitation the
following categories: General acute care hospitals,skilled nursing facilities or convalescent hospitals,
intermediate care facilities,in-patient care facilities for the developmentally disabled,chronic dialysis
clinics,community clinics,health maintenance organizations,surgical clinics,urgent care clinics,acute
psychiatric hospitals,laboratories,medical buildings,physicians offices and clinics,veterinary offices
and clinics,dental offices and clinics,funeral homes or other similar facilities.
Biomedical Waste Treatment: Means incineration,sterilization,or other method,technique,or
process that changes the character or composition of a biomedical waste so as to minimize the risk of
transmitting infectious disease.
Board of Health: The Jefferson County Board of Health.
Buffer Zone: That part of a facility that lies between the active area and the property boundary.Junk
cars are not allowed in a Buffer Zone as defined in Title 18 of Jefferson County Code.
Bulky Waste: Large items of refuse,such as appliances(white goods),furniture,junk vehicles,and
other oversize wastes which would typically not fit into reusable or disposable containers.
Construction Waste: Non-dangerous solid waste,largely inert waste,generated as the result of
construction of buildings,roads,and other man-made structures. Construction waste consists of,but is
not limited to:concrete,asphalt,brick,rock,wood and masonry,composition roofing and roofing paper,
shakes,shingles,plastic and paper wrappings,plastic pipe,fiberglass insulation,carpeting,floor tile,
glass,steel,and minor amounts of other metals like copper.
Demolition Waste: Non-dangerous solid waste,largely inert waste,resulting from the demolition or
razing of buildings,roads and other man-made structures.Demolition waste consists of,but is not
limited to:concrete,asphalt,brick,rock,wood and masonry,composition roofing and roofing paper,
shakes,shingles,plastic pipe,fiberglass insulation,carpeting,floor tile,glass,steel,minor amounts of
other metals like copper,and incidental amounts of soil associated with these wastes. Plaster(i.e.,sheet
rock or plaster board),yard wastes,stumpage,or any other materials that are likely to produce gases or
leachate during the decomposition process are not considered to be demolition waste for the purposes of
this definition. Bulky wastes,white goods,and asbestos-containing materials are not considered to be
demolition waste for the purpose of this regulation.
•
6
• Discarded Commodity: Products or items that because of damage,misuse,wear,or neglect(left out in
the weather to rot,rust or deteriorate)and because of such neglect are no longer being utilized for its
intended purpose.
Disposal Site: The location where any final treatment,utilization,processing or deposition of solid
waste occurs. See also the definition of interim solid waste handling site.
Drop Box Facility: A facility used for the placement of a detachable container, including the area
adjacent for necessary entrance and exit roads, unloading and turnaround areas. Drop box facilities
normally serve the general public with loose loads and receive waste from off-site
Ecology: The Washington State Department of Ecology.
Emission: The release of air contaminants from solid waste into the outdoor atmosphere.
Environmentally Sensitive Areas or"ESA": shall be as defined at RCW 36.70A.030(5)(or as
hereafter amended)to include wetlands,areas with a critical recharging effect on aquifers used for
potable water,fish and wildlife habitat conservation areas,frequently flooded areas and geologically
hazardous areas(and buffers for all such areas)as those terms are defined and described in Title 18 of
the Jefferson County Code in its current form or as it may be in the future,amended,supplemented or
replaced.Junk cars are not allowed in an ESA as defined in Title 18 of Jefferson County Code.
EPA: The United States Environmental Protection Agency.
Hazardous Substance: Any liquid,solid,gas,or sludge,including any material, substance,product,
commodity,or waste,regardless of quantity,that exhibits any of the physical,chemical or biological
properties described in WAC 173-303-090 or WAC 173-303-100.
Health Officer: The Health Officer or the Health Officer's representative,of the Jefferson County Public
Health.
Junk Vehicle: A junk vehicle includes campers,boats, boat trailers or any other type of vehicle used for
human transportation which may exhibit any of the following:
• Build-up of debris,moss or weeds on,in,under, or around the vehicle that obstructs use;
• Damage to the frame;
• More than one missing or shattered window or windshield;
• More than one inoperable or missing headlight or taillight;
• More than one flat tire;
• A missing or inoperable engine or transmission.
• A missing wheel, license plate, driver-side mirror,tire,body panel,door,hood or other obvious
body part,not including a bumper.
• A license plate that has been invalid for more than 60 days.
• Evidence that the vehicle has not been moved in at least 60 days.
A vehicle certified under RCW 46.55.230 as meeting at least three of following requirements:
1. Three(3)years old or older;
2. Extensively damaged,such damage including but not limited to the following:a broken window
or windshield,or missing wheels,tires,motor,or transmission;
3. Apparently inoperable;and/or
• 4. Has approximate fair market value equal only to the approximate value of the scrap in it.
7
For enforcement purposes,possessing three(3)junk cars on a single property of any size is not allowed •
under this regulation.
Minimum Functional Standards(MFS): Chapter 173-304 WAC,Minimum Functional Standards for
Solid Waste Handling.
Moderate Risk Waste(MRW): means solid waste that is limited to conditionally exempt small quantity
generator(CESQG)waste and household hazardous waste(HHW)as defined in this chapter.
Nuisance: Consists in unlawfully doing an act,or omitting to perform a duty,which act or omission
either annoys,injures or endangers the,repose,health or safety of others;or unlawfully interferes with,
obstructs or tends to obstruct,any lake or navigable river,bay,stream,canal or basin,or any public
park,square,street or highway;or in any way renders other persons insecure in life, or in the use of
property. To the extent applicable,the County adopts the definitions of nuisance found in Ch.7.48
RCW.
Owner: The person,business entity or partnership that is the title owner of record with the Jefferson
County Auditor for the parcel or parcels where the violation is allegedly occurring.
Person responsible: The owner,lessee,occupant or operator of the premises,business,activity or
action that is allegedly a violation of this Chapter.
Problem Wastes:
1. Any solid material removed during a remedial action,a dangerous waste site closure,other
cleanup efforts,or other actions,which contain hazardous substances,but are not designated •
dangerous wastes;
2. Dredge spoils resulting from the dredging of surface waters of the state where contaminants are
present in the dredge spoils at concentrations not suitable for open water disposal and the dredge
spoils are not dangerous wastes and are not regulated by Section 404 of the Federal Clean Water Act
(PL 95-217);or
3. Waste abrasive blasting grit or other material used in abrasive blasting. Common aggregates
include,but are not limited to silica sand,utility slag or copper slag. Waste abrasive blasting grit
does not include blasting grit that will be reused for its intended purpose.
Public Health: Jefferson County Public Health or any person acting on behalf of or employed by
Jefferson County Public Health.
Remedial Action: Any action to identify,eliminate or minimize any threat posed by hazardous
substances to human health or the environment including any investigative and monitoring activities
with respect to any release or threatened release of a hazardous substance and any health assessment or
health effects studies conducted to determine the risk or potential risk to human health.
Rubbish: All non-putrescible wastes from all public and private establishments and from all
residences.
Solid Waste: All putrescible and non-putrescible solid and semi-solid wastes including,but not limited
to,garbage,rubbish,ashes,industrial wastes,swill,animal wastes,construction and demolition wastes,
land clearing wastes,contaminated soils,contaminated dredged spoils,junk vehicles or parts thereof
(including waste tires),and discarded commodities. This includes all liquid,solid and semi-solid,
materials that are not the primary products of public,private,industrial,commercial,mining and
8
• agricultural operations. Solid waste also includes,but is not limited to,woodwaste,dangerous waste,
yard waste,bulky waste,biomedical waste,animal waste,waste tires,recyclable materials,and problem
wastes. Municipal sewage sludge or septage is a solid waste when placed in a municipal solid waste
landfill subject to the requirements in Chapter 173-351 WAC,Criteria for Municipal Solid Waste
Landfills,Chapter 173-308 WAC,Biosolids Management,and a solid waste handling permit issued by
the Health Officer.
Used Oil:
1. Lubricating fluids that have been removed from an engine crankcase,transmission,gearbox,
hydraulic device,or differential of an automobile,truck,bus,vessel,plane,heavy equipment,or
machinery powered by an internal combustion engine;or
2. Any oil that has been refined from crude oil,used,and as a result of use,has been contaminated with
physical or chemical impurities;or
3. Any oil that has been refined from crude oil and,as a consequence of extended storage,spillage,or
contamination,is no longer useful to the original purchaser;and
4. Used oil does not include oil to which dangerous wastes have been added,or oil that would
otherwise be considered used oil except that it is used as a fuel in an industrial furnace,which
meets the emission standards of the Puget Sound Clean Air Agency.
8.10.200 - Beneficial Use Permit Exemptions
4111,
WAC 173-350-100 Beneficial Use Permit Exemptions is hereby adopted by reference.
8.10. 210 - Recycling
WAC 173-350-210,Recycling is hereby adopted by reference.
8.10. 220 - Composting Facilities
WAC 173-350-220,Compost Facilities is hereby adopted by reference. Paragraph 220(7)has been
revised as follows:
220(7)Compost Facilities—Financial Assurance requirements.
(a) Financial Assurance may be required for certain compost facilities as determined by Public Health.
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism
in accordance with 173-350-600 for closure in accordance with the approved closure plan. The
funds shall be sufficient for hiring a third party to remove the maximum amount of wastes that
could be present at any time during the operation of the facility and to accomplish closure in
accordance with the facility closure plan.
• (c) If required,no owner or operator shall commence or continue to operate any part of the facility until
a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC
173-350-600.
9
•
8.10. 230 - Land Application
WAC 173-350-240,Land Application is hereby adopted by reference.
8.10.240 - Energy Recovery and Incineration
WAC 173-350-240,Energy Recovery and Incineration is hereby adopted by reference.
8.10.300 - On-site Storage, Collection, and Transportation
Standards
WAC 173-350-300,On-Site Storage,Collection,and Transportation Standard is hereby adopted
by reference and revised with the addition of the following paragraphs.
300(2)(b)(iv) Containers of mixed municipal solid waste,putrescible waste,and rubbish shall be
closed at all times except when waste is being added or removed. Commercial containers
located at public or private collection facilities may be kept open during routine hours of
operation,as long as the container drain plugs remain in place.
300(2)(b)(v) The owner,operator or occupant of any premises,business establishment or industry shall •
store all recyclable materials so as not to produce unsafe or unsanitary conditions.
8.10.305 - Solid Waste Handling Standards for Specific Waste
Stream
8.10.305(1) Animal Waste
(a) Animal waste,as defined in Section 100,shall be disposed of in a manner consistent with these
regulations,or other method approved by the Health Officer.
(b) Any animal waste that is deemed biomedical waste as defined in Section 100,shall be handled,
treated,and disposed of as required in Section 305(b).
(c) Animal Manure. Animal manure shall not be deposited,or allowed to accumulate,in any ditch,gulch,
ravine,river,stream,lake,pond,marine water,or upon the surface of the ground,or on any highway or
road right of way,where it may become a nuisance or menace to health,as determined by the Health
Officer,through the breeding of flies,harboring of rodents,or pollution of water. Manure shall not be
allowed to accumulate in any place where it can pollute any source of drinking water.
(d) Dead Animals. Except as otherwise provided in Section 305(3),dead animals shall be disposed of in a
manner to protect the public health and the environment. Their disposal shall be consistent with local
codes. Dead animals may be taken to a rendering plant,a veterinary clinic,an animal shelter,pet
cemetery,or can be disposed of directly at permitted operating landfills or transfer stations so as not to
create a nuisance. Property owners may bury dead animals on their property,so long as no nuisance is
•
created. If the dead animal is buried,it shall be placed so that every part shall be covered by at least
10
two(2)feet of earth and at a location not less than one-hundred(100)feet from any well,spring,
stream,or other surface waters,and in a place not subject to overflow. In all cases of death from
communicable disease,the dead animal,if disposed of by burial,shall first be thoroughly enveloped in
unslaked lime.
(e) Pet Feces. Pet feces,especially dog droppings,shall be disposed of in a manner,such as burial,or
bagging and placement into containers described in Section 300(2),which does not create a nuisance
or pollute surface waters of the state. Pet feces shall not be disposed of into the sanitary sewer
unless approved by the sewer purveyor. This waste shall not be put into a storm sewer or on-site
sewage system.
8.10.305(2) Asbestos-Containing Waste
(a) General. Asbestos-containing waste material (ACWM),as defined in Section 100,shall be handled
and disposed of pursuant to 40 CFR Part 61,National Emission Standards for Hazardous Air
Pollutants,Chapter 173-303 WAC,Dangerous Waste Regulations,Olympic Region Clean Air
Agency Rule 6.3 and Chapter 296-65 WAC,Asbestos Removal and Encapsulation.
(b) Removal. Persons removing ACWM shall contact the Olympic Region Clean Air Agency for
information and instruction concerning removal and disposal. ACWM must be wetted down during
removal to reduce airborne emissions of particulate matter. ACWM shall be sealed into leak tight
containers or placed in one or more plastic bags with a combined six(6)mils thickness or greater and
identified with the proper warning label.
(c) Disposal. The ACWM shall be disposed of in accordance with 40 CFR Part 61,National Emission
Standards for Hazardous Air Pollutants,at a facility permitted to receive such wastes,in accordance
with an approved operations plan,and covered with at least fifteen centimeters(6 inches)of non-
asbestos containing waste material immediately following disposal.
8.10.305(3)BIOMEDICAL WASTE
(a) Applicability. This regulation applies to all persons who generate biomedical waste including,
but not limited to,individuals,hospitals,medical and dental clinics,medical laboratories,nursing
or intermediate care facilities,veterinary facilities and other institutions,which may generate
biomedical wastes as defined in Section 100,without regard to the quantity of biomedical waste
produced per month.
(b) Storage and Handling.
(i) Containment of biomedical waste shall be in a manner and location which affords protection
from animals,rain,and wind and does not provide a breeding place or a food source for insects
or rodents.
(ii) Biomedical wastes shall be segregated from the general medical waste stream at the point of origin
and stored in separate containers. When possible,biomedical wastes should be rendered non-
infectious through chemical or physical treatment procedures as approved by the facility's site
safety officer.
(iii)Biomedical waste,except for sharps,shall be contained in disposable leakproof containers
having strength to prevent ripping,tearing or bursting under normal conditions of use. The
containers shall be secured to prevent leakage or expulsion of solid or liquid waste during
• storage,handling or transport. The containers can be of any color and shall be conspicuously
labeled with the international biohazard symbol,and the words"Biohazardous Waste"or words
that clearly denote the presence of biomedical waste.
11
(iv)All sharps,including home-generated sharps,shall be contained in leak-proof,rigid,puncture
resistant,break resistant containers that are labeled and tightly lidded during storage,handling and
transport. These containers must be capable of maintaining their structural integrity from the point
of storage to deposition at an approved disposal or collection site. The containers shall be of any
color and shall be conspicuously labeled with the international biohazard symbol,and the words
"Biohazardous Waste"or words that clearly denote the presence of biomedical waste.
(v) Reusable Containers.
(A) Reusable containers for biomedical waste storage,handling or transport shall be thoroughly
washed and decontaminated by a method approved by the Health Officer each time they are
emptied,unless the surfaces of the containers have been protected from contamination by
disposable liners,bags or other devices removed with the waste.
(B) Approved methods of decontamination are agitation to remove visible solid residue
combined with chemical disinfection. Chemical disinfectants should be used in accordance
with the manufacturer's recommendations or by disinfectant concentration/contact times
approved in writing by the Health Officer. Other decontamination methods may be
approved in writing by the Health Officer.
(C) Reusable pails,drums or bins used for containment of biomedical waste shall not be used for
any other purpose except after being disinfected by procedures as described in this regulation
and after the international biohazard symbol and the words"Biohazardous Waste"are
removed.
(vi)The handling and storage of all biomedical waste must prevent the dissemination of biomedical
waste into the environment.
(vii)Trash chutes shall not be used to transfer biomedical waste. 11111
(viii)Biomedical waste shall not be placed into the general waste stream unless contained and treated.
(ix)Sharps shall not be placed into the general waste stream.
(c)Disposal.
(i) All biomedical waste that has been contained as described in Section 305(3)(b) shall be
disposed of at a solid waste handling facility permitted to receive such waste.
(ii) All human or animal body parts, fetuses, and other pathological specimens shall be disposed of
either by appropriate interment,incineration or other method approved by the Health Officer.
(iii)Untreated liquid and liquefied biomedical waste may be disposed of by release into a sanitary
sewage system,if this practice is approved by the providing sewer utility,provided that the Health
Officer shall have the authority to require the treatment of any biomedical liquid,according to
requirements specified by the Health Officer,prior to release into a sanitary sewage system if
deemed necessary to protect the public health.
(iv)Biomedical waste shall be disposed of on a regular basis to avoid nuisance conditions. If
any nuisance condition exists,the Health Officer shall have the authority to require a
specific disposal or collection frequency.
(v) Sharps must be contained in accordance with Section 305(3)(b)(iv)and prepared for disposal by a
means that protects medical handlers,solid waste workers and the public from injury. The
disposal of sharps shall be limited to the following methods unless prohibited by the requirements
of Chapter 70.95K RCW,Biomedical Wastes:(No longer exempts home-generated sharps.) .
(A) Depositing properly contained sharps at a facility that has agreed to accept home
generated sharps.
12
• (B) Depositing properly contained sharps at a medical facility or pharmacy that provides a
program to dispose of sharps waste and that meets the requirements of these regulations.
(C) Using a permitted biomedical waste collection service.(E) Other methods approved by the
Health Officer.
(d) Transfer of Biomedical Waste. Any biomedical waste generator,who produces untreated biomedical
waste,shall have said waste collected and transported by a permitted biomedical waste collection
service.
(e) Inspection. The Health Officer shall have the authority to inspect any biomedical waste generator,at
any reasonable time,to determine if the generator's biomedical waste is being handled,stored,and
disposed of in accordance with this regulation,or to determine if the waste generator's solid waste is
being disposed of in accordance with this regulation.
(f) Disposal Service Required. When a person does not dispose of biomedical waste in a manner
consistent with these regulations,the Health Officer may order said person to obtain ongoing and
regularly scheduled biomedical waste collection and disposal service if said person does not have this
service and if commercial biomedical waste collection and disposal service exists in or is offered in the
geographic areas where the person resides. Said service shall be from a biomedical waste collection
and disposal service holding a Solid Waste Handling Permit issued by Public Health.
(g) Biomedical Waste Collection Services. In addition to the general operation and maintenance
requirements applicable to persons operating a solid waste collection service specified in Section 300,
vehicles used by biomedical waste collection services shall have a leak proof and fully enclosed
vehicle compartment constructed of durable and easily cleanable materials,and shall be identified on
each side of the vehicle with the name or trademark of the biomedical waste collection service.
8.10.305(4)BULKY WASTE
Bulky wastes shall be stored and transported in such a manner so as not to create a nuisance or safety
hazard.Recycling of bulky wastes is encouraged where programs have been established to accept
them. If recycling is not feasible,these wastes shall be taken directly to a disposal site permitted to
accept oversized waste. Land clearing bulky waste such as tree stumps,trees,portions of buildings
and other waste shall be transported directly to a transfer station or landfill designed and permitted to
accept these bulky wastes;provided,that nothing herein shall prevent these wastes from being
salvaged and/or used as firewood.
8.10.305(5)DANGEROUS WASTE
(a)All solid waste must be designated as required by WAC 173-303-070 to prevent the disposal of
dangerous waste at a facility not permitted to accept dangerous waste. All solid waste designated as a
dangerous waste must be managed in a manner consistent with these regulations and Chapter 173-303
WAC.
(b) The Health Officer may require the screening of any waste suspected of being a regulated dangerous
waste as defined in Section 100. The screening process may involve analytical testing,a disclosure of
the waste constituents and waste generation process,and other additional information necessary to
determine if the waste is dangerous. The Health Officer may establish a schedule for compliance as
part of the screening process. Based on the results of the required screening,the Health Officer may
require the generator or transporter to direct the waste to a facility permitted to handle such waste.
• 8.10.305(6)MODERATE RISK WASTE AND USED OIL
13
(a) Small Quantity Generator(SQG)Waste. II
(i) Applicability. This section applies to conditionally exempt small quantity generators
(SQGs) as defined in Section 100. In addition to the requirements of this section, SQGs
must meet the storage requirements of Section 305(6)(a)
(ii) Waste Designation. SQGs shall designate suspected or known dangerous wastes pursuant
to WAC 173-303-070 through WAC 173-303-100.
(iii) Container Labeling. SQGs shall label all containers of MRW and used oil with the name of the
waste and identify the major risk(s) associated with the waste in the container or tank for
employees, emergency response personnel and the public. Containers of MRW shall also be
labeled with the words"hazardous waste"or"dangerous waste".
(iv) Secondary Containment. The Health Officer may require an SQG to provide secondary
containment for liquid MRW and/or used oil stored on-site if the Health Officer determines that
there is a potential threat to public health or the environment due to the nature of the wastes being
accumulated,the location of accumulation,or due to a history of spills or releases from
accumulation containers. When required under this section,a secondary containment system
must be durable,compatible with the waste it is meant to contain,and large enough to contain a
volume equal to ten(10)percent of all containers,or one hundred and ten percent(110%)of the
largest single container,whichever is greater.
(v) Hazardous Materials Management Plans. If a SQG has violated any part of this regulation,
the Health Officer may require the SQG to prepare and follow a written Hazardous Materials
Management Plan approved by Public Health and in a format prescribed by Public Health.
(b) Storage Requirements.
III
(i) SQG Waste,used oil,and hazardous substances shall be stored in containers which are:
(A) Compatible with the waste contained therein;
(B) In good condition and without any leaks,corrosion or other signs of deterioration;
(C) Securely closed at all times except during the addition or removal of contents;and
(ii) Containers of SQG,used oil,and hazardous substances shall be stored on an impervious
surface and in a location(s)that is covered and controlled to prevent:
(A) Container deterioration due to weather exposure;
(B) Surface water run-on and run-off;
(C) Exposure to extreme temperatures;
(D) Unintentional discharge to stormwater, soil, or surface water;and
(E) Any other controllable condition,which may cause or increase the possibility of container
failure.
(c) Accumulation. In addition to the quantity exclusion limits(QELs)for small quantity generators
contained in WAC 173-303-070(8),SQG,used oil,and hazardous substances shall not be
accumulated in quantities that,in the opinion of the Health Officer,present a threat to public
health or the environment.
(d)Transportation. SQG and used oil shall be transported in accordance with WAC 173-350-
300(3)(d)Treatment and Disposal.
(i) SQG Waste. All SQG shall be transported to a permitted MRW collection facility,or picked up •
by a permitted dangerous waste transporter for treatment or disposal at a facility permitted to
14
• accept such waste. SQG shall not be deposited in the general municipal solid waste collection
system,a public sewer system,a storm drain,an on-site sewage system,in surface or ground
water,or onto or under the surface of the ground.
(ii) Pesticides. Usable pesticides shall be utilized in accordance with the EPA approved label
requirements,or shall be disposed of, as appropriate,at a permitted hazardous waste treatment,
storage,or disposal facility,the Jefferson County Moderate Risk Waste Collection Facility,or
through an approved Department of Agriculture collection event.(For additional information call
WSDA at 1-877-301-4555) Empty containers from canceled,suspended,or otherwise unusable
pesticides should be disposed of as a hazardous waste or triple rinsed in accordance with the
requirements under WAC 173-303-160(2)(b). Rinsate from a pesticide container must be reused in
a manner consistent with its original intended purpose or disposed of as a hazardous waste under
Chapter 173-303 WAC.
(iii)Used Oil. Used oil shall be recycled or disposed of at a facility permitted or approved for that
purpose,or as otherwise allowed by Ecology or the Health Officer. Used oil may be taken to
service stations or similar facilities that collect used oil for subsequent reprocessing at a facility
specifically permitted for that purpose.
(e) Mitigation and Control. The person responsible for a spill or non-permitted discharge of SQG,used
oil,and/or hazardous substances shall take appropriate and immediate action to protect public health
and the environment,including any necessary measure required to prevent the spread of
contamination. In addition,the person responsible for a spill or discharge shall:
(i) Notify Public Health and,when an imminent threat to public health or the environment
exists,call 911;
• (ii) Clean up any released hazardous substance,or take such actions as may be required or approved
by federal,state,or local officials;and
(iii)Meet applicable requirements of Section 305(7)as directed by the Health Officer.
8.10.305(7)PROBLEM WASTE
(a) Screening. Persons excavating problem waste as defined in Section 100,which is intended for upland
fill in Jefferson County and which may contain a hazardous substance,endanger the public health,or
adversely impact the environment,shall contact the Health Officer to determine the need for screening
in accordance with Section 305(9)(b)
(b) Management Options.
(i) Beneficial Reuse. Any person intending to beneficially reuse problem wastes must first contact
the Health Officer to determine the appropriate reuse options.
(ii) Treatment. Problem wastes may be treated to remove contaminants and,following treatment,
may be used as upland fill in Jefferson County if the treated waste is determined by the Health
Officer not to be a problem waste.
(iii)Disposal. Problem waste can only be disposed of at a solid waste handling facility permitted to
receive such waste.
(c) Waste Abrasive Blasting Grit Storage. Waste abrasive blasting grit shall be stored under cover in a
manner that minimizes contact with process water or stormwater. Persons recycling waste abrasive
blasting grit at a facility permitted to recycle such waste are exempt from the provisions of Section
305(7)(b)of these regulations provided that the recycling facility enlists a process and produces a
• final product that does not endanger human health or the environment as a result of using said
material.
15
8.10.305 (8) SEPTAGE
Septage must be disposed of directly into a sewage treatment works,licensed as such by Ecology,
with the permission of and according to the requirements of the sewage treatment works or disposed
of into an alternative treatment works or other process approved by the Health Officer. Septage of
domestic quality,meeting all applicable requirements for biosolids under Chapter 173-308 WAC,
Biosolids Management,may be beneficially reused by being applied to land as approved by the
Health Officer on a case-by-case basis.
8.10.310 - Intermediate Solid Waste Handling Facilities
WAC 173-350-310,Intermediate Solid Waste Handling Facilities is hereby adopted by reference.
8.10.320 - Piles Used for Storage or Treatment
WAC 173-350-320,Piles Used for Storage or Treatment is hereby adopted by reference. Paragraph
320(7)has been revised as follows:
320(7)Piles used for Storage or Treatment—Financial Assurance requirements.
(a) Financial Assurance may be required for certain piles treating or storing solid waste as determined
by Public Health. •
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism
in accordance with 173-350-600 for closure in accordance with the approved closure plan. The
funds shall be sufficient for hiring a third party to remove the maximum amount of wastes that
could be present at any time during the operation of the facility and to accomplish closure in
accordance with the facility closure plan.
(c) If required,no owner or operator shall commence or continue to operate any part of the facility until
a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC
173-350-600.
8.10.330 - Surface Impoundments and Tanks
WAC 173-350-330,Surface Impoundments and Tanks, is hereby adopted by reference. Paragraph
330(7)has been revised as follows:
330(7)Surface Impoundments and Tanks—Financial Assurance requirements.
(a) Financial Assurance may be required for certain surface impoundments and tanks used for treating or
storing solid waste as determined by Public Health.
(b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in
accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds
shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be
present at any time during the operation of the facility and to accomplish closure in accordance with4111
the facility closure plan.
16
(c) If required,no owner or operator shall commence or continue to operate any part of the facility until a
suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173-
350-600.
8.10.350 - Waste Tire Storage and Transportation
WAC 173-350-350, Waste Tire Storage and Transportation is hereby adopted by reference.
8.10.360 - Moderate Risk Waste Handling
WAC 173-350-360,Moderate Risk Waste Handling is hereby adopted by reference.
8.10.400 - Limited Purpose Landfills
WAC 173-350-400,Limited Purpose Landfills is hereby adopted by reference.
8.10.410 - Inert Waste Landfills
WAC 173-350-410,Inert Waste Landfills is hereby adopted by reference.
• 8.10.450 - Municipal Solid Waste Landfills
WAC 173-351,Criteria for Municipal Solid Waste Landfills is hereby adopted by reference.
8.10.460 - Construction and Notification Standards Near
Landfills
(1) Construction Requirements.
(a) Methane Protection.
(i) Any person constructing or developing any area within one-thousand(1,000)feet of the
footprint of an active,closed,or abandoned landfill shall provide documentation that
demonstrates that levels of methane gas within this one-thousand(1,000)foot zone are below
the lower explosive limits(LEL)under all conditions. A description of the investigation
methodology,all analytical data,and conclusions shall be presented in a report submitted by a
licensed professional engineer or professional geologist to the Health Officer and the local
building department for review and approval. Copies of this report shall also be provided to
the Washington Department of Ecology and the Puget Sound Clean Air Agency;and
(ii) Any person constructing or developing any area within one-thousand(1,000)feet of the
footprint of an active,closed,or abandoned landfill shall provide documentation that
demonstrates that all enclosed structures are protected from potential methane migration.The
method for ensuring a structure's protection from methane shall be addressed in a report
submitted by a licensed professional engineer to the Health Officer and the local building
17
•department for approval. Such a report shall contain a description of the mitigation measures
to prevent the accumulation of explosive concentrations of methane gas within or under
enclosed portions of a building or structure. At the time of final inspection,the engineer shall
furnish a signed statement attesting that the building or structure has been constructed in
accordance with his/her recommendations for addressing methane gas migration.
(iii)The Health Officer may grant a variance to the requirements in Section 460(1)(a)(ii)above,
based on a review of data submitted pursuant to preceding Section 460(1)(a)(i).
(b) Stormwater. To minimize erosion impacts and leachate generation,no person shall detain
stormwater on a closed or abandoned landfill. Stormwater may be conveyed across a closed or
abandoned landfill if the conveyance system has been engineered to minimize the percolation of
stormwater into the landfill.
(c) Construction within the Footprint of the Landfill. No person shall construct within the footprint of
a closed or abandoned landfill without first having submitted detailed engineering plans
documenting how potential hazards will be controlled. Potential hazards include,but are not
limited to,subsidence,methane,odor problems,hazards associated with subsurface utility
installation,and leachate generation. A qualified,licensed Professional Engineer(PE)shall sign
such plans. These plans must be submitted for review and approval to the jurisdictional building
department and Public Health,or Public Health's designated representative.
(d) Groundwater Supply Wells. No person shall construct a groundwater supply well within one-
thousand(1,000)feet of an active,closed,or abandoned landfill property boundary without a
formal request for variance as outlined in Chapter 173-160 WAC,Minimum Standards for the
Construction and Maintenance of Wells.
(e) Methane Monitoring. All landfills where methane gas is generated shall provide for adequate •
venting,collecting,redirecting,or elimination of gases generated by solid waste.
It shall be the responsibility of the landfill owner/operator to develop a sampling and testing
program to monitor gas production and potential migration.
(2) Notification Requirements for Owners of Landfills.
All owners of active,closed,or abandoned landfills shall:
(a) File a Notice to Title with the County Auditor's office noting the presence of a landfill on the
tax parcel within one-hundred and eighty(180)days of the effective date of these regulations.
(b) For any property without notice to title,Public Health may file a notice to title regarding the
presence of a landfill on the property.
(c) Disclose the presence of an active,closed,or abandoned landfill to all prospective
purchasers of the property.
8.10.490 - Other Methods of Solid Waste Handling
WAC 173-350-490,Other Methods of Solid Waste Handling is hereby adopted by reference.
8.10.500 - Ground Water Monitoring
WAC 173-350-500,Ground Water Monitoring is hereby adopted by reference.
18
111) 8.10.600 - Financial Assurance Requirements
WAC 173-350-600,Financial Assurance Requirements is hereby adopted by reference. Paragraph
600(1)of the WAC is revised by adding the following subparagraph.
(d) Certain waste piles;certain surface impoundments and tanks; and certain compost facilities as
determined by Public Health.
8.10.700 - Permits and Local Ordinances
WAC 173-350-700,Permits and Local Requirements, is hereby adopted by reference. Section 700(1)of
the WAC is revised by adding the following subparagraph.
(d) Landfills closed pursuant to this Chapter 173-351,Mixed Municipal Solid Waste Landfills or Chapter
173-304 are required to obtain a closure-post closure permit.
(e) Permit holders must comply with all rules and intent of the Jefferson County Comprehensive Solid
Waste Management Plan(JCCSWMP).
8.10.710 - Permit Application and Issuance
WAC 173-350-710,Permit Application and Issuance is hereby adopted by reference.
• Appeal of a Permit Denial.Any person aggrieved by the denial of permit denial shall:
1. Within 10 days of receiving the written letter denying a permit,the appellant shall request a hearing
in writing. The appellant shall submit specific statements in writing of the reason why error is
assigned to the decision of the health officer.
2. Upon receipt of such request together with hearing fees,the health officer shall notify the person of
the time, date, and place of such hearing,which shall be set at a mutually convenient time not less
than five business days or more than 30 business days from the date the request was received.
3. Within 30 days,the Health Officer will issue a decision upholding or reversing public health's action.
The health officer may require additional actions as part of the decision.
8.10.715 - General Permit Application Contents
WAC 173-350-715,General Permit Application Contents is hereby adopted by reference.
8.10.900 - Corrective Action
WAC 173-350-900,Corrective Action is hereby adopted by reference.
• 8.10.950 - Administration And Enforcement
(1) Other Laws,Regulations and Agency Requirements
19
(a) All solid waste management shall be subject to the authority of other laws,regulations or other •
agency requirements in addition to these rules and regulations. Nothing in these rules and
regulations is intended to abridge or alter the rights of action by the state or by persons,which exist
in equity,common law or other statutes to abate pollution or to abate a nuisance.
(b) Chapter 173-350 WAC,Minimum Functional Standards for Solid Waste Handling,is
hereby adopted by reference.
(c) If a conflict exists in the interpretation of Chapter 173-350 WAC and these regulations,or in the
interpretation of Chapter 173-351 WAC and these regulations,the more stringent regulation
shall apply to better protect public health and the environment.
8.10.950(2)ENFORCEMENT AUTHORITY
The Health Officer,his or her designee,or any person appointed as an"Enforcement Officer"by the
Jefferson County Board of Health shall have the authority to enforce the provisions of these
regulations equally on all persons. The Health Officer is also authorized to adopt rules consistent with
the provisions of these rules and regulations for the purpose of enforcing and carrying out its
provisions.
8.10.950(3)RIGHT OF ENTRY
(a) Whenever necessary to make an inspection to enforce or determine compliance with the provisions
of these regulations,and other relevant laws and regulations,or whenever the Health Officer has
cause to believe that a violation of these regulations has or is being committed,the Health Officer or
his/her duly authorized inspector may,in accordance with federal and state law,seek entry of any
building,structure,property or portion thereof at reasonable times to inspect the same.
(b) Prior to entering any building,structure,property or portion thereof the Health Officer or his/her
duly authorized inspector shall attempt to secure the consent of the owner,occupant or other person
having apparent charge or control of said building,structure,property or portion thereof.
(i) If such building,structure,property or portion thereof is occupied,the inspector shall present
identification credentials,state the reason for the inspection,and request entry.
(ii) In attempting to contact the owner,occupier or other persons having apparent control of said
building,structure,property or portion thereof,the inspector may approach said building or
structure by a recognizable access route,e.g.,a street or driveway,leading to said building or
structure.
(c) If permission to enter said building,structure,property or portion thereof is not obtained from the
owner,occupier or others persons having apparent control of said building,structure,property or
portion thereof,the Health Officer or his/her duly authorized inspector shall also have recourse
to any other remedies provided by law to secure entry.,
8.10.950(4)INSPECTIONS-PERMITTED FACILITIES
(a) General.At a minimum,the Health Officer may,to the extent resources permit,perform annual
inspections of all permitted solid waste facilities. Findings shall be noted and kept on file. The
Health Officer shall furnish a copy of the inspection report,or annual summary,to the site
operator.
(b) Pre-Operational Inspection.Whenever plans and specifications are required by these regulations •
to be submitted to the Health Officer,the Health Officer may inspect the proposed solid waste
20
• disposal site, solid waste handling facility,or solid waste collection service prior to the start of
the operations to verify compliance with approved plans and specifications.
8.10.950(5)NOTICE AND ORDER TO CORRECT VIOLATION
(a) Issuance. Whenever the Health Officer determines that a violation of these regulations has
occurred or is occurring, he/she may issue a written notice and order to correct violation to the
property owner or to any person causing,allowing or participating in the violation.
(b) Content. The notice and order to correct violation shall contain:
(i) The name and address of the property owner or other persons to whom the notice and order to
correct violation is directed;
(ii) The street address or description sufficient for identification of the building, structure,
premises,or land upon or within which the violation has occurred or is occurring;
(iii)A description of the violation and a reference to that provision of the regulation,which has
been violated;
(iv)A statement of the action required to be taken to correct the violation and a date or time by which
correction is to be completed;
(v) A statement that each violation of this regulation shall be a separate and distinct offense and in
the case of a continuing violation,each day's continuance shall be a separate and distinct
violation;
0 (vi)A statement that the person,to whom the Notice and Order is directed,can appeal the Order to
the Health Officer,in accordance with the terms of this Chapter,and that any such appeal must
be presented to the Health Officer with ten days;
(vii) A statement that the failure to obey this notice may result in the issuance of a notice of civil
infraction,and/or the assessment of an administrative remedy,and/or,if applicable,the imposition
of criminal penalties.
(c) Disposal Receipts. The notice and order to correct violation may also include a statement requiring
the person to whom the notice and order to correct violation is directed to produce receipts from a
permitted solid waste disposal facility,permitted hazardous waste facility, or the local household
hazardous waste facility(moderate risk waste facility)or transporter to demonstrate compliance
with an order issued by the Health Officer.
(d) Service of Order. The notice and order to correct violation shall be served upon the person to whom
it is directed,either personally or by mailing a copy of the order to correct violations by first class
and/or certified mail postage prepaid,return receipt requested,to such person at his/her last known
address. The notice and order to correct violation shall also be served via certified mail/return
receipt requested to the owner of the parcel or parcels where the alleged violations are occurring to
the owner's last known address.
(e) Extension. Upon written request received prior to the correction date or time,the Health Officer
may extend the date set for corrections for good cause. The Health Officer may consider
substantial completion of the necessary correction or unforeseeable circumstances that render
completion impossible by the date established as a good cause.
• (f) Supplemental Order to Correct Violation. The Health Officer may at any time add to,rescind in
part,or otherwise modify a notice and order to correct violation. The supplemental order shall be
21
governed by the same procedures applicable to all notice and order to correct violations •
procedures contained in these regulations.
(g) Enforcement of Order. If, after any order is duly issued by the Health Officer,the person to whom
such order is directed fails,neglects,or refuses to obey such order,the Health Officer may:
(i) Utilize any remedy or penalty under Section 950(6)of these regulations;and/or
(ii) Abate the health violation using the procedures of these regulations;and/or
(iii)Pursue any other appropriate remedy at law or equity.
(h) Written Assurance of Discontinuance.The Health Officer may accept a written assurance of
discontinuance of any act in violation of this regulation from any person who has engaged in such
act. Failure to comply with the assurance of discontinuance shall be a further violation of this
regulation.
8.10.950(6)VIOLATIONS,REMEDIES AND PENALTIES
8.10.950(6)
(a) Violations.
(i) Violations of these regulations may be addressed through the remedies and penalties
provided in this section.
(ii) Each violation of these regulations shall be a separate and distinct offense and in the case of a
continuing violation,each day's continuance shall be considered a separate and distinct
violation. •
(iii)The Health Officer may investigate alleged or apparent violations of these regulations. Upon
request of the Health Officer,the person allegedly or apparently in violation of these regulations
shall provide information identifying themselves.
(iv)Violations,apparent or alleged,that occurred or are occurring in environmentally sensitive areas,
as that term is defined in this Chapter,of Jefferson County will have the highest priority for
investigation by those persons charged in this Chapter with investigating such violations and
enforcing this Chapter and such violations will be subject to a 'zero tolerance' policy.
8.10.950(6)
(b)Civil Remedies.
(i) Except as provided in Section 950(6)(b)(ii),the violation of any provision of these regulations is
designated as a Class 1 civil infraction pursuant to Chapter 7.80 RCW,Civil Infractions.
(ii) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)or waste in an
amount greater than one(1)cubic foot has committed a Class I civil infraction pursuant to
Chapter 7.80 RCW,Civil Infractions. Any person who unlawfully dumps solid waste in an
amount less than or equal to one(1)cubic foot has committed a Class 3 civil infraction pursuant to
Chapter 7.80 RCW. The court may also impose restitution for any violation.
(iii)The Health Officer may issue a notice of civil infraction pursuant to Chapter 7.80
RCW if the Health Officer has reasonable cause to believe that the person has violated any
provision of these regulations or has not corrected the violation as required by a written notice and
order to correct violation. Civil infractions shall be issued,heard and determined as described in •
Chapter 7.80 RCW,and any applicable court rules.
22
• (iv)All other legal and equitable remedies are also deemed available to Public Health or its Health
Officer and may be invoked,utilized or sought at any time regardless of whether other remedies
have or have not been undertaken or sought.
8.10.950(6)
(c) Criminal Penalties.
(i) Any person who unlawfully dumps biomedical waste as described in Section 025(3)(b)shall be,
upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$1,000,or
imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also impose
restitution.
(ii) Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or
RCW 70.105.010(5)in violation of RCW 70.105.090 shall be,upon conviction,guilty of a
misdemeanor. The court may also impose restitution.
(iii)Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or
RCW 70.105.010(5)in violation of RCW 70.105.085 shall be,upon conviction,guilty of a felony.
The court may also impose restitution.
(iv)Any person who unlawfully dumps solid waste as described in Section 025(3)(b)and in an amount
less than one(1)cubic yard,but greater than(1)cubic foot,shall be,upon conviction,guilty of a
misdemeanor,and shall be subject to a fine of not more than$1,000,or imprisonment in the county
jail not to exceed ninety(90)days,or both. The court may also impose restitution as stated in
Chapter 70.95 RCW,Solid Waste Management-Reduction and Recycling.
(v) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)of these
• regulations and in an amount greater than(1)cubic yard, shall be,upon conviction,guilty of a gross
misdemeanor,and shall be subject to a fine of not more than$5,000,or imprisonment in the county
jail not to exceed one(1)year,or both. The court may also impose restitution as stated in Chapter
70.95 RCW, Solid Waste Management-Reduction and Recycling.
(vi)Any person who fails,neglects,or refuses to obey an order of the Health Officer to correct a
violation as set forth in Section 950(5)(g)above shall be,upon conviction,guilty of a
misdemeanor and shall be subject to a fine of not more than$100,or imprisonment in the
county jail not to exceed ninety(90)days,or both. The court may also impose restitution.
(vii)Any person who fails,neglects,or refuses to comply with a written assurance of discontinuance
pursuant to Section 950(5)(h)above shall be,upon conviction,guilty of a misdemeanor and
shall be subject to a fine of not more than$100,or imprisonment in the county jail not to exceed
ninety(90)days,or both. The court may also impose restitution.
(viii)Any person who operates a solid waste facility or collection service without a permit shall be,
upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$1,000,
or imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also
impose restitution.
(ix) Any person who operates a solid waste facility or collection service after a permit has been
revoked shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not
more than$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both.
The court may also impose restitution.
• 8.10.950(6)
23
(d) Noncompliance Fees.
(i) Pursuant to the most current Public Health fee schedule adopted by the Board of Health,Public
Health may assess a noncompliance fee to a permittee or small quantity generator for the
following:
(A)Public Health oversight and review required as a result of the Health Officer's determination
that a permitted facility or small quantity generator is not in compliance with its permit and/or
applicable regulations and has not met the compliance dates specified in a notice and order to
correct violation;or
(B) Amendments to an existing Public Health permit required as a result of the permitted
facility not being in compliance with its permit and/or applicable regulations.
(C)Second and subsequent re-inspections conducted by Public Health in response to the permittee
or small quantity generator not complying with their permit and/or J.C.C.code or the permittee
not meeting the requirements outlined in a notice and order to correct violation.
(ii) Whenever a re-inspection fee is assessed by Public Health,the fee shall be due and payable
thirty(30)days after receipt of the invoice by the permittee.
(iii)The noncompliance fee shall not be assessed in addition to the permit fee for permitted facilities
where permit fees,as described in the most recent Public Health fee schedule,specifically include
those Public Health activities described in Section 950(6)(d)(i).
8.10.950(6)
(e) Stop-Work Orders.The Health Officer may cause a Stop-Work order to be issued whenever the Health
Officer has reason to believe that a violation of this regulation is occurring. The effect of the Stop-
Work order shall be to require the immediate cessation of such work or activity that has contributed to
the violation until authorized by the Health Officer to proceed.
(i)Content. A Stop-Work Order shall include the following:
(A)The name and address for the person responsible for the alleged violation;
(B)The street address or description sufficient for identification of the building,structure or
premises,or land upon or within which the alleged violation has occurred or is occurring.
(C)A description of the violation and reference to the provision of the Jefferson County Board of
Health Ordinance,which has been allegedly violated;
(D)The required corrective action;
(E) A statement that a failure to comply with the order may lead to issuance of a civil
infraction to the person named in the order;
(F) A statement that the person to whom the Stop Work Order is directed can appeal the Order to
the Health Officer in accordance with the§950(7)of this Chapter and that any such appeal
must be presented to the Health Officer with ten days.
(ii)Service of Notice. The Health Officer shall serve the Stop Work Order upon the owner of the
property where the alleged violation occurred or is occurring and the person,firm or business entity
that has allegedly violated this Chapter,either personally or by mailing a copy of the notice by
regular and certified or registered mail,within a five-day return receipt requested,to the owner at
his or her last known address. A copy of the Order shall also be posted on the property where the
alleged violation occurred or is occurring.
(iii)Posting of Notice. In addition to service of the notice listed above,an additional notice shall be •
posted on the property in substantially the following form:
24
•
Under the authority of Jefferson County Public Health Ordinance 09-1020-05,Solid Waste Regulations
you are hereby required to immediately
STOP WORK
This order is in effect at this property for all work and activities that relate to violations of Jefferson
County Public Health Ordinance 09-1020-05,Solid Waste Regulations,and remains in effect until
removed by Public Health. It is a violation of these regulations to remove,deface,destroy,or conceal a
posted Stop Work Order. FAILURE TO COMPLY WITH THIS ORDER MAY RESULT IN THE
ISSUANCE OF A CIVIL INFRACTION.
8.10.950(6)(f)Voluntary Correction. When the Health Officer determines that a violation has occurred
or is occurring,he or she shall attempt to secure voluntary correction by contacting the person
responsible for the alleged violation and,where possible,explaining the violation and requesting
correction.
(i) Voluntary Correction Agreement. The person responsible for the alleged violation may enter into a
voluntary correction agreement with Public Health. The voluntary correction agreement is a
contract between Public Health and the person responsible for the violation in which such person
agrees to abate the alleged violation within a specified time and according to specified conditions.
The voluntary correction agreement will be in lieu of the issuance of further citations or the
abatement of the property pursuant to RCW 7.48 or §950(6)(g) of this Chapter. The voluntary
correction agreement shall include the following:
(A)The name and address of the person responsible for the alleged violation;
• (B)The street address or other description sufficient for identification of the building,structure,
premises,or land upon or within which the alleged violation has occurred or is occurring;
(C)A description of the alleged violation and a reference to the regulation,which has been
violated;
(D)The necessary corrective action to be taken,and a date or time by which correction must
be completed;
(E)An agreement by the person responsible for the alleged violation that Public Health may enter the
property and inspect the premises as may be necessary to determine compliance with the voluntary
correction agreement;
(F)An agreement by the person responsible for the alleged violation that Public Health may enter
the property to abate the violation and recover its costs and expenses(including administrative,
hearing and removal costs)from the person responsible for the alleged violation if the terms of
the voluntary correction agreement are not satisfied;and
(G)An agreement that by entering into the voluntary correction agreement,the person responsible
for the alleged violation waives the right to a hearing before the Health Officer under these
regulations or otherwise,regarding the matter of the alleged violation and/or the required
corrective action.
(i) Right to a Hearing Waived.By entering into a voluntary correction agreement,the person
responsible for the alleged violation waives the right to a hearing before the Health Officer
under these regulations or otherwise,regarding the matter of the violation and/or the required
corrective action. The person responsible for the alleged violation may,by through written
documentation provided to the Health Officer,state his or her decision to reject and nullify
25
the voluntary correction agreement,at which time that person is entitled to an appeal to the •
Health Officer pursuant to§950(7)of this Chapter.
(ii) Extension and Modification.The Health Officer may,at his or her discretion,grant an
extension of the time limit for correction or a modification of the required corrective action if
the person responsible for the alleged violation has shown due diligence and/or substantial
progress in correcting the violation,but unforeseen circumstances have delayed correction
under the original conditions.
(iii)Abatement by Public Health.The county may abate the alleged violation in accordance with
Section 950(6)(g)if all terms of the voluntary correction agreement are not met,except that
the person responsible for the alleged violation shall not have a right to appeal the
Abatement Order.
(iv)Collection of Costs.If all terms of the voluntary correction agreement are not met,the
person responsible for the alleged violation shall be assessed all costs and expenses of
abatement,as set forth in Jefferson County Public Health Ordinance
09-1020-05,§950(6)(g).
8.10.950(6)(g)Abatement Orders.Where the Health Officer has determined that a violation of these
regulations has occurred or is occurring,he or she may issue and Abatement Order to the person
responsible for the alleged violation requiring that the unlawful condition be abated within a
reasonable time period as determined by the Health Officer.
(i) Prerequisite to Abatement Order. Absent conditions which pose an immediate threat to the public
health,safety or welfare of the environment,the procedures for abatement of conditions constituting
a violation of these regulations should only be utilized by Public Health only after corrections of
such conditions have been attempted through the use of the civil infractions process. Once it has
been determined by Public Health that there is no immediate threat to the public health's safety or
4111
welfare and that correction of such conditions has not been adequately achieved through use of the
civil infraction process,then Public Health is authorized to proceed with abatement of such
conditions pursuant to these regulations. Public Health shall also attempt to enter into a voluntary
corrections agreement prior to issuing an Abatement Order.
(ii) Content. An Abatement Order shall include the following:
(A)The name and address for the person responsible for the alleged violation;(B) The street
address or description sufficient for identification of the building,structure or premises,or land
upon or within which the alleged violation has occurred or is occurring;
(B)A description of the violation and reference to the provision of the Jefferson County Board of
Health Ordinance,which has been allegedly violated;
(C)The required corrective action and a date and time by which the correction must be completed and
after which,the Health Officer may abate the unlawful condition in accordance with§950(6)(g)
of this Chapter.
(D)A statement that the costs and expenses incurred by Public Health pursuant to§950(6)(g)of this
Chapter,including any amount expended on staff time to oversee the abatement,may be assessed
against a person to whom the Abatement Order is directed in a manner consistent with this Chapter;
and
(F) A statement that the person to whom the Abatement Order is directed can appeal the Order
to the Health Officer in accordance with§950(7)of this Chapter.
(iii)Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the
•
property where the alleged violation occurred or is occurring,either personally or by mailing a copy
26
S
of the notice by regular and certified or registered mail,a five-day return receipt requested,to the
owner at his or her last known address. The Order shall also be served on each of the following if
known to the Health Officer or disclosed from official public records:the holder of any mortgage or
deed of trust or other lien or encumbrance of record;the owner or holder of any lease of record and
the holder of any other estate or legal interest of record in or to the property or any structures on the
property. The failure of the Health Officer to serve any person required herein to be served,shall
not invalidate any proceedings hereunder as to any other person duly or relieve any such person
from any duty or obligation imposed by the provisions of this section. A copy of the Order shall
also be posted on the property where the alleged violation occurred or is occurring.
(iv)Authorized Action by Public Health. Using any lawful means,Public Health may enter the subject
property and may remove or correct the condition that is subject to abatement.
(v) Recovery of Costs and Expense. The costs of correcting a condition which constitutes a violation
of these regulations,including all incidental expenses,shall be billed to the owner of the property
upon which the alleged violation occurred or is occurring,and shall become due within fifteen
calendar days of the date of mailing the billing for abatement. The term"incidental expenses"
includes,but is not limited to,personnel costs,both direct and indirect and including attorney's
fees;costs incurred in documenting the violation;towing/hauling,storage and removal/disposal
expenses;and actual expenses and costs to Public Health in preparing notices,specifications and
contracts associated with the abatement,and in accomplishing and/or contracting and inspecting
the work;and the costs of any required printing and mailing.
(vi)Collection of Costs and Expenses. The costs and expenses of correcting a condition,which
constitutes a violation of these regulations,shall constitute a personal obligation of the person to
whom the Abatement Order is directed. Within fifteen days of abating any violation,the Health
Officer shall send the person named in the Abatement Order a bill that details the work performed,
. materials removed,labor used and the costs and expenses related to those tasks as well as any other
costs and expenses incurred in abating the violation.
8.10.950(6)(h)Notice to Vacate. When a condition constitutes a violation of these regulations and poses
an immediate threat to life,limb,property or safety of the public or persons residing on the property,
the Health Officer may issue a Notice to Vacate.
(i)Content. A Notice to Vacate shall include the following:
(A)The name and address for the person responsible for the alleged violation;(B) The street
address or description sufficient for identification of the building,structure or premises,or land
upon or within which the alleged violation has occurred or is occurring;
(C)A description of the violation constituting an emergency and reference to the provisions of the
Jefferson County Board of Health regulations,which has been allegedly violated;
(D)A date,as determined by the severity of the emergency,by which any persons must vacate the
premises. In case of extreme danger to persons or property immediate compliance shall be
required;
(E) The required corrective action;
(F) A statement that the person to whom the Notice to Vacate is directed can appeal the order to the
Health Officer in accordance with§950(7)of this Chapter and that any such appeal must be
presented to the Health Officer with ten days.
(ii) Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the
• property where the alleged violation occurred or is occurring,either personally or by mailing a copy
of the notice by regular and certified or registered mail,within a five-day return receipt requested,to
27
the owner at his or her last known address. A copy of the Order shall also be posted on the property •
where the alleged violation occurred or is occurring.
(iii)Posting the Notice. In addition to providing service as states above,an additional notice shall be
posted on the property in substantially the following form:
DO NOT ENTER
UNSAFE TO OCCUPY
It is a violation of the Jefferson County Board of Health Ordinance 09-1020-05 to occupy this building,or
to remove or deface this notice.
,Health Officer
(iv)Compliance. No person shall remain in or enter any building,structure,or property which has been
so posted,except that entry may be made to repair or correct any conditions causing or contributing
to the threat to life, limb,property,or safety of the public or persons residing on the property. No
person shall remove or deface any such notice after it is posted until the required corrective action
has been completed and approved.
8.10.950(6)(i)Permit Violations,Suspension,and Revocation
(i) Any violation of a permit requirement issued pursuant to these regulations shall be a violation of
these regulations.
(ii) Suspension of Permits.
(A) The Health Officer may temporarily suspend any permit issued under these regulations for: •
(1) Failure of the holder to comply with the requirements of the permit;
(2) Failure to comply with any notice and order to correct violation issued pursuant to these
regulations related to the permitted activity;
(3) Failure to comply with a stop-work or abatement order issued pursuant to Section 950(6)(e)and
(g)of these regulations;or
(4) The non-payment or dishonor of any check or draft used by the permit holder to pay any
Public Health fees associated with the permit.
(B) Permit suspension shall be carried out through the notice and order to correct violation
provisions specified in Section 950(5),and the suspension shall be effective upon service of the
notice and order to correct violation upon the holder or operator. The holder or operator may
appeal such suspension as provided in Section 950(7)and Section 950(6)(i)(iv)of these
regulations.
(C) Notwithstanding any other provision of this regulation,whenever the Health Officer finds that a
violation of this regulation has created or is creating an unsanitary,dangerous or other condition
which,in his/her judgment, constitutes an immediate and irreparable hazard,he/she may,
without service of a written notice and order to correct violation,suspend and terminate
operations under the permit immediately.
(iii)Revocation of Permits.
(A) The Health Officer may permanently revoke any permit issued by him/her for:
(1) Failure of the holder to comply with the requirements of the permit; •
28
(2) Failure of the holder to comply with any notice and order to correct violation issued
pursuant to these regulations related to the permitted activity;
(3) Failure to comply with a stop-work or abatement order issued pursuant to
Section 950(6)(e)and(g);
(4) Interference with the Health Officer in the performance of his/her duties;
(5) Discovery by the Health Officer that a permit was issued in error or on the basis of incorrect
information supplied to him/her;or
(6) The non-payment or dishonor of any check or draft used by the holder to pay any Public
Health fees associated with the permit.
(B) Such permit revocation shall be carried out through the notice and order to correct violation
provisions specified in Section 950(5)and the revocation shall be effective upon service of the
notice and order to correct violation upon the holder or operator. The holder or operator may
appeal such revocation,as provided in Section 950(7)and Section 950(6)(i)(iv)of these
regulations.
(C)A permit may be suspended pending its revocation or a hearing relative to revocation
pursuant to the provisions of Section 950(6)(i)(iii)(B)above.
(iii)Permit Appeal.
(A) Subject to Appeal. Any denial, suspension or revocation of a solid waste permit by the
Health Officer may be appealed.
• (B)Appellant Defined. The appellant shall be the applicant for a solid waste permit or holder of
a solid waste permit who appeals a decision denying, suspending or revoking a solid waste
permit.
(C)Appeal Procedure. Appeal of a Permit Denial. Any person aggrieved by the denial of permit denial
shall:
(1) Within 10 days of receiving the written letter denying a permit,the appellant shall request a
hearing in writing. The appellant shall submit specific statements in writing of the reason why
error is assigned to the decision of the health officer.
(2) Upon receipt of such request together with hearing fees,the health officer shall notify the
person of the time, date, and place of such hearing, which shall be set at a mutually convenient
time not less than five business days nor more than 30 business days from the date the request
was received.
(3) Within 30 days,the Health Officer will issue a decision upholding or reversing public health's
action. The health officer may require additional actions as part of the decision.
(4) Within 30 days of receiving the Health Officers decision,the appellant,may file an appeal
with the Pollution Controls Hearings Board pursuant to RCW 70.95.210.
(5) The Hearing will be conducted as specified in JCC 8.10. 950(7)(4).
8.10.950(6)(j) Other Legal or Equitable Relief. Notwithstanding the existence or use of any other
remedy,the Health Officer may seek legal or equitable relief to enjoin any acts or practices or abate
• any conditions that constitute or will constitute a violation of this ordinance,or rules and regulations
adopted under it, or any state health law or regulation,or that otherwise threatens public health.
29
8.10.950(6)(k) Imminent and Substantial Dangers. Notwithstanding any provisions of this regulation the •
Health Officer may take immediate action to prevent an imminent and substantial danger to the public
health by the improper management of any waste irrespective of quantity or concentration.
8.10.950(7)APPEALS
Appeal—of an NOCV,Enforcement Action,or other Public Health Action
a) Appeal of Public Health Action—Health Officer Administrative Hearing.Any person aggrieved by
the contents of a notice and order to correct violation issued under this regulation,or by any
inspection,permit issuance or enforcement action conducted by public health under this regulation,
may request,in writing,a hearing before the health officer or his or her designee.
(i) The appellant shall submit specific statements in writing of the reason why error is assigned to the
decision of public health. Such request shall be presented to the health officer within 10 business
days of the action appealed;except in the case of a suspension,the request for a hearing must be
made within five business days.
(ii) Upon receipt of such request together with hearing fees,the health officer shall notify the person of
the time,date,and place of such hearing,which shall be set at a mutually convenient time not less
than five business days or more than 30 business days from the date the request was.received.
(iii)Hearing Procedures.Hearings shall be open to the public and presided over by the health officer.
Such hearings shall be recorded.Hearings shall be opened with a recording of the time,date and
place of the hearing,and a statement of the cause for the hearing.The health officer shall then
swear in all potential witnesses.The case shall be presented in the order directed by the health
officer. The appellant may present rebuttal.The health officer may ask questions.The health officer
may allow the opportunity for a closing statement or summation. General rights include: •
(A)To be represented by an attorney;
(B)To present witnesses;
(C)To cross-examine witnesses;
(D)To object to evidence for specific grounds.
In the conduct of the proceeding,the health officer may consider any evidence,including hearsay
evidence that a reasonably prudent person would rely upon in the conduct of his or her affairs.
Evidence is not admissible if it is excludable on constitutional or statutory grounds or on the basis
of evidentiary privilege recognized in the courts of this state.The health officer shall decide rulings
on the admissibility of evidence,and the Washington rules of evidence shall serve as guidelines for
those rulings.
Inasmuch as any appeal to the board of health from a health officer decision is a review on the
record,the health officer shall ensure that the record generated contains testimonial and
documentary evidence supporting the health officer's determination.
The health officer may continue the hearing to another mutually acceptable date to allow for
additional submission of information or to allow for additional consideration.Prior to closing of the
hearing,the health officer shall issue its oral ruling unless the health officer determines that the
matter should be taken under advisement.Written findings of fact,conclusions of law and orders
shall be served on the appellant within 14 days of the oral ruling. If the matter is taken under
advisement,written findings,conclusions and orders shall be mailed to the appellant within 21 days
of the close of the hearing.
The appellant shall bear the burden of proof and may overcome the permit revocation order by a .
preponderance of the evidence.
30
• (b) Appeal of Administrative Hearing to the Board of Health.
(i) Any person aggrieved by the findings, conclusions or required actions of an administrative hearing
shall have the right to appeal the matter by requesting a hearing before the board of health. Such
notice of appeal shall be in writing and presented to the health officer within thirty(30)days of the
health officers decision. The appellant shall submit specific statements in writing of the reason
why error is assigned to the decision of the health officer and shall be accompanied by a fee as
established in the current public health fee schedule. The appellant and the health officer may
submit additional information to the board of health for review.
(ii) The notice and order to correct violation shall remain in effect during the appeal.Any person
affected by the notice and order to correct violation may make a written request for a stay of the
decision to the health officer within five business days of the health officer's decision. The health
officer will grant or deny the request within five business days.
(iii)Upon receipt of a timely written notice of appeal together with the hearing fee,the health officer
shall set a time, date,and place for the requested hearing before the board of health and shall give
the appellant written notice thereof Such hearing shall be set at a mutually convenient time not less
than fifteen(15)business days or more than thirty(30)business days from the date the appeal was
received by the health officer.
(iv)Board of health hearings shall be open to the public and presided over by the chair of the board of
health. Such hearings shall be recorded. Board of health hearings shall be opened with a recording
of the time, date and place of the hearing, and a statement of the cause for the hearing. The hearing
shall be limited to argument of the parties and no additional evidence shall be taken unless,in the
judgment of the chair, such evidence could not have reasonably been obtained through the exercise
of due diligence in time for the hearing before the health officer.Argument shall be limited to the
record generated before the health officer unless the chair admits additional evidence hereunder.
(v) Any decision of the board of health shall be final and may be reviewed by an action filed in
superior court.Any action to review the board's decision must be filed within 30 business days of
the date of the decision.
8.10.950(7)(c)All revocation hearings shall be conducted by the board of health.
8.10.950(7)(d)The following guidelines apply to all hearings and appeals conducted by the board of
health pursuant to this section:
(i) Appeals shall be made in writing and shall be signed and dated by the petitioning party.
(ii) Appeals shall include a brief and concise statement of the law and facts,which affirmatively establish
that the health officer has committed an error.
(iii)Appeals shall be transmitted to the board of health by JCPH following receipt from the petitioning
party together with all relevant material associated with the health officer's action, including,but not
limited to, applications,reports, soil logs,photographs,staff analysis and recommendations.
(iv)Upon receipt of the appeal materials transmitted by JCPH,the board of health shall conduct a hearing
to determine the correctness of the decision by the health officer within 35 days. The petitioner shall
be given five days' notice by certified mail of the purpose,time, date and place of said hearing.
Further,if the petitioning party is a person other than the permit applicant or a permit holder,then
notice of the purpose,time,date, and place of said hearing shall likewise be mailed by certified mail
to the permit applicant or permit holder.
31
(v) Any hearing conducted pursuant to this section shall be a public hearing and the chairperson of the •
board of health shall open the hearing and take testimony from any interested persons;provided,that
testimony in suspension or revocation hearings shall be limited to that presented by the health officer,
the certificate holder and any witness called by them;provided further,that the chairperson may limit
the length of the testimony to a specific amount of time to be applied equally to those interested
persons wishing to speak,except in suspension or revocation hearings where the board of health is
authorized to use its discretion.
(vi)The procedure to be utilized during any hearing conducted pursuant to this section shall be as
follows:
(A)The petitioning party,permit applicant,or permit holder and the health officer,if not the petitioning
party,shall be given an opportunity to present evidence,analysis and recommendations.
(B)Members of the board of health may direct questions to the petitioning party,permit applicant or
permit holder and health officer.
(C) The chairperson of the board of health shall permit the presentation of testimony by any interested
person as set forth in this chapter.
(D)Following presentation of evidence and testimony,the chairperson of the board of health shall close
the hearing and initiate discussion with other board members on the matters presented.
(E) Following discussion,the board of health shall make ruling on the appeal.
(F) Under no circumstances shall cross-examination of persons making presentations at the hearing be
permitted,notwithstanding that the board of health may ask questions as set forth above.
(vii) Should the board of health require additional testimony,it may continue the public hearing to a date ,
and time not to exceed 35 days following the date of the initial public hearing;provided,that at the
close of the second public hearing the board of health may continue its deliberations on the appeal to
another time and date not to exceed 35 days following the close of the second public hearing
conducted to receive additional testimony. In all other cases the board of health may continue its
deliberations on the appeal to another date and time not to exceed 35 days following the close of the
public hearing.
(viii) Relevant evidence is admissible,if in the opinion of the board of health it is the best evidence
reasonably obtainable having due regard for its necessity,availability and trustworthiness;provided,
that in passing upon the admissibility of evidence the Jefferson County board of health may give
consideration to,but shall not be bound to follow,the rules of evidence governing civil proceedings
in matters not involving trial by jury in the superior court of the state of Washington.
(ix)A full and complete record shall be kept of all proceedings and all testimony shall be recorded.The
record of testimony and exhibits together with all papers and requests filed in the proceedings shall
constitute the exclusive record for the decision in accordance with the law.
(x) All decisions shall become a part of the record and shall include a statement of findings and
conclusions.
(xi)Notice of the decision of the board of health shall be provided not later than 10 days following the
date of its decision.
(xii) The petitioning party,permit applicant,permit holder,or designated agent,and JCPH shall be •
notified of the decision of the board of health,together with the findings and conclusions. [Ord. 6-12]
32
8.10.950(8)VARIANCES
(a) Applicability.Any person who owns or operates a solid waste facility may apply to the Health
Officer for a variance from any paragraph of these regulations except as provided in Section
950(8)(b)(iv)of these regulations.
(b) Granting Requirements.
(i) The Health Officer may grant such variance if it finds that:
(A)The solid waste handling practices or site location do not endanger public health,safety
or the environment;and
(B)Compliance with the regulation from which variance is sought would produce hardship on the
applicant without equal or greater benefits to the public;and
(C)No other practicable or reasonable alternative exists. A practicable alternative is one that is
available and capable of being carried out after taking into consideration cost,existing
technology,and logistics in light of overall project purposes,and better reducing or
eliminating impacts to health and the environment. It may include equipment or facilities not
owned by the applicant that could have reasonably been or be obtained,utilized,expanded,or
managed in order to manage,reduce,or eliminate impacts to health and the environment. A
reasonable alternative is one that could feasibly attain or approximate compliance,but would
better reduce or eliminate impacts to health and the environment.
(ii) No variance shall be granted pursuant to this paragraph until the Health Officer has considered the
• relative interests of the applicant, other owners of property likely to be affected by the waste
handling practices,and the general public.
(iii)Any variance or renewal shall be granted within the requirements of this paragraph and for time
period and conditions consistent with the reasons therefore,and within the following limitations:
(A) If the variance is granted on the grounds that there is no practicable means known or available
for the adequate prevention,abatement or control of pollution involved,it shall be only until
the necessary means for prevention,abatement or control become known and available and
subject to the taking of any substitute or alternative measures that the Health Officer may
prescribe.
(B)The Health Officer may grant a variance conditioned by a timetable if:
(1) Compliance with this regulation will require spreading of costs over a considerable
time period;and
(2) The timetable is for a period that is needed to comply with this regulation.
(iv)No variance from Chapters 173-350 WAC,Minimum Functional Standards for Solid Waste
Handling,and 173-351 WAC,Criteria for Municipal Solid Waste Landfills,shall be granted by
the Health Officer except with the approval and written concurrence of Ecology prior to action
on the variance by the Health Officer.
(v) The Health Officer may grant variances from these regulations for standards that are more
stringent than the standards of Chapters 173-350 and 173-351 WAC,or from provisions in these
regulations that are not contained in Chapters 173-350 and 173-351 WAC,without Ecology
• approval.
(c) Application.
33
(i) The application shall be accompanied by such information as the Health Officer may require. •
(ii) An application for a variance,or for the renewal thereof,submitted to the Health Officer shall be
approved or disapproved by the Health Officer within ninety(90)calendar days of receipt unless
the applicant and the Health Officer agree to a continuance.
(iii)Notice shall be given by mailing a notice of the variance application to persons who have written
to the Health Officer asking to be notified of all variance requests.
(d) Renewal. The Health Officer may renew any variance granted pursuant to this paragraph on terms
and conditions and for periods that would be appropriate on initial granting of a variance. No
renewal shall be granted except on written application. Any such application shall be made at least
sixty(60)calendar days prior to the expiration of the variance.
8.10.960 - REPEALER
Jefferson County Board of Health Solid Waste Regulations,Ordinance#09-0715-04,dated July 15,
2004 and Ordinance#08-0919-02,dated September 19,2002,are hereby repealed. In addition,if any
resolution,code,words,rules or regulations of Jefferson County Public Health is in conflict with this
regulation,they are hereby repealed to the extent necessary to give these regulations full force and
effect.
8.10.970 - SEVERABILITY
Should any paragraph,phrase,sentence or clause of these regulations be declared invalid or •
unconstitutional for any reason,the remainder of these regulations shall not be affected thereby.
8.10.990 - CRITERIA FOR INERT WASTE
WAC 173-350-990,Inert Waste Criteria, is hereby adopted by reference,
S
34
• APPENDIX A. REFERENCES
The following is a list of Federal,State,and local laws,regulations,and documents referenced in
Jefferson County Board of Health Ordinance 09-1020-05,Solid Waste Regulations. Copies of these
documents may be found at the Port Townsend office of Jefferson County Public Health,the Jefferson
County Courthouse,or through your local library.
A. Federal:
1. United States Code(USC):
33 USC 1344 PARAGRAPH 404 OF THE FEDERAL CLEAN WATER ACT(PL 95-
217),PERMITS FOR DREDGED OR FILL MATERIAL
42 USC 300 SAFE DRINKING WATER ACT(PL 95-523)
42 USC 2011 ATOMIC ENERGY ACT OF 1954
42 USC 6901 RESOURCE CONSERVATION AND RECOVERY ACT OF 1976
(RCRA)
42 USC 9601 COMPREHENSIVE ENVIRONMENTAL RESPONSE
COMPENSATION AND LIABILITY ACT OF 1980(CERCLA)
2. Code of Federal Regulations(CFR):
10 CFR Part 20 STANDARDS FOR PROTECTION AGAINST RADIATION
40 CFR Part 61 NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR
POLLUTANTS
• 40 CFR Part 258 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS
40 CFR Part 503 STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE
3. Environmental Protection Agency:
SW-846 TEST METHODS FOR EVALUATING SOLID WASTE,PHYSICAL/
CHEMICAL METHODS
B. State:
1. Revised Code of Washington(RCW),Chapters:
7.80 CIVIL INFRACTIONS
42.17 DISCLOSURE-CAMPAIGN FINANCES-LOBBYING—RECORDS
43.21A DEPARTMENT OF ECOLOGY
46.37 VEHICLE LIGHTING AND OTHER EQUIPMENT
46.55 TOWING AND IMPOUNDMENT
70.05 LOCAL HEALTH DEPARTMENTS,BOARDS,OFFICERS-
REGULATIONS
70.93 WASTE REDUCTION,RECYCLING,AND MODEL LITTER
CONTROL ACT
70.94 WASHINGTON CLEAN AIR ACT
70.95 SOLID WASTE MANAGEMENT-REDUCTION AND RECYCLING
70.95K BIOMEDICAL WASTE
76.04 FOREST PROTECTION
90.48 WATER POLLUTION CONTROL
• 2. Washington Administrative Code(WAC),Chapters:
35
173-160 MINIMUM STANDARDS FOR CONSTRUCTION AND •
MAINTENANCE OF WELLS
173-200 WATER QUALITY STANDARDS FOR GROUND WATERS OF THE
STATE OF WASHINGTON
173-201A WATER QUALITY STANDARDS FOR SURFACE WATERS OF THE
STATE OF WASHINGTON
173-218 UNDERGROUND INJECTION CONTROL PROGRAM
173-240 SUBMISSION OF PLANS AND REPORTS FOR CONSTRUCTION
OF WASTEWATER FACILITIES
173-303 DANGEROUS WASTE REGULATIONS
173-304 MINIMUM FUNCTIONAL STANDARDS FOR SOLID WASTE
HANDLING
173-308 BIOSOLIDS MANAGEMENT
173-314 WASTE TIRE CARRIER AND STORAGE SITE LICENSES
173-350 STANDARDS FOR SOLID WASTE HANDLING
173-351 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS
173-425 OUTDOOR BURNING
197-11 SEPA RULES
246-203 GENERAL SANITATION
246-220 RADIATION PROTECTION-GENERAL PROVISIONS
246-232 RADIOACTIVE MATERIALS-LICENSING APPLICABILITY
296-24 GENERAL SAFETY AND HEALTH STANDARDS
296-62 OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR
CARCINOGENS
296-65 ASBESTOS REMOVAL AND ENCAPSULATION
480-70 SOLID WASTE AND/OR REFUSE COLLECTION COMPANIES
3. Washington State Department of Ecology(Ecology): •
Ecology document 80-12,Biological Testing Methods
Ecology document 91-30: Guidance for Remediation of Petroleum Contaminated Soils
(revised November 1995)
Ecology document 93-51,Chemical Testing for Complying with the Dangerous Waste
Regulations
C. Local/Regional:
1. Jefferson County Public Health:
Jefferson County Comprehensive Solid Waste Management Plan(JCCSWMP)
36
• JEFFERSON COUNTY BOARD OF HEALTH
David Sullivan,Chair County Commissioner District#2 Jill Buhler,Hospital Commissioner
Sheila Westerman,Vice Chair Citizen Kris Nelson,Port Townsend City Council
Phil Johnson,County Commissioner,District#1 Sally Aerts, Citizen
John Austin,County Commissioner,District#3
•
•
37
1.
Board of Health
V
New Business Items
Item 2
EH Hourly Rate for Technical Staff
•
0 August 21 , 2014
JEFFERSON COUNTY PUBLIC HEALTH
ENVIRONMENTAL HEALTH DIVISION
• ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information
Health Officer Administrative Hearing 309.00
Administrative Hearing Appeal 309.00 _
Technical Assistance/Plan Review-Minimum
Technical Assistance/Plan Review-Per Hour
Filing Fee 53.00
Notice to Title Rescission 517.00
ONSITE SEWAGE DISPOSAL ::•
Sewage Disposal Permits
New Conventional 561.00.Valid for 3 years
New Alternative 668.00 Valid for 3years
_New septic tank and/or pump chamber only 266.00 Issued in conjunction with an existing sewage disposal
New Community or>1000 G.P.D.(base fee) 561.00`Plus$88 per connection-valid for 3 yrs
New Commercial>1000 G.P.D.
Conventional 668.00 Valid for 3 years
Alternative 715.00."Valid for 3 years
Repair/Upgrade/Modification/Designate Reserve Area 124.00 Applies to existing installed sewage disposal system
Expansion 418.00.
Redesign 124.00 Applies to pending or active but not installed
Reinspection 155.00
Evaluation of ExistingSystem/Monitoring Inspection -
Septic system only 309.00
Septic system plus water sample 322.00
Retest/Reinspection 108.00
"On Site Sewage
OnSite-Site Plan Advanced Approval Determination(SPAAD) 309.00
Septic Permit with SPAAD(conventional) 302.00
Septic Permit with SPAAD(alternative) 418.00
Subdivision Review Base Fee 401.00 Plus$79.00 Per Lot
Boundary line adjustment review fee 158.00 Plus$79.00 Per Lot
Pre application meeting fee 158.00_
_Planned rural residential development review fee 158.00
Density exemption review fee 79.00_
Density exemption review fee requiring field work 158.00
Other
Waiver/Variance Application 186.00
Waiver/Variance Hearing 309.00
_Wet season evaluation 418.00.
Revised building application review fee 158.00
New building application review fee:
Residential 79.00
Commercial 158.00
General environmental health review fee 95.00 it.tr'tout
•
Licenses
Installer,Pumper,Operator(maintenance person) 418.00
Retest 170.00
Homeowner Authorization 10.00
Annual Renewal 294.00
Delinquent Renewal after January 31 418 00
FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit):,,
Restaurants/Take-Out(Based on menu complexity&'seating-menu changes may change category)
0-25 seats(Limited Menu) - 188 00 No cooling or reheating
0-25 seats(Complex Menu) - 334.00 Cooling and reheating allowed
26-50 seats 334.00-
51-100 seats 401.00
101-150 seats 455.00;
With Lounge,add 147.00 Separate lounge area _
Bakery Business 147.00
B&B 188.00
Caterer
w/commissary or catering-only kitchen _ 334.00.
w/restaurant,additional fee for catering 188.00
Concession/Commercial Kitchen/Church 147.00
Espresso Stand 7147.00..
Grocery
1-3 checkouts _ 188.00 May serve pre-packaged baked goods
>3 checkouts 455.00
Meat/Fish Market _ 334.00.
Mobile Unit
Limited Menu 188.00 No cooling or reheating
Complex Menu 334.00 Cooling&reheating allowed
School Cafeteria
Central K Itchen 334.00
Warming Kitchen . 188.00
Tavern w/food(see Restaurants)
Annual Permit Issued after September 1 1 50%of fee 150%of Annual Permit Fee
TemporaryPennits ;. w3, „
Single Event
Initial Application(First Event) 106.00 Not to exceed 21 days at your location
Additional Event(Same Menu Only) 60.00 Not to exceed 21 days at your location
Organized Recurring Event(e.g.Farmers Market)
Limited Menu 106.00 Not to exceed 3 days a week at a single location
Complex Menu 140.00 Not to exceed 3 days a week at a single location
Additional(Paid when application is submitted less than 7
Late Fee for Temporary Permits +50%of fee days prior to the event)
Other Food Fees - ..
Permit Exemption 40.00
Waiver/Variance 35:00: Per Hour
• Reopening Fee 27.00 Per Hour
Manager's Course 227.00
Plan Review
Pre-opening inspection S5:00 Per Hour _
Minimum 85.00..
Per Hour 85.00'
Reinspection
First Inspection - 94.00
Each inspection after first 160.00
Food Handler Card
Reissue Unexpired Food Handler Card 10.00 f
.SOLID WASTE
Annual Permit Fees
Landfills requiring environmental monitoring 548.00
Biosolid/Composting Facilities .481.00
m.
•
•
•
ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information
• Inert Waste Landfills 348.00
Other Solid Waste Facilities _ 348.00
Drop Boxes 160.00
Miscellaneous Fees - -
New Facility Application 441.00
Exempt Facility Inspection 348.00
Facility Reinspection 50%of fee
Plan,Document and Waiver/Variance Review 1 27100 1+557 001'hour for>4 hours
WATER _. .. ..;
l'''''''' Inspection of well construction,decommission&
Application Fee reconstruction
Determination of Adequate Water Supply 67 00 Building Permit Process
Well Inspection&Water Sample for Loan 135.00
Well Site Inspection-Proposed4rublic water supply 321.DC 1
LIVING.ENVIRONMENTS% ,.,''„
Water Recreation Facilities Operation Permit
Single Swim Pool(in operation for<6 months of the year) 291.00
Single Swim Pool(in operation for z 6 months of the year) 294.00
Single Spa Pool(in operation for<6 months of the year) 255.00
Single Spa Pool(in operation for a months of the year) 294.00
Single Wading Pool(in operation for<6 months of the year) 211.00
Single Wading Pool(in operation for>_6 months of the year) 371.00
Spray Pool or Pools(in operation for<6 months of the year) 105.00
Spray Pool or Pools(in operation for a 6 months of the year) 159.00
Each Additional Swim,Spa,or Wading Pool(in operation for a6 63.00
months of the year)
Each Additional Swim,Spa,or Wading Pool(in operation for 2 6 84.00
months of the year)
Reinspection _ 85.00 Per Hour plus associated lab costs
Plan Review 05.00 Per Hour
dndoo'r=AlP(Tobacca) d' ''k -
Compliance Enforcement . 85.00 Per Hour
Reinspection - 79.00
Rebuttal Application 158.00
Note:2013 Fees have been adjusted per Ordnance 12-1205-96,Section 4-Annual Fee Indexing Fixed amount fees established by this ordnance shall be adjusted annually on the first
business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW).The CPIW is the Consumer Price Index-US City Average for Al Urban Wage
Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor.
The annual fee adjustment shall be calculated as follows:each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported
for the month of September precedng the Adjustment Date.Increases will be rounded to the nearest dollar.A fee shall not be reduced by reason of such calculation.However,tee
increases in accordance with this calculation shall not exceed 5 percent per year.
•
I .
Board of Health
V
New Business Items
Item 3
Community Health Improvement Plan — Activity
� Update
� August 21 , 2014
DRAFT
Jefferson County Data Review and Health Priorities Process, 2014
• BACKGROUND: From February-April 2014, a group of community data users led by Jefferson Health Care and
Jefferson Public Health reviewed the results of a community health assessment.The assessment included
current data and trends for demographics,socioeconomics,community safety, quality of life, health care
access, pregnancy and births,and behaviors, illness, injury, hospitalizations and deaths. In May,the group
reviewed and compiled a list of top issues. In June,the group formalized those top issues into final priorities.
This data is available at: http://www.jeffersoncountvpublichealth.org.
NEXT STEPS to Imporve the Health of Jefferson County:Specific goals and action steps to address the
priorities are under development.A cycle of systematic and ongoing monitoring of action steps, progress
toward goal and assessment of health status should be established to ensure accountability to the process and
June 13, 2014: FINAL PRIORITIES TOTAL
VOTES
1.Access to mental health and substance abuse care 19
Goal:Create stable mental health treatment structure in Jefferson County
Action:Work with Accountable Community of Care to integrate mental
health,chemical dependency and medical services for all Medicaid 1
recipients within Jefferson County and the region.
Action:Stabilize local mental health service structure.
Goal:Reduce tobacco use in pregnant women and youth
Action: Identify tobacco prevention strategies.
Goal: Ensure adequate access to mental health,substance use and
• tobacco treatment.
Action: Evaluate access to treatment and structural community
prevention.
2. Nutritio`
Goal:Prevent chronic disease through healthy living,diet and exercise
across the lifespan
Goal: Increase access to needed preventative care with special focus on
dental,prenatal and seniors
4. ImmunizatV'
Goal:Improve immunization rates
Underlying these top issues are the ongoing root causes that impact health. Root causes are
academic, economic and housing and must be addressed by the community as a whole.
•
8/8/14:Prepared by Siri Kushner,Epidemiologist,Kitsap Public Health District
DRAFT
Jefferson County Data Review and Health Priorities Process, 2014
May 18, 2014:TOP ISSUE SELECTION BY VOTING CROSS-WALK TO •
CATEGORY ISSUE VOTES FINAL GOAL#
Morbidity Mental health inadequacy for both adult and youth # �mmmq 10 1
Chronic Disease 2 2
Preventable
Immunization Rates 4/11,
Behaviors 7 4
— —
Healthy Eating/ Exercise 4 2
Active Living Healthy foods available 2
Dental Care3
Clinical Care _-
-
PrenatalCare 3
Substance Abuse Drug,alcohol,tobacco abuse 1
Care Substance abuse care 1
Education and __�..
Employment Poor academic performance
root cause
Who&Where Needs of older population/fall prevention 3
A.C.E 3 1
Social Outcomes
Bullying/adolescence 1 1
Economic Disparity 2 root cause
Income Poverty Lack of affordable housing 0 root cause
Housing children living in poverty 0 root cause
%of Medicaid births 0 root cause
Mortality (no subjects listed)
•
•
8/8/14:Prepared by Sid Kushner,Epidemiologist,Kitsap Public Health District
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00
RESEARCH AND PRACTICE
•
Caregivers Who Refuse Preventive Care for Their Children:
The Relationship Between Immunization and Topical
Fluoride Refusal
Donald L. Chi, DDS, PhD
The 2013 Institute of Medicine report Child Objectives. The aim of this study was to examine caregivers' refusal of
hood Immunization Schedule and Safety:Stake-
preventive medical and dental care for children.
holder Concerns,Scientific Evidence,and Future Methods.Prevalence rates of topical fluoride refusal based on dental records
Studies provides an up-to-date review of and caregiver self-reports were estimated for children treated in 3 dental clinics in
immunization safety for children.'This re- Washington State.A 60-item survey was administered to 1024 caregivers to evaluate
port,along with numerous other publications, the association between immunization and topical fluoride refusal. Modified
indicates that childhood immunizations are Poisson regression models were used to estimate prevalence rate ratios(PRRs).
safe,have decreased morbidity and mortality Results.The prevalence of topical fluoride refusal was 4.9%according to dental
by reducing the incidence of serious diseases, records and 12.7% according to caregiver self-reports. The rate of immunization
and play an important role in population- refusal was 27.4%.In the regression models,immunization refusal was significantly
2_4 associated with topical fluoride refusal (dental record PRR=1.61;95%confidence
based disease prevention. Similarly,topi- interval ECU=1.32, 1.96; P<.001; caregiver self-report PRR=6.20; 95% CI=3.21,
cal fluoride is safe,effective,and prevents 11.98; P<.001), Caregivers younger than 35 years were significantly more likely
dental caries,5 the most common disease than older caregivers to refuse both immunizations and topical fluoride(P<.05).
worldwide.6 However,as is the case with all Conclusions. Caregiver refusal of immunizations is associated with topical
drugs and preventive therapies,inamuniza fluoride refusal.Future research should identify the behavioral and social factors
tions and topical fluoride are not completely related to caregiver refusal of preventive care with the goal of developing
risk-free,which can lead to concerns among multidisciplinary strategies to help caregivers make optimal preventive care
caregivers regarding preventive care decisions for children. (Am J Public Health. 2014;104:1327-1333. doi:14.2105i
AJPH.2014.301927)
for children.
Most children in the United States receive
immunizations as recommended,but immure pertussis rubella),hospitalizations,and threats school among children and underemployment
zation hesitancy and refusal among caregivers to herd inunrmi :21-27za s2
are growing problems.According to a recent tY and lower earnings among adults.
The dental caries process begins with intake Low levels of fluoride are found in drinking
study,20%of children 6 to 23 months of age of dietary fermentable carbohydrates,which water,toothpastes,and mouth rinses.Individ-
did not receive recommended immunizations.7 are metabolized by intraoral bacteria.Over uals at increased risk for dental caries who lack
Another study reported an increase in the time these bacteria produce acids that demin- access to fluoridated water can be prescribed
percentage of immunization-hesitant caregivers eralize tooth structure.Topical fluorides are fluoride tablets or drops that are taken daily at
from 2.5%to 9.5%between 2006 and 2009.6 defined as any fluoride source(e.g.,fluoridated home.33 High-risk individuals may periodically
Overall immunization refusal rates range from drinking water,toothpaste,mouth rinses)that have higher levels of fluoride applied to their
1.6%to 2.4%,and they are known to duster promotes remineralization and inhibits demin- teeth in the form of fluoride gels,foams,and
geographically within school districts,cornmu- eralization on the tooth surface.Regular expo- varnishes during dental or medical visits.
nities,and counties. sure to topical fluorides helps to prevent tooth Relatively few studies have addressed fluo-
More than 90%of pediatricians and 60%of decay,za ride hesitancy and refusal among caregivers,
family medicine physicians report having Inadequate or irregular exposure to topical One study examined predictors of fluoride
treated at least 1 child whose caregiver had fluorides leads to increased risk of dental caries varnish refusal but focused on child behaviors
previously refused immunizations."Reasons (cavities),which requires dental treatments and provider factors as correlates of refusal by
for immunization hesitancy or refusal include such as fillings,crowns,or extractions.When children.34 A number of investigations have
concerns about safety and side effects,religious left untreated,dental caries can lead to pain, identified caregiver concerns regarding fluo-
objections,and philosophical or personal be- infection,hospitalization,and,in rare cases, ride safety,particularly among caregivers of
liefs.rz-zo The public health consequences death.The social and economic consequences children with autism spectrum disorders.35-37
• of immunization refusal include outbreaks span the life course and include missed school Most studies focus on opposition to community
of life-threatening diseases(e.g.,measles, days,poor grades,and teasing or bullying at water fluoridation3a-4U
July 2014,Vol 104,No. 7 I American Journal of Public Health Chi I Peer Reviewed I Research and Practice 11327
RESEARCH AND PRACTICE
III
Concerns about topical fluoride may stem years who were patients of record at 1 of 3 literatures were used to identify child,care-
from the handful of cases of accidental hyper- dental clinics during 2009 or 2010.Patients giver,and household sociodemographic factors
fluoridation of community water,41-49 which is were required to have received at least 1 that could serve as potential model con-
extremely rare and most commonly results in comprehensive oral evaluation(identified founders(Figure 1).
temporary nausea and vomiting.Since the through Current Dental Terminology ICDT1 Outcome variables.The primary outcome was
1980s,there have been fewer than 20 incidents 200558 code D0150)or 1 periodic oral evalu- caregiver refusal of topical fluoride(yes or no).
of hyperfluoridation across community water ation(CDT code D0120)in either calendar year. Fluoride refusal was operationalized in 2 ways
systems,which serve 72.4%of the US popula- The study was based on a convenience with respect to the chart review.In the
non."However,I documented death related to sample of children drawn from 3 dental clinics private-practice dental clinic,fluoride refusal is
water fluoridation was reported in Hooper Bay, in Washington State:a university-based pedi- consistently noted,and charts were manually
Alaska,in 1992.This incident was caused by atric dentistry clinic,an urban community reviewed for any entries indicating caregiver
insufficient system monitoring and an equip- health center affiliated with a regional children's refusal of topical fluoride.In the case of the
ment malfunction,47 highlighting the impor- hospital,and a private-practice dental clinic in other 2 clinical sites,at which there is no
tance of proper training and oversight of water a rural community.Although the 3 clinics were consistent charting of fluoride refusal,elec-
hygienists responsible for fluoridating water. physically located in areas with fluoridated tronic claims were reviewed to identify chil-
Dental fluorosis,in which the teeth exhibit community water,the specific water fluoridation dren who did not receive fluoride treatment
diffuse,whitish mottling,is a more prevalent status of each child was unknown. (CDT 2005 code D1201 or D120358)in
side effect associated with fluoride overexpo- The second phase involved a prospective 2009 or 2010.In the survey,caregivers were
sure.8I-83 Fluorosis occurs with chronic intake survey administered to caregivers of children asked whether they had ever refused topical
of low levels of fluoride during early childhood, identified in the chart review.Those surveyed fluoride for the children in their care at
particularly when young children brush their included caregivers who refused topical fluoride a dental care visit.
teeth unsupervised and ingest fluoridated for the children in their care(case participants) Predictor variable.The predictor variable,
toothpaste in excess of the amount needed to and those who did not(control participants). measured with a single item,was whether
prevent dental caries.54 Topical fluorides pro- Case and control participants were matched on caregivers had ever refused to have their child
• vided during dental visits are not known to
1 basis according to a 1
cause dental fluorosis.84 to the clinic and the immunized(yes or no).
child's age and gender(n—1024).
Potential confounders.The following child,
Immunizations and topical fluorides are caregiver,and household sociodemographic
front-line preventive strategies in pediatric Survey Development and Administration factors(measured via the survey)served as
medicine and dentistry.As such,the growing A 60-item English-language survey was de potential confounders:child's race(White
number of caregivers who refuse preventive veloped,pretested with 3 caregivers,and or non-White),ethnicity(Hispanic or non-
care for children is a significant public health modified to improve its clarity and flow.The Hispanic),and health insurance category
concern.The links between medical care and survey included questions about the child(age, (Medicaid,private,or other)59;caregiver's
dental care use among children88-87 suggest gender,race/ethnicity),caregiver(education), age(5 35 years,36-50 years,or?.51 years)
that caregivers'refusal of immunizations and household(income,food security),and immu- and education(5 high school,some college,
refusal of fluoride are related behaviors;how- nizations and topical fluoride(history of re-
ever,to my knowledge,no investigations to fusel,acceptance,beliefs about the efficacy of
date have examined this relationship.In this preventive care,ability to obtain care,barriers Potential Confounders
study,the goals were to estimate the prevalence to care).Surveys were mailed to caregivers,and Child race
Child ethnicity
of caregiver refusal of topical fluoride through a$2 bill was included with each survey as an Child health insurance type
chart review and survey data and to evaluate incentive for participation.After 2 weeks, Caregiver age'
Caregiver education
the association between immunization and a trained research assistant contacted care- Household income
topical fluoride refusal.Such work has impor- givers who had not responded by telephone to Household food insecurity
tant public health implications for developing request that they complete a survey.Caregivers
/
clinical strategies that can be deployed by were asked to return the completed survey, Predictor Outcome
medical,dental,and public health professionals mailed a second survey as requested,or offered Immunization ---> Topical Fluoride
to help caregivers make optimal preventive the option of completing the survey via telephone. Refusal Refusal
care decisions for children.
Study Variables t<.05.
METHODS en.-,-oncepEual model for the study was FIGURE 1—Conceptual model depicting
based on previous work indicating significant the proposed relationship between
1-1-.......,ty was conducted in 2 phases.The associations between preventive medical and immunization and topical fluoride
first phase involved a retrospective chart re-
dental care use among children.58-87 The
refusal among caregivers.
0 view of data from children younger than 18 immunization refusal and medical care use
1328 1 Research and Practice I Peer Reviewed I Chi American Journal of Public Health 1 July 2014,Vol 104,No. 7
RESEARCH AND PRACTICE
•
or`colle_ge)!4;and household annual income were no significant differences in response Regression Models
(<$20 000,$20 000—$39 999,$40 000— rates across the 3 clinics(P=.09).However, In the,caregiver age-adjusted regression
$59 999,or Z$60 000):60 caregivers of privately insured children were models,caregiver refusal of immunizations was
An exploratory confounder was household significantly more likely to respond(P<.001). significantly associated with both record-based
food insecurity,61 measured through a 2-item Approximately 50%of caregivers cared for and caregiver-reported refusal of fluoride.The
food insecurity screener.The items were as privately insured or dually insured(e.g., prevalence of fluoride refusal based on dental
follows:"In the last 12 months,the food that we private and Medicaid)children or children records was 1.61 times as high(95%CI=
bought just didn't last,and we didn't have with Tricare(e.g.,uniformed services 1.32, 1.96;P<.001)for caregivers who re-
money to get more"and"In the last 12 months, insurance)coverage;30.30/0 cared for fused immunizations as for caregivers who did
we worried whether our food would run out Medicaid-enrolled children and 33.50/0 not refuse immunizations,and the prevalence
before we got money to buy more."Children of for uninsured children: based on caregiver self-reports was 6.20 times
caregivers who responded affirmatively("often" as high(950/0 C1=3.21, 11.98;P<.001).
or"sometimes")to both items were classified as Prevalence of Topical fluoride and
being food insecure.The remaining children Immunization Refusal DISCUSSION
were classified as being food secure.This 2-item The record-based prevalence of topical
screening instrument has been validated against fluoride refusal was 4.9%.Clinic-specific re- This is the first published study,to my
the US Department of Agriculture's 6-item in- fusel rates were 1.7%(community health knowledge,to examine topical fluoride refusal
strurnent and has high sensitivity and acceptable center),4.00/a(private practice dental clinic), with an emphasis on assessing the relationship
specificity62 and 12.8%(university-based pediatric den- between caregivers'refusal of preventive
tistry clinic).According to the survey data, medical and refusal of dental care.The findings
Data Analyses the caregiver-reported prevalence of fluoride suggest that fluoride refusal is highly prevalent
On the basis of data from the chart review, refusal was 12.7%,and the prevalence of among caregivers and that refusal of immuni-
the prevalence of fluoride refusal was esti- immunization refusal was 27.40/a zations is associated with refusal of topical
mated and adjusted to account for multiple fluoride offered to children during dental visits.
children from the same household.Caregiver- Bivarlate Analyses The first primary finding is that topical
IIIreported topical fluoride and immunization The survey data showed that 34 of 94 fluoride refusal rates ranged from 4.9%(based
refusal rates were estimated from survey data caregivers(36.20/o)who refused immunizations on dental records)to 14.60/a(estimated from
Modified Poisson regression models were used also refused topical fluoride,whereas 11 of survey data).There are no study data to which
to evaluate the bivariate relationships between 220(5%)who did not refuse immunizations these rates can he compared.In this study,the
each potential confounder and the predictor refused topical fluoride(P<.001),Of the 45 topical fluoride refusal rate based on dental
and outcome measures.63 All potential con- caregivers who refused topical fluoride,34 records was not as high as the immunization
founders that were significantly associated with also refused immunizations(75.6%),and refusal rate(27.4%)and might appear to be
both the predictor and outcome were included 60 of 269(22.3%)who did not refuse clinically inconsequential.However,at the
in the final regression model(a=0.05).In topical fluoride refused immunizations population level,a 4.9%fluoride refusal rate
testing the study hypothesis,a multiple-variable (P<.001). corresponds to 3.6 million children.65This is
modified Poisson regression model was used Of the 7 potential confounders,only care- a substantial number of children unable to
to estimate prevalence rate ratios(PRRs)and giver age was significantly associated with benefit from evidence-based care to prevent
950/a confidence intervals(Cls).SPSS was used immunization and fluoride refusal(Table 1). dental caries.Furthermore,studies sus'est that
in conducting all of the analyses.64 The prevalence of refusal was greater among at least 4 fluoride varnish treatments are
caregivers younger than 36 years than among needed in high-risk infants to ensure thera-
RESULTS those 51 years or older in the case of both peutic levels of caries prevention.66 As such, '
immunizations(PRR=2.46;95%CI=1.23, even occasional refusal of fluoride may reduce
Of the 1024 mailed surveys,75 were 4.93;P=.01)and fluoride(PRR=3.25;95% the overall effectiveness of topical fluoride.
returned because of an invalid address;in CI=1,04,10.76;P=.04).Caregivers of White What is unknown from the current study is
addition,40 caregivers did not communicate children had a significantly greater prevalence the extent to which fluoride hesitancy or re-
in English,343 could not be reached by of immunization refusal than caregivers of fusal is a growing health behavior among
telephone, 155 were not interested in taking non-White children(PRR=1.67;950/a Ch= caregivers as documented in the immunization
part,and 50 were interested but did not return 1.17,2.39;P=.01).The prevalence of fluoride literature.8 Longitudinal studies involving larger
a completed survey.A total of 361 surveys refusal was greater among caregivers who samples are needed to monitor population
were completed and included in the analyses had completed 4 years of college or more based trends in caregiver behaviors regarding
(35.3%response rate;39.7%response rate than among those with a high school education refusal of preventive dental care for children.
• adjusted for invalid addresses and c regiveis or less(PRR=3.14;95%Cl=1.15,8.58; This study did not include an examination
who did not communicate in English).There P=.03). of reasons why caregivers refused topical
July 2014,Vol 104,No. 7 I American Journal of Public Health Chi I Peer Reviewed I Research and Practice I 1.329
RESEARCH AND PRACTICE
0
among caregivers A common risk factor ap-
TABLE 1-Results of Bivariate Analyses Identifying Factors Related to Immunization and proach72 would suggest that caregivers'refusal
Topical Fluoride Refusal:Caregivers of Children in Washington State,2009-2010 of preventive medical care and their refusal of
Caregiver-Reported Immunization Refusal Caregiver-Reported Topical Fluoride Refusal dental care have similar religious,philosophical,
_ and behavioral etiologies.12-20•73 Furthermore,
Potential Confounder PRR(95%Cl) P PRR(95%CI) p
-' the growing prevalence of immunization hesi-
Child race tancy and refusal may lead to concomitant
White 1.67(1.17,2.39) .01 0.92(0.54,1.58) .77 increases in fluoride refusal behaviors,which
Non-White(Ret) 1.00 1.00 has implications for future disease prevention
Child ethnicity strategies aimed at children.Both inirnuniza-
Hispanic 1.33(0.88,2.03) .18 1.67(0,87,3.20) .13 tions and topical fluoride prevent transmissible
Non-Hispanic(Ref) 1.00 1.00 diseases,and refusal of preventive care can
Type of health insurance lead to treatment needs that place additional
Private(Ref) 1.00 1.00 demands on the health care system.2°
Public 1.04(0.71,1.51) .85 0.81(0.47,1.42) .46 The ethical concerns associated with man-
1.01(0.54,1.89) .98 0.18(0.03,1.29) .09 dating preventive care,eliminating personal
Caregiver age,y belief exemptions,penalizing nonusers of pre-
5 35 2.46(1.23,4.93) .01 3.25(1.04,10.76) .04 ventive care,or dismissing hesitant families
36-50 1.77(0.90,3.47) .1 1.67(0.53,5.30) .39 from a practice74-78 need to be balanced with
2 51(Ref) 1.00 1.00 the consequences associated with allowing
Caregiver education caregivers to refuse preventive care,including
5 high school(Ref) 1.00 1.00 threats to herd immunity and increased corn-
Some college 1.45(0.89,2.37) .14 2.17(0.75,6.30) .16 municable disease rates.Future studies should
2.college 1.34(0.83,2.16) .23 3.14(1.15,8.58) .03 continue to expand our understanding of both
Annual household income,$ behaviors and adopt common risk factor
• <20000(Ref)
1.00 1.00 models to help develop
20 000-39 999
1.57(0.89,2.74) .12
2.39(0.90,6.34) .08 clinical and public
health strategies that optimize disease preven-
40 000-59 999 1.57(0.85,2.92) .15 1.87(0.61,5.75) .28 tion in children.
60 000 1.40(0.82,2.39) .22 1.83(0.70,4.80) .22 This study has multiple public health impli-
Household food insecurity cations.First,immunization and topical fluo-
No(Ref) 1.00 1.00 ride refusal behaviors may be indicators of
Yes 0.81(0.53,1.25) .35 0.66(0.31,1.40) .27 broader societal concerns regarding various
Note,0-confidence interval;PRR-prevalence rate ratio, public health strategies(e.g.,community water
fluoridation,folic acid supplementation,rice
fortification).79-83 For example,opposition to
fluoride.However,the bivariate analyses in- are related to fluoride refusal.Furthermore, water fluoridation has affected a growing
dicated that topical fluoride refusal was signif- 700/o of caregivers who refused fluoride number of communities both in the United
icantly more prevalent among caregivers reported their child as having had a history of States and abroad.Yet,there is a dearth of
younger than 35 years and those with college dental caries,making it unlikely that fluoride interdisciplinary research on ways to broadly
degrees,the latter of which is consistent with refusal is related to a low perceived risk of address anti-fluoride behaviors,which is an
tudies on immunization refusa1.6"7 There dental disease.Other potential reasons for re- obstacle to preserving this cost-effective public
are additional reasons a caregiver might refuse fusal include lack of cooperation by children,34 health strategy.84 Second,the population-based
fluoride that parallel broader concerns about a belief that topical fluoride is ineffective,in- health gains that have been secured through
the safety of community water fluoridation, ability to pay among those who are uninsured, preventive strategies such as immunizations
including potential side effects such as dental and sodal norms.71 Future research should and topical fluoride may be at risk,exposing
fluorosis as well as purported epidemiological identify the behavioral and social determinants vulnerable children to greater levels of disease.
associations bei.:wcen nuoricie intake and au- of fluoride refusal with an emphasis on the Third,there is an assumption in health
tism spectrum disorders,lower IQs,and other reasons why caregivers refuse topical fluoride, disparities research that improving access to
systemic childhood conditions.35•68-7° The second primary finding is that the health care services leads to automatic uptake
In this study, 1 in 2 caregivers who refused prevalence of topical fluoride refusal was of preventive care.Caregiver refusal of pre-
topical fluoride reported that they were some- greater among caregivers who refused immuni- ventive care presents challenges for health
S what or very concerned about fluoride,pro- zations,which suggests a link between preven- professionals regarding how to offset the addi-
viding preliminary evidence that safety concerns live medical and dental care decision-making tional health risks to which a growing number
1330 1 Research and Practice I Peer Reviewed ( Chi American Journal of Public Health I July 2014,Vol 104, No. 7
RESEARCH AND PRACTICE
0
of children may be exposed.Additional re- immunizations commonly required for school WA 98195-7475(e-mail:dchi@uwedu).Reprints can be
search is needed to improve our understanding entry.Future work should adopt validated onlered at httpilwww.ajph.org by clicking on the"RepHnts"
link '
of caregiver refusal of preventive care and to immunization hesitancy and refusal measures 77tis article was mxepted February 8,2014.
identify the social,economic,and policy impli- to provide a better understanding of how
cations of health care decision-making among immunization refusal is related to topical fluo- Acknowledgments
caregivers. ride refusal.There is also a need to develop and This study was supported by the National Institute of
In terms of the clinical significance of the validate fluoride hesitancy and refusal instru- Dental and Craniofacial Research of the National Institutes
of Health(grants K08DE020856,L60MD003921,
,
current study,previous research has stressed merits.Second,the study was cross sectionalRO3DE021439 and U54DE019346),the University
,
the importance of health providers establishing which limits causal inferences,Longitudinal of Washington Institute for Translational Health
trust-based relationships with families and study designs and qualitative data collection Sciences(grant UL1RR025014),and the William T.
Grant Foundation Scholars Program.
conveying information on the benefits of im- methods might be used in the future to better I thank the following individuals who made the study
munizations to caregivers. 6-99 Findings from understand the relationship between immuni- possible:Charles Brown,Christopher Delecki,and
another study indicate that caregivers trust zation-and fluoride-related behaviors. JoAnne Scott for assistance with dental record data
aoluisition;Chao Ying Chen and Zoljargal Bayarsaikhan
health providers but do not trust the inforrna- Third,the findings are generalizable only to for help with survey data collection and pro ' g;and
don they dispense regarding immunizations.89 children from 3 dental clinics in western the caregivers who kindly participated in the study.
There is an immunization behavior continuum Washington State.Finally,caregivers of chil-
with endpoints corresponding to unquestioning dren with private insurance were significantly Human Participant Protection
acceptance and refusal,9"-92 and this is also more likely to have responded to the survey The institutional review boards of the University of
Washington and Seattle Children's flospital approved
likely to be the case for fluoride-related beliefs than caregivers with publicly insured or un- this study.Caregivers provided a waiver of consent in
and behaviors.Medical and dental care pro- insured children.Population-based studies are phase 1 of the study and provide informed consent via
viders may find it helpful to identify a caregiver's needed with special efforts devoted to ensuring mail or telephone in phase 2,
position on this behavioral continuum,which equivalent response rates from caregivers of
could play a role in delivering tailored strategies various socioeconomic backgrounds,which References
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, ;
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-
Additional behavioral and social science re- for pediatric medicine and dentistry in terms of
Topical fluoride(toothpastes,mouthrinses
vat-
rushes)for preventing dental 'es in child'gels or var
and
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whether the caregiver had ever refused im- gies to help caregivers make optimal preventive Pediatr 2012;12(5);375-383,
munizations.There was no information avail- care decisions for children.• 8. Robison SG,Groom H,Young C.Frequency of
able regarding whether the caregiver was
alternative immunization schedule use in a metropolitan
area Pediatrics.2012;13011):32-38.
hesitant about or refused all immunizations.In
About the Author 9. Omer SB,Salmon DA,Orenstein WA,deHart MP,
addition,caregivers were not asked to sperifv__, Donald L.Chi ts with the Department of Oral Health Halsey N.Vaccine refusal,mandatory immunization,and
the types of immunizations refused.Given the Sciences,School of Dentistry,University of Washington, the risks of vaccine-preventable diseases.N Engl J Med.
2009;360(19):1981-1988.
wide age range of the study children,caregivers
phSeaDC70:rre;:pond:rywoefsIrivoausldhingbetosneiiisto Dolnoaflned L.Dentistry,
DDS,O10, Atwell JE,Van Otte.rioo.1,Zipprich.J,inet al.Non-.
• may have refused controversial immunizations
(e.g.,human papillomavirus)as opposed to medics]vaccine exemptions and pertussis California,
panment of Oral Health Sciences,Box 357475,Seattle, 2010.Pediatrics,2013;132(0624-630.
July 2014,Vol 104, No. 7 1 American Journal of Public Health Chi I Peer Reviewed l Research and Practice I 1331
RESEARCH AND PRACTICE
0
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2006;3:13.
Themes Epidemiol. ORDER TODAY!
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July 2014,Vol 104,No,7 I American Journal of Public Health Chi I Peer Reviewed I Research and Practice I 1333
0 Board of Health
V
New Business Items
Item 4
SBHC Review
0
• August 21 , 2014
• Jefferson County
School Based Health Centers
2013-2014 Participation Report
Background:
School-Based Health Centers(SBHCs) were established during the 2008-2009 school year to address a
need for adolescent primary and mental health care in East Jefferson County. Currently there are SBHCs
in Port Townsend High School (PTHS) and Chimacum High School (CHS) providing students with two
days of medical and two daysi2l of mental health care per week. Medical services are provided by
Advanced Registered Nurse Practitioners(ARNP)for medical services. Mental health services are
delivered by counselors under a contract with Jefferson Mental Health Services.
Medical services are funded by Jefferson County Public Health and Free and Reduced Lunch Rates
Jefferson Healthcare. Mental health services are funded by the Jefferson May 2013
County Mental Health/Chemical Dependency sales tax. Services are Chimacum School District 51
available regardless of insurance or ability to pay—about 4 in 10 Chimacum Creek Primary 61
students at CHS and PTHS are low-income (see Free and Reduced Lunch Chimacum Elementary 59
rates table). Services focus on preventative services including Chimacum Middle 47
immunizations, tobacco cessation, nutrition, eating and weight Chimacum High School 42
concerns, reproductive health care, physicals, and mental health Port Townsend School District 44
• counseling.Visits for injuries, illness, and infection are also common Grant Street Elementary 47
throughout the year. Blue Heron Middle School 51
Port Townsend High School 37
Evaluation Methods:
For every medical visit, data on student concerns, clinician addressed topics, and referrals were
recorded by the SBHC nurse practitioner.Additional demographic and health care access data were
collected at each client's first visit by the AmeriCorps member serving in the SBHCs.
Data in this report were collected from August 2013 through June 2014.
4110 [1]8 hours PTHS, 12 hours CHS
IZI 10 hours PTHS, 10 hours CHS
SBHC Report analysis by Sid Kushner,Kitsap Public Health District(7/25/14) 1 I P a g e
• SBHC Demographics
The majority of students using the SBHC in Chimacum are 10th and 11th graders; 12th, 10th and 11th graders at Port
Townsend. Most clinic users are female.
Grade (unduplicated) Gender(unduplicated)
In 50 Chimacum •Port Townsend 100%
a, 80%
= 40 72%
u
•� 30 50%
p 20 28%
20%
10 III_�
0%
Z 0 �' '� Female Male
6 7 8 9 10 11 12 ®Chimacum E Port Townsend
Grade
SBHC Clinic Usage
PTHS CHS Based on enrollment numbers(grades 9-12 only),39%
Total visits:288 Total Visits:361 of CHS students and 29%of PTHS students utilized
Total#of clients: 130 Total#of clients: 143 SBHC physical health services during the 2013-2014
• Total#clinic days:79 Total#clinic days: 73 school year.
Port Townsend:Average number of clinic visits per day
per month
05
10
c
u 8
a`, 6
a
4
izt 2 I i . liii I
0
CU
Aug Sept Oct Nov Dec Jan Feb Mar Apr May June OVERALL AVERAGES:
v
a' 2013 2014 PT:26 visits per month;
4 visits per clinic day
Chimacum: Average number of clinic visits per day per
CH:33 visits per month;
month
6 visits per clinic day
10
c
u 8
a, 6
a 4 4.
c'St ,X, 4 , l 'k
t p
v
co
a Aug Sept Oct Nov Dec Jan Feb Mar Apr May June
• > 2013 2014
SBHC Report analysis by Siri Kushner,Kitsap Public Health District(7/25/14) 2 ' Page
• At Port Townsend, 12th graders had the greatest number of clinic users, 11th graders had the greatest number of total
visits.On average,clinic users made 2.2 visits during the year.
At Chimacum, 10th graders had the greatest number of clinic users and total visits. On average,clinic users made 2.5 visits
during the year.
Port Townsend Clinic Visits by Grade Chimacum Clinic Visits by Grade
Total#individuals(unduplicated) IN Total#visits W Total#individuals(unduplicated) ■Total It visits
120 120
100 93 103
87 100
80 80 69 83 78
60 57
47 60
40 33i 33 37 39 35
23 40 24 28
20 1 1 1 1 20 , 4 10 II
0 FA.
6 7 9 10 11 12 7 8 9 10 11 12
• Chimacum saw students in grades 7 through 12 while Port Townsend saw students in grades 9 through 12 and
only one student each from grades 6 and 7.
The elementary, middle, and high school share a campus in Chimacum likely explaining the higher use by
younger students.
SBHC Visit Reasons
Top five clinic visit issues by category:
BEHAVIORAL HEALTH PHYSICAL HEALTH HEALTH EDUCATION
Student Clinician
concern addressed Student concern Clinician addressed Clinician addressed
anxiety mh screen reproductive health reproductive health pregnancy
depression school sports physical sports physical tobacco
mh screen family injury screen:vision/hearing/blood pressure injury prevention
stress relationships immunization injury substance use
family stress flu/cold immunization nutrition/exercise
S
SBHC Report analysis by Siri Kushner,Kitsap Public Health District(7/25/14) 3 I P a g e
• Top 10 Student Concerns Top 10 Issues Addressed by Clinician
reproductive health reproductive health
sports physical omm mh screen
injury IN school I,am
immunization • family moms=
flu/cold • relationships Emma=
mh screen ■ sports physical omm•
depression • stress mem
anxiety • screen:vision/hearing/bp emim
stress
injury �
family i immunization •
0 100 200 300 400 500 0 100 200 300 400 500
The vast majority of visits are for reproductive health which may include STI screening,pregnancy test,birth control,emergency
contraception,and education on risky sexual behavior and harm reduction techniques.Likely due in part to the SBHCs,
Jefferson County has one of the lowest teen pregnancy rates in Washington State(Source:WA State Dept of Health,2012 Vital
Statistics.http://www.doh.wa.gov/DataandStatisticalReports/VitalStatisticsData/AbortionPregnancyData/AbortionPregnancyTa blesbyYea r.aspx.)
Student athletes are required to get a sports physical every two years.Both SBHCs provide this service which is also available to
Quilcene students.Before fall sports begin in August,both clinics open to give students convenient and inexpensive access to
sports physicals.
. According to data from the 2012 Healthy Youth Survey(HYS),Jefferson County youth have higher rates than state average for
current and lifetime alcohol use as well as binge drinking for 10th and 12th graders.They also report higher rates of current
cigarette smoking,marijuana use,and substance use at school.10th graders report higher than state average for illegal drug
use.
Further,Jefferson County youth perceive that access to cigarettes,alcohol and marijuana is not very difficult and that most
adults do not think youth drinking and smoking marijuana is"very wrong"(Source:2012 HYS).
A third of 10th graders and 12th graders in Jefferson County reported experiencing depressive feelings in the past year.One in 4
10th graders and 1 in 5 12th graders reported having seriously considered suicide in the past year(Source:2012 HYS).
SBHC clinicians regularly address all of these issues with students,working to educate and empower our youth
to make healthier choices!
SBHC Referrals
Referrals for students are made on a consistent and ongoing basis to a variety of providers and organizations in the
area. Common referrals from the SBHCs are for mental health services(in-patient,out-patient or to the SBHC MH
counselor),dental services(including the Smile Mobile), insurance plans(Apple Health and Take Charge),
additional medical or public health services,school counselor,chemical dependency programs,emergency housing
and food,and juvenile services.
•
SBHC Report analysis by Siri Kushner,Kitsap Public Health District(7/25/14) 4 I P a g e
s
•
• SBHC Clinic Usage Over Time
Total SBHC Visits Over Time
—A—Unduplicated clients Total visits
1000
800 .
600
400
200 • • •
Spring 2009 2009-10 2010-11 2011-12 2012-13 2013-14
Chimacum SBHC Visits Over Time Port Townsend SBHC Visits Over Time
Unduplicated clients Total visits Unduplicated clients Total visits
600 600
500 500
400 400
• 300 300
200 200
100 100
0 0
Spring 2009-10 2010-11 2011-12 2012-13 2013-14 Spring 2009-10 2010-11 2011-12 2012-13 2013-14
2009 2009
The total number of clients in 2013-14 is about the same as previous years, but total visits decreased indicating
fewer visits per client or a decrease in "frequent clinic users."
S
SBHC Report analysis by Siri Kushner,Kitsap Public Health District(7/25/14) 5 i p a g e
•
•
r
J.
Board of Health
V
New Business
Item 5
• Communicable disease update
410 August 21 , 2014
STDpreliminartMorbid4July2014.pdf-AdobeReade; 1111;-274*ii"2'::11i!: - 11i4tt ',11WAkft;$11164111. 10! 2A. gAz'''1'.2!...:4g11;44iiii'94.4-Al;aftlig§,ikgi ;41Wt44.717:*k7'; ':
File Edo View Window Help
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1410 i;!:(6,;111,01iiiiiiigi4illittOilittligiii:ilittitg
t01,,,ovoc 594iiiilignk4sietlitt,cisoo0e, Washington State STD Services
Washington State Monthly Activity Through July.2014
Year To Date Gonorrhea Cases by County
*16—o,,24444pi8181180619188181111Aivir4tr,184414011iirM
tite:9!!5$14141111elitiRgiti)tiiiiiiiiiiktillr YTD YTD
Cases Cases Percent
1.44‘'''''..f*:'''''i.'..':!..''''''''''''::'::.':.'."'4::,..:' :-:::"4:-, ::•:::.•'....:..:,‘...:. County Jan Feb M31 Api May Jon Jul Aug Sep Oct Nov Dec 2014 2013 Chan
411111141‘L. -• .::, -7 •':•:. •-•••• •i•• ,r,:••':• Moms 1 0 0 1 0 2 1 5 1 400%
,41.1.:%.•:::", .91::.. ...!:- -:'''''.: 9::L. .:5. ":1::. ..0'.':::•:..
AsOtin 0 0 9 1 0 0 0 1 2 -50%111111.:1':..:::,.. :1::;:. -!!::......... :...:::. •.'''':- :!.."..i. 'I.."' ..,:i,..,...
AS, ..•.. •:.,. , ..." ..: - . 5. Benton 15 12 13 10 11 15 1 13 89 34 162%
Chelan 3 1 0 0 I 1 1 2 8 9 -11'
Milani 3 4 1 3 1 0 , 0 8 3 167%
111111... .:,;...„... %,.......,.: ..„.: :..... -::,:, .:..... .... , I Irk
10 12 12 15 11 17 19 95 78 23%
1 0 1 0
*24t. "•. •:::.'... "L''''. •. ..::.:. .- ... ''" Columbia 6 0 0 0 . , 1 0
b444 ).:''... ':"' :. :-.• ..::: .:': --:. •::.• C 0w I itz 0 2 0 1 0 1 1 5 15 -67%
()NOB 01010k 1 3 1 -57%
F e il,
0 0 I 0 -3 5 1 1 2 -50'
,,,41:111 :: .'..'. ....:.::.: _. •.„.. .„... .... Franklin 9 3 9 9 6 12 ! 9 57 31 84%
. ,-...., ... .. ..
'( .:::- ..-:!:::. •''' .9.:: .2_ -:,. „:. 9,i':' Garfield 0 0 0 0 I a ! ,.., 1 0
klell',1411::...: ...:: ..::: .,:-. ,-. ..9.. .",.. --.:
411149,'" :159 ...'— v•:: .::• -::.:. _....5 ..... ..., Grant 3 2 2 12 6 4 1 4 33 8 313%
Grars Hdrb.`"r1 2 I' 2 5 7 5 23 8 18850
d
n
Isla
•‘0949 .:::....... ..... :., :v,.... _ .
2 1 1 1 1 5 i 0 11 13 -15%
9 3 200%
Jefferson 1 2 0 I 2 2
141 141 153 163 173 177 I 196 1,150 1,027 12%
%-*eke .:::::: .......:. -5 .„..:„ .;,:v „,-. .• .
."21; ....:: '.'5.... -:: .:..... r..i.:,... „;„.,... ...'...: :.'..;.: Kusap 16 14 8 8 8 11 7 72 54 331.o
0 r
Kittitas 1 2 2 1 1 , 0 7 2 250%titi.. „.,:... ,..:,...- :::. ..„ ....„.. ....... .....„ .::.
Klickitat 0 0 0 0 1 0 I 2 3 0 *
. Lewis 0 1 3 2 0 0 1 0 6 17 -65%
g:',535M' '''''' '.:,. ':: :5 .9 ...., .,. ::: Lincoln 0 0 i, 0 0 ;.) :.: 0 0
AO....,..vit „:„. :'' ,::: .1. .... _. . .
..'. .::- ..-. l. . - Mason 0 2 2 5 1 5 1 4 19 11 73%
.,,,,t,,,,,2,,L... .r ...: . - .r. .: .. .
lik:"'
Okangan 2 0 0 ,.-,o 0 1 3 10 -70%
tigOiW'MC.:1.:. '','''.- ...:... ..."' .",• :1." '''''. -5' '''. Pacific 0 I 1 3 i 1 1 8 5 likfi
l.::' ,,.. ::1..,... ....: ..:.:.. .....r.. .,.... ...... L
:',;%. .-: .:.' ''' ---. .:.. - ..: Pend Oleine 0 0 0 0 0 0 1 0 1 100%
..t, 9 ,'III,..1•11..— Pierce 84 83 104 115 119 96 96 697 572 22%
!kiii!Aki!.::::',.• ‘1"‘,.. 'I.: ..:::," .-. : ..:._ . , San J11011 l' ° ° 0 0 0 °I 0 0
Nig Skagit 4 2 2 0 4 9 4 34 25 36%
41811
Ska mama 0 0 0 0 0 0 0 0 1 -100%
Snohomish 34 30 29 27 43 43 37 243 130 87%
Spokane 30 25 45 41 45 47 37 270 159 70%
...1.... '''_ ...:. ..: .
'4141 III 1:.:: f 4 Stevens 1 1 0 2 0 0 1 5 7 -29%
Thurston 6 6 12 13 14 17 11 7'9 64 230e
...f, 7.: ''' :1': .... ....... ..4:. , Wahkidum 0 0 0 0 0 0 0 0
itLei462 .... .,:... ..:_. .....
' . ' '''' Walla Walla 1 4 9 4 1 1 4 20 15 87%
%LI ':: ::-.. ..... .:: •:-: - : ... Yaiorna 20 22 28 21 34 29 42 106 80 145%
4t.'"6,MAt ''"': ::::: - - '''. -::- .:• .
krkki -..... %... ..?: ....: :. ..
•
• Board of Health
V
New Business
Item 6
Regionalization of Medicaid and Behavioral Health
•
• August 21 , 2014
... .... -“--'-.. _
,.. ...... _. ..
• aYdJk O_ _ _ __ - . __ / , _ - J- -/r e k------k
- - --- -
A
I Hi hli hts from Monda s Commissioner Meetin r,.s ,2
9 9 y .g ugust 12,2014
� sr 1s7 ,r, s ,t Bi sa :' -‘4,1"" -',I-4-,,,
., viiimminiiminemow
` -i, ' ..e e i ,', r
• p
PUBLIC COMMENT PER1OD:The following is a summary of17,,,,.,.,;,....', -"� ,
comments made by citizens in attendance at the meeting and < .
reflect their personal opinions: �k
• 8 citizens commented on the 1-502 implementation in �
Jefferson County;
• A citizen stated:1)Two PUD candidates will be speaking at ..,. n�. � `
the Chimacum Grange this Wednesday at 6:30 p.m.;2)An �� Seals on Rat Island_
area that was unsafe for bicyclists,has been made safer; _ � . s..� �
and 3)The Ebola virus is an international disaster;
• A citizen noted the Agenda Request for the Climate Action APPROVAL OF MINUTES:The Board approved the meeting
Committee(CAC)did not list a fiscal impact amount;and minutes of July 7 and 14,2014 as presented.
• • A citizen stated climate change is real. PROCLAMATION:The Commissioners read and approved a
CONSENT AGENDA:The Board agreed to delete item No.3 Proclamation proclaiming August 11-15,2014 as Jefferson
(Appointment of New Members to the CAC).The Board County Employee Recognition Week.
discussed and approved the item later in the meeting).The DISCUSSION re:Climate Action Committee(CAC):The
following items were approved as submitted: Department of Community Development(DCD)discussed a
2 AGREEMENTS:1)Support of Court Appointed Special proposed Joint Resolution with the Board.After discussion,the
Advocates(CASA)Guardian ad Litem(GAL)Programs; Board unanimously approved RESOLUTION NO.39-14 re:Joint
Washington State Administrative Office of the Courts(AOC); Resolution of the Board of County Commissioners and the Port
and 2)Government Relations,Seeking Resources for Upper Townsend City Council extending the term of the Climate
Hoh Road;Strategies 360, Inc. Action Committee.The Board discussed and approved Item No.
DELETED:Advisory Board Appointments(4)re:Climate Action 3 of the Consent Agenda as presented.
Committee(CAC); 1)Jack Pokorny,Student Representative;2) UPDATE re:I-502(Legalized Recreational Marijuana): DCD
Kevin Scott,Port Townsend Paper Mill Representative;3) discussed new information they received after a meeting that
Samantha Thomas, Non-Motorized Alternate Representative; included the Washington State Liquor Control Board.After
and 4)Laura Tucker,County Health-Green Business discussion,the Board approved ORDINANCE 07-0811-14 re:
Representative Establishing a Moratorium prohibiting the production,
Payment of Jefferson County Payroll Warrants Dated August processing and retailing of recreational marijuana in the certain
5,2014 Totaling$821,610.14 and A/P Warrants Done by land use designations within unincorporated Jefferson County
Payroll Dated August 5,2014 Totaling$722,958.33AND establishing a work plan for the planning agency.The
COMMISSIONERS BRIEFING SESSION:The Commissioners Moratorium went into effect August 11,2014 at 11:13 a.m.A
provided updates on the following items: hearing on the matter will be held within 6 ays.
All 3 Commissioners: DI •N:The Board met with Publ' orks staff to disc s
- Attended the Jefferson County Fair last week. the six(6)Year Transp.
Chairman Austin LETTER:The Board approved sending a letter to staff of the
- Will be attending a Washington State Board of Health(BOH) Washington State Healthcare
meeting this week. Authority re:maintaining a °'
0 Commissioner Johnson relationship between Clallam, ,,,,!'e,,,,,i4.4ae' „,
- Update re: Hood Canal Coordinating Council(HCCC): Jefferson and Kitsap Counties ins
They have completed their project priority list. the provision of mental health „d. .. ° ,
Commissioner Sullivan : d chemical dependency
- Attended a Quilcene Museum Fundraiser last week. servi
,��SON ccG„
40
WASHiNGT014 �9SHfNG��`'
Clallam County August 13, 2014
Mike Chapman,Chair
Mike Doherty
Jim McEntire
Dorothy Teeter, Director, Washington State Health Care Authority
Jefferson County PO Box 45502
John Austin,Chair Olympia, WA 98504
Phil Johnson
David Sullivan
Jane Beyer, Assistant Secretary, Washington State Department of Social
Kitsap County and Health Services
Charlotte Garrido,Chair PO Box 45050
Robert Gelder Olympia, WA 98504
Linda Streissguth
Dear Ms. Teeter and Ms. Beyer:
In May 2014, the Washington State Health Care Authority (HCA) announced the
availability of planning grants for groups of counties and tribes interested in pursuing
Accountable Community of Health (ACH) designation under Washington State's
• Health Care Innovation Plan. The timeline of these grant applications was exceedingly
brief, with one week to submit a letter of intent and less than three weeks to complete
a grant application. Jefferson County Public Health submitted a letter of intent for a
Jefferson/Clallam ACH with the possible addition of Kitsap County. However, with
insufficient time to involve relevant stakeholders, the ACH application was not
submitted.
Clallam and Jefferson Counties elected to participate in CHOICE's Cascade Pacific
Action Alliance for the planning period July 1, 2014 to December 31, 2014; Kitsap
Public Health District indicated they would explore the possibility of involvement.
Kitsap, Clallam, and Jefferson Counties viewed this participation as a time-limited
community health planning activity carrying no commitment to seek designation as a
10-county ACH. Kitsap, Clallam, and Jefferson Counties never intended this
participation as a commitment to join a 10-county ACH.
2SSB 6312, passed by the Washington State Legislature in 2014, calls for the creation
of regional service areas within the State for the purchasing of behavioral health and
chemical dependency treatment services to be known as Behavioral Health
Organizations (BHO), replacing the current system of Regional Support Networks
(RSN). The County Commissioners of Clallam, Jefferson, and Kitsap Counties
understand the need for the reorganization mandates under 2SSB 6312 and support
the formation of"common regional service areas" that would make the geographical
i
614 Division Street,MS-23 Port Orchard, WA 98366-4676 (360)337-4526
FAX(360)337-5721
August 13, 2014 •
Page Two
boundaries of BHOs and ACHs identical. The Boards of County Commissioners of Kitsap,
Clallam, and Jefferson Counties oppose creation of either a 10-county ACH or BHO that
involves their counties, as do numerous health and social service providers spanning our three
county region. We are aware that this July, the Adult Behavioral Health System Task Force
voted to adopt the Washington State Association of Counties' (WSAC's) recommendation
reaffirming the existing three-county Peninsula Regional Support Network boundary. We
applaud adoption of this recommendation, and again affirm our support for a three-county ACH
and BHO with the same boundaries of the RSN it is replacing — Kitsap, Clallam, and Jefferson
Counties.
We understand the purpose of Regionalization of Medicaid Purchasing and Community
Mobilization is to ensure a common regional approach that: 1) aligns state efforts across
common regions, 2) recognizes that health and health care is local, 3) promotes shared
accountability within each region for the health and well-being of our residents, and 4)
empowers local and county entities to develop a "bottom-up" approach to transformation that
applies to community priorities and environments. We do not believe a ten-county region can
provide for the local priorities setting process and recognition that health and health care is
local. We do believe our history of shared networks and formal tri-county councils is consistent
with effective regional planning and implementation efforts. Much of our region is rural in nature,
posing special challenges associated with health care workforce shortages and populations that •
are older, sicker, and poorer than their urban counterparts. Kitsap, Clallam, and Jefferson
Counties have a long history of working collaboratively on these issues through innovative
community health partnerships involving our public health departments, hospitals, Tribal
governments, and health care providers. These existing partnerships will prove crucial as we
pursue the goals of the Triple Aim throughout our region.
With the stated goal of HCA and DSHS to promote development of regions that contain a
sufficient number of"Medicaid covered lives" to allow full financial risk contracting at a
recommended minimum of 60,000 Medicaid enrollees per Regional Service Area, our three-
county rural and suburban areas combined are sufficient to meet this goal. Ultimately, existing
health care delivery systems, established provider networks, referral and travel patterns, and
geographic accessibility factors are the most important determinates of a successful regional
partnership.
Consistent with our State's vision for health care innovation, we are actively engaging in an
ACH planning process for our tri-county area. Should a second round of ACH funding
opportunities become available, we will pursue that funding, however, we do not want award of
a planning grant to preclude our intent to move forward. As a region, we are committed to
convening stakeholders, leading health improvement activities, strengthening partnerships with
state and local jurisdictions, acting in alignment with statewide healthcare initiatives, and using
collective impact principles to make a three-county ACH successful.
4110
• August 13, 2014
Page Three
We hereby urge DSHS and HCA to support our decision to form a Kitsap, Clallam, and
Jefferson regional service area. Moreover, when the time arrives in 2015 to designate ACH
configurations, we also support this three-county configuration as the basis of an ACH for our
region.
Sincerely,
Charlotte Garrido, Chair Michael C. Chapman, Chair John Austin, Chair
Kitsap County Board of Clallam County Board of Jefferson County Board of
Commissioners Commissioners Commissioner
cc: Eric Johnson and Abby Murphy-Washington State Association of Counties
Adult Behavioral Health System Taskforce
Nathan Johnson, Washington State Healthcare Authority
• MaryAnne Lindeblad, Washington State Healthcare Authority
S
•
AtorIMIztri.44��sO N CoG
r-
Oh1� ,
S
WASHING os 9SktNG`c°�
Clallam County August 13, 2014
Mike Chapman,Chair
Mike Doherty
Jim McEntire
Dorothy Teeter, Director, Washington State Health Care Authority
Jefferson County PO Box 45502
John Austin,Chair Olympia, WA 98504
Phil Johnson
David Sullivan
Jane Beyer, Assistant Secretary, Washington State Department of Social
Kitsap County and Health Services
Charlotte Garrido,Chair PO Box 45050
Robert Gelder Olympia, WA 98504
Linda Streissguth
Dear Ms. Teeter and Ms. Beyer:
In May 2014, the Washington State Health Care Authority (HCA) announced the
availability of planning grants for groups of counties and tribes interested in pursuing
Accountable Community of Health (ACH) designation under Washington State's
• Health Care Innovation Plan. The timeline of these grant applications was exceedingly
brief, with one week to submit a letter of intent and less than three weeks to complete
a grant application. Jefferson County Public Health submitted a letter of intent for a
Jefferson/Clallam ACH with the possible addition of Kitsap County. However, with
insufficient time to involve relevant stakeholders, the ACH application was not
submitted.
Clallam and Jefferson Counties elected to participate in CHOICE's Cascade Pacific
Action Alliance for the planning period July 1, 2014 to December 31, 2014; Kitsap
Public Health District indicated they would explore the possibility of involvement.
Kitsap, Clallam, and Jefferson Counties viewed this participation as a time-limited
community health planning activity carrying no commitment to seek designation as a
10-county ACH. Kitsap, Clallam, and Jefferson Counties never intended this
participation as a commitment to join a 10-county ACH.
2SSB 6312, passed by the Washington State Legislature in 2014, calls for the creation
of regional service areas within the State for the purchasing of behavioral health and
chemical dependency treatment services to be known as Behavioral Health
Organizations (BHO), replacing the current system of Regional Support Networks
(RSN). The County Commissioners of Clallam, Jefferson, and Kitsap Counties
understand the need for the reorganization mandates under 2SSB 6312 and support
the formation of"common regional service areas"that would make the geographical
S
614 Division Street,MS-23 Port Orchard, WA 98366-4676 (360)337-4526
FAX(36o)337-5721
August 13, 2014 •
Page Two
boundaries of BHOs and ACHs identical. The Boards of County Commissioners of Kitsap,
Clallam, and Jefferson Counties oppose creation of either a 10-county ACH or BHO that
involves their counties, as do numerous health and social service providers spanning our three
county region. We are aware that this July, the Adult Behavioral Health System Task Force
voted to adopt the Washington State Association of Counties' (WSAC's) recommendation
reaffirming the existing three-county Peninsula Regional Support Network boundary. We
applaud adoption of this recommendation, and again affirm our support for a three-county ACH
and BHO with the same boundaries of the RSN it is replacing — Kitsap, Clallam, and Jefferson
Counties.
We understand the purpose of Regionalization of Medicaid Purchasing and Community
Mobilization is to ensure a common regional approach that: 1) aligns state efforts across
common regions, 2) recognizes that health and health care is local, 3) promotes shared
accountability within each region for the health and well-being of our residents, and 4)
empowers local and county entities to develop a "bottom-up" approach to transformation that
applies to community priorities and environments. We do not believe a ten-county region can
provide for the local priorities setting process and recognition that health and health care is
local. We do believe our history of shared networks and formal tri-county councils is consistent
with effective regional planning and implementation efforts. Much of our region is rural in nature,
posing special challenges associated with health care workforce shortages and populations that
are older, sicker, and poorer than their urban counterparts. Kitsap, Clallam, and Jefferson411
Counties have a long history of working collaboratively on these issues through innovative
community health partnerships involving our public health departments, hospitals, Tribal
governments, and health care providers. These existing partnerships will prove crucial as we
pursue the goals of the Triple Aim throughout our region.
With the stated goal of HCA and DSHS to promote development of regions that contain a
sufficient number of"Medicaid covered lives" to allow full financial risk contracting at a
recommended minimum of 60,000 Medicaid enrollees per Regional Service Area, our three-
county rural and suburban areas combined are sufficient to meet this goal. Ultimately, existing
health care delivery systems, established provider networks, referral and travel patterns, and
geographic accessibility factors are the most important determinates of a successful regional
partnership.
Consistent with our State's vision for health care innovation, we are actively engaging in an
ACH planning process for our tri-county area. Should a second round of ACH funding
opportunities become available, we will pursue that funding, however, we do not want award of
a planning grant to preclude our intent to move forward. As a region, we are committed to
convening stakeholders, leading health improvement activities, strengthening partnerships with
state and local jurisdictions, acting in alignment with statewide healthcare initiatives, and using
collective impact principles to make a three-county ACH successful.
•
•
• August 13, 2014
Page Three
We hereby urge DSHS and HCA to support our decision to form a Kitsap, Clallam, and
Jefferson regional service area. Moreover, when the time arrives in 2015 to designate ACH
configurations, we also support this three-county configuration as the basis of an ACH for our
region.
Sincerely,
Charlotte Garrido, Chair Michael C. Chapman, Chair John Austin, Chair
Kitsap County Board of Clallam County Board of Jefferson County Board of
Commissioners Commissioners Commissioner
cc: Eric Johnson and Abby Murphy- Washington State Association of Counties
Adult Behavioral Health System Taskforce
Nathan Johnson, Washington State Healthcare Authority
• MaryAnne Lindeblad, Washington State Healthcare Authority
•
� Board of Health
Media Report
f
i August 21 , 2014
• Jefferson County Public Health
July/August 2014
NEWS ARTICLES
1. "Kilisut Harbor, Mystery Bay reopen to some shellfishing," Port Townsend Leader, July
17th, 2014.
2. "Mystery Bay, Kilisut Harbor reopened to shellfish harvest of all but butter, varnish
clams," Peninsula Daily News, July 18th, 2014.
3. "Hearing July 28 to outline mill, county landfill agreement," Port Townsend Leader, July
23rd, 2014.
4. "Shellfish harvest closed at Discovery Bay," Port Townsend Leader, July 24th, 2014.
5. Port Townsend Paper Corp. mill gets permit to add two pulp refiners," Peninsula Daily
News, July 24th, 2014.
6. "Discovery Bay closed to shellfish harvesting as diarrhetic shellfish poisoning risk
rises," Peninsula Daily News, July 25th, 2014.
7. "New Port Townsend Paper mill landfill regulations to be discussed at meeting
tonight," Peninsula Daily News, July 28th, 2014.
8. "Teens: get your sport physicals done now," Port Townsend Leader, July 30th, 2014.
9. "Picnic in PT Aug. 6 to celebrate World Breastfeeding Week," Port Townsend Leader,
July 30th, 2014.
10. "Teens: get your sport physicals done now," Port Townsend Leader, July 30th, 2014.
• 11. "Terms of Port Townsend Paper's landfill agreement celebrated at open house,"
Peninsula Daily News, July 30th, 2014.
12. "Sports Physicals at School Based Health Centers," City of Port Townsend Newsletter,
August 2014.
13. "Teens: get your sports physicals done now," Port Townsend Leader, August 6th, 2014.
14. "Free dental clinic in Quilcene Aug. 29," Port Townsend Leader, August 6th, 2014.
15. "Toxic algae only has Anderson Lake, so far," Port Townsend Leader, August 13th, 2014.
16. "It's a UGN High 5 for Gimme 5 Program," Port Townsend Leader, August 13th, 2014.
17. "Port Ludlow Water Surcharge Meeting is July 14," Port Townsend Leader, July 9th
2014.
18. "Village Council Endorses Ludlow Water Surcharge," Port Townsend Leader, August
13th, 2014.
19. "New Screening Allows Baby to Undergo Treatment Before Ever Getting Sick," The
Spokesman-Review, August 12, 2014.
2_0,AtOry1044/1__ ,
fiko2,01(f
•
• Kilisut Harbor, Mystery Bay reopen to some shellfishing
Port Townsend Leader, July 17, 2014
Mystery Bay and Kilisut Harbor have reopened for recreational shellfishing of all species except butter
and varnish clams. Levels of the marine biotoxin that cause Diarrhetic Shellfish Poisoning are currently
below the recreational closure level, the Jefferson County Public Health reported July 17.
Mystery Bay State Park—the only public tideland in the area—remains closed to all recreational clam
and oyster harvest, per Department of Fish and Wildlife regulations (Washington Administrative Code
220-56-380). Mystery Bay State Park is closed to shellfishing during the peak of boating season from May
1 to Sept. 30.
The area off Marrowstone Island remains closed to the harvest of butter and varnish Clams, due to their
tendency to retain marine biotoxins longer.
Below is a complete list of all beaches that are closed by the Washington State Department of Health
(DOH) to recreational shellfish harvest in Jefferson County. Commercially harvested shellfish are tested
for toxin prior to distribution and should be safe to eat.
Closures are in effect for the following beaches:
•West Jefferson County ocean beaches—all species
• Discovery Bay— butter and varnish clams
• Port Ludlow, including Mats Mats Bay— butter and varnish clams
• • Kilisut Harbor, including Mystery Bay—butter and varnish clams.
Warning signs have been posted at high-use beaches warning people not to consume shellfish from
these areas. This closure does not apply to shrimp. Crabmeat is not known to contain biotoxins but the
guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (butter).
Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish
contaminated with the naturally-occurring marine algae containing toxins. In most cases, the algae that
contain the toxins cannot be seen and must be detected using laboratory testing.
Recreational shellfish harvesters should check the DOH website at
doh.wa.gov/CommunityandEnvironment/Shellfish/BeachClosures aspx or call the DOH Biotoxin Hotline at
1-800-562-5632 before harvesting shellfish anywhere in Washington State.
•
Mystery Bay, Kilisut Harbor reopened to shellfish harvest of all but butter,varnish clams
Peninsula Daily News, July 18, 2014
•
PORT TOWNSEND — Mystery Bay and Kilisut Harbor have reopened for recreational shellfish
harvesting of all species except butter and varnish clams, the Jefferson County Health Department said
Thursday.
Levels of the marine biotoxin that cause diarrhetic shellfish poisoning, or DSP, are currently below the
safe level of 16 micrograms per 100 grams of tissue, according to Michael Dawson, water quality lead for
the county department.
The area remains closed to the harvest of butter and varnish clams due to their tendency to retain marine
biotoxins for a long time, up to a year.
Kilisut Harbor and Mystery Bay beaches were closed to recreational harvesting of all species of shellfish
in June because of high levels of the marine biotoxins that cause DSP.
Commercially harvested shellfish are tested for toxin prior to distribution and should be safe to eat.
The state Department of Health closed Sequim Bay to harvesting of all species of shellfish earlier this
month because of elevated levels of the marine biotoxin that causes DSP.
The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. It does
not apply to shrimp.
Crab meat is not known to contain the biotoxins, but the guts can contain unsafe levels. To be safe, •
clean crab thoroughly and discard the guts.
Closures to the harvest of butter and varnish clams remain in effect for Discovery Bay; Port Ludlow,
including Mats Mats Bay; Kilisut Harbor, including Mystery Bay; and beaches along the Strait of Juan de
Fuca from Cape Flattery east to Dungeness Spit.
All areas are closed for the sport harvest of scallops.
Ocean beaches are closed for the season to the harvest of all types of shellfish.
Warning signs have been posted at high-use beaches.
DSP can cause diarrhea, nausea, vomiting, abdominal cramps and chills.
Marine biotoxins are not destroyed by cooking or freezing.
Recreational shellfish harvesters can get the latest information about the safety of shellfish on the state
website at www doh.wa. ov or by phoning 800-562-5632 before harvesting shellfish anywhere in the
state.
4110
• Hearing July 28 to outline mill, county landfill agreement
Port Townsend Leader, Wednesday,July 23, 2014
A public workshop to discuss the new requirements of a landfill owned and operated by the Port
Townsend Paper Corp. is set for 6 p.m. Monday, July 28 at the Cotton Budding in Port Townsend.
Mill, state Department of Ecology and Jefferson County representatives are expected to be on hand.
The mill filed for and received a Limited Purpose Landfill (LPL) permit in July, ending more than two years
of arguing over how to classify the 25-acre landfill.
The mill and the Jefferson County Public Health Department announced July 7 that a settlement has
been reached and the mill filed for an LPL permit, a higher, more stringent permit classification than it has
had since 2003.
The LPL permit requires the mill to resume water-quality monitoring and provide financial assurance that
it has the means to close the landfill once the landfill is full.
The mill's landfill was the only one of its kind in the state that had no financial agreement to provide
assurances the owners had the means to cap the landfill if the mill closed. The agreement provides:
• That the mill will operate its landfill under a Limited Purpose Landfill permit.
• The mill will install two new groundwater monitoring wells.
• The mill will submit an updated closure plan and closure/post-closure cost estimates.
• The mill will provide financial assurance for closure and post-closure maintenance and monitoring of the
• landfill.
APPEAL PROCESS
The mill had been fighting the county and the state over the classification and had appealed a decision by
the county to require the LPL to the state Pollution Control Hearings Board.
PTPC President Roger Hagan said by email July 18 that in the mediation process, the mill agreed to
withdraw its legal appeal when the permit is final and issued.
"As it has not yet been issued we have not acted to withdraw the appeal, although we anticipate both to
happen shortly after the upcoming workshop in which Ecology and County will discuss the terms of the
proposed permit," Hagan wrote.
For a copy of the agreement, go to jeffersoncountypublichealth.org.
•
Shellfish harvest closed at Discovery Bay •
Port Townsend Leader, July 24, 2014
, '
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Discovery Bay 2014
Discovery Bay beaches have been closed to recreational shellfish harvest as of
July 24,2014,due to high levels of biotoxins that cause Diarrhetic Shellfish Poisoning.
Recreational crabbing season remains open.Photo by Patrick J.Sullivan
The Washington State Department of Health. (DOH) has closed Discovery Bay beaches to recreational
shellfish harvest, effective July 24. Marine botoxins that cause Diarrhetic Shellfish Poisoning (DSP) have
been detected at concentrations above the closure level in shellfish samples collected from Discovery
Bay. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish.
Shellfish harvested commercially are tested for toxins prior to distribution and should be safe to eat,
according to the DOH. •
Recreational crabbing is OK.
Danger signs have been posted at high-use beaches, warning people not to consume shellfish from this
area.
Marine biotoxins are not destroyed. by cooking or freezing. DSP can cause diarrhea, nausea, vomiting,
abdominal cramps and chills, simlar to gastrointestinal or stomach flu type symptoms. Symptoms caused
by DSP-tainted shellfish could begin within a few hours of eating and last one to three days. Anyone
experiencing these symptoms should contact a health care provider.
DSP is caused by okadaic acid produced by blooms of the naturally occurring marine algae Dinophysis.
In most cases the toxic algae blooms cannot be seen, and must be detected using laboratory testing.
Recreational shellfish harvesters should check the DOH website at doh.wa.gov/ehp/sf/biotoxin.htm
or call the DOH Biotoxin Hotline at 800 562-5632 before harvesting shellfish anywhere in Washington
State. Recreational harvesters should also check Fish and Wildlife regulations and seasons at
wdfw.wa.gov/fishing/shellfish/or the Shellfish Rule Change Hotline 866-880-
DOH
66 880 5431.
i
Port Townsend Paper Corp. mill gets permit to add two pulp refiners
By Charlie Bermant,Peninsula Daily News,July 24th,2014
i
The Port Townsend Paper Corp.has been permitted to
add two pulp refiners.—Charlie Bermant/Peninsula
Daily News
PORT TOWNSEND—The state Department of Ecology has approved a permit by Port Townsend Paper Corp. for
a $5 million project to add two pulp refiners.
The mill received the permit Monday for the refiners, which mill officials say will strengthen paper pulp more
cheaply than chemical alternatives.
"Whatever merits the project may have, the mill states that it will increase air pollution by about 3 percent," said
Gretchen Brewer, director of PT AirWatchers, which opposed the permit.
"The public wants to see decreases in their pollution, not increases."
Brewer said her group had not decided whether to file an appeal to the Pollution Control Hearings Board, which can
ilk be filed within 30 days of the decision.
According to an Ecology document, the new process is predicted to increase emissions of sulphur dioxide, nitrous
oxide and small particulate matter.
The terms of the approval gives the mill 18 months to begin construction.
Kevin Scott, director of sustainability at the mill, said installation refiners would begin late this year and take about
six months to complete.
The permit was approved after a public comment period and a May meeting in Port Townsend.
About 60 people had attended the public hearing at Fort Worden State Park, with 17 testifying, many saying that
odor and air quality issues with the mill should be resolved before any new components are added.
Stephanie Ogle, an environmental engineer for Ecology, said no changes were made to the proposal after public
comments were received.
"We will make changes if there is any new information or if it is determined there are existing rules that we didn't
apply or were misapplied," she said.
"That wasn't the case here."
• The refiners will improve the strength properties of the fibers, which will allow the paper machine to process specific
grades of paper at a faster speed than they were previously capable of processing them, according to Ecology's
ruling.
The increase will cause several components to operate at a higher rate, which will result in an increase in some
emissions from the facility.
Scott said an increase could occur but added that once the refiners are in operation, emissions could decrease.
"The refiners will make our operations more stable, and any time that happens, there is the potential to lower
emissions," Scott said.
"This is a hard thing to communicate during the permitting process."
Brewer said the public wants a decrease in pollutants and opposes any emissions increases.
"The public is getting the worst of what we expected from the biomass incinerator project," Brewer said of the mill's
abandoned expansion of its biomass facility.
"These are increases in fine particulate, diesel and heavy-metal pollution, as well as increases in truck traffic
without improvements in their pollution controls," she added.
"The kind of innovation and expenditures that we'd love to see from the mill is to speed up their compliance with the
new air regulations," she said.
"They don't have to wait to comply, as they typically do, until the last minute and to the least degree possible."
Earlier this month, mill officials reached an agreement with Jefferson County for the renewal of their landfill permit
and its classification as inert, something the county had opposed.
After mediation, Jefferson County Public Health, Ecology and Port Townsend Paper Corp. agreed to install two new •
groundwater monitoring wells, submit an updated closure plan and closure and post-closure cost estimates, and
provide financial assurance for closure and post-closure maintenance and monitoring of the landfill.
Ogle said air quality issues will be addressed when the mill's air operating permit expires in May, with public
hearings taking place before the permit is extended.
For the permit decision and all other Ecology documents relating to Port Townsend Paper Corp., visit
http://tinyurl.com/PDN-refiners.
Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant[a peninsuladailynews.corn.
Discovery Bay closed to shellfish harvesting as diarrhetic shellfish poisoning risk rises
Peninsula Daily News, July 25th, 2014
PORT TOWNSEND — Discovery Bay has been closed to recreational harvesting of all species of
shellfish because of the risk of diarrhetic shellfish poisoning, Jefferson County Public Health announced
Thursday.
The state Department of Health found the marine biotoxins that cause diarrhetic shellfish poisoning, or
DSP, in concentrations above the safe level of 16 micrograms per 100 grams of tissue, according to
Michael Dawson, water quality lead for the county department.
Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat.
The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish.
It does not apply to shrimp.
Crab meat is not known to contain the biotoxins, but the guts can contain unsafe levels. To be safe,
clean crab thoroughly and discard the guts.
Sequim Bay remains closed to all species because of the risk of DSP.
Elsewhere, beaches on the Strait of Juan de Fuca from Cape Flattery east to Dungeness Spit are open
to shellfish harvesting except for butter and varnish clams, which retain toxins for up to a year.
Strait beaches from Dungeness Spit to the Jefferson County line are closed only to the harvest of varnish
clams.
• Although the state Department of Health reopened earlier this month
p Kilisut Harbor, including Mystery
Bay, and Port Ludlow, including Mats Mats Bay, to shellfish harvesting except for butter clams and
varnish clams, Mystery Bay State Park is closed by state Department of Fish and Wildlife regulations to
the recreational harvest of clams and oysters.
Mystery Bay State Park—the only public tideland in the area — is closed to shellfishing during the peak
of boating season from May 1 to Sept. 30.
All areas are closed for the sport harvest of scallops. Ocean beaches are closed for the season to the
harvest of all types of shellfish.
Warning signs have been posted at high-use beaches.
DSP can cause diarrhea, nausea, vomiting, abdominal cramps and chills.
Marine biotoxins are not destroyed by cooking or freezing.
Recreational shellfish harvesters can get the latest information about the safety of shellfish on the state
website at www.doh.wa.gov or by phoning 800-562-5632 before harvesting shellfish anywhere in the
state.
Recreational shellfishers also should consult state Fish and Wildlife at www.wdfw.wa.gov.
•
New Port Townsend Paper mill landfill regulations to be discussed at meeting tonight
Peninsula Daily News,July 28th,2014
•
PORT TOWNSEND—State, county and Port Townsend Paper Corp. representatives are expected to discuss
details of an agreement on the paper mill's landfill at 6 p.m. today.
A permit issued this month for the mill's landfill changes requirements for its operation.
At tonight's public workshop at the Cotton Building, 607 Water St., representatives of the mill, the state Department
of Ecology and Jefferson County Public Health are expected to discuss the new requirements and answer
questions.
The company, which had operated under a permit for inert waste since 2004, applied for renewal in September
2012.
The Jefferson County Public Health Department denied the request, saying the landfill should be permitted under
the more stringently-regulated limited purpose classification.
Mill officials appealed the decision. Mediation among representatives of the paper company, the county and
Ecology led to the present permit, effective July 3, which will expire in five years.
The permit allows disposal of lime grit—also known as slaker grit—boiler ash, inert wastes and incidental metal
residual material from the combustion of boiler fuel at the mill which, with nearly 300 workers, is the county's largest
private employer.
. Port Townsend Paper must install two groundwater monitoring wells, one by the end of this year and another during
the first quarter of 2016, and is responsible for quarterly groundwater monitoring.
It must submit an updated closure plan and closure/post closure cost estimates and provide financial assurance for
closure and post-closure maintenance and monitoring of the landfill.
The company has agreed to monitor for landfill gases, especially methane, for three years, the county health
department said in a fact sheet on the agreement.
If no landfill gases are detected above a specific level during that time, the company can discontinue monitoring
them.
"Ash and lime grit do not contain significant quantities of organic matter that would decompose and generate
methane or other harmful gases," the county said.
The company will not be required to use a liner, which is generally necessary for landfills.
That's because of low rainfall, tests that show heavy metals in the leachate being below regulatory thresholds and
because ground water will be monitored, the county said.
The company also will be allowed to cover the landfill with soil and plants rather than with a cover that includes a
layer of plastic.
• "The approach has been approved by the U.S. Environmental Protection Agency as being suitable for sites with
characteristics similar to Port Townsend," the county said.
The company had operated an inert waste landfill at the mill from 1983 to 1990.
In 1989, Jefferson County Public Health issued an inert waste landfill permit, and Ecology appealed the decision to •
the state Pollution Control Hearings Board, which ruled in Ecology's favor.
From 1990 until 2004, the landfill was permitted under the limited purpose classification.
In 2004, after Ecology issued new solid waste standards, the mill applied for an inert waste permit.
Ecology recommended it remain a limited purpose landfill but supported a variance to a requirement for a liner.
However, the county health department approved the inert waste permit in 2004. Ecology did not appeal the
decision and it remained in effect.
When the health department denied the 2012 application for an inert waste landfill permit, mill officials argued that
since neither regulations nor the content of the landfill had changed since 2004, the permit should not either.
The health department said that the 2004 permit was issued in error.
"The waste stream generated by the pulp and paper mill . . . is capable of producing leachate or emissions that
have the potential to negatively impact soil, groundwater, surface water or air quality and thus the PTPC waste
stream cannot satisfy the criteria for inert waste," concluded the county's denial of the inert waste permit.
Port Townsend Paper, Corp., appealed the decision. The Pollution Control Hearings Board was to hear the appeal
this summer.
Part of the agreement leading to the issuance of the most recent permit is that Ecology will not appeal it and Port •
Townsend Paper will withdraw its appeal to the state.
For documents pertaining to the permit, see http://tinyurl.com/PDN-milllandfill.
410
Picnic in PT Aug. 6 to celebrate World Breastfeeding Week
Port Townsend Leader, July 30, 2014
World Breastfeeding Week is Aug. 4-9. Jefferson County Public Health supports the annual global
celebration with a picnic on Wednesday, Aug. 6, from 11 a.m. to 12:30 p.m. at Chetzemoka Park in Port
Townsend.
Breastfeeding moms (current and former), babies, families and friends are invited to come to the picnic
and bring their own lunch to celebrate and support the benefits of breastfeeding.
"Babies are for nursing," said Caroline Ruth, a local breastfeeding supporter. "Nursing mothers need to
eat a lot, so come to the picnic. Let's celebrate!"
The 2014 theme is "Breastfeeding: A Winning Goal for Life."
Jefferson Healthcare medical providers, local midwives and Jefferson County Public Health's WIC
program provide education and support to help ensure that women successfully meet their breastfeeding
goals, including the Breastfeeding Tea Party support group, which meets on Wednesdays at 11 a.m. at
Jefferson County Public Health (JCPH), 615 Sheridan St.; and the WIC breast pump loan program.
Breast pumps are available to breastfeeding WIC moms who are working or going to school.
"The benefits of breastfeeding include reduced child mortality, improved health, environmental
sustainability, eradication of extreme poverty and hunger, improved readiness to learn and more," said
Kathy Anderson, a nutritionist at JCPH.
The WIC program recognizes the importance of breastfeeding and its impact on health and reduction of
long-term illnesses, such as diabetes, asthma and obesity. WIC has openings; call 385-9432 to sign up.
Visit the World Breastfeeding website at worldbreastfeedingweek.org. For more information, contact the
county health department at 385-9400.
•
Teens: get your sport physicals done now •
Port Townsend Leader, July 30, 2014
Sports physicals are available in August in Port Townsend, Chimacum and Quilcene to help Jefferson
County teens get ready for the first week of team practice.
Parents are encouraged to make a sports physical appointment with their child's primary care provider or
with the School Based Health Center. The School Based Health Centers are a partnership between
Jefferson County Public Health, Jefferson Healthcare, and the local school districts, providing health care
services to meet the needs of adolescents.
Appointments are available 9 a.m. to 3 p.m. on the following dates and locations, and are open to any
student who needs a sports physical:
Chimacum High School: Aug. 18, 20, 25, & 27
Port Townsend High School: Aug. 19, 22, & 26
Quilcene office of Jefferson County Public Health: Aug. 13
The health centers can bill a family's insurance, or help a family sign up for insurance. The fee for a
physical is $45.
Make appointments with Jefferson County Public Health at 385-9400.
i
•
• Teens: get your sport physicals done now
Port Townsend Leader, July 30, 2014
Sports physicals are available in August in Port Townsend, Chimacum and Quilcene to help
Jefferson County teens get ready for the first week of team practice.
Parents are encouraged to make a sports physical appointment with their child's primary care
provider or with the School Based Health Center. The School Based Health Centers are a
partnership between Jefferson County Public Health, Jefferson Healthcare, and the local school
districts, providing health care services to meet the needs of adolescents.
Appointments are available 9 a.m. to 3 p.m. on the following dates and locations, and are open
to any student who needs a sports physical:
Chimacum High School: Aug. 18, 20, 25, & 27
Port Townsend High School: Aug. 19, 22, & 26
Quilcene office of Jefferson County Public Health: Aug. 13
The health centers can bill a family's insurance, or help a family sign up for insurance. The fee
for a physical is $45.
Make appointments with Jefferson County Public Health at 385-9400.
S
i
Terms of Port Townsend Paper's landfill agreement celebrated at open house
By Charlie Bermant,Peninsula Daily News,July 30`h,2014
t t
Julia Cochrane,left,examines the documents
relating to Port Townsend Paper Corp.'s
landfill agreement along with Jefferson County
Commissioner Phil Johnson at an open house
Monday night.—Charlie Bermant/Peninsula Daily News
PORT TOWNSEND—An agreement that led to the approval of a Port Townsend Paper Corp. limited-purpose
landfill permit was lauded by the parties involved.
"A lot of time and a lot of effort has been spent to get here," said Jefferson County Environmental Health and Water
Director Jared Keefer at a public workshop Monday night.
"We are very, very pleased to have reached this point."
Keefer's short speech was the only public statement during the 90-minute gathering at the Cotton Building, which
iowas attended by about 60 people and included representatives of the county, the mill and the state Department of
Ecology.
Julia Cochrane of Port Townsend said she was disappointed in the format: "There is no sitting down with an oral
presentation of what this stuff means to make it understandable for people like me."
Cochrane said she was looking to find out the exact amount of new pollution that will result from the new permit.
"I still don't understand what the justification for this is," she said.
Kevin Scott, director of sustainability at the paper mill, the county's largest private employer, said the company was
happy with the permit.
"It covers all of the things that people were concerned about," he said.
"It includes financial assurance for the future closure of the mill and additional groundwater monitoring."
Under the terms of the permit, Port Townsend Paper must install two groundwater monitoring wells, one by the end
of this year and another during the first quarter of 2016.
It is responsible for quarterly groundwater monitoring.
It must submit an updated closure plan and closure/post-closure cost estimates, and provide financial assurance for
closure and post-closure maintenance and monitoring of the landfill.
PT AirWatchers president Gretchen Brewer, whose organization has opposed the permit, said it was important for
the mill to put up enough money to cover the potential costs of maintenance and monitoring.
"That will be an issue: that they cover any problems they may cause," Brewer said. •
"We haven't yet seen how that will work."
Dr. Thomas Locke, public health officer for Jefferson and Clallam counties, said the permit addressed the county
health department's concerns.
"From the beginning of this process, we had some very detailed objectives, and all of them are met with this
permit," he said.
"It's the right set of regulations for this type of landfill and takes into account anything that may happen down the
road.
"It has addressed our financial concerns, and any problems that emerge will be a mill expense and not a public
expense."
The company, which had operated under a permit for inert waste since 2004, applied for renewal in September
2012, and the Jefferson County Public Health Department denied the request, saying the landfill should be
permitted under the more stringently regulated limited purpose classification.
Mill officials appealed the decision. Mediation among representatives of the paper company, the county and
Ecology led to the present permit, effective July 3, which will expire in five years.
The permit allows disposal of lime grit—also known as slaker grit—boiler ash, inert wastes and incidental metal
residual material from the combustion of boiler fuel at the mill.
The company has agreed to monitor for landfill gases for three years. If no landfill gases are detected above a
specific level during that time, the company can discontinue monitoring them.
The permit was scheduled to be addressed by the Pollution Control Hearings Board later this year.
In preparation for that hearing, all parties entered mediation, during which time the agreement was reached.
David Alvarez, the Jefferson County chief civil deputy prosecuting attorney, called the agreement"a great success"
that took a long time to achieve.
"When you get lawyers involved, things don't always go well," Alvarez said.
"I don't worry about why it took so long because it's more important to see where we are now."
Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cb_ermant@peninsuladailynews_com.
•
•
•
August 2014
City ok'. portTownsend NEWSLETTER
4,,,,
360.379.5047 / citycouncil@cityofpt.us ?www.cityofpt.us
4
Sports Physicals at School Based Health Centers ,`
Get ready for fall sports!
Make an appointment for a sports physical with your primary
care provider or with the School Based Health Center. The
School Based Health Centers are a partnership between Jef-
ferson County Public Health, Jefferson Healthcare and the lo-
cal school districts, providing health care services to meet the
unique needs of adolescents.
Chimacum High School: August 18, 20, 25, & 27
Port Townsend High School: August 19, 22, & 26
Quilcene office of Jefferson Co. Public Health: August 13
Appointments are available 9 a.m. to 3 p.m. Open to any stu-
• dent who needs a sports physical. We will bill your insurance
or help you sign up for insurance or pay $45. Call for an ap-
pointment at Jefferson County Public Health 385-9400.
•
Teens: get your sports physicals done now •
Port Townsend Leader, August 6, 2014
Sports physicals are available in August in Port Townsend, Chimacum and Quilcene to help Jefferson
County teens get ready for the first week of team practice.
Parents are encouraged to make a sports physical appointment with their child's primary care provider or
with the School Based Health Center. The School Based Health Centers are a partnership between
Jefferson County Public Health, Jefferson Healthcare, and the local school districts, providing health care
services to meet the needs of adolescents.
Appointments are available from 9 a.m. to 3 p.m. on the following dates and locations, and are open to
any student who needs a sports physical:
Chimacum High School: Aug. 18, 20, 25, & 27
Port Townsend High School: Aug. 19, 22, & 26
Quilcene office of Jefferson County Public Health: Aug. 13
The health centers can bill a family's insurance, or help a family sign up for insurance. The fee for a
physical is $45.
Make appointments with Jefferson County Public Health at 385-9400.
•
•
Free dental clinic in Quilcene Aug. 29
Port Townsend Leader, August 6th, 2014
Appointments are available for a free dental clinic at the Quilcene Community Center on Friday,
Aug. 29.
This program is designed to fulfill the dental needs of adults; children are scheduled if they have
emergency needs.
Additional clinics are planned on a monthly basis, with dates to be determined. These clinics are
made possible through the Volunteers in Medicine of the Olympics (VIMO) dental organization.
The organizers anticipate a big response and are focusing on urgent needs, mainly extractions,
for the clinic's first day.
To make an appointment, call 360-765-3321 between 8 a.m. and 1 p.m. on weekdays, or come
in to the center to fill out the necessary paperwork.
•
Toxic algae only has Anderson Lake, so far
•
Port Townsend Leader, August 13, 2014
Gibbs Lake and Lake Leland —two of the best freshwater swimming holes in East Jefferson
County — have had light algae blooms but only low levels of toxins so far in 2014.
The lakes are both open to swimming and fishing, according to a Jefferson County Public
Health lake quality inspection reports from Aug. 4. Both lakes carry a "Caution" tag, which
means don't drink the water, or swim in areas of visible scum.
Anderson Lake remains closed to all public access, due to high levels of the potent nerve toxin
anatoxin-a that were detected in May. As a result, Washington State Parks has closed the lake
to fishing, boating and swimming. Visitors are also urged to keep pets out of the water.
Anderson Lake State Park remains open for hiking, biking and horseback riding.
Anatoxin-a is produced by bluegreen algae (cyanobacteria) and can result in illness and death
in people and animals. The toxin level is more than four times greater than the Washington state
recreational criteria.
Since 2006, (when two dogs died after drinking from Anderson Lake) the county health
department has been collecting and submitting water quality/algae samples from Lake Leland,
Anderson Lake and Gibbs Lake to determine what species of algae are present and in what
concentrations.
SWIMMING HOLES
The other fine freshwater swimming hole option is Sandy Shore Lake (located south of State •
Route 104 between Center Road and State Route 19), which has no algae problem. The lake is
at the end of a dusty gravel road, and there is no sandy beach, but there is easy access for
anglers and swimmers.
In terms of saltwater beaches, kids and families love the sandy swimming beach and offshore
float next to the Herb Beck Marina at the end of Linger Longer Road in Quilcene. The sandy
beaches at Fort Worden State Park and Fort Flagler State Park on Marrowstone Island are
enticing, although colder water than Hood Canal; parking at those beaches requires a Discover
Pass.
S
It's a UGN High 5 for Gimme 5 program
Port Townsend Leader, August 13, 2014
F %P°¢ . ..+.f «ems
3
•
[1R11L >
p
t
41:**5173Kiti: 411114%,0714.Darcy Reader is a community member who
appreciates the new Gimme 5 program,which
links healthy food from the farmers market with the
public health department's Women Infants and
Children program.United Good Neighbors helped
•
the program
develop.Submitted photo.
In this community where health seems to be a focal point for all, a creative partnership is
continuing between the Jefferson County Farmers Market (JCFM) and the Jefferson County
Public Health's Women Infants and Children (WIC) program, thanks to grant funding assistance
provided through United Good Neighbors (UGN) of Jefferson County .
These collaborative efforts are working to help local farmers and low-income families at the
same time, according to a UGN press release. This effort provides a means for encouraging
low-income families to prioritize expensive produce over cheaper processed foods and to allow
anyone, of any income level, to feel that they can participate in the farmers market.
This collaboration is called Gimme 5 —The Farmers Market Food Assistance Program. Gimme
5 is primarily a food benefits matching program. For every $10 in Basic Food Benefits (aka food
stamps) redeemed at the market, the customer receives an extra $5 token, and for every $20,
an extra $10 (two tokens). WIC and Senior Benefits are matched one to one. While basic food
stamps can be used to buy cookies and soda, the Gimme 5 matching funds are only good for
fresh farm products.
The JCFM is the nonprofit organization that operates the Port Townsend and Chimacum
farmers markets. The JCFM was formed to support the development of local sustainable
farming by cultivating a vibrant farmers market that serves as a community gathering place.
Hand in hand with the market, Jefferson County Public Health (JCPH) works to protect the
health of all Jefferson County residents, and in this case, specifically through administration of
the WIC Supplemental Nutrition Program and its WIC/Senior Farmers Market Nutrition Program.
When Karen Obermeyer, WIC health educator with JCPH, and Will O'Donnell, director of
Jefferson County Farmers Market, put their heads together to implement the Gimme 5 program,
•
they knew they had a successful tool in their hands.
But all programs need ongoing funding, and when Gimme 5 funds were needed again in 2014,
what better place to go than to UGN. O'Donnell and Obermeyer submitted a request to the UGN
board of directors in June for a special grant to help them reach more people through their
program. The UGN board responded with a $2,500 grant.
"UGN maintains a reserve fund for emergency or supplemental funding for programs that clearly
meet an urgent need in the community and that need an extra financial boost outside of the
regular UGN granting cycle," said Kim Hammers, UGN board president. "Gimme 5 meets those
criteria, and we wanted to help it reach more people this summer."
O'Donnell shared his pleasure with this new partnership, "There aren't a lot of win-wins in life,
but here at the farmers market, we have found one. Our Gimme 5 program has helped low-
income shoppers take home more fresh and healthy local produce than ever before, benefiting
both their own families and the farms that come to market.
"The Gimme 5 program, which works to match federal and state food benefits at the market, is
funded by community donations, and we are so proud to have received funding from United
Good Neighbors in 2014."
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Village Council endorses Ludlow water surcharge - Port Townsend & Jefferson County
Leader: News
Village Council endorses Ludlow water surcharge
By Jeff Noedel Contributor, Port Townsend Leader, Wednesday, August 13, 2015
Port Ludlow's utility company now has the support of a divided Port Ludlow Village Council after a last-
minute push to settle a water surcharge dispute outside a courtroom.
Olympic Water & Sewer Inc. (OWSI) ratepayers would still pay the same amount the company wants to
recoup from the failed drilling of Well 17, a total of$160,000, but $48,000 of it would be billed with the
next well project. OWSI also conceded that if another attempt were to be made to drill on that same
North Bay location and it were to fail, ratepayers would not be billed.
The Port Ludlow Village Council (PLVC), an advisory body for a community that has no municipal
government, voted 5 to 2 with one abstention, to support OWSI's surcharge request, proposed three
years ago.
State Utilities and Transportation Commission (UTC) staff urged OWSI and the PLVC to resolve the
issue before an August deadline, when the case would be turned over to an administrative law judge.
Now, UTC staff are to study the proposal (a copy, dated Aug. 11, is attached to this story on
ptleader.com) and make a recommendation to the UTC board — approval is not guaranteed, and could
take eight months, according to UTC staff.
The controversy stems from costs OWSI incurred from a failed attempt to increase water supply
specifically for Ludlow's North Bay area. OWSI has one water well on its property at 781 Walker Way,
the largest company-owned parcel in North Bay, and in 2009 attempted to drill another. At 50 feet down,
the new well hit groundwater contaminated by gasoline, apparently from a known underground tank leak
(an estimated 110 feet away) thought to be resolved in 1991. Existing Well 2 (85 feet from the known
contamination) has not shown any problems, according to OWSI.
. OWSI, a division of Port Ludlow Associates (PLA), master-planned resort community owners, wants
customers to pay for the costs of the failed Well 17. Dozens of customers have objected to the surcharge
proposal in public meetings.
In a July 28 negotiation meeting between PLVC and OWSI, the water company offered to defer$48,000
of the proposed surcharge and bundle it with future well drilling. That would reduce the surcharge to each
customer from an originally proposed $2.70 to a new $1.92 per month for three years.
Also during the July 28 meeting, the PLVC extracted a concession that if OWSI drills at Walker Way
again, and again has to abandon a drilling project because of contamination, that OWSI would not seek
ratepayer reimbursement.
An attempt to reach a settlement between the PLVC and OWSI has had a new sense of urgency, as time
has officially run out with the UTC, and the matter is about to be turned over to an administrative law
judge. That hearing process is tantamount to a trial, which could cost $300,000 or more, according to the
PLA. If OWSI prevailed in the administrative hearing process, customers could be saddled with the
original $160,000 plus legal fees.
Lately, the majority of the PLVC board has favored a settlement rather than risk losing before an
administrative law judge, especially after the July 28 concessions by OWSI.
Laury Hunt, an attorney and PLVC board member who conducted the Aug. 7 meeting, acknowledged a
"substantial financial risk" in letting the issue go before an administrative law judge.
"I don't want to go into court," Hunt said.
In the Aug. 7 meeting, nine board members and 20 people debated primarily over two new twists that
OWSI injected into its draft letter to the UTC. OWSI wanted the PLVC to endorse that letter.
The first OWSI change was to narrow the reference to pledging never to seek reimbursement through a
surcharge. Audience members immediately objected that the new language seemed to leave open the
possibility that OWSI could seek reimbursement through a rate increase instead.
Carol Reichstetter, one of the surcharge's most strident critics, said, "The only value to this, if there is
any, is that we are guaranteed forever that if they decide that they're going to drill at that site [and
abandon it for contamination], we will never have to pay for any part of that. It's a tiny little concession.
It's the only one they made to us. And this is essentially taking all the force out of it."
Later in the one-hour deliberations, OWSI withdrew the reference to surcharge, opening up the
prohibition of future failed Walker Way costs to all forms of customer reimbursement.
The second new wrinkle in OWSI's draft was its proposal that any future failed Walker Way drilling costs •
be approved or disapproved by the PLVC board in the future. Not only was this opposed by many PLVC
board members and customers, but the debate quickly mushroomed into the suitability of PLVC to
represent the Port Ludlow community in the first place.
OWSI withdrew this language from its draft letter, but not before two PLVC board members and one
audience member stated their opinions that the PLVC does not represent the community on the
surcharge issue.
Board member Dave Armitage implied that OWSI had flip-flopped on how it rates the PLVC. Armitage
referred to a public document in which OWSI manager Larry Smith implies that the PLVC represents
fewer than 200 people; OWSI has 1,700 customers. Armitage then asked, "Since when did the PLVC
speak for the whole community?"
Audience member Dianne Ridgley, her voice raised, took to the podium in the Bay Club auditorium and
delivered an impassioned speech. She said:
If you've already agreed you don't speak for all of Port Ludlow, why are you sending a letter to the UTC
saying the community thinks we should pay this bill? From everything I've read, what I see is the
contamination is owned by PLA and Pope Resources; it is not ratepayers."
PLVC board member Tamra McDearmid also criticized some of her colleagues. She said, "I am a little
disappointed with some of the members of our council that so politely voted this through, when they
know darn well that most people in the community do not agree with it. So are they voting for themselves
or are they representing the community?"
PLA President Donna Smeland responded, saying that there are many customers who accept the
surcharge. She said "many" customers have come to the PLA office with a check to pay the surcharge.
PLA declines to accept those checks. She added that most customers who phone PLA with questions
about the surcharge seem satisfied with PLA's explanations.
Smeland had also noted that PLA believes the surcharge request is fair but the company has "other •
things to work on" and in the interest of saving time and money, wants to get the issue resolved at the
UTC level because "nobody wins" if it goes before an administrative law judge.
With time in the meeting running out before a mandatory 5 p.m. adjournment, PLVC President Terry
Umbreit said it was time to decide.
Armitage made a motion, which McDearmid seconded, that the letter of support be refused. That motion
failed 5 to 3.
Then, Laury Hunt made a motion that the letter be supported by the PLVC, seconded by Larry Nobles.
That motion passed 5 to 2, with one abstention. Voting for the motion were Hunt and Nobles, plus Linda
Haskin, Mike Nilssen and Rose Hablutzel-Jackson. Voting against the motion were Armitage and
McDearmid. New PLVC board member Brett Oemichen abstained from the vote, because he felt the
draft letter, in its unfinished form, should not be voted on at all. President Umbreit only votes to break a
tie.
New screening allows baby to undergo treatment before ever getting sick - Spokesman.co... Page 1 of 5
THE SPOKESMAN-REVIEW August 12, 2014
New screening allows baby to undergo
treatment before ever getting sick
Adrian Rogers
The Spokesman-Review
Tags: children's health
Ezra Dixon's heartbeat dropped with every contraction,
his umbilical cord circling his neck.
So after Rachel Dixon delivered her second son in
Everett on April 7, the Spokane native was just happy to
" have him. After the drama of his birth, Ezra looked
Four-month-old Ezra Dixon underwent
healthy and normal, and his mother slept during the
a stem cell transplant at 9 weeks old newborn screening that all babies go through — a prick
after a newborn screening found he on the heel, his blood dropped on a specimen
had severe combined
immunodeficiency, or SCID, also
collection card.
• known as "bubble boy disease." His
mittens keep him from pulling out his But the screening results, delivered when Ezra was 3
feeding tube. days old, were alarming. The baby had no T cells — the
specialists that battle viruses, bacteria and fungi —
making him highly vulnerable to infections. More testing confirmed the problem: Ezra had
a rare condition called severe combined immunodeficiency, or SCID. It's also known as
"bubble boy disease," after the Texas boy who lived in a germ-free plastic bubble until he
died in 1984 at age 12.
Ezra was the first baby in Washington with the condition to be flagged by the screening,
which expanded to include SCID this year. His early diagnosis allowed for early treatment,
which doctors and researchers are learning dramatically increases survival rates.
"He's on the road to recovery now, at 4 months old," said Rachel Dixon, 24, who moved
with her family from Spokane temporarily to Arlington, Washington, where she and her
husband attend ministry school. "This is the time when babies in the past were going to
the hospital, because they were getting sick and not getting better."
I
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New screening allows baby to undergo treatment before ever getting sick- Spokesman.co... Page 2 of 5
The addition of SCID to the state's "newborn screening panel" took three years of lobbying
by doctors and researchers and the families whose babies had died. It raised the cost of
the mandatory screening for ail babies born in Washington.
The payoff, for Rachel and her husband, Zach Dixon, 25: a baby who's getting healthier,
not sicker. They pulled his name from the Bible. It means "help."
"A little more than 50,000 babies have been born in Washington state this year, and he's
the only one that has been caught," Rachel Dixon said, holding her baby as she talked at
the Ronald McDonald House in Seattle. "And I am so thankful for it. Huh, buddy?"
'A little breathing room'
The "bubble boy," David Vetter, was born in 1971 after the SCID-related death of his
brother. So his parents and doctors knew he might also have the hereditary condition, and
they prepared plastic "isolator bubble" environments while he waited for a matching bone
marrow donor or a cure. David died after finally receiving a transplant from his sister, an
imperfect match and whose marrow contained a virus that led to lymphoma.
These days, doctors know a lot more about bone marrow transplants, and they view SCID •
as a pediatric emergency. It's treated with a transplant as soon as possible.
Newborn screening "gives us a little breathing room with our emergency," said Dr.
Suzanne Skoda-Smith, clinical director for the Division of Immunology at Seattle
Children's Hospital, where Ezra was treated.
A donor's bone marrow, which produces blood cells, is introduced into the body through a
central line. If all goes well, the new immune cells start reproducing, rebuilding the baby's
immune system.
It's a gradual process.
"I always like to say to families, 'I planted a seed in a garden,' " said Dr. Lauri Burroughs, a
physician at Seattle Children's Cancer and Blood Disorders Center, who also treated
Ezra. "It takes months and months and months, even upwards of a year, or longer, to
have a full producing garden."
Ezra received cells drawn from the hip bones of his brother, Judah, who was 20 months i
old and a perfect match.
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New screening allows baby to undergo treatment before ever getting sick - Spokesman.co... Page 3 of 5
Ezra was 9 weeks old. He'd already endured a week of chemotherapy, partly to reduce his
existing marrow to make room for new cells. Chemo caused a blistering rash that covered
his body and sores throughout his gastrointestinal tract that prevented him from eating.
His nutrition came from an IV.
But his brother's cells took hold. Ezra doesn't have T cells yet, because one of his chemo
drugs prevents them from growing quickly, Rachel Dixon said. But other cell lines
are "engrafting."
"All the other cells in his system are 100 percent Judah," Dixon said.
The family will stay at the Ronald McDonald House until Ezra hits the 100-day mark post-
transplant, making twice-weekly clinic visits to Seattle Cancer Care Alliance
for monitoring.
For a year or two, Ezra will receive injections of immunoglobulin, the fraction of blood
plasma that contains antibodies.
If all goes well, his SCID will be considered cured: "He should be able to live a completely
• healthy, normal life," Rachel Dixon said, "with no restrictions."
For Judah's part, Dixon said he said "owie" a few times during diaper changes after the
procedure. He asked about the bandages — "Stickers?" — on his back.
Judah spent about three months with his grandparents in Deer Park and Loon Lake,
Washington, during Ezra's treatment. During rare visits to the West Side, Judah could see
his brother only through a hospital window, to protect the baby from germs.
"He loves brother," Dixon said.
Costs and benefits
Of about 50,800 babies screened in Washington so far this year, Ezra is the only one
found to have the classic form of SCID.
On New Year's Day, "bubble boy disease" became the 28th treatable disorder on the
state's panel, a list of hard-to-pronounce maladies unfamiliar to most parents.
40
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Including Ezra, screening has led to definitive diagnoses in 65 babies with conditions such
as congenital hypothyroidism, cystic fibrosis and amino acid disorders, according to the •
state Department of Health. Babies with the conditions on the list usually appear normal
at birth.
Washington is among 23 states that screen for SCID. Idaho does not, but the regional lab
in Oregon that processes its newborn tests is working toward adding the disorder to its
panel, said Carol Christiansen, newborn screening coordinator with the Idaho Department
of Health and Welfare.
SCID screening became possible a few years ago with the development of a test that can
detect it on the dried-blood cards. The Immune Deficiency Foundation, which advocates
for SCID screening in all 50 states, says testing lets doctors treat and likely cure SCID in
infants for less money than ongoing and less-effective treatments for children who
develop infections.
But the main holdup is cost, Skoda-Smith said.
Skoda-Smith said SCID screening advocates in Washington worked on a cost-benefit
analysis with the Department of Health that factored in spending on long-term, intensive •
care for sick babies as well as the "value" of a baby's life, a dollar figure used by
government agencies.
"SCID had a fabulous cost-benefit analysis, when you sat down and crunched the
numbers," she said.
The addition required new equipment and supplies along with additional personnel at the
state's newborn screening lab, DOH spokesman Donn Moyer wrote in an email.
It bumped up the cost by $8.10 for each baby, boosting the total to $77.40 for each baby.
Families or their insurers pay the bill.
Early detection, early transplant
Skoda-Smith and Burroughs both contributed to a new large-scale study that found that
SCID babies treated earlier in life fared better. That's because younger babies are more
likely to be infection-free, said Burroughs, who's also a researcher at Fred Hutchinson
Cancer Research Center in Seattle. (The center first reported Ezra Dixon's treatment on
•
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its website (http:/lwww.fhcrc.org/en/newsicenter-news/2014/08/transplant-saves-first-
41) bubble-boy-in-wash--state-detected-SCID.html) .)
The study, led by researchers in Boston, tracked data on babies over 10 years.
Burroughs' hope for the study's result: "That more children survive, because they go to
transplant early."
Overall, 74 percent of the 240 babies with SCID tracked in the study lived to be 5 years
old, according to the study, published July 31 in the New England Journal of Medicine.
But the survival rate was much higher— 94 percent—for those who underwent stem cell
transplants at age 3.5 months or younger. Just 50 percent survived who were older than
3.5 months and had active infections when they got their transplanted cells.
It's more difficult to treat babies who are already sick. And before screening, "the way they
presented was with infection," Burroughs said.
Some of those infections, added Skoda-Smith, end up killing babies with SCID before they
41) can get transplants.
Ezra's grandfather David Dixon lives in Loon Lake. Ezra's other grandparents, John and
Marie Layman, live in Deer Park.
David Dixon credits the newborn screening for his grandson's survival.
"If he'd been born a year earlier," he said, "he probably wouldn't be here right now."
Get more news and information at Spokesman.com
i
http://www.spokesman.com/stories/2014/aug/12/new-screening-allows-babyto-undergo-tre... 8/15/2014
Lawmakers: Don't shortchange mental health l Editorials The News Tribune Page 1 of 3
The News Tribune
4111/ Previous Story
Next Story
Lawmakers: Don't shortchange mental health
The News TribuneJuly 27, 2014
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By conservative estimates, one American out of 20 suffers from a severe psychiatric illness,
Seven million people live in Washington. That translates into 350,000 men, women and children who face
schizophrenia, chronic depression, disruptive bipolar disorder and other potentially crippling illnesses of
the brain.
Lawmakers should consider that number every time they make decisions about funding psychiatric
hospitals, community mental health services, competency hearings and the like.
Over the past 50 years, both the federal and state governments have closed hospital wards and released
patients "to the community" to be treated in the "least restrictive setting."
The mentally ill were theoretically going to be cared for as outpatients, in group homes and small, friendly
residential facilities. Instead, lawmakers found other uses for much of the money they had been spending
on the big hospitals.
faWashington was especially enthusiastic about closing hospitals. It now has fewer beds per capita than
nearly all other states. This was a triumph of libertarian values: The patients were "freed" and the
government spent less on them,
Libertarian values don't work very well in the world of mental illness. Many of the mentally ill who would
previously have been hospitalized now wind up adrift, untreated, and often homeless, Some run afoul of
the law and end up in jail. A bitter irony: The least restrictive setting turns out to be the most restrictive
setting of all.
Sometimes untreated delusions, irrational anger or paranoia contribute to violence. The most recent
horror story is Aaron Rey Ybarra, who is accused of shooting a 20-year-old student to death at Seattle
Pacific University last month and attempted to kill others before being tackled by a student security guard.
The Seattle Times last week detailed Ybarra's long journey through family chaos, depression, alcoholism
and drug abuse. It was impossible to get him committed to a hospital. He heard voices in his head. He
had a violent streak and he's culpable for what he did — still, it's possible a young SPU student might be
alive today if Washington's mental health system had the capacity and the legal tools to handle someone
like him.
In a starker case of system failure, Jonathan Robert Meline of Tacoma failed to get adequate therapy for
his paranoid schizophrenia despite his history of violence, his disconnection from reality and his mother's
repeated attempts to get him committed for long term care.
He needed confinement, but Western State couldn't or wouldn't hold him. He wound up hatcheting his
father to death in 2012. Now he'll get treatment. In June, he pleaded guilty by reason of insanity and was
committed permanently to Western State.
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Lawmakers: Don't shortchange mental health ) Editorials I The News Tribune Page 2 of 3
One factor underlies most of the system's problems: inadequate funding. Sometimes this is a matter of
open discrimination against people who suffer an illness in their brain rather than another organ. The
federal government, for example, refuses matching Medicaid funding for most adults in psychiatric
hospitals with more than 16 beds.
This has led to the elimination of many psychiatric beds. How many non-psychiatric patients lose their
Medicaid when they are admitted to a general hospital?
VVashington lawmakers have actually made modest improvements in funding over the last couple years.
Next year, though, they'll again be under intense pressure to economize on psychiatric care.
If they look at the jai|s, though, and listen to the families of the mental ill, they'll realize that doing mental
health on the cheap is intolerably expensive.
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