HomeMy WebLinkAboutWAI2024-00025 - WAI Health Waiver - 5/13/2024 •
r •
v`��c roc MAR l 3 2L4
� ,` z MASON COUNTY
'�
.11.. x By
COMMUNITY SERVICES
,oi Building,Planning,Environmental Health,Community Health
O').HL-p3v,
415 N 6`h Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 Belfair: (360) 275-4467 ext 400 Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: a s
Receipt Number: �4'-
Instructions
1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant/Parcel Identification
Name of Applicant ANDREW TEMPLE Telephone
Mailing Address of Applicant PO BOX 784
City MERCER ISLAND State WA Zip 98040
12-digit Tax Parcel No. 2 2 0 2 3 - __ 7 5 0 0 0 4 0
Site Address 671 WOODLAND BEACH LANE. SHELTON
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
O Building Permit Review Policies ❑ Group B Water System Regulations
&1 Location, WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
0 Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
REDUCE SETBACK FROM WELL(S)TO DRAINFIELD FROM 100FT DOWN TO 75FT.
WELLS ARE UPGRADIENT OF DRAINFIELD REPLACING OLDER FAILED CONVENTIONAL SYSTEM
SYSTEM WILL BE PRE-TREATED W/OUT DISINFECTION, MEETING TL-B
WELL LOGS W/CONFINING LAYERS ATTACHED. NEIGHBOR NOTIFICATION SENT CERT. MAILED
Applicant Signature: Date: 3
J:\EH Forms\Waiver-Appeal Mason County Local Revised I/20/2017
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver(if applicable) -7
Appeal ')(Waiver None required Class A Class B Class C l)`'' �-
2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/
Standard revision) V t �I _7:7 iii---0-?Ac-)
3. Nature of Appeal: "
\jvqviA.610&k wt , kr) -1 c-..(4- .
4. Hearing Official:
❑ Board of Health 0 Health Officer
O Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board X Environmental Health Manager
5. Mitigating Factors: _ \/"-I aw yr _ (Lev0--
- .1--IA
6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted. , ,,�,/�
Staff Signature: c V r J Date: ''/2( `Z I
PART 4: Determination of the Hearing Official
gi, The hearing official has determined that approval of this request will not adversely affect public health and
is ylcranted. This decision js based o9)he following findinvnd co diio s:
2 tc,r e- we ((I '2., � � 6/ ti/I C 4 At li.04.p
rt/-ay4,1
❑ The hearing official has determined that approval of this request could potentially adversely effect public
health and is hereby denied. This decision is based on the following findings and conditions:
Hearing Official Signature: Date: -V1-
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
1 I 1
RESERVE: 1/2//
I1 \\
1500 SOFT � ,, • �t6
/ CI \ e; .;
I / O I \ t et:. FoeERT'r°,i1►ursse
1 / \ �$ IA:-►. • IC .i4. :
/ \ EXPIRES
EXISTING WELL \I ��
I 1 1 �}
1 I 1 1
I 1
,t-- �_ = 7Oo, I
/ /; v
/ / \ \ 1
\
// EXISTING WELL \\\ 2\‘'‘ ‘\\\11
//I EXIST. WELL \ /I I �\ D \� 1 ,�
I 1 i 0 \
\ ,s1�X \ I ` LOCATES ARE STRONGLY
\\ ce \ ADVISED BEFORE INSTALLATION
\ \ // /s\ \ /L�
\ \ O 7,3 \ GL
'— `'"N = 1 7) TRANSPORT
• & RETURN LINES
PROPOSED DRAINFIELD
1125+ SOFT \
/ 0 \
EXISTING FAILED _�\ \ EXISTING HOME
DRAINFIELD
GARAGE (IN CONST.) \ Vyw, �\
\ boo !
PUMP OUT& ABANDON ,'- -.1\ ?
EXISTING TANKS. INSTALL _ - s •
NEW ATV & PUMP TANK \
501+ FROM SHORELINE \
— .... G pP`SSp,GE
p\C
AN ASBUILT/INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGIN1G, NC. PARCEL ER: ANDREw TEMPLE TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
PARCEL# 22023 75-00040 *36 12
36 120 0-24 G51.
2a+1120 N
SEP I IC DI SIGNS ADDRESS: 67I WOODLAND BCH LN 111.1 36 TILL.@ 34
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE DISCLAIMER: THIS IS NOT A SURVEY.REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED
INTENDED OR SURVEYS.FIELD MEASUREMENTS ANC COUNTY GIS DESGN INTENDED FOR SEPTIC
OFFICE•360-42618113 FAX 360-427 2353 SHEET: SITE PLAN SCALE 1"=50' PURPOSES ONLY PROPOSED DEPARTMENT/AGENCY REVIEWDESIGNE DEVELOPMENT
NOT
FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS
File OrV)nal and First Copy•wit -~, •
Depart Nett ofF�cology/i::, I," -4 , TER WELL REPO ,' Mart Card
8��d c' Cwnrs STATE OF WASHINGTON
Ttfltd Copy ZDrlUsr's,,•- SP .Y ............... wets. Permit No. •
.
1 by (1) OWNER: Name 711_;0 J 4)itri r+A Addresa
tr. (2) LOCATION Of.WE ..County !!tCr $Q'7 •{\ /1 A. 14 Sec)3 T e2 0 N.,R_W.M.
(2a) STREET ADDDRESB',f�WELL(or nearest address) ) CCr L/,.e c- r C-e-1 944 d I r..41,d 74 f.Q t iN "
(3) PROPOSED`US tI Domestic Industrial.Q, ,.,MuMcipal 0 (10) WELL LO�;gr ABANDONMENT PROCEDURE DESCRIPTION
❑ Irrigation •-
❑ DeWater Teat Well 0 Other 0 Formation: Describe by color, character. size of material and structure, and,show
thickness of aquifers and the kind and nature of the material In each stratum penetrated;
(4) TYPE OF WORK:Owner's number of well with at least one entry for each change of information.
•.Of more than one)
MATERIAL FROM TO
Abandoned 0,‘ Newwell7• CA Dug ❑ Bored 0 -
Deepened 0 Cable CH, Driven 0 /Q j`) O) 12
Reconditioned 0 Rotary 0 Jetted O -10,1/f)V L t 56 kvisi,9to✓r/ e2 ar ov
(5) DIMENSIONS: Diameter of well inches. �'O.- N h C in 1/.5G vlc! Trtt J C I t 2 'I
Drilled (p 9 feet. Depth of completed well 67(7 ft. rr'`' ,r .?ciN d `t'9 rL)✓to/ I I .6o
LFrr:lJ n C It, • Sp n,1 tS rci tl�P! �a V
(6) CONSTRUCTION DETAILS: / Cj Ln��..e '56,nd `A Grp ✓ r/ 64 r!p 7
Casing InstalWeldedled: Olam.from + 1 It.to (Q f h. te
1.1 r1 �'it/ky- rid se-,5 too e/ G ��
Liner Installed L�--- - _Qlam.,from ft.to ff. 9►•Gt:t.J t 1 = 7/1rr.J,C/-bic,I e-r (4, -- cO. __
Threaded LUJ II-�-�l • Diem.from R.to ft.
Perforations: YealJ No
Type of perforator used
SIZE of perforations In.by In.
perforations from rt.to ft.
perforations from ft.to tt.
perforations from ft.to ft.
• Screens: Yes CI Notsil
Manufacturer's Name
Type Model No I
Diem Slot size from ft.to ft.
Dlsm Slot size from ft.to ft.
Gravel packed: Yea U No,Xsize o,gravel
Gravel placed from ft.to ft.
Surface NMI: Yea ' Not: To what depth? J X ' ft.
Material used In seal P 11 f in 71I }-
DId any strata contain unusable water? yes ID ` No ffpplI
,.
Type of water? Depth of strata _
Method of sealing strata off
(7) PUMP: Manufacturer's Name q+ 0 Li id$ //
Type. $ L•43 i+i`�1���, pL l '� H.P l!
(8) `WATER-LEVEL Land•surtau elevetlon
�h -shove mean sea level
etatlo level .W •
ft.below top of well )
Arteelan pressure lbs.per square Inch Date
• Artesian water le controlled by
(Cap,valve,etc.)) ![2. c',
(9) WELL TESTS: Drawdpy�la am t water level is lowered below steno level Work started r ,t9. Completed f,�-// t9;u
Was a pump test made?'Ye.0 NoX..yyes.by whom? WELL CONSTRUCTOR CERTIFICATION:
Yield: gal./min.with ft.drawdown after hrs.
l - ' I constructed and/or accept responsibility for construction of this well,
and its compliance with all Washington well construction standards.
Materials used and the information reported above are true to my best
Recovery data(time taken as zero,when pump turned off)(water level measured knowledge and belief.
from well top to water level) r
Time ' Water Level TWA-- Water Level - Time Water Level 'rr/� •
. .G, • NAME /�1/Z, (PERSON.
SON.^FIIRM,OR/CCOR�ATION) /,' /�/2�PE OR PRINT)
Address/ 57 7 D;(!' C fl (a-il,54-ell ..f t
1 •
,. Date oftest�`' J//� �/A
(Signed), .-r-f�-t A �7 L License No./j.)r�
BaMaf fast OCO gel./min.with_12_ft.drawdown after a hrs. • (WELL DRILLER)
Contractor's
Airiest W 1• L/mla.with stoat set at ft.for hrs. R i ration
Art.ela�l saw . aP m at. No )A n k•id 3-j j ?d-.4 Date/d —/J ,19/�(,
`,Q 1 i iifil6tpr}ot ttat.anlIattted% eYris �d ti tt,4 i M C� (USE ADDITIONAL SHEETS IF NECESSARY)
hlcYoso-lt,91�g6! (Ioien l•T �fe i I in:MasorTT County DMS i� .";.4 �+
�'. ) r*FI • ,f
1 7'. . • . .. , .. . . ..
•
WATER WELL REPORT Start Card No. 045390
STATE OF WISMINGTOM Water Right Permit No.
LannsammwmazamaranammiraurszaSsmaumitsmwspuramem Af■■s=ssauusa■.ss■ KW Zmu■s■mmmarf■■
O (1) OWNER: Name ZEMAN, KEN Address 1609 PIERCE AVE. SE RENTON, WA 98058-
a aamaassaaa■■■■■■.as■■■ s■■a:■s■a ■■■■■
GI (Z) LOCATION OF WELL: County MASON - NE 1/4 NW 1/4 Sec 23 T 20 M., R 2 WM
cc (2s) STREET ADDRESS OF WELL (or nearest address) E 691 WOODLAND BEACH ■ya s■s�iuu.sm
— .sa.mss.a=asa +ss■massss -
GI (3) PROPOSED USE: DOMESTIC (10) WELL LOG
i ...ssss.a.a.aseses■
(1) (If
TYPE OF WORK: Owner's Number of well Formation: Describe by color, character, size of material
(If more than one) and structure, and show thickness of aquifers and the kind
2 NEW WELL Method: CABLE and nature of the material in each stratum penetrated, with
'4'' ■aaa.a.ssasass■a■sWOO ■us at least one entry for each change in formation.
C (5) DIMENSIONS: Diameter of well 6 inches
O Drilled 83 ft. Depth of completed welt 83 ft. MATERIAL FROM TO
C . sa.amssass...aaa ■ SILTYSAND BROIAI 0 16
O (6) CONSTRUCTION DETAILS: HARD PAM BROWN 16 36
++ Cuing installed: 6 " Dis. from .1.5 ft. to 77 ft. HARD PAN BRAY 36 47
(C WELDED " Dia. from ft. to ft. SILTYSAND GRAVEL GRAY 47 79
E " Dia. from ft. to ft. SAND & GRAVEL MULTICOLOR WATER 70 83
4- Perforations: N0
C Type of perforator used
SIZE of perforations in. by in.
0) perforations from ft. to ft.
I perforations from ft. to ft.
perforations from ft. to ft.
O
Screens: YES
i C Marwfscturer'$ Name JOMMSON
03 Type SLOTTED Model Mo.
Dias. 5 clot size 16 from 77 ft. to 83 ft.
a-' Dian. slot size from ft. to ft.
R
3 Gravel pecked: MO Size of gravel
CI Gravel placed from ft. to ft.
s
Z Surface seat: YES To what depth? 20 ft.
Zi Materiel used in seal BENTONITE ;
C Did any strata contain unusable water? MO 87 ' L I6 * 6
03 Type of water? Depth of strata ft.
L Method of sealing strata off
03 asom.s■aaarasssa■sasa. ■"mu
(7) PUMP: Manufacturer,* T Type RR SIBLE M.P. 3/4
I—
O (8) WATER LEVELS: Lend-surface elevation
Z above elan see level ... ft.
y Static level 45 ft. below top of well Date 09/27/91
Q) Artesian Pressure lbs. per square inch Date
O Artesian water controlled by Work started 09/23/91 Completed 09/27/91
,...4,4=4. auauaasau "■
O (9) WELL TESTS: Drawdown is amount water level is lowered below WELLI CONSTRUCTOR constructed and/or accept for con-
static level.
C Was a pump test made? NO If yea, by Whom? struction of this well, and its compliance with all
C) Yield: gal./min with ft. drswdown after hrs. Wand the in well construction formation stands/de.
reported above a Materials true omybest
4Uli- knowledge and belief.
Recovery data
4,,1 Tine Water Level Time Water Level Time Water Levet MAZE ARCADIA DRILLING(Person, firm, rIN corporation) (Type or print)
C
d
E ADDRESS SE 170 WALKER P RD
+-' Date of test / / ./�
License No. 1444
(� Bailer test 14 pal/min. 2 ft. drawdown after 2 hrs. (SIGNED)
11 Air test gal/sin. w/ stem set at ft. for hrs.
O) Artesian flow g.p.m. Date Contractor's
0 Temperature of water Was a chemical analysis made? MO Registration No. ARCADD'147K1 Date 10/08/91
CU ......stalpv......44.4.seillIM MaLSMSSIM MillMallnian NU Mar
.0
r
WATER NELL REPORT Start Card No. W119325
Unique Well I.D. 6 APB1S9
STATE OP WASHINGTON Water Right Permit No.
L
O (1) OWNER: Name HONARD, ORRIS Address 40 E. ISLAND SHORE ROAD SHELTON, WA 9E684-
IX
J(2) LOCATION OF WELL: County MASON - NW 1/4 NE 1/4 Sec 23 T 20 N., R 2. WN
y. (2a) STREET ADDRESS OF WELL (or nearest address) WOODLAND BBACO LANE. SHELTON
CD (3) PROPOSED USE: Do14ESTIC (10) WELL LOG
(4) TYPE OF WORT:: Owner'D Number of well Formation: Describe by color, character, size of material
H (If more than one) and structure, and show thickness of aquifers and the kind
tNEW WILL Method: CABLE and nature of the material in each stratum penetrated, with
imp at least one entry for each change in formation.
C (5) DIMENSIONS: Diameter of well 6 inches
o Drilled 64 ft. Depth of completed well 64 ft. MATERIAL PROM Ti)
C = - TOP SOIL 0 1
Q (6) CONSTRUCTION DETAILS: BROWN HARD PAN 1 34
j:m Cao:ng installed: 6 " Dia. from ♦1.5 ft. to 61 ft. ORAY CLAY AND GRAVEL 34 61
R WELDED CASINO " Dia. from ft. to ft. GRAVEL a WATER 61 64
E " Dia. from ft. to ft.
0 Perforations: NO
41*
C Type of perforator used
SIZE of perforations in. by in.
CO perforations from ft. to ft.
�4-0perforations from ft. to ft.
Em perforations from ft. to ft.
0
.Screens: YES
CManufacturer's Name ROUSTON
03 Type SLOTTED Model No.
Diam, 5 clot size .030 from S9 ft. Co 64 ft.
Dian. clot size from ft. to ft.
03
Q Gravel packed: NO Sire of gravel
CO Gravel placed from ft. to ft.
44 Surface peal: YES To what depth? 20 ft.
Material used in neal BENTONITE
Did any otrata contain unusable water? NO
C Type of water? Depth of otrata ft. •
L Method of pealing otrata off ''
•
LCS --- - _
(7) PUMP: Manufacturer's Name
CM
Type H.P. t�
O (6) WATER LEVEL;: Land-surface elevation
Z above mean sea level ... ft. .
Static level 39 ft. below top of well Date 01/03/00
U) Artecian Prec0ure lbs. per square inch Date
O Artecian water controlled by - • i
Work started 12/29/99 -Completed 01/03/00
(9) WELL TESTS: Drawdown i0 amount water level in lowered below WELL CONSTRUCTOR CERTIFICATION:
Cif static level. I conotructed and/or accept responsibility for ton-
O Was a pump tect made? NO If ye0, by whom? etruction of thin well, and its compliance with all
OYield: gal./min with ft. drawdown after • hre: Washington well conotruetion standards. Materials used
V and the information reported above are true to el'. hes"
W knowledge and belief.
W Recovery data
Q Time water Level Time Water Level Time Water Level NAME ARCADIA DRILLING INC.
i.m (Peroon, firm, or corporation) (Type or print!
BADDRESS SE 170 i�
4C Ate
of sect / / • S(/J//
Nailer test 20 gal/min. 2 ft. drawdowh after 1 hre. (SIGNED] once No. 1992
03 Air tent galimin. w/ stem set at ft. for hre.
C. Artecian flow g.p.m. Date Contractor's
W = Temperature-of water- Was • chemical analysis made? NO Regi0tration No. ARCADDIO9EK1 Date nl,'Di:00
Snits
ei
w
.0
I-
•
start card P o. W 088061
DRleepartment
and WATER WELL REPORT UIM°U£WELL I.D.A ABV 928
peparbflent d Ecology
Seoond Copy—Owner's Copy Third Copy—Drilter'a Copy STATE OF WASHINGTON water Right permit No. --
p sej (0) OWNER: Name Richard Green address 736 1st St. S. Kirkland, WA 98033
CL
ce (2) LOCATION OF WELL: Count' Mason . NE /:4 .NW .5.4sec 23 T 20 N,R 2W wM.
— (2e) STREETADORESSOFWEIL(anearestaddresa) E 693 Woodland Beach Ln. Shelton, WA 98584
15
1Q WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION
IX Domestic Industrial n.. Municipal I: (10)
—
} (3) PROPOSED USE: 1�
f] Irrigation Test Well C. Other I) Formatlon:Describe by color,character.size of material and structure.and Show thickness of aquifers
y ❑ DeWatereWte and the kind and nature of the material In each stratum penetrated.with at least one entry for each
change of information.
'� (4) TYPE OF WORK: Owner's rwrilber of wolf
(If more than one) MATERIAL
O FROM To
Abandoned I I New well IX Method: Dug.I Bored❑
Deepened r_] Cable 1 Driven:I
o Reconditioned.71 Rey Brown conglomorate-• 0 12_
(5) DIMENSIONS: Diameter of well_ - 6 _ inches.
co
E Drilled 73 feet. Depth of completed wet_ _ 73 It. Gray hardpan 12 68..
p (6) CONSTRUCTION DETAILS: Sand & gravel with water 68 73
C Casing installed: _6___. Blunt I►om_a--II.m 68 it.
— Welded g Diem.from ft* ft. .
0) Liner installed LiDiem.from h.W_ ft,
.0 Threaded D] --- -
—
t... Perforatlona: Yes 0 No1Z -
O Type of perforator used _ __ --
SIZE of perforations in.by_-- In.
RSperforations from_ ft.to_ ft.
R — _ perforations from— ft.to_- ft.
fl3 perforations from ft.to_ ft.CI —
tQ —
Screens: Yes K No ❑ -
Manufacturer's Name Cook -
—
T0.e_5t,alnless wire wrap Model No. — .
> Diam. 5 Slot size— 40 from 68 rt.to_ 73 _ft.
C Diam. Slot size front ft.to ft.
(13
L Gravel packed: Yes❑ No ® Sae of gravel
L Gravel placed from ft.to ft-
.
surface seal: Yes[ No❑ To what depth?— 18 it
aMaterial used in seal Benin,t_e r-
Z Did any strafe contain unusable water? Yes t_I No Ed
H Type of water? Depth of strata v
O Method of sealing strata oft
• (7) PUMP: Manufacturer's Name Goulds
Type: Stlh. — .— _H.P. t
CR
O (8) WATER LEVELS: Land surface elevation work started 11/15/96 .19. Cempieeed 12/2/96- .19
above mean sea level — ft. ll
✓ Static level-- 42 — ft.below top or well Date WELL CONSTRUCTOR CERTIFICATION:
I.IJ Artesian pressure es per square mat Date
Artesian waxer is oonEWed by _ _ I constructed and/or accept responsibility for construction of this well, and its
0 ICap,valve,etc.) compliance with all Washington well construction standards.Materials used and
the information reported above are true to my best knowledge and belief.
C (9) WELL TESTS: Drawdown Is amount water level is lowered below static level
GI Was a pump test made?Yes❑ No ES If yes.by whom? NAME Davis DrillingE (TYPE OR P —
— (PERSON.FIRM OR CcePORandnl WN)
Yield: gal.lrm.with ft.drawdown after hra.
i " Address Belfair WA 98528
Cu. " It
(Signed) License No. 2284 _
a) Recovery data(time taken as zero when pump turned of)(water revel measured from well a
CI top to water level)
Time Water Level Time Water Level Time Water Level Contractor's
_ — _ — Reglstr ti
)— —. _ _ No._ AViSDI1100A _Date Dec.. . ,1996
(USE ADDITIONAL SHEETS IF NECESSARY)
Date of test
~
Bailer test 15 gal./min.with 10 It drawdown after 1 hrs.
n for tvs Ecology is an Equal Opportunity and Affirmative Action employer. For spe-
Airtost gel.lmin.wth stern set at cial accommodation needs,contact the Water Resources Program at(206)
Artesian flow _ g.p.re. Date Fr-�L� 407-6600.The TDD number is(206)407-6006.
Temperature of water Was a chemical analysis made? Yes❑ No y(
ECY 050-1-20(&93)''I
Pioneer Digging Inc.
3083 E. Mason Benson Rd.
Grapeview, WA 98546
SMITH TRUSTEES, B JOEL & KIMBERLY F 3/8/2024
31557 SE 275TH PL
RAVENSDALE WA 98051-5500
To whom it may concern:
I am a Septic Designer working with your neighbors on Harstine Island, Andrew Temple,
on a new septic design. This letter is to inform you that the Temples have made application for a
waiver to locate their septic drainfield closer than the standard setback of 100 ft. from the well
located on your parcel, but not closer than 75ft. Actual distance from the proposed primary
drainfield is closer to 80ft from the closest point on the primary system. Washington State allows
these setback reductions provided it meets specific mitigation measures which include enhanced
treatment prior to disposal, and evidence of confining layers. This proposal includes an aerobic
treatment unit and will be located downslope of the well. It is replacing their older gravity
conventional system which is in the same area. I have attached the site plan from the design for
your information.
We are required to notify you of this application as part of the review process. If you have
any questions or concerns you may contact myself or Mason County Health Department at the
numbers below. Thank you for your time.
Pioneer Digging Inc. - 360-426-1803 - (Robert H. Paysse/Designer)
Mason County Health Department - 360-427-9670 -Ext. 400
U.S. Postal Service
CERTIFIED MAIL RECEIPT
8 13r� r+. .' '
1;2
. CentedUlFse $4.40 0501
N. $ 15
Extra Eel &r-on(disci:box,mid fee egigipfm w
❑Ratan Reoa:pt Qtatdcoyy) S. VV
O ❑Return Reoeyd(ctnntmnlc) -C Pof:inatt;
ElCmiman *l man Restricted t?a5v:.ry E---$3�.rfy(n�-- Woo
❑Adult Signature Rersered (k ... 0:[JV-'
I]Adult stdnc.ue Restricted Ddv ty S^�_
o Po stem $0.68
rl
03/13/2024
10.ttlaga
end Pees
5snt — _--
p
Gs,>lf;-l6
i�al'5;ryn 300,