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Home My WebLink AboutWAI2024-00042 - WAI Health Waiver - 5/20/2024 MASON COUNTY COMMUNITY SERVICES Burding Plamin%Environmental Health,Community Heahh 415 N 6'a Street, Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 ext 400 O Belfair:(360)275- 467 ext 400 O Elms:(360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Z V Amount Paid: Receipt Number: Instructions WptS '^, 11 . OuU4O- 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 �IGnJ. 1C.e eFer�75e� Name of Applicant� '{nv1-1'�Lt Telephone 31 U. D.ISiN1 Mailing Address of Applicant QO &ft 1416 city �hellcr StateWA_ Zp 61%-Am 12-digit Tax Parcel No. U (J -- L1 - — " U IIU See Address 1050 r 16ka-IL Ua-& l7nV<-� dhP�SLl�1 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 ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Onsite Standards ❑ Departmental Determinations ❑ Other Description of Waiver/Appeal(include justification,additional material may be attached.): AV S 0 V !1 r% Applicant Signature: tivct lf-h LAPJ- Date: S, kS.7S ]:\6H Forms\Waiver-Appeal Mason County Local Revised 1/202017 Page 1 of PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal ryWalver ❑ None required ❑Class A ❑Class B ❑Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/ Standard revision) ^4SOn CO �y $d d COnSY�fi'e✓I Sf[O¢(�' 1AY 4"vp d W�♦d"jrS�21ryF, t17 a= w'A onoJon COMI,7 Cale 6.6'1.060(6), 3. Nature of Appeal: $ 4 1/ril trd�aarr el sit r 'I VT cs�rr�S �Yp lo{s rn W4 to 2a let �r f I�rSf anor Igrsu to I. M, ad Hw wolersowCe 4. Hearing Official: !s A 0"r91Ce( tvGll. ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ® Public Health Director ❑ Certified Contractor Review Board ❑ Environmental Health Manager S. Mitigatin�Fa+l i0 OCi1Pr✓t Otltili►ledn /of ri a,-. /1fl✓UQY3S' 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. (' Staff Signature: '�'r � if Date: Jtl2o'Lay, PART 4: Determination of the Hearing Official 14 The hearing official has determined that approval of this request will not adversely affect public health and Is hereby granted.This decision is based on the following findings and conditions: ❑ The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied.This decision Is based on the following findings and conditions: Hearing Official Signature: Date: <//ry/"� InEH Forms\Waiver-Appeal Mason C000ty Loesl Revised 120/2017 Page 2 of 2212458 MASON CO WA 0612612024 01 55 Pa En$MT 1NIIIIINHII1111111111111111INITII1111A11III1 .aes . Return Address: Cyan,. <Po brf, k413 AFFIDAVIT sJ A- 6[g'5Zq Nc........................-.... WA R.E.EXCISE TAX JUN 25 2024 -/UN 5 EXEMPT 1 1�1E LISAFRAZIER Treas.. Mason County EASEMENT GRANTOR: Island Lake Enterprises, LLC GRANTEE: Island Lake Enterprises, LLC LEGAL DESCRIPTION (abbreviated): Resulting Parcels 4, 6, & 7 of BLA # 23-11, PTN NE '/. SE '/. St & NW '/. SW -/a S6, all in T20N, R4W (full legal descriptions on pages I & 2) ASSESSOR'S PARCEL NOS.: 42001-41-90041,4200141-90043,42001-41-90444 The Grantor, Island Lake Enterprises, LLC, a Washington limited liability company, is the owner of the following described real estate in the County of Mason, State of Washington: Parcel A: Resulting Parcel 4 of Boundary Line Adjustment No. 23-11, as recorded June 29, 2023, under Auditor's File Nos. 2198930 and 2198931, in the records of Mason County, Washington, being a portion of the Northeast quarter of the Southeast quarter of Section I and the Northwest quarter of the Southwest quarter of Section 6,all in Township 20 North, lunge 4 West,W.M.; Assessor's Parcel No. 4200141-90041; (hereafter"Parcel A"). Parcel B: Resulting Parcel 6 of Boundary Line Adjustment No. 23-11, as recorded June 29, 2023, under Auditor's File Nos. 2198930 and 2198931, in the records of Mason County, Washington, being a portion of the Northeast quarter of the Southeast quarter of Section I and the Northwest quarter of the Southwest quarter of Section 6,all in Township 20 North,Range 4 West, W.M.; Assessor's Parcel No. 4200141-90043; Easemew—Page I or4 (hereafter"Parcel B"). Parcel C: Resulting Parcel 7 of Boundary Line Adjustment No. 23-11, as recorded June 29, 2023, under Auditor's File Nos. 2198930 and 2198931, in the records of Mason County, Washington, being a portion of the Northeast quarter of the Southeast quarter of Section 1 and the Northwest quarter of the Southwest quarter of Section 6,all in Township 20 North, Range 4 West, W.M.; Assessor's Parcel No. 42001-41-90444; (hereafter"Parcel C"). WHEREAS, the Grantor desires to facilitate the installation and maintenance of utility lines and septic systems for future development on the subject properties; WHEREAS, the Grantor recognizes that neighboring properties possess adequate land area for the installation of septic systems and utilities and seeks to secure easements to access and utilize such land area for the benefit of the subject properties; WHEREAS, the Grantor is willing to accept the easements for utility access and septic installation for the purpose of expanding the total available land area of the subject properties to the equivalent of one acre for future development; NOW, THEREFORE, in consideration of the premises and mutual benefits, the Grantor hereby creates and declares the following easements: 1.Easement for Parcel A: The Grantor grants a perpetual and non-exclusive easement over Parcel C for the purpose of accessing, installing, maintaining and repairing utility lines and septic systems to serve Parcel A. 2. Easement for Parcel B: The Grantor grants a perpetual and non-exclusive easement over Parcel C for the purpose of accessing, installing, maintaining and repairing utility lines and septic systems to serve Parcel B. Euement- Page 2 of 4 3. Scope of Easements: The easements granted herein shall include the right of ingress and egress for installation, maintaining and repairing of utility lines and septic systems, as necessary, to facilitate the development and utilization of Parcel A and Parcel B for residential purposes. 4. Binding Effect: These easements shall run with the titles to the real estate described herein, shall be binding on all parties having or acquiring any right, title or interest in the real estate described herein or any part thereof, and shall pass to, benefit and burden the owners thereof. 5. Govemirm Law: These Easements shall be governed by and construed in accordance with the laws of the State of Washington IN WITNESS WHEREOF,the parties hereto have executed this Easement as of the date written below. // �7 Dated: lA (/s , 2024. Island Lake Enterprises,LLC By Jerry P. Radtke, Member By C hia A. Radtke, Member Ea went Page 3 of 4 STATE OF WASHINGTON ) ) SS. COUNTY OF MASON ) On this Z day of J aKc , 2024,before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and swom, personally appeared Jerry P. Radtke and Cynthia A. Radtke to me known to be the Members of Island Lake Enterprises, LLC, the limited liability company that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said limited liability company,for the uses and purposes therein mentioned, and on oath stated that they are authorized to execute the said instrument. WITNESS my hand and official seal hereto affixed the day and year first above written. otary Public in and for the State of Washington,residing at 00 0- ii"lfo" NIL EDWDT JENSEN My Commission Expires: 8 ! 2oL Public ashington p D074862 es Aug 16, 2027 Easement—Page 4 of4