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Home My WebLink AboutWAI2024-00043 - WAI Health Waiver - 5/13/2024 .11 MASON COUNTY COMMUNITY SERVICES Building Planning,Environmental Heald"Community Health 415 N 6"Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 4 Belfair (360)275-4467 ext 400 + Elma: (360)4825269 ext 400 FAX (360)427-7787 Application for Wgiiver/Appeal Amount Paid: I Z Receipt Number: 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 yo�MVJ- L4.Ite �n}Psp Vi Name of Applicant Lra,tYhi:.. ��J-1-ILe Telephone 34.0. Mailing Address of Applicant PD NY M13 City SheAwA State WA, zip 4-9544 12-digit Tax Parcel No. 1- 2 U U L - �L L - 1 iL -a- Site Address 1051 e- 1. ct (fir;,Ic t -L.4on Subdivision Name and Lot Pt,(-I,- 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 Del cscription of Waiver/Appeal(include justification,additional material may be attached.): f a kf1rlLw Applicant Signature:�,A'!�S u.t,�- QIA" Date: )• l'J.�l'�' 1:\6H Forma\Waiver-Appeal Mason County Local Revlaed 1/20/2017 Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal tywaiver ❑ None required ❑ Class A ❑Class B ❑ Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/ Standard revision) Mgfon covr1f 4 Q CoeffAc-,&, I Sfw44re fM 4,tvp d wt*fksfeW. in au011fitl44(10 rIVA�e+Ce1% rAvnly Code 6.611.060(6). 3. Nature of Appeal: prf swycef PIAX dVAV,0,i?-- �- Low- t4 +htiLffie WdAy.4stem SavCf flri7 IoIS tnW47A leaek let ts of wif An 4ye- or 601&1 to ji; a and IA& 9AV— (z 4. Hearing Official: 's N ir Nee/ trGll ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board M Public Health Director ❑ Certified Contractor Review Board ❑ Environmental Health Manager 5. Mitigating Factors: ,TA difsn of �ofeucR� +o ocilPNe MtnrNwl7 4of �'� AFiV LZIZY� 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted.^ S(/ Staff Signature: 'K ` , Date: wwo y, PART 4: Determination of the Hearing Official /11 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 Signatu Date: S 2d J:\EH Forms\Waiver-Appeal Mason Cowry Local Revised 1202017 Page 2 of2 2212458 MASON CO WA 06,25,2024 01 55 PC CAW RPOTXC CYW,H'M p,A .. ... ... $306.50 Paees 4 I milli�1111 Ell III IN IIII�I IIIII IN IIIIII11�1111II1IIII IN Return Address: �A,, PO yal. l413 AFFIDAVIT QShe0m WA- E S* No.............................. WA R.E. EXCISE TAX JUN 25 024EXEMPT JUN VF�, LISAFRAZIER RfCFI 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 G SE '%. SI & NW 14 SW '/. S6, all in T20N, R4W (full legal descriptions on pages 1 &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. 2199930 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 Al-90041; (hereafter"Parcel A"). Parcel B: Resulting Parcel 6 of Boundary Line Adjustment No. 23-1 I, 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. 42001-41-90043; Easement-Page I of (hereafter`Parcel B"). Parcel C: Resulting Parcel 7 of Boundary Line Adjustment No. 23-I1, 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. 4200141-90444; (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 R. Erarmeat PaSe2of4 3. Scope of Easements: The casements 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: Thcse 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. Governing 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. Dated: (9, ZS , 2024. Island Lake Enterprises, LLC By Jerry P. Radtke,Member By Qbkhia A. Radtke, Member Euemeat Page 3 of 4 STATE OF WASHINGTON ) ) ss. COUNTY OF MASON ) On this 25-tl� day of J v.�c , 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 daand doofficial seal hereto affixed the day and year first above written. 1 �o - ot�and for the State of Washington,residing at NIO V. Nc OAADSC01rJENSEN My Commission Expires: . Natary Pubac State o/Washington Commission M 23034962 My Comm.Expires Aug 16, 2027 Eaaemeol—Page 4 o174