HomeMy WebLinkAboutWAI2026-00046-WAIVER/APPEAL - WAI Health Waiver - 6/30/2026 ty
415 N.6"'STREET,SHELTON WA 98584
HELT0N:360-427-9670,ext 400
M ASO N COUNTY BEL AIIR:360-275-4467,,ext.400
Public Health & Human Services
Application for Waiver or Appeal BY:..
Amount Paid: (0 Receipt Number: 3c L - 3
WAI 000 4 Le.
Please note, all approved Onsite Waivers have the same expiration date as their OSS Permits.
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 Information
Name of Applicant Gospel Lighthouse Church Telephone 360-426-7550
_---
Mailing Address PO Box 142 ____
City
Shelton State WA Zip 98584
N
3 Parcel No. 2 0 2 8 -- --2 3 6 0 1 5 0 0 `
_
Site Address 982 SE Arcadia Rd Shelton WA 98584
Subdivision Name and Lot m i
PART 2: Nature of Waiver/Appeal
El Onsite: Class A Waiver ❑ Food Sanitation Requirements
❑ Onsite: Class B Waiver El Group B Water System Regulations
❑ Onsite: Class C Waiver El Water Adequacy Requirements
❑ Onsite: Location, WAC246-272A-0210 El Building Permit: EH Review Policies
❑ Onsite: Holding Tank, WAC246-272A- ❑ Appeal: Enforcement Timelines
0240 ❑ Appeal: Departmental Determinations
❑ Onsite: Contractor Certification El Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.):
See attached, "FD2651-SE Arcadia Rd Justification Letter.pdf'
Applicant Signature: Date: (9112-
.12-CP
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsite Waiver (if applicable) N V
❑Appeal *Waiver ❑ Class A ❑Class B ❑Class C ❑ Local
State Waiver Criteria
Number of Bedrooms: Nitrogen Treatment: ❑Yes ❑ No
Soil Type: Minimum Lot Size: sq.ft.
Water Source:❑Public ❑Private This Lot Size: sq.ft.
Is This Lot Eligible for State Waivers: ❑Yes O No tK N/A
Hearing Official:
Environmental Health Manager . Public Health Director ❑ Other:
2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest
Code/ Standard revision): YYMC.L (,, . (o-1 C6 w k1w Sys.}�vyl
3. Nature of Appeal:
9ofY\t -) LUttt v\ ø & u- t
5. Mitigating Factors:
h S10 d Y°ri, vt I Th tD' L ( rIJ?r. b�L,
0 1 vyn i a h T4- --t
v T we
jO ["(\n 4 i i v I t .
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: yo Date: 6 II7 Z
PART 4: Determination of the Hearing Official
J 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:
7 J
❑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:
Health Official Signature: Date: 6 3° Z
Revised 03/03/2026
This form may be scanned and available for public view on the Mason County Web site.
Page 2 of 2
June 8, 2026
Fuller Designs
1111 Kresky Ave, Suite 100 Centralia, WA 98531 FULLER DESIGNS
Rhonda Thompson I Environmental Health
415 N 6th St, Shelton, WA 98584
Subject: SE Arcadia Rd Sanitary Control Area Reduction
982 SE Arcadia Rd, Shelton, WA 98584
Dear Ms. Thompson,
Summary:
Based on my review of public resources, nearby well logs, and site visits, it is my opinion that an
encroachment into the Sanitary Control Area (SCA) shown on the attached map is acceptable.
Please review this finding with the appropriate health officials, and we respectfully request
approval of building a storage building within the 100' SCA of the onsite group B well. To be
clear we are not requesting a reduction in SCA but rather approval to build within the SCA with
justification allowed by Mason County Municipal Code 8.52.120.13.B.i. This report is intended
to be consistent with Mason County Municipal Code 8.52.120.13.B.ii.
Purpose:
The well is located at 982 SE Arcadia Rd, Shelton, WA 98584 (Tax Parcel Number
320282360150) and is owned by The Gospel Lighthouse Church. This well is a Group B system.
A portion of the neighboring property encroaches into the 100-foot Sanitary Control Area by
approximately 88 feet south of the well. The proposed building and existing church building both
fall within the SCA Please note property boundaries are approximate and taken from overlaying
the site plan from the Pre-Application Conference. These encroachments prompted an evaluation
focused on justifying a variance which would allow the new building to continue as planned. It is
the intent of this letter to perform that evaluation.
Well Construction:
The well was completed on 11/30/1982 and is a standard 6" diameter well that was drilled to a
depth of 250'. There is a welded steel 6" diameter casing from 0' to 242'. There are no
perforations in the casing. There is a 6" diameter Johnson Stainless Steel screen from 242' to
247' with 0.035" slot sizes. Additionally, the well has a Bentonite surface seal to 18'. Physical
inspection of the well was limited to surface components, however all seemed to be in working
order and well maintained.
Geological and H,ydrogeological Data:
The attached well log details soils found during well construction. The lithology of the well log
indicates predominantly cemented gravel, clay, and some sand in the upper layers of the soil
which could be considered an aquiclude. The well log does not indicate specific water bearing
layers; however, it can be assumed the water bearing aquifer is the "sand and gravel" layer
between 224 and 247' deep where the screen was installed. The static water level sits at 102'
below the top of the well casing also indicating that the aquifer is confined due to the
potentiometric surface rising approximately over 120' above the water bearing strata.
The subject well is located at an approximate ground elevation of 163'. Surface elevations in the
immediate vicinity slope from the northeast to the southwest corners of the property. Surface
1111 KRESKEY AVE, SUITE 100, CENTRALIA, WA 98531
T (360) 807 - 4420 U WWW.FULLERDESIGNS.ORG
FULLER DESIGNS
2 � Page
water runoff travels from across the field north of the well similarly to surface contours. Oakland
Bay & Hammersley Inlet (which are saltwater bodies connected to Puget Sound) are
approximately 3,000' to the north. The well head is approximately 158' higher than the inlet.
Mill creek is approximately 1900' southwest of the project site and is roughly 90-100' lower than
the well head. There is no indication of salt water in the well system based on conversations with
the project representative and observation of well treatment systems already installed (no RO or
other saltwater removal system).
Site Arrangement:
This property is located southeast of Shelton city limits and is zoned Rural Residential 5 Acres.
Surrounding properties are also Rural Residential 5 Acres zoning. The site currently has a church
and picnic area as well as associated parking and ADA features. The church's parsonage is on a
separate parcel but utilizes the subject well. The well is in the southwest of the property
approximately 12' from the southern property line and approximately 115' from the western
property line. The church and southern property line currently encroach on the 100' buffer. The
county has requested that the site be evaluated and determine that there is no danger to the water
system due to the proposed new storage building. See the attached map for the layout.
Discussion and Justification:
Existing Site Conditions:
The existing Group B well is currently operational and serves both the existing church and
associated parsonage. The water system has successfully operated in its current configuration for
many years. The well itself is located approximately 12 feet from the southern property line, and
a portion of the existing church building already lies within the 100-foot Sanitary Control area.
As such, the sanitary control area has historically been encumbered with site improvements.
A recent Bac-T water quality test for the Group B system has been included with this justification
and demonstrates that the well is currently producing safe drinking water by showing negative
test results for coliform contamination. The continued satisfactory operation of the water system
further supports the conclusion that the existing site conditions and proposed development will
not adversely impact the well or the quality of the water supply.
Due to the existing lot configuration (e.g. location of existing well, drainage path, church
building, parsonage, parking lot, septic tanks & drainfields), there is no practical location outside
of the sanitary control area where the proposed storage building can be constructed. The proposed
location represents the most feasible building site that allows the property owner to utilize the
property while avoiding conflicts with existing structures, utilities, circulation areas, and
property setbacks.
Hydrogeologic Litholoey:
It should be noted that the well log for this site includes many layers of cemented soils and the
static water level of the completed well is approximately 120' above the water bearing strata.
This water level increase is indicative of several items.
1111 KRESKEY AVE, SUITE 100, CENTRALIA, WA 98531
T (360) 807 - 4420 U WWW.FULLERDESIGNS.ORG
FULLER DESIGNS
3 � Page
First the aquifer appears to be confined between impermeable geologic layers. This is consistent
with the cemented and clay soils reported in the well log. I would suspect that groundwater
movement in the top 240' below ground surface of this well is highly restrictive and would take
much longer than a 6-month travel time for surface water to penetrate the soil as intended by a
100' SCA.
Second, the 120' rise in the water level indicates that the static surface of the water is
commensurate with the Mill Creek water level at approximately 75' above sea level. Also, the
well does not appear to have saltwater intrusion, which indicates that groundwater is moving
from the south to the north (from Mill Creek toward Hammersley Inlet).
Proposed Conditions:
The proposed structure will be an enclosed storage building intended solely for the storage of
church-related equipment. The project representative has communicated that the building will not
contain plumbing fixtures, floor drains, septic system components, hazardous materials, or any
other potential sources of groundwater contamination. The building is not intended to generate
wastewater, industrial discharges, or any activities that could negatively affect water quality
within the vicinity of the well. Intent for the building is a covered area for vehicles to park. The
project representative also indicated no vehicle maintenance is anticipated within the new
building as that is handled offsite. We suggest if the project is to proceed, a covenant to this
effect should be filed against the deed of the property.
The proposed building will be constructed in accordance with all applicable building and
stormwater requirements. Surface drainage will be managed to prevent adverse impacts to the
well site, and the project will not alter the operation, access, maintenance, or protection of the
existing water system. The wellhead will remain accessible for inspection, maintenance, and
repair activities.
I have also discussed the possibility of a slight slope of the slab for the new building to the north.
This would ensure any moisture developed inside the new building would flow away from the
well and maximize travel distance back to the well. Also installing a plastic membrane below the
foundation of the new building would inhibit surface moisture from penetrating the building area.
This membrane would be a secondary protection from potential pollutants.
Summary and Findings:
Given the existing conditions of the site, the longstanding operation of the Group B water system,
the existing encroachment of developed areas within the sanitary control area, the absence of any
proposed contaminant-generating activities, the presence of an obvious aquitard in the upper 240'
of the site, and the demonstrated water quality of the system, the storage building is not
anticipated to create an adverse impact to the water system or compromise public health. The
proposed development can be consistent with the intent of the sanitary control area requirements,
which is to protect the well from potential sources of contamination. If allowed to proceed I
recommend the following conditions of development be placed on building approval.
1. The slope of the finished slab shall be slightly sloped to the north.This will ensure the travel path of
moisture is away from the well.
1111 KRESKEY AVE, SUITE 100, CENTRALIA, WA 98531
T (360) 807 - 4420 U WWW.FULLERDESIGNS.ORG
FULLER DESIGNS
4 J Page
2. An impermeable membrane shall be placed below the slab as a secondary protection from moisture
penetration into the subgrade. This membrane shall follow the same slope as the slab.
3. The aquiclude in the upper 240' of the soil shall continue to remain intact as tertiary protection.
4. No maintenance activities shall be performed within the 100' SCA and a covenant be filed against the
deed of the property to ensure this.
5. Any driveway placed between the existing parking area and new building be gravel and shall follow the
same storage and maintenance requirements of the building listed above with the exception of the
underlying membrane.
6. Surface runoff from the existing parking area shall remain consistent with existing conditions and not
allowed to run down a proposed driveway toward the new building/well site.
7. No hazardous materials are stored within the proposed building.
8. No sewage connections or drains to groundwater from the concrete slab be installed within the SCA.The
only drain that may be allowed is for uncontaminated roof runoff.
9. Continued group B monitoring be performed consistent with the testing schedule required by the
approved group B system(routine coliform,nitrate,and other tests/maintenance described in the group B
workbook).
Based on the above, I find that the proposed project will not have adverse impacts on
groundwater. I respectfully request Mason County approve the proposed storage building within
the sanitary control area. Please accept this letter as a justification to proceed with development
of a new storage building.
Sincerely,
4 6/8/7026
Aaron Fuller, PE oN L. FUll�
Fuller Designs 0W AS .p
360-807-4420
afuller@fullerdesigns.org
s_org
CC: Cameron Reece, Project Representative
SSIDNAL�yG
Enclosure: Site Map
GIS Site Contour Map Exp. 12/21/2026
Well Log
Coliform Test Results
1111 KRESKEY AVE, SUITE 100, CENTRALIA, WA 98531
T (360) 807 - 4420 U WWW.FULLERDESIGNS.ORG
FULLER DESIGNS
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O County Boundary ❑ Tax Parcels(Zoom in to 1:30,000) 1. , - , .T' � I
❑ _ 0 0.01 0.02 0.04 km -_
No Filled Contours 5 ft Source:Esri,Vantor,Earthstar Geographics,and the GIS User Community
• Site Address (Zoom in to 1:3,000) Mason County WAGIS Web Map Application-
Mason County disclaims accuracy,reliability,or timeliness of website info,not liable for losses from reliance on it.https://www.masoncountywa.gov/disclaimer.php
File Original and First Copy with WATER WEL.I. REPORT Application No. .......-..._....................
3soond CapY t OMrter'i Copy
T Ird Copy—Drillers Copy BTATE OF WAamNOOTON Permit No. .... ......._........—..........
(1) OWNEW N.m� f st_ �Lt tL./
O (2) LOCATION OF WELL: .cwtas _.. u.7i _._ £≤ %4l.l,.I v 8.e..2.Ll_T#Z_S..N., R....3 /vex.
0) Rearing and distance from eactk or sy►bdhrWon corner 3G�
(3) PROPOSED US$: Domestic ❑ Industrial D Municipal O„ (10) WELL LO(*:
frriga*oaU-'Pest w.11 Ll Other .f FW'matibn:Daaerlbt�MtO+,dearacter rise of matertat and structure, and
show eltaeae ha of era and CM kind and na*ure a/CM merw atl in each
suntan ell Penetrated.. at least one entry for each claanpe of formation.
(4) TYPE OF WORM UflWSt
((f—'s -eban ooeif.' .____._._� _ - MATERIAL
>f7tolaI TO
New well JW_ 3Latbod: Diu ❑ Bored O ` b
Despeoid Q Cab!. -0- Drfveo❑ =- ç . e 4i
Os.aanmtionid 0 ROWY p tte Jed O
(5) DIMENSIONS: Diameter of Mall —1laalw _a c I r , 37 S3
O nrlu d_,'�. r -st.r Depth of o0-,pW.,d wa>_ 347 . ss - g o y
E (i) CONSTRUCTION DETAILS: d t o 0
O Casing installed; Dram ftauri it. to _ x:-- t. r p
Threaded Q Diam-from it.4w ft. .j J
Welded R Dtwm. !toad _ R to • .!t.
Perforations: Yes O -
L Type of perborabr ,J.d --
0 SIZ! of perforsttwu. in. by _ tn. -. . .
10 _ Destositfaa. Beal - ft.to . ft
pppi from ft.to -- ft. -
perporatioi from ft. to
tQ Seree4lt: Yea 6( No 0 V .
Yaatdactmrses Nanw-.. -r0 jr f, s 0
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= Diem. -4— Slot sus. 1 - from .�.-L? ft.to A 1L7 ft.
Dlam. slot aiae ...__^.from _ ft. to !t
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Gravel Packed: YM O No QL 8sss of Bratel;
Gravel pliaad from_ ft.to_ V —!Y
Surface seal: yes of - Non To what depths _It ft.
- Material u.d in aeaL_J..°> '1!•7-I - .. -
I— Did aar strata contain unusable w.grf Yes[] Y90
Z Type of vented Depth of strata_ - _
1I od of.asllnm strita-' ' /r— ./
N r 1 T�a//I it
(7) PUMP: Manutaclunr'e N /h
0 Ty": -..C L.. h a - - -
�` (8) WATER LEVELS: �a nirfaa et�anoa_ .__.. - -_ - _ --
aI stove eteao aaa lxvd._... "--
O static level _Q 2.2 ___et below top at w511 _____ - -
O Artesian premise _Sba. Per.aquI Inch Data_. . .. -
(� Artesian water to controlled br valve. its.)
LLJ
O (8) WELL TESTS: belowaa water level a .. _
wok shrt:d..^!�.�3:_._.:..:I9: pl.ted-1.1."�51.__......
Was a pump teat made? Yes U No O if yet, by whmnt.. . rte _ D18ILI.ER'5 STATEMENT:
Yield: 3 gaL la/m with ./.. ft. drawdown afpn / hrs. WELL.
�' alt well gyps-drilled-•.undef my Jurisdiction and this report is
�� - true to the best-of my knowledge and belief.
ReeaverY data (bait taken Y sera when ptetnp turnad ash (shier turd r /
measured frown will top to water lewd) (�f�
Q Time Water Level Time ,4attr Level Tbne Water Level NA ype 0-r print)•........... .......:.
(Person.firm. or corpora (T
s ....-1.1J '.__. -•----- _ _ .. ......... .._.._..
... ...a7......................................................_........._. .._
Date of text _ _..._-. _._..._ _ [$igpedj................ ....._... - -wall Driller
.......... ......................................
Bailer test_-s�12_...galJazin.with...._ 2-4t.drawdown aftQ� - hri. (
Art,n flow ___._g.p.m. Date_ a'
Temperature of . Was a chemical analysis mad.?Yea O No Cl License No ._..C'"2"" . ......... . Date-..._//.......3.............. lOri._c�
(UfE ADDITIONAL IF NECESSARY)
ECY 060-1-20
Thurston County Environmental Health
412 Lilly Rd NE t Olympia,WA 98506
360 867-2631
ThURSN CO
COLIFORM BACTERIA ANALYSIS
Time Sample County
Date Sample Collected Collected
I lQ I20 6 O : 50p M/15
Month Day Year
Type of Water System(check only one box)
0 Private Household
❑Group A
Group B ❑Other_
Group A end Group B Systems Provide from WaterFacilities Inventory
WFI:
System Name:/"F 33 P&L-
L! /if Cl, L4 rA
G
Contact Person: eC/o 11A e?,(
Day Phone:(3�Cr) �'
qZ Cell Phone:(.3(O )YYd S
E-mail:
5L-C I t'(f°1 S�'vatGe.•� .C ; ve.Phone:(364)gTIa-
Send re to: tint fulbname,add s and zip code or email address)
fO8O. /42
----------
SAMPLE INFORMATION/ j
Sample collected by(name): A��N� f� /�, ` /A /
Specific location or address where sample collecteid: Special instructions or comments:
Type of Sample(must check only one box of#1 through#4 listed below)
1.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine)
Distribution System
Chlorinated:Yes No._ . ❑Chlorine Residual:Total_.Free X Chlorinated:Yes No
3.Raw Water Source Sample
Chlorine Residual.Total_.Free_
❑E.coil—GWR(AIP)
❑Fecal—Surface,GWI,springs(numeration)
Unsatisfactory routine lab number.
Filtered:Yes_No —— —
❑Assessment Monitoring(NP) Unsatisfactory routine collect date:
❑Other
S
4.0 Sample Collected for Information Only
Investigative Construction 1 Repairs__ Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
Satisfactory
❑Unsatisfactory Total Coliform Present and o-Coliform detected
❑E.coli present 0 E.coli absent
Replacement Sample Required:❑Sample too old(>30 hours) ❑TNTC ❑
1100mt. E.coli 1100m1.
Bacterial Density Results:Total Conn
lifo --
Fecal Coliform
110om1 Enterococci___---1100 ml.
Date and Time Received:
Method Code;❑SM 9223B ❑SM 9222D „at `` e
❑SM 9215B 0 Enterolerll
f Date Reporte _. 2
Date and Time Analyzed: ` Lab Use Only:
Sample Number(DOH number plus five digits)[jr+�
0 8 0 ' C56
Notes
tructures:
Arcadia Rd. Arcadia Rd. Existing structure/s:
Ingress/Egress A:Pumphouse 325 SF
North B:Family Center 3500 SF
Property Line Arcadia Rd. C:Pink Area 730 SF
315.20 Ingress/Egress D:Residence 2630 SF
E:Sanctuary 3890 SF
.I --—--— I Proposetl Structure:
-— ` I F:Garage/Storage Building 3200 SF
20'Easement{—}`• I I Im errneabk Surfaces:
(Roatl antl Uhlity�
1 j '�• 1]5 I ^I E Bltlg ld.
.(A(A-E) 11075 SF
I• ___ Patios(Concrete) 7800 SF
Parking Lot(Asphalt) 25395 SF
D Total 44270 SF
y ___ i_ I Proposed:
----- - -- - I Existing Slab 945 SF
--- -- -- I I Total 2255 SF
s � I I I j I Total spaces 60
I I
/ `u -topography is approximate
\ i I
F B
I sa
ea I i i �'_❑_---_� � I 5a C I ae No. Revsion/Iss Dot=
93 3a A I 2] 5]
�� Property Project name and address
Line
/ South 40x60x20 Metal Building(S-2)
\ Property 982 SE ARCADIA RD
Line
\ Rroo SHELTON,WA 98584
\ PCL#32028-23-60150
Project Sheet
New Construction 1 OF 1
Date
4/16/2026
Scale
i
2243683 MASON CO WA
07/28/2026 01:39 PM COV
MASON COUNTY PUBLIC HEALTH 0E(224455tRec Fee $305 50 Pages: 3
After recording,return to: 11111111 ii 1111111 111111 111101111111111111111 Dliii 1111111
Mason County Public Health
415N 6th St.
Shelton, WA 98584
JUL 2 8 2026
By
C D -c - cod
COVENANT RUNNING WITH THE LAND
GRANTOR: The Gospel Lighthouse Church
GRANTEE: Mason County of Washington Public I Icalth
ABBREVIATED LEGAL DESCRIPTION: SW 1/4 of the NW 1/4 of Section 28,Township 20 North,
Range 3 West, W.M.
ASSESSOR'S PROPERTY TAX PARCEL NUMBER: 32028-23-60150
RECITALS
WHEREAS, the Grantor is the owner of that certain real property located in Mason County, Washington,
commonly known as 982 SF.Arcadia Rd, Shelton,WA 98584, and more particularly described above; and
WHEREAS, a Group 13 public water system well (ID#AA926D) is located on the property to provide
drinking water;and
WIIERIAS, the Grantor has proposed the construction of a new enclosed storage building within the
100-foot Sanitary Control Area(SCA)of said well; and
WHEREAS, the Mason County Public Health Department has conditionally approved a variance/waiver
under case number WAt2026-00046, permitting the storage building within the SCA subject to the
execution and recording of a restrictive covenant to protect groundwater quality;
NOW,THEREFORE, the Grantor declares that the property shall he held, sold, and conveyed subject to
the following restrictions, covenants,and conditions, which shall run with the land and bind all current
and future owners, heirs, successors,and assigns:
COVENANTS AND CONDITIONS
1. Slab Slope: The slope of the finished concrete slab for the new storage building shalt be sloped
slightly to the north to ensure the travel path of internal moisture flows away from the wellhead.
2. Impermeable Membrane:An impermeable plastic membrane shall be installed directly
underneath the concrete slab as a secondary protection mechanism to prevent moisture
penetration into the subgrade. This membrane must follow the same northward slope as the slab.
3. Aquiclude Preservation:The existing natural aquiclude layer found within the upper 240 feet of
the subsurface soil profile shall remain undisturbed and intact to serve as tertiary groundwater
protection.
4. SCA Maintenance Restriction: No vehicle maintenance, equipment servicing,or related
commercial maintenance activities shall he performed inside the 100-foot Sanitary Control Area
(SCA)or within the new storage building.
5. Driveway Restrictions:Any new driveway section installed between the existing paved parking
lot and the new storage building must he constructed of gravel. It shall be subject to the same
storage and maintenance restrictions as the building itself, with the exception of the underlying
membrane.
6. Surface Runoff Management: Surface water runoff originating from the existing asphalt
parking lot must be managed to maintain existing drainage paths. Runoff shall not be permitted to
drain down the new gravel driveway toward the new storage building or the wellhead site.
7. Hazardous Materials Prohibited: No hazardous materials, chemicals,petroleum products,or
potential groundwater contaminants shall be stored within the proposed storage building at any
time.
8. Plumbing and Drains Prohibited: No plumbing fixtures, floor drains, sewage connections, or
wastewater disposal links to groundwater shall he installed within the concrete slab or inside the
structure within the SCA.The only drainage feature permitted within the SCA is for
uncontaminated roof runoff.
9. Water Quality Monitoring: The property owners shall ensure ongoing compliance with the
mandatory Group B water system testing and monitoring schedule as outlined in the approved
Group B workbook, including routine coliform,nitrate,and required maintenance testing.
These covenants shall remain in effect in perpetuity unless formally released or amended by the written
consent of the Mason County Public Health Department.
DATED this day of_ .�t _ / ,2026.
Ora tor
L4Authorized Representative, The Gospel Lighthouse Church
2243683 Page 2 of 3 07/28/2026 01:39:24 PM Mason County, WA
NOTARY ACKNOWLEDGMENT
STATE OF WASHINGTON
sS.
COUNTY OF MASON
On this day personally appeared before me Cameron Reece,to me known to be the authorized
representative of The Gospel Lighthouse Church, the entity that executed the foregoing instrument,and
acknowledged the said instrument to he the free and voluntary act and deed of said entity, for the uses and
purposes therein mentioned.
GIVEN under my hand and official seal this 2..D ' day of , 2026.
1 uIt1+ulni
NOTARY Pt IC in and for the State of Washington, ,E r C
Residing at: ____L c -v.___ = : NOTARY
PUBLIC :
My commission expires: O OL°�
2243683 Page 3 of 3 07/28/2026 01:39:24 PM Mason County, WA
Arrow Septic Designs, Inc
171 E. Vuecrest Dr.
Union, WA 98592
July 22, 2026
Mason County Department of Health Services
415N 6th St
Shelton, WA 98584
RE: Gospel Lighthouse Church(Parcel #32028-23-60150) Flow Calculations & Reserve
Drainfield
Dear Inspector:
The Gospel Lighthouse Church property located at 982 SE Arcadia Rd, Shelton, WA 98584 has
an existing church. There is a proposed new structure intended for primary use as a bus garage
and storage of supplies. The new structure will not have plumbing or be hooked up to the
existing septic system. There is no current planned change of use or increase in septic flows
involved in this project, although if the church attendance grows, the septic system has ample
capacity. See average daily usage and septic flow calculations attached.
There is a gravity flow septic system currently serving the church that was installed in 1982. It
consists of a 1,500 gallon 2-compartment septic tank followed by 230 if x 36"wide= 690 s.f. of
drainfield.
The system was pumped and inspected 7-10-26 by B-Line Construction& Excavation and
checked out with no deficiencies noted. It was noted that"Everything appears to be functioning
as it should."Reports attached.
The church was approved in 1983 with a drainfield size of 690 s.f. for a total of 690 GPD (using
a conservative historical/legacy sizing of 1.0 application rate). See attached flow calculations for
the current usage which averages only 86 gallons per day using an estimate of 3 gallons per visit
per person. This daily average is well below capacity.
The plot plan attached shows a designated reserve drainfield area for the future if needed. The
area soils are a sandy loam so we have designated 1,200 s.f. of shallow trench reserve drainfield
area(690 gpd @ 0.6 ap rate= 1,150 s.f. minimum). The entire existing septic system and
proposed reserve area are outside of the existing well 100' setback radius.
In 2010, a septic system for a 3-bedroom home on the adjacent property at 980 SE Arcadia Rd,
Shelton(Parcel#32028-23-60130)was installed on the subject property. The reserve area was
documented in between the primary trenches at that time and there is additional space and
adequate soils available on the parcel with the home if needed. A"Declaration of Covenant for
On-Site Sewage System" was notarized and filed on the property deed at that time. A copy of
the recorded document is attached. Adequate reserve area for the home is also shown on the
attached plot plan.
The property owner's contact information is as follows:
The Gospel Lighthouse Church
PO Box 142
Shelton, WA 98584
Cameron Reece 360) 545-5336
If you need 4i ormation, please feel free to contact my office at(360) 898-2255.
Sincerely �' y�ay •�.
570 949
PAULA JOY JOHNSON
Paula J. Johnson
Licensed Onsite Wastewater Treatment System Designer
The Gospel Lighthouse Church Arrow Septic Designs, Inc
Parcel#32028-23-60150 7/22/2026
982 SE Arcadia Rd
Shelton,WA 98584
Number of Gallons Total Gallons
Average Usage: Attendees per person per Week
Sunday AM Service 80 3 240
Sunday PM Service 60 3 180
Thursday PM Service 60 3 180
Total Average Flow *per Week 600
Average Flow *per Day 86
Estimated GPD is from EPA ManualTable 3-5:Typical wastewater flow rates from industrial sources.
Assembly Hall,Range 2-4 gpd,Typical 3 gpd.
Existing Septic Tank Size:
1,500 Gallon Tanks x 1 each= 1,500 gallons
Using 2.2 days retention time (1,500/2.2 days) 682 GPD
Existing Drainfield Size:
230 lineal feet x 3 ft wide= 690 s.f.
Original Design Flow Capacity(using 1.0 ap rate) 690 GPD
Reserve Area DF Sizing(using 0.6 application rate) 1,150 s.f.
Use 36"wide trenches 383.3 I.f.
Use 400l.f.
RESERVE AREA: Use 400' lineal feet of 36"wide trenches 1200 s.f.
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DECLARATION OF CO q TT F9I ON-SITE SEWAGE SYSTEM
I(We)the undersigned grantor(s)hereby declare this oveazfut and place same on record (We)the grantor(s)
herein,am(are)the owne(s)in fee simple of(an interest in)the following described real estate situated in Mason
County,State of Washington:to wit (Division and Lot Number or Range/Township!Section Number. Note:
Range,township,section numbers are<.e i°5 digits of the parcel number) _
3 s�OR
Sutdivisim Divisiaa ` `Lot Range Towast p S &xi
and having the Tax ParcelNumbei a! --�3_ (v 10
on which the grantor(s)owns' des portions of an on-site sewage disposal system and drasafield or repair
area that serves a stxucUlocstetf�n the following described real estate situated in Mason County,State of
Washington;to wit(I)ivision a Lot Numbers or Range!Township/Section Number. Note:Range wnship,
section nursers at5 d1 of the parcel number)
�--�� OR
S i Lot Runge Township Section
and having T Parcels umber of..3.4C>Q —�3—
and gxnfmi(s)1a are)required to maintain the on-site disposal system in such a manner to facilitate treatment and
dispos 1'of by a ur�t.
It is thèjipose of these grants and covenants to allow easements for placement and access and to prevent certain
ay have significant adverse impacts to the fimetion of the septic system.
NOW, REFORE,the grantor(s)agree(s)and covenant(s)that said grantor(s),his(her)(their)heirs,successors
\ad assis will allow a utility casement for the use and purpose of conveying sewage from one parcel to the other,
easement for the purpose of maintaining or repairing the on-site septic system and appurtenances thereto
10 feet of any portion of the septic system and to prevent practices not consistent with state and local
gti1ations in this area.
These covenants shall run with the land and shall be binding to all parties having or acquiring any right,title,or
in the land described herein or any part thereof,and shall inure to the benefits of each ow N� W `e l.'
VTI'NESS_______hand this da of 20
Signature
State of Washington ) �Bs
County of Mason ) y� 29 3 �_
I,the undersigned,a Notary Public in and for the abovegamed County and State,do
day o 2 O1j,t .\�► ., qc�e ,mc C •t re
me,who is known to signer of the above instrument,and ac owledged that he(she) they) 'gned it.
GIVEN under m d an seal day and year last above written.
Notary Public in and for the State of Was gton,
il at My commission expires:
8-LINE CONSTRUCTION&EXCAVATION
2971 E PHILLIPS LAKE LOOP RD 3604264221
SHELTON, WA 98584
PROPERTY INFORMATION
Location:982 SE ARCADIA RD
Shelton
Tax ID:320282360150
Ma tl To: THE GOSPEL LIGHTHOUSE CHURCH
PO BOX 142 Use:
SHELTON,WA
985840142 GENERAL SYSTEM TYPE:Conventional (Non-Pressurized)
ON ID:320282360150
County Area:Oakland Bay MRA
Here Hen
Inspected:07/10/2026 - Inspection Type:ROUTINE - Correction Status:No corrections needed
Company: Work Performed By: Submitted 07/21/2026 by:
B-LINE CONSTRUCTION&EXCAVATION B-Line Construction B-Line Construction
COMMENTS&GENERAL INSPECTION NOTES
No Deficiencies Noted
Everything appears to be functioning as it should,pumped at time of inspection.
GENERAL SITE&SYSTEM CONDITIONS
The General Site and System Conditions were: Fully Inspected
Components accessible for service: YES
All required service performed(if no-specify omitted inspection items in notes): YES
Surfacing effluent from any component(including mound seepage): NO
Components appear to be watertight-no visual leaks: YES
Improper encroachment(structures/impervious surfaces) NO
All riser lids securely fastened upon departure: YES
Electrical repairs needed. If YES describe in comments: N/A
If a reserve area is designated on the property,is it undisturbed?(select N/A only if no reserve has been YES
designated)
Inspected components appear to be in good physical condition: YES
Root intrusion on any components. If YES describe in comments: NO
Settling problems observed. If YES describe in comments: NO
The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO
The system is operating as designed based on existing records,such as record drawing,previous reports YES
or other documents?(N/A if no existing records)
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
This component was: Fully Inspected
0-Box in good condition: YES
0-Box outlets set to allow a ual effluent distribution: YES
This component was: Fully inspected
Effluent level within operational limits(if NO explain in comments): YES
AlI re uired baffles in place N/A=No baffles required): YES
compartment I Scum accumulation Inches,Jr Other specify). 8-10
Compartment 1 Sludge accumulation(Inches,if other specify): 10
Compartment 2 Scum accumulation(Inches,if other specify): 2-3
Compartment 2 Sludge accumulation Inches,if other specify): 10
Purr in recommended: YES
a
This component was: Fully Inspected
Component appears to be functioning as intended: YES
Ponding present?If YES explain in comments: NO
Drainfield was vacuumed,flushed or hydro-jetted?(If YES,explain in comments) NO
This report indicates certain characteristics of the onsite sewage system at the time or visit.In no way is this report a guarantee of operation or future performance.
RepordD:1549266 View inspection reports online at www.onlinerme.com Page 1 of 1
Slh Name:
Loatlon:982 SE ARCADIA RD Service Company:
p Y:
Shelton
Tax ID:320282360150 B-LINE CONSTRUCTION & EXCAVATION
use: 2971 E PHILLIPS LAKE LOOP RD
SHELTON,WA 98584
3604264221
Serviced:07/10/2026 by:B-Line Construction Submitted 07/21/2026 by:B-Line Construction
oumpLocstion:Bio-Recyding Jurisdiction ID:320282360150
COMMENTS
OM done at time of pumping.Everything appears to be functioning as it should.
Tank Pumped: YES
Total Gallons pumped from tank(Number only,no text): 1500
Tank Size(Gallons)(Number only,no text): 1500
Tank depth below grade(inches): 12
Effluent level within operational limits(if NO explain in comments): YES
Effluent returning back into tank after pumping: NO
Access Risers installed to grade(N/A if not present): N/A
Tank Construction Material: Concrete
Tank Condition Good: YES
Baffles in good condition(N/A if not present): YES
Effluent screen deaned(N/A if not present): N/A
Effluent surfacing around site components(N/A if not checked): NO
Tank abandoned after pumping: NO
Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO
Compartment 1 Scum accumulation(Inches,if other specify): 8-10
Compartment 1 Sludge accumulation(Inches,if other specify): 10
Compartment 2 Scum accumulation(Inches,if other specify): 2-3
Compartment 2 Sludge accumulation(Inches,if other specify): 10
This,pod indicates caffein Maractenatics of tife onsde sewage system at the time of vied.In no way is itus report a guwrentw or operation or Mute perronnancs.
ReportiD:898043 View pump reports online at www.onlinerme.com Page 1 of 1