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HomeMy WebLinkAboutWAI2026-00039 - WAI Health Waiver - 8/25/2026 415 N. 6th STREET,SHELTON WA 98584 400 MASON COUNTY SHELTON: 670,exit 400 �T} Public Health & Human Services Application for Waiver or Appeal y� Amount Paid: / O Receipt Number: 7,V74 OZ-rg I WAI �0�� - OOO3I Please note, all approved Onsito Waivers have the same expiration date as their OSS Permits. Instructions: 1. Complete Parts I 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 Brad Henson Telephone 2489301988 Mailing Address 1829 29th Ave city Seattle State WA zip 98122 Parcel No. 1 2 2 3 0 __ 7 5 -- 0 0 1 6 0 Site Address 300E Sherwood Hills South, Allyn, WA 98524 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements El Onsite: Class B Waiver ❑ Group B Water System Regulations 0 Onsite: Class C Waiver 0 Water Adequacy Requirements El Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies ❑ Onsite: Holding Tank, WAC246-272A- ❑ Appeal: Enforcement Timelines 0240 ❑ Appeal:Depamfinental Dete,ininations ❑ Onsite: Contractor Certification ❑ Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.): Good faith efforts have been made to contact the neighboring property owner to obtain a Restrictive Covenant for water supply protection zone on neighboring parcel without success. There is already a 5ft setback from OSS components to a property line for the south neighbor, and since the well radius only encroaches slightly on to the neighboring property, the impact is minimal. ti64a-G[. e/Z.,.30'L 05 / 12 / 2026 Applicant Signature: Date: Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 1 oft Doc ID: efb55c028498729a26c62d23fle87a64a7d036bf PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) ❑Appeal ( Waiver ❑ Class A El Class B Class C ❑ Local II State Waiver Criteria Number of Bedrooms: 'IR- (iit.7QQ,X i Nitrogen Treatment: ci l Yes l(No Soil Type: Minimum Lot Size: &C (.. sq.ft. Water Source:❑Public Private This Lot Size: _5. 0 I (C X *tt) sq.ft. ppyo IO1'r> Is This Lot Eligible for State Waivers: Yes ❑ No ❑ N/A (t i.'- fCj-t 5 Hearing Official: AEnvironmental Health Manager ❑ Public Health Director ❑ Other: 2. Identification of Specific Code/ Standard/ Determination (include date of determinatonlor Ia est Code/Standard revision): 7i�.10-Z'2,�- �) 1�Q 3 -O L7, ,I f 3. Nature of Appeal: Uri Mc vi+ v wr�( 5. Mitigating Factors: o©d u'L a#c ed) -Fw . , -So kv'4 rt bVl (-t I > 4 JA(1 O1tp wi1 'ti's 0 r-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:' Date: [( 1 PART 4: Determination of the Hearing Official .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: Health Official Signature: Date: 11 Lf __ Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 Doc ID: efb55cO28498729a26c62d23f1e87a64a7d036bf On-Site Sewage Systems (Chapter 246-272A WAC) We.T7agten51le0eparinentd Request for Waiver from State Regulations t i, HEALTH Section I. I (Completed by applicant) Name: (1) Brad Henson Local Health Jurisdiction Received (2) (See instructions) Address: 1829 29th Ave Seattle WA 98122 Telephone: 2489301988 Signature: A/eo Property Identification: (3) �j n Parcel-122307500160 — — - -- -------- _ __ Address: 300 E Sherwood Hills South, Allyn, WA 98524 Section II. I (Completed by applicant) WAC Number: (4J WAC Requirement: (5) Waiver Sought: (5) 246-272A- Restrictive Covenant No Restrictive Covenant Subsection: Justification (Proposed mitigation measures): (7) Good faith efforts have been made to contact the neighboring property owner. There is already a 5ft setback from OSS components to a property line for the south neighbor, and since the well radius only Section III. (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures: (9) Comments/Conditions: (10) Type of Waiver: (11) Class A Class B Class C — Request DOH review before granting? Yes n No Neighbor Notification: (12) Required?Yes❑Non if needed, are agreements, easements, etc.filed? Yes No Section IV. (Completed by health officer) This Request for Waiver from State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems.The review criteria applied, and the mitigation measures proposed and/or required, have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. nDenied nV Approved/Granted —Subject to,pl1omments, conditions and requirements oted in ections II and III. Local Health Officer(13) Date: DOH 337-175 February 2024 Doc ID: efb55cO28498729a26c62d23fle87a64a7d036bf DECLARATION OF HEIDI LLOYD Record of Attempts to Obtain a Corrected Well Covenant Mason County Short Plat No, SPL2025-00003 I,Heidi Saucier, declare as follows: 1. I am over the age of eighteen and competent to make this declaration. I make this declaration in connection with my work on behalf of Win Win Homes LLC on the matter identified above. The facts stated herein are within my personal knowledge and are true and correct. 2. This declaration concerns the corrected Well Covenant required in connection with Mason County Short Plat No. SPL2025-00003. A Well Covenant executed and notarized on June 18, 2026 was incomplete and required correction and re-execution. Completion of the corrected Covenant required the signature and notarization of Kerry Woolley, a neighboring well owner, and his wife, Shari Woolley. 3. From June 20, 2026 through July 14, 2026, efforts to obtain Mr. Woolley's corrected and notarized signature were conducted primarily by Brad Henson of Lombard Developers. I was a party to that contact and was kept informed of it throughout,and the events described in the following paragraphs are within my knowledge on that basis. 4. On June 20, 2026, Mr. Henson discussed with Mr. Woolley the need to correct the Covenant. It was agreed that a corrected version would be prepared and provided to Mr. Woolley for review. 5. On June 24, 2026, the completed corrected Covenant was emailed to Mr. Woolley, the $10 payment stipulated in the Covenant was sent, and a notary signing was scheduled for June 26, 2026. 6. On June 26,2026,Mr. Woolley did not appear for the scheduled signing and did not respond to follow- up calls or emails. 7. On July 6,2026,Mr.Woolley agreed by telephone to meet for a notary signing on July 7, 2026. On July 7, 2026, he did not respond to calls or texts regarding the scheduled signing. S. On July 8, 2026, Mr. Woolley responded that he had been busy, and the signing was rescheduled for July 14, 2026. On July 14, 2026,Mr. Woolley again did not appear and did not respond to calls or texts. 9. Beginning August 10, 2026, 1 undertook direct outreach to Mr. Woolley. At 5:07 PM that day, I texted Mr. Woolley at(253)222-2178 and proposed sending$100 via Venmo at that time and an additional$100 once the signing was completed through Proof.com that evening,and asked him to confirm the arrangement and his Venmo handle. 10. At 5:16 PM the same day, Mr. Woolley replied that I could either send $200 up front or "do it the longer way," and confirmed his Venmo handle. 11. At 6:33 PM the same day, I texted Mr. Woolley: "First half sent. Please let me know once you and Shari have signed and I can send the other half." I did not observe Mr. Woolley's 5:16 PM reply before sending this message. r ., in. co„i 12. On August 13, 2026 at 3:11 PM, I texted Mr. Woolley noting that the $100 had been sent on August 10 but that the Proof.com request had not been signed or attempted, and asked him to call me. Later that day I received a missed call from Mr. Woolley. 13. On August 14, 2026 at 10:57 AM, I texted Mr. Woolley to ask for a good time to discuss completing the notary. On August 20, 2026 at 11:48'AM, I texted again asking for a good time to call. I placed an unanswered call to him at 3:03 PM on August 20,2026. 14. On August 20, 2026 at approximately 3:14 PM, I spoke with Mr. Woolley by telephone (a transcript of the call has been retained). During that call, Mr. Woolley declined to proceed with the incentive arrangement, stated that he had previously instructed that the correction be pursued through the county rather than by re-execution, stated that he had not accepted or claimed the$100 Venmo payment and would return it, expressed dissatisfaction with the frequency of contact, and requested that I not contact him further. I apologized, advised that Venmo would not permit me to reclaim the funds directly and that he would need to return them to the originating account, and stated that I would contact Mason County regarding available options. 15. Following that call, and on the same day, Mr. Woolley telephoned again and asked to speak with me. He apologized for his manner during the earlier call, stated that he would speak with his wife regarding signing the document, and requested that I call him back at 9:00 AM on August 21, 2026. 16. On August 21,2026,1 called Mr.Woolley at 9:00 AM,as lie had requested. That call was not answered. A follow-up call at 9:48 AM and a text message at 9:48 AM were likewise not answered. 17. As of the date of this declaration, the corrected Well Covenant has not been re-executed by Mr. Woolley. A chronological summary of the communications and correction attempts described above is attached as Exhibit A. VERIFICATION I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Dated this 21 St day of August , 2026, at Renton , Washington. Jaucc• Heidi Saucier Win Win Homes LLC n...,m. aa.,a„7(fl AC c n �a.o oa n cr „ EXHIBIT A Chronology of Correction Attempts— Well Covenant, Short Plat SPL2025-00003 Contact through Judy 14 conducted by Brad Henson(Lombard Developers);direct outreach from August 10 by Heidi Lloyd. r ITr June 18,2026 Original Well Covenant notarized in incomplete form. June 20,2026 Brad Henson(Lombard Developers)discussed with Kerry Woolley the need to correct the Covenant;agreed to update it and send to him for review. June 24,2026 Corrected Covenant emailed to Mr. Woolley;the$10 payment stipulated in the Covenant sent;notary meeting scheduled for June 26. June 26,2026 Mr. Woolley missed the scheduled signing and did not respond to follow-up calls or entails. July 6,2026 Agreed by telephone to meet for a notary signing on July 7. July 7,2026 Mr.Woolley did not respond to calls or texts for the scheduled notary. July 8,2026 Mr. Woolley responded that lie had been busy; signing rescheduled to July 14. July 14,2026 Mr. Woolley missed the signing and did not respond to calls or texts. Aug. 10,2026—5:07 PM Heidi Saucier texted Mr.Woolley(253-222-2178)proposing$100 via Venmo now and$100 after the signing was completed via Proof.com that evening; requested confirmation of the arrangement and.Vennio handle. Aug. 10,2026—5:16 PM Mr.Woolley replied to send the$200 up front or"do it the longer way,"and confirmed the Venmo handle. Aug. 10,2026—6:33 PM Ms. Saucier texted"First half sent. Please let me know once you and Shari have signed and I can send the other half." Aug. 13,2026-3:11 PM Ms. Saucier texted noting the$100 was sent 8/10 but the Proof request had not been signed or attempted;asked Mr.Woolley to call. Aug. 13,2026 Missed call received from Mr. Woolley. Aug. 14,2026- 10:57 AM Ms. Saucier texted asking for a good time to discuss completing the notary. Aug.20,2026—11:48 AM Ms. Saucier texted asking for a good time to call. Aug.20,2026-3:03 PM Unanswered call to Mr. Woolley. Aug.20,2026-3:14 PM Telephone call with Mr.Woolley(transcript retained). Mr.Woolley declined to proceed with the incentive arrangement,stated he had not accepted or claimed the $100 payment and would return it,expressed dissatisfaction with the frequency of contact, and requested no further contact. Aug.20,2026—after 3:14 Mr. Woolley telephoned again and asked to speak with Ms. Saucier.He PM call apologized for his manner during the earlier call, stated he would speak with his wife regarding signing the document,and requested a callback at 9:00 AM on August 21. Aug. 21,2026 Ms. Lloyd called at 9:00 AM as Mr.Woolley had requested; the call was unanswered.A follow-up call and a text at 9:48 AM were also unanswered. n,... in. ,,,.cO,. ,.7rn7(_,.o„)r,.I..cn..cr,.c,.c7 X Dropbox Sign Audit trail Title well Covenant timeline declaration File name Well_Covenant_timeline.pdf Document ID ea53a 1 c7f9b0aa49afc9e76c8a3feb59e5fa6a57 Audit trail date format MM 1 DD /YYYY Status Signed DOCLtment History 1J 08 1 21 !2026 Sent for signature to Heidi Saucier (heidi@winwinhomes.com) SENT 19:58:39 UTC from offer@winwinhomes.com IF: 174.164.204.127 Uo 08 1 21 /2026 Viewed by Heidi Saucier(heidi@winwinhomes.com) VIEWED 19:59:06 UTC IP: 174.164.204.127 08 /21 !2026 Signed by Heidi Saucier (heidi@winwinhomes.com) SIGNED 19:59:32 UTC IP: 174.164.204.127 G 08 1 21 1 2026 The document has been completed. 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