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HomeMy WebLinkAboutWAI2026-00039-APPLICATION FOR WAIVER/APPEAL - WAI Health Waiver - 2/10/2026 415 N.6t°STREET,SHELTON WA 98584 MASON COUNTY RLFAIR'360275446,ext.400 Public Health & Human Services pg7� 'at� Application for Waiver or Appeal i Amount Paid. Receipt Number:7.fA l�f7� Vl? g I WAI 2oz-b - __ 1 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 hilted far waivers and appeals, based on the Environmental Health Fee Schedue. 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 300 E Sherwood Hills South, Allyn, WA 98524 Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Onsite. Class A Waiver ❑ Food Sanitation Requirements ❑ Onsite: Class B Waiver ❑ Group B Water System Regulations 0 Onsite: Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location,WAC246-272A-0210 ❑ Building Permit. EH Review Policies ❑ Onsite. Holding Tank,WAC246-272A- ❑ Appeal: Enforcement Timelines 0240 ❑ Appear Departmental Determinations ❑ 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. Applicant Signature: 0� '/en,lca Date: 05 / 12 / 2026 RcdseJ 0110320?fi This form may be scanned and available for public view on the Mason County Web site. Page lof2 Doc ID: efb55cO28498729a26c62d23f1 e87a64a7d036bf PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver (if applicable) ❑Appeal I�TWaiver ❑ Class A ❑Class B Class C ❑ Local T State lWaiver Criteria Number of Bedrooms: flk Ltab`C.XI') Nitrogen Treatment: 4 Yes No Soil Type: Minimum Lot Size: t LOO sq.R Water Source:❑Public Private This Lot Size: 3. 01 cr/f'V2cn' sq.ft. P^Ypsu{ Iol5 Is This Lot Eligible for State Waivers: Yes ❑ No ❑ N/A `ZI Z,L(9 otcrL5 Hearing Official: T.c�_ ' l Environmental Health Manager ❑ Public Health Director ❑ Other. 2. Identification of Specific Code/Standard/ Deter nation (include date of determinat(on or la est Code/ Standard revision): h �// 1.10`Zf} O 3ZO LI7 ) c 1 1 3. Nature of Appeal'. tO ftfrE ,P.yU)-2 f h'R RV ()\ 4\W* F V Wt-t(pnc11zni '2t -e cvt'ar,-'ra on+l r.e3 l)2 r ( o-E. 5. Mitigating Factors: , - o1 a-c I ''If __4e /I ,IL / 0 -cryltnf- wr z o*R -SoJ1Vt v "A' 04r tit,) 'MVa17 ' —ts 0rC . 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: I PART 4: Determination of the Hearing Official paThe 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: 12ccicad 03/032UM This form may be scanned and available for public view on the Mason County Web site. Page 2 orz Doc ID'. efb55c028498729a26c62d23fle87a64a7d036bf On-Site Sewage Systems (Chapter 246-272A WAC) ; H E A LT H Request for Waiver from State Regulations , Section 1. (Completed by applicant) Name: (1) Local Health Jurisdiction Received (2) Brad Henson (see instructions) ... _. Address: 1829 29th Ave Seattle WA 98122 Telephone: 2489301988 Signature: tiQ . / i1/e/� .��/�. Property Identification: (3) /7)j c Parcel: 122307500160 Address: 300 E Sherwood Hills South, Allyn, WA 98524 Section II I (Completed by applicant) A WAC Number: (4) WAC Requirement: (5) Waiver Sought (6) 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. I (Completed by local health officer) Additional Mitigation Measures: (9) Review Criteria: (8) -. -- - --- Comments/Conditions:(10) Type of Waiver: (11) Class A Class B Class C— Request DOH review before granting? Yes❑ No Neighbor Notification.(12) Required?Yes❑No❑ If needed, are agreements, easements,etc.filed? Yes ❑ Nofl Section IV. (Completed by health officer) This Request for Waiver from State Regulations has been reviewed according to the provisions of Chapter 246-2724 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. ❑Denied LXJ Approved/Granted—Subject to comments,conditions and requirements totted i ac ions ll and Ill. Its Date: 8 J Local Health Officer(13) DOH 337-175 February 2024 Doc ID:efb55cO28498729a26c62d23fle87a64a7dO36bf DECLARATION OF HEIDI LLOYD Record of A tiempls 10 Obtain a Corrected Well Coven"an N(ason County Short Plat Na SPL2025-00003 I. Heidi Saucier,declare as follows: 1. 1 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 sated herein are within my personal knowledge and are true and correct. 2. d in h Plat Ihis SPL2025 concerns the 00003. A Well Covend ant ant executed a'ndrnoar¢ed on connection IR. 2026Mason 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 obain Mr. Woolley's corrected and notarized signature were rad Henson of Lombard veIoPcrs was a pay at conbct and was kept inf xmedtof ed p throughout imarily by B and the events described in the following paragraphs t o h are within m}' knowledge on that basis. 4. On June 20, 22026, 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 cmailed 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 noary signing on July 7,2026.On July 7, 2026,he did not respond to calls or texts regarding the scheduled signing. 8 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 tested Mr. Woolley at(251)222-2179 and proposed sending$100 via Venmo at that time and an additional$100 once the signing was completed through Proof.eom that evening,and asked him to confirm the arrangement and his Venmo handle. 1p 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 tested Mr. Woolley: "First half sent. Please let me know once you and Shari have signed and 1 can send the other half." I did not observe Mr. Woolley's 5'.16 PM reply before sending this message. 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 Pmof.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, ! 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 count' rather than by re-execution,stated that he had not accepted or claimed the$100 Venom payment and would d return it. expressed dissatisfaction dvise 1 that Vewith nmo the frequnot pen i contact, e to eclaim thetfu contact that him he further. I apologized, t would need to return them to the originating account, and stated that I world coNact Mason County regarding available options. I5. Following that call, and on the same day, Mr. Woolley telephoned again and asked to speak with me. lie 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 2l 2026. 16. On August2l,2026,1 called Mr.Woolley at 9'110 AM,as he had requested.That all 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 1 declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Renton ,Washington. 21st day of August ,2026, at_ Dated this Y Heidi Saucier Win Win Homes LLC EXHIBIT A Chronology of Correction Allempty — Well Covenant Short Plat SPL2025-0013lleidi Lloyd.Contact tlrcmgh.ltdy Id coin icicd hr Brad llenson/Lmvhard Developers): dbvm outreach from + 0 0 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. .tune 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 emails. ----- July 6,2026 Agreed by telephone b,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 he had been busy;signing rescheduled to July 14. July 14 2026 Mr.Woolley missed the signing and did not respond to calls or texts. 22=178) Aug. 111,2026—5:117 PM Heidi and$100 afterdthersi oollewas2completed via Proof proposing IQO via nmo aucier that evening: requested f t f tt arrangement and Vennie 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 Veneto 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 halt" Aug. 13,2026-3;11 PM Maucier yeeo signed texied noting the SI attempted;asked 00 was tocall.ent80btdte Proof request had not 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— I I:4S AM Ms. Saucier texted asking for a good time to call. Aug.20,2026-3:03 PM unanswered call to Mr. Woolley. Telephone call with Mr.Woolley(transcript retained).Mc Woolley declined to Aug. 20,2026—3:14 I'M Tel.p proceed with the incentive arrangement,stated he had not accepted or claimed the $1110 payment and would return it,expressed dissatisfaction with the frequency of contact,and requested no further contact.in to speak with .Saucier.Aug.20,2026—after 3:14 Mr. zed forlley e his manner during the earlier call,stated he s would speak with his PM call wife regarding signing the document,and requested a callback at 9:00 AM on August21, pug 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. Audit trail $ DropboxSign well Covenant timeline declaration Title Well_Covenant_limel ine.p File name ea53a1c7f9b0aa49afc9e76c8a3feb59e5fa6a57 Document ID MM/DO I YYYY Audit trail date format Signed Status Document History 08/21 / 2026 Sent for signature to Heidi Saucier (heidi@winwinhomes com) SENT 19:58:39 UTC from offer@winwinhomes.Gem IP: 174.164.204127 08121 ! 2026 Viewed by Heidi Saucier (heidi@winwinhomes.com) VIEWED 19:59:06 UTC IF: 174.164.204.127 08 /21 /2026 Signed by Heidi Saucier(heidi@winwinhomes.com) -� 19:59:32 UTC IP: 174.164.204.127 SIGNED 08/21 /2026 The document has been completed. 19:59:32 UTC COMPLETED Powered by It DmpbOx Sign \ ' x 3' 9Ug \ \ \ \/ \ / § 7 \ \ } y _, 955•_ 3,5', t � � \ alter> Q 22 & - } i } / \ \ ( \ < ) ) \ I I a :- W ~ : p , n — �\ 9 a ® K m �®- « --. . \' \ \\ \ \ \\ \ /\ - - -- - ». ` \ \ } : - © ` © - : \ ` : . . > z » \ : 2 4{ , y E \ \ �\ \ } CD -0 C -. 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