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Home My WebLink AboutWAI2026-00081 - WAI Health Waiver - 10/7/2026 415 N.6'"STREET,SHELTON WA 98584 MASON COUNTY SHELT°" 36°_42'967°..x`400 fiELFAIR: 360-275-4467, ext.400 } Public Health & Human Services Application for Waiver or Appeal �� Amount Paid: O�5 Receipt Number: rat— �_ WAI cAb --�iat t 3ZZ7 Please note,all approved Onsite 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 Melvin Enger Telephone 360-280-0874 Mailing Address c/o Jef Conklin - P.O. Box 729 City Shelton (JEF@HCTC.COM) State WA Zip 98584 Parcel No. 2 2 1 2 9 . 2 4 . 5 0 0 2 0 Site Address 8391E State Route 3 - Shelton, WA 98584 Subdivision Name and Lot Lot 2 of LLS #06-06 PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements ❑ Onsite: Class B Waiver ❑ Group 6 Water System Regulations D 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 ❑ Appeal:Departmental Determinations ❑ Onsite: Contractor Certification tZ Other Requirements Description of Waiver/Appeal (include justification, additional material may be attached.)-. 2 Party well waiver of restriction of the proximity to old landfill -over 700 feet away See WEL 2026-00026 Applicant Signature: tQ &Yt Date: 10.7.2026 Revised 03/03!2026 This form may be scanned and available for public view on the Mason County Web site. Page ! or2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal .Waiver ❑ Class A O Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedrooms_ Nitrogen Treatrner4jQuI ❑ No Soil Type: Minimum Lot sq.ft. Wa urce.❑Public ❑Private This LotSii& sq.ft. Is This Lot Eligible for State Waivers. ❑Yes ❑ No N/A Hearing Official. ❑ Environmental Health Manager Public Health Director Other: 2. Identification of Specific Code/ Sand rdl Determf nation includ date of determ}nation or latest Code/ Standard revision): Z r 3r7'c rt f/ r4 3. Nature of Appeal. IJUa rtl 1, /° / 4 / h// 5 Mitigating Factors. Ser- ,Aft 4 I / Jc. 6. I have received this waiver/appeal renest. It is complete and mitigation required by the state and local policy has been submi 2�l Staff Signature:_______________________________________ Date:______________ PART 4: Determination o 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: Date: Health Official Signatur % Revised 03103/2026 This form may be scanned and available for public view on the Mason County Web site, Pap`.,of 2 Engineering•Management•Planning • P.O.Box 123•Port Orchard,WA 98366.888-881-0938.360.876-0958 October 7, 2026 Ian Tracy Environmental Health Manager Mason County Health Department 415 N 6'" Street Shelton, WA 98584 Re: 2-Party Well Application, File#2026-00026 Dear Mr. Tracy, In 2022 Northwest Water Systems completed a waiver request for a proposed Group B Well (ID'XLA503) associated with TPNs 22129-24-50020 and 22129-24-50030. This well was drilled within 1000 feet of a landfill. The landfill was for the disposal of woody debris. The waiver successfully demonstrated and documented that the landfill would uved cause no potential threat to public health and was app by the ty Health Department. The Group B Water System never materialized. The property owners now want to establish the well as a 2-Party Private Water Supply under MCI-ID file#2026-00026. Site conditions have not changed. In addition,the landfill was and is still abandoned; and there are no known new or additional significant potential sources of contamination or threats to the health and safety of the aquifer. 1� Therefore, variance ully well-protected otected and is adequate for supplying still saf applies to andreabledriniwhich ki t rr ng wa to a2- is party private water supply. Please let us know if you have any additional questions or need more information. Sincerely, NORTHWEST WATER SYSTE Qp of wns Gyn�'O N/ C ri/r/,` 111 p 319 0• y Todd Krause, PE w7oNAL o President ,/ ,off Cc: Projects\220801\Sunset Ridge 2 Party Variance Letter 10.7.26