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Home My WebLink AboutWEL2023-00004 - WEL Application, Design, Letter - 2/21/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269, EXT 400 ,��-�� a41 FAX:360-427-7787 C Estrada Inc 11659 SE Black Rd OLALLA, WA 98359 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00004 101 NE MAPLE WOOD CT 123297590072 The 2-party water system, Sandhill, has been reviewed and is hereby APPROVED for 2 connections. Please continue to follow best management practices with maintaining your water system including regular water analysis, landscaping, keeping wellhead area free of contaminants, and stormwater management around the water source. If you have any questions, please contact me at 360.427.9670 x581 or email at rhompson@masoncountywa.gov Sincerely, Rhonda Thompson Environmental Health Specialist Mason County Environmental Health ;1\�•((.lt\ �� Irrift7° � MASON COUNTY Date Received: _:. j' COMMUNITY SERVICES Amoun 4 Receiv �2, �,�/ Building,Planning,Environmental Health,Community Health 415 N.6ih Street,(Bldg 8)—Shelton,WA 98584 W E L 10113, 0 D'Ot Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT NC- ((ce J ES Q- J PH 3_ 3 �./ -8c25- MAILING Eo ` ADDRESS-STREET,CITY,STATE,ZIP i t G 5`\ S d\o.�- ),� , O1a\\c. w p Z35� SITEADDRESS-STREET,CITY, f\c\`T'�(�\1�\_Li ^2. CT ``- Q 5 28 PRIMARY PARCEL NUMBER(WELL SEE) W r l23ZG 9 Sq'Of 2- SECONDARY PARCEL N R(IF APPL� ` WATER SOURCE G 1 12:3SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE 0 New IN Existing.* gl Well 0 Spring I 2 Az... ` 3I PROPOSED WATER SYSTEM` ME(REQUIRED) 'S XV �n\� PROJECT DESCRIPT ON DIRECTIONS TO SITE/ NDITIONS • NVO� :' NwC'13°° NQXjL— C. "t nz �a‘i h N 2 - Z3h'� L 1\0 \ )c. , �\ , )-. Lc - oh i `*k' . Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius, driveways,roads,septic/sewer components and lines,easements,etc...) FEB 21 2023 L) ' By iY/ Submittals Checklist: (these additional items will be required for approval) Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) r5k Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) .& Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) Septic Records (additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021 Page 1 of 2 ----------------- Staff Use Only Review Step 1: Well Site Inspection: YES NO NA ❑ A ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) ❑ g ❑ Are there roads within the 100 foot radius of the water source? If so, is road private, County or State. What is distance to ROW? X ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) 0 —1g ❑ Is the well cap satisfactory? f1ep41'�( c'n 7/2 zt, z p -Ems ❑ Screened and vented?- II ❑ The well casing extends ,. v above level ground/concrete slab? (circle one) ❑ ❑ [53 Is there evidence of a surface seal? .f ❑ ❑ Does the seal appear adequate? ❑ 12 ❑ Is a variance necessary for well site approval? Comments Loth- : "7 i y S I (a 19 '1 i)rya -- 1Z2 - F)y I -f cI Pass ❑ Fail Inspector0- Date 7 y Cb ?e Z Review Step 2: Two-Party Review: �T NO NA �i �{ ❑ ❑ Water Well Report with adequate pump test on file? If NO, date of Capacity Test Driller GPM ,-[ ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 2 I I 17— ( ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN 2Vb 2 LO 12_ ❑ ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments APPROVED ❑ Approved ❑ Denied Reviewer,2FEs-2 11 2023 Date 2 L( F G!) 26' 23 n��NNTY EN RONMENTA ALTN Findings in this review reflect obsen �lfttilzs as existed on the day of the site inspection. No claim is made, express or implied of the future success or failure of this system. Well site approval does not constitute water system approval. Water System approval is a two-part process. All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19rh, 2018 per ESSB 6091. This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021 Page 2 of 2 r •_.13111 2o2Z- 0ia,--i .' M ?io+ FIG APPROVED (N. r �, K i c i .V(f(___ � � 4 2023 �QYce(# i2329-75- 9007! Ma t V OOd G± p Roolf •. tNVIRONMENTAL EALTF' ..E.11.5 P i ' DJA SCOt-e `�— � $o +ASoN tout E000a i, � 0 2 0 yo ��{G i t LQ4 i• ( / \le Loam() SGha ( [ : CLI) 3`xp: rr Imaru 56 • \ . :TWe 0 C fPSt/f\1-e 442. ahaN� I `r ; / Key; OAudio Visual Alarm °e. .. 0 Cleanout _i- 3$R O1200 Gallon Septic Tank 2-Compartment with \ .- -i Effluent Filter .---k•-- .. \ .i2:-- 1 0, 1000 Gallon Pump Chamber �J OValve Control Box • O • ‘11:S5' 4 1.. .:,..-:.:J ..;1'..:i.: .'lay J I. I. rriT. ` C� y. 5 03<3 .r/.� Y'C PAULA JOY JOHNSON tsyl Igo, - -'T LiCtc1St0 U lait#• i � s; � — �1 L. Maple vJ 3o d L.-r i ( I 30 ef..sap -k 1 1 Ql) 3 '6 .eir Thurston County Environmental Health --d i�. 2000 Lakeridge Dr.SW ♦Olympia,WA 98502 ►-_15 . • 360 867-2631 THURSTON COUNTY "' COLIFORM BACTERIA ANALYSIS Date Sample Collected 1 Time Sample County t 3 ' /�� Collected ❑ Month Day Year 1 Z "pm � Y) Type of Water System(check only one box) ❑ Private Househo a CI Group A 0 Group B El Other\eH pW € S Group A and Group B Systems-Provide from Water Facilities Inventory(WFI): ID# System Name: 4 Contact Person:C ckyd, Day Phone:( ) Cell Phone:pg))3)0ZYTj E-mai{ .5 k 1J G EvePhone:( ) , Send resul to: Pnn full na address and zip r emai ddress) oaf c�M�.. --1:2.,1uc ek 1��1 s' 131 �, SAMPLE INFORMATION Samp ollec b na ): v Specific location or address where sample collected: Special instructions or comments: e L)k +c L uJ P1.t.-• \)C 1 Type of Sample(must check only one box of#1 through#4 listed below) 1.($Routine Distribution Sample 2.Repeat Sample(after unsaL routine) Chlorinated:Yes No 0 Distribution System Chlorine Residual:Total Free Chlorinated:Yes No APPROVED • 3.Raw Water Source Sample Chlorine Residual:Total Free ❑E.coli-GWR(A/P) FEB 2 4 2023 ❑Fecal-Surface,GWI,springs(numeratoet Unsatisfactory routine lab number: Filtered:Yes No - _ MASON COUNTY ENVIRONMENTAL HEALTH ❑Assessment Monitoring(A/P) Unsatisfactory routine collect date: DJA ['Other _t 4.0 Sample Collected for Information Only Investigative Construction/Repairs Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and atisfactory El E.coli present 0 E.coli absent �o`oliform detected Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑ Bacterial Density Results:Total Coliform /100m1. E.coli_ /100m1. Fecal Coliform /100m1 Enterococci /100 ml. i Method Code: SM 9223E ❑SM 9222D Date and Time Received:cs).g0 SM 9215E 0 Enterolert® a-)-a3 la Date and Time Analyzed: ,1—'•-o 3 Date Reporte -Z-Z'1 ap-- Sample Number(DOH number plus five digits) Lab Use Only: `�-} —0 8 0 cl 1 `/'�'�' DOH Form#331.319(revised 01116) son Card No. W 38685 FilDe rtmntendootCopywith WATER WELL REPORT UNIQUE WELL I.D.a ABF 884 Department of Ecology Second Copy—Owner's Copy STATE OF WASHI NGTON Third Copy—DrilMrs Copy Water Right Permit No. ) (1) OWNER: mar. Walt Allison _ mbees Maple Ct Lane Belfair WA 98528 L I (2) LOCATION OF WELL: Cowry Mason NW Ira SW va Sec 29 r. 23 N,A 1W wM. (2a) STREET ADDRESSOF WELL(or nearest ear se) _Maple Ct Lane Belfair_WA 98528 i (3) PROPOSED USE: A Domestic Industrial C Municipal C (10) WELL LOG Or ABANDONMENT PROCEDURE DESCRIPTION irrigation Test Welf ❑ Other LJ Formation. Describe by cola,character.size of material and Nrudure,and show thickness of aquMMs I ._1 DeWater and the fund and nature of the material in each syrslum penetrated,with at lam one entry for each gs f (4) TYPE OF WORK: (if rneere tlnuan�of wen den d hbnnMbn - ( 12 MATERIAL FROM TO Abandoned I : New well KJ Method: Dug❑ Bored G Deepened ❑ CableX] Driven(1 Reconditioned I_ Rotary n Jetted❑ Top soil 0 2 i (5) DIMENSIONS: Diameter of well 6 inches. Drilled 79 feet. Depth of completed woe 79 ._ft. Brown clay. 2 40 • j (6) CONSTRUCTION DETAILS: Blue clay 40 74 Casing Installed: 6 Diem.from 0 ft.a 74 ft. ▪ Welded I • Diem.from ft.to ft• //t+ 79 II Liner installed❑ Sand with water _- , Threaded n • Darn from h.to - -_h. i • Perforations: Yes No L9 Type of perforator used ' : SIZE of perforations in.by a'. — $ perforations from _.. h.to ft. fperforations from ft.to h- It.b ft. $ perforations from ♦ - ) Screens: Yes N No❑ — ▪ Manufacturer's Name Hpuston - ' Type stainless wire wrap Model No. - ▪ Diem. . 5'.'slot size 25 from 74 ft.to79 ft.• • Dram. Slot size _ ft.to__ tt' $ Appiit, ▪ Gravel peeked: Yee❑ No Size of gravel• r = Gravel placed from -- ft.to - ft. ftP El• No CI To what depth? 18 _ ft. M�S�NrO ?y J� SurfaCf Baal: Yes _ Materiel used In seal _ Setonite UN/Val// • Did any strata contain unusable water? Yes ❑ No fic I Type of water? Depth of strata —. AM 1'4 r,�- � i Method of sealing strata Off 1 f (7) PUMP: Menutacturets Name A.Y A.Y. McDonald F "' Type: St Ih. _H.P. 374 I; ) (8) WATER LEVELS: Land'sur4ce elavanon rt. abwe mean sea level - _- ' stalk level 26 . ft.below top of wee Date _ ) Artesian pressure _. ibs per square inch Data Mrnlan water is controlled by (CsO.veTvri.Nc— - _ j work Started 12/16/93,le Compared ,19 (9) WELL TESTS: Drawdown Is amount water lave!is lowered below static level Wes a pump test made?Yes NI No❑ II yes,by whom? 2062 WELL CONSTRUCTOR CERTIFICATION: • Yield: —30! gel./min.with__ 24 h.drawdown atter 1 hrs. I constructed and/or accept responsibility for construction of this well. and its i compliance with all Washington well construction standards. Materials used and » 30 24 2 the information reported above are true to my best knowledge and belief. L „ 30 » 4 Davis Drilling I Recovery dela(tine talren es zero when pump turned on(water lewd measured from well NAME rPERson.F1AM Oft C ORArIOHI (tvpE OR PRINT fop to water level)I Time Water Level Time Water yevel Time Water Level Q_ 50 3 min,, 29 _ 10 min_ 26' Address Belfair WA 98528 — • 1 mine 35'— 4 min. 28' (Signed) Cl2.r<ak .jam' _ License No. 2062 2 min, 30 5 min. 27' / iwruo LER) Dated test Contractor's Bailer tesi gd./rnin.with ft drawdown oar_ hrs. Registration Airtest gal./min.with steer set at _ft.tar ---hre- No. DAVT SDT 1100A _ Date Dom. .19 93 Artesian flow g.p.m. Date (USE ADDITIONAL SHEETS 1F NECESSARY) m Teperature of water_ Was a ciremk �1al analysts made? Yee 0 No tJ l 2182812 Mason County WA 06/08/2022 03:50:22 PM AGREE eRecorded #175886 RecFee: $211.50 Pages: 9 LAND TITLE CO Name and Mailing Address Rodney and Tracy Harker 101 NE Maple Wood Court Belfair WA 98528 9 Document Title(s): Q212918I.TC WELL OPERATION & MAINTENANCE AGREEMENT Reference Auditor's File Number(s): Grantor(s): RODNEY C HARKER AND TRACY L. HARKER Grantee(s): RICHARD D. BUCKNER AND CRISTAL M. BUCKNER Abbreviated Legal Description: SW 29-23-1 W (LOT B AND C SP 1748) ,q Pp Assessor's Tax Parcel Number(s): I? 12329-75-90072 and 12329-75-90071 MASONCOUNry FFB 2 4 2013 0JA":EATA(HE gC t1 211 WELL OPERATION&MAINTENANCE AGREEMENT Grantors: RODNEY C HARKER AND TRACY L HARKER Grantees: RICHARD D BUCKNER AND CRISTAL M BUCKNER Description of Real Property Affected: Parcel Which Contains Well(See Attached Exhibit A)- Assessors Tax Parcel Number: 123297590072 Parcel to be Shared(See Attached Exhibit B)- Assessors Tax Parcel Number: 123297590071. The purpose of this agreement is meant to assure specific water rights and maintenance responsibility for the current and future owners involving two party well to share. WELL MAINTENANCE(EQUIPMENT AND WELL HOUSE) A. The cost of major changes in equipment,the repair and maintenance of in-place equipment,and any costs for water testing needed or recommended by county standards will be shared equally by both parties. B. Storage equipment(tank,lines,etc.)will be the responsibility of both owners. C. The maintenance of the water lines outside of the well head serving the respective parties will be the responsibility of the landowners they serve. D. Electricity used for water pumping and protection of the well head from freezing will be paid equally by both using parties. E. Protection from freezing,minor leaks,inspections,and the maintenance of the well head(clean,insect free, etc.)will be taken care of by the users. F. In the event of a repair when the grantor is not home,the grantee shall have the right to access grantors property to make such repairs. The overall purpose of this agreement is to ensure a safe and adequate water supply for both parties;to maintain the system in accordance with county health standards;to provide an equitable basis for sharing the water from the well and costs of operating the well based upon usage. This agreement shall run with the land and be binding upon the heirs, successors,and assigns of the parties herein. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE WATER WELL OPERATION AND MAINTENANCE AGREEMENT. RODNEY C HARKER DATE TRACY L HARKER DATE RICHARD D BUCKNER . DATE • /- CRISTAL h4 8 DATE 2182812 Page 2 of 9 06/08/2022 03:50:22 PM Mason County, WA WELL OPERATION&MAINTENANCE AGREEMENT Grantors: RODNEY C HARKER AND TRACY L HARKER Grantees: RICHARD D BUCKNER AND CRISTAL M BUCKNER Description of Real Property Affected: Parcel Which Contains Well(See Attached Exhibit A)- Assessors Tax Parcel Number: 123297590072 Parcel to be Shared(See Attached Exhibit 0)- Assessors Tax Parcel Number: 123297590071 The purpose of this agreement Is meant to assure specific water rights and maintenance responsibility for the current and future owners involving two party well to share. WELL MAINTENANCE(EQUIPMENT AND WELL HOUSE) A. The cost of major changes in equipment,the repair and maintenance of in-place equipment,and any costs for water testing needed or recommended by county standards will be shared equally by both parties. B. Storage equipment(tank,lines,etc.)will be the responsibility of both owners. C. The maintenance of the water lines outside of the well head serving the respective parties will be the responsibility of the landowners they serve. D. Electricity used for water pumping and protection of the well head from freezing will be paid equally by both using parties. E. Protection from freezing,minor leaks,inspections,and the maintenance of the well head(clean,insect free, etc.)will be taken care of by the users. F. In the event of a repair when the grantor is not home,the grantee shall have the right to access grantors property to make such repairs. The overall purpose of this agreement is to ensure a safe and adequate water supply for both parties;to maintain the system in accordance with county health standards;to provide an equitable basis for sharing the water from the well and costs of operating the well based upon usage. This agreement shall run with the land and be binding upon the heirs, successors,and assigns of the parties herein. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAI FALSE INFOR TION WILL NEGATE D INVALIDATE THE WATER WELL OPERATION AND MAINTENANCE AGREEMENT. r A, 7,‘ __,..„„,. ..._. ,, i ' 6= 1. RODNEY C HARKEk DATE TRACY L HARKER DATE /702,..,... €,-,-..A . RICHARD D BUCKNER DATE 1/- 4. /-,,, ,Q CRISTAL B N ` DATE 2182812 Page 3 of 9 06/08/2022 03:50:22 PM Mason County, WA WELL OPERATION&MAINTENANCE AGREEMENT Grantors: RODNEY C HARKER AND TRACY L HARKER Grantees: RICHARD D BUCKNER AND CRISTAL M BUCKNER Description of Real Property Affected: Parcel Which Contains Well(See Attached Exhibit A)- Assessors Tax Parcel Number: 123297590072 Parcel to be Shared(See Attached Exhibit B)- Assessors Tax Parcel Number: 123297590071 The purpose of this agreement is meant to assure specific water rights and maintenance responsibility for the current and future owners involving two party well to share. WELL MAINTENANCE(EQUIPMENT AND WELL HOUSE) A. The cost of major changes in equipment,the repair and maintenance of in-place equipment,and any costs for water testing needed or recommended by county standards will be shared equally by both parties. B. Storage equipment(tank,lines,etc.)will be the responsibility of both owners. C. The maintenance of the water lines outside of the well head serving the respective parties will be the responsibility of the landowners they serve. D. Electricity used for water pumping and protection of the well head from freezing will be paid equally by both using parties. E. Protection from freezing,minor leaks,inspections,and the maintenance of the well head(clean,insect free, etc.)will be taken care of by the users. F. In the event of a repair when the grantor is not home,the grantee shall have the right to access grantors property to make such repairs. The overall purpose of this agreement is to ensure a safe and adequate water supply for both parties;to maintain the system in accordance with county health standards;to provide an equitable basis for sharing the water from the well and costs of operating the well based upon usage. This agreement shall run with the land and be binding upon the heirs, successors,and assigns of the parties herein. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE WATER WELL OPERATION AND MAINTENANCE AGREEMENT. RODNEY C HARKER DATE `� ( ,Cti n-,L,L q7/2-2_ V DATE L HARKER DATE ,,-,":;;' 2/:,,,,,,,,-/>e ., , RICHARD D BUCKNER . DATE , , - 6= /-cif . cQ CRISTAL Mr8lk(N !—r� DATE 2182812 Page 4 of 9 06/08/2022 03:50:22 PM Mason County, WA NOTARY ATTACHMENT TO WELL OPERATION&MAINTENANCE AGREEMENT STATE OF COUNTY OF p : I cey that I know or have satisfactory evidence that �i�. (' Serf iu�. s ,the person(s)who appeared ore me, and id eler i�(s)acknowledged tha g/she/they signed this instrument and acknowledged it to be 7herttheir free and voluntary act for the uses and purposes mentioned in this instrument. Given under my hand and official seal the day and year last above written. Sig am' r� GAYLE G.ASTORE .9-z5%i)/c C ,�'�+of A4T6•. ; NOTARY PUBLIC for the Print Name r State of MOrttdna SEAL Reseing at Helena,Montero Notary Public in s d for the State of My Commission Expires Residing at (>��.�e-s�-�� °F February 15,2025 My Commission Expires/1o7/lS j.:1Qr1?a STATE OF COUNTY Or On , I certify that I know or have satisfactory evidence that ,the person(s)who appeared before me,and said person(s)acknowledged that he/she/they signed this Instrument and acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned In this instrument. Given under my hand and official seal the day and year last above written. Sign Name Print Name Notary Public in and for the State of Residing at My Commission Expires 2182812 Page 5 of 9 06/08/2022 03:50:22 PM Mason County, WA NOTARY ATTACHMENT TO WELL OPERATION &MAINTENANCE AGREEMENT STATE OF k!r't COUNTY OF 1GlSUN''` On Lt i \22 , I certify that I know or have satisfactory evidence that 4y1._ 1PtLi ( _ `t-(c&,y t%t/1/ ,the person(s)who appeared before me, and said person(s)acknowledged that he/she/they signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned in this instrument. Given and r hand and officia al the day and year last above written. r Sign Name r'n1 k C-)ne lst YYr x Print Name MICHELE MANU Notary Public i and for the State of(/ - NOTARY PUBLIC Residing at My Commission Expires VL L{(Z MATE OF WASHINGTON COMMISSION NUMBER 29601 COMMISSION EXPIRES DEC.4.2024 A STATE OF COUNTY OF On , I certify that I know or have satisfactory evidence that , the person(s)who appeared before me, and said person(s)acknowledged that he/she/they signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned in this instrument. Given under my hand and official seal the day and year last above written. Sign Name Print Name Notary Public in and for the State of Residing at My Commission Expires 2182812 Page 6 of 9 06/08/2022 03:50:22 PM Mason County, WA STATE OF WASHINGTON } p , }ss. COUNTY OF I"( aLre- } On 6// /Z-0 ZZ. before me, Leal M. Po A-144;Nv4y4a6GLC� personally appeared 12 toh A?J D Buclin i 4 C1i 1J tit Bcu?ic , personally known to me (or proved to me on the basis of satisfactory evidence)to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)acted,executed the instrument. WITNESS my hand and official seal. `��miiili+uio/ \\" N M..P O ('/., CC . %s s iOn 9 'i • v�o▪ �NOTggy+moo T' �. PUBLIC - Signature ., o . • Printed Name L.e#L- m . A 'coal-0— �„oi.,,mbec,`._O•�O? /��',��WAS'k\NG\\\\ Commission Expires II isf)(1/20 24 NOT.'RY SE:4 THIS CERTIFICATE MUST BE ATTACHED TO Title of Document TypetalkSee- o�n'J,kf i,s Nti..O•�✓etiria✓+ THE DOCUMENT DESCRIBED AT RIGHT. Number of Pages�__J D to of Document(p j i ,201 - Signer(s)Other Than Named Above 2182812 Page 7 of 9 06/08/2022 03:50:22 PM Mason County, WA isimmomminmeemmimmor EXHIBIT "A" Parcel 1 Lot C of Short Plat No. 1748, recorded January 11, 1988, under Auditor's File No. 476303, being a portion of the Southwest quarter of Section 29, Township 23 North, Range 1 West, W.M., in Mason County, Washington. Parcel 2 An easement for ingress, egress and utilities as described and delineated in Short Plat No. 1748, recorded January 11, 1988, under Auditor's File No. 476303. I 2182812 Page 8 of 9 06/08/2022 03:50:22 PM Mason County, WA EXHIBIT "B" Parcel 1 Lot B of Short Plat No. 1748, recorded January 11, 1988, under Auditor's File No. 476303, being a portion of the Southwest quarter of Section 29, Township 23 North, Range 1 West, W.M., in Mason County, Washington. Parcel 2 An easement for ingress, egress and utilities as described and delineated in Short Plat No. 1748, recorded January 11, 1988, under Auditor's File No. 476303. 2182812 Page 9 of 9 06/08/2022 03:50:22 PM Mason County, WA Davis Drilling 340 NE Davis Farm Rd Belfair, Washington 98528 United States • (360)275-5367 p aid C Estrada I Inc Invoice Number 0000104 151 Maplewood Court Date of Issue 02/23/2023 151 Maplewood Court Belfair US Due Date 03/25/2023 Amount Due (USD) $0.00 Description Rate Qty Line Total Properly seal well from contamination $200.00 1 $200.00 +Mason Vented well cap with rubber gasket $150.00 1 $150.00 +Mason Subtotal 350.00 Mason (8.5%) 29.75 Total 379.75 Amount Paid 379.75 Amount Due (USD) $0.00