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Home My WebLink AboutWEL2023-00039 - WEL Application, Design, Letter - 7/19/2023 MASON COUNTY 415 N 6TH STREET, SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 BELFAIR:360-275-4467,EXT 400 ^f� Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX: 360-427-7787 EMPIRE HOME CONSTRUCTION LLC P 0 BOX 241 KELSO, WA 98626 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2023-00039 605 E Inspiration Way 120303190083 The 2-party water system, Nighthawk Water System (120303190083/120303190084), 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 Ext.353 or email at danderson@masoncountywa.gov Sincerely, David Anderson Environmental Health Specialist Mason County Environmental Health rww• y; a ,,..i4,106 � MASON COUN 9 e Received 1 — ' `� A i II• oyptF i(e!yed _ ` Recei �_ .1 COMMUNITY S VEo �`v �,, a l Building,Planning,Environmental Health,Community Health 415 N.6'h Street,(Bldg 8)—Shelton,WA 98584 W E L '1_6 z.3 - 0 .J 39 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elm:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE t.W1 ;c 2 4.. r.� C. •�"C�c.._:k; �n LLC. 3.0 -7S/ .-$o c Z MAILING ADDRESS-STREET,CITY,STATE,ZIP PG 53.A ')-tit Kr_1sd, kJ-A ` Vc.16 SITE ADDRESS-STREET,CITY,STATE,ZIP , / A p L p be 5 L Tnse;fc io,_ 47 S 4.c.\ -1-o:• i N P1 7J J y PRIMARY PARCEL NUMBER(WELL SITE) 12v3c;- 3I - 9c)c.>g3 SECONDARY PARCEL NUMBER(IF APPLICABLE) 12. 30- 3 1 .- cfc� S Li WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE ' PARCEL 2 LOT SIZE pi'Ncwti ❑Existing V/Well 0 Spring j . 'ZS he 1,-ZS A C. PROPOSED WATER SYSTEM NAME(REQUIRED) PROJECT DESCRIPTION (/ F.e n TS♦A.t .4l ,v IecO o;.s J r. ,C—k414Q/. 2- QCt(V1 La›L-\\ -V ( 6.b-7 E '-T nse,n, 1. : . l,Sn,1 car`A- dos' E nS,P�tw k',oc kt"-- 0,--( . DIRECTIONS TO SITE/CONDITIONS p ` ` f-lu,st a- 3 s)4v (4d.A. S T� a 1( '-'"r F I- G•-, T, 5 oYc, 41 4, ti,`A/i ice. II 0.....,,, tti.ro-‘y� ioc\Lct=1 ejc.., I-C.., 5, 4-,_ a.. -c-h e- 1E-14- C g. 1 I ct f e\,c...,, i- -c.— y 4,f-e. cc ci e_ 0 4-> c O"v/C t( Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...) C7A- Olean/L.1 p T, M [I d \\ It l `-(74 JUL 17 2023 11 1\ By____----._-._--- S ub ittals Checklist: (these additional items will be required for approval) iSatisfactory Bacteriological sample (this may be deferred if well is not yet drilled) 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 ❑ RI ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) ❑ 1k71 ❑ 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? Al ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) -Eykit ❑ Is the well cap satisfactory? d X 0 ❑ Screened and vented? Pabove�Q kElThe well casing extends 20 level ground I concrete slab? (circle one) �'{(16/ :: ❑ Is there evidence of a surface seal? �'" i►_w,:, 0 Does the seal appear adequate? 1'n ❑ Is a variance''necessary for well site approval? Comments (dfvd"-/A Ofer4 ( /IA" 5aC.PaCc here/ — 51� t ✓� �Ci 11 vV ` ` v Date 0 t v ❑ Pass Fail Inspector 6 / Review Step 2: Two-Party Review: YES NO NA ❑ ❑ Water Well Report with adequate pump testte on file? n (' If NO, date of Capacity Test (�/! J/Ld l�ZDriller Popp O !//l GPM 1l ,4 ❑ El Received Satisfactory Bacteriological Analysis? Date of test J VL$ ZZ !'d ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN u i6as pf ❑ ❑ System appears adequate to serve 2 single-family residences based on irrr 'on provided? Comments PQ5ceeJ � e an ?'/ (GC/z3 ‘..,1,z., /�!`♦'' ` FP ASpNcoto 15?O?3 < Approved 0 Denied Reviewer __g7\ Date 2 ItA Findings in this review reflect observed conditions as they 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 19', 2018 per ESSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 �.- CENTRIC 178ti SE Mile Iiill Drive r`�! : ^...,: ; Port Ochard,WA 98366 �'` t..3 !'�• ' LABORATORIES www.centricanaly tical.com ` w viipriavall �-•M1 ..rc.rKi t. . • (360)443-7845 �1 _ COLIFORM BACTERIA ANALYSIS FORM '". �'`__' 4'` r - Dale Sample Collected Time Semple ( County •-...y-'ti.:"-`. Collected 5-. .,• ,s^..�.r..-✓ ..� Web Day Year �._35 OPM �n'5(/ S ..1. �...:". ..." Type of Water System(check only box) •r t" ,�; .� ❑Group A ❑Group B Other r• Q,f" s 3+•,�~,..%�.. ..3 Group A and Group B Systems-Provide from Water Faciliites Inventory(WFI): _. , ; ,;..,,; .1 �.. • ° V.'s t• ..), ' -....r %. System Name: , U fr.,. I/ ,V°vUl A to =�`` 4 `�'.. Contact Person:1' WG.ne }-nO4.p7 ` .- _:ram, ._S•�' Y4,N._�� Day Phone: 3 Leo-H7 -•'11-I1 Cell Phone: ' �_-- -' " •��'~J'-••-$ Email:�nr;+.p ptLtl ltl l�C C ma 1 t-La.,Eve.Phone: `',-s-•,--.'". `•."---'�•... .. •...'...'i`..,, �'. ce,n a'utts„(Flint to i name address and rip pwe-man • .s s.."'....i`,r,i ',_.!'`...: ,t.."4..= `,..;'•j'-•,.a `%_ 1. �... ,�w ..% _A ', L . o L-e Sate r =-:_^,. - .$--„; =_ _.r-_""".. '''....;-'. -'`�-... •..s•'',..�.. yip y�� } L. Qlj :1 x•.._s.',...s-N...: ,..R .\:,.�' `,.0 N...1�_F_`-,,:: SAMPLE INFORMATION � Sample collected by(name): ---- ' �'' Specific location where sample collected: Spedal instructions or comments: Coliform Distribution System ,: erg 0,06J/ii--P Sampling Procedure Type of Sample(check only one box) Step One Step Four 1.❑ Routine Distribution Sample 2.Repeat Sample(after unsat routine) Avoid poor sample sites such as There may be some liquid or Chlorinated.Yes 0 No❑ ❑ swivel faucets,hot and cold miring powder in the sample bottle to oismbution System faucets(with a single lever);leaky or remove chlorine.Do not rinse it Chlorine Residual:Total Free Unsatisfactory routine lab number spraying faucets,drinking out. 3.Source Ground Water Rule Sample -. _____ fountains,janitorial sinks,frost-free Step Five LS 1 I I I Unsatisfactory routine collect data/ e; hose bibs,and faucets below or near To a oid contamination ti�rhtle ground level. taking the sample,hold the bottle ❑Triggered Chlorinated:Yes U No U Step Two nearthe bottom with onehand and Chlorine Residual.Total Free Remove any attachm eats from the hold the top of the cap with the ❑Assessment faucet,including aerators,screens, other.Now unscrew the cap. 4. EnulriniallonSoucowaterSampie I S I I I washers,hosesandwaterfilters.If 0E.eel 0Fecal-Surface.GNtspiry:Rbred Yec❑ No❑ you choose to disinfect the sample DO NOT setthe cap clown,touch site prior to sample collection,be any part of the cap that touches the s.el sample Co.lected for Information Only C.,fSj'Y 5 0Cid'1 t bottle or let anythingtouch the rim sure to flush thoroughly to remove LAB USE ONLY DRINKING WATER RESULTS $E ONLY all disinfectant of the bottle or inside the cap., CI Unsatisfactory Total Coliform Present and isfactory • I " Step Six ❑E coipresent _ CI E.colabsent •, " ''r' Hold the bottle underthe stream of Replacement Sample Required: httW.� :• water,be careful n ot to let the bottle 0 Sample too old(>30 hours) O TNTC O touch the sample tap.Fill the b ottle — - - to the indicated fill line,do not allow Bacterial Density Results:Total Coliform nooml. E.co6 rlOOmt. '' it to overflow.Remove the bottle from the waterflow and secure the Fecal Coliform_ Sr1100m1. HPC /1 ml. Lab l' V I a T , Step Three gyp' 0I r��'� 4" ° � �z}(c) Turn on the cold water only and Step Seven let it run with as tea dv stream for Complete the lab slip.Note anything Method Code: Date and TimeIrxsbated: at least five minutes.Before �M 9223 B NOV l 1072 unusualaboutthesamplecolleetion. collecting the sample,turn the DateAnayzed: •f�y'V . �O� Dais Reported t n,,� ttaterdown toathin stream and Step Eight �,1 2 let the water run for one minute. Secure the lab slip to the bottle with DOH tabSample# (r \' lab Use onlr ' If they system is chlorinated, rubber band.Deliver the sample to 225 ��if� themeasurementonthelabslip. possible. ( � V measure the free chlorine and note Centric Analytical Labs as soon as cc+,ramp01m18 te.ave. t-e ruuneeelm N�dlenN n rreseeelame.ar 803.525.0177(TE rrTYd8 r11) Pis lee pew oae+drw.R,.abie r.v..sn fat yoedx+iy+Ka. Spectra Labs - Kitsap, LLC (Port Orchard) SPECTRA Laboratories -Kitsap 1786 SE Mile Hill Dr. Where experience matters Port Orchard,WA 98366 Phone: (360)443-7845 JessicaD@spectra-lab.com www.spectra-lab.com Spectra Labs- Kitsap,LLC (Port Orchard)received samples for Knapp Drilling on Monday, November 14,2022 at 2:36 pm. Unless otherwise noted, all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures.A summary of the samples received are outlined below. Sample No. Description Location Sampled 135698-01 Duvall-David Inspection Way 11/14/2022 9:35 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call(360)443-7845 or email us at JessicaD@spectra-lab.com. This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 11/17/2022 Page 1 of 1 17-1115 Ivo( fog lo be replaced by p&onane/!f copy from DoF WATER WELL REPORT t...311 DEPARTMENT OF Notice of Intent No. W =1_7661ig pp//�� ECOLOGY Unique Ecology Well ID Tag No. 0 I V)7 Type of Work: WI State of Washington t1 Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NO1 No. Water Right Permit/Certificate No.�,/ �/ /,�^� - Proposed Use: ❑a Domestic 0 Industrial 0 Municipal Property Owner Name Empire- (N �ce45 7�c I ❑Dewatering ❑Irrigation 0 Test Well 0 Other Well Street Address 60f E -ThStrlifeall Ivor Construction Type: Method: City Shelton County Mason ❑O New well 0 Alteration 0 Driven 0 Jetted 0Cable Tool h' 0 Deepening 0 Other 0 Dug 0 Air- 0 Mud-Rotary Tax Parcel No. 120303190083 Dimensions: Diameter of boring 6 in.,to 235 ft. Was a variance approved for this well? 0 Yes 0 No Depth of completed well 240 ft. If yes,what was the variance for? Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread p I ❑ 6 in. +1 235 1/4 in. ❑ I ❑ 17 I ❑ Location(see instructions on page 2): 0 WWM or E EWM ❑ I ❑ in. _ — in. D I ❑ ❑ 1 ❑ sw '/-'/,of the ne %;Section 30 Township 20n Range 1w ❑ 1 ❑ in. in. ❑ I ❑ DD O ID in. in. ❑ I ❑ ❑ 1 ❑ .Latitude(Example:47.12345) �� i�yT�6iY Longitude(Example:-120.12345) "12-1.853.554 Perforations: 0 Yes A No Type of perforator used Driller's Log/Construction or Decommission Procedure No.of perforations Size of perforations in.by in. Formation:Describe by color,character,size of material and structure,and the kind and Perforated from ft.to ft.below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: ❑a Yes 0 No ❑8 K-Packer b Depth 233 ft. information. Use additional sheets if necessary. Manufacturer's Name alloy Material From To Type stainless Model No. brown sandyloam 0 3 Diameter 5 in. Slot size 12 in.from 235 ft.to 240 ft. Diameter_ in. Slot size_ in.from_ft.to ft. brown till 3 18 brown sand w/occasional gravels 18 178 Sand/Filter pack:0 Yes O No Size of pack material in. fine to med sand brown water bearing 178 240 Materials placed from ft.to ft. Surface Seal: O Yes 0 No To what depth? 19 ft. Material used in seal bentonite chips Did any strata contain unusable water? 0 Yes ❑I No Type of water? Depth of strata Method of sealing strata off Pump: Manufacturer's Name goulds Type: sub H.P. 2 Pump intake depth:225 ft. Designed flow rate: 18 gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing ft.above ground surface Static water level 170 fl.below top of well casing Date Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? A No 0 Yes => by whom? Yield_gpm with_ft.drawdown after hrs. Yield gpm with_ft.drawdown after hrs. Yield gpm with_ft.drawdown after_hrs. Recovery data(time=zero when pump is turned off-water level measured from well • top to water level) Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test 15 gpm with 111 ft.drawdown after 4 hrs } Air test gpm with stem set at ft.for hrs. Date Artesian flow gpm Temperature of water_°F Was a chemical analysis made? 0 Yes I]No Start Date 10-12-2022 Completed Date 11-18-2022 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. ID Driller 0 Trainee 0 PE-Print Name Drilling Company KNAPP DRILLING INC. Signature Punt. t4, 1�Utl�ZQ�' Address 50 east lesasca Dr. License No. 1706 !l/� !�� City,State,Zip Shelton Wa.98584 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.KNAPPBI952B1 Date 11/15/2022 ECY 050-1-20(Rev 08/19)If you need this document in an alternate format,please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341. 2199605 MASON CO WA 07/17/2023 12:03 PM NOTCE EMPIRE *188809 Rec Fee: $204.50 Pages: 2 1110111/III �Ii 11 III 011011 lon I EH�I Ill Return To Er - ss 'TP`iC_�Yor t,LL (i.aX 2- S Grantor(s): (1) Ew.t,;r_ }ao,•.c. Cons tfs":""t)-` (2) Grantee(s): (1) PUBLIC Legal Description (1) t.-I-- 3 e-C si 08(:, , PT(\ s S 2/11-d j (Abbreviated form:i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: (1) Tt, 2 3 G - 3 1 - 9 0 G g 3 NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We) the undersigned grantor(s), certify that the water source located on the above-described real estate under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason County, State of Washington, has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington; herein described: Tax Parcel: (Connection 1) I 2, 6 3 0 - 3 - `( O O Tax Parcel: (Connection 2) 2 a 3 0 3 - 9 O 0 S 4 The system owner is responsible for keeping this system in compliance. The name of the water system is: 1 v h30-h,\,...›u- 5Ise+�^ This system is designed to provide for two service connections. Planning and design approvals must be obtained from the department prior to expanding beyond this number of services. Additionally, a water right, obtained from the Department of Ecology, is required if the water system exceeds exemption standards. This system (has/ has not) been granted one or more waivers from specific provisions of the regulations. Dated on this / day of , 1 , 20 L 3. Signature of Grantor(s): (1) ______-2/- Z9.4 I , (2) Page 1 of 2 State of Washington County of-Mpcon 0i0WI1.f2 I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this 13* day of Tttly , 20 a3 , b xid. L.bµVall , Member personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and y ar last abo riff . DEENA L DOLBEY Notary Public in and fort e State of Washington, residing at 1_Dnci Vt6.c1 NOTARY PUBLIC My commission expires: to fab�3 STATE OF WASHINGTON COMMISSION NUMBER 74363 COMMISSION EXPIRES OCT.25,2023 Page 2 of 2 2199607 MASON CO WA 07/17/2023 12:03 PM AGREE EMPIRE #188809 Rec Fee: $206.50 Pages: 4 111111I ll III I I I II III III IIIiI IIII DII 1011 IIIII II III I I I I III III III WHEN RECORDED RETURN TO: Ekfv.�� r LLC Pa 2-ll xLt s� W✓L 9 g(J2 L DOCUMENT TITLE(S): • � s N-,c uSE,(L. e-.JA —' r REFERENCE NUMBER(S) OF DOCUMENTS ASSIGNED OR RELEASED: GRANTOR(S): crkc—n., GRANTEE(S): b\ c- TRUSTEE(S): ABBREVIATED LEGAL DES RIPTION: L—T 3 a g 5 P 4 kJ`' S Z /��►I Lr s Cr' T(t. 5 2 /ry/ TAX PARCEL NUMBER(S): l2 c 30 '31 - c�� 12.= 3 c 3 ly o u o P-r WATER USERS AGREEMENT Water System Name: Nighthawk Water System Serves TP# 120303190084 and TP# 120303190083 Ownership of the Well and Waterworks It is agreed by the parties that each of said parties shall be and is hereby granted an undivided one-half interest in and to the use of the well and water system to be constructed. Each party shall be entitled to receive a supply of water for one residential dwelling and shall be furnished a reasonable supply of potable and healthful water for domestic purposes. Cost of Water System Construction Both parties herein agree to share equally in the cost incurred in well site approval,well construction,design of the water system for approval by the Health Officer,and construction and/or installation of the waterworks equipment,the pump house and water distribution pipes,and initial well water quality tests. Cost of Maintenance of Water System Each party hereto covenants and agrees that they shall equally share the maintenance and operational costs of the well and water system herein described. The expense of water quality sampling as required by the State of Washington and Mason County shall be shared equally by both parties. The parties shall establish and maintain a reserve account at a mutually agreed upon banking institution. Each party shall be entitled to receive an annual statement from said banking institution regarding the status of the reserve account. The monetary funds in the reserve account shall be utilized for the sole purpose of submitting water samples for quality analysis and maintaining,repairing or replacing the well and common waterworks equipment or appurtenance thereto. Easement of Well Site and Pump House There shall be an easement for the purpose of maintaining or repairing the well and appurtenances thereto, within 25 feet of the well site in any direction. Said easement shall allow the installation of well house, pumps,water storage reservoirs,pressure tanks,and anything necessary to the operation of the water system. Water Line Easements Owner of Tax Parcel 120303190083(owner name/parcel#containing the well)grants Owner of Tax Parcel 120303190084(owner name/parcel#adjacent to well)an easement for the use and purpose of conveying water from the well to the property of Owner of Tax Parcel 120303190084(owner name/parcel#adjacent to well). Said easement shall be five(5) feet in width and shall extend on,over,across,and underneath said strip of land from designated well site to shared property line. No permanent type of building shall be constructed upon the water line easement except as needed for the operation of the well and water system. Maintenance and Repair of Pipelines All pipelines in the water system shall be maintained so that there will be no leakage or seepage,or other defects which may cause contamination of the water,or injury,or damage to persons or property. Pipe material used in repairs shall meet approval of the Health Officer. Cost of repairing or maintaining common distribution pipelines shall be born equally by both parties. Each party in this agreement shall be responsible for the maintenance,repair,and replacement of pipe supplying water from the common water distribution piping to their own particular dwelling and property. Water pipelines shall not be installed within 10 feet of a septic tank or sewage disposal drain field lines. Prohibited Practices The parties herein,their heirs,successors and/or assigns,will not construct,maintain or suffer to be constructed or maintained upon the said land and within 100 feet of the well herein described,so long as the same is operated to furnish water for two-party domestic use,any potential source of contamination,such as septic tanks and drainfields,sewer lines,underground storage tanks,roads,railroad tracks,vehicles,structures, barns,feed stations,grazing animals,enclosures for maintaining fowl or animal manure,liquid or dry chemical storage,herbicides,insecticides,hazardous waste or garbage of any kind.The parties will not cross connect any portion or segment of the water system with any other water source without prior written approval of the Mason County Department of Public Health and/or other appropriate governmental agency. Water System Purveyor Owner of Tax Parcel 120303190084 is designated"Purveyor"of the water system. The purveyor shall be responsible for arranging submission of all necessary water samples as required in the Washington Administrative Code,and Mason County Rules and Regulations and handling emergencies such as system shutdown and repair. The purveyor shall provide his/her name,address and telephone number to the Health Officer and shall serve as a contact person to the Health Officer. The purveyor shall organize and maintain the water system records and notify the Health Officer and all parties,service connections and lots that are included in this agreement,of the water quality tests that are require by WAC 246-291 and Lewis County Rules and Regulations. Water system records shall be available for review and inspection by all parties in this agreement and the Health Officer. Provisions for Continuation of Water Service The parties agree to maintain a continuous flow of water from the well and water system,herein described in accordance with water supply requirements of the State of Washington and Mason County. In the event that the quality or quantity of water from the well becomes unsatisfactory as determined by the Health Officer,the parties shall develop a new source of water: Prior to development of,or connection to a new source of water, the parties shall obtain written approval from the Health Officer. Each undivided interest and/or party shall share equally in the cost of developing the new source of water and installing the necessary equipment associated with the new source. Restriction on Furnishing Water to Additional Parties It is further agreed by the parties hereto that they shall not furnish water from the well and water system herein above described to any other persons,properties,or dwelling without prior consent of both properties and written approval from the Mason County Department of Public Health. Restriction on Water Use State water right laws prohibit this system from using more than 1900 gallons of water on any day. Also,the total amount of property that can be irrigated by the system cannot exceed r/i acre. In order to remain in compliance,each parcel,Tax Parcel 120303190083 and Tax Parcel 120303190084 is prohibited from using more than 900 gallons of water on any given day. Heirs,Successors, and Assigns These covenants and agreements shall run with the land and shall be binding on all parties having or acquiring any right,title,or interest in this land described herein or any part hereof and it shall pass to and be for the benefit of each owner thereof. Enforcement of Agreement on Non-conforming Parties and Properties The parties herein agree to establish the right to make reasonable regulations for the operation of the system, such as the termination of service if bills are not paid,within forty-five days of the due date,additional charges for disconnection,reconnection,etc. Parties not conforming to the provisions of this agreement shall be subject to interest charges of S%per annum together with all collection fees. Signed: ..p `v .e;(; ( Owner(s)of ropertIy with the Well Print Name: �3 ` L. �`'�v g t r KAREN HURLEY NOTARY PUBLIC#101167 State of Washington ) STATE OF WASHINGTON 's )ss COMMISSION EXPIRES County of 110.SCY"\ ) J U LY 15, 2025 I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this I—1 day of cSI,t_,k ,202A ,personally appeared before me I)etV;Ct Z 7 u.��.I ( to me known to be the individual(s)described in and who executed the within instrument,and acknowledge that he(she)(they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. Nota Public' and for the.State of ashington, Residing in: i My Commission xpire : 7 (S Signed: Owner(s)of Second Property Served by the Shared Well Print Name: I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this day of ,20 ,personally appeared before me to me known to be the individual(s)described in and who executed the within instrument,and acknowledge that he(she)(they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. Notary Public in and for the State of Washington, Residing in: My Commission Expires: Sees ^ROAD _T! k§ § \ r -- ,2 ? § / } ) ) E---� ® m ! � w I S 3 t I m / --r* k ■ A1, Ill ° , , O. f . \ >c Z. t . ! . - ? (I) P. ? /-- j , , \ ® q ' ?` • 1 , , 1 !— _ I; 1 . ; 4 . i' / k 1 > j UUt ` ,tr7 ]§;| ; INSPIRATION»a 0 |A�|;- 9 §!}\} $ §e|E\ F. !I N; i § § ll §`! 2� \ |§\ k ( | § k & ®f .0 5 i / ; - ! «.i2, | | | i §1 § !/§F9 ` ' ! ;$ § /§)2§ / ;> § egngx r - |/ ! |/ = ; ;