HomeMy WebLinkAboutWEL2023-00039 - WEL Application, Design, Letter - 7/19/2023 I 44 A
MASON COUNTY 415 N 6TH STREET,60427 967 ,E 984400
00
SHE TREE ,S 42 TON, ,EXT 584
BELFAIR:360-275-4467, EXT 400
&at 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
11.111111111
.coif;'
_ a
cy` `'.... MASON COUN _ i 9 i a Ie Received: — ' 1
COMMUNITY S -- -.i. = : V D •mo eic Receia
N7' Building.Planning,Environmental Health,Community Health
\\ 415 N.6th Street,(Bldg 8)-Shelton,WA 98584 WE L 'Z() Z.3 - 0 l
Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT PHONE
ILw,p;c.2- 46." n"`‘..c CoiNS4-(VIC:k.i •Jr. 1.--LC' 3 .o -75/ -e0C1.
MAILING ADDRESS-STREET,CITY,STATE,ZIP
I,G 3dn )-ti 1 Kr_Ise; ILO 9N62.6
SITE ADDRESS-STREET,CITY,STATE,ZIP ` / n
T N !T c/
PRIMARY PARCEL NUMBER(WELL SITE)
12030- 1 - 9c,e„83
SECONDARY PARCEL NUMBER(IF APPLICABLE)
k Z,:„3 o- -3 1 '- 9' o e> s Li
WATER SOURCE SOURCE TYPE / PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE
WeNCw 0 Existing 'm Well 0 Spring j r 'ZS n- Was A L
PROPOSED WATER SYSTEM NAME(REQUIRED)
P,', 1,A 1-‘0,w 1L a•-e✓ Sy s .}Q..—
PROJECT DESCRIPTION
,-V,r 6d-1 E 1 fvStfti1-+.J �. WQty cu.1-- �c 1 L L seo-c,A..., V.- 0.( .
DIRECTIONS TO SITE/CONDITIONS ` 1 f ( 1
Ock,/$Air` '- n S,SiurA cL S To (i l 1- G✓Z Tvi
1,�,4).-./, 1 ►Ion t-N1r �y►� /oc-\L 9� �-� � 5:.-r_ .4ke- I ii-
Site Plan: (may also be attached)
(property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...)
CCL.Cc €x h b 4- ��
6-fav L./ r . i, T TN
.i (`(74 JUL 17 2023
1Y
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
❑ K ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields,tanks, buildings; indicate distance on plot plan)
El IK] ❑ 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?
,15 ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan)
—qP ❑ Is the well cap satisfactory?
d X 0 ❑ Screened and vented? n f//�
�Q if The well casing extends � above level ground I concrete slab? (circle one)
�� :: ❑ Is there evidence of a surface seal?
a 4; 0 Does the seal appear adequate?
►`i ❑ Is a variance necessary for well site approval?
Comments (OA, Ater' ( AA, 5✓ /�f c. 6c- i/ , 5ic��p�i �i4J
/
❑ Pass Fail Inspector 45r/116` tT2,- Date t `2.--�
Review Step 2: Two-Party Review:
YES NO NA
0 ❑ Water Well Report with adequate pumpl test
on S file? vJ ('
If NO, date of Capacity Test (f/( 5/Cbv rilier rill --(/I•` GPM 1l
4 ❑ 0 Received Satisfactory Bacteriological Analysis? Date of test 1I/17 ZZ
!-. ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN u 6aS
ps ❑ ❑ System appears adequate to serve 2 single-family residences based on iAngil provided?
Comments fr./% 6,j /� (0 P CC47 on
6( f[ i0v3 Ro
k
ASoNC Sep ,
Approved ❑ Denied Reviewer Date Z
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
C E N T R 1 C 1786 SE Mile Hill Drive rllrr•. 7y . :. •.r ally \
Port Orchard,WA 98366 .�1`+.1
LABORATORIES www.centricanalytical.com -5 -:
(360)443 7845 .��` p
•
COLIFORM BACTERIA ANALYSIS FORM ``"4, •"'�.-;-_'r ?'
Date Sample Collected Time Sample I County — ';1',,:�''`:"' -
Collected '` •,rr, c •, ," .„
Mae, Day Year OPY ��s�� •`." `.MS .' v.
Type of Water System(check Doty one box) ist. S'•'• `i,y'•S': r ,'
0 Group A ❑Group B #30lher 0.,-t" 'iiiik S''' 5**. -."- .
Group A and Group 8 Systems-Provide from Water Facilities Inventory(YYFI): ' • y
ID# i x"� _1. i
Z. N...i 1-c-\
System Name: U i/ tr./VI p `t.� 'r`N; �•+ ;~
Contact Person:14.
` W(!k(1 e l:nC�.p}2 `�`'.."N <.• !• - •- ti{.�`s'. ,-
Day Phone: 31,e •(iv-•I ii-ti Cell Phone: ,�. i.--. '.N.
Email:V(1U,p pLLY1 Ili AO ta'rj ilia l l• Eve.Phone: '.-;� t
See^resdts to:(Printtoll name.
Yadd and ripoodytlrem .i 3 k., �.--.,•.. ,. : ,•4.r`�..>>-,..,''_• .i \..;•"�
,'``.1.. \.J-'•...J''•.. i ',IN.:-,..✓4,...r'-.~,.s,. _--- '+, :tit
L. �0 L-e Sc c r _ r-z -3-„,i. s\•_ +Y e,,,.. -..... '1...,.
5by I -Dn Wa (III :_,•� :s ..._
SAMPLE INFORMATION ,y-;'R:S`�..3••" ti''-�:'r••. .,
Sample collected , �•' ^�~• .-
OZJUO? f 11,60(60 - _
Specific location where sample oolteded: Spedal Instructions oraortments: Conform Distribution System
Tx IV�� ro,���q�i Sampling Procedure
Type of Sample(check only one box) Step One Step Four
I.❑ Routine Distribution Sample 2 Repeat Sample(after unsat routine) Avoid poor sample sites such as There may be some liquid or
Chlorinated.Yes 1-_-_] No E]Chlorine Residual:Total. Free CI swivel faucets,hotand cold mixing powder in the sample bottle to
Distribution System faucets(with asinglelet•er),leaky or remove chlorine.Do not rinse it
__ Unsatisfactory routine lab number: spraying faucets;drinking out.
3.Source Ground Water Rule Sample -- _ __ fountains,janitorial sinks,frost-free
Unsatisfactory routine collect date: hose bibs,and faucets below or near Step FiveS I I ground level To avoid contamination while
/ / taking the sample,hold the bottle
El Triggered Chlorinated:Yes U No U Step Two near the bottom with one hand and
Assessment Chlorine Residual.Total Free Removeanyattachments from the hold the top of the cap with the
faucet,including aerators,screens, other.Now unscrew the cap.
4. Enumeration Source WaterSamola I S I I E washers,hoses and waterfilters.If
you choose to disinfect the sample DO NOT set the cap down,touch
0E.coi OFecal-sutaa,Gw6 Sales.RMMYee❑ ue❑ l
5� samplecoAec9edheftdonnatimonlr L 5 ,Itm site prior to sample collection,be any part of the cap that touches the
sure to flush thoroughly to remove bottle or let anything touch the rim
LAB USE ONLY DRINKING WATER RESULTS LAB . E ONLY all disinfectant of the bottle or inside the cap
E3 Unsatisfactory Total CoEform Present and liain > Step Silt
DEcoipresent 0E.co,absent ..'
_ Hold thebottleunderthestreamof
Replacement Sample Required: - r water,be careful not to let the bottle
0 Sample too dd(>30 hours) °TNTC ID " . touch the sample tap.Fill tit ebottle
to the indicated fill line,do not allow
Baderial Density Results:Total Cotfam NOOmI. E.cob ItOpml 'iL it to overflow.Remove the bottle
•
Fecal Coiifam 1100m1. HPC nmt. - fromthewaterflowandsecurethe
,Np-�rrp {?
Lab 1 N,,,, ,,, (,y .f I oval
1 rimed:lid: (Z , rk�/ Step Turn
Three
j )C—,i' nV .0
v 4 LULL (No
Turn on the cold water only and Step Seven
let it run with a stea dy stream for Complete the lab slip.Note anything
Method Code: Date and Timelneubated: at least five minutes.Before
_SM 9223 UV 1 ? _ collecting the sample,turn the
unusualaboutthesamplecollection.
DateAnyzed: r�nV 1 2�Li DateRepated any 5 au water downtoathinstreamand Step Eight
iet the water run foroneminute. Secure the lab slip tothebottlewith
/ � If they system is chlorinated rubber hand.Deliver the sample to
DOH L abSamplr# � Lab Use Only. �
225 1 measure the free chlorine and note Centric Analytical Labs as soon as
the measurementonthelab slip. possible.
DDH Fmn mm orar *.a 61-11n+moil/it Hekeld In e,elltmetrelormt of 900.5150171 nD0rfTY es77111.
DC er.ana:ttrww.e relate a ww.tln.nyc+wed:N*140.
f
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
7h(%5 ►vCll ivy be plQced b7 prm ailei?f Copyft'o, 1 oo F
WATER WELL REPORT r..mi DEPARTMENT OF Notice of Intent No. iN E-1•766e4 �p
ECO LOGY Unique Ecology Well ID Tag No. B PU3 7 7
1i1 Type of Work State of Washington
9 O Construction Site Well Name(if more than one well):
i 0 Decommission b Original installation NOI No. Water Right Permit/Certificate No.�,/ (�//�� /���[,, �y�
Proposed Use: ❑O Domestic 0 Industrial 0 Municipal Property Owner Name . $IT IIV /a45/0/c "*I ttc
❑Dcwatering ❑Irrigation 0 Test Well 0 Other
Well Street Address 60S E . Istr of1b1) Way
Construction Type: Method:
C New well 0 Alteration 0 Driven 0 Jetted ❑O Cable Tool City Shelton County Mason
I ❑Deepening 0 Other ❑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? O Yes E 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
EID 6 in. +1 235 1/4 in. ❑ I ❑ El I 0 Location(see instructions on page 2): 0 WWM or CI EWM
❑ 1 0 in. — in. ❑ I 0 0 1 0 sw %.-1/4 of the ne %.;Section 30 Township 20n Range 1w
0 1 0 in. _ in. ❑ I 0 0 1 0 t� I�y
❑ I ❑ in. in. ❑ I ❑ ❑ I ❑ Latitude(Example: 77 ?toy
Longitude(Example:-120.12345) ^12.2.8131sq
Perforations: 0 Yes ❑a No Type of perforator used
No.of perforations_ Size of perforations_in by in. Driller's Log/Construction or Decommission Procedure
Perforated from_ft.to A.below ground surface Formation:Describe by color,character,size of material and structure,and the kind and
nature of the material in each layer penetrated,with at least one entry for each change of
Screens: ❑a Yes ❑No ❑a K-Packer > Depth 233 ft. information. Use additional sheets if necessary.
Manufacturer's Name alloy Material From To
Type Stainless Model No.
Diameter 5 in. Slot size 12 in.from 235 ft.to 240 ft. brown sandy loam 0 3
Diameter_ in. Slot size in.from ft.to A. brown till 3 18
brown sand w/occasional gravels 18 178
Sand/Filter pack:❑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: a❑Yes 0 No To what depth? 19 ft.
Material used in seal bentonite chips
i Did any strata contain unusable water? 0 Yes ❑a 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 ft.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? M No 0 Yes b 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 A.for hrs. Date
Artesian flow gpm
Temperature of water_°F Was a chemical analysis made? 0 Yes ❑a No Start Date 10-12-2022 Completed Date 11-18-2022
WELL CONSTRUCTION CERTIFICATION: 1 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.
(1 Driller 0 Trainee 0 PE-Print Name Drilling Company KNAPP DRILLING INC.
Signature Z7t uzZd 4. Address 50 east lesasca Dr.
License No. 1706 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
II III iIII III Oil IIIIIII Iillll IIII 111 IIIII IIIII DVIII III IIIII 1011 II I IIll
Return To \ 7
LUX-
QUX 2.'-1
Grantor(s): (1) En\t'.n
Grantee(s): (1) PUBLIC
Legal Description (1) Lc-I- 0SC€ ?TN S
(Abbreviated form:i.e. lot, block, plat or section, township, range)
Assessor's Tax Parcel: (1) . 2. c3 3 G - 3 I - 9 0 O 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 b - 3 -q C b
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: N:ghl- t- S5 to-,
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.,_i 'y , 20 Z .S.
Signature of Grantor(s):
(1) f`).e1 /,rj1 / , (2)
Page 1 of 2
State of Washin ton )
County of Mase4 - C0 W i 1f2 )
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this 13+t► day of Tikty , 20.a3 ,
• 1)544 . L.bu,Vall , 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 ritt
Notary Public in and fort e State of Washington,
• DEENA L DOLBEY residing at t..onsiview
NOTARY PUBLIC My commission expires: IOia5/1b_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
1 I111111 III 11111 E1111111 III 1111111 I III 0111 1111 III 1 II�111�111
WHEN RECORDED RETURN TO:
m
Pa &o-SC ZK 1
DOCUMENTTITLE(S): • � 5 NTEp._ 0SE fL (kciLks;e-1- 1
REFERENCE NUMBER(S) OF DOCUMENTS ASSIGNED OR RELEASED:
GRANTOR(S): L re.c): C\s1.'•• �^S
GRANTEE(S): 3\:c-
TRUSTEE(S):
ABBREVIATED LEGAL DES 'RIPTION: L-c 3 0� se 0 3•�L
TO- $ S 2 /`-11 /Lr 4-1 c.c.s? N ?Tr'. T(t- S Z /1�!
TAX PARCEL NUMBER(S): 3c> - c'6%S
I2- 3 "' 3l 9'V-t
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 1 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: .794. ,tom.!/
Owner(s)of Propertly with the Well
Print Name: rp ct,-s .1 L. (D.v ck 'r
KAREN HURLEY
NOTARY PUBLIC#101167 's
State of Washington ) % STATE OF WASHINGTON
� ,�ISGp ('� )ss COMMISSION EXPIRES 5County of � ) ;,, 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
Lday
of c IA,LtA ,202- ,personally appeared before me
CA..VUGC 1-. ka 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 abovewritten./
--/ Ctit.bs-- L-1,ZiL
Nota Public'{and for the.State of ashington,
Residing in: 1 i�
My Commission gxpire : 7 1 S -Z 2-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:
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