HomeMy WebLinkAboutWEL2024-00004 - WEL Application, Design, Letter - 1/17/2024 584
MASON COUNTY 416N6 SHELTON: ,SHELTO70,EXT 40D
SHELTON:360-027-96]O,EXT 400
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360427-7787
WILLIAM MCTURNAL
P O BOX 12048
OLYMPIA, WA 98501
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2024-00004
1003 W KAMILCHE LN
319074490042
The 2-party water system, West Coast Mobile (well on 319074490042 with
319074490041/319074490043), 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
LEN
® MASON CO JAN 212024 R xw
COMMUNTIYSE VI
ED A w4 "O
MaMq PMnA4EmirnmnrY MAIM ����.
415 N.6i°SD (Bldg 9)-Shelron,WA 98584 WEI za .� - �� dp
Shelton: 360-42)-%W x400 Belf'r 360-2]5J 7 x400 Elmo:360482-5269 AW
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT
�� PxoxE
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1 ppRE98-BTREET,CRV.9TATE,9P
sd�od
$TflEET.0 ,STATE.
/ !Q c/ GAafr khe-
PRIMARY PAR LE NUM RIWELL SITEI _
<7O _ . I; a D YZ v 1 SIC 0 v4
9E60NDPR7 PAROEL NUMBER OF APPLICnaLE1
0-7- `tLi- 9ooti3
WATER SOURCE "URLE TYPE PNRCELILOTB� PARC
�ew ❑Existing ell ❑ EL3LOT$QESpring k
PROPOBEDWATMUTUIEMNAMEIREOUIREm /�
I.JL
PROJECTO RIPTION
OIRECMNSTOSniJ tONOIT10113
of
((Lf M u N fD
kf OkiL aTo Cao of i
Site Plan: (may also be attached)
(property boundaries,structures,sell site w1100'radius,ddvsways,roads,septidsewer comlwneMs and lines,easements,are J
Va ' lwtel� L
0
I4 pM Z�wtAN I t��
J 7
Submittals Checklist: (these additional items will be required for approval)
Satisfactory Bacteriological sample(this may be deferred '1f well is not yet drilled)
19 Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled)
I _ Notice to Future Property Owners recording (record with Mason Co.Auditor, supply copy of recorded document)
/(g`( Septic Records(additional locating requirements may apply if there is a lack of septic records on file)
This farm 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:
_WJ hoLrVi f19fe54-ed b-lfl?enl Pll$P{,(T
YES NO NA -ty ' -to prtv44c roaJ
❑ ❑ Evidence of existing sources of contamination within 100 foot radius of water source?
(drainfields,tanks, buildings; indicate distance on plot plan)
Eg ❑ ❑ Are there roads within the 100 foot r dills of the water source?If so, is road iv , County or State.
What is distance to ROW? _
06 ❑ ❑ Does the ground slope away from the water source site?(show slope on plot plan)
❑ Is the well cap satisfactory?; llt/t Ihlled-
❑ ❑ Screened and vented?
❑ The well casing extends 1 above level ground slab (circle one)
❑ ❑ Is there evidence of a surface seal? [hf= if-M V,71j,
[� ❑ ElDoes the seal appear adequate? 41 -t2 3 -0}87 r r 17�i
❑ ❑ Is a variance necessary for well site approval? 5- Jf q
Comments - and rM Will l� O LV
il-I l /Zb�tY
Pass*Fail Inspector Date J ZaL
l iG l z°z`l
Review Step 2: Two-party Review:
YES NO NA
❑ ❑ Water Well Report with adequate pump test on file? 4otw4ce� /
/dayl'rh' �(zj WO Vvq Ar 2h f,
If NO, date of Capacity Test C v0 Driller GPM
❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test L 1}f;yalyfq
❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z m
It ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided?
Comments
[Approved ❑ Denied Reviewer Date
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 ar failwe ofthis system. Well site approval does nor 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 668,
Water usage restrictians and additional fees may apply m all crew wells drilled olio Januar),19'6, 2018 per ESSB 6091.
This form maybe scanned and available for public view on the Mason County Web site. Revised: 10/13/2021
Page 2 of 2
WATER WELL REPORT aDEPARTMENT OF Nogceaflntmt No.WFS2706
ECOLOGY Unique Leal.,W.O TO Tag No.BPN 040
Type dwnk state of Wmhingmn
IN Comnuctinn Site W.UName(ifmmethenomws0):
❑ Decm®mioo 0 onguad llm-NOl Np. Water RightPwnh Cerificate No.
Prwrd Dan Il Dea� ❑ladacaul ❑Maaicyml Peopaty(svaa Name EARL SMITH
❑oewemdog ❑htwtiaa ❑test Wen DO — was Shed Add.. 1001 KAMILCHE LANE
COYtrocOoie1 Mdaea:❑ City SHELTON Comty MASON
ODewwell ❑Altmtbo es ❑ks O(Lbk Teel Dspeov:S DO —uc O DugO Av- O M"avry Tax Pucd No.3190744-000/2
Dimemiam: numckrofbo.kg/ m.,m im a Wose veriaow epprovd for Chia.117 ❑Yes, ONo
D.Pusa pkrodweum A.
Cesstrntiw Oeh6: well Dyes,whet wee We vmiamefalt
Ceei, Liner Dmslc Ram To Thkla,asn SW PVC Wvllsd lLmed
p 1 ❑ 8 m -2 94 _m. m I ❑ N I ❑ Locatiw(swinshuad onpage2): OO W1YMor❑EWM
❑ 1 ❑ iA — _in. ❑ I ❑ ❑ I ❑ SE '/l%.ftho BE V4Sn d. 7 Township 19N Bear 3
❑ I ❑ —it. ❑ I ❑ ❑
❑ ❑ ❑ 0 IAtiw&(Ex 1.:47.12345)47.14356
I ❑ m — — _m ❑
Lwgimde(Example:-120.123/5)-123.08891
Ped4ulom: OYm RN. Type ofper(avaor and DrOkr'a lag/Covelredov or Deeommisalon Procdare
Nndpufaedom_ S'veofpmfaratiom_laby_m Pwmtipe:Damae bywlor,cbrr•aten tim dmvr.iel mdm tore.snd Wckad and
Pakmdfwm_am_flbelaw pamd exfia mmaoftim mrtorW us hbyer cw.,K whh at leaaw eatry(ar tech rheoge of
Sennett: OYm ONO LaX-Pr}Rb Depte 92 R. tefwmVbA Use additiomishaeh Vmemmy.
Mam&wae(s N.JOHNSON Material From TO
Type STAINLESS Model No. SANDY LOAM GREEN 0 2
Dis.5 in. Sk.sae4U imaemm am90 @
nkmam_ �. sk:e®_ ia@om_asp fl. SAND LOAM GRAVEL 2 8
RAY SAND SILT 6 18
senmbuterpmkoYes ®No Size oepvY arvvl_m. BLUE CLAY 16 20
M.1spkad5om_8m_@ GRAVEL CLAY BROWN 20 40
Surfrcesd: 9Yu ON. TowhNdepth119 fi. SAND GRAVEL W 80
Mmuieluedmseal 311 SENTONRE BROWN CLAY GRAVEL 60 80
Didmysvemcoommwusahle a OYa ONo SMALL GRAVEL 80 80
Mmrodd ofealad o l 1sep:hdmW SMALL GRAVEL WB 90 99
ag evamaff GRAY STIFF CLAY 99 100
Pomp: MuuficMu'sNme Type:-
PP.— Pump make dmte:_ft D.Welfiaw.sk:_Nes,
W,asa- eb: Imdem6ve ekvatiwabovamrmsea level_ft
Seek-up oftap ofwe9 mrivg—2 @above gaud svrGce
Smuc wua kcel fib 9.hekw Npafwall maivg Dam %R72021
Arbkn Prmame_ks.Ivrgvvekch Dek
Arimmv we:¢kromwlbdbY (rap,valve.ctu)
WWTeak:
Wu elamPmB tarps!d4 ®No OYm G bywhma7
YieM_�mwim_@ dmwtlmmafier_hen
Ykld_wmwim_ft Mwdown elkr_hn.
YieM_gymwhb_@ dnwdownaMr_ben.
Rxawydrm(time=mo whwpimp k homdaH-wasmkcel mnewed wmwen
top kve0
Tana WtlmLpvel Than Wemrleml T®e Wma]enl
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ashes tut_®m weh_@ 6mdewv afiu—bw
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TagTaspengow_ppm J
matme ofwera_°F Wm aahmialamtyssmrde7 ❑Yu MN. Stml Date 07R92023 Complemd Date 07f272023
WSLLCONSTRUMONCSRTIFICATION: Irnoshnctedmdlwaccpt=Tmmbil"f cavaWclimofthiswell.mdilswmpliavicewithaOWashmgtmwel
conwae ien stm W&.Materials asd and the info.matiw reported above one hoe m my best knowldge and belief.
MMus ❑Tramw❑PE-Print Name ROSERTLAYMON Driaivg CormmyADVANCED DRILLING LLC
Signustune Add.11530 SCHOOL LAND RD SW
License No.2586 City Store,Zip ROCHESTER WA 98579
ff TRAINEE:Stsovsor'e I!.Na. Cmmcmr's
Spoosmse's S'mahtre Rmi ti N ADVANDL804DL D,,OSl0812D23
ECY 05U-1-20IN.08/19)7fyou need thir domonent in an alternafeforma4 W.call the Water Reaourcer Prngwm of 3 60-40 7-68 72,
Pavans wYrh hearing lens ran Wl711for Wuhington Relay Service. PenomwfthaspeanduabiUtyeaacatIM-833-6341.
Arcadia Drilling Inc.
P.O.Box 1790
Shelton,WA.98584
Customer: Bill McTumel Well Tag#: BPN040
Site Address: 1003 W Kamilche Ln. Shelton,WA Depth: 99,
Date of Test: 2/28/2024 Static: 61.5
TIME GPM LEVEL RECOVERY
1 Min 12 65.8 TIME LEVEL
2 Min 12 67 1 Min 66.2
3 Min 12 67.5 2 Min 63.1
4 Min 12 67.9 3 Min 62
5 Min 12 68 1 4 Min 1 61.5
6 Min 12 68.1
7 Min 12 68.15
8 Min 12 68.2
9 Min 12 68.2
10 Min 15 68.25
15 Min 15 71.8
20 Min 15 72.7
25 Min 15 72.9
30 Min 15 72.95
35 Min 15 73
40 Min 15 73
45 Min 15 73.05
50 Min 15 73.1
55 Min 15 73.15
1 Hr A15
73.15
1 Hr 10 Min73.15
1 Hr 20 Min73.15
1 Hr 30 Min73.15
1 Hr40Min73.15
1 Hr 50 Min73.15
2 Hr 73.15
Total
Gallons 1758
pumped
Thumton County EfwlrOnmertle Health
02 Lilly Rd NE S
Qly 18,Wg9S50
rxowsidN�
COLIFORM BACTERIA ANALYSIS
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SAMPLE INFORMATON
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mvaaYgnma,! C°",,oOAIRap8n IqB USE ONLY
LAB USE ONLY. DRINNINOWATER RESULTS Satlsactory -
"' roan Colibmt Preaent and W ybrmdeacad
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Return Address: '
2207487 MASON CO WA
James E.Hungerford W"JRPo EaO k7193912"Z Fee: $306.60 Peeez: 4
Attorney at Law 1111311 lit NIIIIuIIII4111111111
P.O. Box 1191
Shelton,WA 98584
SHARED WELL COVENANTS
GRANTOR: West Coast Mobile Equipment Repair,LLC
GRANTEES: William McTmml,Janet McTumal
LEGAL DESCRIPTION (abbreviated); PTN SE '/4 SE '/4 S7, T19N, R3W (full legal
descriptions on page 1)
ASSESSOR'S PARCEL NOS.: 3190744-90041,3190744-90042, 3190744-90043
This Declaration is made this �A day of December, 2023,by the Grantor, West
Coast Mobile Equipment Repair, LLC, a Washington limited liability company, and the
Grantees, William McTumal and Janet McTumal, husband and wife, in consideration of
mutual benefits.
THE GRANTEES, William McTurnal and Janet McTumal are the owners in fee
simple of the following parcel of real estate in Mason County, Washington.
Lot 1 of Short Plat No. 3142, recorded December 3, 2021, under Auditor's File
Nos. 2172118 and 2172119, being a portion of the Southeast quarter of the
Southeast quarter of Section 7,Township 19 North,Range 3 West, W.M.;
Assessor's Parcel No. 31907-44-90041;
(hereafter Parcel 1).
THE GRANTOR, West Coast Mobile Equipment Repair, LLC, is the owner in
fee simple of the following parcels of real estate in Mason County,Washington.
Lots 2 and 3 of Short Plat No. 3142, recorded December 3, 2021, under
Auditor's File Nos. 2172118 and 2172119, being a portion of the Southeast
quarter of the Southeast quarter of Section 7,Township 19 North,Range 3 West,
W.M.;
Assessor's Parcel Nos. 31907-44-90042 and 31907-44-90043;
(hereafter Parcel and Parcel 3,respectively). M
Shared Well corrsara9-Page l : g X 2 2024 D
Bye—��
COVENANTS
The GRANTOR and the GRANTEES hereby declare and establish the following
easements,covenants, conditions and restrictions:
Location of the Well and Water System
There is a well on Parcel 2 near the common boundary line between Parcel 1 and
Parcel 2,which serves Parcel 1 and Parcel 3. The well does not serve Parcel 2,
Cost of Operation.Maintenance and Repair of Water System
The owners of Parcel 1 and Parcel 3 will share equally in all costs of operation,
maintenance, and repair of the well and water system. The cost of repairing common
distribution water lines, if any, shall be home equally by the owners of Parcel 1 and
Parcel 3. Each owner shall be responsible for the installation, maintenance, repair, and
replacement of any water lines supplying water from the well and water system to such
owner's own particular dwelling and/or property.
Easements for Well Site and Water Line
The Grantor hereby establishes an easement for a water line on Parcel 2 for the
benefit of Parcel 1 for a water line ten(10) feet in width, lying 5 feet on each side of the
existing water line, from the existing location of the well Westerly to the East line of
Parcel 1. The Grantor also hereby establishes an easement for access for the benefit of
Parcel I in a circle with a radius of 10 feet, with the well being at the center of the circle.
The owners of Parcel 1 will have the right to use the easements for access to the well,the
water system, and the water line as needed for maintenance and repair of the water system
and the water line.
The Grantor hereby also establishes an easement for a water line on Parcel 2 for
the benefit of Parcel 3 for a water line ten (10) feet in width, lying 5 feet on each side of
the existing water line, from the existing location of the well Easterly to the West line of
Parcel 3. The Grantor also hereby establishes an easement for access for the benefit of
Parcel 3 in a circle with a radius of 10 feet, with the well being at the center of the circle.
The owners of Parcel 3 will have the right to use the easements for access to the well,the
water system,and the water line as needed for maintenance and repair of the water system
and the water line. -
Shared well Cave is-Pap 2
Restriction on Furnishing Water to Additional Parties
The owners of Parcel 1, Parcel 2 and Parcel 3 shall not furnish water from the
well and water system to any other properties or dwellings without the consent of all of
the owners of Parcel 1 and Parcel 3. _
Heirs. Successors and Assigns
This Declaration shall run with the land and shall be binding on all parties having
or acquiring any right,title or interest in the land described herein or any part thereof, and
shall pass to and be for the benefit of each owner thereof.
General Provisions
This Agreement shall benefit and burden the real estate described herein and shall
run with the title&to the real estate described herein. This Agreement may be amended or
terminated only by a written instrument signed by all of the owners of Parcel I and Parcel
3. In any litigation arising out of this Agreement, the prevailing party shall be entitled to
recover reasonable attorney's fees and costs.
GRANTOR: GRANTEES:
West Coast Mobilise Equipment Repair,LLC /
By Earl Smith,Member illiam cTumal
anet Mc al
Shared Well Covem=U-Page 3
STATE OF WASHINGTON )
ss.
COUNTY OF MASON )
On this /37tt—day of December, 2023, before me, the undersigned, a Notary Public in
and for the State of Washington, duly commissioned and sworn,personally appeared Earl
Smith to me known to be the Member of West Coast Mobile Equipment Repair,LLC,the
limited liability company that executed the foregoing instrument, and acknowledged the
said instrument to be the free and voluntary act and deed of said limited liability
company, for the uses and purposes therein mentioned, and on oath stated that he is
authorized to execute the said instrument.
GIVEN under nd end official seal the day and year last above written.
No Publi ' t and for the State of JAMES E NUNGERFORD
' gtnn, idinga[ NOTARYPUBLIC#74094
My Commission Expires: STATE OF WASNINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
STATE OF WASHINGTON )
as.
COUNTY OF MASON )
I, the undersigned, a Notary Public in and for the State of Washington, do hereby certify
that on this 1'b"rW day of December, 2023, personally appeared before me William
McTurnal and Janet McTumal to me known to be the individuals described in and who
executed the within instrument, and acknowledged that they signed the same as their free
and voluntary act and deed,for the uses and purposes therein mentioned.
GIVEN nder m 1 a d o rcial seal the day and year last above written.
No ubhe in t or the State of
W gton,residing at
My Commission Expires: JAMES E HUNGERFORD
NOTARYPUBUC#74094
STATE OF WASNINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
Shared Well Covenants-Page 4
Return Address:
2205512 MASON CO WA
James E. Htutgerford tZ/jarNEpFORD K1933]9nReo Pee $206 50 Pa9e5 4
Attorney at Law
P.O. Box 1191
Shelton,WA 98584
SHARED WELL COVENANTS
GRANTOR:.West.Coast Mobile Equipment Repair,LLC .. _
GRANTEES: William McTumal,Janet McTumal
LEGAL DESCRIPTION (abbreviated): YIN SE '/4 SE '/4 S7, T19N, R3W (full legal
descriptions on page 1)
ASSESSOR'S PARCEL NOS.: 31907-44-90041,31907-44-9004Z 31907-44-90043
This Declaration is matte this ha day of December, 2023,by the Grantor, West
Coast Mobile Equipment Repair, LLC, a Washington limited liability company, and the
Grantees, William McTumal and Janet McTumal, husband and wife, in consideration of
mutual benefits.
THE GRANTEES, William McTumal and Janet McTumal are the owners in fee
simple of the following parcel of real estate in Mason County,Washington.
Lot 1 of Short Plat No. 3142, recorded December 3, 2021, under Auditor's File
Nos. 2172118 and 2172119, being a portion of the Southeast quarter of the
Southeast quarter of Section 7,Township 19 North,Range 3 West,W.M.;
Assessor's Parcel No. 31907-44-90041;
(hereafter Parcel 1).
THE GRANTOR, West Coast Mobile Equipment Repair, LLC, is the owner in
fee simple of the following parcels of real estate in Mason County, Washington.
Lots 2 and 3 of Short Plat No. 3142, recorded December 3, 2021, under
Auditor's File Nos. 2172118 and 2172119, being a portion of the Southeast
quarter of the Southeast quarter of Section 7,Township 19 North,Range 3 West,
W.M.;
Assessor's Parcel Nos. 31907-44-90042 and 31907-44-90043;
(hereafter Parcel 2 and Parcel 3,respectively).
Shmnd Well Covenants-Page 1
COVENANTS -7
The GRANTOR and the GRANTEES hereby declare and establish the following '.
easements,covenants, conditions and restrictions: ,
Location of the Well and Water System
There is a well on Parcel 2 near the common boundary line between Parcel 1 and
Parcel 2,which serves Parcel I and Parcel 3. The well does not serve Parcel 2.
Cost of Operation Maintenance and Repair of Water System
The owners of Parcel 1 and Parcel 3 will share equally in all costs of operation,
maintenance, and repair of the well and water system. The cost of repairing common
distribution water lines, if any, shall he home equally by the owners of Parcel 1 and
Parcel 3. Each owner shall be responsible for the installation, maintenance, repair, and
replacement of any water lines supplying water from the well and water system to such
owner's own particular dwelling and/or property.
Easements for Well Site and Water Line
The Grantor hereby establishes an easement for a water line on Parcel 2 for the
benefit of Parcel 1 for a water line ten (10) feet in width, lying 5 feet on each side of the
existing water line, from the existing location of the well Westerly to the East line of
Parcel 1. The Grantor also hereby establishes an easement for access for the benefit of
Parcel I in a circle with a radius of 10 feet,with the well being at the center of the circle.
The owners of Parcel 1 will have the right to use the easements for access to the well,the
water system,and the water line as needed for maintenance and repair of the water system
and the water line.
The Grantor hereby also establishes an easement for a water line on Parcel 2 for
the benefit of Parcel 3 for a water line ten(10) feet in width, lying 5 feet on each side of
the existing water line, from the existing location of the well Easterly to the West line of
Parcel 3. The Grantor also hereby establishes an easement for access for the benefit of
Parcel 3 in a circle with a radius of 10 feet,with the well being at the center of the circle.
The owners of Parcel 3 will have the right to use the easements for access to the well,the
water system,and the water line as needed for maintenance and repair of the Water system
and the water line.
Shared Well Covenants-Page 2
Restriction on Furnishing Water to Additional Parties
The owners of Parcel 1, Parcel 2 and Parcel 3 shall not furnish water from the
well and water system to any other properties or dwellings withoultthe consent of all of
the owners of Parcel 1 and Parcel 3.
Heirs. Successors and Assitms
This Declaration shall run with the land and shall be binding on all parties having
or acquiring any right,title or interest in the land described herein or any part thereof,and
shall pass to and be for the benefit of each owner thereof.
General Provisions
This Agreement shall benefit and burden the real estate described herein and shall
run with the titles to the real estate described herein. This Agreement may be amended or
term-rated only by a written instrument signed by all of the owners of Parcel 1 and Parcel
3. In any litigation arising out of this Agreement, the prevailing parry shall be entitled to
recover reasonable attorney's fees and costs.
GRANTOR: GRANTEES:
West Coast Mobile Equipment Repair,LLC
��G,ue.�-v✓�3
By Earl Smith,Member illiam cTurnaal
gnat MeTkunal
Shared Weli Covm •Page 3
STATE OF WASUNGTON )
COUNTY OF MASON )
w
On this I37T day of December, 2023, before me, the undersigned, a Notary Public in
and for the State of Washington, duly commissioned and sworn,personally appeared Earl
Smith to me]mown to be the Member of West Coast Mobile Equipment Repair,LLC,the
limited liability company that executed the foregoing instrument, and acknowledged the
said instrument to be the free and voluntary act and deed of said limited liability
company, for the uses and purposes therein mentioned, and on oath stated that he is
authorized to execute the said instrument.
GIVEN under d and official seal the day and year last above written.
No 1?ubli ' t and for the State of JAMES E HUNGERFORD
'ngton,n „iding at NOTARY PUBLIC#74094
My Commission Expires: STATE OF WASHINGTON
COMMISSION EXPIRES
OCTOBER 24, 2024
STATE OF WASHNGTON )
as.
COUNTY OF MASON )
I, the undersigned, a Notary Public in and for the State of Washington, do hereby certify
that on this I bT14- day of December, 2023, personally appeared before me William
McTumal and Janet McTumal to me ]mown to be the individuals described in and who
executed the within instrument, and acknowledged that they signed the same as their free
and voluntary act and deed,for the uses and purposes therein mentioned.
GIVEN der m o cial seal the day and year last above written.
No rblic in or the State of
W"i n,residing at
My Commission Expires: On
LCOMMISSION
ES E HUNGERFORD
ARY PUBLIC#74094
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