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HomeMy WebLinkAboutWAT2024-00308 - WAT Application - 3/7/2024 MASON COUNTY WAT COMMUNITY DEVELOPMENT 415 N 6-Street,Sldg 8,Shelton WA 98584, Shelton. (360)427-9670 ext 400 O Belfair(360)2754967 ext 400 O Elma:(360)482-5269 ext 400 FAX(360)427-7787 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application,with any required attachments for review. 4. An approved building site plan must accompany this appliaation. Part 1: Applicantl Parcel Identification ��� Name on Applicant: Maki;It J#li 1`CTa✓t,fYN1ri$' Date: 7j'1 Mailing Address: �� SE r"ell- ewi IJY. Phone: Parcel Number: �I-1gin-3�,-���n� Type of Water System Reason for Application ❑ Public/Community Water System (2 or more El Building permit BtD2O-'T-,10306 connections) ❑ Division of land: El Individual water source(one connection), #of Parcels? SPL El Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel(please indicate name If you have more than one residence connected of water system below if applicable-no to this well, check the PublieXommunity,Water signature required) System box. `,, _1�F/��ti/�N,I �ZYl yq 11k- ,IA u) vu.1 Part 2: Water Connection Information (lY) Ip , 3—WOOD Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System. Water Facility Inventory(WFI) Number. (write"none"for two-parry) ❑ 1 am the manager of this water system.The water system has been approved for services. There are presently connection(s)in use This will be the connection. ❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing connection on this system(i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this(these)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date This forth may be scanned and available for public view at www.co.mason.wa.us. ],\FH Fans\Dunking Wala Rcvia' 1125n018 Individual Water Well Water well report(attached to application). Depth 1R Well capacity Test(attached to application) 1� apm 7 I 0 C) gpd. r The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test,which provides stabilization of drew-down and recovery data,must be performed by a licensed contractor. Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA htto'11gis.co.mason.we.us/plannim 14015016=122M Water use or limitation recorded................................... WA=Yes_[= Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day;and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) 6sfactory Determination: This determination does not address adequacy of the distribution system,guarantee an adequate supply of water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6,68.O40-Determination of Adequacy for Building permits are satisfied. Additional Growth Management requirements may apply. Chapter 3630A RCW. ❑ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of as intended use for the following masons s). , ,, ,,,• ,,Reviewer's Signatures: Environ. 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Box 1790 Shelton,WA.98584 Customer: Peter Francis Well Tag#: BPF187 Site Address: t�1�110' '� Depth: 146' Date of Test: 6/17/2024 Starting Static: 12.4 12.50pm TIME GPM LEVEL GALPLIMPED RECOVERY 1 Min 6 12.9 6 TIME LEVEL 2 Min 6 15.5 6 21 hrs 25 mins 12.4 9:25am 3 Min 6 17.3 6 4 Min 6 21 6 ITotal Gallons Pumped= 407.5 5 Min 6 23.5 6 6 Min 6 24 6 7 Min 6 25.5 6 8 Min 6 27.9 6 11 9 Min 1 6 28 1 6 10 Min 6 29 6 1 15 Min 6 80.3 30 20 Min 6 94 30 25 Min 4 110 20 Sack J1%t ' 30 Min 4 1195 2035 Min 1.25 120.1 6.25 �n4 ✓� 40 Min 1.26 120.1 6.25 45 Min 1.25 120.1 6.25 50 Min 1.25 120.1 6.25 55 Min 1.25 120.1 6.25 60 Min 1.25 1 120.1 1 6.25 70 Min 1 1 130.9 1 10 80 Min 1 120.1 10 90 Min 1 120 10 100 Min 1 120 10 110 Min 1 120 10 120 Min 1 120 10 130 Min 1 121 10 140 Min 1 122.6 10 150 Min 1 124.2 10 160 Min 1 124.9 10 170 Min 1 125.5 10 180 Min 1 126 10 190 Min 1 127 10 200 Min 1 127.9 10 210 Min 1 128.4 10 220 Min 1 129.2 10 230 Min 1 130 10 240 Min 1 130.9 10 250 Min 1 131.8 10 260 Min 1 1 1 132.8 1 10 270 Min 1 1 1 132.9 1 10 v anguaTo taoaaloTy v2635 Pmrkrn mt I,ane SW,Suite A OINT*a WA 4850_2n 360-967-7010 COL"M BACTERIA ANALYSIS FORM Dan C So"Couacba Tm S-* rl le O6//7/2024 `olav . ow MASON I TYDa al Wabr SHa'^(C'M,OY(an 0u) ❑Craw• 0Omv8 0Dew Cimw A and Cn 8S"Wro-Pmw*hvm Wabr FaHDw WW"IWFg Id -- -- s3aanNsw PETER FRANCIS Cahn Pn Arndru�"g ire Dry Fao/u.t" )4263395 .aah. I Eme Eva Phaq! ) Mwe)o,w a Ma mess ra m ma aema: ewp.cwe.Nq mm nno�nnQ.�m� SAMPLE NFORIIIATIMI Saaok maVapinamel MAX ka<octcwm Mee a a"0"aw SPar+al wdmCaxaa mmrla 726 W Wivell Rd, Shelton T3paS�,a1F IauenaMer�meaeamlakomm.+eragn s habai ) ❑RaaEw Dm,*A$ nS&"(oN) 2 ❑ PAPOISw:pIF9N% Chbmaaa Yw Ab 'b^'Mill x.ra*d.„ms maul Chome RaOdW TM F.— U:aebNtbf+ma[M UL n+mUer 36:ured woom RPN5enRF SFmFb Unsabdaxy:duore mlba dae LJ�i�I —�—J— Chbartd Yw Nd 0TlWv,W1AIP) Chbft Res" TP+d___F.-- 0 Asmso a )AT) a anYnm<RIIMrSaua�aYrtw9)F 4E�wnwwm) ' _ ' 1 ❑E cai ❑Feral LIB USE ONLY ORWAG WATER RESULTS LAB USE ONLY ❑uueuFAe l,q TaM ft—w Payn:W x3 SiAYY[Yry ❑E.culanant ❑Ema l aFar4 Dewar Ruud Tan Coldaan ____�nrox EFOY �a0bnl. FRW DONoen__-_._ndam nPG n ml daaa�aSwlgF da+�aC' ❑TNTC 091'"woo ❑ SawbvoN ❑Damaged Cmbuw ❑ MIEZ'Ll gm awn..ncam - ua Pewaea amen l R Tw C- SMg2233 a AommbW t1/IW0,/DO"�sovoo — 285- 2215891 MASON CO WA 091191202E 01:36 PM EPSMT IIIIMqRKIII III IIII IIIIIII IIIIII IIII IIIII IIIII IIIIIII III IIIII IIII II9ee: 9 Recorded t re nest of: c3VAA,on SH AFFIDAVIT No..!�:� WA R.E. EXCISE TAX SEP 17 2024 EXEMPT LISA FRAZIER Treas., Mason County Document Title(s) WELL AND WATER SYSTEM EASEMENT AGREEMENT Reference Number(s) of Related Documents N/A Grantor(s)(Last,First and Middle Initial) Stickley Trust,Dated July 20,2017 Stickley, Kenneth David Stickley, Colette Michelle Grantee(s)(Last,First and Middle Initial) Francis, Peter Smith,Markie Abbreviated Legal Description Grantor: SW SW, S 49/210 5 j0 1q , YU Grantee: SE SW, S 49/210 Assessor's Property Tax Parcel Number Grantor: 41910-33-00000 Grantee: 41910-34-00000 After recording return to: %N�k or. WELL AND WATER SYSTEM EASEMENT AGREEMENT This Well and Water System Easement Agreement is made and entered into on the below stated date by and between Stickley Trust, Dated July 20, 2017, Kenneth David Stickley and Colette Michelle Stickley,Trustees,("Grantor'),and Markle Smith and Peter Francis,individually and jointly, ('Grantees'), as follows: I. RECITALS 1.1 Grantor is the owner of the following described real property: Abbreviated Legal Description: SW SW, S 49/210 Assessor's Tax Parcel No.: 41910-33-00000 1.2 Grantees are the owners of the following described real property: Abbreviated Legal Description: SE SW, S 49/210 Assessor's Tax Parcel No.: 41910-34-00000 1.3 The parties desire to enter into a Well and Water System Easement Agreement for their common benefit. NOW THEREFORE,in consideration of the terms,conditions,covenants and performance contained herein,the parties agree as follows: II. GRANT OF EASEMENT 2.1 CONVEYANCE OF WELL AND WATER SYSTEM EASEMENT: Grantor hereby grants and conveys to the Grantees an easement interest in the supply of water from the well and water system on the property of Grantor, generally described as follows: The 80't by 20' water easement is further described as follows. Beginning at the NE comer of Lessors property heading south approximately 318 feet to the point of beginning,turning Westerly approximately 80 feet,then Southerly 20 feet then Easterly 80 feet, then Northerly 20 feet along the East property line back to the point of beginning. As more particularly described on the diagram attached hereto as Exhibit"A." 2.2 OWNERSHIP: Grantor shall retain ownership of the well,well housing,and pump. Grantees shall have ownership of the pipes, power system, and other related. Structures. Grantees shall have the right of reasonable access to enter upon the property of Grantor for the purposes of monitoring, inspection, maintenance, and repair of the system, without the prior written or oral consent of Grantor. 2.2 PURPOSE AND SCOPE OF EASEMENT: (a) One-Party Water System: The purpose of the Easement is to provide a supply of water to Grantees'property for one,single family residence and associated yard,gardens, and related irrigation purposes, and for no additional dwelling units;provided that Grantor and his successors shall be allowed short term and limited use of water derived from the spicket at the well head. (b) Two-Party Water System:The parties anticipate submission of a Two-Party Water System Application to Mason County Community Services for the purpose of designating the well and water system as a Two-Party Private Water System, serving each of their properties for one,single family residence on each of the properties,and associated yard,gardens,and related irrigation purposes.The parties agree that in the event the well and water system is qualified as a Two-Party Private Water System, then it shall serve solely as a source of water to each property as stated above. The system shall not serve as a source of water for any commercial or agricultural use whatsoever. 2.4 MAINTENANCE AND REPAIR: (a) Onc-Party Water System: Except in the case of an emergency as described herein, Grantees shall be solely responsible for the inspection, testing, maintenance and repair of the well and water system so long as it remains a one-party water system; 2.8 ALTERNATIVE DISPUTE RESOLUTION: Any dispute, controversy or claim arising under or relating to this Agreement, or any subsequent Amendments to this Agreement, including its validity, binding effect, interpretation, performance, breach or termination, shall first be submitted by the parties to mediation,pursuant to RCW 7.07,with a mediator mutually agreed upon. To the extent possible, mediation shall take place within a reasonable time thereafter. In the event that the dispute is not resolved at mediation, then thirty(30) days thereafter the aggrieved party may file suit in Mason County Superior Court. In the event that any action is filed in relation to this Agreement,then the prevailing party shall be entitled to reimbursement of reasonable attorney's fees and costs incurred. III. MISCELLANEOUS 3.1 GOOD FAITH COMPLL4NCE: Grantor and Grantees shall at all times cooperate in good faith with each other and with any third party maintenance companies in the performance of this Agreement. 3.2 EASEMENT SHALL RUN WITH LAND: This easement shall run with the land and be binding on and shall inure to the benefit of the parties to this Agreement, their respective heirs, successors, and assigns. 3.4 NOTICES: Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by regular mail to the last known residential address of each party,and with a verification copy also sent by email to each parry's last know email address of record. 3.5 ENTIRE AGREEMENT: This Agreement shall constitute the entire agreement between the parties, and any prior understanding or representation preceding the date of this Agreement shall not be binding upon any party except to the extent it is incorporated into this Agreement. GRANTOR: GRANTEES: AStckl d July 20,2 Peter Francis Kenneth Stickley,Trustee otStickley Trust,Dated July 20,2017 Markle Smith Colette Michelle Stickley,Trustee STATE OF WASHINGTON ) ss. COUNTY OF K� ) On this day personally appeared before me Kenneth Stickley, Trustee of the Stickley,Trust, Dated July 20, 2017, described in and who executed the within and foregoing instrument, and acknowledged to me that they signed the same as his free and voluntary act and deed,for the uses and purposes therein mentioned. 1Y'jj GIVEN under my hand and official seal this U day of_�_,2024. O PUBLIC NOTARY PUBLIC in and for the tale of Washington,residing at Commission expires: ',lll1/1 n IAi'Isi n n o aa```• STATE OF WASHINGTON ) )ss. COUNTY OF ) On this day personally appeared before me Colette Michelle Stickley,Trustee of the Stickley Trust,Dated July 20,2017, described in and who executed the within and foregoing instrument,and acknowledged to me that they signed the same as his free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal this�.day ofA 2024. �aa\qw\n A ulpllll� ... J ,�aa��x,,r�l�Exf'•. �! (PaRJTNAt.E) .'d?`rlor�B •t �= NOTARY PUBLIC m and for the Sta fl 3 �•� a of Washington,residing at 3 i °�euc Commission expires: °ogl�nlmal�ia\o`\�e GRANTEES: GRANTOR: V Gl Stickley Trust,Dated July 20,2011 Peter Francs Kenneth Stickley,Trustee Stickley Trust,Dated July 20,2017 Markie Smith Colette Michelle Stickley,Trustee STATE OF WASONGTON ) )as. COUNTY OF �. — ) On this day personally appeared before me Peter Francis and Markie Smith,described in and who executed the within and foregoing instrument,and acknowledged to me that they signed the same as their free and voluntary act and deed,for the uses and purposes th mentioned GIVEN under my hand and official seal this day of 2024. ` NAME) NOTAR PUBLIC in and jl e Sta e of Washington,residing at d Commission expires: �po�rrrpU NN/q��ii =:U aOTARY :2 4�i EOF1WAS�o�° (b) Two-Party Water System: Grantees shall pay for all fees and costs associated with a Two-Party Water System Application,including but not limited to testing of the well system. In the event that the well and water system is later approved by Mason County Water Services as a Two-Party Private Water System, then in that event the parties shall proportionally share in the inspection,testing,maintenance and repair of the well and water system. If the parties cannot agree upon the proportionate sharing of expenses based upon water usage,then in that event the parties may negotiate for the installation of meters or other devices to determine water usage. The fees and costs incurred for testing and construction of any such meters shall be shared by the parties;however,Grantor shall pay any application fees,costs,and any changes or revisions to the system as required to provide water from the well to his future home. Any additional expenses shall be shared by the parties in proportion to their respective water uses. (c) Lien:The parties agree that in the event either party fails to pay the costs or expenses as defined above within thirty(30)days of written notice, a lien for the amount due and owing plus costs and attorney's fees may be filed against that party's property. Interest on such costs and expenses shall be at the rate of twelve percent(12%)per annum from the date notice was mailed to the non-paying party. 2.5 FAILURE OF SYSTEM: If at any time the well and water system in its entirety substantially fails or is otherwise rendered inoperable,to the extent that it is not financially reasonable to repair or replace, as determined by a written estimate from one or more of the third party maintenance companies defined above, then this Agreement will automatically terminate and be of no further force and effect. In that event, any funds in the collection account will be divided equally between Grantor and Grantees, after payment of fees and costs to decommission the wellhead and remove power and water lines from the property. Grantor and Grantees shall then each be responsible for obtaining a.source of water on their own property. 2.6 RESTRICTIONS: The parties agree that neither of them shall obstruct the area of the Easement from the use or access of the other in any manner whatsoever. 2.7 BREACH OF AGREEMENT AND DEFAULT: Time is of the essence in the performance of the rights and obligations in this Agreement. In the event that either party,or a party's successors or assigns,fails to perform the obligations under this Agreement, or otherwise breaches its terms, then the non-breaching party shall provide written notice to the breaching party setting forth the nature of the claimed breach, and requiring that it be cured within ten (10) days of the date of written notice. In the event that the breach is not then cured within this time period, or the breach or default otherwise continues, then the non-breaching party shall be entitled to all remedies available in law or in equity, subject to the Alternative Dispute Resolution terms stated below.