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HomeMy WebLinkAboutWEL2025-00032 - WEL Application, Design, Letter - 7/17/2025 a , MASON COUNTY 415 N 6TH STREET,SHELTON,wA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 BLANTON JOHN H 161 W BLANTON ACRES SHELTON, WA 98584 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00032 161 W Blanton Acres 319071400010 The 2-party water system, Blanton 2 (319071400010/319071400050), 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 7(77(z z1 ,r-WrMASON COUNTY Date Received: °1 r '' COMMUNITY SERVICES Amon i �� - q ZO 2� Amount Reserved:y `�O Received By cke Building,Planning Environmental Health,Community Health �Uj `✓1 415 N.6'h Street,(Bldg 8)—Shelton,WA 98584 WE L 2 625 - 00632 Shelton: 360-427-9670 x400 Bclfair.360-275-4467 x400 Elma:360-482-5269 x400 1.,-,e2,40.1.1M4OtRuliii.69270/1/00.8.1.1=,ArANSWALICalle.23,6,,MIIIIMile TWO-PARTY PRIVATE WATER SYSTEM APPLICATION AP LICANT PHONE. 1 —_,..XN l- MAILING� ADDRESS(-STREET STATE,TIP < �1--{1j[�)!� j('''��'�, SITE ( tSS-STREET,C.rrY 1 ill-00 Acce1 ( ,S\oe [ , l L3A cis _" - N\ C7 n 1 i Cc,' (.A- ilekn-I- A-COC.s , iiel+ern, Wo c35sq a PRIMARY PARCEL NUMBER(WELL SITE) � ��� ���� 319'0`7 - 1'-1 - O©ol p (IN SECONDARY PARCEI.NUMBER(SAME AS PRIMARY IF LOCATED ON SAME:PARCEL) /1 VA SOURCE - ( � O� 0SOURCE TYPE ('5O kr ���PARCEL�)T W.F.i(acre) PARCEL 2 LOT SI* m 7 Ncw /Existing ,---Well ❑ Spring S. 3Li I. 11 PROPOSED WATER SYSTEM NAME.(REQUIRED). PROJECT DESCRIPTION(e.g..,detached ADU,new singk ramily residence,existing connection,etc.) 0,ri_r) ,5,nj)e — .FY1; IA/ rt',S once 0,..A-- IRG l,J '1' Lt.ra7on Acre_s DIRECTIONS TO SITE/CONDITIONS/CATE CODE/KEY LOCATION I ETC. r-nm ?,y 101 Q can k.r-ton, L on una:-- . 1 ovt j- ctn-+-t)n A-t re s tt.)el1 1 J i't us+ psseid /01 63 E la 44)4 Aa- ' Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,water lines,property easements,etc.) Required Submittals Checklist: (additional information located on the first page of this packet) i2 atisfactory bacteriological test from within the last year Well report with well tag number,well tag secured to well casing,and capacity test showing 800 gal per day ,Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office fr Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and made available for public viewing on the Mason County website. Revised:01//2025 Page 1 of 2 i 7 — — — --- Staff Use Only -------- ---------------- Review Step 1: Well Site Inspechmon::r1linlG n�tn•l �/ ` l�/ ��s p( fr- COl/ayn4 led If,1vl GA' 7 YE NA V�w1 1'✓I lO f f f lt� 6 ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, ti�15 tanks,buildings;indicate distance on plot plan)) 1 IX ❑ ❑ Are there ro.• within a 100-foot radius of the water source? ) ' Is the roa. % : e,County,or State?(circle one) Distance to the road(s) '/C X ❑ ❑ Does t e ground slope away from the water source site? [R El ❑ Satisfactory well cap? 7 ❑ ❑ Well cap screened and vented? ❑ The well casing extends 75 above level round concrete slab?(circle one) DI] ❑ ❑ Evidence of a surface seal? Lat: `1 7.(SZ 1.( ❑ ❑ Adequate surface seal'? Lon: -1 ij.O98'oz ❑ [ ❑ Variance necessary for well site approval? Tag: A iti'\ ti q L. Comments: ccilll kin t44/`1-5- reaoted /! ( U/?.c „t. Pass s ail Inspector Date ‘./Z ?71O Z Review Step 2: Two-Party Review: - YES NO NA ,J/,A� / ❑ El ❑ Water well report(well log)with a concurrent capacity test? d.'(tai t!t 1 ZV o3 6y NW 'vet(Di (Th,1•" ❑ ❑ ❑ Nonconcurrent/separate capacity test? Cu/1trCf 5.' Capacity test information: Date -7(07 Driller 4C !i'( O'1(r419 Duration(minutes) Total Gal aj r ( G�I-da takuft GPM « S � �' F5 ❑ ❑ Satisfactory bacteriological analysis? Date of test 67 7(7,75 '4 0 ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN 72 Z 6 l . 0�/ .,. 7C ❑ ❑ The system appears adequate to serve two connections based on the information provid ? ,J�( �t4 s O4'("0& 16�o4�s , Comments: F/Vy in /yr /101k d1 (T Approved 0 Denied Reviewer Date (IG(lo 41 '� fr, 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 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'h, 2018 per ESSB 6091. Revised:02/04/2025 This form may be scanned and made available for public viewing on the Mason County website. Page 2 of 2 OIWATER WELL REPORT CUR d TTteltt f�-1 Lr1/ Q Z8 I'is i'ois'r'Ongmal&1st copy-Ecology,2nd copy-owner,3rd copy-driller t1' � �[ Unique Ecology Well ID Tag Na / t ! 7 yiStruction/Decommission('x"in circle) /3 9/3i s- Construction Water Right Permit No. 0 0 Decommission ORIGINAL CONSTRUCTIO� Noticee p / , >1Z of Intent Number ( - 1(ot' C.6, Property Owner Name 3• C)')� J dt't' Q n I CD IX PROPOSED USE: ffDomestie ❑Industnal ❑MunicipalWell Street Address(Ai �) 1Cln c. (1e❑DeWater trngation ❑Test WeU ❑Other ,/y� a) City 40 el County. ' t fyc oNJ WE OF WORK: Owner's number of well(if more than one) 2 EWM circle is New Well 0 Reconditioned Method ❑DugLocadOt�E 1/4- 1/4M1/4 Sec= Twn� RZ— tA 0 Bored 0 Driven Of one S0 Deepened 0 Cable Rotary 0 Jetted r (��°g: I-at Deg Lat Min/Sec �• DIMENSIONS: Diameter of well i inches,dolled (!3 ft REQUIRED) Long Deg Long Min/Sec O Depth of completed well ft ' D� I OO/ Q C CONSTRUCTION DETAILS Tax Parcel No. o roz Casing Welded to " Diam from+L/ ft to/57 ft CONSTRUCTION OR DECOMMISSION PROCEDURE ftt Installed' 0 Liner installed Main from ft.to ft Formation.Describe by color,character,size of material and structure,and the E 0 Threaded " Diam from ft to ft kind and nature of the matenal in each stratum penetrated.with at least one entry for each change of information Indicate all water encountered w Perforations: 0 Yes RI No (USE ADDITIONAL SHEETS IF NECESSARY) C Type of perforator used MATERIAL FROM TO CD SIZE of perfs in by in and no of perfs from ft to ft ei i/4A,efe n o / Z y�.i Screens: es 0 No K- ac Location �5/•� '�' ! / >` Manuf cturer's ame S `f 5-A/W T 67rJ f 1 v 3 O T Mod,0 No -a Diam S ct Slot Sizes 0/9 from 15 A ft to /(,3 ft /4)4 /54t 4Ct/`i/?g C to Mani Slot Size from ft to ft CCI Gravel/Filter packed: ❑Yes OS No 0 Size of gravel/sand4.0 tQ Matenals placed from ft to ft a Surface Seal: psi Yes o- - To what dep /v Ct t Materials used in seal J' eJ17 ✓ r >t Did any strata contain unusable water' Oyes Rislo Type of water'_ Depth of strata ft; Method of sealing strata off s` a- PUMP: Manufacturer's Name CU JC Type HP WATER LE LS Land-surface elevation above mean sea level ft O Static level 5 0 ft below top of well Date 9�-Z-- Z Artesian pressure lbs per square inch , Date N Artesian water is controlled by C (cap,valve,etc) 0 WELL TESTS: Drawdown is amount water level is lowered below static level Was a pump test made?Oyes El No If yes,by whom', CI Yield gal/min with ft drawdown after hrs + O Yield- gal/min with ft drawdown after his O Yield gal/min with ft drawdown after hrs V Recovery data(tune taken as zero when pump turned of(water level measured from RECE Y`J .r D W well top to water level) V 0 Time Water Level Time Water Level Time Water Level SEPa820 C C) E Date of test Washington S ate ar Bailer test2_gal/,run with L'� ft drawdown after�__hrs Departnent tit t Ology Airiest gal/min with stem set at ft for his QArtesian flow g p m Date 7�0? ' 0 QTemperature of water Was a chemical analysis made? ❑Yes 4]'No Start Date/�Z J Completed Date 2. D WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all • Washington well construction standards.Materi used and the information reported above are true to best Irnowledge an beliefs I— ADriller 0 Engineer 0 Trainee me tit Zee DnllingCompai Driller/Engineer/Trainee Signatt [+�-l4.......E_--X Addres06/ r ^1-1,4 ( 0 I f-,L0, Driller or Trainee License No. ! 15 City,State,Zipe �M• 96S�y Contractor's se�yy If trainee,licensed driller's Registrau� a '"�Date � �3 Signature and License no. Ecology is an Equal Opportunity Employer ECY 050-1-20(Rev 4/01) Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA. 98584 Customer: Jeanne Blanton Well Tag #: AHR494 Site Address: 161 W Blanton Acres, Shelton Depth: 163' Date of Test: 7/9/25 Static: 79.2' Pump Set: Unknown TIME GPM LEVEL RECOVERY 1 Min 11.5 82.9 TIME LEVEL 2 Min 11.5 83.4 1 Min 83 3 Min 11.5 83.5 2 Min 82.1 4 Min 11.5 83.6 3 Min 81.4 5 Min 11.5 83.7 4 Min 81.1 6 Min 11.5 83.8 5 Min 81 7 Min 11.5 83.9 6 Min 80.8 8 Min 11.5 84 7 Min 80.7 9 Min 11.5 84.1 8 Min 80.6 10 Min 11.5 84.2 9 Min 80.45 15 Min 11.5 84.3 10 Min 80.35 20 Min 11.5 84.3 25 Min 11.5 84.3 30 Min 11.5 84.3 35 Min 11.5 84.3 40 Min 11.5 84.3 ✓� ` 2 45 Min 11.5 84.35 50 Min 11.5 84.35 S 2Q 55 1 Hrn 11.5 84.4 11.5 84.4 R �F/CFO ZS 1 Hr 10 Min 11.5 84.4 II Total Gallons Pumped: 805 0 sli • Thurston County Environmental Health 412 Lilly Rd NE t Olympia,WA 98506 360 867-2631 THURS ON COUNTY COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County r Collected It AM 9.•: Month Day Year s'b ❑PM �)QSOL Type of Water System(check only one box) ❑ Private Household S •t-/Y i#s,•/F y ❑Group A ❑Group B l Other �� Group AAand Group B Systems-Provide from Water Facilities Inventory(WFI): ID# ,4__ J:L R System Name: 1 ea vi, sr. Contact Person: -.56 v► F{,Bich, r< „ Day Phone:( 360)- E 7--)c1 - 3. Cell Phone:(5(,0 ) Eve.Phone:( ) Send results to: Print1uil name,address and zip code or email address) w g, g/961/11,k.Ack( S /-e/i4 h cam,_ 98S e SAMPLE INFORMATION Sample collected by(name): Alvl Specific location or address where sample collected: Special instructions or comments: / 91 u-j f3/�vt�, ,4 CV'ri Type of Sample(must check only one box of#1 through#4 listed below) 1.❑Routine Distribution Sample 2.Repeat Sample(after unsat.routine) Chlorinated:Yes No_ ❑Distribution System Chlorine Residual:Total Free Chlorinated:Yes No__ 3.Raw Water Source Sample Chlorine Residual:Total __.Free ❑E.coli-GWR(A/P) ❑Fecal-surface,Gwl,springs(numeration) Unsatisfactory routine lab number: Filtered:Yes No ❑Assessment Monitoring(A/P) Unsatisfactory routine collect date: ❑Other 4.0 Sample Collected for Information Only Investigative X __ Construction/Repairs _ Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and ►: Satisfactory ❑E.coli present ❑E.coli absent o*.)(form detected Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC ❑ Bacterial Density Results:Total Coliform 1100m1. E.coli /100m1. Fecal Coliform _/100ml Enterococci /100 ml. / ❑E Method Code';e.SM 9223E ❑SM 9222D ate and Time Received:j-L�T ❑SM 9215B nterolerK� pate ) J O Date and lime Analyzed: (,2 ' Date Reportedd'' ' S Sample Number(DOH number plus five digits) Lab Use Only: 0 8 0 � l DOH Form#331-319(revised 11123) r c46/,� ,,o, l;,`v \f,?,0-(7(_) III well �e`� 4e Vc PA AI' vi•r Y t /lig 7 . .___ _ _ _ :,.. _._ ,71 ! C Teotv� , ,, Q N ` PryPA+c�► vie)!, i { e ' aI� �� r � RA A 1 r/ I 04614,4 t OP PA c :__ ._. _ r RD. ' +�--�'�' 2(�0 Yvl G h o or �''n C Y nor cA .)k wed ate, _..,,,,.-...,- _..,.._._.. _ -._.......----- . . _......,.-\)001.--'.. ‘• .. -•-- r. MASON COUNTY HEALTH DEPARTMENT JUL 1 2 1982 3403 71 • STREET • , . (1 SHELTON, WE (ASH) 985 MAMAS. t -,- Y l E � •b}4Z6 SSbI HEALTH t, 'IT ,R S • • • ANAL INSPECTION OF YOUR S AGE ISPOSA WR OWNER �,44-01t' /" �.p ADDRESS - l THIS RECORD I OT A GUARANTEE OF PERFORMANCE. LEGAL A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER DESCRIPTION 7 ` t -3 WITH PROPER MAINTENANCE AND CAREFUL USE OF .--�/'' .t/ le WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- I I y se �INE VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE FIELD X LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. SIZE FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND THE AMOUNT THAT A GARBAGE DISPOSAL IS USED.CLEAN- SIZE ( lQO b ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- SEPTIC TANK f ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS GRAINFIELD TN" FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH 3 ' Z$ 3 FT. MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA SQ. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS TILE ❑ CORRUGATED ilt. RIGID ❑ CEMENT RECORD WHEN HE COMES. 'DEPTH ROCK SOW TOTAL HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE CU_ YDS. PIPE DEPTH DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. 4 NORTH SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO THE SEPTIC TANK AS THEY WOULD INTERFERE WITH CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE DRAINFIELD_ ANY SETTLING OF THE GROUND OVER THE TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX -aill , - CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. • WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT EQUAL TO ONE HALF INCH OF RAIN PER DAY. FOOTING DRAINAGE, DOWNSPOUTS AND WATER SOFTENER RECHARGE WATER SHOULD NOT BE CON- �P - NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE DRAINFIELD AREA. THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE NORMAL USE OF BOWL CLEANERS OR CLEANING COM- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. ` L Q uZ Pri THIS IS AN IMPORTANT DOCUMENT DAes-\ VED BY CERTIFIED BY 0 me KEEP IT WITH DEED-OR OTHER �� 1 ' t ESSENTIAL .- ,,..:;i'Icvc:50?3'-- ountyDMS 1 w ff•Ns A f R U. • it ik ii,' •i - `00 ,� '•• •. �`l '"..' '- .e» \1%�, � 1,11•".. O ,sl,;.j 0 11% ti La h 11 a v L I I O W •7'% PpT > SEP 1 2 2003 E' . . • m 0 V .. rC . • • 11 , ..s.0 yJ G. o-c • S �A AI-Fs -0-.* i Z L I is 2 -.A. r 4 r ill O VI II ("‘.j.';'1 4 1 : il 4 /4 cil.°is. 14'- •......_____ S n a Z 4 , ; Q _�-!.Y Y 4O Q 0 e i a r 1 o w . t o \O Y. .1 o l x 1— O01 O07 " W ni IYl --17/ 411 rye... ;eta From Mason County Di', Primed from Masun County DMS 1 ' ©� � © in *4iiikCI 9\Ij6*<‘7?'C2..-:(5.444711- • 4.3. 0 V 0.0 . I \ P 1 „ ., 4• fro fosedt Wa in.- I NS \ (Sau.4-10-‘4,- z-100.43/ ___ _ _ 1 o i W 3k, Awed. w Cam_ - --f- ----_. ' (4)3' x so' '?.s ,� p.F. " / , % 0 Zu 40 4e $b ,...t.,A_c,,, -* waiN ; J\re. A�¢e��,ki 45.419A-k.: ? 3 i q„ .. t 4-0„ ur�kl,u-� 18 ,ate"i" _ 5 ,� wR- 9g5�3i • , r, ,a gitor ik ( : 35" ,la ,to. (�w•.,,a,,t,) SEi-' 6 :1 •i- 2 =SS" =ta-4_,---a-u—k 3-0.,.`+ ,a te-, • Arrow Septic Designs 171 E. Vuecrest Dr Union.WA 98592 (360)898.2255 • 2121526 MASON CO WA Name and Return Address: BLANTON�*139 25322Rec F::: $158 50 Pao•s 6 Jec.e v' �,I<}� n IIIIIIMIIIIIIIIINIIIIIIIIINIIIIIII IllhlIIIOIIIIIIIII1111fiII'I�It 1 c - AFFIDAVIT WA R.E.EXCISE TAX NOV 21 2019 EXEMPT LISAPRADIER Woes..Mason County Document Title(s) - ,n 1. 4�Oct.d lv\ft�i�TC�1Gf1G� 7rL{`Qt YheA 2. Reference Numbers(s)of Documents Assigned or Released ADDITIONAL REFERENCE tYS ON PAGE Gr�ln or(s) --� �`lll(V\r .(\k. A. tAn Y1 Eak 2.NV x &NAV( ADDITIONAL GRANTORS ON PAGE ____ Grantee(s) 1. \ \t\t pteee4"}' "tv At`c �1c�r1P rS 2 `[ ADDITIONAL GRANTEES ON PAGE Legal Description (abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) 'At i 7 Tic! I� ADDITIONAL I[GAL IS ON PAGF Assessor's Property Tax Parcel/Account Number(s) 31c1 '7 - - ciboAG 39b`1 - aoo2C , 31�-r6-1 - 4 c'1 - 14 - L4 s '3 1 1 Q 1-14- cs G ADDITIONAL PARCEL IYS ON PAGE THE AUDITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEXING INFORMATION PROVIDED HEREIN. I am requesting an emergency nonstandard recording for an additional fee as provided in RCW 36.18.010. I understand that the recording processing requirements may cover up or otherwise obscure some part of the text of the original document. Signature: 0 y Date: i 1 g � a � � Return Address: James E. Hungerford Attorney at Law P.O.Box 1191 AFFIDAVIT Shelton,WA 98584 NO,, WA R.H.EXCISE TAX Nov 21 2019 Tram.UMW USA MAIM ROAD MAINTENANCE AGREEMENT GRANTORS: John H. Blanton, Donna Kempton Edwards, Linda L. Crume, Michelle R.Corey,Mary Ann Wanton GRANTEES: the present and future owners of the real estate described herein LEGAL DESCRIPTION (abbreviated): PTN SE'/, NE'/, S7 T19N R3W (full legal description on pages 1 through 3) ASSESSOR'S PARCEL NOS.: 31907-14-00010, 31907-14-00020, 31907-14-00030, 31907-14-00040,31907-14-00050,31907-14-00000 THE GRANTORS, John H. Blanton, Donna Kempton Edwards, Linda L.Crume, Michelle R.Corey,and Mary Ann Blanton,the owners of the real estate described herein, in consideration of mutual benefits with the Grantees, the present and future owners of the real estate described herein,hereby agree as follows: 1. Real Estate Affected by Agreement. John H. Blanton is the owner of the following real estate in Mason County, Washington: Parcel 1: The South 178.55 feet of the North half of the Southeast quarter of the Northeast quarter of Section 7,Township 19 North,Range 3 West,W.M.; Assessor's parcel no. 31907-14-00010; hereafter"Parcel 1". Donna Kempton Edwards is the owner of the following real estate in Mason County,Washington: Parcel 2: The West 283 feet of the North 158 feet of the South 336.55 feet of the North half of the Southeast quarter of the Northeast quarter of Section 7, Township 19 North, Range 3 West, W.M.; Assessor's parcel no. 31907-14-00020; 2121526 Page 2 of 6 11/21/2019 04:02:59 PM Mason County, WA hereafter"Parcel 2". Linda L. Crume is the owner of the following real estate in Mason County. Washington: Parcel 3: The East 293 feet of the West 576 feet of the North 158 feet of the South 336.55 feet of the North half of the Southeast quarter of the Northeast quarter of Section 7, Township 19 North, Range 3 West, W.M.; Assessor's parcel no.3 1 907-1 4-00050: hereafter"Parcel 3". Donna Kempton Edwards is the owner of the following real estate in Mason County, Washington: Parcel 4: The West 283 feet of all that portion of the North half of the Southeast quarter of the Northeast quarter,North of the South 336.55 feet thereof,and South of the North half of the North half of the North half of the Southeast quarter of the Northeast quarter of Section 7,Township 19 North,Range 3 West,W.M.; Assessor's parcel no. 31907-14-00030; hereafter"Parcel 4". Michelle R. Corey is the owner of the following real estate in Mason County, Washington: Parcel 5: The East 293 feet of the West 576 feet of the North half of the Southeast quarter of the Northeast quarter,North of the South 336.55 feet thereof,and South of the North half of the North half of the North half of the Southeast quarter of the Northeast quarter of Section 7,Township 19 North,Range 3 West, W.M.; Assessor's parcel no. 3 1 907-1 4-00040; hereafter"Parcel 5". Mary Ann Manton is the owner of the following real estate in Mason County, Washington: Parcel 6: The North half of the Southeast quarter of the Northeast quarter of Section 7, Township 19 North, Range 3 West. W.M., excepting therefrom rights of way and those portions thereof particularly described as follows: A) The North half of the North half of the North half of said Southeast quarter of the Northeast quarter; B) The South 178.55 feet of said North half of the Southeast quarter of the Northeast quarter; C) The West 576 feet of said North half of the Southeast quarter of the Northeast quarter; Assessor's Parcel No. 31907-14-00000: hereafter"Parcel 6". 2121526 Pag3ent 11/21/2019 04:02:59 PM Mason County, WA An easement was described in the instrument recorded under Auditor s File No. 324733,which easement is hereby re-affirmed and described as follows: A perpetual, non-exclusive easement for ingress, egress and utilities over and across the East 20 feet the West 293 feet of that portion of the North half of the Southeast quarter of the Northeast quarter, lying North of the South 178.55 feet thereof, and South of the South line of the North half of the North half of the North half of said Southeast quarter of the Northeast quarter; and over and across that portion of the North 20 feet of the South 198.55 feet of said North half of the Southeast quarter of the Northeast quarter which lies East of the West 293 feet thereof; all in Section 7. Township 19 North,Range 3 West,W.M.,situated in Mason County,Washington; hereafter"the Road". 3. Maintenance The owners of Parcels I through 5 will each pay $120.00 per year due on January I of each year for repair and maintenance of the Road to the owner of Parcel 6. Repair and maintenance of the Road will consist of repairing and maintaining the Road in its present or better condition, and will include grading, filling pot holes, replacing gravel. and repairing and maintaining existing drainage ditches, but not expanding, paving or otherwise improving the Road. If the amount necessary for repair and maintenance of the Road exceeds $120.00 per parcel in any year, the owners of Parcels I through 5 will share equally in the additional amount. The owner of Parcel 3 is exempt from paying the $120.00 per year assessment or sharing in additional costs until the property has been improved with a house or a modular,manufactured or mobile home. 4. Improvements Any of the Parcel owners may improve the Road at their own expense with written consent of all other Parcel owners. In order for all Parcel owners to be required to share in the costs of any improvements to the Road beyond repair and maintenance of the Road. all Parcel owners must agree to such improvements and the sharing of costs in writing. 5. Risk of Use All risks associated with use of the Road described herein and related improvements are assumed by individual users. The Parcel owners assume no liability for damages to persons or property from use of the Road by any other Parcel owners or users. 6. Enforcement of Agreement on Non-Conforming_Parties and Properties Parcel owners not conforming with the provisions of this Agreement shall be subject to interest charges of 12% per annum together with all collection fees. Unpaid charges shall become a lien against the property owned by the non-conforming party and a Notice of Claim of Lien may be filed with the Mason County Auditor. The owner of any lot liened shall also be responsible for costs and attorney's fees associated with filing and collection of the lien. 7. 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 terminated only by a written instrument signed by all of the parties to this Agreement or their successors in interest to the real estate described herein. In any litigation arising out of this Agreement, the prevailing party shall be entitled to recover reasonable attorney's fees and costs. Dated this 0,70 ' day of 11/410f ,2019. /V . John H.Blanton Donna Kempton Edwards `r'‘&tit4�L `/- "(q 2121526 ��' /�a•1�"�4.02:59 PM a�br��ount�r, WA Lin a L.Crume Michelle R.Cor > git 1 /-ao1 � Mary Ann Blanton STATE OF WASHINGTON ) ) ss. \\\\\tntl111rrru/// COUNTY OF MASON ) \��\\\ \E.,M & //// r,..\S, son F•. 'F' I, the undersigned, a Notary Public in and for the State of Washington,do hereby certify Z �OTARy -to'•••p _ that on this Zu`' ' day of /Ub,/1ut. O� , 2019, personally appeared = ��� before me John H. Blanton to me known to be the individual described in and who l u' P% UB L1C ? • executed the within instrument,and acknowledged that he signed the same as his free and '%�-7j,•'•.!7.2p 2pti'�.•*.'•O\�� voluntary act and deed,for the uses and purposes therein mentioned. '�i "O V� ////,/��r r rWA�S H�.\\\\� GIVEN un er m 'hand and official seal the day and year last above written. ititiounkj a(5-kf,t-6— Notary Public in and for the State of w l r t Washington,residing at OZk � t�A-`f7adff )'J--- Siiv My Commission Expires: ,L( ZU ( Z�Z t STATE OF WASHINGTON ) ss. COUNTY OF MASON ) \\oktlllUrrlf/o// I.the undersigned,a Notary Public in and for the State of Washington, do hereby certify `\\\�\ $1 E /Lj //,//// that on this ZID` day of AID,/1¢.E�.4�1•vA , 2019, personally appeared .` �..••'Mssio,,,••, '9 ;ac° Ft'•.� before me Donna Kempton Edwards to me known to be the individual described in and ••, Wrgio .b Y who executed the within instrument, and acknowledged that she signed the same as her _ u , J- co: D free and voluntary act and deed,for the uses and purposes therein mentioned. -I A0 "= _ q : QLIC ' '•20-202�••'• O .`� GIVEN un er my hand and official seal the day and year last above written. '% OF . , '0,////WASrH\14 xvv`� r---, itki-L--"IA-2)6-"%- Notary Public in and for the State off Washington,residing at �t ln.; 7 ( r My Commission Expires: 11(2._b J 20 Z I STATE OF WASHINGTON ) ) ss. o C��, COUNTY OF yA�5 10h ) ���x‘�� tK rl��'(V���'. 1, the undersigned,a Notary Public in and for the State of Washington, do hereby certify $ 1i1r. S r that on this 7 day of f vQl/ - 2019, personally appeared `,t� i a+ = before me Linda L. Crume to me known to be the individual described in and who t1Ij .• h1 executed the within instrument, and acknowledged that she signed the same as her free ;; to ,,,..�,,,,r� ti;.. and voluntary act and deed, for the uses and purposes therein mentioned. �'�.�4 �e ofyy0b�. s'%•'`'ninon n0- GIVEN under my hand and official seal the day and year last above written. 2121526 Page 5 of 6 11/21/2019 04:02:59 PM Mason County, WA 2226486 MASON CO WA 06/09/2025 02,00 PM NOTCE 1111111111111111111111111111111 II 1577 1//1111 I1111111 III11111IIIII VII1111 Pages 2 Return To Jh�c,y� \ v-AALvn 1 o\ L3 Rj1 e S ke.Ann L3 9tas-ay- Grantor(s): (1) � ovlr\ • 6.(14-n ,(2) Grantee(s):(1)PUBLIC Legal Description(1) t \ oc 5E 1Jt 7 ' 19 - 3 (Abbreviated form:i.e. lot,block,plat or section,township,range) Assessor's Tax Parcel: (1) -3 flal&"-/-- I `-\ - GOc>k 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) -319 O-7 - 1 A—COO, Tax Parcel:(Connection 2) 3 i`10-7 - 1 y - pcy�Sb The system owner is responsible for keeping this system in compliance. The name of the water system is: 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 ??�A. day of V v<'\ ,20 a S. Signature of Grantor(s): (1) ,(2) Page 1 of 2 siminummaamumismommimmolor State of Washington County of Mason I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this 3 rd day of t1U( k. ,20 ca�, \i once . 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 year last above written. . 1//(/ `�p.a ton pF %�� Notary Publicli in d for the State of Washington, Oo�•N3-2 off)% residing at `,�( / � w0.SMier Pc\ ! ^a0IARY _ _ My commission expires: 1a- 13 ' �a1 I•c N: = r. PUBS-�G N'• _ •O per.*A, muse rt.•"V'��� .mbO /// OF W AS?\\ Page 2 of 2