HomeMy WebLinkAboutWEL2026-00001 - WEL Application, Design, Letter - 3/2/2026 >,\ MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
eks,}• BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
n.tom.
FAX:360-427-7787
03/02/2026
1208 FIR LLC
1089 LAKE WASHINGTON BLVD N APT A201
RENTON, WA 98056
RE: WATER SYSTEM PERMIT: TWO-PARTY
WEL2026-00001
300 E Sherwood Hills Rd S
122307500160
The 2-party water system, Two-Party Well (SFR + SFR): 300 E Sherwood Two-Party Water System
(122307500160/122307500160), 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
4l P 1 M SON COUNTY •
Date Received: o t jai,
l , , COMMUNITY SERVICES Amount Received: 5w Received Ely:
Building,Planning,Environmental Health,Community Health ���� ) i/
415 N.6th Street,(Bldg 8)—Shelton,WA 98584 WE L aoa O _ DO c t t
Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400
TWO-PARTY PRIVATE WATER SYSTEM APPLICATION
APPLICANT PHONE
1208 FIR LLC 248-930-1988
MAILING ADDRESS-STREET,CITY,STATE,ZIP
1089 Lake Washington Blvd N Apt A201, Renton, WA 98056
SITE ADDRESS-STREET,CITY,STATE,ZIP
300 E Sherwood Hills,Allyn,WA 98524
PRIMARY PARCEL NUMBER(WELL SITE)
12230-75-00160
SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL)
12230-75-00160
WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE(no minimum) PARCEL 2 LOT SIZE(no minimum)
❑New X Existing X Well ❑ Spring 2.49 AC 2.49 AC
PROPOSED WATER SYSTEM NAME(REQUIRED).
300 E Sherwood Two-Party Water Syst/em PROJECT DESCRIPTION(e.g.,detached ADU,new single-family residence,existing connection,etc.) ']�( /,te,_Lot Split permit number SPL 2025 00003 //;;" :--
LI ( //'"I n/.7 —
Nil JAN —Li GI Igii
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DIRECTIONS TO SITE/CONDITIONS/GATE CODE/KEY LOCATION/ETC. , j
21.125 ..
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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.)
;I
ATTACHED
•
Required Submittals Checklist: (additional information located on the first page of this packet)
m Satisfactory bacteriological test from within the last year
0 Well report with well tag number,well tag secured to well casing,and capacity test showing 800 gal per day
Ed Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office
m Septic Records(additional locating requirements may apply if there are no septic records on file)
This form may be scanned and made available.for public viewing on the Mason County website. Revised:07/23/2025
Page 1 of 2
Staff Use Only
Review Step 1: Well Site Inspection: Ntiv 40 G°`l'i4 a(S 01
-ct'a�, Pal ? ,,
YES N/O - Glt Coop It A-Li 3 -b r (i1/1
1(�,i ` ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields,
O`` W tanks,buildings;indicate distance on plot plan)
-1)\I O fi ❑ Are there roads within a 100-foot radius of the water source?
Is the road Private,County,or State?(circle one) Distance to the road(s)
❑ ❑ Does the ground slope away from the water source site?
O ❑ Satisfactory well cap? Vfr/ CAQ0t
O ryi ❑ Well cap screened and vented?
❑ The well casing extends 6 above level ground/c ncre slab?(circle one)
❑ ❑ Well tag attached to well casing? Lat: 'i •363m6
O 1 Evidence of an adequate surface seal? Lon:—I Z 2. P3-1.5.F
❑ ❑ Variance necessary for well site approval? Tag: i34G(s®
Comments:..Cl tker! ipoil woe" vik i z f f c4' Lei. Litt Cap cg//D�•the c riitveil irArse
Rile( 1 ' ca- abaci-- 43 ft film L-P.f 1
31 Z(ZU1G� ter ,c z1417076 Z(y l7r'76 ! CGr?f�n n S 1I o
3( Vass Fail Inspector Date j /2, O26
411,
3_0/1 PO
Review Step 2: Two-Party Review: ititi, yell re *r'f eh( ty AO'U U. No orl`9r�tt t o fYel
YES NO NA 7
❑ O Water well report(well log):Date Completed ( l o f?O'6 Driller 14 �'�U 1
❑ ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static level within 24 hours?
Capacity test information:Date 11(' q Za?Driller/Pump Installer 4(W 0i'ff j
GPM Is- Duration(minutes) 6 Total Gal MV Recovery Time(minutes)to Static 6
❑ ❑ Satisfactory bacteriological analysis? Date I I/S(�Zr Testing Lab *Iliad✓' f/ lab 0 l)/4991
/ef
❑ O Signed,notarized,and recorded notice to future property owners?AFN 2 2 3 .01 706(Z Zt
;_f-
❑ ❑ The system appears adequate to serve two connections based on the information provided - r.p
'mot v. F
Y ADComments: '
MARCp�, �� � 3
'7r)[Approved ❑ Denied Reviewer /1" Date tr' far
p,�
L HEAL rH
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 adequaoy 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 196, 2018 per ESSB 6091.
Revised:07/23/2025
This form may be scanned and made available for public viewing on the Mason County website.
Page 2 of 2
Figure A-2. Example Water Well Report for an Existing Well
Water Well Report For An Existing Well
Your well must be properly tagged prior to submitting this form.
Jr7AC'S1r Nr Or Asterisks(')indicate required fields.Mail completed original form to:
ECOLOGY WA State Department of Ecology,PO Box 47600,Olympia,WA 985047600
Sire 0.Wash tx;,rcn
Use this form if an original Water Well Report was never filed or is missing from Ecology records.
'Current Use
omestic ❑Industrial ❑hhmicipal ❑Dei'rater 'Unique Ecology Wet ID Tag Number. BO C150
Q
.❑Inigaton ❑Test Welt [(Other 'Water Right:DYes(if yes,attach a copy) 18(No
Dimensions Property Owner Name: i2Oe Fir,{ LI-C.
Diameter of well.ID in. r� ,!competed well ft.(if known)
'Well Street Address: 300 C S'ierwocd Ili I LS Rd
Depth of competed
Construction Details 'City: Allyn 'County Mason
Liner installed Oyes ONo ' Unknahn
Type:❑PVC ❑Steel ❑Concre Liner 'Site Well ID: 1111khQW Yl
cDUnknorn Daher.__ 'Tax Parcel Number: r2.230-15-0011420
a Perforations 'Date Well Constructed: unknown
g. DYes [No Anknavn
d Size of perforations In.by In. 'Location(Township,Range,Section)
3 Number olperfora onsfromft.toft. An accurate location of your well is very important.The
in Screens Section,Township,Range,and'h.%can be found on your
"e.. DYes ONo nknown tax parcel legal description or through your county
c Type:OSlainless Steel ❑PVC D0th� assessor's office.
Diameter Slot Size from ft.tatt. Township 2Z IU Range"1W ❑E1h'M or M
c
o GraveliFliter Pack Section 30 .6 114-1,4 $E_114
c DYes ONo ,Unknown
E Materials placed frontft.to R. Comments:
t.
o Surface Seal RECEIVED
L ❑❑Neos If Wm,Urtknownhat depth ft.
N. Materials if known:
Dept of Ecology SWRO
vDBenton to [(Cement
�P�ynp 11 Nov25
o tgYes ❑No I]Unknown
p ��ype subrnersti te.Horse Power I_5 Latitude/Longitude
d Water Levels (Decimal Degrees recorded to 5 decimal places)
+
Land-surface elevation above mean sea level, R Latitude Example 47.12345)
Casing stick-up I i above/below land surface 1 141.311731 .1I N
c Static Level 1PA.41t.below top of casing Date measured:ii L't 1� Lon itude(Example 118.12345)
L Artesian pressure lbs.per square in.Date measured: —I�, ,8532lotii I
3 Well head has cap? fes ONo Shut off valve?Dyes❑No
Well Tests: Additional Information(If available,please attach)
I—
Drawdown is amount wd er evel Is lowered below static level. DLocation marked on topographic map
Z Was a pu test made?�Y jattach copy)ONo ❑Unknown ❑Location marked on alt photo
to
Yield: I'gaumin.with Ict It.drawdovm alter_L hrs. ❑Consultant well report
of
73
'Certification:The information reported above is true to the best of my knowledge
edge and betel.
al
O [(Consulting Firm %Driller [(Engineer ❑Property .vner
w Name:�Q�QI� ph'y}h l Qrl Company.Ar cc a Dr it[i ng,i nc•
c License Number 2 rj3 Address of person completing this tem
y Signature: 17r 21w WPS 121f Ci-
Date Signed: l l O4 City,State,Zip:Shetionp/A q2524
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a EC 1.G-.: :-:-:c ai`,' t-4'. ,Ail:r:tr::�� .==::11:!=r
Q .. - :�>:rm:;:>t Iowa,!:::ae:::utly u;m-C :il:_,c:o:?11 e:r.i ra.¢:a:?.:::,f.7....7.,?..
.- . .-_..- ,.:n ra;u:rd C:n-..z::.t}t;l'.1 V.,, n;::o£ein'.t:.::o-�e'1: H...-.,1.-117.-:::.t:t.:.:^:ma•:ca T ir.! '
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EAP081,Version 1.2 Page 20
Uncontrolled copy when printed
Arcadia Drilling Inc.
P.O. Box 1790
Shelton,WA. 98584
Customer: 1208 Fir, LLC Well Tag#: BQC150
Site Address: 300 E Sherwood Hills Rd,Allyn Depth: Approx. 300'
Date of Test: 11/4/25 Static: 189.4'
Pump Set: Unknown
TIME GPM LEVEL RECOVERY
1 Min 15 197.6 TIME LEVEL
2 Min 15 204 1 Min 195
3 Min 15 204 2 Min 192
4 Min 15 204 3 Min 191
5 Min 15 204 4 Min 190
6 Min 15 204 5 Min 189.7
7 Min 15 204 6 Min 189.4
8 Min 15 204
9 Min 15 204 Well Diameter: 6"
10 Min 15 204 Latitude: 47.3631211 N
15 Min 15 204 Longitude: -122.8532691 W
20 Min 15 204
25 Min 15 204
30 Min 15 204
35 Min 15 204
40 Min 15 204
45 Min 15 204
50 Min 15 204
55 Min 15 204
1 Hr 15 204
Total Gallons Pumped: 900
1-"
Vanguard Laboratory
2635 Parkmont Lane SW, Suite A
Olympia WA 98502
=,u7nIIAP>? 360-967-7010
COLIFORM BACTERIA ANALYSIS FORM
Date Sample Collected Time Sample County
Collected
11/04/2025 3 5 ❑AM Mason
Month Day Year I PM
Type of Water System(check only one box)
0 Group A 0 Group B 0 Other
Group A and Group B Systems—Provide from Water Facilities Inventory(WFI):
ID#
System Name: 1208 Fir, LLC i
Contact Person:Arcadia Drilling,Inc
Day Phone:(360 )426-3395 Cell Phone:( )
Email: Eve.Phone:( ) •
Send results to:(Print full name,address and zip code or e-mail)
arfeta@arcadiadrilling.comANDjenn@arcadiadriliing.com
SAMPLE INFORMATION .
Sample collected by(name):Max
Specific location where sample collected: Special instructions or comments:
300 E Sherwood Hills Rd,Allyn Counts please
Type of Sample(select only one type of sample from types 1 through 5 below)
1.0 Routine Distribution Sample(NP) 2.0 Repeat Sample(NP)
Chlorinated:Yes No (from distribution system after unsat.routine)
Unsatisfactory routine lab number:
Chlorine Residual:Total Free
3.Ground Water Rule Source Sample
S I I Unsatisfactory routine collect date:
I
Chlorinated:Yes No
❑Triggered(A/P) Chlorine Residual:Total_Free
❑Assessment(A/P)
4. Surface or GWI Raw Source Water Sample(Enumeration)
S
❑E.col/ 0 Fecal Filtered Yes_No
5.❑i Sample Collected for Information Only:
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY'
❑Unsatisfactory Total Coliform Present and xi Satisfactory
❑E.coll present 0 E.col absent
Bacterial Density Results:Total Coliform <1.0 /100ml. E.cofi <1.0 /100ml.
Fecal Coliform /100ml. HPC /1 ml.
Replacement Sample Required: 0 TNTC 0 Sample too old
❑ Sample Volume 0 Damaged Container 0
Date rime Received: 11/5/25 Lab Reference Number
V251105-22 •
Receipt Temp C": Method Code:
SM9223B
Date Reported to DOH Lab Use Only:
DOH Lab-Sampte#
285-10522 •
DOH Farts o101J14(effect.05f17)-N you reed et®pcbkadoe in en Smarm format ad 800 5250127(TDDTTY cal 711).
This and aTc pts a s en inaddide of tr.dotwagortdnnYmgrater.
Return To 2237008 MASON CO WA
02/18/2026 08:52 AM NOTCE
Brad Henson HENSON 9112 Rec Fee: $304.50 Pages: 2
����U����i����ii ii ESE MI THii D
1829 29th Ave,
Seattle, WA 98122 iI;.:IiLii ; flfl'' FEE211:P12026
Grantor(s): (1) Brad Henson (2)
Grantee(s): (1)PUBLIC
Legal Description(1) 300 E Sherwood Hills, Allyn, WA 98524 gee, 3D-W22_12-..1
(Abbreviated form:i.e. lot, block,plat or section, township, range)
Assessor's Tax Parcel: (1) 12230-75-00160
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) 12230-75-00160
Tax Parcel: (Connection 2) 12230-75-00160
The system owner is responsible for keeping this system in compliance.
The name of the water system is: 300 E Sherwood Two-Party Water System
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 11 day of Feruary ,20 26 .
Signature of Grantor(s):
(1) 8 , (2)
Page 1 of 2
Electronically signed and notarized online using the Proof platform.
yP
State of WAX1O41O41 Texas \I
County of MOM( TARRANT YP
I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify
that on this 11 day of FEBRUARY ,20 26 ,
Brad Henson 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.
d�llllltllli/i E
o•paY 1'4'6�� V0NTRICK DAVIDS0N Notary Public in and for the State of �n'Texas
a.: ,.+. 0 _ residing at TARRANT COUNTY
12/08/2028
N.. V/\ ID NUMBER$ y My commission expires:
a . 'P 132814711
OF S �\� COMMISSION EXPIRES
/14041pP0 December 8,2028
Electronically signed and notarized online using the Proof platform.
Page 2 of 2
320 E Sherwood Hills Rd,Allyn,WA 95524, USA Union-Grapeview Township, Parcel Id: 1223075 60
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eur mobil
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--- _ ,
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�, 2 Existingshop NE-/
3 -- --
3.1150 Septic tank e• ii i E� e - gravity tied
_�@serve ar@__._, _ _ ._. .__.__- l �-�
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g complet@d F`•..:f.:: 991 is_accurate. It was scoffed \� '
_ of by ca Bamford Septic Repair 13
1.
-----...._,...—... ._...44.,..,„,____________„_ a. Parce6 Lines Buffer 5 ft �./ , L A / co
4 .
0. ®5 r"j t6 Lott , I
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' 2 IVIobi1 home r@mom_d 495 • � . A IF.
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- --' __::::_ -_ ., 31176 tank _
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— OX. .
-- _Existing drainfield � ��
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@serve .i
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area r--------------__:_7.:.:.=:.
--- _-- •t'
4.
a Waterline s " -j
The record d "
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rawin
gcoml
in 1992 Is completed z
accura__te. ft
Gi s 1_ by Bamford S - _ --
@�tiC Ri=palr j _ li 9 1
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;.'A Mason 10 f₹. Contours .,\ ,
v , N ' :
-�.-
Scale=> l in : 7®ft ,, ,
SHORT SUBDIVISION NO.
ORIGINAL LEGAL DESCRIPTION' NOTE FIRE MARSHALL CONDITIONS
PER REAL ESTATE CONTRACT,RECORDERS NUMBER 2218732 RECORDS CF MASON ALL LOIS mums FROM 11)15 PROPEL ARE MIN 500 FEET 0T LAND 512004TEO 1. ERE DEPT ACCESS 8040 RE Access COUNTY,WASHINGTON: s E EACH PARCEL SHORT PLAT FOR
FOR CMWMR(AAL FORESTRY,8211015 OR AGRICULTURE MASON COUNTY HAS SHALL REACH EDEN 150 RE THE RIMIEST PONT
R ANY STRUCTURE MELVIN D. SWAN
TRIG/I8 OU SKYEY RECORDED NOVEMBER IO 197E M SGUYE 2 SwVE15,PALE ESTA%1516D DESGUIED LONG-TERM CONHERDAL FOREST LOUD THAT EIS AS A CONSTRUCTED AFTER APPROVAL OF DRS SHORT SUBDIVISION.ACCESS ROADS P.0. BOX 425
IDS TLB UNDERSURREAMORE ECCFILE N0.J216 H. PRIORITY THE USE O°DFSE LAM FOR COMMERCIAL CHEST MANAGFLOLT,IMO. THROUGH DRIER PARCELS SNAIL HAVE ESTABLISHED ACCESS EASEMENTS
AID AG0'DRTURE RESIDENTS OF TM PROPERTY MAYO SUBJECT TO MCONYBEINRE MITRED ON BNAL MAPS ALLYN, WA 98524
OR DISCOMFORT ASSOCIATED HIE THE LW!eau=BUT NOT MMRMD TE 2 E001-AR0JN0 FOR ACCESS ROADS N EXCESS OF 309 FFE7,AT THE
RASIR OF REARMS: OC10A ORAL OILS?,NOISE AND Ern FROM COMMERCIAL nomnq CLEAR CUTTING MORMON OF SAID ROAD,AN AFFRO)04 PROVISION FOR TURING AROUND
BETWEEN DIE GRAM COW EN TO SEC 29 30 31 AND 32 AND RE S WARIER SASH BIA MN0.RAM SWAGE WING REAR MEAL APPUCATRw1! FIRE APPARATUS SHALL IE PROWLED.MCC 7617090 PARCEL #12230-75-00180
CORNER OF SAN SECTION JO(SPBffi'4.T E) MIME MAMMOA PROPERTY TEEN 500 FEET OF SAID LARDS SHED a DRIwNc SURFACE AN ALL-NERVY DRIVE SURFACE CAPABLE OF
SITE ADDRESS:
NECESSARY
m ALAI IT R WALL RE RE a DISCOMFORT R FROM PROPER.Yrm TING DE MONT HF FOIE APPARATUS STALL BE PROVIDED FOR 300 E SHERWOOD MILS
N rrCCARI PEARS PLA IT BE T S RESPDNSBDm a A.4 PROPERTY Y OETER PEROT ACCESS ROADS SERGE EACH BUDDING SIM MCC 7077.040 ALLYN, WA 98524
REFERENCE� � ERE T A DESICNATTEED LLLw i GF sE IAANDPROMPT' 4. ADDRESS SIGVAGe PERMANENT REFLECTIVE ADDRESS SWAGE SHALL BE
5)0217 AFlE327604 TO ROPY ME*MA(LAND OEFR O MDR OMIT TO 00 S N ACCORDANCE NTH PROVED EDa4 MEETS FRE MARSHAL STANDARD.(MEGRIM ADDRESS DECLARATION OF SHORT SUBDIVISION
DE MSG COUNTY RE51CRCE ORDINANCE(MCC 8.52). SEWAGE).FOR DIEWOA15 SERVE I ME THAN ONE PAM,ADDITIONAL
MBI'HODOLOGY• SWAGE SHALL RE PROVIDED AT ANY NEHSCDOI(S)ON SAD DREW NO. IS RECORDED UNDER AUDITOR'S
DOS SURVEY HAS PERFORMED VIA CONVENTIONAL AND RADIAL SURVEY MORES AND FOR ROAD MARNDHAIICL SEE P80111,1Mz COMMIS 0F SMOKED TRACTS 1Emm0D MCC 14)7.160 FILE NO. •
MEET 0R IXETD ROE AC0DRACY REQUIREMENTS AS SET Finn!BY RAC 012150090 0041 EER I7,19714 UNDER AUDITORS HE NO 321676 5 FDE SPENDER SYSTEM:DUE TO MIKADO GUS EXCEEDING A IRS SEE
A FIRE Slogans AnILM THAT CONFORMS TO NFPA-721/13 SHALL 00
WATER ALLOCATION STATEMENT, INSTALLED N ANY REsowna/rnNERCIAL STRUCTURES BUILT AFTER WARNING:
DDS GREY COMES EMI DE STANDARDS AND GOETHEE a TIE'GREY WATER IBD DRAwNS FROM ANY AND ALL ED!PTHELLS APPLY TO PARCELS CREATED
RECORDING 0F 7165 SHORT I18DIVISOL MCC 7077.710.
REmwwc ACT'CHAPTER 5809 ROW FROM THE BRARAL LOT(I223o-75-OM60)MAR ARE COOLECR ELY LPNED TO 5,000
CALLOW PER DAY TOTAL UARESS A WATER HEGHT IS C?TABL D TOR DE ADDITIONAL SEPTIC ROTS MASON COUNTY HAS No RESPONSIBILITY TO BUILD,
EQLIIP1 ET USED, KUR E ADDLE DO'OOIRT 5,CCO GALLOPS THE MOUNT OF WATER THAT CAN BEIMPROVE, MAINTAIN, OR OTHERWISE SERVICE THE PRIVATE
YARILRAON ER EARN LOT S STORED MOW FOR SPCC SYSTEM BETARS,SF AS-DIR.T5 ON FOE ERR MASON OXMrY ROADS WITHIN OR PROVIDING SERVICE TO THE PROPERTY
T ISLE Si 1 SECOND TOTAL STATION OIEORO&DGTAL HEALTH CEPARRIOOT N DESCRIBED IN THIS SHORT PLAT.
IWOMAX ZOOM>ao 2 SECOND ROTOR TOTAL SEARCH LOT 1:7,500 GALLONS PER DAY ANY FURTHER DIVISION OF EATS WITHIN THIS SHORT
TO'LON EWE 1 V CPS WEGNER LOT 22500 GALLONS PER DAY ♦ 4 SUBDIVISION SHALL BE SUBJECT TO TITLE 16 OF MASON
VERTICAL DATUM O1FN LOTS ARE ALLOCATED MORE RAN RE MGM REGIMENT,RE BALANCE OF W....99.4„, EGE COUNTY CODE
MW Gas A EM(NADO!/GEOID 728(MAW 88) 00 EE RRMIDH MAY
CHANGED ECORDED 011 THE CORM OF D Cf E Pa TIES ROFETY �, � DIRECTORS APPROVAL
PER RCW 904'00 4 RE MICA=OF LIENS OR NOV�— R0AL 0.41866I5 S FILED FOR RECORDING PURSUANT OF MASON COUNTY
OYIECRELY LOOTED TO ONE—HALF ACRE ET OUT A STATE EVADER WORE GRAPHIC SCALE TITLE 16.38
PER B 6091,LOIS RESULTING FROM MS DILI=ARE LIMITED lO AN ATONAL 0 50 100 200 FEET
MB
AIRRA6E MAXIMUM USAGE OF 950 GPO M WATERSHED RESOURCE NYHNTORY AREA 14. �
the Table L,m Lao , DIRECTOR OF COMMUNITY DEVELOPMENT
Lune/ Direction Length I II I LE M DATE APPROVED:
If I
LI ASSEG OYIE 2865
ROBERT& RAMCL2 Su37.071v 067 1 0-755---M70 I I I 0 OTIFR CORNERS FOUND AS 6000 AUDITOR'S CERTIFICATE
I1 I • SET 1/2'ROTH VI/CAP Lsp2443
II I ARTHUR J CURDS II + E01ON WEER FILED FOR RECORD THIS_DAY OF_2025 AT
_ 11881:111881:154.4125 �W ggg,4p' I I 12230-75-00080
IN BOOK OF SURVEYS AT PAGE
1.5'RCN PIPE - _I- h0� WAH7IFR LOOFR
6DH CAP EGAD MAR , " I I SWB,ECTPARCL BWYDARY AT THE REQUEST OF MELVIN A SWAN.
15/I8018 r�i%_% NO GP I
I LOT LIFE COUNTY AUDITOR
'a'4 LOP 1 MOBILE HOME FOR / „ , I BE EAELINT PER ARE 321916 - _ Ek15lR'G EASEMENT[NE
d 7(w555 SF. E ^m
9g 249 AC I SCOTT A SARAH MUNffA
RAGMEN STATE DIP!.0F,'J • I g I 12230-75-90094 - EASEMENT BEING DEDICATED
FARM RESOURCES N66T5'43'W-48515' ' 20' I AMMO PARCEL Le4Es SURVEYOR'S CERTIFICATE
12230-00-64000 r0'WIRY FA5EMEHr Fa n e sawn a 001 7 = / •-69805'43'W-171.62'4 _, _ _SHORT PLAT
IS'TM ACCESS FASDD IT 20'•\ I — - OHP— DORM MEAD PORN LINE
-
RR TTE COS35 A WT 1'i I"- TORY ME11. \ J/2878 THIS MAP CORRECTLY REPRESENTS A SURVEY MADE BY
ME\ I ® EUSMNC SEPTIC TARP(VD ME OR UNDER MY DIRECTION IN CONFORMANCE WITH THE
R 1O}2 Avt NWSE_'L Htiw 'Cl1±\ \ "_va ME= I mama EARL A RELY L TINDER REQUIREMENTS OF THE SURVEY RECORDING ACT AT THE
1 I 1zz3o-7s s0D93 da EATING GtEU Our RE@UEST OF J HOLDINGS IN MARCEL 2025.
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AUDITOR'S INDEX NT,S
I 1 L
I I3L i► --- SURVEYING
e Jp�L ENGINEERING
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\�-, GEOLOGY
SEPTIC DESIGN
_ _ LEROY SURVEYORS&i EN.t,INEERS'• GPS
1 S88'06 E 2BOS24' P.O.Box 740,Puyallup,Washington 98371 ODE MAPPING
3722 (253)848.6608 Farr(253)9404140
www.I6eiOOrom
9 A PORTION OF THE SW 1/4 SE I/4 SEC. 30,
R T.22N, RICO., WM
3
C LEROY SURVEYORS&ENGINEERS 12/31/25 MASON COUNTY, WASHINGTON
. ti .
ititi:, ,-,, i , i
. , COUNTY
ItoBENERAL SERVICES OE?ARTMENT °'
P.O.EM 188 • 428 WEST CEDAR• SHELTON,WA 9®384 '
LJI __RECORD
-- 1R '-
' C/
'• rid ADDRESS IT ae'T --
THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. AI "z•S
A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER oily
um- y nZIP
WITH PROPER MAINTENANCE AND:CAREFUL USE OF LEGAL DESCRIPTION
ESC'RIPTI J G
WATER IT CAN GIVE MANY YEARS OF:TROUBLE FREE SER- e54c4.. 30 T 'AI I.Z..0/ !c/GU . W`/1/10%,_
VICE. MANY.PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL
BY FLUSHING EXCESSIVE AMOUNTS .OW PAPER, CLOTH COMMENTS 0-5'® C PA 449Ai
AND PLASTIC MATERIALSI DOWN THE ;DRAIN, OR BY SITE q '
LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR 1 v 7 SIZE X $
NO.
FAULTY FIXTURES. SIZE •
auF
THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY DEPTH TO MONTH
WATER TABLE"""Q` OF YEAR
TWO OR THREE YEARS DEPENDING ON TF E HABITS OF THE INSTALLER ./1 G r, 14 7
FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND �� -4i°'�
THE AMOUNT THAT A GARBAGE DISPOSAIl IS USED.CLEAN- SIZE '/`
ING AT THE RIGHT TIME WILL AVOID THEIRISK OF INJUR- SEPTIC TANK(S) l�S`�
ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS DRAINFIELD
CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH FEET
MASON COUNTY HEALTH DEPARTMEI4T['FOR A LIST OF TRENCH AREA SQ. FT.
LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE �� O
CLEANER CAN SERVE YOU BEST IF YOU$kOW%HIM THIS TIE
RECORD WHEN HE COMES. - / DEPTH 0 CORRUGATED [ RIGID O.CEMENT
HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BEOSDEPTH
TOTAL
ROCK
DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS CU, YDS, /.5.-t, DEPTH
RECORD IN CASE OF ANY BUILDIN DRIVEWAYS, SPACE RESERVED FOR
REPLACEMENT DISTRIBUTION FIELD: ��¢
SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING Sq, FT.
ARE LATER CONTEMPLATED. I ;NORTH b • ... .., ..
'1;rC
SHRUBS OR TREES SHOULD NOT BE PLA ED CLOSE TO M --j
THE SEPTIC TANK AS THEY WOULD II TERFERE WITH
CLEANING OF THE TANK. THEY CAN BE NTED IN THE 5
tin
DRAINFIELD AREA PROVIDING WILLOWS ,RE NOT USED.
. --... n
THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE
SUCH THAT SURFACE WATER IS NOT POCKETED ON THE
DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE •
TRENCHES SHOULD BE FILLED IN WITH SOLI. DO NOT EX-
CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA.
t LC
WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT 6.?0,dei
EQUAL TO ONE HALF INCH OF RAIN PER I7AY.
FOOTING DRAINAGE, DOWNSPOUTS. AND WATER f o .
SOFTENER RECHARGE WATER SHOULD' NOT BE CON- .,
NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE
DRAINFIELD AREA. ; ' 2
THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE
ALWAYS FOUND IN SEWAGE. THERE IS NOS NEED TO ADD I
YEAST OR OTHER STARTERS TO A SYSTEM; THE USE OF RE- ;,
JUVENATORS OR CHEMICALS TO CLEAN,A SEPTIC TANK !
HAVE NOT BEEN PROVEN TO BE BENEFICIAIi AND MAY BE L4 1HARMFUL BY FLUSHING SOLIDS OUT OF TH TANK OR BY ���
CHANGING THE CHARACTERISTICS OF THE SOIL. THE
NORMAL USE OF BOWL CLEANERS OR CLEANING COM- ;
POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH
DOWN THE OPERATION OF THE SEPTIC TANK.
f tTH1515 APl<IMPOTAITDCXCU,hA ENTp y 'l s lQ 6 �! ' / O/j�C —
KEEP IT iviTH DEED`OR OTHER z"- '"-,:d 07h/ !/ \ JTEQ1STALLERESSENTIAL PAGER$ ! DATE SIGNATURE OF EPECTOR
i
I
•
-i, MASON COUNTY HEALTH DEPARTMENT
1 ! 428 WEST BIRCH STREE
SHELTON, WASHINGTON 98584
• I PHONE (206)426-5561 3cci 6 51t ;tilt. El> 5'.
_ `RECOR,D OF FJNAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM
I
OWNER�,�L/V./.o 4.- S�0:% ADDRESS �� Aa% 1 -\ c`
THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. LEGAL '' •• n.
A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER DESCRIPTION -\‘.O >�u ``�XL``e: `� S
WITH PROPER MAINTENANCE AND CAREFUL USE OF
WATER IT CAN GIVE MANY YEARS OF TRQUBLE FREE SER-
VICE.MANY PROBLEMS WITH SEPTIC TANKS QRE CAUSED SOIL ...--�
BY FLUSHING EXCESSIVE AMOUNTS OF;PAPER, CLOTH COMMENTS fry t , 4Att'+1�'r6. , .
AND PLASTIC MATERIALS TOWN THE•DRAIN, OR BY SNIT FIELD
X le"-D
LARGE AMOUNTS OF WATFROM LEAKY FAUCETS OR
FAULTY FIXTURES. 1 DEPTH TO MONTH
THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR id
TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER • �s ' 1 \\ A . �
FAMILY, THE NUMBER OF FIXTURES INTHE HOUSE, AND SIZE THE AMOUNT THAT,A GARBAGE DISPOSAL IS USED.CLEAN- SEPTIC TANK (S) /7 7 5
ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR-
ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS EENGTH `?
CARRYING OVER INTO THE DRAINFIELD. CALL THE TRENCH AREA SQ. FT.
MASON COUNTY HEALTH DEPARTMENT iFOR A LIST OFV TRENCH
LICENSED SEPTIC TANK CLEANERS IN;YOUR AREA. THE TILE ----
CLEANER CAN SERVE YOU BEST IF YOU 4HOWJHIM THIS DEPTH 0 CORRUGATED 0 RIGID 0 CEMENT
RECORD WHEN HE COMES. 'f, DEPTH /
TOTAL
HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE CUB. YDS. -6 y it il 58po �'DEPTH
DRIVEN OVER THE TANK OR DRAINFIELD; CONSULT THIS SPACE RESERVED FOR I •
RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: 6--,40- 0 SQ. FT.
SWIMMING POOLS,OR EXTENSIVE GRADING OR FILLING NORTH '-
ARE LATER CONTEMPLATED. ' i^
SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO
THE SEPTIC TANK AS THEY WOULD INTERFERE WITH
CLEANING OF THE TANK. THEY CAN BE1PLANTED IN THE . Lai 2. I
t _{G Zd
DRAINFIELD AREA PROVIDING WILLOWS;ARE NOT USED. f'Jlei
THE YARD GRADE 'iN THE DISPOSAL;AREA SHOULD BE •.
SUCH THAT SURFACE WATER IS NOT POCKETED ON THE
DRAINFIELD. ANY SMILING OF THE GROUND OVER THE 1 '
TRENCHES SHOULD BE FILLED IN WITH!SOIL. DO NOT EX-
CESSIVELY
WATER THE LAWN IN THE!DRAINFIELD AREA. {4#'t 0 Si -' .I7
WATER EVAPORATION FROM THE DRAINFIELD is ABOUT .417 t a".
EQUAL TO ONE HALF INCH OF RAIN PER DAY. /D
FOOTING DRAINAGE, DOWNSPOUTS AND WATER `% i� 3
SOFTENER RECHARGE WATER SHOUDL? NOT BE CON-
NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE 4//75 ,
DRAINFIELD AREA.
THE TYPES OF BACTERIA NEEDED IN A`5EPTIC TANK ARE tZ' -b8GI: 7
ALWAYS FOUND IN SEWAGE.THERE IS tO NEED TO ADD
YEAST OR OTHER STARTERS TO A SYSTFJ�A.THE USE OF RE /GJ
.IUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK Q °hi
HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE
HARMFUL BY FLUSHING SOLIDS OUT Q THE TANK OR BY
CHANGING THE CHARACTERISTICS F THE SOIL. THE • O
NORMAL USE OF BOWL CLEANERS ORICLEANING COM- 3 2 '4i SOUTH
POUNDS WILL NOT KILL THE BACTERIAL CTION OR SLOW _
DOWN THE OPERATION OF THE SEPTIC TANK. •
DATE 3/-CS p r�- .
.:��' �,i ..; ENT �Prrto eY
s.. �.: '1 E, w , if ,my s J ze &' —__. „/ 6 2---
If ...•ES$ENTlALP PEI '•!'• DINA: DATE TWFI Y O
I
1
,� G$ EnviroTech Septic Solutions
12635 183rd Ave SW,Rochester WA 98579
A.
Phone:360-273-3840
www.envirotechsepticsolutions.com
s£,PTio
5aY
BILL TO FFS
�
Lombard Developers 1 '/ 7,
1829 29th Avenue
Seattle,WA 98122 USA ®
INVOICE INVOICE DATE
16766169 Feb 11,2026
JOB ADDRESS Completed Date:2/11/2026
300&304 East Sherwood Hills Road
300&304 East Sherwood Hills Road
Allyn,WA 98524 USA
DESCRIPTION OF WORK
Examined and inspected both septic systems at 300&304 Sherwood hills
Examined septic systems at 300&304 E.Sherwood Hills Rd.found that both systems are operating as intended ran camera
down outlet pipe of both systems to locate drainfield found distribution box on 300 dug down to distribution box opened up
D box and camera and located both laterals on D box
304 grand camera down outlet pipe and discovered that system has three separate laterals all 5 feet apart marked with flags
and paint
Examined drywall that is over near the well I believe it is a type of drainage for either a water softener or some sort of
French drain for some sort of drainage dug down inside of drywall and exposed a inch and a quarter or 1 inch pipe that was
running in from the direction of where the house is took photos of what I saw on site secured lid down on drywell
The 24 inch riser over the 1 inch pipe is a access to the waterline that runs to the water hydrant the 4 inch pipe that is inside
of the riser is on top of a shut off valve for the yard hydrant the 1 inch pipe is likely running to the house and is the waterline
for the yard hydrant
The riser is not a dry well and is not related to any septic components and is not indicated as being so as per the as built
TASK DESCRIPTION QTY PRICE TOTAL
1 Service Call: 2.00 $260.00 $520.00
Service Call(Up to 30 mins.Any additional time is billed at$260 an
hour.)
2 Camera and Locate: 1.00 $295.00 $295.00
Camera and Locator(Up to 60 minutes.Any additional time is billed at
1 hour increments at$295.00 an hour)
3 Digging: 2.00- $100.00 $200.00
Invoice #16766169 Page 1 of 2
Locate and hand dig per 30 minutes.
PAID ON TYPE MEMO AMOUNT
2/11/2026 Credit Card $1,102.29
POTENTIAL SAVINGS $0.00
SUB-TOTAL $1,015.00
2300-MASON COUNTY 8.6% $87.29
TOTAL DUE $1,102.29
PAYMENT $1,102.29
BALANCE DUE $0.00
Thank you for choosing EnviroTech to care for your septic system!We appreciate your business and look forward to serving
you for all your future septic needs.
CUSTOMER AUTHORIZATION
Envirotech Septic Solution is hereby authorized to furnish all materials and labor required to complete the work for which
the customer signed below and agrees to pay the amount of the invoice.
WARRANTY IS BASED ON SYSTEM BEING USED WITHIN THE DESIGNED INTENT
Sign here Date 2/11/2026
CUSTOMER ACKNOWLEDGEMENT
Sign here Date 2/11/2026
I authorize EnviroTech Septic Solutions-Pumping&Service to charge the agreed amount to my credit card provided herein.
I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.
Sign here Date 2/11/2026
Invoice #16766169 Page 2 of 2
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