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HomeMy WebLinkAboutWEL2026-00004 - WEL Application, Design, Letter • MASMASON COUNTY 415N6THSTREET,SHELTON, ,E 98584 ON SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 tttr FAX:360-427-7787 04/09/2026 DAVID ASHBY BY 30 E Main St UNION, WA 98592 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00004 95 SE Dusty Ln 319027590022 The 2-party water system, Two-Party Well (SFR+ SFR): Fjord 1 (319027590022/319027590020), 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 Authentisign ID:71C77921-6B12-F111-A69A-000D3A4FF82A 5 Date Received: O �,` �� MASON COUNTY COMMUNITY SERVICES Amount Received: _ Received By. Building Planning,Environmental Health,Community Health 415N.6th Street,(Bldg 8)—Shelton,WA98584 WEL ( _ () ( L. L. Shelton:360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE David Ashby 808-740-3690 MAILING ADDRESS-STREET,CITY,STATE,ZIP 30 E Main St, Union, WA, 98592 SITE ADDRESS-STREET,CITY,STATE,ZIP 95 SE Dusty Lane, Shelton, WA 98584 PRIMARY PARCEL NUMBER(WELL SITE) 31902-75-90022 SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) 31902-75-90020 WATER SOURCE SOURCE TYPE PARCEL!LOT SIZE(no minimum) PARCEL 2 LOT SIZE(no minimum) New ❑Existing ❑� Well ❑ Spring 1.15 acres 1.20 acres PROPOSED WATER SYSTEM NAME(REQUIRED). Fjord 1 PROJECT DESCRIPTION(e.g.,detached ADU,new single-family residence,existing connection,etc.) New Single-family residence on each lot DIRECTIONS TO SITE!CONDITIONS/GATE CODE/KEY LOCATION/ETC. Lynch Road, Left on Philipps, Right on Dusty Lane, Left into neighborhood, 2nd home on left l I Required Submittals/Requirements Checklist: MAR 0.2 2026 1Jj El Original water well report(well log)or DoE water well report for an existing well. ` i ., 0 Well tag secured to the well casing.EEl ---- Capacity test showing 800 GPD with drawdown and recovery to static level information. 0 Bacteriological test(Bac-t)results: current(within 12 months)and satisfactory. El Septic Records(additional locating requirements may apply if no septic records are on file). ❑'' Applicable utility easement documents. El Notice to Future Property Owners of a Private Two-Party Water System,Water Use Agreement,and Access Easement(s)recorded with the Mason County Auditor's Office. *Note: May be recorded after the permit has been preapproved. I own the proposed two-party water well and have the right to grant access for a second connection.I attest that the well currently has no more than one connection. - A fl an,,c David Ashby [David A '- y 02/25/26 Print: Sign: Date: This form may be scanned and made available for public viewing on the Mason County website Pg 2 Last Updated: 1/7/2026 Authentisign 19:71077921-6B12-Fl 11-A69A-000D3A4FF82A Please include the following site features for each parcel served by the proposed two-party well: 0 Parcel numbers(s) 0 Property lines/boundaries 0 Applicable easements with the Auditor's File Number(AFN) 0 Roads and driveways 0 Well location with a 100 ft radius around it Structures*Water wells shall not be located in garages,barns, storage buildings,or dwellings(WAC 173-160-171) 0 Water lines for existing and proposed connections Q Septic and sewer components(tanks,primary and reserve drainfields,transport lines) 0 Barns,chicken coops,barns,manure piles,dog kennels,commercial gardens,compost piles 0 Chemical Storage within 100 ft 0 Landfills(existing or former)within 1000 ft Site Drawing This form may be scanned and made available for public viewing on the Mason County website Pg 3 Last Updated: 1/7/2026 Authentisign ID:71C77921-6B12-F111-A69A-OOOD3A4FF82A --------------------------------------------------------- Staff Use Only ------------------------------------------------------- Review Step 1: Well Site Inspection: YES NO N/O ❑ ❑ Sources of contamination within 100 ft of the well?(septic components,chemicals,livestock,etc.) ❑ ZI ❑ Roads located within 100 ft of the water source?Private/County/State Distance to road(s) ❑ ❑ Ground slopes away from the well? ❑ ❑ Well located outside of garages,barns,storage buildings,and dwellings,with at least 5 ft of separation? 1 ❑ Satisfactory metal or plastic well cap that is mechanically secured or welded to the casing? / 1 1 ? Mo4f 60/fS�BO ❑ O Access ports and openings sealed/screened to prevent contamination;pressure gauge installed for artesian wells? ❑ ❑ Adequate surface seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. ❑ ❑ The well casing extends /9 above level OOu /concrete slab. Lat: 9? l6poq ❑ ❑ DoE well tag attached to the well casing? Lon: -IZ 3.8 171 Tag: N!n 8 fZ ❑ LfJ LiVariance necessary for well site approval? Comments: Pass " Fail Inspector Date 3/ 2C? Review Step 2: Two-Party Review: YES NO NA 7 r r /,W /��❑ ❑ Water well report(well log):Date Completed 'CIIL.! ?07> Driller 0l L"t?1''"� 214111}1Ji ® ❑ ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static level within 24 hours? Capacity test information:Date Driller/Pump/ Installer �VI(/Q Di' GPM (6�Duration(minutes) (OS Total Gal 1608 Recovery Time(minutes)to Sta is 20 QT] ❑ ❑ Water system capable of supplying at least 30 PSI to each connection?PSI 6" [[ IKI ❑ ❑ Satisfactory bacteriological analysis? Date 3 ZS Z6?(Testing Lab _hv__ i_ Can?y /%( ® ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN Z ® ❑ ❑ Signed,notarized,and recorded water use agreement?AFN ZZ-7 a7 ❑ ❑ Signed,notarized,and recorded access easement(s)?AFN z z 3 D 7?0 EV Etv F ❑ ❑ The system appears adequate to serve two connections based on the information provided? . , `f l 2076' ' /► MfW w 1 i ierL 4- Comments: o sQ� ^ Approved ❑ Denied Reviewer Date y/ 1 j r Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied oft fture success or failure of this system. Well site approval does not constitute water system approval Fq All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 668. Water usage restrictioi and additional fees may apply to all new wells drilled after January 19'",2018 per ESSB 6091. This form may be scanned and made available for public viewing on the Mason County website Pg 4 Last Updated: 1/7/2026 WATER WELL REPORT rq, DEPARTMENT OF Notice oflntentNo. WE59625 v} ~ ECOLOGY Unique Ecology Well ID Tag No. BNM812 Type of Work: State of Washington Cal Construction Site Well Name(if more than one well): ❑ Decommission b Original installation NOl No. Water Right Permit/Certificate No. Proposed Use: ®Domestic 0 Industrial 0 Municipal Property Owner Name AHHBY LLC ❑Dewatering 0 Irrigation O Test Well 0 Other Well Street Address DUSTY LN Construction Type; Method:(HNew well 0 Alteration 0 Driven ❑Jetted 0 Cable Tool City SHELTON County MASON ❑Deepening ❑Other 0 Dug 2 Air- 0 Mud-Rotary Tax Parcel No. 319027590022 Dimensions: Diameter ofboring 6 in.,to 176 R Was a variance approved for this well? ❑Yes °❑No Depth of completed well 176 & Construction Details: Wall Ifyes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread (9 I 0 6 in_ +1 166 250 in. (] I 0 9 I ❑ Location(see instructions on page 2): [H WWM or O EWM ❑ I 0 in. — — in. 0 I O 0 I ❑ NE /4-y4 of the NE %4;Section 2 Township J. L Range 3 ❑ I ❑ __in. _ in. ❑ I 0 ❑ I ❑ ❑ I El in in El I ❑ ❑ I ❑ Latitude(Example:47.12345) 47.168936 Longitude(Example:-120.12345) -123.016686 Perforations: ❑Yes O No Type of perforator used No.of perforations Size of perforations in.by in. Driller's Log/Construction or Decommission Procedure Perforated from ft.to ft.below ground surface Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: 0 Yes ❑No HI K-Packer : Depth ft. information. Use additional sheets if necessary. Manufacturer's Name Material From To Type STANLESS Model No. Diameter 6 in. Slot size 10 in.from 166 ft.to 176 ft, CLAY&GRAVEL BLUE 0 50 Diameter in. Slot size in.from ft.to ft. CLAY BLUE 50 60 CLAY&PEAT BLUE 60 80 Sand/Filter pack:❑Yes (H No Size of pack material is SAND&GRAVEL WOOD BLUE 80 95 Materials placed from ft to R PEAT 95 120 Surface Seal: O Yes ❑No To what depth? 20 R CLAY&GRAVEL BLUE 120 135 Material used in seal BENTONITE Did any strata contain unusable water? ❑Yes ©No SAND&GRAVEL WOOD BLUE 135 158 Type of water? Depth of strata SAND&GRAVEL H2O BLUE 158 176 Method of scaling strata off Pump: Manufacturer's Name GOULDS Type: SUB H.P. Pump intake depth: It Designed flow rate: gpm Water Levels: Land-surface elevation above mean sea level ft Stick-up of top of well casing.......j..... ft.above ground surface Static water level 112 ft.below top of well casing Date 7-15-25 Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? 0 No O Yes s by whom? Yield 18 gpm with 38 ft_drawdown after 4 bra. Yield ppm with_R drawdown after bra. Yield gpm with_ft.drawdown after_his. Recovery data(time=zero when pump is turned off—water level measured from well top to water level) Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test gpm with_ft.drawdown after_his.} Air test gpm with stem set at %for hrs. Date Artesian flow gpm Temperature of water_°F Was a chemical analysis made? 0 Yes 17 No Start Date 6-24-25 Completed Date 7-11-25 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. Driller❑Trainee O PE—Print Name MADI TROTTER Drilling Company COOLWATER DRILLING,INC. Signature -i ' Address 10921 NW HOLLY RD License No.3367 City,State,Zip BREMERTON WA 98312 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.COOLWDI941QM Date 7-22-25 ECY 050-1-20(Rev 11/18) If von need this document in an alternate format,please call the 13 rater Resources Program at 360-407-6872. Persons with hearing loss can call Ill for Washington Relay Service. Persons with a speech disability can call 877-833-6341_ COOLWATER DRILLING, INC. 10921 HOLLY RD NW BREMERTON, WA 98312 360-830-9005 COOLWDI941QM CUSTOMER NAME IDATE 7-15-x25 ASHBY LLC CUSTOMER ADDRESS 319027590022 TIME STATIC GPM TIME STATIC GPM 112 U t 05 135 18 120 150 16 10 147 18 135 150 16 By 15 150 16 150 5016 20 150 16 165 150 16 25 150 16 180 150 16 30 150 16 205 150 16 45 150 16 220 150 16 60 150 16 235 150 16 75 150 16 90 150 16 105 150 16 RECOVERY STATIC RECOVERY STATIC TIME 150 TIME 05 132 30 10 119 45 15 114 60 20 112 75 25 90 Thurston County Environmental Health 412 Lilly Rd NE m Olympia,WA 985O6 Tt-tuxsroNcoutaTY 360 867-2631 C0LIF0RM BACTERIA ANALYSIS Date Sample Collected Time Sample f �ee Collected County Month C� l ZDay Year Z : tt�PM Type of Water System(check only one box) ❑ Private Household ❑Group A ❑Group B ❑Other Group A and Group B Systems—Provide from Water Facilities Inventory(WF)): ID# System Name: Contact Person: Day Phone: E-mail: Cell Phone:( ) q Eve.Phone:( Send results to:(Print full nam address and zfp de or email add ss) iiiiiii SAMPLE INFORMATION Sa le collected by(name): S Specific location or address where sample collect "l t— S E D 0 S.T,t� &. ` t Special instructia�s or comments: J1�1 L1OJJVj�1�7 : l�v ,1- ,cL; I n 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.coil—GWR(A/P) ❑Fecal—Surface,GM,springs(nurseraton) Unsatisfactory routine lab number: Filtered:Yes_No ❑Assessment Monitoring(A/P) — ———— Unsatisfactory routine collect date: ❑Other S ! ! 4.I Sample Collected for Information Only Investigative__ Construction/Repairs Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY 0 Unsatisfactory Total Coliform Present and Satisfactory ❑E.coli present ❑E.coii absent No liform detected Replacement Sample Required: ❑Sample too old(>30 hours) O TNTC ❑ Bacterial Density Results:Total Coliform /100m1. E.coli 1100m1. Fecal Coliform__._ ______/looms Enterococci /100 ml. Method Code:ISM 9223B ❑SM 9222D Date and Time Received:Q$2 ❑SM 92158 ❑E'nterolert® Date and Time Analyzed: Sample Number(DOH number plus five`dig5 Date Reported: 0 8 0 Lab Use Only: DOHFomr#3331J1g(revvjsedd►11O3t- -- co G t-r,F•-rynm; v t•n•m•,• ••7'.sO,.:l.:MC3-5�..3A.'7LnT 'F•..'3�^,'3fl415u.RL'Y�`FL�Rs•�r irt11Si1�d�CLfytfJ:�c"-0L".i,'�"-'a;�iSfE:it₹+S.'+':�=y'��-���•��"-"" . S'.iL'Ud�1A]� "-i�:Jl-tiiS4'"' [',u'L:f4"oLSEi ^]fa•�Yrtr^•^r.Yv�.-..ra+m.' � ,�t:�ar� l• •1 - 1, - 7(• F. _S /y�/ /7yg7�i•rJ l;;Fv�'�f•,JI,),{,,t_',S+,S,�j�,Tlpsr{tny jlwr„x y5�r!•trv^ * i C I Q I (' ��'r <�u�•'1�.E;`� v�\ J 1'�/� ..`i,�}F t ,.9;7S,CHii1"""'�.5tia1 'ea}�6A'''cif'cSu�.!.li;iti; 'ctW:[.` 11'�.:�=;'r£„sr.... .. lj I , SP/O/ FIAT FOR. �� P R� I Box 9crLD fi sal ,� I « �r,.Y,w�yes�� -/✓3� o7r o�"�- ; ', : X28 OTC qNT sT, , 7” 7 y� Laos —+��,��..•� do0.3� . � • I o ~\� '� t► ram o� / \ ,, tsi f) ^ Q £ V%7 ZS 'Br9.et.��c�SriccR�'5�r' y • N O SCALE• • �y -- --• E T � �jjlppd � I t 4H4 J .LATE Sf/A c c /y7 a� us y/72� 'q& 4/SPGtSRC S ! °I , x\ OC'�Wcr6 1�✓c-sr,�vcr�i� .a :� p¢• t L �i r�aouT .�ia ��� I i t $. TMJ NT 4 ,L/OL Mf4 O S l prof ass/a/✓,�4. 1.4/`/o .su��/, )' i ! SHE!TO� Nom. 984 s cra ice _��„ s. �lz xr n ^:s+z r�r �sasx .. Tom,zmx szv as�sccm.srasr:�r 7 9 / T_ : / / \ ' - ---- - --- - (T AiOV1sUaI Al2 0 ( Cea° 3 ti U,`v aye'315 Uvalve Cc �O� Oti q 2 v 4 D U 1'-' `� ✓ APR ti 25 2025 ^nV��YI r ' '%� 510U34y A50;y `1 > F1�' I�) �� PAULA,JOY J0HNS0PJ .1h h{ Sm �}, COUN TY ENVIRON.ti4ENTAL HEALTH � gFc0 2238770 MASON CO WA 04/02/2025 03:53 PM AGREE DAVID ASHY IIi220559 Reo Fee; $307.50 Pages 5 Name and Return Address: IO011 111111 liii 11111liii111111 11111 lii141111 Ill 1111111111 III till DPct D P�r '-( ST UM LotJ, WA qS"Z, COVERPAGE THE RECORDER WILL RELY SOLELY ON THE INFORMATION PROVIDED ON THIS COVERPAGE FOR INDEXING PURPOSES. THE STAFF WILL NOT READ THE DOCUMENT OR VERIFY THE ACCURACY OR COMPLETENESS OF THE INFORMATION PROVIDED HEREIN. Document Title(s) 1. 2 ce ( 2. Reference Numbers(s)of Documents Assigned or Released ADDITIONAL REFERENCE#'S ON PAGE Grantor(s) 1. P tin rd 1iwesk+ r ' 2. ADDITIONAL GRANTORS ON PAGE Grantee(s) 1. t O 1el 2. ADDITIONAL GRANTEES ON PAGE Legal Description (abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) Q S T e t9. s1' J ADDITIONAL LEGAL IS ON PAGE Assessor's Property Tax Parcel/Account Number(s) 3lgc2Z—��--gDo2o I g v G 1()o Z ADDmONAL PARCEL fl'S ON PAGE TWO PARTY SHARED WELL WATER USERS AGREEMENT BNM812 Well ID Number: 31902-75-90020 Serves Parcel Number: 4 Dusty Lane Lot Number: of Subdivision N/A Physical Address: AND 31902-75-90022 Parcel Number: Lot Number: 2 of Dusty Lane Subdivision 95 SE Dusty Lane Physical Address: Ownership of the Well and Waterworks It is agreed by the parties that each of said parties shall be and is hereby granted an undivided one-half interest in and to the use of the well and water system to be constructed. Each party shall be entitled to receive a supply of water for one residential dwelling and shall be furnished a reasonable supply of potable and healthful water for domestic purposes. r Cost of Water System Construction Both parties herein agree to share equally in the cost incurred in well site approval, well construction, and construction and/or installation of the waterworks equipment,the pump house and water distribution pipes, and initial well water quality tests. Cost of Maintenance of Water System Each party hereto covenants and agrees that they shall equally share the maintenance and operational' costs of the well and water system herein described. 2 Party Shared Well Users Agreement Page 1 of 4 Water Line Easements Fjord Investments LLC,parcel#31902-75-90022,Dusty Lane lot 2 and parcel#31902-75-90023,Dusty Lane Lot 3 (owner name and parcel#, name of subdivision, and lot number containing the well) GRANTS Fjord Investments LLC, parcel#31902-75-90020, Dusty Lane lot 4 (owner name, parcel#, name of subdivision,and lot number adjacent to well) An easement for the use and purpose of conveying water from the well to the property of Fjord Invesments, parcel#31902-75-90020, Dusty Lane lot 4 (owner name, parcel#, name of subdivision,and lot number adjacent to well). Said easement shall be five (5)feet in width and shall extend on,over,across, and underneath said strip of land from designated well site to shared property line. No new permanent type of building shall be allowed to be constructed upon the water line easement except as needed for the operation of the well and water system. Maintenance and Repair of Pipelines All pipelines in the water system shall be maintained so that there will be no leakage or seepage,or other defects which may cause contamination of the water,or injury,or damage to persons or property. Cost of repairing or maintaining common distribution pipelines shall be born equally by both parties. Each party in this agreement shall be responsible for the maintenance, repair, and replacement of pipe supplying water from the common water distribution piping to their own particular dwelling and property.Water pipelines shall not be installed within 10 feet of a septic tank or sewage disposal drain field lines. Prohibited Practices The parties herein,their heirs, successors and/or assigns, will not construct any potential source of contamination,maintain or suffer to be constructed or maintained upon the said land and within 100 feet of the well herein described, so long as the same is operated to furnish water for two-party domestic use.Any potential source of contamination may include but is not limited to: septic drainfields, sewer lines, underground storage tanks,feed stations and/or grazing animal pens where manure can accumulate, enclosures for maintaining fowl or animal manure, liquid or dry chemical storage, herbicides, insecticides, hazardous waste or garbage of any kind. New structures and/or barns shall meet required setbacks and not harbor any potential source of contamination.The parties will not cross connect any portion or segment of the water system with any other water source or waste water disposal outlet without prior written approval of the (Mason County Public Health Department and/or other appropriate governmental agency. Provisions for Continuation of Water Service The parties agree to maintain a continuous flow of water from the well and water system, herein described in accordance with water supply requirements of the State of Washington and Mason County. In the event that the quality or quantity of water from the well becomes unsatisfactory the parties shall develop a new source of water. Each undivided interest and/or party shall share equally in the cost of developing the new source of water and installing the necessary equipment associated with the new source. Restriction on Furnishing Water to Additional Parties 2 Party Shared Well Users Agreement Page 2 of 4 It is further agreed by the parties hereto that they shall not furnish water from the well and water system herein above described to any other persons, properties, or dwelling without prior consent of both property owners and written approval from the (Mason County Public Health Department. Restriction on Water Use Use restrictions are set at the time of water budget neutral determination and associated with the parcel. The amount of water allowed is recorded on the deed of the parcel and may be monitored and recorded depending on the source of the water rights. Water use for the lots referenced within this agreement are acre feet/year for parcel# and acre feet/year for parcel# . (Include indoor and outdoor use restrictions). Termination of this Agreement This agreement may be revoked at any time; however, it may not be revoked without each property obtaining a sufficient acceptable potable water source and prior consent of both property owners. Termination of this agreement shall require the property owners to provide: 1) proof of a notarized revocation of this agreement and 2) proof of the potable water source for each property to the Mason County Health Department for review and approval.After, review and approval by the health department the property owners shall then file: 1)the notarized revocation of this agreement and 2) proof of the potable water source approved by the health department for each property at the Mason County Auditor's Office as a recorded document that runs with the title of the land. Heirs,Successors,and Assigns These covenants and agreements shall run with the land and shall be binding on all parties having or acquiring any right, title,or interest in this land described herein or any part hereof and it shall pass to and be for the benefit of each owner thereof. 8m �e5 eCn a �`e� �b Sha►'�- uAt' in CO Q�ncl t^ o5,bi\ ®c p<e od;call -4es��-tn urej� wct+er, 2 Party Shared Well Users Agreement Page 3 of 4 Signed: Owner(s) of Prope with a Well Print Name: 1 1A-y t O AS )cv n f.(� ��.Ofb� T nu-��i�►-gyp vyTe State of Washington County of ) I, the undersigned,a Not ry Public in and for the above named County and State, do hereby certify that on this L ,day of 20 , personally appeared before'me .≥O,).j1.Ct 1hai4 to me known to be the individual(s) described in and who exe uted the within instrument, and acknowledge that he(she) (they)signed and sealed the same as free and voluntary act and deed, for the uses and purposes therein mentioned. GIVE 'AW*k nd and official seal the day and year last ove written. ��,�� • so; • •q / OTAp- mN Notary Public in and for the Late o ashington, r ! ! Residing in: /YIJn UBLI c ' My Commission Expires: (74t1202P') •!Vumbe� Cy ��• /''' ��WASH`� Signed: 0w 6F of Second Pro y Served by tStjbed Well Print Name: �L},fl� \Q AS 4►'� Q 2f' F I ec'ee\ 2_yyre��k�,n A fl I,the underrs ned,a Notary Public in and for the above named County and State, do hereby certify that on this C� day of 20�, personalty appeared before me to me known to be the individual(s) described in and who executed the ithin instrument, and acknowledge that he (she) (they) signed and sealed the same as free and voluntary act and deed, for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last ab ve written. "ti u n i r rrrr�� S A•L w''''% ��``�:• �ysion E,` :91-'�.� ¼ A,&L cE21 Notary Public in and for the Statington, Residing in: �AR}' My Commission Expires: r PUBL\C 0;�2 Ci by � �'�.e7s 1�•;h0 � WAG\ 2 Party Shared Well Users Agreement Page 4 of 4 • 2224684 MASON Co WA 04/30/2025 09:22 AM NOTCE 0AVID ASHBY #209071 Re c Fee- $304 50 Pages: 2 11111111111III till 1111l111111111111IIIVIII111111111111III Jill till Return To 9�b trlJTIL1 Jf j2 4 qgçgz Grantor(s): (1) p D 148Y , (2) Grantee(s): (1) PUBLIC Legal Description (1) I R -2 ®1` S UIZ V T9 z OF _5? ' S-' (Abbreviated form:i e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) ) O Z - �- _ 1i1 s1.2. Z TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA (WRIA) I (We), the undersigned grantor(s), hereby place this notice on record that the described real estate situated in Mason County, State of Washington is subject to water use restrictions and conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These restrictions and conditions are based on location of property and/or Water Resource Inventory Area or WRIA. WRIA: /L( Maximum Annual Average Gallons Per Day: gallons Dated on this t .C J day of , 203 Signature of Grantor(s): State of WashingL ) County of Mason ) Page 1 of 2 I, the undersigned, a Noti ry Public i and f r the above named County and State, do hereby cerif that or this rvof , 204J, personally appeared before me, w o is known to be signer of the above instrument, and acknowledged that he he) (they) 1g d it. GIVEN under my hand and official seal the day a ye r I t abo wri ,,rrrnunrrrrp ; �fNplARY ��N: o u {c 'n fo e S to of Washington, 23036426 _ residing at �,• PUBLU0 p'�; My commission expires: ) : '�'a��•' ,10/1712�,�-'�C9 rrrr►urrrnoiee Page 2 of 2