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Home My WebLink AboutAPPLICATION WITHDRAWN ON 4-10-2026 - WEL Application, Design, Letter - 4/10/2026 APR 0 0 2026 By 4 " b(DOa / d141 i . 51� a tot> Vanguard Laboratory 2635 Parkmont Lane SW, Suite A Olympia WA 98502 360-967-7010 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County 09/15/2025 Collected 5 ❑AM Mason Month Day Year il PM Type of Water System(check only one box) O Group A El Group B 0 Other Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): ID# System Name: Austin Heilman Contact Person:Arcadia Drilling,Inc Day Phone:(36O )426-3395 Cel Phone:( ) Email: Eve.Phone:( ) t Send results to:(Print full name,address and zip code ore-mail) arlela@arcadiadrilling.com ANDjenn@arcadiadriilirig.com SAMPLE INFORMATION Sample collected by(name):Sam Specific location where sample collected: Special instructions or comments: 67 E South Island Dr,Shelton Counts please Type of Sample(select only one type of sample from types 1 through 5 below) 1.O Routine Distribution Sample(AIP) 2.❑ Repeat Sample(AIP) Chlorinated:Yes No (from distribution system after unsat routine) Unsatisfactory routine lab number. Chlorine Residual:Total_Free_ 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: S ii Chlorinated:Yes No ❑Triggered(A1P) Chlorine Residual:Total_Free_ ❑Assessment (AIP) 4. Surface or GWI Raw Source Water Sample(Enumeration) I „ I I I ❑E.core O Fecal F9tered Yos_No_ 5.I]Sample Collected for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Colifonn Present and Satisfactory ❑Ecofi present O E-coli absent Bacterial Density Results:Total Coliform 0 I100ml. Ecolj �1•_ I100ml. Fecal Coliform I100ml. HPC I1 ml. Replacement Sample Required: ❑TNTC O Sample too old ❑ Sample Volume ❑Damaged Container ❑ Lab Reference Number DateTme Receced: C( 1 \J Receipt Temp C': Method Code: Date Reported to DON Lab Use Only. DOH Lab-Sample# 285- f\\bz N ou�eC N+s it§ceoannmz.e�^-+ero=e k cl Boo.525 W27(iGUM W 111). Dot Fam7;4]t-3191�feave o6n7)- Y F krintw9',rater. i ibis ztd aSe[P'�@Caq.e evaizQe ztvw�Awa9ov Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA. 98584 Customer: Austin Heilman Well Tag#: AFF218 Site Address: 67 E South Island Dr, Shelton Depth: 110' Date of Test: 9/15/25 Static: 88.6' Pump Set: 101' TIME GPM LEVEL RECOVERY I Min 12 92.8 TIME LEVEL 2 Min 12 93.4 1 Min 89.8 3 Min 12 93.6 2 Min 89.05 4 Min 12 93.6 3 Min 88.85 5 Min 12 93.6 4 Min 88.8 6 Min 12 93.65 5 Min 88.75 7 Min 12 93.65 6 Min 88.75 8 Min 12 93.65 9 Min 12 93.65 10 Min 13 93.7 15 Min 13 93.7 20 Min 13 93.75 25 Min 13 93.75 30 Min 13 93.75 35 Min 13 93.75 40 Min 13 93.75 45 Min 13 93.75 50 Min 13 93.75 55 Min 13 93.75 1 Hr 13 93.75 1 Hr 5 Min 13 93.75 Total Gallons Pumped: 888 Gallons After Recording Return To: Robert W. Johnson PLLC PO Box 1400 Shelton, WA 98584 DECLARATION OF WATER AND WELL MAINTENANCE AGREEMENT THIS AGREEMENT, dated this ay of December 2025, by and between AUSTIN HEILMAN and BRITTANY HEILMAN, husband and wife, (hereinafter referred to as HEILMAN) in consideration of the mutual covenants and conditions as hereinafter provided, agree as follows: RECITAL: A. HEILMAN is the owners of that certain real property located in Mason County, State of Washington, legally described as follows and hereinafter referred to as Parcel A: Parcel#22003-34-90073 Lot C of Short Subdivision No.2528,recorded January 4, 1995,Auditor's File No.601262,and being a portion of Government Lot 2,Section 3,Township 20 North, Range 2 West, W.M., in Mason County, Washington. Together with and subject to an easement for ingress,egress and utilities,30 feet in width,as shown on the map of Short Subdivision No.2528,recorded January 4, 1995,Auditor's File No.601262. B. HEILMAN is also the owners of that certain real property located in Mason County, State of Washington, legally described as follows and hereinafter referred to as Parcel B: Parcel #22003-34-90074 Tract D of Short Plat No.2528,recorded January 4, 1995,Auditor's File No.601262,and being a portion of Government Lot 2, Section 3,Township 20 North, Range 2 West, W.M., in Mason County, Washington. Together with and subject to a non-exclusive easement for ingress,egress and utilities,30 feet in width,as shown on the map of Short Subdivision No.2528,recorded January 4, 1995,Auditor's File No.601262. C. Located on Parcel B is presently a well owned and operated by HEILMANS which has the capacity to serve both properties with water for domestic purposes. NOW THEREFORE, in consideration of the mutual covenants and conditions hereinafter provided, the parties agree as follows: 1. HEILMAN declares that the future owners of Parcel A and their heirs and assigns the right to draw and receive water from the well located on parcel B in sufficient flow and quantity as will flow to support a single family residence and all the water usage which is ordinary and customary to a single family dwelling; PROVIDED, however, that the owners of Parcel B are not responsible or liable for any failure or deficiency in the quantity or quality of water supplied. If there is an insufficient water supply to provide water for both parcels, The owner of Parcel B is granted the right to place reasonable use restrictions on the water or limit its availability. 3. The owners of Parcel A, their heirs or assigns, shall not permit said water, or any portion thereof, to run to waste. 4. HEILMAN declares that the future owner of Parcel A and their heirs and assigns a perpetual non-exclusive easement over and across Parcel B as may be necessary to install, replace, operate and maintain water and/or electrical lines from parcel A to the well site. 5. The owners of Parcels A & B shall share equally in the cost of operation, maintenance, repair and/or replacement costs. The owners of Parcels A & B shall pay $35 each month into an account for operations, maintenance and repairs. Every 5 years this amount shall be adjusted for inflation based upon the CPI-U, Seattle-Tacoma-Bellevue. If sufficient funds are not available in the account, the owner of Parcel B shall bill the owner of Parcel A for their portion of the operation, maintenance, repair and/or replacement costs incurred. The owners of Parcel A shall pay the sums billed by the owners of Parcel B within 30 days of billing date. Each party shall be solely responsible for maintaining the water lines from the well to their respective properties. 6. Either Party may elect to install water meters on the supply lines to Parcel A and Parcel B. Should a Party make such an election, the costs of said installation shall be divided equally and billed according to paragraph 5 herein. After installation of said meters all costs associated with the well operations including electricity, routine maintenance, repairs and replacement of the well and water system shall be shared based upon the actual cubic feet of water supplied to the parcel. After installation of such metering system, the owner of Parcel B shall bill the owners of Parcel B monthly for the pro-rata share of operating costs on the basis of water supplied. Such assessments shall replace assessments made pursuant to paragraphs 5 of this agreement. 7. If after thirty (30) days from the date of billing of assessments under paragraphs 5 or 6, the owner of Parcel A shall fail to pay said assessment, the unpaid balance shall bear interest at the judgment rate for Mason County Superior Court (12% at the date of this agreement). Also, unpaid assessments shall become a lien against Parcel A and a Notice of Claim of Lien may be filed with the Mason County Auditor. A lien may be foreclosed in the same manner as a mechanics and materialmens lien as prescribed by RCW 60.04 et seq. If any cost or assessment be delinquent for a period of sixty (60) days of invoice the owner of Parcel A shall have the power, after ten (10) days written notice to the owner of Parcel A, to disconnect delivery of water until the assessment is paid in full and a twenty-five dollar ($25) reconnect fee is paid. 8. The assessments for the water system shall be junior and subordinate to the lien of any first lien purchase money mortgage or first lien purchase money deed of trust (hereinafter referred to as "mortgage") only to the extent that the assessment subordinated becomes due and payable after the date of recording of said mortgage and prior to the date of issuance of Trustee's or Sheriff's Deed. Sale or transfer of any lot shall not affect the assessment lien. 10. This agreement shall benefit and burden Parcel A and Parcel B and shall be appurtenant to and run with the land. The agreement shall bind said parties their successors and assigns. AUSTIN HEILMAN BRITTANY HEILMAN STATE OF WASHINGTON ) : ss. COUNTY OF MASON ) On this day personally appeared before me AUSTIN HEILMAN and BRITTANY HEILMAN, to me known to be the individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN UNDER my hand and official seal this 0.of , 2025. ELIZABETH JOHNSON Notary Public State o; Washington License Number 163269 I 9,& pç )7LA_.- My Commission Expires N TARY( B1UJJ AND FOR THE STATE January 15, 2029 of Washington, residing at Wp� My commission expires: 1 S 2.