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HomeMy WebLinkAboutWEL2026-00015- TWO PARTY PRIVATE WATER SYSTEM - WEL Application, Design, Letter - 6/1/2026 J MASON COUNTY 415 N 6TH STREET,SHELT967 ,E 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 06/23/2026 KAUFFMAN, ALLY A PO BOX 11422 OLYMPIA, WA 98508 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00015 241 SE Oyster Beach Rd 319217500090 The 2-party water system, Two-Party Well (SFR+.SFR): Kauffman Well (319217500090/319217500090), 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 MASON COUNTY Date Received: 05 1: COMMUNITY SERVICES AmountReceiv �� Received By: Building,Planning,Environmental Health,Community Health 415 N.6'Street,(Bldg8)—Shelton,WA98584 WEL � - ( 'o o 15 Shelton:360-427-9670 x400 Belfair:360-275-4467 x400 Elma:360-482-5269 x400 �/ TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT i1 ^_ � PHONELkA ��� '-ç � MAILING ADDREro [STREET, '/. 1,ST TE,q ZIP 7-2. O' lC 1fiP[ 1] \ 1 VA U 15 V r SITE ADDRESS-STREE ,CITY,STATE,ZIP UIL7'. PRIMARY PARCEL NUMBER ELL SITE) lVl.' LOZE iqz i - 15--GD 9O SECONDARY PARCEL NUMBER(SAME AS PRIMARY IF LOCATED ON SAME PARCEL) ( P cved - - re WATER SOURCE SOURCE TYPE PARCEL I LOT SIZE(no minimum) R (no rmmmum New Jj Existing IN Well ❑ Spring PROPOSED WATER S S M NAM . QUIRED). rn Wof i PROJECT DESCRIPTION(fie. ,detached ADU, ew sin a-family residence,misting connection,etc) lV Tl DIRECTIONS TO SITE/CONDITIONS GTE CODE/KEY LOCA ION/ETC.wt , QQr. -7,(lC7 f Required Submittals/Requirements Checklist: (2.3 S 5 Original water well report(well log)or DoE water well report for an existing well. l Well tag secured to the well casing. Capacity test showing 800 GPD with drawdown and recovery to static level information. �,�{Bacteriological test(Bac-t)results:current(within 12 months)and satisfactory. _ I!1 S tic Records(additional locating requirements may apply if no septic records are on file). Applicable utility easement documents. 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. i n: Date: /R/7_ e Print: Yi X-6ftvi P g This form may be scanned and made available for public vi i on the Mason County website Pg 2 Last Updated: 1/7/2026 Fleaasee include the following site features for each parcel served by the proposed two-party well: M Parcel numbers(s) ,/Property lines/boundaries I A licable easements with the Auditor's File Number(AFN) Roads and driveways Lj 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) Water lines for existing and proposed connections l "/ Septic and sewer components(tanks,primary and reserve drainfields,transport lines) Lv1 Barns,chicken coops,barns,manure piles,dog kennels,commercial gardens,compost piles Chemical Storage within 100 ft Landfills(existing or former)within 1000 ft Site Drawing r. .t c�h ci Pt This form mayb scanned and made available for public viewing on the Mason County website Pg 3 Last Updated: 1/7/2026 1 ' N Review Step 1: Well Site Inspection: L 7 (, l } YES O N/O1/l .f it � �5"` /t '��4N✓� ❑ Sources of contamination within 100 ft of the well?(septic components,chemicals,livestock,etc.) �cl$ ❑ ID ❑ 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? ❑ Satisfactory metal or plastic well cap that is mechanically secured or welded to the casing? 61,01 Access ports and openings sealed/screened to prevent contamination;pressure gauge installed for artesian wells? R'�+ Adequate surface seal,filled to land surface level?*Leaving voids for future installation of equipment is prohibited. NA ❑ The well casing extends to above level ground/ oncrete lab. Lat: 'L17 Il q ❑ ❑ DoE well tag attached to the well casing? Lon: --L 2J3 ❑ [A ❑ Variance necessary for well site appro al? Tag: (j t 3 r l • W (I (ep cc(recji4, on c u r (6 mo . Comments: O ,f en/ "✓G C pn"f ciy G✓•eLL 1id'i5e, Pass ail Inspector (2Date Review Step 2: Two-Party Review: P �1 ?le YES NO NA l l���� ►T' � c/���1 y Water well report(well log):Date Completed I7I Driller O1h/iij ❑ ❑ Satisfactory capacity test showing a a minimum of 800 GPD with full recovery to static level within 24 hours? Capacity test information:Date /[ 3 Z Driller/Pump Installer R ' 44 ( PV "111 fs GPM f .. Duration(minutes) 0 Total Gal Recovery Time(minutes)to Static ❑ ❑ Water system capable of supplying at least 30 PSI to each connection?PSI f I-P ❑ ❑ Satisfactory bacteriological analysis? Date L////70 Lab 11.UI'S*r7 (c4jIf ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN �Z __ ❑ ❑ E Signed,notarized,and recorded water use agreement?AFN ❑ ❑ [ Signed,notarized,and recorded access easement(s)?AFN ❑ ❑ The system appears adequate to serve two connections based on the information provided? 11"v 6i7(zo7(, : Rerx11 te,u, ivif *t (1Se- gqjeIk7 'I' Comments: 6 'v or .� ! tJ u;2 Approved ❑ Denied Reviewer Date C(fQ if Findingein 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 19rsi,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 Fels Original and Fitit Copy with Ecolog WATER WELL REPORT Start Card No. 063507 Oepartmenl of Second Copy—Owner's Copy STATE OF WASHINGTON Third Copy—Drillers Copy Water Right Permit No. (1) OWNER: Nam• Fred Kaufman Addaees SE 660 Bloomfield Road (2) LOCATION OF WELL: Coumy Mason . NE W SW x sec 21 T. N. (2a) STREET ADDDRESS OF WELL(or nearest address) SE 1070.Bloomfield Rd., Shelton Wad,a (3) PROPOSED USE: IN Domestic Industrial ❑ Municipal❑ (10) WELL LOG or ABANDONMENT PROCEDURE DESCRIPTION ❑ Irrigation El DeWater Test WON ❑ Other ❑ Formation: Deaerlbs by color, character. size of material and structure, and chow thickness of aquifers and lb.kind and nature of the material in each stratum penetrated. (4) TYPE OF WORK' ownsr's number of well withal leal one fairy for each change of Inforrnallon. (N more than one) MATERIAL FROM TO Abandoned❑ New well ® Method: Dug ❑ Bored ❑ 0 Deepened ❑ Cable O Driven ❑ Bro'wn cemented clay Reconditioned O Rotary O Jetted ❑ Brown rocky clay 5 DIMENSIONS: 6 inches. Sandy Clay cemented 11 22 ( ) Diameter o(wall 68 Drilled 77 feet. Depth of completed well 77 ft. Brown clay & loose gravel 22 (6) CONSTRUCTION DETAILS: Casing installed: 6 • Dram.from plus 1 it,to-77 n. Welded E • Diem.from ft.to n. Litter Installed O Threaded ❑ • Diem.from ft.to ft. Perforstlons: Yea No Type of perforator used SIZE of perforations In.by In. perforations from ft.to fl- perforations from n.to ft• perforations from ft.to N. Screens: a.EI No Manufaotureta Name Type ModetNo Diem.__________Slot from ft)fo'' f. DIsm. Slat else Irom_ ft.t" ft. Gravel packed: Yes Na S1ze of gravel Gravel placed from n.to ,...., ft. Surface seal: Yea® Na[ To whatdeplh7 20 n, Material used in semi Bent onite Did any$trata contain tatuamble waler7 yes❑ HoQ Type of water? Depth of$lrat'L Method of as sling strata art (7) PUMP: rv4mifectursr'e Nams Type: H.P 1 (8) WATER LEVE Land-aurtace elevation — ft flbove mean sea level static level •a 0 H.below top of well Date Arta elan pressure Iba.per■goare Inch Date Artesian water is controlled byiCe p,Volvo.ete.) Work alerted 9 ,te. Corn chars ,19, (9) WELL TESTS: Drawd¢vm is amAV water level im lowered below stub level Was a pump last made?Yes No IIyes.bywhom? WELL CONSTRUCTOR CERTIFICATION: Yield: gal/mm .with it.drs+vdown after bra. I constructed and/or accept responsibility for construction at this well, and its compliance with all Washington well construction standards. Materials used and the information reported above are true to my beet knowledge and belief. Recovery date(time taken as zero when pump turned oil)(water level measured from well top to water level) • Time WaterLwal rune WatarLwel Time WNarLeral NAME Arcadia Drill. ng_. (PERSON.FIRM.OR CORPORATION) (TYPE OR PRINT) Address 170 S Walker Park Road Shelton Date of last l45 5 (Signed) License No. Bailortest........2 __gal.lmin.with ft.drawdotvrt after 2 bra. (WELL D i t.LER) 70 Contractor's Airteat gal./min. with stem set it -n.tar bra. Registration Deis 8-6— i _22 m. Date No. Artesian flow g•P- ❑ Temperature of water__Wail chemical anslysis made? Yea❑ No (USE ADDITIONAL SHEETS IF NECESSARY) ECYOSO•I.20 (101St) -132a- �3 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. cr Asterisks(')indicate required fields-Mail completed original form to: ECOLOGY WA State Department of Ecology,PO Box 47600,Olympia,WA 98504-7600 Use this form if an original Water Well Report was never filed or is missing from Ecology records. 'Current Use 'Unique Ecology Well ID Tag Number social ❑x Domestic ❑Industrial ❑Municipal ❑Devwater ❑imgation ❑Testwell ❑Other. 'VW'ater Right:❑Yes(if yes,attach a copy) (]No Dimensions Property Owner Name: saiyKaufman Diameter of well 6 in. 'Well Street Address: 900 SE Bloomfield Rd Depth of completed well n ft.(if known) 'City; Shelton 'County. Alison Construction Details Liner installed: Dyes ❑x No ❑Unknown Site Well ID: N/A Type:❑PVC E❑Steel ❑Concrete Liner ❑Unknown ❑Other. 'Tax Parcel Number: 30.07643 Perforations 'Date Well Constructed: 05051990 Dyes ]No ❑Unknown 'Location(Township,Range,Section) Sumbere of fpeatioati in.by in. An accurate location of your well is very important. The Number of perforatiats_iront- Section.to_fl. Section,Township,Range,and X.Y4 can be found on your Screens tax parcel legal description or through your county Dyes ❑x No ❑Unknovm assessor's office. Type:❑Stainless Steel ❑PVC ❑Other. Diameter Slot Size front f.to_L Township 19N Range 3W ❑EVVMor❑x'WWM GraveUFilter Pack Section 21 NE 114-114 SW 114 Dyes ENo ❑Unknown Materials placed from_t.to Pt. Comments: Surface Seal ❑E Yes if known,to atiat depth 20 fL ❑No ❑Unknown Materials used if known: ©Bentonite ❑Cement Pump E❑Yes ❑No ❑Unknown Type submersible Horse Pourer 1 2 Latitude/Longitude (Decimal Degrees recorded to 5 decimal places) Water Levels Land-surface elevation above mean sea level iso ft Latitude(Example 47.12345) Casing stick-up 1 above/below land surface Static Level 55 ft.below top of Casing Date measured:°" 6 Longitude(Example 118.12345) Artesian pressureIL's.per square in.Date measured: -'2 n55 a w Well head has cap? ®Yes❑No Shut off valve?[Thes❑Na Well Tests. Additional Information(If available,please attach) Drawdown is amount water level is lowered below static level. ❑Location marked on topographic map Was a pump test made?IK]Yes(attach copy)❑No ❑Unknown ❑Location marked on air photo Yield: 12 gaVimin.with 1 t.drawdorm after hrs. ❑Consultant wen report 'Certification:The information reported above is true to the best of my knowledge and belief. ❑Consufvng Firm ❑E Driller ❑Engineer ❑Property Owner Name:Roger Phythian Company Arcadia Drilling,Inc License Number.2053 Address of person completing this font: 21 W Westfield Ct Signature: Date Si ned:4/14/ City.State.Zip:Shelton,WA 98584 EAP08 1,Version 1.2 Page 20 Uncontrolled copy when printed Arcadia Drilling Inc. P.O. Box 1790 Shelton,WA.98584 Customer: Sally Kauffman Well Tag#: BQC132 Site Address: 900 SE Bloomfield Rd,Shelton Depth: 77' Date of Test:4/13/2026 Static: 55' Pump Set: Unknown TIME GPM LEVEL RECOVERY 1 Min 12 55.8 TIME LEVEL 2 Min 12 56 1 Min 55 3 Min 12 56.1 4 Min 12 56.1 5 Min 12 56.1 6 Min 12 56.1 7 Min 12 56.1 8 Min 12 56.1 9 Min 12 56.1 10 Min 12 56.1 15 Min 12 56.1 20 Min 12 56.1 25 Min 12 56.1 30 Min 12 56.1 35 Min 12 56.1 40 Min 12 56.1 45 Min 12 56.1 50 Min 12 56.1 55 Min 12 56.1 1 Hr 12 56.1 1 Hr 10 Min 12 56.1 Total Gallons Pumped: 840 Gallons eztc 1 ( t Thurston County Environmental Health 412 Lilly Rd NE 6 Olympia,WA 985O6 360 867-2631 THURSDDN COUNTY COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County Collected Month Day Year 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(WFI): lD# System Name: Contact Person: !S tit• c V' Day Phone:(2'3) 2`"i��'6r`e5 J Cell Phone:! —'3 )21 S- 'G E-mail: 5L.L1r-oral CQ Mc&sf,ytt Eve.Phone:(Scr -P Send results to:(Print full name,addre and zip code or email address) Po f I zZ SAMPLE INFORMATION Sample collected by(name): il/ L 0.L1 Specific location or address where sample.collected: Special instructions or comments: IL4 t S E oy zr ge c �`J��tM 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(AIP) ❑Fecal-Surface,cwt,springs(numeration) Unsatisfactory routine lab number: filte(ed:Yes No —_ - ❑Assessment Monitoring(AIP) Unsatisfactory routine collect date: ❑Other 1J S 4 Sample Collected for Information Only Investigative.___ Construction.I Repairs Other LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and Satisfactory ❑E.coli present ❑E.coli absent Coliform detected Replacement Sample Required: o Sample too old(>30 hours) O TNTC ❑ Bacterial Density Results:Total Coliform Ji00ml. E.colf 1100m1. Fecal Coliform 1100ml Enterococci 1100 ml. Method Code: SM 9223B ❑SM 9222D Date and Time r Received: ❑SM 9215B ❑Enteerolert® '1 "Zy Date and Time Analyzed: 'l 2 Date Reported 2.•%.G Sample Number(DOH number plus five digits) Lab Use Only: 0 8 _ __ ±. ±L_ DOH Form#331-319(revised 11123) 4 2241854 MASON CO WA 06/15/2026 11:12 AM NOTCE KAUFFMAN #222997 Rec Fee: $304.50 Pages: 2 Return To III II IIIII Dliii 111101 I II II III II IIII IIII III I I I I III i 13I I d+zZ JUN 1 5 2026 By J . 0��- oOv Grantor(s): (1) (J i �[UX&Ln , (2) Grantee(s): (1)PUBLIC Legal Description(1) q O� y( r_ye q l/i q - Z-� F# z '3 r3 (Abbreviatedform:i.e.lot, blo ,plat r section,township,range) Assessor's Tax Parcel: (1) :":3g)V 7 ,.o 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: -3 - I lU P l-'( - 5'c. 2_t Tax Parcel: (Connection 1) ,)l a Z 1 —' I5)_ 0C)Qgp Tax Parcel: (Connection 2) 3)_ 2 l — -1 s` Oo?O The system owner is responsible for keeping this system in compliance. The name of the water system is: t c J.., CLy1 r V`�e4 1 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/hasriot)been granted one or more waivers rom specific provisions of the regulations. Dated on thisay of 20 Signatur of Grantor(s): (1) , (2) Page 1 of 2 i State of Washington County of Mason I,the undersigned,allotary Public in d forte above named County and State,do hereby certify that on this y of 20SQ, personally appeared before me,who is known to be signer of the above instrument,and acknowledged that he(she)(they igned it. GIVEN under my hand and official seal the day and year I bove ' en. 9,4,j11111 III111//�/j,' `�.P`S �' paorgRy '�N;. Y P is r the tate of Washington, residing at 23038426 = My commission expires: PUBLIC '_ .'O wAsN��.,��'. +,IfQJ/II II IIIII 1' Page 2 of 2 - n r -.. ...� _.' i • k_,.r 90 Bloomfield d, Shelton,-WA98584; PUSA, Kan fiche Township. el ld; 19217 00090 r 1 ... f��~ *v^ Asa ,r ,en" :�. .P+„�,...r- + �,✓ 'i3_ie! e �... j /y wrr„# J fX� /I��Q i yr�y, '���,��,�•���, ya✓,. ��f, ✓�o- , � �,-,.,,• fJy i �i••+r 1 1 1 r ''i lyt,y r' f♦ ¢"" '' iI:I: —. > fr �, 1 p !'� 4 � � ✓d yy! /✓ ; 4 � i 1 ° d d �°►" dP ! ✓d� d '• 9 a e A 1 df r > e d r.// I � ' ti r4 t♦ ..,y �.N /` /.r „� `" ^ ..r r• _ t i�r Y` - 0 IP gy — i1 ! a ! ~*'♦ m'+ >� ,. 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I— / Scale 1 in . 950 ft / 1 . r' a • ✓ //• '�r r,r y. < —.-- - __ N - 900 SE Bloomfield Rd, Shelton, WA 98584, U A, Kamiiche Township, Parcel Id: 319217600090 JTL IL `� 1 1 rf I 7 900 SE Bloomfield Rd ; _2TSeptic c , 3 jEx sang septic system ' �'�~ °' _4 Reerve drainfeld(600 sf) _ fl;;;O��-party 5 water system t 1 ti ; V , ®q` \ / u 1 J 1 I � � � 1 r t 1 1 nd 1 1ri✓�t�'C- 1 'r y y �`Iu AA B 1 / I 1 � I F GIS Legend j t ' Measure Area , 7 I d WA Mason 10 ft_Contours �® I moo, �� ; I A _ � ..._... .. ....._...._. ...... .. .. ....... ....r,,..n_...w...,.,,,.,. — - - ',r+< . <.m.,,a .. .............r..,,d...o.......,v.,��i"tw.�»..m... ,...Y®Hy,..,m.:� u i T Pt 900 SE Bloomfield Rd, Shelton,WA 98584, USA, Kamilcfte ownship, Parcel Id: 319217600090 St a,1 a' 'a P ® r 2 1 241 S! O __2- ;Septic Tn — -t a__ . Eiv/a �m ed.-� � .. ��/ 3 !Septic Tank SF PGs�' &a4 QdJ __ 4 )Existing septic s stem 5555 5 ,Reserere grainfield{630 s� Y '1aa t 0.KQ ., a�� �� t o ^}a\a , KI" .-?-: \ t Q 4 ,a ��lu as I � f/t' 7 1 do aa g ! aaa r �.—_ ._.�� _ —._ : --•—_— _ __.._.. LLL GIS Legend Measure Area WA Mason Toff. Contours qo a4 � '" 2E .. s t: Dale a 9 m 40 `• � . � f� "'k Q� s LEGAL DESCRIPTION (AS-BUILT CROWN _ MASON COUNTY SHORT SUBDIVISION OF THE 320'WIDE / ry1 I N0, NO.GRIPITON 6329-00001°ON 7782,DATEDTM C GUARANTYH RD 2026.) 28 COMPANY.GUARANTEE Q�\r\ � ASPHALT ROAD Sg6�99 fL / ORIGINAL ASSESSOR'S TAX PARCEL NO: 31921-75-00090 A TRACT OF LIAR SITUATE PARTLY IN THE NORTHEAST QUARTER OF THE SOUTHWEST QUARTER.AND PARTLY IN THE EAST ONE-THIRD OF THE I AUDITOR'S INDEX: SEE/4 NWT/4, NE1/4 SW1/4, NWI/4 SE1/4, R QUARTER OF THE NORTHWEST QUARTER,AND THE NORTHWEST ! gL 6 I SEC 21,TI9N, R3W, W.M. 119 NNOERTH,RANGE OF TATE S3LWEST.WA.,MASEAST ON COUNTY ALL IN ,WASHINGTON. RCTION 21. IGHT-OF-WAY RIGHT-OF-WAY SE N6gg1 6 O`' I DESCRIBED AS FOLLOWS: BEEN 60'WIDE JQ 7.A' NOTES COMMENCING AT A 5'%70'X20'ROCK WITH A CROSS AND PK THEREON PER RD(4)&(10)� WHICH SEARS SOUTH 705713'WEST,1319.92 FEET FROM THE �\ 314'WIDE 1. RESPONSIBILITY AND EXPENSE FOR BUILDING,IMPROVEMENTS OR MAINTENANCE OF EASEMENTS AND MEANDER CORNER COMMON TO SECTIONS 21 AND 22,SAID TOWNSHIP i 6 /�© GRAVEL PRIVATE ROADS LEADING TO OR SERVING LOTS WITHIN THIS SHORT SUBDIVISION(UNLESS SUCH ROADS THENCEAND PIPE STHE BEACH;6' G3'WEST.987.06 FEET TO A 1.5 INCH IRON /�6Kg�p0 a SHED& I DRIVEWAY I NAVE BEEN 2 ANY FURTHER°CEPTED DMSION INTO LOTS WITHIN THIS SHORT SYSTEM) BDMS ON SHALL WOW BE SUBJECT TO THENCE SOUTH 51'23'4°WEST,519.72 FEET; < CARPORT J I REQUIREMENTS OF CHAPTER 16.36 OF MASON COUNTY CODE. THENCE SOUTH 44.37'13'WEST,2.68 FEET TO A 5/8 INCH REBAR I ;A I 3. DECLARATION OF SHORT SUBDIVISION IS RECORDED UNDER AUDITOR'S FILE NO. AND THE POINT OF BEGINNING; I� N / n 4. WATER WITHDRAWALS FROM ANY AND ALL EXEMPT WELLS APPLY TO PARCELS CREATED FROM THE THENCE NORTH 314245'WEST.352.81 FEET TO A 5/8 INCH REBAR: ORIGINAL LOT(LOT 9)AND ARE COLLECTIVELY LIMITED TO 50,0 GALLONS PER DAY(GPD)TOTAL THENCE NORTH°15218'EAST.72285 FEET TO A 5/8 INCH REBAR In .y UNLESS A WATER RIGHT IS OBTAINED FOR THE ADDITIONAL VOLUME ABOVE THE EXEMPT 5,0°0 ON THE SOUTHERLY RIGHT-OF-WAY LINE OF BLOOMFIELD COUNTY ��+ GALLONS.THE AMOUNT OF WATER THAT CAN BE WITHDRAWN FOR EACH LOT IT SPECIFIED BELOW: gl 'mom--- LOT I GALLONS PER DAY ROAD NO. 14410: pp\ I THENCE SOUTH 88'52'28'WEST,ALONG THE SOUTHERLY A S ♦ 1 m LOT 2 GALLONS PER DAY RIGHT-GE-HAT LINE OF BLOOMFIELD COUNTY ROAD,219.36 FEET TO r ♦♦ WHEN LOTS ARE ALLOCATED MORE THAN THE MINIMUM REONREMENT,THE BALANCE OF THE A 5/8 INCH REBAR; .� '. ml iv ALLOCATION MAY BE CHANGED WITH THE CONSENT OF THE INVOLVED PROPERTY OWNERS WITH THE THENCE SOUTH 154246'EAST,184.69 FEET; I JI 95 60A Op A 'A-' I CHANGED RECORDED ON THE TITLES OF THE PROPERTIES. THENCE SOUTH 49'16'07'WEST,75.00 FEET TO A 5/8 INCH REBAR; 9 R10R•�(f�1 © PER RCW 90.44.050 THE IRRIGATION OF LAWNS OR NON-COMMERCIAL GARDENS IS COLLECTIVELY THENCE SOUTH 01'52'18'WEST,498.60 FEET TO A 5/8 INCH REBAR; 11 THENCE SOUTH 3705'55'EAST,251.55 FEET TO A 5/B INCH REBAR; I i �1fiy01, i RD(1) LIMBED TO ONE-HALF ACRE WITHOUT A STATE WATER RIGHT. THENCE SOUTH 564501"WEST,24.55 FEET; I ADA I �+ I z PER ESSB 6091 LOTS RESULTING FROM THIS SHORT SUBDMSION ARE LIMITED TO AN ANNUAL THENCE SOUTH 53.0152'EAST,68.73 FEET TO A 5/8 INCH REBAR; i 10 I AVERAGE MAXIMUM USAGE OF 950 GPD. THENCE SOUTH 32'05'55"EAST, 126.21 FEET; WELL THENCE NORTH 443713'EAST.220.62 FEET.MORE OR LESS.TO vq�' `' HOUSE / RO(I) THE POINT OF BEGINNING; I �, 9 ?o I DIRECTOR'S APPROVAL EXCEPTING THEREFROM ANY PORTION THEREOF AS MAY INCLUDE I O � RO(1) I I APPROVED FOR RECORDING PURSUANT TO MASON COUNTY TITLE 16.36 TIDELANDS; �? '7 ---" SAID LAND BEING ALSO KNOWN AND DESCRIBED AS A PORTION OF I B LOT 2 0 = TRACTS B AND 9 OF SURVEY RECORDED OCTOBER 3,1973,IN VOLUME 1 RD(1) I DIRECTOR OF COMMUNITY SERVICES OF SURVEYS,PAGES 19 AND 20,AUDITOR'S FILE NO.283513; TOGETHER WITH AND SUBJECT TO AN EASEMENT FOR WATER PIPELINE RD(1) I S 1D�•pAE NOT SURVEYABLE 107 ' I DATE APPROVED AND ROAD PURPOSES,20 FEET IN WIDTH,AS SHOWN ON SURVEY gA • WIDE WATER LINE I RECORDED OCTOBER 3,1973,IN VOLUME I OF SURVEYS,PAGES 19 I 7.4 Ng} EASEMENT LEGEND APPROXIMATELY LOCATED I AND 20,AUDITOR'S FILE NO.287513; / O FOUND REBAR S AND CAP Q APPROXIMATE DRAIN FIELD LOCATION IN THIS AREA PER OUR 1 PER MASON COUNTY SEPTIC REORO. SITUATE IN MASON COUNTY,WASHINGTON. // ^ CLAIM DEED AFN 307538. O FOUND REBAR WITHOUT CAP SET 5/8'%24'LONG REBAR AND Q WATERLINE ANDENT ROAD FOR PURPOSES. SITE DATA 1.5 210W F3244,C240P 303394' CALCULATED PER RD(1).SHOWN TPA:31921-75-00090_ TOTAL ARE0.5.201 ACRES OS SEPTIC TANK PER RD(3)&(B).PRIVATE ROAD OMNEMENT E;SLXSA SALLY A KAU FMST,NEi CONING;RRS(RURAL 5 RU RESIDENTIAL apL1I' l LINE TABLE \ (NE)FE FENCE E LIES NORTHEASTERLYUSE RECORDEDIUNDEE EART 1960979. LOT II AREA(ACRES) I ADDRESS(SHELTON,WA 98584 LINE LENGTH BEARWC (M)MEASURED DISTANCE \ L1 2a.s6 sssas'o1 w LINE TYPES 1 3.187 241 SE OYSTER BEACH RD V 2 2.014 900 SEBLOOMFIELDRD I C'H )Y�y \J` L2 30.00 S}705'55, ❑ ❑ ❑ ❑ WOOD BOARD FENCE OA, 7 ? �. / PROPERTY LINE - LOT USE EASEMENT LINE ROAD R Ag1/ ' ® 'C. Xry ROAD CENTERLINE \ LOT s`G, \ //�g TOE-TOE TOE OFI THE SLOPE! 20'WIDE 3 gp �"' ORDINARY HIGH WATER MARK AOE551 O � �oo Nom\o I3,, Q LINE MAPPED 3/19/2026 EASEMENT \ ° �^ ® P� ?s HOUSE � / MONUMENT NOTES ♦.A1�e'p♦ o`'m ' H'1 `ri1•`(A' GARAGE 3 / T. FOUND 5/8'REBAR WITH ILLEGIBLE YELLOW CAP. 2. FOUND 1/2'REBAR WITH YELLOW CAP MARKED•LS 7397'.645Ap♦l'% $o GRAVEL ORIDRIVEpa \ 3. FOUND 1/2'REBAR WITH YELLOW CAP MARKED'LS 7397'•STB'27'E,0.3' 11 'l`A j� FROM CALCULATED POSITION, ♦ry' 4. FOUND 1/2'RERAN WITH YELLOW CAP MARKED'LS 7397. ♦' 00A♦g Ng0� SOUTHERLY MARGIN 1 J /Py BASIS OF BEARING 5, FOUND 1/2'REBAR WITH YELLOW CAP MARKED'LS 7397.N0'38'E,0.4' p/ g 3 / FROM CALCULATED POSITION. ,�g3 OF EASEMENT G. `� HELD WEST LINE TRACT 9 OF SURVEY N. FOUND 5/8'IRON BAR WITH ORANGE FLAOGING. O 1 yg /\ COURSE#7.RD(1). \ 2 i1q' / RECORDED UNDER VOLUME 1,PAGE 19 7, FOUND 5/8'IRON BAR WITH ORANGE FLAGGING. M1A'•p♦ Q ♦r WIDE Off' N44'37'13'E (RDt),RECORDS OF MASON COUNTY, B. FOUND 1/2'BENT REBAR WITH BROKEN YELLOW CAP,WTM ORANGE FLAGGING. Ag $ LOTS !! GRAVEL V 2.69 M NOT'5218 E AS BASIS OF BEARING. 9, FOUND 1/2'REBAR WITH YELLOW CAP MARKED'LS 7397'. ♦ cAhb \\ RU(1) L,'�4� CJ� / \d•.P DRIVEWAY 12 C 10.FOUND 1/2'REBAR WITH YELLOW CAP MARKED'LS 7397'. \ OJT` /SEY DETAIL 4 0' 00' 200' I1.FOUND 1/2'REBAR WITH YELLOW CAP MARKED'LS 7397'. � a SSSOI'52'E OF' a 12.FOUND 5/8'REBAR WITH CAP MARKED'BORNE LS 8183' RD(6) \ !!� S y'( gry 13.FOUND 8/8'REBAR WITH ILLEGIBLE YELLOW CAP.S8024W,0.5'FROM 68.73 / a, . CALCULATED POSITION. 36'TALL. �r\��• Ol ./ // 2 '11' y SCALE I"-100 \ QQ SURVEY NOTES FENCE o s o��J �� / \ / 213.7807w I, (v� RD(1. RECORD OF SU .ART 203513.REFERENCED DOCUMENT 2' INSTRUMENT SUERVEYUMEETSSOR EXCEEDS TIME STANDARDS OF WAC 332-130-090. RD(1) Vs�e \\ ryrry // 2 \LOTS COURSE B #9 DI1 �Gj� 2. RECORD OF SURVEY.AFN 433892 3. SURVEY COMPLETED 4/28/2026 O• / O Q 3, RECORD OF SURVEY.AFN 450497. 4. ALL MONUMENTS SHOWN AS FOUND,VISITED 3/2026. \ 4. BOUNDARY LINE ADJUSTMENT.AFN 2210894. 5. MTN2COAST,LLC(M2C)WAS RETAINED BY BICKA BARLOW TO COMPLETE A $ '$ / 5. SrAMORf WARRANTY GEED,AF5 450616. SHORT SUBDMSION SURVEY OF MASON COUNTY TPN:318217000090. B. QUIT CORM DEED,AFN 450817. U. BOUNDARY CALCULATED PER REFERENCED DOCUMENT 1,2 AND 3.M2C DETAIL NORTHERLY MARGIN /X00 $ / / 7. STATUTORY WARRANTY DEED,AFN 449594. COMPLETED A CLOSED LOOP TRAVERSE TO TIE MONUMENTS,AND FOUND SCALE 1' = 20' OF EASEMENT 8. OYSTER BEACH ROAD EASEMENT AND MONUMENTS FIT WELL WITH THE BOUNDARY. COURSE/9,RD(1). / MAINTENANCE AGREEMENT,AFN 196°979. 7. ALL DISTANCES SHOWN ARE GROUND DISTANCE,US SURVEY FEET. 9. DEED OF TRUST,AFN 209474. B. ALL EASEMENTS ARE SHOWN AND REVIEWED BASED ON STEWART SUBOMSION 10.RIGHT-OF-WAY DEED.AFN 165577. GUARANTEE GUARANTEE,ORDER NUMBER 2026-4-87851,GUARANTEE NO. G-6329-0O017782•DATED MARCH 23RD 2026. AUDITOR'S CERTIFICATE SURVEYOR'S CERTIFICATE SHORT SUBDIVISION FILED FOR RECORD THIS DAY OF I HEREBY CERTIFY THAT LAND DESCRIPTIONS OF THIS F. AT,,,,,,,,,,,,,,,,,,M. IN BOOK_OF SHORT SUBDIVISION ARE FULL CORRECT DESCRIPTIONSV'^A�iar FOR z1 OF THE LAND AS THEY APPEAR ON THIS SHORT PLAT, J.,a ` y` SALLY KAUFFMAN AT PAGE AT THE REQUEST OF THAT THE LOT CORNERS HAVE BEEN STAKED ON THE aQ« �'' BIITN MTN2COAST. LLC, GROUND WITH 5/8" X 24" LONG REBAR WITH YELLOW Cp$T� DRAWN BY I DATE JOB NUMBER PLASTIC CAP MARKED "LS 21013244 & 24030394" Po 24030394 u° MMYC 4/28/2025 26-053 s 4E Eo Qa PROFESSIONAL LAND SURVEYORS CHECKED BY SCALE SHEET NUMBER LINTY 1q,°jpTL" s° 2320 MOITMAN RD SW, SfE 106 GMB 1"=100' SV-1 OF 1 4L LAM TUMWATER, WA 98512 AUDITOR'S FILE NUMBER PAUL E. BOUGHAL JR., PLS #24030394 360-688-1949 AUDITORS INDEX: SET/4 NWT/4, NET/4 SW1 4. NWT/4 SET/4, SEC 21, 1195. R3W, W.M. WHEN RECORDED RETURN TO: Inge A.Fordham Fordham Law,PLLC 3218 Sixth Avenue Tacoma,WA 98406 SHARED WELL AGREEMENT Grantor: Sally H.Kauffman,an unmarried individual Grantee: Sally H.Kauffman, an unmarried individual Abbrev.Legal Desc.: (Servient Estate)—Lot 2 of Mason County Short Subdivision No. recorded on under AFN (Dominant Estate)—Lot 1 of Mason County Short Subdivision No. recorded on under AFN Tax Parcel Nos.: (Servient Estate)and (Dominant Estate) This Shared Well Agreement ("Agreement"), made and entered into this _ day of 20 by and between Sally H.Kauffman,also appearing of record as Sarah Anne Kauffman,an unmarried individual, as Grantor, and Sally H. Kauffman, also appearing of record as Sarah Anne Kauffman, an unmarried individual,as Grantee,for the purpose of establishing certain rights and obligations relating to a shared well to be used by current and future owners of the parcels described herein. Grantor and Grantee may be collectively referred to herein as"the Parties"or each, individually, as"a Party." RECITALS A. WHEREAS Grantor owns the real property commonly known as 241 SE Oyster Beach Rd., Shelton,WA 98584,legally described as follows: Lot 1 of Mason County Short Subdivision No. recorded on under AFN Tax Parcel No.: (hereinafter,the"Dominant Estate"). B. WHEREAS Grantee owns the real property commonly known as,legally described as 900 SE Bloomfield Rd., Shelton, WA 98584,legally described as follows: Lot 1 of Mason County Short Subdivision No. recorded on under AFN Page 114 Tax Parcel No.: (hereinafter,the"Servient Estate"). / C. WHEREAS there is a well located on the Servient Estate that supplies water to the Dominant Estate and the Servient Estate("the Well"). The Well is housed in a well house located on the Servient Estate("the Well House"). The location of the Well House housing the Well is delineated on the survey map attached as Exhibit A. D. WHEREAS the Parties desire to establish a means for current and future owners of the Dominant Estate and the Servient Estate for accessing, maintaining, operating, repairing, and using the Well, the Well House, and all related pump(s), electrical service, waterline(s), pipeline(s), and related equipment(collectively hereinafter,the"Water System")into perpetuity. NOW THEREFORE, in consideration of the mutual covenants and benefits contained herein, the receipt and sufficiency of which are acknowledged,the Parties agree as follows: AGREEMENT 1. Shared Use. The Parties desire for each Party, and each of their respective successors, heirs, and assigns,to have equal right to access and use the Well,the Well House,the Water System, and the easement area created below. 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. Except as set forth herein, no Party to this Agreement shall prevent any other Party from using the Well, the Well House or the Water System and no Party to this Agreement shall deny the other Party access to or use of the Well, the Well House, the Water System, or the easement area created below. The purpose of such access shall be for the reasonable inspection,maintenance,operation,repair,replacement of the Well, the Well House, and the Water System, or any portion thereof,to ensure the continual supply of water for the purposes described herein. 2. Grant of Easement. Grantor hereby grants and conveys to Grantee: (1) a perpetual, non- exclusive easement in a one half share of the water produced by the Well; (2) a perpetual, non-exclusive easement for maintenance and repair on,in,over,across,and underneath the Well,the Well House,and the Water System or any portion thereof; and (3) a perpetual, non-exclusive easement for ingress and egress across that portion of the Servient Estate as is reasonably necessary to access,maintain, operate,repair, or use the Well,the Well House, and the Water System or any portion thereof. Initial access shall be via the 14' wide gravel driveway for Lot 2,which is delineated on the survey map attached as Exhibit A. 3. Duration of Easement. The easement granted herein and the rights and obligations of the Parties to this Agreement shall be binding upon the Parties and the properties identified herein. It is the intent of the Parties that the easement granted herein and all other covenants, restrictions, and provisions contained in this Agreement shall run with the land and shall bind every person or entity having any fee, leasehold, or other interest in any portion of the properties identified herein, at any time or from time to time,to the extent that such portion is affected or bound by the easement,covenant,restriction or provision. 4. Maintenance of Ground Over Easement Area. Grantor shall be responsible for the maintenance of the ground, including the soils and any landscaping,above the easement area. However,if it should be become necessary to disturb the soils or landscaping in the easement area in order to gain access to,maintain,operate,repair,or use the Well,the Well House,the Water System,or any portion thereof,the Parties to this Agreement shall share equally the cost and responsibility of restoring the easement area to as good of a condition as it was in prior to the disruption. Page 214 5. Maintenance,Repair,and Replacement of the Well,the Well House,and the Water System. The Parties agree to maintain a continuous flow of water from the Well and Water System and to perform such maintenance, repair and/or replacement of the Well, the Well House, and the Water System, and the various components thereof, so as to further the purposes outlined in this Agreement. The Parties shall share equally the cost of operation,maintenance,repair, and replacement of the Well,the Well House,the Water System, and and the various components thereof. Operating costs include but are not limited to the cost of electricity to run the Well and the Water System,which shall be charged at the rate of fifty dollars and no/100($50.000)per month from the effective date of this Agreement,and shall be increased by three percent(3%)every calendar year thereafter commencing January 1. Unless otherwise agreed upon by the Parties in writing,operating costs owed by Grantee for the month prior shall be paid by delivering payment to the Grantor at the address stated above on the 1st day of every calendar month. 6. Maintenance, Repair, and Replacement of Waterlines and Pipelines. All waterlines and pipelines in the Water System shall be maintained or repaired so as to avoid leakage or seepage, or other defects which may cause contamination of the water or injury or damage to persons or properties identified herein. The cost of repairing or maintaining common distribution waterlines or pipelines shall be born equally by the Parties. Each Party to this Agreement shall be responsible for the cost of maintaining, repairing, and replacing any waterline or pipeline supplying water from the common water distribution source solely to his or her particular property and/or dwelling. 7. Payment of Shared Costs. Unless otherwise agreed upon by the Parties in writing, any costs incurred for maintenance, repair and/or replacement of the Well, the Well House, and the Water System,and the various components thereof,shall be billed by the Party who arranged for the service(s)by delivering an invoice to the other Party at the address stated above. Every invoice shall include a description of the service(s)rendered,the person or entity who rendered the service(s),and the total cost thereof. The receiving Party shall remit payment for fifty percent(50%) of the sum stated in the invoice by delivering payment to the Party who arranged for the service(s), or the provider of the service(s), whichever may be appropriate under the circumstances, within fifteen(15) calendar days of delivery of the relevant invoice. The Parties shall use best efforts,to the extent practicable,to discuss the service(s)to be performed and the cost thereof before the service(s)are rendered and shall endeavor to resolve any dispute as to the necessity or cost of the service(s)before the service(s)are rendered. 8. Notice. Grantee shall give Grantor reasonable advance notice of any need to access the easement area for the purposes stated herein. There is a rebuttable presumption that 48 hours is a reasonable time for such advance notice. In the event emergency conditions exist, Grantee need only give such notice as can reasonably be given under the circumstances,which may possibly mean no advance notice prior to entering the easement area. 9. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the Parties' successors, heirs, and assigns. Recording a deed or conveyance of any property identified herein shall constitute an agreement by the new owner of such property that the provisions of this Agreement are accepted and ratified by and binding upon the new owner. The prior owner shall thereafter be fully released from all obligations and liabilities imposed or arising after the conveyance, but shall remain liable for any charges incurred for operating costs, maintenance, repair, or replacemet of the Well, the Well House,the Water System,and the various components thereof,up to the date of the conveyance. 10. Modification or Termination of Easement. The easement and covenants contained in this Agreement shall run in perpetuity and may only be modified or terminated upon the execution of a writing signed by both Parties and recorded with the Mason County Auditor. Page 314 11. Enforcement of Easement. The Parties agree that Grantee and Grantee's successors,heirs, and assigns shall have the right to access the easement area without interference from Grantor or Grantor's successors, heirs, or assigns. The Parties to this Agreement, and any future owners or occupants of the Servient Estate and Dominant Estate, or any portion thereof, shall have the right to enforce any terms or provisions of this Agreement at law or in equity, and specifically including the remedies of specific enforcement or injunction. 12. Applicable Law and Attorney. This Agreement shall be governed by and interpreted in accordance with the laws of the State of Washington. In the event of any dispute arising out of or relating to this Agreement,the prevailing Party shall be entitled to recover reasonable costs and attorneys'fees from the non-prevailing Party,regardless of whether a legal action is initiated. 13. Waiver. No delay in exercising any right or remedy hereunder shall constitute a waiver thereof, and no waiver of the breach of any provision of this Agreement shall be construed as a waiver of preceding or succeeding breach of the same or any other provision of this Agreement. 14. No Merger. The easement created herein is intentionally granted, conveyed, and entered into notwithstanding the identity in ownership of the affected properties, and the doctrine of merger shall not operate to extinguish the easement. 15. Severability. If any term, covenant, restriction, or provision of this Agreement is held to be invalid or unenforceable in any respect, such invalidity or unenforceability shall not affect any other provision hereof and this Agreement shall be construed as if such invalid or unenforceable provision had never been contained herein. Sally H.Kauffman,Grantor Sally H.Kauffman, Grantee Date: Date: STATE OF WASHINGTON ) ss. COUNTY OF ) Signed and sworn to before me on ,by Sally H.Kauffman. Print name: NOTARY PUBLIC,in and for the State of Washington Residing at: My Commission Expires: Page 414 6/3/26,9:07 AM Sent-Mail-slkauffman@comcast.net-Xfinity Connect WATER QUALITY TESTING • Testing shall occur at least: annually • Testing shall include coliform bacteria, nitrates, and other required contaminants • Costs shall be shared equally • Results shall be shared between the Parties https://connect.xflnity.com/appsuite/#!!&app=io.ox/mail&folder=default0//pc%a7Co6Zhtt&waitSeconds=30 1/1