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HomeMy WebLinkAboutWEL2026-00022-TWO PART WELL APPLICATION - WEL Application - 7/24/2026 ( tEtt4 MASON COUNTY 415N6THSTREET, 0427970,EXT 400 SH STREE 360-02TO67q EXT400 SELFAIR.36n-275-4467,EXT 400 Public Health & Human Services ELMA.360-082-5269,EXT 400 I_IFAX'.360-427-7787 08/24/2026 Kris Klusman 481 NE Alder Creek Ln Belfair, WA 98528 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2026-00022 XXX NE Alder Creek Ln 122052190073 The 2-party water system, Two-Party Well (SFR + SFR): ACL Water System No. I (Well: 122052190073 to SFR: 122052190072 and SFR: 122052190071), 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 Sincerel��G�y, David Anderson Environmental Health Specialist Mason County Environmental Health a/� '\I MASON COUNTY 3lO (�t� •I COMMUNITY SERVICES AmountRce,eO I RB, B Pe. .9E ,a mental. ,B.Commo,n aFth fl D7° 415 N N"Snet.IBldg8)-Sh@,en,WA9S584 WEL ©"tl—'pp�p 0 Shelton:26O-02]-96'0 x4UD Nclruir:3602'SA46T x41111 Elms:?6D-IS2-52n9 400 TWO—PARTY PRIVATE WATER SYSTEM APPLICATION 10]T PLg _ K o o l a PI „RA O t'0bio xrriz irlo �3-Q SITE SIR LET. I .5E AT t1,ZIP� R.. CITY.• z•I...j 4 +ti4 12Zos- a) ua 73 PRIMARY PARCEl.NUMBER WEL l.RfTEI 1z2OS - aI -Rrk»,3 SECONDAR PARCE L NtMBERISAME AS PRIM ART 6 LOCAT DIEM SAME PARO]J IZ.Zay-- 21- 4K77t - WATER sOr tRarvev PARCElIlOT SIZE mlm Pm.ml ARC El2LOT mo..ml.Im> O New Existing . Well Spring I 34 ALr[ l• 3(J f}G.t; ROPOSty WATER SYSTEM NAME IRE0PIRED) CL wuu & cioc tic L PRWECT DESCRIPTION(eP&$StS ABC.InJ .mly ruNea txSI m.ectn ay - Pcr4iwtll a n 2ezz IONS E.,RE.LnCATIO,.Fit TO 40,:-InNDI R GATE Crett ut', /of 1 s+ #b0 U C tCLvA 0EA LeFl. Si d a1 iweJ u€jI tad FuAM CwJUL 7 Required SubmiUals/Requiremcnts Checklist: Original water well rayon(well log)or DoE water we'I report for an existing well Well tag secured to the well casing. 53 Capacity test showing SO()GPI)with drawdown and recovery to static level information,as described on page one of this packet. Bacteriological test(Bac-0 results:current(within 12 months)and satisfactory. ry Septic Records(additional locating requirements may apply if no septic records are on file). Applicable utility easement documents- Piling requirement,,as described orI page I of this packet.'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 n//o more than one connection. �' 7/Z'/t6 (ac 7/-'7/ ry Print: l /4 Ur.4 ) Sigl . Date: ) 6 This form may be scanned and made available for public viewing on the Mason County wehsite Pg 2 Last Updated: 6'3[/2026 Please include the following site features for each parcel served by the proposed two-party well: 0 Parcel numbers(s) Property lines,/boundaries Applicable easements with the Auditor's File Number(AFN) d9 Roads and driveways 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 'Ef Septic and sewer components(tanks,primary and reserve drainfields,transport lines) , Barns,chicken coops,barns,manure piles,dog kennels,commercial gardens,compost piles $) Chemical Storage within 100ft NjA Landfills(existing or former)within 1000 ft Site Drawing Z . I. iL e' e. This form maybe scanned and made available tor public viewing on the Mason County we sue Pg 3 Last Updated: 6/30/2026 — Staff Use Only Review Step 1: Well Site Inspection: t YES NO NO w ��� ❑ ❑ Sources of contamination within 100 ft of the well?(septic components,chemicals,livestock.etc.) ❑ ❑ Roads located within 100 it of the water source'!&/County I State Distance to road(s) i� 0 ❑ 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? ❑ ❑ Access ports and openings sealed/screened to prevent contamination:pressure gauge installed for arlcstan wells? ❑ ❑ Adequate surface seal, filled to land surface level?"Leaving voids for future installation ofequipmenl is prohibited. ❑ ❑ The well casing extends 1� above level ou 1 concrete slab. Let' ?. ❑ ❑ D.1-w el I tag attached to the w ell valiant? Lon: _01,9349f ❑ `f' 0 Variance necessary for well site approval? Tag' aVV9io Comments: Pass ❑ Fail InspectorL Date Review Step 2: Two-Party Review: YES NO NA tit J��[/���t� `/� t w ❑ ❑ Water well report(well log): Date Completed 3/fcj( fl Driller I `M f Dpi!, �1 ® ❑ ❑ Satisfactory capacity test showing a minimum 9u i,1800 GPD with full recovery�t�o}static level withi 4 hours? Capacity test information:Date 8f2(?o76 Driller/Pump Installer DQV') P mlps GPM J.i Duration(minutes) 600 Total Gal7 100 Recovery Time(minutest to Static (20 ❑ ❑ Water system capable of supplying at(cast 30 PSI to each connection'?PSI ❑ ❑ Satisfactory bacteriological analysis? Date 7 esting Lab _Lab: M1ay-f(,A- 0 ❑ Signed,notarized,and recorded notice to future property ownefrs' A,,FNI2'I ZZ YY F 7 2 ❑ ❑ Signed.notarized, and recorded water use agreement! AFN (? ❑ ❑ Signed. notarized, and recorded access easement(s)?MN 2!! 7�I ❑ ❑ The system appears adequate to scree two connections based on the ivfnmtauonpnrcided? d r Comments: APProced ❑ Denied Reviewer Date Find,ngsin thisrerr ioll rr ohsnrl eundituar..as thv crud mdo,ph,'day of site rn sptinr- No lain iemml'. 1 rroplred of the hiture uc-c'e.cs or/ 7i Ith. sjsfrp, Jt //s,te approtald t tit ' t.r.crstern applvfla/ 4111 1 .ed -on ne rionsv cell hje ucate,u/eq no Li req i/item enIs at time ofhalding perntitper AICC 6.68. Hatrnrsag. r[nriatione and addaumal fe t map app/v ht all n a arrltr drilled t)tcr lanuarr 19 2018 per ESSH 6091. This farm may be scanned and made available for public viewing on the Mason County websitc Pg 4 Last Updated: 6/30/2026 WATER WELL REPORT DEPARTMENT of NotieeoflntentNo. We46802 ECOLOGY Unique Ecology Well TO Tog No. BNV900 Type of Work State of Washington 0 eouwceon Site Well Name(ifmore then one well): ❑ Decommission C Original installation NOT No. Water Right Permit/Cettificate No. Proposed[/w, O Domestic ❑Wdusuial ❑Municipal Property Owner Name Kris Klusman 0 Dewvtmng O inses.ou 0 Teat Well 0 Other Well Street Address NE Alder Creek Lane Como-ua Type: Metal: 0 New well 0 Alteration ❑L4iveo ❑Jetted ❑Cable Tool City Bel(alr County Mason ❑Deepening D Omer U pug 1 Air- U Mad-sotmy Tax Parcel No. 12205-21-90073 mmem:om: Dreamesofbming 6 in.,to 100 ft Was a variance approved for this well? ❑Yes No Deem ofcoepleted well 99 A. Comtrucl:on Details: Wail If yes,what was the variance fool Casing Liner Diameter From To Thickness Steel PVC Welded Thrtad C3 I ❑ 6 n 0 7a .025 in. L9 I ❑ ❑ I ❑ location(see instructions on page 2): [W WM or❑EWM ❑ 1 ❑ in ❑ 1 ❑ ❑ I ❑ NE y%ofthe NW r4:Section 5 Township 22N Range 1W ❑ I ❑ —n in ❑ I ❑ ❑ I ❑ Latitude(Example.47.12345) 47431693- Longitude(Example-120.12345) -122.834225 Perforations; a❑T �No TypeofpeTon used No.nfperfomtiom Sts nip=ttmtioca_in by—in Driller's Log/Construction or Decommission Procedure Perforated from ft.to B.below ground surfce Futmahuu:IMaibe by color,ebanctq sve of natetal and mactmq and the kind and nature o£me material m each layer pemvated with at less[one e®y for each chmge of Screens: OO Yes Li No K-Packer d Depth Yfi ft information Use additional sheets if necessary Maturenecr'e Name Johnson Screen Material From To Type Wlre Wrapped Model No. Diameter 5' Slotalze 008 in from 98 e.to se a_ Fine sandy gravel,silt bound,tight,dry 0 53 Diameter_ Slot she in.from fin ft. Fine sandy clayee silt,dry 53 79 Fine brown sand,water 79 94 Sand/Filter peek❑Yet ❑e No Sin o£pack material in Brown cla tie silt,dry 94 100 Materials placed from_A n—ft Surface Seal: D Yes 0 No To what depth? 20 f. Material used in seal Bento0lte Chips Did any aeon contain unusable water? ]Yes EJ No Type ofwater? Depth ofstmm Method of sealing snatacR Pump: Momr6dmcrs Maine Type. HP. Pump intake depth: R Designed flow rate:_gem Water Levels: Land-surface elevation above mean sea level ft Stick-up ofmp Orwell casing 1 ft.aheve ground sur6ce Static water level 64 R.below top ofwdl castes Date 3114122 Annlan pressure lbs.per square inch Date Anesim water is controlled by (cap,valve,etc.) Well Tab: Was a pumping test perrortmd? No 0 Yes O by whom? Yield gem with 4 d swduwo alter for Yield with ft dmwdawn after hrs. Yield gem with ft drawdewn elks—his. Recovery data(tine—ones when m mPhrwned off water level measured homwell top to water level) lone Water Level T Water level Time Water Level - — Date ofpumping test Bailer ten gem with is drawdoweafer his. Au-test 5 gem with stein at 80 ft.for 1 his Date 3/14/22 Artesian flow gem Tmnperamm ofwemr °P was a ehendcalaalysis made? ❑Yes No Stan Date 3114/22 Completed Date 3114/22 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for Constmetion ofthis well,and its compliance with all Washington well consvudion stndeNs.Materials used and the information reported above are rate to my best knowledge and belief M Driller C Trainee❑PE—Print Nam Dger hylhlen Drilling Comprio Pu mia Drilling lnc- Signature Addroa PO Box 1790 City.Suite Zip Shelton,WA 98584 License No. 2053 IF TRAINEE:Sponsor's Liemse No. Contractor's Sponsor's Signature Registration No.ARCADD109SK1 Date 3114/22 FAY 050-1-20(Rey 09/18) Ifyauneedthis document in an aleernatefp.mat,please call he Water Resources Progmn at 360.407-6872. Persons with hearing loss can call 711 Washington Relay Servse. Persons with a speech disability can call 877-833-6341 Vavü 1 nyia, Inc. 340 WC Vauia'farm lid &((air,'Wa 98528 (360)801-6107 i 1 = f- '�r Itl Project 460/450 NE Alder Creek Capacity Test Lane Belfair,Wa 98528 1 AUG (1 2flZf TAG: p- Date 8/2126 .ly-� Pump 1/2hP _ Well Depth 99' Static Water Level 65.7' Draw Down Recovery Time Water GPM Time Water GPM 0 81.3 Level Level 0 min 65.7' 0 11 hr 81.3 3.5 1min 78.1 5 min 73.0' 35 12 hr 81.3 3.5 2 75.8 12:36 10 min 75.9' 35 13 hr 81.3 3.5 3 74.6 15 min 77.4' 3.5 14 hr 81.3 3.5 4 83.6 1 hr 80.0' 3.5 16 hr 81.3 3.5 10 70.0 2 hr 80.4' 3.5 17 hr 81.3' 3.5 20 67.6 3 hr 81.1 3.5 18 hr 81.3 3.5 30 67.0 4 hr 81.3 3.5 19 hr 81.3 3.5 1 hr 66.3 5 hr 81.3 3.5 20 hr 81.3 3.5 2 hr 65.7 7 hr 81.3 3.5 22 hr 81.3 3.5 8hr 81.3 3.5 23 hr 81.3 3.5 9 hr 81.3 35 24 hr 81.3' 3.5 10 hr 81.3 35 Capacity Notes: Measured with tape and deployed data logger for 24 hr test.Pump discharge fitted with 3 gpm flow restrictor. 26276 Tweho Hess l,n'Nw Stec SPECTRA Laboratories Kitsap Poulsbo,WA - ...wA�ns mm„7onn, 7370 (aeo)ns-star COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County 716 126 collec ted un )u.,,n Day O jqJ I cF-t70/l—�Type of'/aler System(he only onehoe) ❑Group A ❑Group B ,Qother r7 [✓611 Group A and Group B Systems-Pmkde from Wale,FecYllles lnvf,(pry(WFl[ DA System Name: Dal 1G'hl/�l r>l✓t DarPh ore 27 f�Ig /O ' CelPho o �1ol 5jo Emai': c*/f/, %otn Nor ). oIl SerA re to:Ipnnl Nlr+mr.'to &d —r1lCrr�i>?[crn �o /L< W0. 96'52% SAMPLE INFORMATION Sample collected by(name) L1/9 ,1A Spe Lc boob 1ere sanipleAlerted Specialinshuctions orcomn.enb: NED dE Ndefc$tu{ LN 2 -r- ___wa 9ssz6 Hose �;y Typ Type of Sample(check anlY one box) - l 1.❑Routine Disitlbutlon Sample(AIP) 2.O epeat Sample(AP) _ Chbdnated Yes ❑ No (hem dui,bWon system after- sal mudne) Unsatisfactory rooms lab number Chbbne Residual Total Free 3.Ground Water Rule Source Sample - — Unsatisfactory routine date: lIe l Chbnnated Yes No ❑Tdpgered (NP) Chbnne Residual:Total_Free ❑Assessment(A]?) < Sudace or GWI Raw Source Water Sample(Enumemtlon) I $ ❑ E cvl ❑Fetal nu Yn Ne S s Sample Collected fnrbfwmmen Onry'. CRMYpse'Aw Ca¢Nvbr' JPeFe1v LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑unsatisfactory Total Colifolm Present and Satisfactory ❑Fool,pesenl ❑Fool,absent Bacterial Density Resume.Total Gollfomr__mpnll00ml.Ewli mpnll Ooml FecalColiom cfullo0nl. HPC cleltml. Replacement Sample Required: ❑TNTC ❑Sample loo cltl ❑ Sample Vobme ❑Damaged Container ❑ meea«.Ired' Lab remarerce camber Date Do �uz� �! Receipt Temp C. Method Lode SMY[ iLOUN ,SM93II0 One In DatQth. oc sm a " ° D3o Is...— .t 010 .+=mmrm. ��os� r.,W°..% (4a e d �7/17z 5,Tht Ro F i o � DAVID WILBUR LINDA L. SHALLIT RPo I I I � 400 Ron I v ' R' if v� I ei .i & F � � o cm f'Jo/Joi a 1/ al m e O o I• \ ' b---------------4-------- ---------a — \\ s\ el L v� _sons__ �' i �\Rol r¢,r - o..g o• o V BEESON "do.�egqBoYi apq a 3 6 g$ �y why oRro 3 g w9 4�3�i$ tak b R � 'dY j i8 z^ z1 cn £ s ng a +f z� a aq as�"aasane$� w o a r', a r a s a � E $� a ;^rF�s au r � n a [7 ° ge-' 8$�`I I - .�?. o mm ^3•^e fG wm �e0 S i n ! oM SE-°c� s.b > e � a A l ep � Ir t n � n � ° �� pp gF6E ;Ss ,zr�0 6. . e ^ �%n :(7+• +� rFp ?• e -e [ _ _ � O A 4 vA[Y O moi'71 e a 't 3 ce4 x. iji : �$a�'a€�;$'� ��=�z� _ ,`� cx � �; z _zzFE f Ill �i i i Z 2172531 Mason County WA 12/09/2021 02:11:39 PM EASMT eRecorded #168287 RecFee: $208.50 Pages: 6 AEGIS LAND TITLE GROUP WHEN RECORDED RETURN TO: Kristopher Klusman PO Box 2816 AFFIDAVI\ Belfair,WA 98528 N1YRçEIANC> WA 3CISE TAX c4d2O2l T lLI * ZIER TTeasure Mason County J Escrow No.: 2021-34530-BF Filed for Record at Request of:Aegis Land ároup DOCUMENT TITLE(S): Declaration of Easement REFERENCE NUMBER(S)OF D 'LIMEN7S ASSIGNED OR RELEASED: GRANTER(S):Kristopher k ñ7 àpdTerri Klusman GRANTEE(S): Kristr K11r�r11an and Terri Klusman and Earl Lincoln ABBREVIATED LEGAL DESlb PTION: Lot A, B and C SS#2900, PTN NE NW and Lot A SS# 2769, PTN I,gt�4SriI ' heler's Home and Garden Tract. TAX PA MBER(S): Property 1: 122951-9)Ø , 12205-21-90072, 12205-21-90073 and 12332-50-90851 LPB 01-05 Return to: Kristopher Klusman `\ PO Box 2816 \\ Belfair,WA 98528 — :�Grantor.(1)Krlstopher Klusman,(2)Terri Klusman Grantee:(1)Kristopher Klusman,(2)Tend Klusman, Abbreviated Legals:LOT A,e&C OF SP 12900 PfN�F NE NWT, and Lot A SS#2769,PTN Lot34,Sam B. Theler's Home and Garden Tract Parcel Nos: 1220S-21-90071, 12205-21-900 ', 1220"3 -9O073 812332-50-90851 DECLAM71�O\EASEMENT This agreement is made this ZIE S N r 2021,between Kdstopher and Terri Klusman, husband and wife,herelnafter< cejae1 K WSMAN,and Earl D.Lincoln,a single man,hereinafter referred to as LINCOLN for the Iestablishingg easements for Ingress,egress,utilities, maintenance,repair and r t areas for two(2)two-party water systems. LAND AFFECTED NN KWSMAN Is OW WT A. B&C OF SP 12900 PTN OF NE NW recorded August 18,1998,in Volume 3 coats sge 61,Auditor's File No.673150,being a portion of the Northeast quarter of the NooreSEg4orter of Sections,Township 22 North,Range 1 West,W.M.,In Mason County, Wash `J o!)n LT owner of Lot A SS#2769,PIN Lot 34,Sam B.Theler's Home and Garden Tract N . A&LJSMAN and LINCOLN each to Install a water system on LOT C for a total of two(2)two-party water systems,with each water system approved for two(2)water hookups. LOT A and LOT B OF SP #2900 PTN OF NE NW shall each have one(1)water share in the two-party water system known as ACL WATER SYSTEM No. 1,and Lot A 55#2769,PTN Lot34,Sam B.Theler's Home and Garden Tract shall have two(2)water shares In the two-party water system known as ACL WATER SYSTEM No. 2 LOCATION OF WATER SYSTEMS ACL Well No.One(1)and ACL Well No.Two(2)shall be located Within the North Soft of the East 25ft of LOT C Of SP#2900 PTN OF NE NW 2172531 Page 2 of 6 12109/2021 02:11:39 PM Mason County, WA FASEMENTCONVEYANCFS KLUSMAN hereby dedicates,establishes,grants,quit claims and coeys to KLUSMAN and LINCOLN the following described easement wNdr shall be for the benefit of the three(3)lots which are described within this agreement and shag be for the installation,operatic fin�tneimenence,repair, replacement and/or upgrading of any component no(e ofe(2) -party water systems: 1) A perpetual non-acluslve easement over the Nort I of the East 25 feet of LOT C OF SP #2900 PIN OF NE NW where Well No.One m1We .Two(2),elorg with theIr Individual pumping chambers and the electrical contrp(panel ll be located.\ OWNERSHIP OF TKE TWO 121 WATER KLUSMAN shag be the sole owner of ACL W3Y5 1 No.One(1)and LINCOLN shall be the sole owner of ACL WATER SYSTEM No.Two 12) The owners of each watersyste shell be solely.responsible for all of the costs of the installation, operation,testing,maintenance, ía Ibis future upgrade and/or replacement of their respective water system.The ewner(s t C shag have no obligations with respect to any such costs. \/> \J �y A \\APPURTEMANT The easements and he otlkE/rr rovlslons of this document shall run with the titles to the land described herein and shala(nrta rtenant thereto,and shall be binding on KLUSMAN and LINCOLN,its/their successors gdd/ot•t`3signs: // Nom) ;AGis p r sm n _ f I Klusman Earl O.Lincoln 2172531 Page 3 of 6 12/09/2021 02:11:39 PM Mason County, WA EASEMENT CONVEYANCES KLUSMAN hereby dedicates,establishes,grants, quit claims and con41ys to KLUSMAN and LINCOLN the following described easement,which shall be for the benefit of the ! (3)Lots which are described within this agreement and shall be for the installation,operation l€stfnggraintenance,repair, replacement and/or upgrading of any component part of e e(2)two-party water systems: 1) A perpetual non-exclusive easement over the Nortt of the East 25 feet of LOT C OF SP 02900 PTN OF NE NW where Well No.One Two(2),along with their individual pumping chambers and the electrical comr9/l mnels sri'tll be located. OWNERSHIP OF THE TWO 12)WATER SYSTEM C1 KLUSMAN shall be the sole owner of ACL WATERSY5tEM No.One I1)and LINCOLN shall be the sole owner of ACL WATER SYSTEM No.Two(2) The owners of each water system\a(nall be solely.responsible for all of the costs of the installation, operation,testing,maintenance,re irNan ssible future upgrade and/or replacement of their respective water system.The!q wner(sJ t C shall have no obligations with respect to any such costs. APPURTENANT WITFW'CITItN 4 The easements and\ a otherovisions of this document shall run with the titles to the land described herein and shalf4eco irtenant thereto,and shall be binding on KLUSMAN and LINCOLN,its/their waessors /orais. L YYs lkristoD 'r1 usman �,� �� llyL C.OIAlItYY'� - --3TgiKusman %� Earl D.Uncoln 2172531 Page 4 of 6 12/09/2021 02:11:39 PM Mason County, WA STATE OF WASHINGTON ). z COUNTY OF MASON Jam" ) On this day of lkst-Wr2021,before me,the undersi a ary Public In and forth.State of Washington,personally appeared Kristopher Klusma man to me known to be the Individuals describe in and who executed the foregolj Instru/� nt,and acknowledged that they signed the same as their free and voluntary act and de(e4-�' *euw;and purposes therein mentioned. GIVEN under my hand and official seal hereto fflxed theiday and year first above written. TRISHA WILSBAC �47 Name: _____ Notary Pu State of Washi o� Notary Public ina dforthe State of My Commis EA fifes ��I Residingln: Mey 0 My appointment expires: ftyt N . STATE OF VANTON > ). C )ss. COUN1$FL1Ok ) ay ofeer 021,before me,the undersigned Notary Public in and for the State of WashIngt ,personally appeared Earl D.Lincoln to me known to be the Individual describe in and who b(uteye foregoing instrument,and acknowledged that he signed the same as his free and voluntary M flM deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal hereto affixed the day and year first above written. r r yokr Grrrir br �OtM` " t i Na 5 irga"o pz Notary Pub d forth. ofIiW �\. s,M;s! j` Resdingln: rr4�Op WAGN�P My appointment a s: 1j111111\Nv�����" 2172531 Page 5 of 6 12109/2021 02:11:39 PM Mason County, WA STATE OF WASHINGTON ). COUNTY OF MASON ) ;;A N> On this_day of October 1,before me,the undersigne�Nd ry Public in and for the State of Washington,personalty appea ristopher Klusm �jcuks' ate kltl an to me known to be the individuals describe in and who exec d the forego' strurint,and acknowledged that they signed the same as their free and voluntary act deed foS 'Prrd purposes therein mentioned. GIVEN under my hand and official seal hereto!\ d thr)flay and year first above written. N-// Name: Notary Public in and fort State of Resid ng in: My appointment expires: cl u STATE OF WA HIt*TOF1 ' ). O ( )ss. COUDTF /OF ) 9n `ebky of Oete�e 2r 021,before me,the undersigned Notary Public In and for the State of �$4ashingt $,personally appeared Earl D.Lincoln to me known to be the Individual describe in and who ijpc$Ø4he foregoing instrument,and acknowledged that he signed the same as his free and voluntary " ?IIct an deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal hereto of xed the day and year first above written. Nam 4 iu :gagac 2 ' Notary Publi ,nd for the of Uc N baP "C° t/ My appointment eI es: 2172531 Page 6 of 6 12/09/202102:11:39 PM Mason County, WA 2244747 MASON CO WA OBI21/2026 10 AB PM AGREE KRIS KLUSMAN #2252a8 Fec Fee $307 50 Pages. 5 Name and Return Address: � II[I IIIIII I ILL IL ILl I 111111IIII INIIIM 1III K 's K Lc4 -..p a PLC Box 2ulio )3ekFcar vM 9kTt8 f ! �I A.UU 2 i 2U2A Il COVERPAGE I- 9 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) i. S'i J 1A)2( Uf)me- 1O"6 wtt. 2. Reference Numbers(s)of Documents Assigned or Released ADDITIONAL REFERENCE a'S ON PAGE Grantor(s) 1. Kell KLa,4srV�aN 2. ADDITIONAL GRANTORS ON PAGE Grantee(s) 1. . x Ies( L\v�sc-tki Z ADDITIONAL GRANTEES ON PAGE Legal Description (abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) LorA $6 of SP +* 29yo oc /J NkJ ADDITIONAL LEGAL IS ON PAGE Assessor's Property Tax Parcel/Account Number(s) )2205-2I-gcorn )2205- 2 )-9co76� ADDITIONAL PARCEL WS ON PAGE SHARED WELL WATER AGREEMENT ACL Water System No. 1 This Agreement, made and entered into this 17'"day November 2022,of by and between Kristopher Kiusman, party of the first part, hereinafter referred to as the"supplying party",and Alexander Lincoln, party of the second part hereinafter referred to as the"supplied party": WITNESSETH:THAT WHEREAS,the supplying party is now the owner of Tax Parcel#12205-21-90071 (Parcel A)and of ACL Well System#1 Well Tag#BNV900 located on Tax Parcel#12205-21-90073 on Alder Creek In in Belfair WA 98528 located in the County of Mason,State of WA as recorded in AFN 2172531 Mason County WA. WHEREAS,the supplied party is the owner of Tax Parcel#12205-21-90072 (Parcel B), located in the County of Mason,State of WA. And WHEREAS,the undersigned parties deem it necessary to provide a well system to service the parcels described herein,and an Agreement has been reached relative to supplying water from the well and the cost of supplying said water;and WHEREAS,there is a well located upon Tax parcel#12205-21-90073,together with water distribution facilities, hereinafter referred to as"water distribution system",for the purpose of supplying water to the two properties connected to the said water distribution system;and WHEREAS, it is the intention and purpose of the undersigned parties that the well and water distribution system shall be used and operated to provide an adequate supply of water for each of the properties connected thereto,for the domestic consumption of the occupants of said properties,and to assure the continuous and satisfactory operation and maintenance of the well and water distribution system for the benefit of the present and future owners,their heirs,successors and assigns of the properties connected thereto;and WHEREAS,the said well is deemed by the parties hereto to be of adequate capacity to supply a single family dwelling on each of the parcels described herein with water from the well for all domestic uses of a single family residing therein; and WHEREAS,the United States of America, Rural Housing Services, will not finance or guarantee mortgage loans covering the separate properties and improvements thereon unless proper assurance is given by the parties as demonstrated by execution of this Agreement,that the water distribution system will have a continuous and satisfactory operation in accordance with the terms of this Agreement;and WHEREAS,the water from the well has undergone a water quality analysis from the State of Health authority,or in the absence of local health department,results reported by a certified water testing laboratory and has been determined to supply safe and potable water; and WHEREAS,the parties hereto desire to enter this Agreement for the purpose of reducing to writing their respective rights and obligations pertaining to said well and water distribution system. Notice to Future Property Owners-NOW THEREFORE,inconsideration of the promises and covenants herein contained, it is agreed that the well and water distribution system situated on Tax Parcel N 12205-21-90073 shall be used by the parties to this Agreement,as well as by all future owners and occupants of said parcels, upon the following terms and conditions: 1.That until this Agreement is terminated, as hereinafter provided,the parties hereto,their heirs, successors and assigns,for the exclusive benefit of the respective parcels of real estate, and far the exclusive use of the household residing thereon,are hereby granted the right in common with the other parties to this Agreement,to draw water from the well located on for ordinary domestic use excluding the right to draw water to fill swimming pools and other large withdrawals of any type . 2.That the owners or residents of the dwellings located on said parcels, as of the date of this Agreement shall: a. Pay or cause to be paid to the supplying party, an annual fee for this use of the well and water distribution system. b. Pay or cause to be paid promptly,a proportionate share of all expenses for the operation and maintenance of the well and water distribution system that may become necessary. Each respective share shall be determined by dividing the amount of each expense by two, it being understood that the supplying party and the supplied party shall pay an amount equal to one half of the total of such necessary repair or replacement.Shared expenses include the cost of water sampling, repairs and maintenance of said well and water distribution system. 3.That the cost of any removal or replacement of pre-existing site improvements on an individual parcel necessary for system operation, maintenance, replacement, improvements, inspection or testing, damaged as a result of repair of the well or water distribution system maintenance will be borne by the owner of the affected parcel, except that costs to remove and replace common boundary fencing or walls damaged as a result of repair shall be shared equally between or among parties so damaged. 4.That each of the parties hereby agrees that they will promptly repair, maintain and replace all water pipes or mains serving their respective dwellings. S.That each of the parties hereby agrees to have performed an annual well water bacterial sampling at minimum by a certified water testing laboratory. 6.That the consent of all parties to pay a proportionate share of costs shall be obtained prior to embarking upon expenditures for system maintenance, replacement or improvement, except in emergency situations.An arbitrator shall he chosen by the parties;shall be consulted in the event the parties cannot agree regarding the said expenditures; and the arbitrator's decision shall be definitive. 7.That the supplied party shall pay to the supplying party his/her proportionate share for the cost of energy for the operation of the pumping equipment.This cost shall be S25 per month.Any future increases to this annual expense shall not exceed 5% in any given year. 8.That it is the agreement of the parties hereto that the payment for energy cost shall be made not later than the 5t°of each month, in the event that any such payment remains unpaid for a period of 30 days,the supplying party may terminate the supply of water to the supplied party until all arrearages in payment are received by the supplying party. Notice of intent to lien: Any payment not received within 90 days of the due date may be held as a lien against the property. 9.That it is the agreement of the parties that they shall permit a third party to cure a default of payment or other obligation and shall permit water distribution service to be reinstated upon such curative action. 10-That no party may install landscaping or improvements that will impair the use of Well easement as noted in AFN 2172531. 11.That each party shall have the right to act to correct an emergency situation and shall have access to the pertinent parcel in the absence of the other. An emergency situation shall be defined as the failure of any shared portion of the system to deliver water upon demand. 12.That only those parcels of real estate hereinabove described,and the dwellings located thereon shall be permitted to receive water from said well and pumping equipment; and each of the parties hereto does hereby covenant and agree that he/she will not allow or permit other persons,other than household guests, to take,draw, use or receive water from the well, nor permit other persons to connect to the pipes or mains serving his/her respective parcel. 13.That in the event the referenced well shall become contaminated and shall no longer supply water suitable for domestic consumption or shall no longer supply water adequate for the needs of all relevant parties,or in the event that another source of water shall become available to the respective parcels, then the rights and obligations of the parties created by this Agreement shall cease and terminate in accordance with the terms and conditions hereinafter described. 14.That the respective rights and obligations of the parties shall continue until the parties who wish to terminate their participation in the Well Agreement have executed and filed a written statement of termination at the Office of the Register of Deeds of the County of Mason,State of WA, and to the "supplying party'. Upon termination of participation in this Agreement, the owner and occupant of each residence which is terminated from the Agreement shall have no further right to the use of the well.The terminated parties shall disconnect their respective lateral connection from said well system and shall have no further obligation to pay or collect for maintenance and related expenses incurred thereafter. The costs of disconnection from the well and water system shall be borne by the owner of the pertinent parcel. 15.That the undersigned parties shall permit well water sampling and testing by a responsible authority at the request of an undersigned party, state or local authority, mortgagee,or the United States of America, Rural Housing Services and the costs of such well tests are shared like any other expense. 16.That the parties may amend this Agreement to assure equitable distribution of shared costs and responsibilities; however,this Agreement may not be amended during the term of a Federally-insured (direct) or guaranteed mortgage on any property served,except as provided herein,for the purpose of adding to the prescribed number of parties. 17.That the term of this Agreement shall be perpetual, except as herein limited. 18.That the benefits and burdens of this Agreement shall constitute a covenant running with the parcels of land herein described and shall be binding upon the heirs, successors in title and assigns of the parties hereto. 19.Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third.The third arbitrator so selected shall arbitrate said dispute.The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. IN WITNESS WHEREOF,the parties have hereunto set their hands and seal the day and year first above written.Witness of our signatures this the 17th day of November 2022. Kristopher Kinsman(Owner of Parcel A) Alexander Lincoln (Owner of Parcel B) County of aSo )ss State of Of,1 .nA 'tsi) On this_day of OAugust 2026, before me,the undersigned Notary Public in and for the State of Washington, personally appeared Kristopher Klusman to me known to be the individual described in and who executed the 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 seal hereto affixed the day and year first above written. � (1Qt-� `nnYt . O '�ssionE••.2,'% T !m T�p o"°-r-zone N!d,c Name. �i 1l� ls�O r1nS NOTAFY Notary Public in and for the Sate of r' PUBLIC h _ Residing in: MrC crl �a'icOF WA'S�{`�\0\ My Appointment expires: Dl—O7 " t r OZC7