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HomeMy WebLinkAboutCertificate of Water Supply Utility ServiceLS�LSQ V LS IIff OCT - 4 2016 D IEFFBSON COUNN CERTIFICATE OF f1EPTOFCOkINJ11NIIVIIFVFIOPR,I[WATE SUPPLY UTILITY SERVICE Application No.._-M(ARP - pS SUB00-21 OFFICIAL USE ONLY DO NOT WRITE IN THIS SPACE Application Number Project Name Approved Water Plan Water Utllity Assigned By Dete Water UHiity PUDISMA Date Inchoate the number of ulR of each ateg-rY Resaantial Y� MUI&FamI Commercai Indushal Agricultural Other ea 1 yr signrnq c apelleativn £am, fie epVllcantmxne: —Or. cca ma i n p,-IOOd eete;n i c .. ane ece t e l,a tc.. aa,cd a- ial lalaahon aaY m ial fact malt ns the ;�pi r/ •re- n.-ry ...., rn IL,. aPFI: ••av, me4rt m+r r...ne .e e, s n•r neinp a', am —it. [thea lac -11 t^a hale eae - unry agar all iia L,t inaeynent - ,neleoareiney,a ane zxpa,u omen mzya r x0.0.0 ...—a e.1—an cca., ea a aesu3t of of lnacomegaence at toe ec. ting of ti- pein1L 111, "1. via. erre vignr 1r, ♦ en my n emplcYee ieptm agnn s foo ch' putpoa c£ ap`lica a vi_wt enc array cagavic a slat¢ nnpec .. Ta. and [i,teof ae try o0 the taiiGy paope[ty t ccal—c scall he algae tae Masn 1 .eons tlaa'ing lcla [0-1n es Page 1 of 5 APPLICANT TO COMPLETE Applicant Name Trw'm5an irP�ti R21'b�3-00� . Proposed Project Tk[ 6$ A SHO% PPL. -t Project LocatIcn ItA ON' 13xi Rd, Pe r 14" LO KtµlP Project Preliminary Plan: [, LZ1 vIk dN Co A,r.,1t.{L6 '�'� Y•`�'J r"'a'"'^ Inchoate the number of ulR of each ateg-rY Resaantial Y� MUI&FamI Commercai Indushal Agricultural Other ea 1 yr signrnq c apelleativn £am, fie epVllcantmxne: —Or. cca ma i n p,-IOOd eete;n i c .. ane ece t e l,a tc.. aa,cd a- ial lalaahon aaY m ial fact malt ns the ;�pi r/ •re- n.-ry ...., rn IL,. aPFI: ••av, me4rt m+r r...ne .e e, s n•r neinp a', am —it. [thea lac -11 t^a hale eae - unry agar all iia L,t inaeynent - ,neleoareiney,a ane zxpa,u omen mzya r x0.0.0 ...—a e.1—an cca., ea a aesu3t of of lnacomegaence at toe ec. ting of ti- pein1L 111, "1. via. erre vignr 1r, ♦ en my n emplcYee ieptm agnn s foo ch' putpoa c£ ap`lica a vi_wt enc array cagavic a slat¢ nnpec .. Ta. and [i,teof ae try o0 the taiiGy paope[ty t ccal—c scall he algae tae Masn 1 .eons tlaa'ing lcla [0-1n es Page 1 of 5 .-o-I t_LIT hlo. TO BE COMPLETED BY THE WATER UTILITY A. Please circle me ap,rs,md.actions) anchor fill in the appropriate 1, un Ns. 1. Thu proposal lars not within our approved water on@earea 2. The011�manl a t 1 n410: waterullf Joel ous not aasrein serve MIs devdnphis lim lever. a The water utility odds not wllling to assnne intedn sal&Illie aperegonal meneganeld esponsibility far the proposed water system until a cannaaflan to our system is passible. If you (Me utility) are not going to manage the supply of water for this development, please present to number 16 and attach a letter explaining the 'Justification of Denial'. The County will be unable to proceed without this'Justlfleaden of Denial'. In all other cases. contlaue with me gaestyrummire. a. Tba proposed develop.n�a not consisturewilh our approvet watersystem plan. S. Water samry can be made available 0 No development immediateblylby _1-1— 3. Indicne sefimeted peak heuq peek day, and mr,rut average wafer wµAy seeded in gaitons perminute (GP61). RyN Nae mwik nay Armee P.vp nequirad iee luw, MA MA Estbnated contesti0 /o •S Thai requhamenb / d %Ilber of fire hydrants required AI a,c P The (:�)A r v if n� •wetar system has been uppuved Ip Wrincefi nn and cueemy has t !L2 xdve mvtn'tlans and _.1D1, serriae commiNrenls. WI9 me prgen. eHensim of water mans or adjustmana to aarvics arca thountlane59Ya5 J to yes. pinvse deaQ91a: 10. squ,roant herittes Improvements other Nan waterihe extension would uW not e required. Listimpavereente* OCT 14 2016 JEFFERSON COUNTY DCO Application No. 1 t. the amine to, systom cobable W serving the clues,. donem,ment densuY willlwill not be installed kdllatly prior to foal Plat approrel. If staged dewhpmant a proposed. specify •+hat lone and the method of s sty which will be pmdtled b guarantee u4imam ihatalation of water When hbdbt as. 12. till Netbws Ma[muld be p.idedto thedemlopemm olth amitmnum pnas,mnfW psi and 20 Psi. -----JC�a GPM at 30 psi �i dO GPM at 20 pet 13 Intllcate sve of ream reguiretl for hookup: inches. 14. IMicafe dstarke from exis4n9 main to Pmlad: eet. 15. Deegn aid Installation of the prapcaed wata, system wlll II not teyiewed and inspected by our ag 113. A satisfactory eentrh es natba,h made with the applicant to serve this proposal. Commen . I, the undersiDnmpase Nthat ll and# Pits yoM the apWksnC�cW sledge that Ne dluuss this arm. afift, ham MMap In inalellao' xaleral'slem hBs IhB caPaci31' facBdresthat ndwelh e 0foto he Posedpmjxi�consisfeM rvkflN Ay's wa(ars nl'slm per. WAT UP ttY REPRESEN THE DATE Page 4 of 5 L '✓ � oc1 i a zoos JEFFERSON C004 -v pC© APPlica Cion 'Io- --To BE COMPLETED BYAPPROPRIATE REVIEW AGENCY B. Please circle the appropriate action(s) andlorfill in blanks. I. Jefferson County Health DepuMmre(UWividoal Wells) The Jefferson Canty Heem Oeparbnent Fess reviewed the prnposed method of wafer supply antl Hereby oRem mrs:epbal approvaV tltsapproval for me proposal. Final apWovi l wall ba reserred until a suit weal mte is approved and until it is dereoustaled that applicable ! separation distances and It"M regulators are incurable. Ceun, Health DapartmBat lJff CW Data T. JeHsrson County Development Reale. Division (Reviews for consistencywlm Count, land use policies.) I he uevslopmenc Hatem Useless has avmwed the proposed machine of water supplyand hereby rtlkremmeptuel appmvaVdleappmval for the pmpasm supply Comment, Developmard Revlew Divkion Sweaters Date a. Washtngtor State Department of Health Revkws e,scears, where there is a disagreement of iemis of wakrserviareorformatnn of a MWwntmauppyinllty. Due atlhamadiaegreemem ontams otwalerservice ork me formation of a newwatersuppty Allty, the DOH has mak a ded'an on wearsemos. This deosion'6 presenod in der ahached kner dated am slgrwe by. The Wates Utility Caordimtlng Committee dtdldld hot ..it. rervmmentlabous appllcabk an this case which arekre not attached. Washingtonl3bb.Departmentof Healm Data GBPermilCenmrl###F0RM5#NN10RD FORlvI=WSP&USRco QWB Page 9 Pf 5 13 nct � w zoos JEFFERSON COUNTY DCD