HomeMy WebLinkAboutMLA08-00509 CERTIFICATE OF WATER SUPPLY NOO-65-2008 16:12 D. R. STRONG 425 827 2423 P.03/88
FROM FAX NO. :3683794487 Nov. 85 2008 04:15PM P3
CERTIFICATE OF
WATER SUPPLY UTILITY SERVICE
JEFFERSON COUNTY
*********OFFICIAL USE ONLY DO NOT WRITE IN THIS SPACE***********
*4+*************4+**4+4+4+4+**************94+***4+ r*,+4+*******9+*****4+a
Application Number Project Name
Approves ' Tater ' an Water tility m Assigned By
*********************************scat********************- *****
APPLICANT TO COMPLETE
Applicant Name Pb 407 A .; e .S t L c
Proposed Project
Project Location Cecl-,r`
Project Preliminary Plan: -1 r 14, Le se;v-€3 Eat
Indicate the number of units of each category:
Residential 1/ Multi-Family Commercial
Industrial Agricultural Other
1, the undersigned, certify that I, or my appointed representative have discussed this
proposed project and its impacts with the Water Utility shown above. I acknowledge
that this proposed project may require improvements to the water system shown
above which would incur my financial obligation. Prier to Final Plat approval, or
approval of the Water $vstem Plan or the Engineer's Report, it is understood thil.L2
Baal contract betwgya/i7y ed and th? WWtar Utility must besliImi.tt 'rI to JefforsOn
County which specifies the terms of the_water service, operational responsibility, and
financial obligation. Furthermore, I acknowledge that I have read and understand the
following material.
Sign ature o' Applicant Date
Page 1of6
NOU-05-2008 16:12 D. R. STRONG 425 827 2423 P.04/08
FROM FAX NO. :3603794487 Nov. 05 2008 04:15PM P4
UTILITY SERVICE REVIEW PROCEDURE (USRP)
If an individual well is proposed, then the Procedure (USRP) is not required at this
time. Individual well proposal is forwarded to the County Health Department for
review and approval.
Priority 1: Within Service Area
Jefferson County will determine whose service area water supply
the request is located in, and will then direct the applicant to
that purveyor or water utility with a Certificate of Water Supply
Utility Service in hand. If the utility declines service, a letter
stating 'Justification of Denial' will be required.
If the purveyor declines service, then go to Priority 2.
Priority 2: Satellite System Management Agency (SSMA)
The designated SSMA for the County will be allowed to respond
to the service request and provide conditions of service to the
applicant. If the SSMA declines service, a letter stating
'Justification of Denial' will be required.
If the SSMA declines service, then go to Priority 3.
Priority 3: Adjacent utility
The applicant must approach adjacent utilities to determine if
service can be provided. If the adjacent utility declines service,
a letter stating 'Justification of Denial' will be required.
If adjacent utility declines service, then go to Priority 4.
Priority 4: Create new Public Water System (PWS)
After the first 3 priorities are ruled out, a new PWS may be
considered through the required State review process. The
applicant will be directed to have an engineer contact the DOH
Regional Engineer for specific requirements (Water System Plan,
project report, construction documents, etc.).
Note: Once service is determined, Jefferson County will sign off on the Certificate
for Water Supply Utility Service and adjust service area maps as necessary.
Sign off will occur only after consultation with the DOH to determine whether
the proposed system is adequate to serve.
Page 2 of 6
(9N. I
3 7
NOU-05-2008 16:13 D. R. STRONG 425 827 2423 P.05/08
FROM FAX NO. :3603794487 Nov. 05 2008 04:16PM P5
TO BE COMPLETED BY THE WATER UTILITY
A. Please circle the appropriate action(s) and/or fill in the appropriate blanks.
•
1. The proposal is/is not within our approved water service area.
2. The water utility does/does not
desire to serve this development at this time/ever.
3. The water utility is/is not willing to assume interim satellite operational
management responsibility for the proposed water system until a
connection to our system is possible.
If you (the utility) are not going to manage the supply of water for this development,
please proceed to number 16 and attach a letter explaining the 'Justification of
Denial'. The County will be unable to proceed without this 'Justification of Denial'.
In all other cases, continue with the questionnaire.
4. The proposed development is/is not consistent with our approved water
system plan.
5. Water service can be made available to this development immediately/by
6. Indicate estimated peak hour, peak day, and annual average water
supply needed in gallons per minute (GPM).
Peek Hour Ptak Day Armuel Avg.
Required fire flow n/a _ nja
Estimated domestic
Total requirements
7. Number of fire hydrants required
8. The water system
has been approved for service connections and currently has
active connections and service commitments.
Page 3 of 6
�( 7
NOO-05-2008 16:13 D. R. STRONG 425 827 2423 P.06/88
' FROM : FAX NO. :3603794487 Nov. 05 2008 04:16PM P6
Application No.
9. Will the project require extension of water mains or adjustments to
service area boundaries? Yes/No If yes, please describe:
10. Significant facilities improvements other than waterline extension
would/would not be required. List improvements:
11. The entire water system capable of serving the ultimate development
density will/will not be installed initially prior to final plat approval. If
staged development is proposed, specify what form and the method
of surety which will be provided to guarantee ultimate installation of
water system facilities.
12. List the flows that could be provided to the development with a
minimum pressure of 30 psi and 20 psi.
GPM at 30 psi
GPM at 20 psi
13. Indicate size of main required for hookup: inches.
14. Indicate distance from existing main to project: feet.
15. Design and installation of the proposed water system will/will not be
reviewed and inspected by our agency.
Page 4 of 6
a1
7
NOV-05-2008 16:13 D. R. STRONG 425 827 2423 P.07/08
FROM: FAX NO. :3603794487 Nov. 05 2008 04:16PM P7
Application No.
16. A satisfactory contract has/has not been made with the applicant to
serve this proposal. Comments:
I, the undersigned, certify that I, or another authorized representative of the
utility, have discussed this proposed project and its imparts with the applicant.
I acknowledge that the water system
has the capacity in installed facilities and water rights to serve the proposed
development with the Improvements identified above and that the service to
the proposed project is consistent with this utility's water system plan.
WA `EFfiJtILITY REPRESENTA7ivE DATE
*aa******** TO BE COMPLETED BY APPROPRIATE REVIEW AGENCY**********
B. Please circle the appropriate action(s) and/or fill in blanks.
1. Jefferson County Health Department (Individual Wells)
The Jefferson County Health Department has reviewed the proposed
method of water supply and hereby offers conceptual approval/
disapproval for the proposal. Final approval will be reserved until a
suitable well site is approved and until it is demonstrated that applicable
separation distances and health regulations are attainable. Comments:
County Health Department Official pate
Page 5 of 6
J. I
NOU-05-2008 16:13 D. R. STRONG 425 827 2423 P.08/08
R FROM : FAX NO. :3603794487 Nov. 05 2008 04:16PM P8
Application No.
2. Jefferson County Development Review Division (Reviews for
consistency with County land use policies.)
The Development Review Division has reviewed the proposed method
of water supply and hereby offers conceptual approval/disapproval for
the proposed supply. Comments:
•
Development Review Division Signature Date
3. Washington State Department of Health
Reviews applications where there is a disagreement of terms of water
service or formation of a new water supply utility. Due either to a
disagreement on terms of water service or to the formation of a new
water supply utility, the DOH- has made a decision on water service.
This decision is presented in the attached letter dated
and signed by _
The Water Utility Coordinating Committee did/did not make
recommendations applicable to this case which are/are not attached.
Comments
Washington tate Department of Health Date
Page 6 of 6
h:lhamelpincntrlinfohlthkwsp W95
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7 7
TOTAL P.08
Olympic
'-rro e
Gro
O N 1'['t , ( 't„,,„,,,,1'
TRANSMITTAL
TO: Michelle Farfan
APR 13
SUBJECT: Revised Tala Point Certificate of Water Supply
Date: April 9, 2009
COMMENTS
Michelle,
Here is the revised Tala Point Certificate of Water Supply. Let me know if you
need anything else.
Thanks,
Brandon Bird
From the desk of...
Brandon Bird
Project Manager
Olympic Property Group LLC
19245 Tenth Avenue NE
Poulsbo,WA 98370
bbird@orminc.com
Direct(360)394-0573
Office(360)697-6626
Fax: (360)697-1156
I
= NOV-05-2888 16:12 D. R. STRONG 425 827 2423 P.03/88
FROM : FAX NO. :3603794487 Nov. 05 2088 04:15PM P3
APR 13Q9
CERTIFICATE OF
WATER SUPPLY UTILITY SERVICE .
JEFFERSON COUNTY iltutAa.
- *********OFFICIAL USE ONLY DO NOT WRITE IN THIS SPACE***********
*************************************************************
Application Number project Name
Approved Water Plan Water Utffity .- Assigned Ey
******************************************** *********- ******
APPLICANT TO COMPLETE
Applicant Name P6 pr Q r- l e s L,L C
Proposed Project F 1
Project Location S `19r‘ I kIh
Pro'ect.Preliminary Plan: 1-44-er W., 1l 6 e Se r-v-e,., iNeA.4 wtti u. ( l —
/1-fp 1.) P I, c� -r..-� v. & - o3
Indicate the number of units of each category:
Residential Multi-Family Commercial
Industrial Agricultural Other
I, the undersigned, certify that I, or my appointed representative have discussed this
proposed project and its impacts with the Water Utility shown above. I acknowledge
that this proposed project may require improvements to 1112 water system shown
above which would incur my financial obligation. Prior_tp final Plat approval, of
approval of the Water_sUsLeatelan or the Engineer's Report, it is understood tea
•e .. •ntrac . - w— it • and th- W: .{r iii m • •mi . o Jeff-r on
County which specifies the terms of the wjer service. otzeclign$l responsibility, and
financial obligation. Furthermore, I acknowledge that I have read and understand the
following material.
Y •00-110 / &X)
Sig eture o Applicant m Date
Page 1 of 6
1
NOV-85-2888 16:12 D. R. STRONG 425 827 2423 P.04/08
FROM : FAX NO. :3603794487 Nov. 05 2008 04:15PM P4
UTILITY SERVICE REVIEW PROCEDURE (USRP)
If an individual well is proposed, then the Procedure (USRP) is not required at this
time. Individual well proposal is forwarded to the County Health Department for
review and approval.
Priority 1: Within Service Area
Jefferson County will determine whose service area water supply
the request is located in, and will then direct the applicant to
that purveyor or water utility with a Certificate of Water Supply
Utility Service in hand. If the utility declines service, a letter
stating 'Justification of Denial' will be required.
If the purveyor declines service, then go to Priority 2.
Priority 2: Satellite System Management Agency (SSMA)
The designated SSMA for the County will be allowed to respond
to the service request and provide conditions of service to the
applicant. If the SSMA declines service, a letter stating
'Justification of Denial' will be required.
If the SSMA declines service, then go to Priority 3,
Priority 3: Adjacent utility
The applicant must approach adjacent utilities to determine if
service can be provided. If the adjacent utility declines service,
a letter stating 'Justification of Denial' will be required.
If adjacent utility declines service, then go to Priority 4.
Priority 4: Create new Public Water System (PWS)
After the first 3 priorities are ruled out, a new PWS may be
considered through the required State review process. The
applicant will be directed to have an engineer contact the DOH
Regional Engineer for specific requirements (Water System Plan,
project report, construction documents, etc.).
Note: Once service is determined, Jefferson County will sign off on the Certificate
for Water Supply Utility Service and adjust service area maps as necessary.
Sign off will occur only after consultation with the DOH to determine whether
the proposed system is adequate to serve.
Page 2 of 6
NOU-05-2008 16:13 D. R. STRONG 425 927 2423 P.05/08
FROM FAX NO. :3603794487 Nov. 05 2008 04:16PM P5
TO BE COMPLETED BY THE WATER UTILITY
A. Please circle the appropriate action(s) and/or fill in the appropriate blanks.
1 . The proposal is/is not within our approved water service area.
2. The water utility does/does not
desire to serve this development at this time/ever.
3. The water utility is/is not willing to assume interim satellite operational
management responsibility for the proposed water system until
connection to our system is possible.
If you (the utility) are not going to manage the supply of water for this development,
please proceed to number 16 and attach a letter explaining the 'Justification of
Denial'. The County will be unable to proceed without this 'Justification of Denial'.
In all other cases, continue with the questionnaire.
4. The proposed development is/is not consistent with our approved water
system plan.
5. Water service can be made available to this development immediately/by
W / /
6. Indicate estimated peak hour, peak day, and annual average water
supply needed in gallons per minute (GPM).
Peak Hour Peak Day Annual Avg.
Required fire flow n/a nJa
Estimated domestic
Total requirements
7. Number of fire hydrants required
8. The water system
has been approver- service connections and currently has
active connections and service commitments.
Page 3 of 6
NOV-05-2008 16:13 D. R. STRONG 425 827 2423 P.86/88
FROM : FAX NO. :3603794487 Nov. 05 2888 84:16PM P6
Application No.
9. Will the project require extension of water mains or adjustments to
service area boundaries? Yes/No If yes, please describe:
10. Significant facilities improvements other than waterline extension
would/would not be required. List improvements:
•
11, The entire water system capable of serving the ultimate development
density will/will not be installed initially prior to final plat approval. If
staged development is proposed, specify what form and the method
of surety which will be provided to guarantee ultimate installation of
water system facilities.
12. List the flows that could be provided to the development with a
minimum pressure of 30 psi and 20 psi.
GPM at 30 psi
GPM at 20 psi
13. Indicate size of main required for hookup: inches.
14. Indicate distance from existing main to project: feet.
15. Design and installation of the proposed water system will/will not be
reviewed and inspected by our agency.
Page 4 of 6
NOU-05-2888 16:13 D. R. STRONG 425 827 2423 P.07/08
` FROM : FAX NO. :3603794487 Nov. 05 2008 04:16PM P7
Application No,
16. A satisfactory contract has/has not been made with the applicant to
serve this proposal. Comments:
I, the undersigned, certify that 1, or another authorized representative of the
utility, have discussed this proposed project and its imparts with the applicant,
i acknowledge that the water system
has the capacity in installed facilities and water rights to serve the proposed
development with the improvements identified above and that the service to
the proposed project is consistent with this utility's water system plan.
SER UTILITY REPRESENTATIVE DATE
********** TO BE COMPLETED BY APPROPRIATE REVIEW AGENCY**********
B. Please circle the appropriate action(s) and/or fill in blanks.
1. Jefferson County Health Department (Individual Wells)
The Jefferson County Health Department has reviewed the proposed
method of water supply and hereby offers conceptual approval/
disapproval for the proposal. Final approval will be reserved until a
suitable well site is approved and until it is demonstrated tht applicable
separation distances and health regulations are attainable. Comments:
County Health Department Official Date
Page 5 of 6