HomeMy WebLinkAbout13- CERTIFICATION OF WATER SUPPLYApplication No.
CERTIFICATE OF
WATER SUPPLY UTILITY SERVICE
JEFFERSON COUNTY
OFFICIAL USE ONLY DO NOT WRITE IN THIS SPACE
|Application Number Project Name
Approved Water Plan Water Utility Assigned By Date
Water Utility
PUD/SMA Date
APPLICANT TO COMPLETE
Applicant Name Ann Burkhart
Proposed Project Pomona Woods Development
Project Location 3O Oak Bay Poad Portadoc WA
Project Preliminary Plan:
Indicate the number of units of each category
Multi-Family reomS Residential Commercial
Industrial Agricultural Other
I, the undersigned, certfy that !, or my appointed representative have discussed this proposed project and its impacts with the Water
Utility shovwn above. l acknowledge that this proposed project may require improvements to the water system shown above which
would incur my financial obligation. Prior to Final Plat approval. or approval of the Water System Plan or the Engineer's Report, it is understood that a legal contract betweenmyself and the Water Utlity must be submitted to Jefferson County which speciies the tems of the water senvice, operational responsibility. and fnancial obligation. Furthemore, I acknowledge that I have read and understand the following mateial.
By signing the application fom, the applicant/owmer attests that the informmation provided herein is true and correct to the best of
their knowiedge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this
application packet may resut in this permit being null and void.
further agreeto save, indemnity and hold harmiess Jefferson County against all iabilities, judgments, court costs, reasonatble
attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the
granting of this permit.
further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the
purpose of application review,and any required later inspections. Access and right of entry to the applicant's property or
structyre shall berequested aid shall occur during regular business hours.
Signatüreot Applicant Date
Page 1 of 5
Exhibit 13
Exhibit 13 Page 0172
Application No._________
Page 2 of 5
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.
Exhibit 13 Page 0173
Application No._________
Page 3 of 5
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).
Peak Hour Peak Day Annual Avg.
Required fire flow N/A N/A__
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.
9. Will the project require extension of water mains or adjustments to service area
boundaries? Yes/No If yes, please describe:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
PUD's Quimper Water System
Quimper
Prior to water service being provided, the Applicant will be required to design
and construct improvements. Please refer below for the improvement requirements.
Per the 1997 JC Coordinate Water System Plan (CWSP) hydrant spacing: 750-ft for
residential and 300-ft for multi-family and commercial and the placement approved by the PUD, JC building dept. and fire
marshal.
Currently Quimper is unspecified, on the
number of connections.
The improvements where modeled for a fire flow of 1,000gpm at the
end of our Quimper Water System.
An 10-inch PVC water main will be required to be extended from the termination of the
PUD's existing water main, approximately at the intersection of Eagle Ridge Drive and Oak
Bay Road. The extension will be approximately 1,500-ft, south along Oak Bay Road. The
design shall follow the PUD's extension policy (2021 WSP Appendix 3-1; technical
standards 2021 WSP Chapter 11 and standard water details, 2021 WSP Appendix 11-1.
The PUD will pay for the up charge from an 8-inch water main to a 10-inch water main. As
this improvement is over-sizing for future capacity. Per 2021 Water System Plan Appendix
3-1 Extension Policy, "For pipes greater than 4 inches larger in diameter than the District's
design standard required to serve the applicant's development/lot - reimbursable costs will
include increased material and construction costs (eg. cost differentials for larger
components, increased excavation, special bedding, testing, cleaning, etc.)"
Exhibit 13 Page 0174
Application No._________
Page 4 of 5
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.
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.
___________________________________________ _________________
WATER UTILITY REPRESENTATIVE DATE
The proposed improvements within the Oak Bay Rd. right-of-way were modeled with a fire flow of 1,000 gpm.
According to the modeling the pressure at the proposed water main in Oak Bay Rd. right-of-way would be between
45-55 psi. The applicant will need to install a private (individual) booster pump on the customer side of the meter,
due to the topography of their proposed site. The applicant will also need a DOH approved testable double check
valve assembly on the customer side of the meter. Please refer to the PUD's Cross Connection Control page for
more information at https://www.jeffpud.org/cross-connection-control/
Approx. 1,500
10
The applicant will submit the design to the PUD for review and approval then
the PUD would submit to Jefferson County Public Works for a Utility Permit application for the water main work in Oak Bay
Rd. right-of-way.
Quimper
The PUD comments within this document is meant to give the county and applicant the
general PUD requirements. This is not meant to be all inclusive of the PUD requirements
and fees/charges. The applicant will work directly with the PUD on the PUD requirements
and fees/charges.
Please refer to the individual, customer side of the meter, requirements in item 12.
1/31/2022
Exhibit 13 Page 0175
Application No._________
Page 5 of 5
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 Date
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 State Department of Health Date
Exhibit 13 Page 0176