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Jefferson coun~y-_~_------
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RETURN ADDRESS
Jefferson County Commissioners
P.O. Box 1220
Port Townsend, WA 98368
Please print neatly or type information
DOCUMENT TITLE
Resolution No. 29-09 De-Annexation of Property from Water District #3
REFERENCE NUMBER (S) OF RELATED DOCUMENTS
Additional Reference #'s on page
GRANTOR (S) (Last, First and Middle Initial)
William W. Thomas
Additional grantor on page
GRANTEE (S) (Last, First and Middle Initial)
Water District #3
Additional grantee on page
LEGAL DESCRIPTION (Abbreviated form: i.e. lot, block, plat or section, township, range,quarter/quarter)
Section 33 Township 26 N. Range I W
Additional legal on page
ASSESSOR'S PROPERTY TAX PARCEL/ACCOUNT NUMBER
601-334-271
Additional parcel #'s on page
The Auditor/Recorder will rely on the information provided on this form. The staff will not read the document
to verify the accuracy or completeness of the indexing information provided herein.
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J~f-.LeLsQY'_COJ,JI]J'LFlYf:L -.JEEFERSOl'J .c -
STATE OF WASHINGTON
County of Jefferson
In the Matter of De-Annexation of }
Property from Water District No.3}
(Coyle); William W. Thomas }
RESOLUTION NO. 29-09
WHEREAS, William W. Thomas filed a petition to withdraw his property described as
parcel no. 601 334271 from Water District No.3; and
WHEREAS, the petition was certified as being sufficient by the Jefferson County Auditor
on March 11, 2009; and
WHEREAS, the Commissioners for Water District No.3 published a hearing notice and
held a public hearing at 7:00 p.m. on April 3, 2009 and determined that the withdrawal of the
property owned by William W. Thomas satisfies the criteria listed at RCW 57.28.050; and
WHEREAS, the Commissioners for Water District No.3 have transmitted a certified copy
of their Resolution to the County legislative authority as required by RCW 57.28.060; and
WHEREAS, the petition has been reviewed by the County and was determined to be in
compliance with the County's Comprehensive Plan, Sewer Plan and Coordinated Water System
Plan;
NOW, THEREFORE, BE IT RESOL VED, that the Board of Commissioners hereby
approve the de-annexation of parcel no. 601 334271 from Water District No.3 submitted by
William W. Thomas.
APPROVED AND ADOPTED this
9"t
if--
day of
JJ J t'R-Y
,2009.
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\~~a De aney, 2'MC ()
Clerk ofthe Board ' ,
JEFFERSON COUNTY
BO~
Dav' 'v, Chairman
1 Jo on, Member
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Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO:
Board of County Commissioners
Philip Morley, County Administrator
FROM:
Leslie Locke, Deputy Clerk of the Board
DATE:
May 4, 2009
SUBJECT:
RESOLUTION NO. _ re: De-Annexation of Property from Water District
No.3; William W. Thomas
STATEMENT OF ISSUE:
A petition to de-annex from Water District No.3 was received in the Commissioner's Office on April 6,
2009. The property is located on the Coyle Peninsula and is served by a well on the property.
Per RCW 57.02.040 the Commissioners have thirty days to approve the action or hold a hearing on the
action.
Applicant, William Thomas has complied with all the procedures to de-annex his property.
Water District No.3 held a public hearing and recommends that the de-annexation be approved.
Jefferson County Public Health concludes that the de-annexation would comply with the Coordinated Water
System Plan (CWSP)
Jefferson County Community Development has reviewed the request and determined that the de-annexation
does not conflict with the Jefferson County Comprehensive Plan, Development Regulations or Water Plans.
DCD recommends approval of the request.
RECOMMENDATION:
Approve the Resolution regarding the De-Annexation of property from Water District No.3 submitted by
William W. Thomas
~ SY'OJ'
istrator
Date
Page lof2
RCW 57.02.040
Water-sewer district activities to be approved -- Criteria for approval by county legislative
authority.
(1) Notwithstanding any provision of law to the contrary, the following proposed actions shall be
approved as provided for in RCW 57.02.045:
(a) Formation or reorganization under chapter 57.04 RCW;
(b) Annexation of territory under chapter ;i}.24 RCW;
(c) Withdrawal of territory under chapter ;i}.28. RCW;
(d) Transfer ofterritory under RCW i'Z.32.lQJ2;
(e) Consolidation under chapter 57.32 RCW; and
(f) Merger under chapter 57.36 RCW.
I .\1> (2) At least one of the districts involved shall give notice o.f.t~e proposed action to the COUll!L.
2P()orJ~giSlatiVe authority, state de artment of ecology, and state department of health. The county legislative
authority shall witlUn thirty ays receiving notice of the proposed action approve the action or hold a'
" dr.1 O~ nearing on e actIOn. - '
~~ 10\ (3) The county legislative authority shall decide within sixty days of a hearing whether to approve or
not approve the proposed action. In approving or not approving the proposed action, the county
legislative authority shall consider the following criteria:
(a) Whether the proposed action in the area under consideration is in compliance with the
development program that is outlined in the county comprehensive plan, or city or town comprehensive
plan where appropriate, and its supporting documents;
(b) Whether the proposed action in the area under consideration is in compliance with the basinwide
water and/or sewage plan l!Jl approved by the state department of ecology and the state department of
social and health services; and
(c) Whether the proposed action is in compliance with the policies expressed in the county plan for
water and/or sewage facilities.
(4) If the proposed action is inconsistent with subsection (3)(a), (b), or (c) of this section, the county
legislative authority shall not approve it. If the proposed action is consistent with subsection (3)(a), (b),
and (c) ofthis section, the county legislative authority shall approve it unless it finds that water or sewer
service in the area under consideration will be most appropriately served by the county itself under the
provisions of chapter 36.94 RCW, or by another district, city, town, or municipality. If there has not
been adopted for the area under consideration a plan or program under subsection (3)(a), (b), or (c) of
this section, the proposed action shall not be found inconsistent with such subsection.
(5) Where a district is proposed to be formed, and where no boundary review board is established in
the county, the petition described in RCW 57.04.J230 shall serve as the notice of proposed action under
this section, and the hearing provided for in RCW 57.04.030 shall serve as the hearing provided for in
this section and in RCW 57.02.045.
[1996 c 230 ~ 105; 1988 c 162 ~ 7; 1971 ex.s. C 139 ~ 2.]
http://www.mrsc.orglmc/rcwIRCW%20%2057%20%20TITLEIRCW%20%2057%20.%200... 417/2009
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street
Port Townsend, WA 98368
AI Scalf, Director
To: Jefferson County Board of County Commissioners
f/--'
From: AI Scalf, Director of Community Developmen~, f'i:~,cJll!:n, "c.
1t(1::l~/"L i 11# '"_~
Date: April 27, 2009 I
Regarding: Petition for De-Annexation of Land
;,,';< 2 8 1009
Petitioner: William W. Thomas
14500 Coyle Road
Quilcene, Wa 98376
'''''''''''ER ~^Id !"'1\!l1I\'n/
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Parcel number: 601334271
The department has reviewed the petition presented by Mr. Thomas
and various background documents which supplement the petition.
The statute pertaining to the request to de-annex the subject property
from Water District #3 can be found at RCW 57.02.040 and includes a
provision for the local government to evaluate the de-annexation in
terms of the potential impacts to the comprehensive plan,
development regulations and any water plans for the County.
Comprehensive Plan:
The parcel in question is zoned Rural Residential 1: 5. This
parcel is approximately 4.4 acres in size and would not be sub
dividable under the current zoning density. This parcel has an existing
house, garage and a septic system. On April 9, 2007 the land owner
applied for a well inspection of the casing seal installation to the
Jefferson County Environmental Health Department. The Jefferson
County Environmental Health Department provided notice to the Water
District #3 of the request for the well casing inspection on April 10,
2007. On April 17, 2007 Water District #3 stated they would not
provide a public water connection in a timely and reasonable period to
this parcel. As such, on April 20, 2007 the owner gave notice of intent
to construct water well to the Department of Ecology. The well was
drilled in May of 2007.
Building Permits/ Inspections
(360) 379-4450
Develooment Review Division
Long Range Planning
FAX: (360) 379-4451
Development Regulations:
This parcel is subject to the provisions of the Jefferson County
Code Title 18. The County code calls out requirements for use and
development as well as provides regulations for protection of critical
areas, storm water, septic and water. Additionally, Title 15 of the
Jefferson County code calls out requirements for building construction
methods under the international building codes. This area is mapped
as a coastal SIPZ or a salt water intrusion protection zone under the
critical area mapping for Jefferson County.
Water Plans:
Water District #3's water system plan is part of the Jefferson
County Coordinated Water System Plan. Their water system plan is
subject to approval from the Washington State Department of Health.
Their water rights are subject to approval from the Washington State
Department of Ecology. Should the deannexation be granted, Water
District #3 will be required to amend their water system plan at the
next amendment cycle.
This area is part of WRIA 17. Is the well being utilized and
therefore put to beneficial use? Will instream flow regulations place
additional constraints on this area or parcel?
Recommendation:
The de-annexation request doesn't conflict with the Jefferson
County Comprehensive Plan, Development Regulations or Water Plans.
Rural zoning districts allow for on site wells or service via public water
systems for developing land. The department recommends approval
of the request for de-annexation from the Water District #3.
.
.
.
- ON
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PUBLIC HEALTH
Always Working for a Safer and
HEALTHIER JEFFERSON
;", f, , ;, 'ltlll!l
......',erni"fV! (''''\I\'kITV
J l'::r~t:~;i.~ 3~\J'\,>J,~}t~~\1 ~
Date:
Re:
April 13, 2009
De-annexation of Thomas, Wm. Property from Water District #3
The Board of County Commissioners is required, before approving or rejecting the request for
William Thomas to have his parcel de-annexed from Jefferson County Water District #3, to
determine if doing so would be in compliance with the Coordinated Water System Plan (or
"CWSP") for Jefferson County. This requirement is found in RCW 57.02.040(3)(c).
Mr. Thomas has at his parcel an individual well drilled with notice to and the permission of
Water District #3. Notice of the well 'start card' had to be given to Water District #3 because Mr.
Thomas' parcel is currently 'Within the service area of that Water District.
Because the well was drilled with notice to and the permission of the Water District and because
the Water District has concluded that de-annexation of the Thomas parcel would benefit the
parcel and not cause harm to the Water District, I am able to conclude that the de-annexation
would comply with the CWSP.
,--#w~- fJdl3
Susan Porto, RS
Environmental Health Specialist 3
Jefferson County Public Health
COMMUNITY
HEALTH
(360) 385-9400
ENVIRONMENTAL
HEALTH
(360) 385-9444
DEVELOPMENTAL
DISABILITIES
(360) 385-9400
SUBSTANCE ABUSE
& PREVENTION
(360) 385-9400
615 Sheridan Street, Port Townsend, Washington 98368
fax: (360) 385-940 I web site: www.co.iefferson.wa.us
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.-.vSJil"sO'\O
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street. Port Townsend. Washington. 98368
www.jeffersoncountypublichealth.org
Date:
From:
Re:
April 14, 2009
Neil Harrington, Water Quality Program Manager
De-annexation of Thomas, Wm. Property from Water District #3
The Board of County Commissioners is required, before approving or rejecting the
request for William Thomas to have his parcel de-annexed from Jefferson County Water
District #3, to determine if doing so would be in compliance with the "basin wide water
and/or sewage plan as approved by the State Dept. of Ecology and DSHS." This
requirement is found in RCW 57.02.040(3)(b).
Mr. Thomas has at his parcel an individual well drilled with notice to and the permission
of Water District #3. Notice of the well 'start card' had to be given to Water District #3
because Mr. Thomas' parcel is currently within the service area of that Water District.
While the Thomas parcel is within the boundaries of Water Resource Inventory Area
("WRIA") 17, the State Department of Ecology has not yet established an "in-stream
flow rule" for that WRIA. I am not aware of any other "basin wide water and/or sewage
plan" that might be applicable to the parcel owned by Mr. Thomas. There are no
sanitary sewers in that region.
In sum, the response of staff to the question of whether the proposed de-annexation
complies with RCW 57.02.040(3)(b) must be "not applicable."
._i
COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
MAIN: 360-385-9400
FAX: 360-385-9401
PUBLIC HEALTH
ALWAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNITY
ENVIRONMENTAL HEALTH
NATURAL RESOURCES
MAl N: 360-385-9444
FAX: 360-385-9401
RE
APR () 6 ?flA9
JEfFERSONCOUNlV
COMMISSIONERS
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RCW 57.28.010
Withdrawal authorized -- Petition.
Territory within a district may be withdrawn therefrom in the following manner and upon the following
conditions: The petition for withdrawal shall be in writing and shall designate the boundaries of the
territory proposed to be withdrawn from the district and shall be signed by at least twenty-five percent of
the qualified voters residing within the territory so designated who are qualified voters on the date of
filing such petition. The petition shall set forth that the territory proposed to be withdrawn is of such
location or character that water and sewer services cannot be furnished to it by the district at reasonable
cost, and shall further set forth that the withdrawal of such territory will be of benefit to such territory
and conducive to the general welfare of the balance of the district.
[1996 c 230 ~ 1002; 1941 c 55 ~ 1; Rem. Supp. 1941 9 11604-1.]
NOTES:
Part beadings not law -- Effective date -- 1996 c 230: See notes following RCW S7.G2.GOl.
.
,
http://www.mrsc.orglmc/rcw/RCW%20%2057%20%20TITLE/RCW%20%2057%20. %20... 3/28/2009
rage 1 Ul 1
RCW 57.28.020
Petition of residents.
The petition for withdrawal shall be filed with the county auditor of each county in which the district is
located, and after the filing no person having signed the petition shall be allowed to withdraw the
person's name therefrom. Within ten days after such filing, each county auditor shall examine and verify
the signatures of signers residing in the respective county. The petition shall be transmitted to the auditor
of the county in which all or the major geographic portion of the district is located, who shall certify to
the sufficiency or insufficiency of the signatures. If the area proposed to be withdrawn is located in more
than one county, the auditor of the county in which the largest geographic portion of the area proposed
to be withdrawn is located shall be the lead auditor and shall immediately transfer a copy of the petitions
to the auditor of each other county in which the area proposed to be withdrawn is located. Within ten
days after the lead auditor received the petition, the auditors of these other counties shall certify to the
lead auditor: (I) The number of voters of that county residing in the area proposed to be withdrawn who
voted at the last municipal general election; and (2) the number of valid signatures on the petition of
voters of that county residing in the area proposed to be withdrawn. The lead auditor shall certify the
sufficiency of the petition after receiving this information. If such petition be found by such county
auditor to contain sufficient signatures, the petition, together with a certificate of ;uijiciency attached
thereto, shall be transmitted to the board of commissioners of the district.
[1996 c 230 ~ 1003; 1982 1st eX.S. c 17 p3; 1941 c 55 p; Rem. Supp. 1941 9 11604-2.]
NOTES:
Part headings not law -- Effective date -1996 c 230: See notes following RCW 57.02.001.
http://www.mrsc.org/mc/rcw/RCW%20%2057%20%20TITLE/RCW%20%2057%20. %20... 3/28/2009
COUNTY OF JEFFERSON)
)55
STATE OF WASHINGTON)
CERTIFICATE OF SUFFICIENCY
Pt: 1.ll.lON FOR DE-ANNEXATION
OF LAND WITHIN
WATER DISTRICT NO.3
.
.
I HEREBY CERTIFY that this office has checked the attached Petition for
the de-annexation of land within Water District No.3 as defined in the area on the
attached map and legal description.
Said Petition containe<:l a total of one signature. There is one valid signature
from the proposed area to be de-annexed and constitutes 100% of the qualified
voters in the proposed land to be de-annexed.
Pursuant to RON 57.28.010, the petition for de-annexation must be signed
by not less than twenty-five percent (25%) of the qualified voters in the proposed
area to be de-annexed. This petition meets the requirement of having no less than
one valid signature from qualified voters in the proposed area and is now certified
as being SUFFICIENT.
. nd STATE OF WASHINGTON SS
Dated thiS 11 Day of March 2009. COUNTY OF JEFFERSON
~/ " ~_. (l/7 { i ThllS IS TO CERTIFY that the, document to which
I Y( ~.~ f/I.. ttil certificate is affixed is a true and co~ect copy
If -.- the same appears on (e,~;:,)rd tr'l the office of the
Jefferson County Auditor.
Ie> WITNESS WHEREOF, I r.e'olmto set my hlllld and
lhlI Seal of Said CoUJ1\~~~~
Dale J/"{O\
Donna M. Eldridge
Jefferson County Auditor
Accounting:
;X5-lJ!21
Elections
:1R5.9117
Licensing
3R5.9 j 15
Recording
3R5-9116
FAX
385-9228
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8AFECO
FilM far ReconI ac R.... of
NAME
William W. Thomas. Jr.
.,...,....
ADDAI;s..c;
Rt. 2, Box 775-G
I:C')'"lrl~"WL~IN~aC<lW"'"
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'SZ FE9 5 PM 3: 13
27670:1.
ClTYAHDSTATE Quilcene, Washington 98J76
QUIT CLAIM DEED
......._....... LOVE AND AFFECTION.
William Wayne Th~mas, Sr.. father of Grantee,
"
TJ.IE GRANTOR
ClDl'Myllndquitdaimsto William ifayne Thottlas, Jr., son of Grantor,
...fo!IowinIcJiIIctit.d.....__.situatedlntfMCOUntyof Jefferson,' .
s.... 01 Wutl.:'~" induding MY "ter acqtIimf ride:
Beginning at a point on the North line of the Southwest
l~ of the Southeast 1/4 of Section JJ. Township 26 North,
Range 1 W.st w... which. point is J69.62 feet Easterly
along eaid North line from the Nortllwe.t corner of said
Southwe.t l/4.tn.aid point al.o being the 1I0rtheast corner
of that c.rta tract of land cO~illy known a. the
lIick.r.on Tract, Th.nce North 89 52' Ia.t along .aid
Morth line a di.tance of 498.0 feet, Thenc. South 8052'JJ"
Weat a diatance of 572.0 feet, Thenc. North 72044'2J"
W.at a distance of 428.0 feet to a point which bear. ~< 1;':1.
South OoOS' Ea.t a distance of 437.0 from the point of ,..r' ~l.- .
be&1nnlngl Thence North OOOS' West a distance of 4J7.0 ~~~l r}';';;"~ rt~ ...-
. to the point of beginning. . :::\t~~c !l~ .,I-..Y-':i!L
Containing approxilllataly 5,28 acr....0:::;-,~
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By
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By
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Sf ATE OF WASHIHGT9N
CllUNTV OF
STATE OF WASHINGTON
. COUHTYOF
Oo~-'J-~~~~
~~t:;;.,'jJ;-::'. :- :?L:'.-': ~-:.
. me mo- fD be the individual dHc:ribed and who
=lhewilhin~trument,.lftdaclcnowl.
~...._. ~
~........'...~ l'Ohmtary act and dMd. for the "'" and PlJl'Pl)SeS
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v::~ 159 .~_ 291
n..SlIll"'l
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On""s c:r.yof
19_. befo....rne. the undersigned,,, No(r( Pubfic in and
for the St... of Wiuhinfton. duty commiuiOMd and sworn.
personallV appeared
...
to 1M known to be m.
...
President
Secretary. respectivety. of
thecorpontion d'tat.xecutH the fOl"lgOing instnmwrlt..Ind
Kkaowtedged tfHI SIIid instnanent to be m. frH and volun-
tal'Y Kt ... dnd of SIkt corporation. tOf' the uses and INr.
PDIft ttIet.m lMntiontd. and OftlHm lUted that _
IUthOfized to uecut. the said
instrument and that tIMt SlliII affiud is the c:orpoute seal 01
gidcorJlOt"ation.
Witneu my hMd and officil>l sui hereto ..ffixed the d.Jv met
..._firrt.lbo..writtetl.
Nobly Public in and for thl! Stat. of Wuhington. rftidii'lf'
..
Page I of} ~
RCW 57.28.040
Notice of bearing -- Bond for costs.
Upon receipt by the board of commissioners of a petition and certificate of sufficiency of the auditor, or
if the petition is signed by landowners and the board of commissioners is satisfied as to the sufficiency
of the signatures thereon, it shall at a regular or special meeting fix a date for hearing on the petition and
give notice that the petition has been filed, stating the time and place of the meeting of the board of
commissioners at which the petition will be heard and setting forth the boundaries of the territory
proposed to be withdrawn. The notice shall be published at least once a week for two successive weeks
in a newspaper of general circulation therein, and if no such newspaper is printed in the county, then in
some newspaper of general circulation in the county and district. Any additional notice of the hearing
may be given as the board of commissioners may by resolution direct.
Prior to fixing the time for a hearing on any such petition, the board of commissioners in its
discretion may require the petitioners to furnish a satisfactory bond conditioned that the petitioners shall
pay all costs incurred by the district in connection with the petition, including the cost of an election if
one is held pursuant thereto, and should the petitioners fail or refuse to post such jl bond, if one is
required by the district board of commissioners, then there shall be no duty on the pArt of the board of
commissioners to act upon the petition.
[1996 c 230 9 1006; 1985 c 469959; 1951 c 112 ~ 3; 1941 c 5594; Rem. Supp. 1941 ~ 11604-4.]
NOTES:
Part beadings not law - Effective date -- 1996 c 230: See notes following RCW C'7 rn nn, .
http://www.mrsc.orglmc/rcw/RCW%20%2057%20%20TITLE/RCW%20%2057%20. %20... 3/28/2009
.
.
$ 138.00
FAX NO. : 36037'34487 Apr.
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1'3 2007 03: l.3PM PI
FROM
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APPLICATION FOR INSPECTION OF
WELL CONSTRUCTION, RECONSTRUCTION OR DECOMMISSIONING
'PART I. TO B[ COMPLE'rtllBV PROPERTY OWNER. AUTHORIZED A(lENT. OR WELL DRILLER
wtLUAM lliQMAS..lfL- ___'__ I'oone 36(). 765-3280
14500 COYLE RD.. QUILCENE. WA Tipeode 98376
601334271 SileAddress 14500 COYLE RD.. QUILCENE, WA 98376
lOFALl WELL DRilLING DrilIotN""", RAYMOND l. BAUER u=# ~
i ~ orappl~ioo (Chock ~): X New Well RecoMlruotlon Abtindo11Tller\L
,
I Anticipltt<<! S..rt Dill< 31512007
Name
MlIilinl! AIkI,..,.. .
I Par<eITOXIll#
, DriUlng C..ompany
81m Cl1I'd No, (ll'received)
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i PAll'1'!, TO BE COI\lPL[1'ED BV PROPERTY OWNER OR AUTUORI1;EO AG';'"
,
I PLEASE ANSWER YES OR NO TO EACH QlIES'I'ION, TllbN j'LbASE COMPI,J1Ty, A PLOT PLAN SKUCH. ON BACK
I
YES b IIw wen..lo k~ 100 root or ..ore fu>rn OilY property Ii",,?
NO ).'" the paroolln auubd.MJloa with pl.. r.endUlnnllii that nquiretbe wr.n to be 1'K..tad IOf" from.n propertY IIn~'
NO Is (btl well sile JoatUd J.., fb.... lOt. f_ from any sources of cuntmninal.jo~ inclu41t~8: septic ~1i:term: and rcscry~
"'J'!"'....... bllm:!, SlOI:I. YllIdo, _lIIloll\llOO"'" hazordou, _10 oil"'l. _ine shorelines, or lll1Y 0""" pol""li.l ",.,<:r
lillled in WAC t73.I60-17I?
_~~_ Is tho woll oilc I<x:alod 100 root mi.i..... lrom.. Oflf'I'ove<i septic am< (Sl'AAD). or pemlltted ..pde ''Y<tcrn?
Y IlS b tho won ';1. b:albJ 1000 Icol ..In...... flOm the prop<rty lioo of 01l OjlCt8l;ng or cloood ..lid wa.'it<> fucilily'I,
NO II) the weD ~tc JocaU:d i. . .tr'elm, or any crher area oflelllODlll or perman.llt ItJlndlng water?
NO "rb" woll . replo"lMIIt woll? On >kmoh un rove!'SO side. show exl!ltitlK and p"'Jl<>lICd ..... woU,
NO ill the well being decommissioned?
R)' ~i8flm8 !he oIi',ppliaditm form, Ih~ ~1tltUllln\olo't1et I.u.~ tb. the infunnation providod hacin is tt'U(; and uornxlt lo the beSlCf\:.tl"lr koowledgc. Any
ma1etial fal~ or any nmillSion of l ~ri.l foct made by the applie.aDtlOWMf wid:! ~l to thili appIicll1ion moy Mutt in the deniRl uf ~ huildn~
pennl.t utlllzIni the slJbjed W4.illllT mS)I n.::Quitt: IIIHLntltnncflt tlf the t<<Jbject well. I a.gm::: to provid; accu;1II W1M1 right ~lf'e(ltry 10 Jeffmon County tmd ilA
eJ!lployus. tq)I'OSt'Otadves. or agcJlts for tflo pul'J.'OllC ()f appIictttilm review imd. uny requiTed ins.pecHcm. Access and ri,ht of entry t!) the applicant's
prop<rty or siIUl:1.r< riIalll 0"'"" <bini! ICf!lIiar 1>11...... ""unr,
I furlhet agree ID save, illdenufY and ho!d bt1rmJc:ss Joff'tnon CI)UI1(,y qgflimll wlljahiHlie<<. judgments. court row, I'ClliOIWoh: K1.lhfney's tees ttnd
e.~ wtuchsnay 1n.aayway accrue again&t .kl.ftcnonCounty t'I8.~ultofurm~~~ee ofthili appUC4lion, drilling of~ prUfX~ weU, or any
SlI\J8Qql'lax: iusrXICd[l.u,
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ECOLOGY
NOTICE OF INTENT TO CONSTRUCT A
WATER WELL
Notification Number
WE06461
This form and required fees MUST BE RECEIVED by the Department of Ecology 72 HOURS BEFORE
you construct a weii.
Submit one fonn and required fee (check or money order ONLY) for each job site. Mail this tonn to the Depertment of -
Ecology, P.O. Box 5128, Lacey, WA 98509-5128.
Properly Owner WIlliAM t1:LQMAS.
Address (include city, slate, zip) 14500 COYLE RD.. QUllCENE. WA 98376
Phone No. INIAl
Consulting Finn (if different from '1) @A)
Address (include city, slate, zip) <W8)
CODE NUMBER AND COUNTY NAME 16-SV\IR Jefferson Counlv
Well Location: Quarter Quarter Section NW Quarter Section Sf Secllon ~ Township 28 Range 1W
Approximate well construction start date: 4/2612007
Vvlllthe intended withdrawal from this well exceed 5000 gallons per day or be used to irrigate more ""'9 1/2 acre of non-
commercial lawn or garden? No
Type of well construction: .I'!!!w
Purpose of Use nn...........
Number of homes to be served 1
Phone No. (i'!l8)
.
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~
Latitude and longitude (If available)
La! Degrees @A) lat Time INIAl
Long Degrees @A) Long TII118 @A) Horizontal CoIleclion Method INIAl
Well Site Street Address 14500 COYLE RD.. QUILCENE. WA 98376
Tax Parcel Number 601334271
Contractor's l & I Registration No. LOFAlWD124C5
Well Orilling Compeny Name lOFALl""';:ll DRILLING Phone No. 360-697-1194
Well Driller Name RAYMOND BAUER Ucense No.1..4:!l3
This notification number must be provided to your well driller: WE06461
Well Size: less than 12 inches in diameter - Fee amount $ 200.00
Amount enclosed:$ 2QQ,QQ
RETURN NAME AND MAIUNG ADDRESS
Client Name JJ,'{/'u-. 77t"""",.,
Agency Validation
LOFALL WEll DRIlliNG
160 NWLOFALL RD.
POUlSBO, WA 98370
CJNo,
Date
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NOTICE TO WATER PURVEYOR
Jefferson County has received notification that an water supply well is about to be constructed on
Today's Date_ 4/10/07
Parcel No 601334271
Street Address _14500 Coyle Rd.
City _Port Townsend
Owner Name _William Thomas _Contact Phone _360-7653280
.
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4
4
Jefferson County Board of Health Policy 96-02 states that a landowner cannot drill a well to obtain
building permit approval on a parcel located within the purveyor's water service area without
consent from the purveyor, provided the purveyor has a signed service agreement with Jefferson
County. The purveyor is required to.provide water "in a timely and reasonable manner," which is
defined as 120 days.
.
-
-
.,
3
Please mail or fax the completed form to:
Susan Porto
Jefferson County Health and Human Services
615 Sheridan
Port Townsend, W A 98368
(360) 385-9401 fax
water utility will provide water within the 120 day
period to comply with Jefferson County Board of Health Policy 96-02
Tbe water utility will NOT provide water within the 120
day period requi to comply with Jefferson County Board of Health Policy 96-02.
Signed;~ -~_ --: A4~.J.
TitleCp.......,. ~.r<' "'-4.<'r"" ~
Datey~~7
H:\W A TER\ Well inspection programIForms\well drilling in service area-purveyor request I.DOC
1
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ESTIMA TE
IL~L
. WE~L DRIL~f~
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(360) 697-1194
lofallwell@comcast,net
www.lofallwelldrilling.com
DQn LQfall . Owner / Operaror
180 NW LC>fa1l Rd, PQulsbQ, WA 98370
Name: WILLIAM THOMAS
Address: 14500 COYLE RD.
QUILCENE, WA 98376
JQb Site: PARCEL # 601334271
QUILCENE, WA 98376
Phone: 360-765-3280
Ordered by: BILL THOMAS
Written by: DON LOFALL
._ Description of Work _ _ _ . _._ .._ _ ..
Drill well 6 inches in diameter from surface to approx, depth and estimated cost as specified below.
Additional drilling (if required) will be billed at the same rate specified below. There is NO CHARGE
for SET UP I MOB-DEMOB of well drilling equipment.
Quantity Description Unit Cost Total Cost,
. - -. - - - . -
80 feet I Drill 6" Well, Including Casing $ 37.00 $ 2,960.00
1 each Ecology Seal, 18' X 10" Bentonite WAC #173-160 $ 600.00 $ 600.00
5 feet , Screen, Stainless Steel, (NO HOURLY INSTALL & DEVELOP TIME) $195.00 $ 975,00
i
1 each Drive Shoe $ 85.00 $ 85,00
1 each Pump, Gould S.S. Submersible 112 HP, Model #10LS05 $ 562.00 $ 562.00
1 each Pressure Tank, 80 Gal. Well-Mate (Fiberglass) WM23WB $ 459,00 $ 459.00
1 misc Fittings, Gauges & Valves $ 135.00 $ 135.00
1 each 1" Pitless Adapter & 6" Watertight Well Seal (installed) $ 130,00 $ 130.00
70 feet Drop Pipe, 1" Sch 80 PVC with 12/4 Sub Wire $2.65 $ 185.50
? feet Water Line, 1" Sch 40 PVC $ 0.95 OPEN
? feet Burial Wire, 12/3 UF $ 1.35 OPEN
1 each Chlorinate - Nitrate, Chloride & Bacteria Tests $ 250.00 $ 250.00
1 each Pump Installation $ 120.00 $ 120.00
3 hour I System Hook-up wl2 men (typically 3 hours) $ 75.00 $ 225.00
2 hour Pump & Recovery Test w/generator $ 60.00 $ 120.00
? feet Ditching & Backfill $3.00 OPEN
SUBTOTAL $ 6,806.50
8.40% SALES TAX $ 571.75
TOTAL $ 7,378.25
WARRANTY: 5 years on all pressure tanks and well pumps. DOWN PAYMENT $ 3 700.00
Terms of payment on balance: CASH ON COMPLETIO~ BALANCE $ 3:678.25
1 C~'''':~!::~~Md:Z~?_PI'~'OO'~ 4'~c-~_Y__""dri"aM~"w~~'oo_m~Mm
th& hole dunng progress of the work The Dnlllng Contractor shall not be obligated to remove the same ~ C
2 The Drilling Contractor shall drill the hole with the diameter and C881ng SIze 8S specified under "Descnption of Work Required" as long as the optnIOfl of the DrilIIIlg Contractor, it remains
practicable to do so coneidering the nature of the material being drilled. The Drilling Contractor does guarantee that the hole drilled shall bel suffICient diameter and plumb and straight enough to
permit installation of deep well pump.
3. Payment shall be made on demand in accordance with the agreed terms for set-up, all holes drilled, materials used and services rendered. The Drilling Contrador does not agree to find or
develop water; nor does he represent, warrant or guarantee the quality, quantity or kind ofwater if any-which may be Ell"ICCUltered. Failure of the Drilling Contractor 10 strike water shall in noway
release the customer from paymenI of the fulllXH1ltacl price for malarials furnished or installed and services rendered.
4. In case ,*suil or action to collecl: any sum 0Je under this order, Customer shall pay attomey'sfees and cost Of suittogetherwith CMying charges on the sum due atUle rate of 1.5% per month
from the date Of discontinuance of drilling.
5. Customer is responsible for all site preparation costs incurred during the set up of all equipment ald well site location in accordance with County regulations.
6_ "NOTICE TO CUSTOMER. This contractor is registered with the state of Washington, registration no. LOFALWD124C5, as a specialty contractor and has posted with the state a bond or cash
deposit of $6,000 for the purpose of satisfying claims agains! the contractor for negligent or improper work or bre8ch of contract in the conduct of the contraclors business. The expiration date of lhis
conIracIor's registration is 3/19/2007. T!1i$ bend or cash deposit may not be sufficient to cover a claim v.tlich might arise from the work done under your contract. If any supplier of materials used in
your construction projeclor any employee of the contractor or SI.tlcontractor is not paid by the contractor or subcontractor on yourjob, your property may be lienee! to force payment. If you wish
additional protecl:ion, you may request the cootractor to provide you with original "lien release" docunent$ from each s~lier or 8Ubcontraclor on yolX project. The contracIOr is required to provide
you with fu1her information about lien retease documents if you request it. General information is also available from the department of labor and industries."
Customer is responsible for $200 Notification Fee to the
Department of Ecology,
Estimate good for 90 days from: 3/112007
We agree to the above and hereby affIX our signatures:
Customer
Customer
~
r~
Date
Date
Date .;~/o 7
Contractor
L8IJMLL
WELL ~RIL4!~(;
Don Lofall, Owner/Operator- 180 NW LofaJJ Rd, Pou/sbo, WA 98370 - (360) 697-1194
INVOICE
Friday, May 18, 2007
WILLIAM THOMAS
14500 COYLE RD.
QUILCENE, WA 98376
PARCEL # 601334271
QUILCENE, WA 98376
,. .
Description Unit Cost
Drill 6" Well, Including Casing $ 37.00
1 each Ecology Seal. 18' X 10" Bentonite WAC #173-160 $ 600.00
5 feet Screen, Stainless Steel, (NO HOURLY INSTALL & DEVELOP TiME) $ 195.00
1 each Drive Shoe $ 85.00
1 each I Pump, Gould 5.5. Submersible 3/4 HP. Model #10LS07 $ 794.00
1 each I Pressure Tank, 80 Gal. Well-Mate (Fiberglass) WM23WB $ 459.00
1 misc. I Fittings, Gauges & Valves $135.00
1 each I 1" Pitless Adapter & 6" Watertight Well Seal (installed) $ 130.00
110 feet I Drop Pipe, 1" Sch 80 PVC with 12/4 Sub Wire $2.65
1 each i Chlorinate - Nitrate, Chloride & Bacteria Tests $ 250.00
1 each I Pump Installation $ 120.00
f . hours I System Hook-up wl2 men $ 75.00
1 hours I Pump & Recovery Test w/generator $ 60.00
Total Cost
$ 4,329,00
$ 600.00
$ 975.00
$ 85.00
$ 794.00
$ 459.00
$135,00
$ 130,00
$ 291.50
$ 250.00
$ 120.00
~ cluli,9B I 7.5
$60,00 I 1
$ 8,453.50
$0.00
$ 8,453.50 I
$ 3,400.00
$ 5,053.50 )
_/5'0.00 '
?J~rJz~~7
Subtotal
0.00% Sales Tax
TOTAL
Down Payment
TOTAL DUE
'-$LJ 700,00
Your prompt payment is appreciated. . . . . Thank you,
Don Lolall, Owner / Operator
Invoice due upon reciept. Balances not paid within 30 days will be charged 1.5% interest per month.
PAGE 1 OF 1
WORK ORDER JCWD3 INSTALL WATER MAIN TO COYLE RD WASHINGTON WATER CO
DESCRIPTION - EXTENSION OF SERVICE UP HAZEL PT RD TO WILLIAM THOMAS JR.
AT 14500 COYULE RD, QUILCENE WA 98376 (360) 756-3280. MR. THOMAS IS
CURRENTLY HOOKED UP THROUGH A PRIVATE EASEMENT AND EASEMENT IS GOING
TO BE TERMINATED. NEED COST JUSTIFICATION FOR EXTENDING WATER MAIN.
THIS ESTIMATE IS DONE WITHOUT THE BENEFIT OF ENGINEERING. COMPLETE
STATUS - ENGINEERED DRAWINGS AND SUBMITAL TO THE WASHINGTON STATE DEPT.
OF HEALT,OFFICE OF DRINKING WATER IS REQUIRED PRIOR TO CONSTRUCTION &
COMPLETION OF FINAL ESTIMATE.
DESCRIPTION DETAIL INFORMATION USE AMOUNT LINE TOTAL
ENGINEERING. . 6500.00
10800138 8 PVC PIPE C900-100 RATE = 6.61 800.0 5288.00
30800194 8 MJ X FLG TEE RATE = 272.32 1.0 272.32
30804167 8 X 4 MJ X PE REDUCER RATE = 50.85 2.0 101. 70
30800095 8 MJ go ELBOW ,RATE = 134.83 1.0 134.83
30800063 8 MJ CAP (TAPPED OR S RATE = 66.48 1.0 66.48
blow off 2" BLOW OFF RATE = 300.00 1.0 300.00
40800285 8 MJ X FLG GATE VALVE RATE = 769.74 . 1.0 769.74
40400285 4 MJ X FLG GATE VALVE RATE = 446.08 , 2.0 892.16
60600082 VALVE BOTTOM CI RATE = 39.92 3.0 119.76
60600081 VALVE BOX W/LID (910) RATE = 48.77 3.0 146.31
11400155 LOCATOR WIRE RATE = 0.15 800.0 120.00
00005 MAN AND BACK HOE RATE = 95.00 32.0 3040.00
00014 HOEPAC (COMPACTION) RATE = 95.00 32.0 3040.00
00003 2 MEN AND TRUCK . RATE = 99.00 40.0 3960.00
//:~/6 '
~~
'4-
TOTAL ESTIMATE 24,751.30
DATES IMPORTANT GOALS
STATUS
TOTAL ACTUAL
PERMITS
OK
1.30
10:48:16 10 Mar 2009
I'.
'TR SERVtCE (:(}?"'1Fft,r-,f'r
'",-);.! 3.3<>.\
ViJ_ ~8~1::':'S
Page 1 of 1
RCW 57.28.050
Hearing - Findings.
The petition for withdrawal shall be heard at the time and place specified in such notice or the hearing
may be adjourned from time to time, not exceeding one month in all, and any person may appear at such
hearing and make objections to the withdrawal of such territory or to the proposed boundary lines
thereof. Upon fmal hearing on the petition for withdrawal, the board of commissioners of the district
shall make such changes in the proposed boundary lines as it deems to be proper, except that no changes
in the boundary lines shall be made by the board of commissioners to include lands not within the
boundaries of the territory as described in such petition. In establishing and defining such boundaries the
board of commissioners shall exclude any property which is then being furnished with water, sewer, or
drainage service by the district or which is included in any distribution or collection system the
construction of which is included within any duly established local improvement district or utility local
improvement district, and the territory as fmally established and defmed must be substantial in area and
consist of adjoining or contiguous properties. The board of commissioners shall thereupon make and by
resolution adopt fmdings of fact as to the following questions:
(I ) Would the withdrawal of such territory be of benefit to such territory?
.
(2) Would such withdrawal be conducive to the general welfare of the balance of the district?
Such findings shall be entered in the records of the district, together with any recommendations the
board of commissioners may by resolution adopt.
[1999 c 153 9 21; 1996 c 230 ~ 1007; 1986 c 109 9 1; 1941 c 55 ~ 5; Rem. Supp. 1941 9 11604-5.]
NOTES:
Part beadings not law -- 1999 c 153: See note following RCW
Part headings not law -- Effective date -- 1996 c 230: See notes following RCW
http://www.mrsc.org/mc!rcw/RCW%20%2057%20%20TITLE/RCW%20%2057%20. %20... 3/28/2009
Page I of I
RCW 57.28.060
Transmission to county legislative authorities.
Within ten days after the fInal hearing the board of commissioners of the district shall transmit to the
county legislative authority of each county in which the district is located the petition for withdrawal,
together with a copy of the findings and recommendations of the board of commissioners of the district
certifIed by the secretary of the district to be a true and correct copy of such findings and
recommendations as the same appear on the records of the district.
[1996c230~ 1008; 19821stex.s.c 17~24; 1941c55g6;Rem.Supp.1941 ~ ]]604-6.]
NOTES:
Part headings not law -- Effective date - 1996 c 230: See notes following RCW
.
.
http://www.mrsc.orglmc/rcw/RCW%20%2057%20%20TITLE/RCW%20%2057%20. %20... 3/28/2009
"'fIR "6 ,nng
JEfFERSONC.
CO!\IIi\RIS'l:IOl\ RSON COUNTY WATER DISTRICT NO.3
ll;ll~ll 0} '" ' RESOLUTION 2009- / r
~A/ N~rd3 +0:(0 petftio'" Ni'~llJiI~ 1Ior fJe-IJNP-E'Xp:lio4/ O.(J Ien,.dt?nJ dt:d- 0-1
Je#e~1J ihlllhf W/l-kvDi5"lrrct No, 3/ Ynaf /(/q.s -A'1e<I /IlK! (Jrf"~ QS Jel" &f#/~/r-vf
~ 'fi.t ~w~ AudtIrJrov ~ IINdf)qr o.{J /MrtdJl',:o,o9; IoIQAtdt 'IN ,AJ/lp<f')(A-HoltIls deslN!tl
~ lillI/film tI). ~ -A,... /lIS 7Px pa~~/ .:1fJ1, Iv Sec:ltch' ~ 7dtWsWF,P .5l"/ NN.M1e..r. ((/ ).
Be it resolved:
We 'lit tJomlflf$SI'CTN'rs 0# Je#ers6V ~.vjrt tdA~"'" jJJYf-rI'Cf A/o.3, tit {1(Jlflf"'AN(le.-
~ 7?ao S7.:J.8 .05"0, ~ A,U'~ -Itird Y4f 'II.t ((Jl#Jc/ypfdl d-f1'1A<t prn!el -2 ~!l)
IV Sed-ioN 331 ld'wNsl1,.,. 2,(" 7?AAlre.:t. WI will be cr ,btpAle.fltf ~ /U,q'-'
Ptrlrrcf No.3, ~ sucIJ IUIYlblraal/ tolll ~ dCrIdel('lve fb -I/1-e rp<f?n:t( w-ellla. roe
(j~ Vito pI!. I.4vc.e. ()-I- ~ cllslr'rd,
nl"5 ~AA=lI'Y is ~w ~It/ NU/'t!/(/ o~ ~ (1Osf 01 ~rvf~ /tooK elf
/Jy'tIJ clrslrrcf./l'Hlc/ -iii /lad ~ ~,"d 7;lIx j'OhYl.2'iJ:;' <<1'//1 JuA#-/rI-;
Q.,(l;w.u d- ..?t2S ~ '7t.Utf o.(l ,J:p~rsoll/ ~A/?, UlAI",..lhffl'Cf M..3 OSLJrrr~,s.
C.r-+ Aa5/1-s OIU71 drdled HN1/1)
~~l
Dated 0/5/0 1
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William Thomas, Commissioner Position 2
State of Washington)
County of Jefferson)
I certify that this is a true and correct copy of a document In the possession of the Jefferson County
as of this date.
Water District No, 3 (JCWD#3) and Troy Glen Breitl{lffjl<iJ .Secretary
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Notary Public - State of Washington
Residing in Quilcene
My Appointment Expires: 10-16.2010