Fillable Water Forms031912 (Kittitas County WA)

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Water Forms031912 (Kittitas County WA)

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Certificate Number:
Application Date:
Status:
Single Family Dwelling Building Permit
Preliminary Plat
Commercial/Non-residential Building Permit
Short Subdivision
1. A. ( ) Water is currently provided by a service connection to a _________ inch size water main
located on ______________________________________________________________________________.
B. ( ) Water will be provided by a service connection to a __________inch size existing water main
located on ______________________________________________________________________________.
C. ( ) Water service will require an improvement to the water system of:
( ) (1) Approximately ____________ feet of water main to reach the site; or ____________
__________________________________________________________________________
__________________________________________________________________________
( ) (2) The construction of a distribution system on site and/or; ______________________
__________________________________________________________________________
__________________________________________________________________________
( ) (3) May require on and/or off site improvements in order to meet City hydraulic
requirements. Developer may be required to provide supply and/or storage equal to demand
of development.
D. ( ) Other: Service is subject to payments of all connection charges in effect at the time service is
requested and limited to a maximum of one 5/8" size meter unless otherwise approved by the City's Public
Works Supervisor upon receiving a water needs report prepared in accordance with Section 13.04.285B.
2. A. ( ) The water system is in conformance with the City approved Water Comprehensive Plan.
B. ( ) The water system will require a Comprehensive Plan amendment.
OFFICIAL USE ONLY
Applicant Name:
Phone:
City, State, Zip
Mailing Address:
Project Address:
Parcel #:
Project Name:
Building Square Footage:
Describe Proposed Project:
Applicant Signature:
Date:
PROVIDE A SITE PLAN WITH LOCATION OF STRUCTURE AND A VICINITY MAP.
WATER INVESTIGATION APPLICATION
BLACK DIAMOND APPLICATION FOR WATER AVAILABILITY INVESTIGATION
3. A. ( ) The proposed project is:
( ) within the corporate limits of the City of Black Diamond and within the retail service area
( ) within the future service area of the City of Black Diamond
B. ( )Annexation/Boundary Review Board approval will be necessary to provide service.
4. A. ( ) Water is available at the rate of flow and duration indicated below at no less than 20 P.S.I.
measured at the nearest required hydrant* located approximately___________feet from the property.
*Maximum distance from property to hydrant location is 300 feet.
Rate of flow Duration
( ) less than 500 G.P.M. ( ) less than one hour
( ) 500 to 900 G.P.M. ( ) 1 hour to 2 hours
( ) 1,000 G.P.M. ( ) 2 hours or more
( ) other
( ) calculation of __________G.P.M. (commercial building permits require flow test or
calculations)
B. ( ) Water system is not capable of providing fire flow.
Conditions:
THIS INVESTIGATION FORM WILL BE VALID FOR A PERIOD OF 12 MONTHS FROM THIS DATE. A
CERTIFICATE OF WATER AVAILABILITY WILL BE ISSUED AT TIME OF BUILDING PERMIT ISSUANCE.
Utilities Supervisor Date
CONDITIONS
NOTE: ALL EXTENSIONS MUST BE ENGINEERED BY A CERTIFIED ENGINEER AND APPROVED BY THE
CITY OF BLACK DIAMOND. ALL EXTENSIONS MUST BE CONSTRUCTED TO CITY OF BLACK DIAMOND
ENGINEERING AND DESIGN CONSTRUCTION STANDARDS.
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Water Forms031912 (Kittitas County WA)

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Completed 18 January 2021

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