2010/02/17 Council Agenda Packet

0, Washington Departmenof Health 6 Division*Environmental Health Office of Drinking water 2010 Drinking Water State Revolving Fund (DWSRF) Application Form Instructions • It is important that you read and understand the revised 2010 DWSRF Guidelines before you complete this application form.You can download the guidelines at http://www.doh.wa.goviehp/dw/our_main_pagesidwsrf.htm • Do not modify this form to change the font size,margins,or any other pre-set formatting. • If you want Affordability Bonus Points,you must submit documentation with your application of your water system's current average annual water rates(such as rates identified in the Water System Plan, Small Water System Management Program, or rates officially approved and adopted by the water system board or commission). • The application consists of the following: • This form, signed and dated • Affordability Bonus Points documentation(if you choose to apply for these points) • The EZ1 and EZ2 forms(the first step in completing the required environmental and cultural review process if you get funded) • Your metering exemption request letter,if applicable Applicant Information Applicant City of Everett Public Works Organization Water Name System City of Everett I PWSID#I 24050E Address 3200 Cedar Street City Everett I State WA Zip Code 198201 I County I Snohomish Phone (425)257-8800 Email mwelbom@ci.everett.wa.us Contact Name Matt Welborn Contact Phone (425)257-8974 Project Information Project Name: Tulalip Water Pipeline Segment No.3 Project Description:Design and Construction of 2,000 If 36-inch diameter water pipeline. Describe public health need for the project: . The Tulalip Water Pipeline—Segment No.3 consists of constructing a 2,000 If of 36-inch-diameter pipeline.The pipeline will replace a 50-yr old water pipeline that has reached the end of its useful life and has had three leaks over the last four years with the most recent two leaks occurring in 2009.This pipeline crosses under the Snohomish River and discharges chlorinated water into the river whenever there is a leak in addition to having the leak as a potential cross connection endangering the health of the public on Smith Island.The proposed new pipeline will immediately eliminate the cross connection potential and the discharge of chlorinated water into the Snohomish River. In addition, currently Smith Island is served through two 8-inch water mains.Those water mains do not supply adequate fire flow to Smith Island.This new pipeline along with the existing south water supply line will provide adequate fire flow to Smith Island. DOH Form 331-201(Rev.01/10) 1 19