20130617Application.pdf

Application for a Certificate of Public Convenience and Necessity
7fl}jlj !7 f 2:55
Fox Creek Water &Sewer,LLC
P0 Box 251 iiiLITJ
Driggs,ID $3422June7,2013 frJ-J-i3oj
Commission Secretary
Idaho Public Utilities Commission
PC Box 83720
Boise,Idaho 83720-0074
RE:Certificate Application &Required Supplemental Information
To Whom It May Concern:
Fox Creek Water &Sewer,LLC is a 49 water user system located in Fox Creek Country Club
Estates and Fox Creek Village subdivisions in Victor,Idaho with the ability to connect a total of
97.User consumption is not metered.
We are requesting the Commission to issue a Certificate of Public Convenience
and Necessity (CPCN)authorizing the Company to operate as a public utility in
the state of Idaho and to serve the geographical area requested.
As per Idaho Public Utilities Commission for a Certificate of Public Convenience and Necessity
(CPCN)application instructions,the following is included and prepared by:
•blue (Michelle May)text
•Bold (Rick Nansen)text
Name of (SWC):Fox Creek Water &Sewer,LLC,PWS#7410034
Contact person-Cost analysis:Michelle May,Bookkeeper [phone]
Contact person-System Operator:Rick Nansen,Certified Operator [phone]
SWC Mailing address:P0 Box 251
City,State Zip:Driggs,ID 83422
Physical well address for SWC if different from mailing address:Well locations-Lots 63 &46 Fox
Creek Country Club Estates Subdivision
City,State Zip:Victor,ID
Email address:
•Bookkeeper-maymichsiIverstar.com
•System [e-mail] [phone]
Review the following questions and include applicable information:
1.Type of business organization that the SWC is registered under:
(Corporation,LLC,Partnership or Proprietorship)
Fox Creek Water &Sewer,LLC is a single member LLC or Proprietorship
Commission Secretary
June 7,2013
Page 2
2.In what state is the company organized?
Idaho
3.Is the company registered with the Idaho Secretary of State (ISOS)and authorized to do
business in Idaho?
Yes
4.Attach copies of appticable by-laws,articles of incorporation and/or other organizational
documents on file with the ISOS.
See attached
5.Are there any affiliated companies with which the water system shares office space,
employees,expenses or provides services to the water system?If there are,please attach a
detailed description of the relationship,otherwise indicate no.
No
6.Attach a legal description for the certificated area to be served and a map.
See attached
7.Attach a map of the area showing the location of wells,reservoirs,water lines,booster
pumps,valves,etc.for your system.Also indicate the locations and names of all public utilities,
corporations,or persons with which the utility will likely compete.
See attached
8.Attach the most recent DEQ Sanitary Survey (if applicable).
See attached
9.Identify the Certified water system operator and certificate number.
Richard R.Nansen Idaho certificate #DWT2-i 51 24
10.Is the system approved by the Idaho Department of Environmental Quality (DEQ)or local
health district?
Yes
11.Attach information showing the water rights license or permit owned by the water utility.See
attached.
12.Attach the anticipated schedule of construction including proposed date to begin providing
service.
N/A-Begin Service Date 09/1 0/2004
13.Attach the estimated cost for utility construction (N/A-Begin Service Date 09/10/2004)and
statement of anticipated annual maintenance costs.
See attached.Includes well maintenance items only.No legal,accounting,bookkeeping
operational or repair/upgrade costs.
14.Attach a statement of the manner in which the applicant proposes to finance new utility
construction.
N/A-Begin Service Date 09/10/2004
Commission Secretary
June 7,2013
Page 3
15.Number of customers currently connected to system.
Number of Residential accounts-49
Number of Commercial accounts-O
16.Number of customers ultimately to be served by the system.
Number of Residential accounts-97
Number of Commercial accounts-0
17.Attach monthly water production data from all sources.
See attached Excel file for last 6 months,additional available
18.Attach monthly consumption data for the various types of customers currently connected to
the water system.
Current users are all the previously mentioned residential userslwith potential
commercial in the future with addition of well(s)
19.Attach a description of proposed rates and charges.
Flat monthly rate unmetered system:as of 10/01/10
Water -32.39 month +$5.00 month management fee
20.Attach a set of detailed financial statements (income and balance sheet)for the most recent
three years for the water system (one or two if new company)or a detailed budget for a new
system with no financial history.
See Attached.Company changed from Fox Development to Fox Creek Water &Sewer between
08122111-10/31111.Income and balance sheetfor both are included for2Oll.
21.Attach a list of current customers and mailing addresses.
See Attached.
22.You are required to inform your customers (if any)of the Application.The
Have the existing customers been notified?Yes,Attached
Has the Company issued a Press Release?N/A existing water system.
23.Attach samples of:
Bill statement:Attached
Reminder Notice -Termination of Service:Attached
Final Notice -Termination of Service:Attached
Annual Rules Summary:Attached-Shared Well Agreement
Company Tariff —including General Rules and Regulations (see Model Tariff 2008)????
Company Main Extension Rules —(see Model Uniform Main Extension Rule of Water Utilities
2009)????
Commission Secretary
June 7,2013
Page 4
Sincerely,
LJ
Rick Nansen
For Robert Kincaid,Owner
Fox Creek Water &Sewer,LLC
Enclosure
ifNOI1S3flt
___—*:Q(u -
251
CERTIFICATE OF ORGANIZATION FILED EFFECTIVF
LIMITED LIABILITY COMPANY
i 1lf2t 4H 8:50(Instructions on back of application)-
1.The name of the limited liability company is:S1AIE
FoxcreekWater&Sewer,LLC
2.The complete street and maihng addresses of the initial designate&prindpal office:go °o S
-st flccs1m(Mg ess.fldereMmanseeiad&esa)j7
3.The name and complete street address of the registered agent:
Robed tncaiô 9 coo s
{Se Mdress)
4.The name and address of at least one member or manager of the limited liabilitycompany:
Nan Addre.
Robett Kincaid :10 Cç(Q
5.Mailing address for ftmire correspondence (annual report notices):
P0 8oxIOdggs.ID 63422
6.Future effective date of filing (optional):
_____________________
Signature of a manager member or authorized
person.
Signature
Typed Name:Robert Klncaid —
Signature—
Typed Name:
R O711O
Seaety of State L$C only
IDAHO SECRETY 1W STATE4?11 5:£K;9992 CT;2f1a38 BH:12877711138.l 1BL URGAI4 LIC 12
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QUESTION 8
S 1A C DA—iC)
DEPARTMENt OF
-ENV RONtvIt\AL flUALIIY
CG North Sky re 0’ye.S..o Ioao za s.icn 3$C2 2h))28.2F.CL ‘B]:Chet.Gtr-rrr
Th9;eraestv.f ocrot
Sentcmbcr 10.2012
1cm Htime
Eo.t Creek Coumn Club Estates
1 575 Crooked Creek Rd
.-\Ita.WY 83414-4533
Suhiect:Pox Creek Enhanced Sanitar Surve conducted on August 25.2012:Public Water System No.
7410034
t)ear Mr.1 lunter:
Copies of the Enhanced Sanitary Survey inspection form and narrative summar lot the Fox Creek public water
system arc enclosed with this mailing for your records.
Attached is a list ot the recommended improvements tot our system:you arc not required to respond or act on
the recommendation.I low ever.the I)EQ urges ou to correct the issues outimed in the recommendation.
The [)EQ found no sign flcani deficiencies (a significant deficiency may Cause.Of have potential to cause,risk
to health or safety,or could affect the reliable delivery of safe drinking water).and no deficiencies (violations of
the IDA PA 58.01.08 Idaho Ruk.for Ptthlic Drinking Water).
If you have any questions,please contact Charlie Mazzone at the DEQ Idaho Falls Regional Office.
Sincerely.
Charlie Mazzone
Stall Engineer
Idaho Department ot Environmental Quality
Enclosures:Sanitary Survey inspection form
Sanitary Survey report
Sanitary Survey deficiencies recommended tmpmvcments list
C:Rick Nansen.Ieton Water.Inc
Robert SpocIhof.h)x Creek Country Club Estates Property Owners Association.5100 Country Club
Drive.Victor 11)83455
Greg Eager.l)EQ Idaho Falls Engineering Manager
Rochelle Mason,t)rinking Water Quality Analyst,l)EQ Idaho Falls
Fox Creek Public Watur System
The I)liQ found no significant deficiencies (a significant deficiency may cause.or have potential tc
cause.risk to health or safety.or could affect the reliable delivery of safe drinking water),and no
deficiencies (violations of the IDAPA 58.()1 .08 Idaho Rules Jar Pub/ic Drinking Water).
The I)FQ has the following recommendations for your system:
I.[he system should investigate and repair the cause ol the flre pUmp’s recurrent loss of prime.
2.The system should verify the proper operatIon of the storage tank overflow drain.
3.The system should verify proper operation of the storage tank transducer responsible br proner
water level maintenance in the tank.
Please see section IX RECOJVLWLWDA TJOAS’of’the Sanitary Survey report for a discussion of the
above three items.
Idaho Department of Environmental Quality
Idaho Falls Regional Office
Sanitary Survey Report
Fox Creek Country Club Estates PWS#7610034
August 25,2012
I.INTRODUCTION 2
A.Purpose of this Report 2
B.Summary of findings 2
C.Consumption and Production 2
I).Intbrmation Sources 2
II.SYSTEM SCHEMATIC 3
Ill.SYSTEM DETAILS 3
A.System operation 3
IV.TREATMENT 8
V.DISTRIBUTION SYSTEM 8
VI.MONITORING AND REPORTING 8
VII.OPERATIONS AND MAINTENANCE 8
VIII.APPRAISAL OF SANITARY HAZARDS AND SAFEGUARDS 8
IX.RECOMMENDATIONS 9
X.WELL LOGS 11
A.WcIIJ ii
B.VcII 2 ii
XL FLOW VERIFICATLONS 12
A.Weill 12
B.Fire Flow 13
XII.FACILITYMAP 14
XIII.WELL HOUSE 2 &STORAGE TANK PROFILE 15
Page I of 16
F INTRODUCTION
The purpose of this report is to present a sanitary survey review of the I-ox Creek Countrt Club listates (FCCCF)
drinkinu water system that was conducted on August 25.2()12.Sanitary surveys are intended to inspect drinking water
systems tbr health risks.
In general,the System appeared to he free of health risks,though there are items that merit attention,as described in the
paragraph below.System Operator Rick Nansen was very knowledgeable of the system and applicable DfQ regulations.
[he l)EQ found no ‘iufic’tiuit tkfickncies (a signilicant deficiency may cause.or have potential to cause,risk to health
or safety,or could affect the reliable delivery of saJ drinking water),anti no defleleucies (violations olthe IDAPA
58.()I .t)8 Idatlu I?utes fi.r Pub/IL Drmking Waier).
[he f)EQ does have the following recu,nniendationx:
-The system should investigate and repair the cause of the fire pump’s recurrent loss of prime.
2.lhe system should verify the proper operation of the storage tank overflow drain.
3 [he system should vcrii proper operation of the storage tank transducer responsible for proper water level
maintenance in the tank.
the above 3 items arc explained in detail in the I?ECOMttENDATIUVS section of this report.
The FCCCE system serves 49 homes (connected to the water system);there are an additional 3 homes with wells and are
not connected.[he FC’CCh has an agreement to supply water to Fox Creek Village.the neighbor community,with its
own homeowners’association,located in the lox Creek subdivision.A subdivision map is fotmcl in section XII of this
report.
[he operator reports no scater loss in the system,and feels confident any substantial loss would be immediately
noticeable.
FCCCh water demand is approximately I 10.000 gallons per day in the summer (that is including irrigation demand).
and 28.000 gallons per clay in the winter.
[he storage for this system,at 120,000 gallons.would supply 2 hours of fire suppression flow,and 4 to 5 days of drinking
water demand.
[he tollnwmg sources were used in the process of this sanitary survey.
I.t)[.Q drinking water system files.
T Idaho l)epartrncnt of Water Resources well logs.
3 I)EQ Plan and Specification files.
4.Previous l)lQ Sanitary Surveys.
5 System Operator Rick Nansen ot [eton Water.Inc
6.fox (‘reek Countr Club fstates Property owners Association President Robert Spoelho[
Pae 2 of 16
II.SYSTEM SCHEMATIC
V’I )UE
c fl 2 booster pumps
1’’re suppression booster
Iweit i
120 000 concrete tank
lit.SYSTEM DETAILS
The system under routine operations uses Well 2 to stipply the storage tank.Stored water is then boosted by twopumpstodistribution,Well I operates only on low pressure demand,a condition which happens only occasionally.Alireboosterpumpconnectedtothestoragetankiscapableofsupplying1000gallonsperminute.
[he well house contains the welt and distribution system appurtenances described below.The vcll house could usesonichousekeepingandinsulationrepair.
Aw
__
IT
Page 3 of 16
\Vell I is backup supply of water to the system.and operates
automatically upon low distribution system pressure.The pump operates
mlreqLtentk’.No well log is available for the well,but the pump rate was
verified at 70 ttallons per iii mute (verification attached to the end of this
document).
Well I has all the necessary appurtenances located inside the well house.
including 4 hydropneumatic tanks for surge control.
I
f
Pae 4 of 16
Ihe Vve]l 2 house contams well 2.the two drinking water distribution booster putiips.the lire pressure booster pump,and
all the necessary well appurtenances.the tvcl]house could use a little housekeepin.
U
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L 11
___
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Page 5 o116
Two 7.5 horsepower booster pumps supply distribution
system pressure.The pumps have all the necessary
appurtenances installed.
A 30 horsepower booster pump supplies fire suppression
pressure.The fire suppression system was proven to supply
over 1000 gallons per minute (documentation is attached to
this document).Please see the REC VMMEVDA TK)A
section of this survey for problems associated with this
booster pump.
Well I is the prin7ay source of water to the system.and
under routine operations —supplies water to the storage
tank.the IS horsepower submersible pump capacity is
245 gallons permit well depth is 210 feet with static water
at 108 feet at the time of drilling.
______
-.
.4,
Divtribiiliw,btj,Ntcr3:llre booster:
Page 6 of 16
Oi.irihuKiou .wtc’n,boosretpump Iwurs nietr .shawiiig et1utd tiriw on the hoosiers:
1Tt.W
A I 20J)OO eallon concrete partially buried storage tank holds tire supply water and reserve drinking water supply [hetankleveliscontrolledbypressuretransducer;water is supplied by the well 2 pump according to the transducer;gravityhowtothedistributionsystemboosterpunipsprovidessupplytothedistributionsystem
lhc tank has all the necessary appurtenances.and appears to be in good repair.
Frizch (kaili Jar ttuiA thrum,tahi/OL’erjlok.and wc’hi hfnrse floor drum:
••••
I
t ‘S.
‘S
At the time of this survey,there appeared to be issues with the pressure transducer,the taTik overliow,and prime loss tothelirepumpduetotheelevationlevelofthetank:most of the tank is below well house plumbino (booster pLimpS toidplumbingtothedistributionsystem).This issue is discussed in detail in the RECOMME,VDATIO:VS section of this
report
lank level tran’ittucer readout:
-••.•___
‘I —--L5
Page 7 of 16
Tank c’lit.s with sre?ifl$?:
IV.TREATMENT
I here is no treatment ion the FCCCF water system.
V.DISTRIBtJTION SYSTEM
Approved plans show an 8 inch water main line running throue.h and connecting (he Fox Creek Village area to Wells I &
2,and an 8 inch water main connecting Well 2 north and providing a perimeter to Well I -1 hat is the approved plans
show inch lines thmughout Fox Creek,except for the four inch line which C0011CC(S Well I to the south side of FCCCL,
and tcnuinates in the vicinit of Well 2.In 2010.the water st-stem looped Well I into the existing FCCCI-8 inch water
main with 8 inch diameter C90t)PVC pipe.
Submitted plans (5/24.05)show hydrants spaced throutthout all bitt the south end of FCCCE.lhe south end should not
have flre hydrants attached to the main line because the 4 inch water main does not meet the 1l)i\PA 58.01.08 Idaho
Rttk’s for I’rthie Drinking Water Nitein’requirements for minimum diameter hydrant line (a minimum of 6 inch diameter
line is required).
VI.MONITORING AND REPt)RTI NC
Ihe system is current with all monitoring and reporting requirements.Operator Rick Nansen has a reptitation for good
communications with the DEQ,and is known to be thorough with monitoring and reporting.
the system uses lAS Fnvirochcrn in Pocatello for water sample anal sis.
Vu.OPERATIONS ANI)MAINTENANCE
The system operations and maintenance are current,though the DIiQ recommends repairing the cause of the recunent flre
booster loss of prime.Operator Rick Nansen is knowledgeable and experienced in water system operations,and has a
good understanding of DEQ rules.
VIII.APPRAISAL OF SANITARY HAZARDS AND SAFEGUARDS
Groundwater Under the Direct Influence of Surface_Water
Under the federal Surface Water Treatment Regulations,all groundwater sources serving public drinking water s sterns
must be evaluated to determine if they are directly iniluenced by surface water or at risk with respect to oiardia.
crptosporidium or other microbial contamination.
PageS of 16
Both of the FCCi vclls have been determined not to be tinder the intluence of surface water.
the drinking water system does not appear to have any smiitan hazards,and utilizes necessary satèguards to public
health.
This sanitary survey found the system to be regulatory compliant,and found no hazards which may compromise public
health.
IX.RECOMMENDATIONS
This section is intended to clarify the three recommendations for the FCCCE water system.namely:
I.[he sstem should investigate and repair the cause of the tire booster pump’s reculTent loss ot’primc.
2.Ihe system should verily the proper operation of the storage tank overflow drain (the l)FQ received notice on09/07/2012 that:I)the overflow line ‘vas scoped and appeared clean:2)the tank drain line was opened andoperatedpropcrlvand.3)the overfloe inlet tiom the tank to the drain line will be scopeci in the near future toverifythereisnoblockac)
3.The system should veri!v proper operation of the storage tank transducer responsible for proper water levelmaintenanceinthetank.
These items are meant as tecornrnc’ndutions.and are not l)FQ enforcement items because they cIa not vif)latc DEQ rulesorjeoparcliiepublichcahht-lowever,they cia merit discussion.
fr—
Proper operation of the tank level transducer was not evident as the tank
should not have filled above the tank top level,
(he above incidents suggest the following may not be working properly:
the tank level transducer:
2.the tank overflow plumbing:
3.the svell house floor drain.
Further,the (DEQ approved)storage tank design hokts the majority of reservoir water below the plumb level of the
distribution system booster pumps,and another I’oet below the fire booster pump (see the plan profile in section XIII of
this report).Consequently.the operator maintains the top two or three feet of tank stol-age as the day to day usable
volume in order to avoid distritiution system booster pump loss of prime
The initial DEQ sanitary survey date fottnd the Well 2 house flooded,the floor drain s’as adjusted to allow water todrain,and after the standing water was
drained a steady stream of water was llowiniz
Irom the storage tank till level transducer
conduit OntO the well house floor,
truii tducL’r contluit above tunk lop:
l’hc transducer condttit exits the storage tank from the access hatch,and
above the tank lid.inclicatmg the tank overtlow was not operiting
sufficiently.‘I he French drain designed to accept overflow t ater was rusted
shut,and we were unable to verity overflow into the drain.
Page 9 of 16
Another complication is the lire boostet located
at an elevation even closer to the full level of the
stola2e tank —loses prime recurrently;therel&e an
operator mist he present in the case of tire
suppression to prime the booster to enable
operation.Once primed,the booster would have
access to the cntii-e storage tank volume.
l)uc to the importance of the tire booster,the DEQ
recommends:
[he system should investigate and repair
the cause of the lire booster pumps
recurrent loss of prime.
Fire boosterpiunp ,nothJk’d wit!?a pri000!!ivdvc’at the top ofthe rotate:
1e eocs,e puflD
I
srt.ton s,sten-b;ote’pn,p
Paee lOot lb
No well Jog s available
X.WF1LL LOGS
Page Ii of 16
o_,c_I Lu
IDAHO DEPARTMENT OF WATER RESOURCES
WELL DRILLER’S REPORT
1.WELLTAGNO.D 0034947
3EWNG P€R%lrr N2 -—12.WELL TESTSWE’.’R1 Ncl’.’.W’.I4b
______
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4.USE:
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5.TYPE Of WORK i,eA d 11,04 ,(Ruçrn3 olu)
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6 DRiLL METHOD:
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7.SEAUND PROCEDURES
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FORWARDWHflE COPY TOWATER RESOURCES
XI.FLOW VERIFICATIONS
M5’&iw.&’
t’J&J2.y4s5
208-787-2952
/1x.4-528 -2595...
Engli1r’s Crif5cation
iox Ctcck Country Water System Apul 4,20OTetonCo,Idaho
DIiQ Water System 7410034
1b Char1ie Maz-ionc;
I Arnold W Woolstenhuime an 1nginecr in the State of Idaho did check the flow from thebackupwell(1)for the Fox Creek Country Club Water System.
L he well was tested by two methods.
1-Isolated the lines to iust pump to waste and read the existing water meter in 1 minuteincrementsfor5minutes.Showed consistent reading at =70 gpm.
2-Measured time it took to fill 15 gu]lon container Took 13 Seconds 70 gprn
Therefore I conc[udcd that Welt 1 with the is presently producing 70 gprn of water.
Sincerely,
Arnold W.Wooistenhulmc P.f.iL.S
Pace 12 of 16
A
1-’<---—---
iQ.5 139 255 5owh Main 5.
Vcor.i 83455
CERTFICATE of FIRE FLGWS
Project fox Creek CounOy Club
Public Water S stern
Driggs Area,Teton County,idakio
AW Enuineering (Arnold Woolstenhulrnc Engineer)along with the followin people didobserveaFireflowtestoftwohydrantsontheFoxCreekCountryClub,Public Water System,
Arnotd Wonistenhulme Idaho Engineer AW Engineering
Alan Wilder ()pcrator Water Solutions
Robert Kincaid Project Partner
Torn ihmtcr Project Parher
David Driggs Driggs Plumbing
Brett Campbell Teton County Fire Masshaii
The water Fire flow was tested at the two separate hydrants as shown.
hydrant Location Flow Pressure Residual Static
——Gpni —Psi AtMHyd Press
2 West hydrant nca;iighway I 130 gprn 45 ps f 42 psi )74 psi
dllb)ISC L EJliZ
These tests were made running only the 30 Ftp lire Booster Pump with the other two 7i hp pumps turnedoffThepressureinattheWell2housewasat60psiwithFirehydrantsclosedand4t)psi with Firehydrantopen.
SL
ihereby certify that from these tests the system will deliver over 1000 gpm at a residual pressure of over 20
Page 13 of 16
91J°ttauj
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ttJ
(5
dYNAIVIIDVAIIX
Xlii.WELL HOUSE 2 &STORAGE TANK PROFILE
___-
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Page 15 ol 16
State of Idaho Public Water System Enhanced Sanitary Survey
Water System Inventory Information
Survey dale fm/ddlyyyy)812512012 PWS No.7410034
Name of Public Water System [_Grvundwatet Sources 2 #of Storage Facihties
#01 Surface Water Sources.0 Total storage (gal)120.000
Date of last stirvey Health Dstnct F]N/A DEQ Regicn Li N/A County.
0312812008 EIPHD IFRO Talon
Number of service conced!ons.Resrdentiat population Status Water purchased from F]N/f Waler sold to E N/A
4g EsImate 49 residences 2.5 j Approved PWS #:PWS #:
cap/res:dence =123 capita Li Disapproved Name Name
.Combined co.Lrces?Soasonai operatinnOwnertypeLegalentityWatersystemclassificationF]No System classification dates.F]N/A
2 IN If vest]Welt Field Distribticn’Date open—F]Cornmun:ty Water SystemPhysicallccat’on of the PWS J ManiIoki/Spring Box VSWS
(Township.Range.Sedan)Li Ncntrnsient Nonccmmurrify Sources combined Treatment.[N/A Date closedUTransientNcr.ccnsmun.ty -NC
Responsible Charge Operator (DO):F]No DO F]N/A -Ider.tfy Opyrator for GW-NC PVJS)Legal Owners Name:
t-’J Mr.F].Rick Nanson Ri f4r.F]ti,s.Tom Hunter
Properly Ucensed’Ym t]No [N/A-OW-NC License type 0t2 &OVtT2 F]N/t MailIng address
Mailing address.License c.uvoUe 15125 &1 5124 Telephone
P0 Box 760 307-733-1143TetonWaterInc.—Dggs,ID 83422
P0 Box 515 Telephor.e 208-354 2030 Day
Driggs.ID 83422-0515 Day 1575 Crcoked Creek Road,Alta.NightWY83414
Night Fax.
E-mai[Fax E-mail
Stibstitute Responsible Charge Operator COP):F]No OP Ri N/A for OW-NC PWS Individuals present during inspection:
t]Mr.Mv.Name.Rick Nansen,System Operator
Prcpcrly ccnsed7 F]Yes F]N F]N/A OW NC I cerise type.LI N/A Name Robed Spcethot,‘-lomeowner’s Assoc President
Mailing address License number Name Tile
Name Tile
City State,Zip Code Telephone:Name Tie
Day Name Tile:
N:ght Name Title
E-mail:Fax Name:rifle:
Samples taken a’the time of survey by inspector?Survey performed by:Agency
F]yey [No Name Maz2One [IDEQ
It yes,what Title Staff Engineer F]Heth Dept.
Phone#[phone] F]Other:
General Information Sanitary Survey Index
yes nn na cr5 nov Modules used #Ri F]F]F]F]I Have prev:ously required Significant Defic:encies &Deficiencies been addressed’F]General Information
F]F]F][‘]F]2 Have modifications been made to the PWS ance the last ESS’F](iroundv,ater Source
F]F]F]F]F]3 If yes,are the modif.cticns considered to be significant’[1 Storage
I I I 4.If yes,were plans and specs submtted to and approved by DEO7 F]Hydrepneumatic Tanks —U Li Li Li H 5 Arc there any knawn issues o:problems with equ pment or operation of the PWS U Oistnbut:cn
that could negatively effect the quality of the water produced9 (ifyes.comment)F]Pumping —
Comments:F]Financial Capacity
Li Managerial Capacity —
J Treatment Application —
F]Dis:nfecfion
Li Notes
F]Photo Cog
lotal modules used:0
Page Of
-Enhanced Sanitary Survey -6)2-09 General lnformsilicn
STORAGE
A separate storage form mImI be ti’leo out for each storage unto the PWS
Storage structure name:Storage structure ID #:
Storage tank none
Physical location:Date in service Li Unk
2010
Adjacent to well 2.Volume (gal);lInk
120000
Storage ConntnrJrrin Li h!euaterj Type urf material:
El keservnir/lank 4rrrr’e C,rciund Plactir Li wrinri
[1 Standppe Partally Below Ground Eherglass Metal
7 Below Ground Ej Concrete [7 Naturally ContSinCd
Total days supply (this structure)Date last inspected:[7 un Cleaned.[7 link
410 5 days [7 link 2010 2010
How is the water level measured?[7 Unk
transducer
nOte ALL STORAGE STRUCTURES
[J 1 Is the storage structure safely accessible to the inspector?
[7 2 Ix the PWS storage tank located vñihin 500 feet of any municipal or
lr.dustriaI wastewater treatment plant or any land which is spray Trgated
with wasld\yatet or used for sludge disposal?
[7 3 Are any of the storage stwcture drains drecily connected to a sewer or storm drain?
4 Is an overflcw provided that dIscharges to dayi:ght in a way that will preclude the
possbility of backficei to the reservoir and,where pracical,provided with an espended
metal screen Installed wdh:fl the p:pe that wIl exclude rodents and deter vandalism7
[7 5 Are ovedows brougritdown to an,elevation between 12 and 24 inches above
the ground surface?f2X the diameterofthe discharge pipe above a basin rim)
El 6 Do crertlows discharge over a drainage met structure or splash plate7(storm crsanitary(
[7 7 Is the stcrage structure secure from unauthorized access7
LI 8 Does the storage reservoir have a watertight roof or cover and is it
sloped to facilitate drainage7
[7 9 Is the storage water protected from ccnt5m;nalion7
[7 10.is the stcrage structure structurally sound7
LI 11 Could vegetation In Pie area potentially mpact the storage struc4.ure?(Recommended)
[7,12 Ix Ire storage structure desgned so that it can be solated from the distribution
system w’lhout r.ecesstat rig loss of pressure ci the distribution systemn
[7 13.Is leakage evident at time of rspectiorii
[7 i Is tra storage structure nier or coating or liner peeling or cracked?
[7 15 Ix the storage structure used to stOre tnrshed water’
[7 16 Am accpy manhole openings for the storage structure 4 robes or greater above the
surface of the roof,with a cover 2 inches overlapping,water tight,hinged and rockedn
17 Are all vents extended 12 iriches above the roof and constructed to eacluce potental
sources of ccnlam;nation7 (The overflow pipe shall not be considered a vent)
ABOVE GROUND STORAGE
[7 18 Do a;ver’ts open downward and are they ttted with a 4 mesh non-corrodible screen?
elite GROUND-LEVEL.PARTIALLY BURIED,or BELOW.GROUND STORAGE
U I Goes Inc overflow for tire storage structure have a vertical section of pipe at
least 2 pipe d,ameters in length7
[7 20 Is the overflow fo toe storage structure provided wlh either a 24 mesh noncorrodibe
screen insta;ed within the p pe when practical or an expandeo metal screen installed
With fi Ine pIpe plus a weighted tlapptr on check?
,J 21 Is the area surrounding the storage structure graded in a warner that will prevent
surface water from standing w-thin 50 feet of j7
[7 22 Are at vents for tire storage structure open downward wIn the opening at least
24 inches above the roof orthe ground loveland covered with 24 mesh noncorrodible
screen to exclude potential ccntaminaton7
PARTIALLY BURIED OR BELOW-GROUND STORAGE
[7 23.Are ‘ALL”manholes elevated 24 inches above tire surface of the roof on the ground
level,whch ever s higher?
[‘1 24 Is there a minIniurn distance o 50 feet between the storage structure and any
coo-potable maui standing water,or other possible source of coctamiration7
SURVEY DATE PwS #
812512012 “](mm/dctr’yyyy)[‘1410034
COMMENTS;-
(indicate question number)
4.the tank overflow
terminates in a French drain.
20.The overflow discharges
inside a french drain.
yes no “ía uk
[7Li[JU
LiiL1Li
LIHEl
LI LIE
[7LiLi
LiLIL
LLIEI
LI[7H
LiLiLi
LILiE
yes no nra
yes no ma
LILiLi
LEili
El
HLi
Li
[ILi
LiH
Li
LIEl
El
Li
P
Li
Li
LIDELi
es ro ma uitS
LILiLiL
LILiLiLi
Page _____
-Enhanced Sanitary Survey -612/09 General Ir,torrrtat on
GROUNDWATER SOURCE page 1.A separate sources form must be fIIed out for each groundwater source in the PNS
API Soure5
yes ire ‘ifs cmi rote 1 This souriw cc’
Li Active I Pd
“i Inactive Li Emergency t<60 days per year)
El P1 H H H 2 Has here been a Source Water Assessment conducted for the source’
Date
P1 H Li LI L 3 Has a !;rrat GAJDI dote rninaticn been done for trim source’
Date I
Welt Information
‘5 ii “$5 ct’4 i’CIC
fl P1 is tire weti cn a separate nt that is arge enough to provide a m:nimum
[Sirsrifcan[ri Deficmncy distarce oPSO feet betweec the well ann the nea’esI property ‘re?
tacp”cab’e it constructed fler 111117/)
5 Are the foll:rrg mnimum distances from the P’NS well being met?
P1 U U -Gravity sewer inc ,,.........,,..Soil
P1 U Li “H -Pressure sewer line 100 ft
17 C][1 L]-Ir,die:dual nonie septic tank 100 tt
17 U E][“j -lrtdindual home disposal t:cid 100 ft.
-Lj [].Individual home seepage pit ,iCOft
]El U Privies lODtt.
H H El U -L vesiock .50 5
LI U U J -Canals,streams,ditches,takes.pcnds and
tanks used to store r.onpotabe sLibstances..50 ft
C 17 Li fl 6.Are pesl;ctdes herbicides fertilizers,ponab:e ccr.tair.ers ofpetroleum
products,or 015cr mac or hazardous materials stored on the mel
Li Li 17 7.Are pest:crdes neibicides or fertitizers app$ed to the well :ot’
LI 17 fl [“S Is the well in a pit’If yes,Date constructed [‘U Li 7 []C]9 Was the well that a located in a pit installed after 1 iSI64?
H C]17 [j [,,10,It pit was ‘nslalled prmr to ¶1,5164 —Has 060 granted an excepticn ard
does the pit have watertght construction of pit walls and ticor.a flooryesno-ia cnk rote -drain ar.d an acceptable pit coset?
11 Is the welt protected from unauthorized entry’trfeccrnrnended)
i U 12 Does me casing extend a minrmum of 16 incites above the I cal ground
C]Signif cant Deftiency surface artY or 12 n.ches above the pump house floor?
Li E’i LI Li C]13 iS the we:l netted with the open end ofthe sent screened and
terminated downward at east 16 itches above the f’nal greurd surface?
P1 ji H 14.is The well providedwth a Santary cap that prevents surface water entry?
17 Li H 15,Is the wet cased and seated n such a manner that surface water
carnot enter the well?
SURVEY DATE 812512012 PWS No,:7410034
fag #:Common name of source.ISohIrce:Is this source treated?Yes P1
unknown Well 1 17 well ‘—b C]Manilotit Treatment objective’17 N/A
Physical location.“]LI Sprmg —b C]Spring Sox
The well is located west of the well house on the southwest corner of the southeast end of County Treatment types’P1 N/A
Club drve:west of truck service garages lidently the treatment train Commontt
Is there a well log for the groundwater source7 Yes 17 rto U N/A H L’nk
Pump capacity (gpm)Casing size (in)bate drilled:1ieti depth tftl [Casing depth (ft)Grout depth(ft)Static water depth (II)
70 gprn [J Unk 8 H lJnk 17 Uirt 17 uii 17 Itoh link J UnIsthecasinpscreened?Screen depth (ft):C]’N/A 17 Unk Is the casiqp,oerforated?Perforation depth (ft)N/A
C]Yen C]No 17 Wok Frcm.C]Yes 17 No 17’Unk From’17 Link
C]N/A To’H N/A To
Latitude(Decimal)’
LongitudeIDecimal)’
Comments:
tindicate the question number)
‘I I hctre is an eascmcnt for thit it]I
Page of
-Enhanced Sanitary Survey-6:2O9 General Intormulion
Common Name SURVEY DAT[PwS #
Well Information (continued)
yes rio na irk note
T Li Z LI Li 16,Is there a smooth nosed sample tap provided on The wetl d:scharge pipe
prior to treatment?(Threaded tap is approved w.Ur backttsw preventer)
‘Li [1 [1 17.5 an instantareous Ond totaiz:ng flow meter equipoed with ncrivo’atle
[1 Unnecessary memory .nstatled on the oump distubutioa line ot the well and is it
maintained and working oropery?
r7 F]Li Li 18.Is a pressure gauge provided at all nstaitatrcns and s it ma:nta.ned
and wOrkng PtOPrY’I
fl 19 Can the well be pumped to waste at the design capacity of the well via
an approved air gap at a locatron prior to The t:rst service connect.on?
Pump House (any structure containing important .vatersyslerrr oonrpcnents)
555 cc fl urir rote
LI Li tLi Li L 20 5 the source orated in a pramp house?
[][7 [21 Is tIre oump house kept riCan and in good repar’tie -floor cracksj
Li LI Li El [7 22 (a tr,e Dump house protected from unauthorized personnel?
11 [7 [7 [23 Does the pump hou,e have adequate IghIng throughout?freccmrnendedJ
Li H Li 24 Are alt non-sample taps nstalled :n the pump house equ pped viitrr an
appropriate backtlow prevention device’
]Li I ]I_I [125 Is adequate ventilatcn provided n the pump hOuse for d:ssipaton of
[7 S:qrrficant [1 fiorcncy]excess heat and mosture from the equiprrent’
Z LI Li Li Li 26 .s sarteatuate heating provided in the pump house to provined sale and
Li srqnricant [J Defrcienuy efficent operalcn of equipment to prevent freez.ng ‘
—27.Is the pump hcuse protected from ttoodang.have adequate drainage
is the flcor surface at east mx (61 inches above the tina ground surface.
and s the ground surface graded so as to lead surface water away front
the pump house7
26 Is ft-a simp for pump house floor drans coser than 30 feet front the well’
29 Is the floor drain connected to sewer,storm drans.ch:oriflation room
ara/is,or any ether source of contarnnation?
Spring Information
yeS to -Ia irk rote
Li L Li Li Li 30 Is the entre a’ea withn a ore rundrel (100)foot radus of the spring box
tenced to prevent trespassing of .vestock and void of builo:c.gs Uweings
acd sources ot coritarrinaton’
Li Li Li Li Li 31 Is surface water duerted Iron the 100 foot protection zone around
the spnng?
Li [1 LI Li Li 32 Is the sprcg housed ri a permanent structure SnU protectec from
contaminator ncluding the entry of surface water animals acd dust’
Li Li Li Li Li 33 Is there a smooth nosed sample tap provided on the spring discharge pipe
prior to treatment?(Threaded tap is approved with backflow prexenter)
Li Li Li Li Li 34 Is a flOw meteror oilier flow measuring device prcvider1
35 Is the spring box equipped with a screened ovrf ow’
30 Is the supply intake located abose the Item of the ccecfion thramber’
37 s the spring box protected from ccntarrrialion nOluding the entry of
surface water,annals.aed dust’
38 Is the access pan fitted with a sold water t:ghl cover whch overlaps a
framed opening and ester.ded down around the frame at least 2 inches?
39 Is the access pod a framed opening that is at least 4 inches IrgIr with a
locking device?
40 is the access pod elevated a!least twenty-four (241 inches above The top
of the box or ground evel.wIrchever is higher?
GROUNDWATER SOURCE page2 I Weill 8/25/2012 7410034
Comments
(Please indicate the questidn number)
27 1 he s cli ltouse has it hdoss grirtmnd
Iloor (abottt Cr feet):all tppurtc1ratfccs ar
heIos grottnd ie ci.
2f &29.thcrc ti no hour drairt
I_i L-’J Li F I L’i
LiLiLILLi
Spring Box Information(not all existing springs have a spnng bOx)
ho CIa UiiO nore
EHRI Lit
Lit]Li LiL
LiEU UL
LILIL Lit
ELiLi [It
LiED DLI
Page
______—
Cf
-Enhanced Sanrlary Survey -612/09 Genera:Intormxlicrr
GROUNDWATER SOURCE page 1.A separate sources form must be filled out for each groundwater source in the PWS.
SURVEY DATE:8/2512012 PWS No 7410034
Tag #Common name of source Source:Is this source_treate,Jfl Yes fi No
D0034947 Well 2 Well El Manfod Treatment objective.LI WA
Physical location:El Spring —)H Spring dcx
The well is located on lot 63 of Fox Creek Country Club Estates,on the northwest corner of the Treatment types N/A
Country Club Drive and Billage Way intersection.(identify the treatment traii in Commenfs
Is there a v,Cll log for the groundwater source?fi Yes [o N/A L]Unk
Pump capacity (gprn)Casing sizeirri drilled IWell depth till ICasing depth ttt)Grout depth(ft)jstatic water depth (ft)
245 El Un/i 10 IJ Unkj1212212004 LI Unkt2lO LI Ln14200 El Unk 60 11 j108 El tin
Is the casinçj screened?Screen depth (if):Li &1A Un/i Is the casin,çioertorated?Perforation depth (II):]N/A
Elves fiNe flunk From 200 Eves Eio flUnk From:flunk
Li N/A To 210 [1 N/A To.
Latitude (Decimal)
Longitude (Doccial’
All Sources
yes no n/a artS note I Tns scurce is
Ri Active fl Prricser1
[tratt,ve El bmcrqenqi (<60 lays per year)
E LI El H H 2,Has there been a Source Water Assessment ccrd’Jcted for the source”
Date I
Ri H H El fl 3.Has a final GWIJDI determ:nafion been done for this source’
Date’
Welt Information
,es no n/s Ck vo:e
‘H El
LI Sgn!icart fi Del’cirr:cy
Is the well on a separate 01 that is large ercugn to prow/ia a minmum
distance of 50 feel between thewell aid the nearest prcpedy line?
(apphcabte it constructed after 1111/771
Are the followog mriinltrm distances from the PWS well being ret’
•Gravity sewer i/ne....,.,....SOft
Pressure sewer ne..,.100 ft
-‘r,dividual home septc tank 100 ft
-Individual home d.spcsat held 100 ft
•Individual home seepage pit 100 ft
-Prv.es 100 ft
-Lvestock .,50 ft
-Canals streams,dIches,lakes,ponds and
tanks usC/i to store nenpctable suOstances 50 ft
A’e pestc:des herbiedes.tertlzers.portable confa.ners ef petroleum
products or Other jox:c or hazardous materials stored on !ne well loP
7 Are pesticides.herbicides,or fertilizers applied to the well lot?
8 Is the well in spit?If yes.Date censtrucled’
9 Was the we!that is located fl a pt installed after 1115/1147
10 II pt was installed prior to 11/5164 —Has DEQ granted an ezoepi cir ar/i
does tile pif have waler tight constructIon C!pf vials and floor,a tour
drain and a.,acceptable pt cover?
11 Is the well protected from unauthorzod erfry7 lRecoinmcnded
12,Does tile casing extend a minimum of 18 Inches above the final gtcund
surface andi et 12 inches above the pump house floor’
ti Li LI Li 13.15 the wet vented wIt,the open end of the vent smeenea and
terminated oowrward at least t8 aches above the final ground surface?
El El El fi 14 Is the mel provided who a sanitary cap that prevents surface water entry7
El H LI H 15 Is the well cased and sealed in such a wanner that surface water
cannot enter the well?
5
RH LIE
LILI HE
EE LIE
ElLi HE
EU [iLlEEl
nfl RHr.iiu flU
fiLl LIE6
EU LIE
ELI LIE
LULl [I IHRLIHE
yes co v/a vri<rule
LIHZ
Comments:
I ndrcafe the question number)
H Li U I]H
I]Significant Deficiency
H
Page Of
Enhanced Sanitary Survey-6;209 General Informatwi
Common Name SURVEY DATE
Well Information(continued)
es no ri/a unk rote
Li Li LI [1 Li 18 Is there a smooth nosed sample tap provded on the well discharge p pe
prior to freatrtren’(Threaded tap is approved w’th backtow presenter)
37 Li Li Li Li I?.Is an instantaneous aid lotafizing flow meter equipped wth norivo’ate
Li unnecessary memory installed on the pump drstr,bulron line o’the stall and is
maintained and working pccperly?
17 El L][1 Li 18 Is a arassure gauge provided at all ir,stal!aticns and is it mainfa.ned
and worklg properly’I
17 LI [1 El 19 Can the well ne pumpec to waste at the design capacty of the welt va
an approsad air gap at a location prior to the fiist service connedt.on9
Pump House (any stmcturtr containing important water system components)
yes no ir/S urk rote
17 Li H El H 20 Is the source located na pump house?
LI LI Li Li LI 21 lathe pump hcuse kept clean and in good repair?(Ia -floorcracks)
Li Li LI Li 22 lathe Dump house prctected from unauthccized personnel?
LI Li Li L Li 23 Does the pump house have adequate hqntrng throughout?(mcomrnended)
[7 ri Li [[]24 Are all non-sample taps installed in the pump house equipped with art
appropriate backttow prevenlon devicet
LI U U Li LI 25 Is adeguate ventilation provided n the pump house (or dissipation of
[7 Signilicant Li Def:niency excess rest and moisture from the equipment’
Li Li Li E 26 is adeauato heatr.g provided ri the pump house to provided safe and
Li Significant Li Deficiency
Li Li Li Li L 27 s the pump rouse protected from floOding,have adequate drainage,is the floor surface at least six (6)nches above the trial ground surface.
and is the ground surface groded so as to Cart surface water away from
the pump hOtis’
fl (7 fl ]E 28.5 the sump tr pump house floor dna-na coser than 30 feet ticm the well?
El Li Li Li 29 is Ih.e floor drain connected to sewer.storm drains,cfrlonnatien room
drains or any other source of contamirtal an?
Spring Information
yes no (a urk mm
Li Li LI Li Li 30.Is the entire area with:n a one hundred 1100)toot radius of the spring bOa
fencea to prevent trespassing of livestock and void ci buildings,dwellings
and sources c-f contamination’
F Li [1 Ii [z 31 Is surface water diverted from the 100 foot protection zone around
the spring9
Li Li Li Li Li 32.Is the spring housed lea permanent structsie and protected front
contamination incud.ng the entry of surface water,animals and dust?
Li H H Li Li 33 Is there a smooth nosed sample tap prov’ded en the spring discharge pipe
prior to treatment?)Threaded tap is approved with backflow preventer)
Li Li Li [1 [1 34 Isa flow meter or other flow measurmg device provided?
35 IS the spring box equipped with a screened overl:ow’
36 Is the supply intake cated above the hoot ofthe collecfion chamber9
37 Is the npr:rg box p’olected from cortaminatron includng the entry of
surface water,animals,and dust?
3S.Is the access port idled with a solid water tight cover which overlaps a
framed open-rig and extended down around the frame at least 2 niches’
39 lathe access poh a framed opening that is at least 4 ncfles hlgfl with a
locking device’
40 Is the access pen erevated at least twenty-tour (243 aches above the top
of the box or ground level whichever is hgfler
GROUNDWATERSOURCE page2 J (tlI21 j 812512012
PwS #
7410034
Comments
(Please ir,d;cxte the question number)
27 1 hit well linuse has a below prciuttd
lhtr (about 6 tet’t:all appttrtunaitco an
b’rtowpround level.
2i &2’)thcre is tin floor Ut/ItIt
efIcient operalon of eqi;iprrent to prevent freezing 9
Spring Box Information (not all exrsfrng springs have a spring box)
yes ‘ro n/a Lrk ,tcte
EHti tILi
ElLiLi OLi
LiLiLi LiLi
LiLiLi LiLi
ELiLi LiLi
LiLiLi LiLi
Page
-bnhanced Sanitary Survey -612109 General Information
SURVEY DATE
8/25/2012
pwS ft
(rnm/ddfyyyy)7410034
HYDROPNEUMATIC TANKS
One form for all Hydropneumahc Tanks
Tank ID#Physical Location Brand Model Bladder (yes/no)Size (gal)Installation Date
Well house I______________________
1002InsidethewellhouseXtrolUnknownyes Unkown3854
Well house 2
1 State After 20052Ins,de the well house Unknown yes 1003Xtcol After 20084
yes no Na sn ncte ALL HYDROPNEUMATIC TANKS COMMENTS:fl [1 fl [1 120 the tank(s)maintain adequate dstr:bution system pressures?(indicate the questicn number)
Li Li U U I2 Is the tank(s)located above normal groLnd surface and completely housed?1 The tanks serve as pressureLiSignificantDef;ciency surge suppressants.LI U t El [9 3 Can the hydropneumatic tank(s)be isoiCted from the system,permLting
operat:on of the SyStCIT17 2.The well house 1 tanks are onLi1_i U U U 4 Ae the interor andlor exterior surfaces in coed condlior?Ihe floor,about 6 feet below[9 [9 [9 5 Are tank supports structuraly sotnd and aceecate?ground surface.[9 LI U [1 Li 5.Is there a pressure gauge and pressure operated StartStop controls7
U Li LI U LI 7 Does the PWS using the hydropneumatic lpressure)tank(s)serve less 6 The tanks are always onlinethan150homes?
and serve to moderate pressureyesnon/a note Non-bladder Tanks Only
U U El Ti a.Is the recharge a r free of polutants such as Cl from an air compressor?surges,they do not store water
9.Do all con-bladder hydropneumatic tank(s)have the tellowing7 so do not need on/off controls.
H U U U -Adrain’
U U [9 [9 U -Means to add air’
H El U U U -Automatic or manual air biowofr?
U U [9 [9 -An access manhcie (24 inches in diameter where practcal)?
U U El H U -Water sight glass?
[1 U U U U 10.Has the non-bladder pressLre tank(s)been tested for structural
rtegrity n the past 5 years’(Reccmmendad?
Page Of
________
-Enhanced Sanitary Strvey -612109 Gerral Information
yes no tiC Cnk
HElEJEJ
LICLJEl U
LHU ri
yes no nia in rare
Li U LI El [1
[1 r i ‘1 H
H E LI U Li
EIEHH r]
HFHH H
LEDLI H
U 1]Li Li Li
tHH[]El
El
H
[“1 11 Ci I H
LILIHEl [1
ULUEl U
HP1HZ H
H L Li H I]
‘jun rio rife r.rk note
Hfl[1E H
DISTRIBUTION
One form for all distributon systems in the PWS
Water hoes materatc
H Unk
H Steel H HOPE (black)H A5cstos!Cement
PVC H Duct/c tron H Copper
U Other:
Size(s).[]Unk
4,6,and 8 inch.No fire hydrants are connected
to the 4 inch line.
SURVEY DATE Pws#
8125/2012 (mm/ddlyyyy)I 7410034
flow many services are metered?Number of fire hydrants.
0 out of 49 unknown
COMMENTS:
tr.d:cate the question number)
8.Operator Rick Nansen
claims a teak would be
ObVIOUS,
rare DISTRIBUTION
Ci 1 Have there been any interruptions in service dunng too past year?(including
cressure :oss)
2 l a loss of pressure occurred (>20 psi),did the PWS provide public notice
and disinfect the system?(Remifldet)
El U U H U 3 Is the PWS able to maintain a rr.inrmum pressure of twenty (20)psi thrcughout
the distributon system (including fire flOw).or forty (40)psi for PWSs
constructed after 7/111985 (exCiudin9 f:re flow),during max,rnum hourly
demand cendit ore?
4 Was the pressure observed at a service connector’
5 If yes
_______Dsi
L,ocation
Tare I j H a.m.L p.m.
6 Do all water mains Cat creeds fire hOW have a dameter of at least 6 inches9
7 Are valves exerc:sed regularly?(Recommended)
Ifyes,how often?I I
6 Is there a eak detection program’(Recommendedj
fi Is 15%or more of the water unaccounted for7
10 Is a waler conservaSon program in effect’(Recommended)
Ii IS an adequate map of the dstributiOfl system mainlaned’tRecommended)
12 Does the system Cush al main Ines annually’(Reco!nrnended,I
13 Are all dead end water ma;ns equipped with a means to flush’
14 If yes,are the deadends flushed at least semrannuaty?
15.Are there any dwlribution materials used that shoud not be in contact with
the dtirkiflg Water’((yes.esp/acri in comments section
16 Is the system adequately protected from freezing?
17.Is there a cross connection control program’(Community PWSs Onty,I
18.Is the operator trained in cross connection control?Recommended
19.Is the operator aware of any cross connections or were any cross
corrections observed during the course of the survey’
20.If a separate non.potacie irrgation system a prov:dei for the consumer,
are all mains,hydrants,and appurtenances eas:ly dentif:ed as non-potable?
(Purple Tape or other)(Reconrmended
AirNacuum Relief Valves placed at hgh po:n.ts in water mains
21 Are all automatic air relief valves eq-upped with a means of b5ckflow
protec:on?
Pace
_______
PUMPING page 1
yes no nia -wk ewe
LiLiZ]Li
[lilLi Li Li
yCS no c’s .,rik ewe
LiHUHU
‘CS J1C na UI*tote
LiLi
C]Sgnificant Li Deficiency
COMMENTS:
(indicate the question number)
1 Max demand:
(100 gal/capd)*estimated
123 capita =12300 gpd
512.5 gph 8 54 gpm
Well 1 was proven to 70 qpm.
10.A storage tank was
constructed in Ieiu of auxilIary
power.
One form for all pumps
SURVEYDATE Pws#
I 8/2512012 I (mm/dd/y.’yy)I 7410034
PUMPS,PUMPHOUSES,AND CONTROLS
Pump lO#Physical ocation Type of Pump Brand I Model Horsepower Purpose
secondary water
Well 1 Outside of well 1 house submersible unknown:m?y_be 5 horse ower supply
Well house 2:
.Primary watersubmersible15supplyWell2
DW 15boosterInsideWell2house Drinking water
DW 15 pressure
booster
Fire 30 Fire suppression
booster pressure
yes cc qi5 :nk new ALL PUMPS
Li Li Li L]Li i Ate ii pumps capable of tho maximum pumping demand or the system’
Li Li Li Li [1 2 Does the pump(s)cyce excessively7 (Recommended)
U Li Li El H 3 Are at!Dumps provided with readiiy available spare parts and tools’
Li Li Li Li Li 4 Is a water pressure rel.ef valve instailed where the pump is direcity
connected to the distribution system’
Li Li Li Li Li S is a standard pressure gauge instailed on the discharge line’
WELL PUMPS
S is there an accessibe checic valve installed ri the discharge line of cacti
weil between the pump and the shut-ott valve?
Li Li Li [1 [1 7 If the system has a vertical turbine motor driven pump(s),is an air
release-vacuum rol:ef valve located upstream from the check valve.w th
exflaust’reliel p:ping terminating ins down-turned pos lion at least 18 inches
above toe floor and covered with a 24 mesh corro5on resistant screen?
a tiThe pump(s)soil lubftated,is the oil NSF approved and suitable for
htman consumptcn’
WATER PUMPS (not well pumps
9 Is an accessible check v5ivc on the discharge side between the pump
and the shut-off valve’
___________________
AUXILIARY POWER
70 Is there auxilaiy power on-site?
U Li Li U Li 11 5 ax tiary power tested’(Recommended)
H Li Li Li Li 12.ifs diesel cr gascine fueled engine is used cn the wet!lot,is the fie!tack
and connecting pp;og double waled’
Li Li El H H 13 is the fuel tank above g’ound?
El H El H H 14 Is a cerited operator present during the t:tlng of the fuel tank’
If the engine is in the weil housenryt-’j I I I 15 Is the engine exhaust directly discharged outside the welt house’
[1 Li El H Li 16 5 a spilt ccnta tirrent structure surroundeg Cl fuet tanks adequate?
(Secondsmy coiitanment -170%fuel tank volume)
Community Systems Only
Li Li El El Li 17.(Community Systems built after 4/15,’07 only)is on-site power or standby
storage prov’ded so water can be :reared and suppi Cd to pressurize the
entire distrbution system during a power outage for a minimum of 8 flours?
Li Li Li Li Li 18 lCommunity Systems built after 4/75/07 only)it standby power is provided.
is there a minimum of 8 hours of rue!stored and located on silO?
Page Of
_________
-Enhanced Sanilsry Survey -6/2109 Generat information
SURVEY DATE —PWS#-
PUMPING page 2 110/1900 (nrm/dd/yyyy)7410034
COMMENTS:
ys ncr c/a .rrk nDt ROOSTER PUMPS (indicate the question number)
LJ U I U U 19,Is an instantaneous and totahzing 90w meter installed where the booster
Unnecessary pump s airectly connected to the distributor system’
H t H U U 20 Ate at n-t:ne c-costar pumps suppled witn an automatic cutoff that
actuates when intake pressure is less than or enual to 5 ps’
El U H [1 2L Is the booster pump Iccated on a SUCilOt line that is direcfiy connected to
any storage reservoir?
El H H H H 22 If yes,are alt booster pumps protectea by an automatic cutoff to prevent
pump damage and avoid excessive reservoir drawdnwn7
yns no c/a tic mw PUMP HOUSE (only pump houses that don’t contain a gmt,r,dwater source)
El U H U L_23 Is the pump house kept clean and in good repair?(floor cracks?,t
El El H H H 24 Is the pump house protected from unauthorized personnel’
El U L L U 25 Does toe pump house have adequate ighting tnroughout?tRecommended
El H H LI El 26 Are all ncn-sample taps nsta:led in the pump house equioc-ed with an
_____________________________
appropriate backliow prevention device’
Li U U U U 27 Is adequate veflttattofl prOvided in tine pump hOLLSO for dissipation of
U Significant U Deficiency excess treat and moisture from the equipment?
Li U Li U U 28.Is adequate treating provcded in the pump house to provided safe and
Significant El Deficiency effic.ent operatcn of equipment (prevent moisture buildup and/or freeirng)
El U LI U U 29 Is the pump house protected from flocd.r.g,have adequate drainage
is the V,oor sur race at least six (8)inches above the hoat groura surface,
ard is the ground surface graded so as to lead surface water away from
yes to ci c,nk nore the pump house?
U Li U U U 30 Is the sump tot pump house flocr drains closer than 30 feet from the well?
H LI U U Li 31 Is the floor main cornected to sewer storm draws.cOlorinatron room
drains.or any other source of contamination’
23.Pump house could afford a tIle
housekeeping
29 the toot drain was not operating
lwo days betore the survey,the fines’
trap on the drain needed adjlistmerrt
Page Of
______
-Enhanced Sandarj Survey -612109 General Infcrmaton
S S
HNANCIAL CAPACITY
_______
ens rute FINANCIAL CAPACITY
1 11 ts the PWS current with the payment of drrking water fees’
LI U 2 Does the PWS charge a drinking water fee to the user?
If yes,what is the fee S 1JU3lthePWSintebusinessofsolingwa!er’
#3 Note:•_.._—.-If no,identify why in the comments section and mark
LI []Ii Li
LIED Li
1 H Li Li
Ti Li H U
LI Li Li U
no rvu ew
t7UDD
U H H ;
[7HHD
HUED
N!A on questions 4 -19.
Li 4 Does the PWS urovwie and use an annual budget’(Recommendec)
Li 5 If appcable is the PWS fund separate from the waste water/sewar
utility fund9 (Recommendedj
U 6,Do water System revenues exceed expenditures9 (Recommended
L]7 Are controls establ:shed to prevent expenditures from exceeding
revenues7
U 8 Has an independent financal audit been Completed?tRccommended)
‘1 9 If yes is a copy of the most recent balance sheet for the water system
avalabie?(Recommended)
Li 1 C Does the water system include a Cash budget within its annual
budget for cash ifow7 (Recommended)
U 11 Ones the water system management review tt’e user fee,user
charge,or rate system at east annually’(Recommended)
12.When was the last user fee user charge,or rate system adtustmcnt?
edo
H 13 Does the water system management review tnancial reports at least
monthly?(Recommended)
U 14 t)oes the PWS preside and use a capital budget?(Recommended?
C]15 Has this PWS produced and does t currently utilize a capital
improvements plan?(Recommended)
16 II yes when was the capital improvements budget produced?
I mm/ddfyy/y
U 17 Has the capital improvement budget beon updated n the last
18 months?(Recommended,l
U 18.Does the waler system budget provide tucdicg for deprecia’ion of
existing plant n service and/or tot the funding of reserves for system
replacement?
U 19 Are thew suffcient funds for training personnel’
yes no n!a
{“C[’]‘[1
DUO
U El 11
8125/2012
SURVEY DATE pws#
(mmfdd/yyyy)7410034
COMMENTS:
findicate the queston number)
Page of
-Enhanced Sanitary Survey -6/2/09 General Information
SURVEY DATE pws #
(mm/ddlyyyy)7410034
yes en na eric ‘rote MANAGERIAL CAPACITY
Li Li C]J []1.Is a properly Icensed operator available at all times?fNIA for GW-NC PWS)
Li Li Li Li [1 2 Is there a Dnnking Water Source Protection Plan deveopeo for this system?
natel__________
Li Li Li Li Li 3 Does this PWS have a governing body or board of directors?
If no.r.eacp ‘edicate
Li Sole Pccp:ietcrsnrp
Li Partnership
H Limited liability Corp
C]Other [
4.How often does tile bnatd meet?Li N/A
C]weekly C]semi-annually never
C]monthly C]annually C]
_______________________
C]bimonthly Li as necessary 1 other:_____________________
-Dacterio!ogical Analysts -5 years retention.
-Chemical Analysis -10 years retention.
Records ot aclons taken to correct violations -3 years retentIon.
-Copies of reports sumrnar:es or communicaton related to
saritary surveys -10 years retention.
-Renods concerning varar.ces or exemptions -5 years retention.
-Copes of pubic no’.ices iSsued -3 years retention
-Daily free ch:orr.e residuals (requited ths;nfecfion)-1 year retention.
C]6.Are routine maintenance schedules established?(Recommended,)
[1 1 Is an operation and maintenance manual(s)orovded for the PWS and
does it r.clude,daly operating nstructions,operator safety procedures,
localen of valves and ottiCr key system features pans list and pails
order form and informaton for contaclirg tire water system operator’
Li Li Li Li Li 8 is there a dear plan of organzahon and control among the people responsible
for management and operattons of the water system?(Recommended,)
q Are any samples ot the following parameters past due’
Li Colform
H Nitrates
Li Nitrites
Li
Li
C]
C]
Li
Li
Li 10 Isa wrtten total coliorm ole (TCR)sample sitO plan available
ror review?
Li ii (lees the (TCR)san-pie site plan meet the minimum requirements?
Li 19 Does the system have a sufficient suppiy of approved samplng
bottles properly stored7 (Reccmrnendedl
Li H 13 Does the PWS provide stairways ladders and handrals where needed?
Li Li 14 Are treads of rionslip material provided where needed?
Li Li 15.Is a health concern produced from inadequately protected eectrical wrrrg?
Li j 16 Are all confined space entry requrements considered?(Reccmmended)
H [1 iT Are there any unused subsurface water storage tanks that need to be
abandoned’
C]18 Are there any water supply wels that are no longer being used that
need to be abandoned’
Page.__Of
MANAGERIAL CAPACITY 08/25t2012
COMMENTS:
(indicate tIe queslon numbOr)
yes lo n!a .nk
Li [1 H H
L]L1 [I C]
LiLiLiC]
Li Li Li H
Li H Li Li
LiLiLiLi
I F]LI H
C]C]ZC]
rote 5 Are tile fcliowng records maintained erwIn or )oca!ed near by’
I]
H
Liri
Li
yes no
LIHH
C]L]C]
LiLiLi
C]LiC]
LiLiLi
LiLiLi
C]Li[1
LiLili
LiLiC]
C]Li Li
C]LiC]
H
Li
Li
Li
U
C]
C]
C]
Li
Li
Li
Li
teed and Copper
lOCs
VOC5
SOC5
Disinfection Byproducts
Radioruclide
LinC]
LiLiC]
LiLiLi
C]C]Li
HLiH
Enhanced Sarilary Survey -612109 General Information
LLNOI1S]fl
Page 1
IDAHO DEPARTMENT OF WATER RESOURCES
Water Permit Report 22-1 3306
WATER RIGHT NUMBER.22-13306
Owner Type Name and Address
Original Owner FOX CREEK COUNTRY CLUB ESTATES HOMEOWNERS ASSOCC1OTOMHUNTER
PC BOX 4310
JACKSON,WY 83001
307 690 2041
Previous Owner TOM HUNTER
1575 CROOKED CREEK
ALIAWY 83414
[phone]
Current Owner FOX CREEK COUNTRY CLUB ESTATES POA INCP0BOX1088
VICTOR,ID 83455
Current Owner FOX CREEK VILLAGE HOA
PC BOX 836
DRIGGS,ID 83422
Priority Date:09/10/2004
Basis:
Status:Active
Source Tributary
GROUND WATER
Beneficial Use From To Diversion Rate Annual Volume
DOMESTIC 01/01 to 12/31 1.420 CFS
Total Diversion:1.420 CFS
Location of Point(s)of Diversion
GROUND WATER SE1/4SE1/4 Sec.23,Twp 04N,Ege 45E,B.M.
TETON County
GROUND WATER NE1/4SE1/4 Sec.23,Twp 04N,Rge 45E,EM.
TETON County
Place of Use
DOMESTIC
Twp Rge Sec NE I NW SW SE
04N 45E 23 I I I I X X XII
Conditions of Approval:
c\m ü \‘
Page 2
IDAHO DEPARTMENT OF WATER RESOURCES
Water Permit Report 22-13306
1.26A Project construction shall commence within one year from the date of permit issuance and shallproceeddiligentlytocompletionunlessitcanbeshowntothesatisfactionoftheDirectoroftheDepartmentofWaterResourcesthatdelayswereduetocircumstancesoverwhichthepermitholderhadnocontrol.
2.X01 Domestic use is for 97 homes.
3.071 The domestic use authorized under this right shall not exceed 13,000 gallons per day per home.
4.DiM After specific notification by the Department,the right holder shall install a suitable measuring device orshallenterintoanagreementwiththeDepartmenttodeterminetheamountofwaterdivertedfrompowerrecordsandshallannuallyreporttheinformationtotheDepartment.
5.X60 Place of use is located within Lots 4 -27 and 29 -72,Fox Creek Country Club Estates Subdivision andLotsAl-A25,Fox Creek Village Subdivision.
6.X59 Points of diversion are located within Lot 63 and Lot 46,Fox Creek Country Club Estates Subdivision.
7.070 The irrigation occurring under this domestic use shall not exceed 1/2 acre within each plattedsubdivisionlotuponwhichahomehasbeenconstructed.This right does not provide for irrigation ofcommonareasorforirrigationoflotsuponwhichhomeshavenotbeenconstructed.
8.046 Right holder shall comply with the drilling permit requirements of Section 42-235,Idaho Code andapplicableWellConstructionRulesoftheDepartment.
9.048 The use of water under this right shall not give rise to any claim against the holder of a senior waterrightbaseduponthetheoriesofforfeiture,abandonment,adverse possession,waiver,equitableestoppel,estoppel by laches or customary preference.
Remarks:
Comments:
1.segbert 12/30/2010 11:33.44 AM POD
Comment:PODID 628789 correlated from SpatialDatalD 355426 to SpatialDatalD 426421
2.segbert 12/30/2010 11:35:03AM POD
Comment:PODID 628790 correlated from SpatialDatalD 355427 to SpatialOatalD 426422
3.jcefalo 11/21/2012 2:23:34 PM POU
Comment:Updated Shape
4.jcefalo 11/21/2012 Permit Revision
Comment;Pursuant to a written request from the current permit holders,permit 22-1 3306 was revised to removed theSWSEofSection23,TO4N,R45E from the place of use description.A condition was also changed to correctly describethenameofthesubdivisioncontaininglotsA1-A25.
Water Supply Bank:
QUESTION 13
Fa
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l
Ri
v
e
r
Ru
r
a
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e
c
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r
i
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Fo
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,
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1,
20
1
2
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y
1,
20
1
3
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05
/
2
1
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0
1
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7
1
6
7
0
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1
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05
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1
(
2
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1
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1
6
7
0
0
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06
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0
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71
6
7
0
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06
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1
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7
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)
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7
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6
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6
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1
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6
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QUESTION 17
Daily Runtime Summary
Minutes and Gallons
Device :Fox Creek Pump
House
Time Pump 1 Pump 2 Total
Minutes Gallons Minute5 Gallons Minutes Gallons
6/5/2013 0:00 310.7 34181 532.6 58586 843.3 92767
6/4/2013 0:00 247.4 27209 382.7 42093 630.0 69302
6/3/2013 0:00 193.8 21314 318.8 35072 512.6 56386
6/2/2013 0:00 208.7 22957 307.4 33816 516.1 56773
6/1/2013 0:00 191.8 21094 275.9 30344 467.6 51438
5/31/2013 0:00 158.3 17408 217.0 23868 375.2 41276
5/30/2013 0:00 151.4 16654 220.1 24215 371.5 40869
5/29/2013 0:00 162.0 17816 245.9 27044 407.8 44860
5/28/2013 0:00 171.9 18909 363.6 39994 535.5 58903
5/27/2013 0:00 287.7 31647 319.7 35165 607.4 66812
5/26/2013 0:00 225.4 24789 375.6 41320 601.0 66108
5/25/2013 0:00 218.7 24057 314.9 34634 533.6 58691
5/24/2013 0:00 231.9 25509 367.4 40409 599.3 65918
5/23/2013 0:00 137.0 15074 187.9 20669 324.9 35743
5/22/2013 0:00 105.6 11611 133.4 14674 239.0 26285
5/21/2013 0:00 116.8 12852 159.9 17593 276.8 30444
5/20/2013 0:00 115.6 12720 145.1 15965 260.8 28684
5/19/2013 0:00 137.4 15112 180.2 19820 317.6 34932
5/18/2013 0:00 152.9 16819 210.2 23117 363.1 39936
5/17/2013 0:00 184.5 20291 276.1 30369 460.6 50661
5/16/2013 0:00 211.1 23217 338.9 37274 549.9 60491
5/15/2013 0:00 216.0 23762 359.1 39499 575.1 63261
5/14/2013 0:00 229.9 25287 419.3 46119 649.2 71407
5/13/2013 0:00 248.2 27300 485.8 53442 734.0 80742
5/12/2013 0:00 282.6 31084 464.7 51117 747.3 82201
5/11/2013 0:00 208.6 22946 291.0 32006 499.6 54952
5/10/2013 0:00 161.5 17767 217.8 23962 379.4 41729
5/9/2013 0:00 139.1 15299 187.4 20610 325.5 35910
5/8/2013 0:00 147.6 16238 200.9 22103 348.6 38341
5/7/2013 0:00 116.4 12806 156.0 17160 272.4 29966
5/6/2013 0:00 116.9 12854 151.3 16647 268.2 29500
5/5/2013 0:00 116.6 12830 152.8 16812 269.5 29641
5/4/2013 0:00 71.8 7902 93.9 10325 165.7 18227
5/3/2013 0:00 73.2 8056 90.9 9997 164.1 18053
5/2/2013 0:00 75.2 8274 101.0 11110 176.2 19384
5/1/2013 0:00 58.5 6437 75.6 8320 134.2 14757
4/30/2013 0:00 55.1 6059 70.5 7757 125.6 13816
4/29/2013 0:00 61.6 6776 76.5 8415 138.1 15191
4/28/2013 0:00 79.5 8749 102.5 11273 182.0 20022
4/27/2013 0:00 99.1 10897 132.4 14564 231.5 25461
4/26/2013 0:00 74.9 8239 96.2 10580 171.1 18819
4/25/2013 0:00 98.2 10802 95.0 10448 193.2 21250
4/24/2013 0:00 72.8 8010 98.3 10809 171.1 18819
4/23/2013 0:00 62.7 6892 80.1 8805 142.7 15697
4/22/2013 0:00 56.3 6193 69.6 7654 125.9 13847
4/21/2013 0:00 59.4 6534 76.1 8371 135.5 14905
4/20/2013 0:00 54.4 5984 70.0 7695 124.4 13679
4/19/2013 0:00 53.0 5834 71.4 7858 124.5 13691
4/18/2013 0:00 53.3 5859 65.1 7163 118.4 13022
4/17/2013 0:00 52.4 5768 55.3 7185 117.8 12953
Daily Runtime Summary
Minutes and Gallons
Device :Fox Creek Pump
House
Time Pump 1 Pump 2 Total
Minutes Gallons Minutes Gallons Minutes Gallons
4/16/2013 0:00 51.5 5663 67.2 7396 118.7 13059
4/15/2013 0:00 53.9 5929 72.8 8008 126.7 13937
4/14/2013 0:00 57.4 6312 72.4 7962 129.8 14274
4/13/2013 0:00 55.9 6151 70.8 7793 126.8 13944
4/12/2013 0:00 56.5 6217 72.6 7988 129.1 14205
4/11/2013 0:00 53.6 5894 65.3 7185 118.9 13079
4/10/2013 0:00 50.6 5570 67.6 7434 118.2 13004
4/9/2013 0:00 54.6 6002 65.2 7167 119.7 13169
4/8/2013 0:00 52.3 5755 66.8 7353 119.2 13108
4/7/2013 0:00 53.3 5858 70.2 7717 123.4 13574
4/6/2013 0:00 46.8 5150 59.9 6593 106.2 11743
4/5/2013 0:00 51.9 5713 62.5 6877 114.5 12590
4/4/2013 0:00 55.0 6045 70.6 7764 125.5 13809
4/3/2013 0:00 62.0 6816 77.7 8549 139.7 15365
4/2/2013 0:00 52.5 5770 66.1 7265 118.5 13035
4/1/2013 0:00 53.5 5881 70.8 7784 124.2 13666
3/31/2013 0:00 55.5 6100 69.2 7608 124.6 13708
3/30/2013 0:00 57.6 6330 67.0 7365 124.5 13695
3/29/2013 0:00 56.2 6186 57.1 6275 113.3 12461
3/28/2013 0:00 47.0 5172 61.1 6719 108.1 11891
3/27/2013 0:00 47.7 5243 63.4 6972 111.1 12216
3/26/2013 0:00 50.3 5528 63.0 6932 113.3 12459
3/25/2013 0:00 51.3 5647 63.3 6963 114.6 12610
3/24/2013 0:00 56.3 6195 71.9 7907 128.2 14102
3/23/2013 0:00 56.7 6241 75.6 8310 132.3 14551
3/22/2013 0:00 51.6 5676 62.8 6903 114.4 12579
3/21/2013 0:00 52.8 5803 67.4 7416 120.2 13218
3/20/2013 0:00 49.1 5399 65.4 7196 114.5 12595
3/19/2013 0:00 51.3 5645 65.6 7214 116.9 12859
3/18/2013 0:00 51.7 5691 62.8 6908 114.5 12599
3/17/2013 0:00 53.8 5922 71.2 7836 125.1 13757
3/16/2013 0:00 51.2 5632 63.5 6987 114.7 12619
3/15/2013 0:00 49.5 5440 63.7 7003 113.1 12443
3/14/2013 0:00 48.9 5383 63.1 6941 112.0 12324
3/13/2013 0:00 49.2 5416 58.7 6459 108.0 11875
3/12/2013 0:00 50.3 5533 65.7 7225 116.0 12758
3/11/2013 0:00 54.8 6023 66.8 7346 121.5 13369
3/10/2013 0:00 65.3 7188 81.1 8921 146.5 16110
3/9/2013 0:00 108.2 11902 123.5 13581 231.7 25483
3/8/2013 0:00 43.0 4734 51.9 5709 94.9 10443
3/7/2013 0:00 46.9 5161 60.8 6684 107.7 11845
3/6/2013 0:00 49.6 5456 67.7 7443 117.3 12899
3/5/2013 0:00 52.1 5725 66.4 7300 118.4 13026
3/4/2013 0:00 54.5 5991 64.4 7086 118.9 13077
3/3/2013 0:00 53.1 5837 66.5 7313 119.6 13151
3/2/2013 0:00 57.8 6354 74.0 8140 131.8 14494
3/1/2013 0:00 51.8 5693 64.1 7055 115.9 12747
2/28/2013 0:00 47.1 5175 57.6 6332 104.6 11508
2/27/2013 0:00 49.6 5456 64.7 7115 114.3 12571
2/26/2013 0:00 59.4 6532 71.2 7832 130.6 14364
Daily Runtime Summary
Minutes and Gallons
Device :Fox Creek Pump
House
Time Pumpi Pump2 Total
Minutes Gallons Minutes Gallons Minutes Gallons
2/25/2013 0:00 47.6 5234 61.7 6789 109.3 12023
2/24/2013 0:00 54.6 6008 65.4 7190 120.0 13198
2/23/2013 0:00 52.7 5793 68.0 7480 120.7 13273
2/22/2013 0:00 51.0 5605 64.3 7077 115.3 12681
2/21/2013 0:00 41.0 4506 54.2 5960 95.2 10467
2/20/2013 0:00 50.2 5517 64.4 7088 114.6 12604
2/19/2013 0:00 51.1 5521 65.0 7154 116.1 12775
2/18/2013 0:00 52.9 5815 69.1 7601 122.0 13416
2/17/2013 0:00 52.1 5733 70.0 7696 122.1 13429
2/16/2013 0:00 45.0 5060 58.8 6473 104.9 11534
2/15/2013 0:00 52.9 5815 61.8 6800 114.7 12615
2/14/2013 0:00 38.4 4226 51.5 5665 89.9 9891
2/13/2013 0:00 44.4 4888 53.9 5925 98.3 10813
2/12/2013 0:00 40.8 4484 52.2 5737 92.9 10221
2/11/2013 0:00 42.6 4680 60.1 6605 102.6 11286
2/10/2013 0:00 50.7 5579 64.8 7128 115.5 12707
2/9/2013 0:00 45.1 4959 59.2 6508 104.3 11468
2/8/2013 0:00 41.5 4560 53.9 5933 95.4 10492
2/7/2013 0:00 43.6 4792 51.8 5703 95.4 10496
2/6/2013 0:00 51.5 5665 58.5 6435 110.0 12100
2/5/2013 0:00 41.5 4567 55.2 6076 96.8 10643
2/4/2013 0:00 50.0 5500 61.3 6741 111.3 12241
2/3/2013 0:00 47.3 5199 60.1 6607 107.3 11807
2/2/2013 0:00 47.8 5263 61.8 6793 109.6 12056
2/1/2013 0:00 44.3 4868 52.5 5773 96.7 10641
1/31/2013 0:00 41.0 4508 54.8 6023 95.7 10531
1/30/2013 0:00 45.0 4954 54.3 5973 99.3 10927
1/29/2013 0:00 40.3 4429 53.4 5874 93.7 10303
1/28/2013 0:00 44.8 4932 57.7 6349 102.6 11281
1/27/2013 0:00 44.7 4913 54.6 6010 99.3 10923
1/26/2013 0:00 47.9 5271 59.8 6574 107.7 11845
1/25/2013 0:00 40.9 4503 55.7 6122 96.6 10624
1/24/2013 0:00 42.5 4677 52.2 5742 94.7 10419
1/23/2013 0:00 40.7 4475 54.1 5945 94.7 10421
1/22/2013 0:00 41.8 4602 54.2 5958 96.0 10560
1/21/2013 0:00 43.4 4774 53.5 5885 96.9 10659
1/20/2013 0:00 45.0 4948 56.5 6213 101.5 11161
1/19/2013 0:00 46.9 5163 63.0 6925 109.9 12087
1/18/2013 0:00 43.0 4728 55.1 6059 98.1 10787
1/17/2013 0:00 40.5 4459 55.5 6107 96.1 10566
1/16/2013 0:00 44.6 4910 54.3 5971 98.9 10881
1/15/2013 0:00 40.1 4407 52.3 5753 92.4 10160
1/14/2013 0:00 49.7 5462 63.6 6994 113.2 12456
1/13/2013 0:00 47.8 5263 60.8 6690 108.7 11953
1/12/2013 0:00 41.5 4560 52.5 5775 94.0 10335
1/11/2013 0:00 40.9 4501 49.6 5460 90.6 9961
1/10/2013 0:00 38.3 4209 48.5 5337 86.8 9546
1/9/2013 0:00 45.0 4946 57.9 6371 102.9 11317
1/8/2013 0:00 38.8 4264 54.1 5947 92.8 10212
1/7/2013 0:00 52.4 5768 63.5 5985 115.9 12753
Daily Runtime Summary
Minutes and Gallons
Device :Fox Creek Pump
House
Time Pump 1 Pump 2 Total
Minutes Gallons Minutes Gallons Minutes Gallons
1/6/2013 0:00 49.6 5450 60.4 6644 110.0 12095
1/5/2013 0:00 38.7 4261 51.1 5617 89.8 9878
1/4/2013 0:00 37.2 4090 45.2 4976 82.4 9066
1/3/2013 0:00 41.2 4528 52.0 5722 93.2 10250
1/2/2013 0:00 37.8 4156 53.2 5848 91.0 10005
1/1/2013 0:00 44.4 488$54.3 5977 98.8 10864
12/31/2012 0:00 40.7 4481 51.4 5658 92.2 10138
12/30/2012 0:00 47.5 5221 61.5 6765 109.0 11986
12/29/2012 0:00 46.8 5150 58.9 6481 105.7 11631
12/28/2012 0:00 41.7 4587 51.9 5713 93.6 10300
12/27/2012 0:00 38.0 4178 52.4 5764 90.4 9942
12/26/2012 0:00 46.8 5148 50.9 5595 97.7 10743
12/25/2012 0:00 43.2 4748 52.7 5793 95.8 10542
12/24/2012 0:00 38.1 4195 49.6 5450 87.7 9645
12/23/2012 0:00 42.0 4618 53.1 5845 95.1 10463
12/22/2012 0:00 45.4 4994 60.5 6659 105.9 11653
12/21/2012 0:00 38.6 4244 50.6 5568 89.2 9812
12/20/2012 0:00 37.9 4173 44.7 4917 82.6 9090
12/19/2012 0:00 39.6 4360 53.1 5843 92.8 10203
12/18/2012 0:00 38.4 4228 48.7 5352 87.1 9579
12/17/2012 0:00 40.5 4457 53.1 5845 93.7 10302
12/16/2012 0:00 43.4 4778 56.5 6215 99.9 10993
12/15/2012 0:00 38.7 4252 48.7 5355 87.3 9607
12/14/2012 0:00 36.6 4026 44.3 4875 80.9 8901
12/13/2012 0:00 39.0 4285 48.5 5331 87.4 9616
12/12/2012 0:00 38.9 4277 49.9 5491 88.8 9768
12/11/2012 0:00 40.3 4435 50.1 5505 90.4 9940
12/10/2012 0:00 40.5 4453 53.7 5907 94.2 10360
12/9/2012 0:00 44.7 4912 55.9 6153 100.6 11064
12/8/2012 0:00 36.8 4052 50.1 5505 86.9 9557
12/7/2012 0:00 39.5 4345 47.5 5223 87.0 9568
12/6/2012 0:00 36.1 3975 49.5 5441 85.6 9416
12/5/2012 0:00 39.0 4288 49.1 5395 88.0 9684
12/4/2012 0:00 41.8 4598 48.8 5372 90.6 9970
12/3/2012 0:00 40.9 4499 48.5 5339 89.4 9838
12/2/2012 0:00 51.6 5676 63.4 6978 115.0 12654
12/1/2012 0:00 45.3 4978 58.4 6420 103.6 11398
11/30/2012 0:00 1382.2 152046 1380.0 151800 2762.2 303846
1446149 1992956 3410821
ONOI1Sfl
u’J J
Fox Development,LLC
Profit &Loss
January through December 2010
Jan-Dec 10
Income
Services 42,692.57
Total Income 42,692.57
Cost of Goods Sold
Infrastructure I 9.727.25
Total COGS -19.727.25
Gross Profit 22,965.32
Expense
Bank Charges 6.00
Licenses &Permits 150.00
Lightning Strike 11,224.90
Office Expense 70.28
Postage 365.22
Professional Fees
Accounting fees 4,692.60
Legal fees 5,644.17
Professional fees -Other 366.47
Total Professional Fees 10,703.24
Utility
Electric
Sewer 14,066.66
Total Utility 17,739.99
Well Repair &Maintenance 5,932.55
Total Expense 46,192.18
Net Income (23,226.86)
V
fox Development,LLC
Balance Sheet
As of December 31,2010
Dec 31,10
ASSETS
Current Assets
Checking/Savings
Key Bank...5578$6.966.56
Total Checking/Savings 6,966.56
Accounts Receivable
11000 Accounts Receivable (24.93)
Total Accounts Receivable (24.93)
Other Current Assets
Work in Process 1,301,356.89
Total Other Current Assets 1,301,356.89
Total Current Assets 1.308,298.52
Fixed Assets
Land
LandLot8 7,000.00
Land Lot A-i 8,898.89
Land LotA-2 8,898.89
Total Land 24,797.78
Total fixed Assets 24,797.7$
TOTAL ASSETS 1,333,096.30
LIABILITIES &EQUITY
Liabilities
Current Liabilities
Accounts Payable
20000 Accounts Payable 175.64
Total Accounts Payable 175.64
Other Current Liabilities
Construction Draws 1,178,548.56
fox Creek Investments (60,000.00)
N/P Hunter 38.775i5
N/P J.Montoya (20,000.00)
Fox Development,LLC
Balance Sheet
As of December 31.2010
Dec 31,10
N/P R.Kincaid (16.982.28)
NIP Teton Builders (80,000.00)
Total Other Current Liabilities 1,040,341.83
Total Current Liabilities 1,040.517.47
Long Term Liabilities
Citizens Community Bank Loans
Building Loan -#648 16 (86,325.30)
Infrastructure Loan #64808 26,7 1 1 .93
Total Citizens Community Bank Loa...(59,613.37)
Total Long Term Liabilities (59.613.37)
Total Liabilities 980,904.10
Equity
3000 Opening Bal Equity 50,000.00
3900 Retained Earnings 325,41906
Net Income -(23226.86)
Total Equity 352.19220
TOTAL LIABILITIES &EQUITY -1.333,096.30
Fox Development,LLC
Profit &Loss
January through October 2011
Jan-Oct 11
Income
Services 27,610.55
Unkn 0.00
Total Income 27,6 1 0.55
Gross Profit 27,610.55
Expense
Licenses &Permits 86.00
Lightning Strike 3,224,90
Office Expense 120.93
Postage 187.69
Professional Fees
Accounting Fees 1,873.63
Legal fees 1,620.83
Professional fees -Other 203.53
Total Professional fees 3,697.99
Repair Well 630.00
Utility
Electric 2,333.12
Sewer 11,585.59
Total Utility 13,918.71
Well Repair &Maintenance 4,539.00
Total Expense 26,405.22
Net Income 1,205.33
10:54AM Fox Creek Water &Sewer,LLC
05/25/13 Profit &Loss
Cash Basis August22 through December 31,2011
Aug 22-Dec 31,11
Ordinary IncomelExpense
ncome
47900Services 10909.16
Total Income 10909.16
Gross Profit 10,909.16
Expense
60100 -Well Operator Monthly Fee 1200.00
60101 -Well Testing 4QQQ
60102 -Well Repair 3,12137
60103 -Sewer Fee 3,484.53
60105 -Well Maintenance 583.40
64600 -Licenses &Permits 100.00
64800 -Postage 78.00
64900•Office Supplies 41.15
66700-Professional Fees
bookkeeping 967.04
Legal Fees --225.00
Total 66700-Professional Fees 1,192.04
68600 -Utilities —-976.82
Total Expense 10,817.31
Net Ordinary Income 91.85
Net Income 9t85
f\)•
)
-Page 1
Fox Development,LLC
Balance Sheet
As of October 31,2011
Oct 31,11
ASSETS
Current Assets
Accounts Receivable
11000 Accounts Receivable -(28.6$)
Total Accounts Receivable (28.6$)
Other Current Assets
Work in Process 1,301,356.29
Total Other Current Assets 1,301,356.89
Total Current Assets 1,301,322.21
Fixed Assets
Land 24,797.78
Total Fixed Assets 24,797.7$
TOTAL ASSETS 1,326,125.99
LIABILITIES &EQUITY -
Liabilities
Current Liabilities
Other Current Liabilities
Construction Draws 1,178,548.56
Fox Creek Investments (60,000.00)
N/P Hunter 38,775.55
N/P J.Montoya (20,000.00)
NIP R.Kincaid (24,982.2$)
N/P Teton Builders (80,000.00)
Total Other Current Liabilities 1,032,341.83
Total Current Liabilities 1,032,341 .83
Long Terni Liabilities
Citizens Conimunity Bank Loa.,.(59,613.37)
Total Long Term Liabilities (59,613.37)
Total Liabilities 972,728.46
Fox Development,LLC
Balance Sheet
As of October 31,2011
Oct31,11
Equity
3000 Opening Bal Equity 50,000.00
3900 .Retained Earnings 302,192.20
Net Income -1,205.33
Total Equity 353,397.53
TOTAL LIABILITIES &EQUiTY 1,326,125.99
10:36 AM Fox Creek Water &Sewer,LLC
05/25/13 Balance Sheet
Cash Basis As of December 31,2011
Dec 31,11
ASSETS
Current Assets
Checking/Savings
Fox Creek Water &Sewer,LLC 124.24
Total Checking/Savings 124.24
Accounts Receivable
11000 Accounts Receivable -32.39
Total Accounts Receivable -32.39
Total Current Assets -91.85
TOTAL ASSETS 91.85
LIABILITIES &EQUITY
Equity
Net Income 91.85
Total Equity 91.85
TOTAL LIABILITIES &EQUITY 91.65
Page 1
10:34AM Fox Creek Water &Sewer,LLC
05/25113 Profit &Loss
Cash Basis January through December 2012
Jan -Dec 12
Ordinary lncomelExpense
Income
47900 -Services 39,030.97
Total Income 39,030.97
Gross Profit 39,030.97
Expense
60100 -Well Operator Monthly Fee 4,800.00
60101 -Well Testing 120.00
60102 -Well Repair 4,027.53
60103 Sewer Fee 13,928.00
60104,-Owner Management Fee 3,920.00
60105 Well Maintenance 2,273.40
60400 -Bank Service Charges 0.00
64800-Postage 311.45
66700 Professional Fees
bookkeeping 3,452.21
Legal Fees —945.00
Total 66700 -Professional Fees 4,397.21
68600 -Utilities 3,693.45
Total Expense 37,471.04
Net Ordinary Income ——1559.93
Net Income 1,569.93
Page 1
10:36 AM Fox Creek Water &Sewer,LLC
05/25/13 Balance Sheet
Cash Basis As of December31,2012
Dec 31,12
ASSETS
Current Assets
Checking/Savings
Fox Creek Water &Sewer,LLC -1656.79
Total Checking/Savings 1,656.79
Accounts Receivable
11000 Accounts Receivable
-
-5.01
Total Accounts Receivable -5.01
Total Current Assets 1651.76
TOTAL ASSETS 1,651.78
LIABILITIES &EQUITY -.
Equity
32000 Members Equity 91.85
Net Income 1,559.93
Total Equity 1651.78
TOTAL LIABILITIES &EQUITY 1,651.78
Page 1
ON FILE
QUESTION 21
QUESTION 22
Dear Water Customer,
This notice is to inform you that Fox Creek Water &Sewer,LLC has submitted an Application for a
Certificate of Public Convenience and Necessity to the Idaho Public Utilities Commission for the
community well system.The unmetered water system has 49 water users with the ability for 97 users.
The current monthly water rate is $32.39 with a$5.OO management fee.In addition,per the Shared Well
Agreement,water customers are responsible for sharing well associated costs.
Contact information is as follows:
Commission’s phone number [phone]
Commission Secretary,Idaho Public Utilities Commission
P0 Box 83720
Boise,Idaho 83720-0074
QUESTON 23
3
[DATE]
Utility Account Number:
Service Address:
DELINQUENT AMOU1JT:Due
CURRENT BALANCE:
Due to lack of response for non-payment of fees in the amount of_____________your water willbeshutoff.If your water is shut off,there will be a disconnect fee of $65.00 &reconnect fee of$65 assessed to you.In addition to paying the delinquent amount,there will be a requireddepositof_____
______
your past due amount in order to reconnect your services.This amount
______________
will be held for 12 months following reconnection of services.If your shut offvalvehasbeenmovedfromthestreetandoutofthewatereasement,a new shut off valve wilt beinstalledatthestreetatyourexpenseinadditiontothereconnectfee.Any tampering with theshutoffvalvesorharassmentofthoseindividualscommissionedtoturnoffyourwaterwillbeprosecutedtothefullestextentofthelaw.
To prevent shut off call Michelle May at 208-354-1635 to arraige immediate delivery of
payment in full.
NO FURTI1ER NOTICE WILL BE PROVIDED.
Sincerely,
Fox Creek Water &Sewer,LLC
—s -‘
‘N ‘
YOUR WATER ACCOUNT IS
DELINQUENT
AND SCHEDULED FOR A SHUT OFF ON
[DATE]
PLEASE CONTACT MICHELLE MAY
202-354-1635
TO SCHEDULE PAYMENT IN FULL
-,Th %ØJc S (C
.7-—
15134?
SILARC1J ‘WILI ACREFmNT
Ihc parlin LU thij ug:etrYci]:are:
krber KiTA3d,Xiembr
lox Developrncffl.LLC
1 7S CroDke.ij Creek RI
Aka.WY 1C4JA
Fo Cicek Cnunttv CIIt Estaies
PIoje:1v Owners Ai’xiaUon
Vivtcir.IL)t55
tmejvEn
;ti-o,i Lü..
UTJ:r:ç-.
JnsfrwlwdoL 181347
t3OS,TETOrI,TOAHD
2Oflh-1€-1&1It44:3S:N,,.çrPaqs:U
TOll HUIER 2
NOL4N a SOYLE t flfl
E.C7jvk k.rdr Th4I.tV
.fl
RECITAL S
WFIEREAS,f’OX rEvrr.GPMENI’.L-L.C,(àvreinacr rcferre4 to s
owii a subdin ,iQti IJJOThTi ;m Tux 1-wck \il1age FtJL1 (btrQjuc,ftcT ycfrrrd to as ‘VIL]auc/‘vii idi
is descH bud as 101 hywE:
A pfli:r oF t SF 1/4 of Sec&ii 23,Teimship 4 Th+urth.Racgv 45 E-s,flnis Medc{iwt,
Tsiri C,juniL,idaho,teing Unther cLcccibud as:
Cosznercirs,the SE corner of said Seciion 23,thcioe N W’5156”W,:34c’.st-EcuL
along the somlieni stcUcn .inc,and thcntt N OZ20151 E,594.50 feet to thu [LH[lL )f
begi iTintg
T1wnie N 695rY55’W.117.R7 feet lea prim!.un ‘Je 1atctn Right-of-WAy Line rf Stare
Tlithcvay 33;
Thenec N O”ZLI’ST”B,20000i5 ftct ning snd Rtqht-oV’Way w a poinu
Thcice S 89’?943”EL 777Th feet toaponl:
[hare S C2c45’‘N,iO.OO !èetto apoiLt,
[1,cmce S iJ’5i3’R.1260.O(J leer to4pthnt;
‘I’h.ri S o..2.v4cIl W.9Z2..(’feet o s EXnL;
Thenc’eI’uI)hIy7r W.41 5.00 tëcttD p-DrtT.
Thbr.ec S 2Y 2533”E,1 cc.s.s tkrt.ro a porn[,
ihcu’:S o’1’:xz4’E>C).’Du feul ‘.u u paint;
Therr.c s wi4 21 w,IOL’.3Sk tç’_f h,:a print,
±&ieiiC S SLYSU’Ol ‘E,41 5.01)L’set to
l’licixx S 020’.i 5”W.634 .Th ftçt to jx”nT;
‘II’ei:;S 69°5?’14”W,72ftX:1 frtlFapIirLt;
ltt:r:;u N 4P2b02uI W,27.1?1cm Ii,a
ThtcrJ SI ‘5’54”‘Ly 25.3 I ted lo itt poLill Lte.g1nAn.
42cn(aiiis crs.more cr Less.
LI.J.EI:’wriz AGREH,m:clr -Pg 1
2(1:<imt.’ji hra.—SV/.’L
jSIILI4V
—‘-I
WEBRbAS,awaer sy.tem and awell.Iix,aftd uxiLo4_v1thitwEsLates,hissenriccct
rcddetice,]ixatect withia LSf FALeis;.Ld
Wij[:Rf.A3 De’ckpcr ha iirpcowd the atbrcmcaticrnedwdt,drilled a 5econU well,ud
earinLcoi the irJcasLrncLurc reLatod te :h wtLI aL1velopcr i’
NOW rHkar.pOag.in oaosideratinn ef thi prOIflies and the rnt:tLnI beneThs,
reprDYe3aahous,CCWeU3DZ tndida}Lnp,s,anc a .rerncnt bereiLartc conta[riez3 aiid for sciod and
vaftiabJt e&nsideration recciove b’.the partie!which ccrniidLkrdLi,m wiil the sufficiciicy theicof
he t.ekzii owlcdgtd by [he >anies hcr-j,U-ic Owner’Asscicrau:ift md the Developer
rL’prttiç c vena’ix.tmdertakc atid agee a follows:
.4CREBMENT:
Sc:tiott Line.lDauiection and \1ainttance.Ovneis Association iigres Lu jilkiw
Uteloptr to on ncct r deie acL4J lots nithkn !h dj ,irejt lox Creek Vi Uagn P LI)ii
ulcJreIneL]onc(i wells asbie.cL t Uxee,ju ot’thir.agrn’..eim
The Paft:e5 VJ tN agrrc1eiIL will equally share ecI assciciaitd win rnainienaare sril
opc:iciuu.TLpirLie fwther tsre-e tc lit Eh.ç.ut of eleothcitw i.o opunttc thit weD..ccn Lf
[he parties will take waler Q-vn .he well ecitcztp:for dcnietic r’wpe-.The Pafl iwrcl au!
eEc-h other rvciproeal easentenis -as nkgln be ‘iccçia n ccwny Via wnscr rri the weLl to tficr
v-añcvs lots md/or res3Jencti wtLiln the Estates orth “ilhie.
tacit party will be ietspc.nihle for rnain[aini uii&cacnnind wabn :nains front the wclls
to ihei:ccspe.Us-e piojrtics.The xpr_me.!I U.sELÜI4I sd!h 1w Iuaintr:nEnr.c it’d iepiiir of the
pumps,vc:ls,easin rir.d \ralye.)ocafrd aL [ho w-lls and pump heads,wilL e beLre euaLlv
betwccu tha parties.
LI is the intenhicn cfthc pwds toznaintain the WCItQT qi.Jalit!;prodilLed from said wells.
ny cii We parties wU hewc the authority leflwe the Watcr fri*id Ifft ini reveals a
waftr qunlfty dekieiicy,the panics toirei:rr v-ill takg correct:vc measures ax iiikih[he
rcwv [he costs ofrnalatenance ss ;.:Pumb thrive wi1l be sLiared by the parlicts Ni equal
ropon>n ;e çhi flhiTriber ci Iiiaç unis each ofther.i pight have coniieclr’J vitLt the wel.
Devol&per t’J-tei ——_m-ãi.ce presentLy ecemected to tI:e wrilL.
No svac Wspc,eal smtcrn or ether pmiieitial cantaadrum wiLl b1omaed wiIluj a
hundred fcc;otthe &hared welt.Nodurigwill be located on the wdll pnipaty In sueb ananrer
aj would eompnmisu due winkit space fccLl:e .ystem op&atioLl tv.aintenaatc.replacei)icnt,
irnproYet!aeic,irp:cUon.nnd?oriing.
sa%ri>wnz.ALIJuiLIthYi •
2V is:.Hir-.-’VVA
1St a41
WHEREAS,IOX CREEK COUN 1K?U.UB ESTATES I’KrJFERTY DWI’TEKS
ASSOCIATiON,(herciutafler rcrerred ;a as “Owner’s Assueitkii”j.wkich represent-i all
?erscns.flrrris arid cirpcurathon&oc;iun property i mx cu&tn<Cot :rnlx CLUB FS.1KL ES
(hereirafter ftierJd t s ‘EsMea”),which adjoins Vrittehiper’s prcDcny un the no’di side4 and
TI the water ysteni fails to dclivci watn upon der.and,any ofThe panfes iI1 have the
tiolit to flt4 (c collect thc itu4ILC’fl.5 Efli eael:eney IflC4UILLI&with Cft[t the approval nfthe parties.
All no euwge:mies,mich as rcpkcDctttelbi or improventer.t.wiLL ie.jo)re the cciosent of
thu rrujoflty ofthe p4lties.
Fdlowiri is a non.cscvsive.ist ofiTenis that will mxuir cosr slniñng:
A.Systeni n-isinteuanoc,iucludhi repiiirs.tCan2,im>pectios E:’iO
di jinlbtLioa:
B Systecv cannpe:tent cpIacmtiar,due to wea;obsole%scence eorroskHL;arid
C.SysTeni rrLprOVeIueftts tc iacrease the scrciee life of any x’ell CcnlipurLerLL.
if the ricgLigt[lce of any pmiy causes darn4gc to this well orrs systena,tJ;1[1yartv wLl be
resonib[c Cor the coti of rtfpah.howc’cei.each part wilihe respontãble fzr their sep4rate
disffibuticnL lines from the valves lucateit at the well ed L)ainagu cirwied to the vs.eui by thiril
parLe-s.other IF an ueals cfth par[ie&will b repised as i rLL:oa1 cost item.
Sec1o two.Tratuftr thc parties agree that the Deve[opcr’wi1[5e ixspoiisihk (or
eclicedug money for thc aEorernetflivned coats flow lot awnets wtbin thc VilLigs ijntil a.aclj gjin
that owner’s aso:iation iii cLthUshcd for the ViUa.gc At such hine that on
;s&nawa is ctthhbed for ilic ViDiige.cie pin(aee that th De’ie.]opc.r’s ;espousibilrucc,
nuder thj rn2ffl will tanstj)r the ne.v owrr’.5 association of the ViSage.
SCL’tfo:L Tiwo,S[ndin Eftecu and Tc,ni This AsrL’LEte;1f shall h:bindi%ç tiper and
incre o th’3 kricf5t uL [he paftic,successor Devdcpi of record uf [he Village.uziaec.
icsseas and upon tn successor cftmeT’association nf the Vi1Lage.
Section Fouc Ncwtl’a Un]C5S otherwise n:,ti ri rid En writbx.all noti cc,requs5ts ard
deiua’ids slnd[be in writE]i and shall be penorc3lly d&ivcrJ to or ruaileé by Ufilteci Staws
cc3tilied EThEl,posLae pIe?aid J3d leftirti rçip rtqu€sred,as :nllov.s:
Scu!icua Five.Sinuuhn-ad I1Jural.Wheaever appropriate i:t this Agreerriem.the :inuiUat
shall include the plural.aad the plural shall inchjde the singuiar.
Section Six,Scthon Headings and Subheadin’.s MI SectioLl hcactiigs or other h(linS
in thisAgrecwcntareforgo:eial aftloftherejWrand shall nol limit the pLain meanIng or
splication of any of the provisions i.rnder the headings whether c.ovcrvd or Lelcclrnt La sudi
her4dir,g or not.
Secini Seen.Re rJjpjj.A copy of this Aweemc’nt ar.d Day arne.nd:neTu[to this
asrccmc.zt thall he rozctrded in the o.ftie4 of the Cowily Rcc.ordrs oflice for Thion Con liw
Se-chop F.ihh.Aothorization to Exedute The otlicers.ofF ox fluilopmern,LLC
extcuti rug this Arcern eat wrtiint that they h-wlbccu lawfully authar]xed b’v their iL-;LieuII Yri
vlenibcrs to execurn this ISgICeLUCUL oo behalf of Fox flave[opmui:LUJ.hhtj tkvaud of
Directors ofthe ?u Cutek Conatry Club Cwner’s Aurociatiuu warmut that they havc bctsu
HnflED W..A’sR:.ShLEIT.J15zu
:‘X Jr :rry CItn thwfriW
kwfu[[y authciizcd by—he Owner’s A ;iidan ti execut this Agreewent.Upon reqaest,Fox
r)cvelqprne.i,LLC and rho Qw;ter’s Associaticrn shall dijiver to each other copLe..s cd’a!]by-laws.
cesohrtms,opei atiag agncineris,1 esat ohiioua cx v[h;dceuincnts roqiñrJ to [e&ly c’.’idcice
the aulhodw to cxcLe this Aweeatcur.m ebalfoithe repoc[ive.eiiti&s.
Steien Nir.e.£ntre AareeLnit ad A3nefldfllerns jn Wriiin.I his Agreitten:sets f3fth
alt the prcnises.iitduejncnts,aigiuen[t.cendiii&wvi and tinderrtandirig be[we-n Devr[cDess
and [[it Ownefs Assndt[ic,n relative to the anbiect maacr of ijils AgrcAJu1:Lr,anti them WV rio
pn mi stS,EccerncpiN .c3[LdflaOilS 4ff uztd&Iandiug.cithr orni or wrina.t2;pfess o:•I 1rp114.XL
berw.tn LintEL.otkerthiin those that are set nut in this AgrcsmrnL Thccept as other*e rovidd
Thete,io iiibsaluent alcaration,rneadrneiit,chRnge r addition toihis Agreeacnt N ball b
binuirg uiGn th pn4iei uj]S authorized in aceord,ince with ]&w and rcdnce4 hi £itbig and
:igntd bc than.
Section Ten.C;iiiutl)efault.‘fhu pin-ties to this Agro1nciL Teerve n iihI to cure any
dLThtlt stider this Aireernern.v,iLhtn 39 iiavs -orn written nodee of the d&iiu[t.
Section Eleven.Conflict Bttweec Sic Toxtancltxhibhs.lr.thc even[ula eontlcrin Ste
[JVOV1SIODE.of ThV text cctbi AgrCELtEIL and the otra;hnd Exhibits,if aiiy,[he Ltd O1tb
ALrctmeaL J1 contwi mid p,evern
Sccdai TweLve-.Scvrabiity.If aw provilrm tf INs Ageem?rtL is ;hetd jìvli by acf-a cempc1cntjurftdctkot or in the cvtttt a court sb]J dc[itneine that tho Owne’s
Associiitirm does not have the [JOWeT fl perform 9.d,xpu[Cd prov]sion tli IC?VL3Ufl shill be
ilerned to be c.:eied froth flits Agrcurinnt und itwaiidiw ah&I mt aliect amy cf the UtheL
pmvions ceotathed here.and Wejudgriwnt or deerea shall relieve the Owiier’s Aqr.zciMIion
rrcm pffiirnhIie4 urtderx-ic Envlid pi-ocision oftFJ5 Arecntern
SectEca Thirteen,Eceentiom cCAwctrient.This Mtreenw:tL cn-ay be Eigncd iLl one Or
IskOte eflLlflitfluIT.eac:ot which shall be deem Rfl oñ4i:ad bet nil ofwSidt Lgether eoilst]thte
ciur md ihe gimc in,Lrurnent.This dar sIul]be the dThtivc date of dits Asmcn:Lent.
IN WflThWSS WbKEOF,the pariies iieeto Jiave exectited this ,4g2eient the date set
flu Iii below
Dated thi /c2_day otM 200ti,
f:[)x CREEK DEVRIflPMEI’T.LLC
<I-L—i’i 4—•3,-i71 7[-t&o%->’
aOIaERT KUstAlD,tetLd:Fet
I&1’%.d1 t
tAV.j9 naKP-:dP’-T
2i1’i L.ai.t-L..sntIWA
STAIN 01 IDAHO I
County of TeLua
On this ]C day of Ct:i.z)ly lit ftc yenr 2OO6.before rno a 1omry J.’ublc in and
perndLy apcarcd before me ROIIERT KLNCAID,who,b ring by ne lust dii ly
d ‘Wntt]h.e15a MDmbet ofEox I)kVELOPMEK1’,110,that Sc igpJ the
uncut s Mejnha-of the cathy,and that the s1atcmt3nt thoeffi Doiit1’dnci are true.
k”flt
Notary Fubi c Sor Idaho
Restdiri Ar u[-fr1-.:JI
MyCemmisbioaflxpres:-‘2Jm;1b(CJ
or y )
Crnty 01r,4 MS.
On thiN V?day of Ij,LiA_?,intheycruf2CO6,be.forc a Nailtry Public 10 nod
üw said Slate,pcnonslly appeared ‘rOMHsNm,who1 behg by me flftt duly 5’[N50 declared
that hcis#Memter c.ftheBi;’id&Dirccrrirs ofFOXCRFEK COLNTh’Y CLTWI OWNF.R3
ASSOCIAJTON.ibat he signed the forccking dc.cujaen as Diroctor of 11w onfl(,awl th Ihc
stateitients thciiit cotiiaire1 3Ic m’c
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NOTARY PU&?C
NEAINEfl .1 flWABT
FAR:I)WELL 4Q[flfF.VF.:“
c’T.&Cyiclrv Clul’tgM •,‘dl tS1;4/
FOX CREEK COTWTF.1 CIi
OWNER’S ASS CL4TIQN
TOM FLThTFR
7Vt;
S.&LLY}4ORE --
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JODI TEST /
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STATE OF2?7J2 I
flitrnw f )
Onthis jjday of &-./--inthy<of2JYJ6 befnn ;nc,ri NotaiyPubUpcin -ilnd
fbi sahd Sncw,personally appr-ared AIULJ MOORE who,beLie by rue 111Sf dl][y sworn,
deo1ard thai he is a Mcw.be:otth€1-kiard otohectoys efFOX CKFJ-K COUr-flY CLUH
OWIcFR’S ASSOCIATION.taat he ----as Director of the ntiy.
and that the uatcrILenLs thercin
STATE orZa flQJ’
(:ounty of 2-’.Ev-,
7:
C)mthi53 clay vf hiffic vniruP2O[Hi,bcftwemc,it Notauy Thablic hi nid
for said Skite,pessoai&lv appeared SALLY isJOORB who,beà by nieftnst riuLy sworn,
tIcSarcd th4t i1ic i 4 M.omjcr nI the Board of I)irçtors of FOX CREEE COUNTRY cLLM4
OWNER’S ASSOCPATION:that --‘s Direflcr of the catty,
and that thy La4cmeflLS therdn F I-r d-—-
:‘lic4 rdo ..
At ornQ
Comrthssiori tires:/-,“t ô7
STArE or ‘
Es.
Ccn.cnty
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Oh this thy of ir thx vat of20(16,bdt’ru rae,a r’.otary Public in arii
for :aid Sfto.pcstnaIl upwarc4 .101)1 TEST;who,ht[ng by me first dcLy sworn,declared tLut
siw is a Metubcs orthi Board ofDiritum of FOX CRREK CO1Th..TRV CLUE OWNRWS
ASSOCIATION:flint the iipieci tiefrrpgçng d[’Curntnt is Director of xhc-c3Tt1ty end thatthv
aa:em:nIs Therein coat atd are
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