HomeMy WebLinkAboutWTR2702106PROJECT NAME: ,P,44z 4Y
ALIAS: �Ie3o /(AE :51IN 9-r jGllO
CONTRACTOR (IF KNOWN):
PROJECT NUMBER:
WORK ORDER NUMBER: S---73 9x
STATE CONST. REPORT
SIGNED BY:
YEAR PROJECT TAKEN INTO PLANT:
RECORDED BILL OF SALE:
RECORDED EASEMENT:
COST DATA INVENTORY: P E $_
BACKFLOW TESTS: Y N
PURITY TEST: no. taken / Test No(s) 7/
PRESSURE TEST:
HYDRANT $
Documentl\
Laucks Testing Laboratories, Inc.
940 S. Harney Seattle, WA 98108
` WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If Instructions are not followed, sample will be rejected.
DATE COLLECTED TIME COLLECTED COUNTY NAME
MONTH DAY YEAR
/�j ❑ AM �,PM K IN c�
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
PUBLIC
❑ INDIVIDUAL
(serves only 1 residence)
NAME OF SYSTEM
yRCP� y t-'Jt/�slivSiC ni
-
fvO 87398
SAMPLE COLLECTED BY: (Name)
CIRCLE GROUP
B
TELEPHONE NO.
DAY (> x_-) Z 3< —Z
EVENING ( )
SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE ❑ GROUND WATER UNDER SURFACE INFLUENCE
❑ SURFACE WEELL or LL FIELD [:]SPRING ❑ NTERT ESED or ❑ OTHNATION
SEND REPORT TO: (Print Full Name, Address and Zip Code)
�,�ilJ7aA-) &JA-7L_-7L t1T 1 L_ I
7Ga0 �//LL A ✓zi- SO .
WASHINGTON
-TYPE OF SAMPLE (check only one in this column)
ROUTINE Chlorinated (Residual: Total Free)
DRINKING WATER ❑ —
check treatment ❑ Fiftered
❑ Untreated or Other
❑ REPEAT SAMPLE
Previous coliform presence Lab k
Date
❑ RAW SOURCE WATER Source tt a ❑ Total Coliform
NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform
❑ OTHER (Specify)
REMARKS:
(LAB USE ONLY) DRINKING WATER RESULTS
UNSATISFACTORY, Coliforms present
SATISFACTORY,
Coliforms absent
REPEAT ❑ E. Coli present ❑ E. Coll absent
SAMPLES REQUIRED resent Fecal absent
❑ Fecal P ❑
OTHER LABORATORY RESULTS
TOTAL COLIFORM A00 ml E. COLT /100ml
FECAL COLIFORM /100 ml PLATE COUNT /ml
ANOTHER SAMPLE REOURED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE:
❑ Sample too old Confluent growth
❑ Wrong container TNTC
❑ Incomplete form ❑ Turbid culture
❑ ❑ Excess debris
SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS
LAB NO. (7 DIGITS)
DATE, TIME RECEIVED
RECEIVED BY
`Io
DATE REPORTED,/
LABORATORY:
REMARKS
DOH 306-002 (REV. 4/92)
WATFR CIIPPI IFR r]nPV
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an exarnwa-
tion for the presence of coliform organisms in trio water -nd �ndicates
the bacteriological quality of the sample. The presence of coi;forrri
organisms is used by health organ -aticns worldwide as air 'ndicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of urinhing
Water Analysis to the State as specified in WAC .'46 :'90 -180
SATISFACTORY RESULT;
The absence of coliforms from any sample is satisfactory Pro;, .,
system maintenance and bacteriological monitoring should he cnn-
tinued routinely to insure the safety of the water suppl4
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not propi:,Iy
protected against contamination and may be unsaie for 1);7Y n con-
sumption . Unsatisfactory samples should be investigated_iMMED1
ATELY and !meat samples submitted.: Contact your local health
department or DOH Regional Office for assistance in letermining the.
source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample ne
IMMEDIATE ACTION REQUIRED by a Public System is:
1. Investigate to determine the cause and correct the situation.
Your local health department or DOH Regional Offic? can
assist you.
2. Submit repeat samples as specified in WAC 246-23:,-48 .
3. Publicly notify the users of public water systems as speci-
fied in WAC 246-290-480,
4. Contact your local health department or DOH Regional
Office as specified in WAC 246-290-480,
TEST UNSUITABLE: Resample Immediately
"Confluent Growth" means bacteria have grown into a continuous
mass which makes counting impossible. "TNTC" means bacteria are
too numerous to count. "Excess Debris" means that particulat s in
the water interfere with the interpretation of test results. "Turbid
Culture" means an overgrowth of other bacteria can interfere with
coliform analysis. If any box indicating an unsuitable test is checked,
the presence of coliform bacteria could not be determined and a new
sample must be obtained for testing.
RESAMPLE:
Sample too old. (Sample to be tested must be received within 30 hours).
Not in proper container. (Bottle to be used for testing must be
purchased from a certified lab within 6 months.)
Insufficient volume. (Sample must be at least 100 ml)
If not tested, a new sample must be submitted for analysis.
FOR ADDITIONAL INFORMATION:
Contact your local health department OR the laboratory where this
sample was tested OR the Department of Health, Drinking Water
Program Regional Office.
PUBLIC WORKS DEPARTMr T"
ENGINEERING DIVISIOi
CITY OF RENTON, WASHINGTON
Owner
W
APPLICATION ONLY - UNTIL VALIDATED PERMIT
NUMBER Q /9
Address v� „ 1 /f V
INSPECTIONS
(,,:,,,,
f CONSTRUCTION
27 S�66 PERMIT
(Public Right -of -Way)
Reference Data
Description of Work
and Number of Feet
T \ ,
Contractor
Address /} /
Date Issued
Expiration Date
52 6os
Location of Work
�-33 �� C
i FEES
Sanitary Sewer/Storm Water Permits
Right-of-yWay Construction4 A ay I/ 1 r� ef�
Water Inspection/Approval Fee (pZ
Special Utility Connection Fee, Water
Water Latecomer Fee
Special Assessment District, Water
Sewer Inspection/Approval Fees 57
Special Utility Connection Fee, Sewer
Sewer Latecomer Fee
SpecMmment DNI t !E Sewer
Special l Deposit, rivate Latecome r
Special Deposit, Cash Bond
TOTAL FEE
Business
License
Telephone
IT IS UNDERSTOOD THAT THE CITY OF RENTON SHALL BE HELD HARMLESS OF ANY AND ALL
LIABILITY, DAMAGE OR INJURY ARISING FROM THE PERFORMANCE OF SAID WORK.
ANY WORK PERFORMED WITHIN THE RIGHT-OF-WAY OR ON SEWER MAIN MUST BE DONE BY A
LICENSED, BONDED CONTRACTOR. LOCATE UTILITIES BEFORE EXCAVATING.
CALL 235-2631 FOR INSPECTION. _
Call between 8 AM and 9 AM for APPLICANT
inspection in afternoon; call ,
before 12 Noon the day before
for inspection in morning.
SPECIFY TIME FOR INSPECTION.
PUBLIC WORKS DIRECTOR
CALL 235-2620 for street signs
and lighting.
CALL BEFORE YOU DIG BY
48-HOUR LOCATORS
1-800-424-5555
AUTHORIZATION OF SPECIAL BILLING
DATE: MAY 3 1993
PROJECT NAME: DALPAY EXPANSION CENTER
PROJECT NUMBER- W - 21 Q (�
WORK ORDER NO- 87398
It is the intent of this letter to authorize the City. of Renton to bill the undersigned for all costs
incurred relative to the above -referenced project, by the City of Renton for the following work
IME & MATERIALS FOR THE CITY OF RENTON TO PERFORM THE FOLLOWING:
WATERMAIN CONNECTIONS, WATER PURITY SAMPLES AND RELATED WORK.
LESS DEPOSIT PAID UNDER P - 1�
YOU WILL BE BILLED TIME AND MATERIAL
FOR ANY WORK DONE BY CITY STAFF TO
REPAIR DAMAGES
BILLING TO BE SENT TO:
Attu:
Phone No ?'�4 , f/,3 6
�/ftw�,�e,
v
4.36 ALWMTEr—,.n;W!
. 2. �. Agent
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PLANNING DIVISION
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�cC ORDER NO. =7 7-3 9,
ECF NO. 92--10
GP--^N NO. 9 P09-Cm
APPLICANT•
CITY OF RENTON-DEVELOPMENT:SERVICES:;
PLAN REVIEW ROUTING'SLIP
- 'FIRE
DATE � `-F PREVENTION BUREAU
OCT `L 1 1992
JOB ADDRESS: �-n� ECEI ` E
NATURE OF WORK:
TO: Comments Due
FIRE PREVENTION BUREAU
WATER SYSTEMS
SEWER SYSTEMS
STORM DRAIN SYSTEMS
PROPERTY MANAGEMENT
TRANSPORTATION DIVISION
REVIEWING DEPARTMENT/DIVISI
Comments Due
BUILDING CODE REVIEW
ENERGY CODE
STRUCTURAL
PLANNING DIVISION
MECHANICAL
OTHERS
APPROVED I APPROVED WITH CONDITIONS II NO APPROVED
►-iT r��
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300
2. II, ' O C C r ON C9 # Of Us -eK% ( 1
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DATE
Signature of Director or Authorized Representative
14:pinrev CDVbld022(9/10/91)
- 7ORK GRDER NO. /5 �`D _ ECF NO . `�-2 �C `r GREEN NO .
APPLICANT:
CITY OF RENTON-DEVELOPMENT SERVICES
PLAN REVIEW ROUTING SLIP
r
DATE "/0 a,,/� Z
JOB ADDRESS: -
NATURE OF WORK:
TO:
Comments Due
FIRE PREVENTION BUREAU
WATER SYSTEMS
I SEWER SYSTEMS
STORM DRAIN SYSTEMS
PROPERTY MANAGEMENT
I TRANSPORTATION DIVISION
REVIEWING DEPARTMENT/DIVISION
Comments Due
II BUILDING CODE REVIEW
ENERGY CODE
STRUCTURAL
PLANNING DIVISION
MECHANICAL
OTHERS
APPROVED I ✓I APPROVED WITH CONDITIONS I I NOT APPROVED
Signature of Director or Authorized/Representative
#4=Plnrev CDVbld022(9/10/91) J
I-
1Y .DEVELOPMENT APPLI��TION REVIEW SHEET
(ENVIRONMENTAL CH, .LIST REVIEW SHEET
L' PLAN REVIEW ROUTING SLIP
L
PPLICANT-
)B ADDRES
A RE OF 1
MER
RECEIVED FROM date)
WO#
GREEN #
SPECIAL ASSESSMENTS AND CONNECTION F APPLIED , / NEED Ij1ORE INFORMATION
Q NOT APPROVED FOR APPLICATION OF FEES.>2�� Q/ SQUARE FOOTAGE
O VESTED O NOT VESTED vu^-/AyJ O FRONT FOOTAGE
O LEGAL DESCRIPTION
O /VICINITY MAP
C (3' OTHER
�SUBJECT PROPERTY PID# D 305 — G% 4Z O DS - ,3"-2-
Ga-..-ems
it is the Intent of this development fee analysis to pu the developer/owner on notice, that the fees quote below may be
f pf c.ble to the subject site upon development of the property. All quoted fees are potential charges that may be due and
Parable at the time the construction permit is Issued to install the on -site and off -site improvements (i.e. underground
iilwes, street improvements, etc.) Triggering mechanisms for the SUCC fees will be based on current Ciordinances and
rdttermined by the applicable Utility Section. 3
pkase note that these fees are subject to change without notice. Final fees will be based on rates in effect a me of
BuNding Permit/Construction Permit application.
fit ; t"
The following quoted fees do NOT Include inspection fees, side sewer permits, r/w permit fees or the cost of te�M"t
ECIAL ASSESSMENT
DISTRICT
PARCEL
METHOD OF
ASSESSMENT
ASSESSMENT
FDISTRICTS
N0.
NO.
ASSESSMENT
UNITS
OR FEE
atecomer Agreement ( vt) WATER)
:'atecomer Agreement ( vt)WASTEWATER
—o—
Latecomer Agreement (pvt)OTHER
/
Spec al Assessment District/WATER
0
—
Special A essment District/WA ST
(p —/�
Joint Use Agreement (METRO)
—
Local Improvement District
^O
/
Traffic Benefit Zones
O—
FUTURE OBLIGATIONS
SPECIAL UTILITY CNECTION CHARGE - WATER � (e/�� //98�
# OF UNITS/
SUCC FEE
O Pd Prev. N'Partiall Pd (Ltd Exemption)'/O Never Pd `
SQ. FTG.
Single familyresidential & mobile home dwelling unit $940/unit x
Apartment, Condo, each multiplex unit $545/ea. unit x
Commercial/Industrial $ 126 sq. ft. of prope x
(.o< k- than $940.00)
X
Boeing, by Special Agreement/Footprint of Bidg plus 1 perimeter
(2.800 GPM throholl)
SPECIAL UTILITYNNECTION CHARGE - WASTEWATER G/a /q8
O Pd Prev, LV Partial) Pd (Ltd Exemption)/ N r Pd
Single famil residential and mobile home dwelling unit $470/unit x
Apartment. Condo, each multiplex unit $270/ea. unit x
Commercial/Indus I $ sq. fL of property x
(.tee Iw th„ $420.00) t?171
SPECIAL UTILITY CONNECTION CHARGE - SURFA6;W TER
O Pd Prev. O Partial) Pd (Ltd Exemption) Never Pd
Single family residential and mobile home dwelling unit $440/unit x
All other properties $.146/sq ft of new impervious area of property x
(not lau than $440.00)
71 _ ��
PRELIMINARY
TOTAL S
Slpoatun of Revle 1.9 Aothwity`, DATE
'If subject property"`LS within an LID, it is developers responsibility to check with the Finance Dept. for paid/un-paid status. A v
t'/f°rtns/Prop-m9rnVf"app/1991/bh EFFECTIVE JULY 1, 1992
pr N
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