HomeMy WebLinkAboutWTR2703109Shdrt Plat (SHPL-#' .
REQUEST FOR PROJECT it Prelim. Plat (PP#
CAG # )
To: Technical Services Date S O 3 WO# Green# 0 ,:3 02- l�
From: Plan Review/Project Manager 3-0 L t P,-0 A S I-rr4-11�c T
Project Name
t LSA z�116-r_- S } 0r2-T P � 1
(70 durac(cus max)
Description of Project:
Fi
t.o'C
►fig vJ
L\erPM
Circle Size of Waterline:
8"
10"
12" Circle One:
New or
Extension
Circle Size of Sewerdine:
10"
12" Circle One:
New or
Extension
Circle Size of Stormline:
12"
15"
18" 24" Circle One:
New or
Extension
Address or Street Name(s)
CCA Ne7Q
op LI NG-ccM A-qe
Qe7
LI NCOtJ4 Pt- NE
Dvlpr/Contractor/Owner/Cnslt::
P �� c�oNs��n Nc�
I Fta,�
(70 daractm max)
Check each discipline involved in Project Ltr Drwg # of sheets per discipline
Trans -Storm ❑ ❑
(Road way/Dcainagc) (Off site improvcmcntsKndudc basinm nac) (include ►FSC shuts)
Transportation (Signalization, Channdization, Lighting)
❑
❑
Wastewater
❑
❑
Sanitary Scwct Main (indudc basin name)
Water (Mains, valve. Hydrants) ❑ ❑ -----
(Include composite 6c Horizonul Ctrs Sheets)
Suface Water ❑ ❑
improvements (CLP NLY)(includc basin name)
TS Use Only ------—
�(v�
0
0
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
❑ AM ❑ PM
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
❑ PUBLIC
❑ INDIVIDUAL LD. N0. CIRCAB LE GROUP
(serves only 1 residence)
NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO.
DAY ( )
EVENING ( )
SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE ❑ GROUNDWATER UNDER SURFACE INFLUENCE
❑ SURFACE [—]WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION
WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print Full Name. Address and Zip Code)
WASIiii
TYPE OF SAMPLE (check only one in this column)
�je (`�]
❑ ROUTINE ❑ Chlorinasidu To Free)
DRINKING WATER vvv Az
check treatment ❑ Filter qh
❑ Unt or
❑ REPEAT SAMPLE g A��5
Previous coliform presence Lab # �CAl
Date / G�
❑ RAW SOURCE WATER Source # IS] m ❑ Total Coliform
❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform
❑ OTHER (Specify)
REMARKS:
(LAB USE
RINKING WATER RESULTS
❑ UNSATISFACTORY, Coliforms present
❑ SATISFACTORY,
Coliforms absent
REPEAT ❑ E. Coli present
❑ E. Coli absent
SAMPLES Fecal resent
REQUIRED ❑ Fl p
❑ Fecal absent
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml
E. COLI /100 ML
FECAL COLIFORM /100 ml
PLATE COUNT /ml
ANOTHER SAMPLE REQUIRED
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
DATE REPORTED LABORATORY:
REMARKS
DOH 305 002 (REV. 4/92)
WATER SUPPLIER COPY
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an examina-
tion for the presence of coliform organisms in the water and indicates
the bacteriological quality of the sample. The presence of coliform
organisms is used by health organizations worldwide as an indicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of Drinking
Water Analysis to the State as specified in WAC 246-290-480.
SATISFACTORY RESULTS:
The absence of coliforms from any sample is satisfactory. Proper
system maintenance and bacteriological monitoring should be con-
tinued routinely to insure the safety of the water supply.
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not properly
protected against contamination and may be unsafe for human con-
sumption. Unsatisfactory samples should be investigated IMMEDI-
ATELY and_reoeat samples submitted. Contact your local health
department or DOH Regional Office for assistance in determining
the source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample. the
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 Office can
assist you.
2. Submit repeat samples as specified in WAC 246-290-480.
3. Publicly notify the users of the public water systems as
specified 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 particulates 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.
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 I TIME COLLECTED I COUNTY NAME
MONTH , DAY ,YEAR
❑ AM ❑ PM
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
PUBLIC
❑ INDIVIDUAL I,D. N0, 71 CIRCALE GB UP
(serves only 1 residence)
NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLECTED I TELEPHONE NO.
DAY ( 1
SAMPLE COLLECTED BY: (Name)
EVENING ( )
SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE LJ GROUNDWATER UNDER SURFACE INFLUENCE
❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION
WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print Full Name, Address and Zip Code)
TYPE OF SAMPLE (check only one in this column)
❑ ROUTINE
DRINKING WATER
❑ Chlorinated (Residual: Total Free)
check treatment
❑ Filtered
❑ Untreated or Other
❑ REPEAT SAMPLE
Previous coliform presence
Lab #
CI1
Date /
'v/
/ c D
4t
?
❑ RAW SOURCE WATER
Source # [S]
--�AIIr
I ��r�, ❑' 900form
❑ NEW CONSTRUCTION or REPAIRS
IIT/t/Toliform
/.
❑ OTHER (Specify)
S1 S`z/QV
9!V
REMARKS:
(LAB USE ONLY) DRINKING WATER RESULTS
❑ UNSATISFACTORY. Coliforms present
❑ SATISFACTORY,
Coliforms absent
REPEAT ❑ E. Coli present ❑ E. Coll absent
SAMPLES Fecal resent
REQUIRED ❑ Fl Fecal absent p ❑
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml E. COLI /100 ML
FECAL COLIFORM _ /100 ml PLATE COUNT /ml
ANOTHER SAMPLE REQUIRED
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
DATE REPORTED LABORATORY:
REMARKS
DOH 305 002 (REV. 4/92)
WATER SUPPLIER COPY
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an examina-
tion for the presence of coliform organisms in the water and indicates
the bacteriological quality of the sample. The presence of coliform
organisms is used by health organizations worldwide as an indicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of Drinking
Water Analysis to the State as specified in WAC 246-290-480.
SATISFACTORY RESULTS:
The absence of coliforms from any sample is satisfactory. Proper
system maintenance and bacteriological monitoring should be con-
tinued routinely to insure the safety of the water supply.
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not properly
protected against contamination and may be unsafe for human con-
sumption. Unsatisfactory samples should be investigated IMMEDI-
ATELY and repeat samples submitted_ Contact ,your local health
department or DOH Regional Office for assistance in determining
the source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample, the
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 Office can
assist you.
2. Submit repeat samples as specified in WAC 246-290-480.
3. Publicly notify the users of the public water systems as
specified 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 particulates 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 ndw
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.
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 I TIME COLLECTED COUNTY NAME
MONTH , DAY ,YEAR
❑ AM ❑ PM
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
PUBLIC
❑ INDIVIDUAL I.D. No. CIRCALE GB UP
(serves only t residence)
NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLECTED I TELEPHONE NO.
DAY( )
SAMPLE COLLECTED BY: (Name)
EVENING ( )
SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE LJ GROUNDWATER UNDER SURFACE INFLUENCE
❑ SURFACE ❑ WELL or n SPRING ❑ PURCHASED or COMBINATION
WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print Full Name, Address and Zip Code)
WASHINGTON
TYPE OF SAMPLE (check only one in this column)
ROUTINE
DRINKING WATER
check treatment
Chlorinated (Resic�aC Total Free)
Filtered !Ql
Untreated or Other
REPEAT SAMPLE
Previous coliform presence
A
Lab # A
Date 4003
❑ RAW SOURCE WATER
Source #
W
�t�Tuy�FgEN
1 form
NEW CONSTRUCTION or REPAIRS Fecal Coliform
OTHER (Specify)
REMARKS:
(LAB USE ONLY) DRINKING
UNSATISFACTORY, Coliforms present
SATISFACTORY.
Coliforms absent
REPEAT E. Coli present E. Coli absent
SAMPLES
REQUIRED Fecal present Fecal absent
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml E. COLI /100 MIL
FECAL COLIFORM /100 ml PLATE COUNT /ml
ANOTHER SAMPLE REQUIRED
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
DATE REPORTED LABORATORY:
REMARKS
DOH 305 002 (REV. 4192)
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an examina-
tion for the presence of coliform organisms in the water and indicates
the bacteriological quality of the sample. The presence of coliform
organisms is used by health organizations worldwide as an indicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of Drinking
Water Analysis to the State as specified in WAC 246-290-480.
SATISFACTORY RESULTS:
The absence of coliforms from any sample is satisfactory. Proper
system maintenance and bacteriological monitoring should be con-
tinued routinely to insure the safety of the water supply.
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not properly
protected against contamination and may be unsafe for human con-
sumption. Unsatisfactory samples should be investigated IMMEDI-
ATELY and repeat samples submitted. Contact your local health
department or DOH Regional Office for assistance in determining
the source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample, the
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 Office can
assist you.
2. Submit repeat samples as specified in WAC 246-290-480.
3. Publicly notify the users of the public water systems as
specified 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 particulates 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.
l;clurn Address:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton, WA 98055
W 3io9 MI�AP�W��YI�AIIR�I�I���
20040409000668
KING COUNTY, WA
BILL OF SALE L Property Tax Parcel Number: ;6541: j Ito Opf
Project File : sect lntcrscction: t,.ttJCAL'i E Address: _
UAA4.0 , p� 14(
L- -� 1. trt
Reference Number(s) of Documents assigned or released: Additional reference numbers arc on page
Grautor(s): Grantee(s):
1. CAMP,5►2-%C 1. City of Renton, a Municipal Corporation
2.
The Grantor, as named above, for, and in consideration of mutual benefits, hereby grants, bargains, sells and delivers to
the Grantee, as named above, the following described personal property
WATER SYSTEM: Length
Size Type
Water Maui
L.F. of
LF. of
" Water Main
L.F. of
Water Main
each of
(.o `` Gate Valves
each of
Gate Valves
each of
Fire Hydrant Assemblies
SANITARY SEWER SYSTEM: Length Size Type
��$ L_F. of Q p�G Sewer Main
L.F. of Sewer Main
L.F. of Sewer Main
each of 43 " Diameter Manholes
each of " Diameter Manholes
each of " Diameter Manholes
STORM DRAINAGE SYSTEM: Length
size Type
Storm Line
OrlL.F. of
L.F. of
1.7
$ Dlt Storm Line
L.F;-ofStorm
Line
�, each of
8 ,air" Storm Inlet/Outlet
' each of
Storm Catch Basin
each of
Manhole
STREET IMPROVEMENTS: (Including Curb, Gutter, Sidewalk, Asphalt Pavement)
Curb, Gutter, Sidewalk 2-Cr7 L.F.
Asphalt Pavement:_ SY or
L.F. of __ Width
STREET LIGHTING:
_ o a- a,�•
# of Poles
By this conveyance, Grantor will warrant and defend the sale hereby made unto the Grantee against all and every person
whomsoever, lawfully claiming or to claim the same.
This conveyance shall bind the heirs, executors,
or persons,
administrators and assigns forever.
Page 1
H:\FIL.E.SYSTRM\84HNDOUIIBILLSALE.DOCWAB
1=ornn 84 0001 /hh
IN WITNESS 1'VHLREOF, I have hereunto set my hand and seal the day and year as vo itten below.
IA'DIVIDUAL FORAY OFACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that
signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and purposes
mentioned in the instrument
Notary Public in and for the State of Washington
Notary (Print)
My appointment expires:
Dated:
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that
signed this instrument, on oath
stated that he/she/they was/were authorized to execute the instrument and
acknowledged it as the and
of to be the free and voluntary act of such
party/parties for the uses and purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)
My appointment expires:
Dated:
CORPORATE FORM OFACKNON'LEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING .: ,JL
^-"� ' ) day of Gat +9, before me personally appeared
VELTA M. STROMB JGI__ - to me known to
t� of the corporation that
STATE OF WASHINGithin instrument, and acknowledge the said instrument to be the free
NOTARY —•— PUBact and deed of said corporation, for the uses and purposes therein
each on oath stated that he/she was authorized to execute said
MY COMMISSION EXPIRES that the seal affixed is the corporate seal of said corporation.
Notary Public in and for the State of Washington
Notary (Print) EG - 6-rA o m B
My appointment expires: /c 7
Dated:
PROJECT CLOSING #4 Final Cost Data
F`INAL COST DATA AND INVENTORY and Inventory
SUBJECT: CITY PROJECT NUMBERS: WTR- J- J� C
WWP-
�j{�� SWP-
Name of project TRO-
\�'k"., 02— TED-
TO: City of Renton FROM:
Plan Review Section Ili tfLPlanning/Building/Public Works [LEFJTbt.1 LIAJA
200 Mill Avenue South
Renton, WA 98055 DATE: A{2<� 2�
Per the request of the City of Renton, the following information is furnished concerning final costs for improvements
installed for the above referenced project.
WATER SYSTEM CONSTRUCTION COSTS
Length Size Type
2 L.F. of p• L
L.F. of
L.F. of
L.F. of
EACH of
EACH of
EACH of-
EACH of • S
(Cost of Fire Hydrants must be listed separately)
(Include Engineering and Sales Tax if applicable
WATERMAIN
WATERMAIN
WATERMAIN
WATERMAIN
GATE VALVES
GATE VALVES
��=I�L�s t2�-�*"r�E �lsn►�r N"�V Y�,,� T
FIRE HYDRANT ASSEMBLIES $ U�
$
TOTAL COST FOR WATER SYSTEM $ Cl 11 C7C-1
SANITARY SEWER SYSTEM: STORM DRAINAGES STEM:
Lenc,th Siz
1 D L.F. of
TY
b�
SEWER MAIN
L.F. of
SEWER MAIN
L.F. of
SEWER MAIN
EA of
DIAMETER MANHOLES
EA of
DIAMETER MANHOLES
(Including Engineering and Sales Tax
if applicable)
TOTAL COST FOR SANITARY SEWER
SYSTEM
$ gQg
Length
/ l7
L.F. of
Si e
TT e
1J " r STORM LINE
t =
L.F. of
1-2—
t7S STORM LINE
L.F. of
STORM LINE
EA of
STORM INLET/OUTLET
EA of
Z- L
STORM CATCHBASIN
EA of
S
STORM CATCHBASIN
(Including Engineering
and Sales Tax
if applicable)
TOTAL COST FOR STORM DRAINAGE SYSTEM
STREET IMPROVEMENTS: (Including Curb, Gutter, Sidewalk, Asphalt Pavement an Street Lighting)
SIGNA TAN : (Including Eng. Design Costs, City Permit Fees, WA St Sales Tax)
` `
STREW LIGHTING: (Including Eng. Design Costs, City Permit Fees, WA St Sales Tax)
Print signatory name
4
day phone #
(SIGN )
fonns/COSTDAT2.DOC(bh (Signatory mu authorized
or owner of subject