HomeMy WebLinkAboutWTR2702285
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FILE TITLE wqe ; c g
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W- 22g5 r
Rerurn Address
City Clerk's Office
City of Renton
200 MITI Avenue South RECEIVED 8
Renton,WA 98055-2189
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Title:File
TffS EASEMENT
Pr Prn rty Tax Parcel Number. Ir153V6 Oorp
- FiI<a: 5trcel lnterternm ur Ject L
Refenaee Number(,)of Documents assigned or released:Addn:aml n,r,,t.jumbo err nn
Grantor(s): Grantee(s): war_.
I. G.I. JM'S Inc„ an OcegM 1. City of Renton,a Municipal Corporation
2. Corporation -
N The Gra.Nr,u n,aed abo.e.I.or—ie<om:dention of o MINN 4 ndk hruabtY.4ann Wathe abuw wrd G :u..1.and denvrrsa
Ad]nlonJ le al u,n
C of decutnent (AaamendrreJ h+mplpr MUSrra er,,
LEGAL DESCRIPTION ,E
.�1 ! b► PLAT-s PR6'sS OR71oU Or- LOT �t MAp kecne.0•o ru vocuaE
I6 g A E)d iM
C1 See Attached d 6dtibit ""A"
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M1fORM,V;CRrt;eaDtEA,EMENT nJC� "y<I FMUI O),maLaC.V.]I.%
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Thu said GamoKs),for and m cansideruion of marshal 6enefns.do by these presents,grant,bargain,sell,
convey,and AMMIS unto the aid Granlec,its successors aid usigri,an easement for public utilities
(including war&,wastewater,and surface water)with necessm)appurtenances over,under,through,across and
upon the following described property(the right-orway)in King County,Washington,more particularly
described on page 1. (or i!full legal is not on page I--Exhibit A)
For the purpose of con structLig,rec,esnurneg,iustellusg,repairing,rtplacic8,eniuging,operalixg and
maintaining utilities and ctility'pipelines.includul&but not limited to,water,sewer and storm drainage an Imes,
together with the light of ingress And egress theme without prior tradition of any suit or proceedings of law
and without intoning any legal obligation«liability therefor. Following the initial constriction of Its facilities,
Grantee may from rune to time construct such additional facilities wit may require. This ears rsu is granted
object to the following terms and cuedmons.
The Grantee shall,a tom 1nNn of an (pen P Y ss od weh, the m.,Vu eorercd by the easement mtorc Nr y. of
the aaumrnt,and any pnvtle improremenu dlVabtd w dubwei drrin;,erecu:ion ua dace wnri.u nearly.u
psaioable To In,1err om they wne m IM. .rom.e1,be(un commencMu,of the work or art,by one GMlee
nshis}. shall rta,. a right a uu she mdve u(the easement a lone u such use near not iu:rfert wish the uumw righu Printed I,me GMae.
Grantor shall n«,however,he.the,,):lo' _
w as Emit«metnainany buddmp«ema4ns w�tl.in lhr euemmf,or a1 .
b Plant Ones Nmbs or,neuuon farms deep root III which mny arse damage an«Intrrfen whh the
C utilities to be placed wish.n s1e."I by the GMtee;«
c De,dop.landsrapr.or bauuy In,eaturin area in MY way which would uuea<ombly satirist she wss an
N Ne Orantire ofnaMoll she a aem ant M a and MY pr lv are impm Vemente I u re in
✓� d. 6lg nmmel or perform ashrr fam•.s of eomsuaeuou a et 11"on the pm Perry whuh woul]tlissurb?<
•' ctvnpanicn or unearth Cranxehs fuililiar an she ref-wa or en
e BIa!within hfleen(Is)feel of tar ngno-ofwq, ] dangu the luenl mppan laellibes
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This easement shall run with the land describec herein.and shall be boding upon the patves,their heirs,
luceuanra in intared aid utigns. Grantors coverans that they are the lawful owners of the above propenies and
dust they have a good and lawful right to execute this aglmnent
By this conveyance,Grantor will WiLoUt and deferd this sale hereby made unto the Graeae against all and
every person ca picsons,whomsoever,lawfuLy claimNg a to claim the same This conveyance shall bind the
hears,executors,administratun and assigns forever
IN WITNESS WHEREOF,said Grantor has caused tie,Iurana:to be u,.,ad This 4 Zay o!—Ttlut_19-a.�,
G.I. JOV E, Inc.
By'e President
s7 A OPVOM aagNr
No;acy Seal muu be within ben STATE 017WASNINGTON ISS
COUNTY OF TONG
I«reify that 1 straw er her cuisfartory oulrute the
a.gned Nn ommarent end
acknowledged it to oe Aa'hevratir(fM and roluNary act for are uses and purposes
nemtglM m the ivnumanl
Nnan Pubh<m and for the State oC Washington
Noury(printl
My app rmmtent expires:_
Dined.
It WNMSIKCRBWxULedflskM'OpL\
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NNt Sat muC.he wRhin box STATE%WASNMOTCN )SS
COUNTY OF KMO )
I cadfy that I know w haw utufietory evidw:e dxu
_sinned Nis,mtrvmeet end
ecknowkdga0 n solo b:hmTer/their Uee uk volunWy act fm the uses end puTosa ^€
madoned m the msnumem
Notary Public in and for the State of Washington
Notary(Print)_
My appointment expires:
Dated:
RT EVFAU'E t'L'OCd .M
Noury Seat mwt bewi,xin boa STATE OF\�ASHMGTON )SS
e'1 COUNTY OF KMO )
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slan
� atNed that hekhe'thf% wadwae uNonsod to eeaute thl o,'L•omm�d on oath
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adro.rlWaednu'he
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r7 of to be the fru tid votumem•en of such
r pup'benia for rho usn and Duryesa mentioned ih the Inswmcrtc
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Notary Public in and for the Smtc of Washington
Notary(Print)
My appointment expires:
Dated
N aq et I xtieun box ()ss State of Oregon
pCounty of Clackamas
@@t lhtf 2LI_N', ,;9.?,before me penoallY rKtd
z Norman Daniels
N m 40 Me 1]IOw;1 to
.C, be The rTve:rhnf -- of the comatia that
Oo cae.utd lot wihin.tatrumeM.old Wi,lxtwledae du atd Iaattwsuu to be the free
x in<1yr rd volaotty WE and deed of said wtporatiaa for the wa rd pwpout thenoo
r^ 7►`-' mentioned,and eah on ad,rued OR tesht wee aethonaed w e u,,"rid
yz g itmnmentand tNt the seal.rued is the corporate ual ofaid mtjorsoon
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p�1 `
au
w: al ,Votary MEW in for the SUIleof Oregon
s Notary(Print), , 1 lit
My appointment expires: 3_,; .f[
N VORMSV(CRECORprEASENENT Oro 1".3 Tow Od 001clewA]21.97
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EXHIBIT A
UTILITY EASEMENT LEGAL DESCRIPTION
(GI JOE'S PARCEL)
THAT PORTION OF LOT 1,BURLINGTON NORTHERN BINDING SITE PLAN,PER MAP
RECORDED IN VOLUME 161 OF PLATS,PAGES 8 THROUGH I l INCLUSIVE,UNDER
RECORDING NO. 9206302696, RECORDS OF KING COUNTY, WASHINGTON, LYING
WITHIN A STRIP OF LAND 15.00 FEET IN WIDTH,HAVING 7.50 FEET OF SAID WIDTH
ON EACH SIDE OF THE FOLLOWING DESCRIBED LINE:
COMMENCING AT THE SOUTHEAST CORNER OF SAID LOT 1; THENCE ALONG THE
SOUTH LINE THEREOF NORTH 87°50'47"WEST 165.00 FEET; THENCE CONTINUING
w ALONG SAID SOUTH LINE NORTH 02.09" "EAST 20.00 FEET; THENCE CONTINUING
0: ALONG SAID SOUTH LINE NORTH 87°5047" WEST 223.44 FEET TO THE POINT OF
BEGINNING; THENCE NORTH 0200737"EAST 48.04 FEET; THENCE NORTH 47°09'27"
.4 EAST 27.59 FEET; THENCE NORTH 42°50'23"WEST 89.95 FEET TO A POINT ON 7HE
WESTERLY BOUNDARY OF SAID LOT I AND THE TERMINUS OF THIS LINE
r DESCRIPTION. THE SIDELINES OF SAID 15 00 FOOT WIDE STRIP TO LENGTHEN OF
SHORTEN AS NECESSARY TO TERMINATE AT SAID SOUTH AND WESTERLY
BOUNDARIES OF SAID LOT 1.
Horton Dennis&Associates,Inc.
320 Second A%enue South
Kirkland,Wathington 98033.6687
(425)822-2525
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Return Address: ROfR
f City Clerk's Office
City of Renton
200 Mill Avenue South A
Renton,WA 98055-2189
125 60-0080-02
BILL OF SALE Property Tax Parcel Number. 125380-0211-00
M 1'ro)- Filea W—2285 Street lnterseenon. 201 SW 34th Street
Reference Nurti at Oocumenx assigned or released:Additional reference numbers arc on page_
Grantor(s): Grantee(s): E
eel I. Farwest Steel Corporation 1. City of Renton,a Municipal Corporation
I'hc Grantor,m named above,tor,and in consideration of mutual benefits,hereby gran,,bargains,sells and delivers to
TIbe Grantee,as named above.the follmring ilmdbed personal property now located at, 9,01 SW 3 WA ST
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91p LP OF 12.a Ole WA4L'R hA l a!
a, S as 6AtEVALYES
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11%this conveyance.Grantor will warrant and defend the sale hereby made unto the Gmnae against all and every person
ar persons,whomsoever,lawfully claiming arlo clainL the same. This conveyance shall bind the heirs-executors,
administrators and assigns forever.
IN WITNESS WHEREOF,I have hereunto set my hand and ,at the day and year as,written below
'1.tL.rtCh
UAL FORM OFACKNOWLEOGMENT
INDIVIDUAL
Not., ra be within box STATE OF WASHINGTON )SS
COUNTY OF KING ) \
I certify that l know or have satisfactory evidence that
ow 6 f signed this
sesandinstrument and
a acknowled ed iuo b In <rM<ir free and luntary act for the uses arm purpose
d M mend nll in the nesnu nl
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��Y1jl�at0"r Notary Pu6hc m and for the State of W ashingtori
Notary(Prim)
I My appoint 1 ant ex wes _C
Dated.
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236-27.'-aa29 SNTN fe4N;. _......w..
553 �Jl 7rN 03 '3: 12:a0
PROJECT CLOSING .rrac D
FINAL COST DATA AND INVENTORY ,nd ra.on
•UDJCCT CITY PIIO)C.CT NUMn 1m 1v"rR.
FARWES- 5-.EEL swp-
NJme of r.", no-
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TO: Car of Rcnton PxVAt HOrtOn Bennis ASSOC.
N.n Rev SccwU ?20 5ecand Avervp ei
MmninVDundinVp bnc aolYs • <,rKIGnY1.NA 06055
200 MID A"..Soum
Renton,WA M55 DATE. II8(Sr7
Per the request of the City of Renton,d1e follov mg information is[umished conceming final costs for
improvements installed for the above referenced prole,,,
wK T A sYSTTN CQN TON C041S
touch S••a Tyro
LF.of DIP WATCRMAIN
15 I LF.of DIP WATERMAIN
010 LT.of l ' DEPP WATERAWN
Le' of A'Ir}I,rytnrATIT
FACII of —_ GATE YALV(_S
2 FACH of _ s, GAIT:VALM
—_ CACH of 12E GATC VAI.V13
GCH of Sr 21 r111C HYDRAni ASRl unll:\ Js5:�92.00 �I.
i .-,Cast of Firt IlpinntA muH Ec NtcU xF,ntd)') 1 +��20o•DfD
1 IndoU<EAatneel.,., dSalo Tat U,Pplic.hle ) 4,099•e0
TOTALCOST'101t1VA1'1:u)YS1j;N S 50l.091.00
1 SANITARY 5rWr•R SYSTTM QRM'NIAINAG SYSITAf
LcnVh Size TY1N Iannl: so" Type
L F of smilm MAIN U.of Tfo"uNE
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TOTAL COar 1Ua YAN11'ANrSCWEa SIYIVAI _ d.ry:�o.4) • 1
l OI Cow OOa 5':OIIM OnewAGE SYnEN �� ��
n1trX.r IMI'tt0vuti$NTs. (IndwL gCuHI Guucr.4k:.r.L.Al.—I!I.IN,n. .I ntU Street'iRllunN)
CONCReTE 51COWALK • *IS.000.00 DRIVEWWA�Y - 03J .0p
tQE PVC SYJRM LING IN LINO AVENUE _'J-Va r 00D.00 __ _
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BRTANT O. M6RC)L. P.E. '
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Form Approved
by VP-Law Pl97-21O2ry
Contract No: 1.tc-e7-oo1
PIPE LINE LICENSE 11',
THIS LICENSE, made this 27 th day of January, 1997, subject to the terms and
conditions set forth herein, between THE BURLINGTON NORTHERN AND SANTA FE
RAILWAY COMPANY, its successors and assigns, a Delaware corporation (hereinafter called i
"Licensor"), parry of the first part, and CITY OF RENTON, WASHINGTON, a municipal
corporation(hereinafter,whether one or more,called"Licensee"),parry of the second part.
WITNESSETH, That the parties hereto for the consideration hereinafter expressed
covenant and agree as follows:
1. Subject to the terms and conditions hereinafter set forth, Licensor grants a "
nonexclusive license to Licensee to construct and maintain ONE (1) POTABLE WATER - ^a
PIPELINE, 12-inches ;o diameter (hereinafter, whether one or more pipe lines, called
the "PIPE LINE"), across or along the rail corridor of Licensor ON Line Segment 405
and/or on an Industrial Spur Track, 855 feet, more or less, east form the center I'ne of _
Lind Avenue and 420 feet, more or less,south from the center line of 34 th Stre ;n or
near the station of Renton, King County, Washington, the location of the PIPE LINE
being more particularly shown on the attached, EXHIBIT"A%Drawing No.1-00344 dated
January 14, 1997,and made a part hereof.
2. This agreement shall be effective IfAV iW 1997 and she!' continue for
ten(10)years from said date,subject to prior to mf ination as hereinafter described.
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3. Licensee shall use the PIPE LINE solely for carrying POTABLE WATER and r
shall not use it to carry any other commodity or for any other purpose whatsoever.
4. Licensee shall pay Licensor as compensation for this license the sum of ONE
THOUSAND AND NO/100 DOLLARS($1,000.00).
5. Licensee shall, at its own cost and subject to the supervision and control of
Licensor's field engineer, hate and/or relocate, construct and maintain the PIPE LINE
in such a manner and of such material that it will not at any time be a source of danger
to or interference with the present or future tracks, roadbed or rail corridor of Licensor,
or the safe operation of its railroad. When the PIPE LINE is used for oil oas petroleum
Qroducts. or other flammable or highly volanle substances under pressure the PIPE
LINE shall be constructed, installed and thereafter maintained in conformity with the
plans and specifications shown on print hereto attached, marked Exhibit B and made a
part thereof. If at any time Licensee shall, in the judgment of Licensor, fail to perform
properly its obligations under this paragraph,Licensor may,at its option,arrange for the
performance of such work as it deems necessary for the safe operation of its railroad,
and in such event Licensee agrees to pay, within fifteen (15) days after bill shall have
been rendered therefor, the cost so incurred by Licensor, but failure on the part of
Licensor to perform the obligations of Licensee shall not release Licensee from liab4ity -
hereunder for loss or damage occasioned thereby.
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6. Licensee shall reimburse Licensor for any expense incurred by Licensor for false
wc,x to support Licensor's tracks and for flagman to protect its traffic during installation
and maintenance periods and for any and all other expense -ncurred by Licensor on
account of the PIPE LINE. (The current rate, sut^ect to change without notice, for
furnish mg of Licensor's Flagman is a minimum daily c iarge of$300.00,for the first eight
hours, jr any part thereof, per day, with an hourty charge of $45.00 per hour for any
time over eight hours per day).
7. F;!nr to any boring work on or about any portion of the Premises, Licensee shall
explc i the prol location for such work with hand tools to a depth of at least three
(3) feet below the surtaxc of the ground to determine whether pipelines or other
structures exist below the surface, provided, h wev r, that in lieu cf the foregoing, the
Licensee shall have the right to use suitable detection equipment or other generally
accepted industry practice (ems.,, .onsulting with the Undergromtd Services Association)
to determine the existence or location of pipelines and other s- surface structures prior
to drilling or excavating with mechanized equipment.
8. Prior to installation, five (5) days advance notice must be given to Licensor's
Roadmaster,Brian E.Hipol at Seattle,WA.,telephone(206)625-6462. "
9. (a) Except as set forth in Section 9(b), Licensee shall release, indemnify,
and hold harmless Licensor for all losses, damages, expenses, injuries or death to
Licensee, its employees, agents and contractors, arising in any manner from the
performance of this agreement, except for Licensor's gross negligence or intentional
misconduct.
Licensee further agrees to release,indemnify,and hold harmless Licensor for all
losses, damages, expenses, injuries, or death to any person, including Licensor, which
arise in any matner from the construction, maintenance, use, state of repair or
presence of Licensee's pipelines.
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(b) Whenever any employee, agent or contractor of Licensee or any of
Licensee's Parties makes any claim for personal injury or death against Licensor within `
the meaning of the Federal Employers' Liability Act, or any applicable safety act, (45
U.S.C. e57 at. sea.),for any incident caused,wholly or in part, by property, equipment,
fixtures or Condit on belonging to or subject to the control of Licensee, or claims or
alleges that he or she is an employee of Licensor or is furthering the operational
activities of Licensor, Licensee agrees to indemnify and hold harmless Licensor for all
losses, damages, costs or expenses related to such claim, regardless of Licensor's
negligence.
(c) The liability assumed by Licensee shall not be affected by the fact, if it is tt
a taC, that the loss,damage,death or injury was occasioned by or contributed to by the
negligence .:f Licensor, its agents, servants employees, or otherwise, to the fullest
extent permittEd by applicable law; provided, however, that Licensee shall have no _
obligation to assume such liability to the extent caused by the negligence of Licensor or
its employees or agents where assumption of such liability would violate Washington,
Oregon, Idaho or the Province of British Columbia Laws. i.
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10. If at any time during the term hereof Licensor shall desire to make any use of its
rail corridor with which the pipeline will in any way interfere, including the relocation of
existing or the construction of new pipelines and other facilities in which it shall have an
interest, Licensee shall, at Licensee's own cost, within thirty (30) days after receiving
written notice from Licensor to such effect, make such changes in the pipeline as in the
judgment of Licensor may be necessary to avoid interference with the proposed use of
its rail corridor.
11. (a) Licensee shall, at its expense, procure and maintain throughout the term
of this License a comprehensive general form of insurance covering liability, including,
but not limited to, Public Liability, Personal Injury and Property Damage, as well as
Contractual Lability in the amount of$1,000,000 per occurrence and$2.000000 in the
aggregate. Such insurance shall contain no exclusion with respect to rail corridor of
Licensor in the care, custody or control of Licensee. LICENSOR AND CATELLUS
MANAGEMENT CORPORATION SHALL BE NAMED AN ADDITIONAL INSURED
(b) All risk insurance on the PIPE LINE of the Licensee, or Licensor's
property in Licensee's care,custody and control,shall contain a waiver of subrogation of
claims against Licensor. Licensee shall maintain Workers Compensation insurance
which shall contain a waiver of subrogation against Licensor.
(c) All insurance shall be placed with insurance companies licensed to do
business in the State in which the PIPE LINE is located,with a current Best's Insurance
Guide Rating of B and Class X.or better. Licensee shall provide Licensor in advance of
said installation a Certificate of Insurance evidencing such insurance. Insurance must
provide for coverage of incidents occurring within fifty (50) feet of a railroad track, and
any provision in the insurance policy to the contrary must be specifically deleted.
(d) A Railroad Protective Liability insurance policy issued in the name of
Licensor with limits of$2,000,000 for bodily injury and property damage per occurrence
with an rggregate of $6,Oo0,000 must be provided when construction work will be
performed within fifty(50)feet of Licensor's tracks. The policy will remain in force donna
the construction Phase f his proiect and must be provided poor to Licensor sic
-in hi
license
(a) The lurnishing of insurance required by this Section shall in no way limit
or diminish the liability or responsibility of Licensee as provided under any Section of this
License.
(f) Licensee shall be allowed to self-insure any or all of the insurance
coverages referenced above.
12. Upon wr%an notice from Licensor, Licensee agrees to assume the defense of
any lawsuit,or other proceeding brought against Licensor by any public body,individual,
Partnership, corporation, or other legal entity, relating to any matter covered by this
y' License for which'Licensee has an obligation reassume liability for and/or save and hold
harmless Licensor. Licensee shall pay all the costs incident to such defense including,
' but not limited to, attorneys' fees, investigators' fees, litigation expenses, settlement
payments,and amounts paid in satisfaction of judgments.
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13, (a) Licensee shall comply with all federal,state and Iccal environmental laws
and regulations in its use of Licensor's rail corridor, including, but not limited to, the
Resource Conservation, and Recovery Act, as amended (RCRA), and the
Comprehensive Environmental Response,Compensation,and Liability Act, as amended
(CERCLA). Licensee shall not maintain a treatment.storage,transfer or disposal facility,
or underground storage tank, as defined by RCRA, on or under Licensor's rail comdo:.
Licensee shall not release or suffer the release of oil or hazardous substances, as
defined by CERCLA,on Licensee's rail corndor. Notwithatanding any other requirements
in this contract, Licensee assumes all responsibility 10i the investigation and cleanup of
such release and shall indemnity and defend Licensor and its agents for all costs and
claims,including consultant and attorney fees,arising in any manner out of such release
or Licensee's failure to comply with environmental laws, regardless of whether such
costs or claims are caused or contributed to by the negligence or alleged negligence of
Licensor,except to the extent such costs or claims are proximately caused by Licensor's
gross negligence or intentional misconduct.
(b) Licensee sh.'l give Licensor timely notice of any release, violation of
environmental laws or inspection or inquiry by governmental authorities charged with
enforcing environmental laws with respect to Licensor's rail corridor. icensee also shall
give Licensor timely notice of all mnasures undertaken by or on behalf of Licensee to
investigate,remediate,respond to or otherwise cure such release or violation.
(c) In the event that Licensor rocenes notice from Licensee or otherwise of a
release or oblation of environmental laws which occurred or is occurring during the term
of this License, Licensor may require Licensee, at Licensee's sole expense, to take
timely measures to investigate, remediate,respond to or otherwise cure such release or
violation.
14, It default shall be made in any of the covenants or agreements of Licensee
contained in this document. or in case of any assignment or tn,isfer of thls License by
operation of law. Licensor may, at its option, terminate this Li,unse by serving five (5)
days' notice in writing upon Licensee; but any waiver by Licensor of any default c•
dntaults shall not constitute a waiver of the right to terminate this License for any
subsequent default or defaults, nor shall any such waiver in any way affect Licensor's
ability to enforce any Section of this License. The remedy set forth in this Section shall `
be in addition to, and not in limitation of, any other remedies that Licensor may have at
law or in equity.
15. Licensee shall promptly pay and discharge any and all liens arising out of any
construction, alterations or repairs done, suffered or permitted to be done by Licensee `
on the PIPE LINE and shall indemnity Licensor agains' any loss, liability or expense
incurred by Licensor on account of such liens. Licensor is hereby authorized to post any
notices or take any other action upon or with respect to the PIPE LINE that is or may be
perriitted by law to prevent the attachment of any such liens to Licensor's premises;
provided, however, that failure of Licensor to take any such action shall not relieve AM
Licensee of any obligation or liability under this Section or any other Section of this
Linenae.
16. In the case of eviction of Licensee by anyone owning or obtaining title to the rail
corridor on which the PIPE LINE is located,or the abandonment by Licensor of said rail
4
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corridor, Licensor shall not be liable to Licensee for any damage of any nature
whatsoever or to refund any payment made by Licensee to Licensor hereunder, except ..
the proportionate part of any recurring rental charge which may have been paid
hereunder in advance.
17. Any notice to be given by either party shall be deemed to be properly served if
deposited with the United States Postal Service, or other acceptable mailing service,
postage prepaid, addressed to either party, at the addresses and department shown
beneath signature of the parties.
18. In the event that License consists of two or more parties, all the covenants and
agreements of Licensee herein contained shall be the joint and several covenants and
agreements of such parties.
19. Any contractor or subcontractor performing work on or in connection with the
PIPE LINE shall for the purpose of this license be conclusively deemed to be the
servant and agent of Licensee acting on behalf and within the scope of such contractor's
or subcontractor's employment for Licensee.
20. Neither Licensee, nor the hel,s, legal representatives, si .essors or a3:igns of
Licensee, nor any subsequent assignee, shall undedease or sublet the PIPE LINE nor
assign or transfer this License or any interest herein, without the prior written consent
and approval of Licensor.
21. It is understood and agreed that this License shall not be placed of public record.
22. All the covenants and provisions of this License shall be binding upon the heirs,
legal representatives, successors and assigns of Licensee. No assignment by Licensee
shall be binding upon Licensor without the written cc isent of Licensor in each instance.
23, All questions concerning the interpretation or application of provisions of this
License shall be decided according to the laws of the State in which the PIPE LINE Is
located.
24. To the maximum extent possible, each provision of this License shall be
interpreted in such manner as to be effective and valid under applicable law, but if any
provision of this License shall be prohibited by, or held to be invalid under, applicable
law, such provision shall be ineffective solely to the extent of such prohibition or
invalidity, and this shall not invalidate the remainder of such provision or any other
provision of this License.
25. The waiver by Licensor of the breach of any prevision herein by Licensee shall in
no way impair the right of Licensor to enforce that provision for any subsequent breach
thereof.
26. Notwithstanding any other provisions of this license. Licensee shall comply with _.
Pill statutes, ordinances, rules. regulations, orders and decisions issued by any federal,
state or local governmental body or agency established thereby relating to Licensee's
use of Licensor's premises hereunder.
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27. This license is given by Licensor and accepted by Licensee upon the express
condition that the same may be terminated at any time by either party upon thirty (30)
days' notice in writing to be served upon the other party, stating therein the date that
such termination shall take place,and that upon the termination of this license in this or
any other mar,i ar herein provir'dd, Licensee, upon demand of Licensor, shall abandon
the use of!�- PIPE LINE and remove the same and restore the rail corridor of Licensor,
as near as possible, to the same condition in which it was prior to the placing of the
PIPE LINE thereunder. In case Licensee shall fail to rectors Licensor's rail corridor
within Thirty(30)days after the effective date of termination, Licensor may proceed with
such work at fine expense of Licensee. No termination hereof shall release Licensee
from any liability or obligation hereunder, whether of indemnity or otherwise, resulting
from any acts, omissions or events happening prior to the date the PIPE LINE is
removed and the rail corridor of Licensor restored as above provided.
28, This License is the full and complete agreement between Licensor and Licensee
with respect to all matters relating to license on the Premises,and supersedes any and
all other agreements between the parties hereto relating to license on the Premises.
Catellus Management Corporation is acting as agent for The Budinglon Northern And
Santa Fe Railway Company.
WHEREOF,the parties have executed this agreement in duplicate the day and year first
above written.
THE BURLINGTON NORTHERN AND SANTA FE RAILWAY
COMPANY
By: Catellus Management Corporation
Its Attorney in Fact
_ 4545 Fuller Drive,Suite 105
ruing,TX 75038
By:
Ja A.Ball,Manager Contracts
CITY OF RENTON,WASHINGTON
Municipal Building
�,,• 200 Mill Avenue South
Renton,WA,98055�5
By7
Jesse Anrr. Wyor
Till-
RWJ-2r ;,,,
ATfZY'1'r7
Naeilyo Grua, city Clark
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FILE NO.
EXHIBIT "A"
ATTACHED TO CONTRACT BETWEEN
THE BURLINGTON NORTHERN AND SANTA FE RAILWAY COMPANY
AND J
zi
CITY OF RENTON o
FORT WORTH. TEXAS SEC 30
SCALE: 1 IN. = NONE FT. T.23.N - R.5.E
PACIFIC DIV.
WOODINVI
I F .SUBOiv. L.S. 0405 �
DATE 01/14/1997
AIO
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1010
Tp Mw� O r /� ••�'
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DESCRIPTION OF PIPELINE i
PIPELINE SHOWN BOLD
CARRIER CASING CARRIER CASING
PIPE PIPE PIPE PIPE
SIZE: 12„ ,_2D LENGTH ON Rm 30' 30'
CONTENTS: WAT R WORKING PRESSURE: 60 PSI
PIPE MATERIAL: F'fEEL BURY: BASE/RAIL TO TOP OF CASING 5• -6"
SPECIFICATION / GRADE: RA
WALL THICKNESS: [G.L 7 BURY: NATURAL GROUND MIN
_ 0.379 BURY: ROADWAY DITCHES M N
COATING: NONE :6LO CATHODIC PROTECTION N N
VENTS: NUMBER N/A SIZE HEIGHT OF VENT ABOVE GROUND
NOTE: CASING TO BE JACKED OR DRY BOREr' ONLY
AT RENTON
COUNTY OF KING STATE OF WASHINGTON
RLN
DRAWING NO. 1- 00344
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Return Address:
City Clerk's Office
City of Renton.
200 Mill Avenue South .
Renton,WA 98055.2189
l (
BILL OF SALE 125360- 0
Property Tu Parcel Number: 1253800-021 1
Pram Ed,r.W 285 Suttl lmcrxcuon
201 SW 74eh Street
CranGranate tor(s):Number(a)of Docummis suigncd or rcleuetl:Additional mferc numbers,nec numbe are on page
Crantee(s):
I. Farvest Steel Corporation I. City of Renton,a Municipal Corporation +,
'I'h<Cnntor,u named above,for,and m ir.m.diermum of mutwl benefi6,herc6y grantt,bargain,sells and delivers to
the Crimea,u maned above.the following described personal property now located m: AO) Suit 3 it ST
- a
LF 0P gn D) P IJATEXMA,.
910 LP Of )ya DIP (.4AcrfzALAl a<
a• S rr 6{YTE VAL✓E'S
N ,art 6w'rErALk'85
d Fitt NVD¢Aa-r IF&g6M6Cf CS
1 %, PVc S'Pb-cM a a,E l V L IVO 4U SLJ
tfy thls cunveyance,Grantor will warrant and defend the sale hereby made unto Uie Grantee against all and ncry person
or persons,whomsoever,lawfully claiming or to claim Ne same. This conveyance shell bind the heiq execumrs,
adninlsualars and auigrs forever.
IN WITNESS WHEREOF,I have hereunto set my hLid and seal the day and year u written below
I C ENT d`jt lM
!1'U!V/DUAL FORAf OFACXNO1VSlEDGAI
Nmary.e ust be.;thin box /STATE OF WASHINGTON )SS
COUNTY OF ) ` t,
1 certify not I knownow or have satis(ndory evidena that �) �x T
`� -
416.
VI
signed this u:stm m me and
-
uknowledgW n to hi to/their frtt and menu ned�n the insw 1 turtles act for the uses mid purposes
rbp
�yu11R/,arr r Notary Pubic in and for the State of Washington
Nobly(Print) L-r•c>\ca
My R'Poin ant ea uu
Dated- 1.� 1 1
It TORv4Su.CREC J DQlOS.DOC"
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PROJECT CLOSING «^•'^••-
FINAL COST DATA AND INVENTORY
.UOJc6T. CITY MIO)ECT NUMnrim WTR.
WtT.
PAR EST STEEL SWP
N+mc of pro'ct TRO
TED
TO: Gry of Acmon I•xO.e HOrt2n 0--nn15 @ A550G.
M,n M'11 w5ution 520 Se ono Avenu& `;
MmninSJOundiA�/MIbRc wnlY.+ • K1rklOn NA G6033
200 Mill Axnue Sovn,
IkEmon,WA 98055 DATE. 1/819.7
Per the.request of the City of Renton,the following infomation h furnished concerning final costs for
Improvements installed kr the above referenced pram _
WATER SYSTxM CoNsTAUCTION COSTS
krvtth S:+c LP.of DIP DIP tYATERMAIN
I I L.F.of DIP LYATERMAM
Clio LF.of 12° DIP WATEAAtAIN
L.F.of At•ATLAN • i
RAOI of GATE VALVES
2 F{•CH of _ M. -- GATE VALVES
EACH of 12• — GATE VALLI_c
2 CACM of c -, — .IRE IIYDIIANi AS•IvuLrs 1 46,192.00
-(Cnst of fire l lyd.m,Tc' stodup,n(d)) 1 5,200.00
)ncludc EngncennA sna._..,Tu t applkmle 1 4+099•co `,y
TOTAL CASs I'OII WA Il'R SYSI LM a 5+.Del 1•00
SANITARY SEWER SYSM±M: V(IDM❑IUINAOp SYSTIW'
Length six Type I;nµdl She Type
LP of SEWN MAW LF.of STOW YN0
�- U u( — IIwEa MAW —� I_P.of _ STOW LINE
LP of N.,Yra uAw Lf n( y_ SfOM,uNE
_ EA of DUNEltll X• ,,OLn _ Fn VI MKII WLETR),f:U:l
EA Vf ol.MREF M WItb FA of �— Sm11A,G'KIIIL�<IN
pMluhnµ Pn14111n,M U$ T6 FA of . — SrOIlA1 GKINAHN
If TN1eWlc) ;IncA:oaS FwµllMennT and Zak,Tu
TOTAL<Orf1UM 5.Wl1'ANT IEWEII MI'1'A1 —___I mi-*r•1.M) , 1 = -
101'A,fAII ma S•OFaI 9nA1MALF SYSTCM
"t
SI1trZr IMI'IIU V PAIIiNTs: (Including QW I,(•nnu4 tiidc•+Atl,n.'.:ul:H•cn.cu a W hacl 1,11IN11)
CONGReTE 51LeWALK • $ 5,000.00 DRIVEWAY- 1`3_%W.00
- 1
10E PVC NORM UNe IN UND AVENUE $0-0a000.00
11ONnL'%s lION' p'wlaWinA lnF OclAO Guan.(:Iry^Snn4 ec'rr aY'.•a]Ala!l iA)
NIA
$TnEn LICM INC. (Ind wrnA C.., Ix,:A"c�u,.oIy n�,n rL...!.•A>,o",IA.I
16.
8RYANT 0. MERCIL. P.I!. 1 _ C2D5) 622- 2525
Pnm Slµmmp'nama ,WY IWwea e -
(SIf:hAIIIRE)
I,rr•.q•A!!,uMl lnn nn' lMµuuw:y. ulp•+ucd+lic+n
u.V•.na•,v metro a.reMMm nq
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05i 20/97 A 2:38 FAX 205 235 2541 RUNID, rr011.
Rel Address
City Cluk's Office
City of Renton
200 Mill Avenue South
Renton,WA 98055-2I89
Title: UTILITIES EASEMENT Property Tax Parcel Number: J,25380 0010
PM1.1 File A: Svra In¢nectwa v Pr9jut home 2 - -r
Reference Number(s)of Documents assigned or released:Addmao.l m!aence cumbers are on page
Grantor(s): Grantee(a):
I. G.I. JOE'S Inc., an Oregon I. Cily of Renton,a Municipal Corporation
2. 0oxporation
The Granter,as named abovr.for ur and in carmdemion clmunal b<ndus,herby g,uu, -hers,.11,and deW.to
the above mead Gnataa,lM(pllawu,g dwibA pe tonal Pmperry now looted n: Add,honal legal a on pµe
I of document. IAIIrMaellgaf demHpya AIUSTge Aen1
LEGAL DESCRIPTION: ,, POR.TIDU OF L0-r a-`K MpP RGCo O&D lu voLoH4
f`1 OF OLAts PA oS 9 THtleew /J.
See Attached Exhibit "A"
A
R.1lOM,SSCaECORD�,ASEaiEM Phi "µa FORM 03 9000bVCN41.97
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05,20107 12t38 FAE 206 255 2541 BENT0N PIRIM .t
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nrot(z) for and m cdnsidauion of mutual benclu,do b ths< resenn,wanatta unto the widGranke,...successorsus,g,,,anememem(oraasolibSlt usell,
ater,\vasmwateq end 5unc.e wa:a1 with necesz dIllibrad curyVpwteoanceover,under,through,across and
pagegI to ifbill 1e�(the not-I PaeI ey)in Kug County.Washington,more lwnicularlyVw P g Exhi6il A)ose of nsnstructing,recros,rucuc6.ihtll l u0t.papa g,replaucg,enioging,opnluig and
ngutilities and ctiliq•PIP11mal.includmP,bat not limited Id,wsor,sewer and stone drainage lines,
"gather with doe fight of ingress and egress thlrcw",moth Pont mslimtion of any sort or proceedings of law
and wialwm intoning en)kgal obhgelion or lia9ili:v therefor. Fallowing the initial construction of its facilities,
Granite may Goo rune•o lone construct such additional facilities u it may require lilts Wement is granted
mbjecUo the folbwmg Berms and ctmJniwn
The Grata Shall uPo\compkbon of any.,ore wt"n Nep
the essemms,and any pf.ux im r°Veb:owred by the ea¢menl meson Inc swfac<°f
proremcnb d vwped or dernoya dwvtg erew.ion a!1<aorz.as neel l u prnaicab.e w Ih1 cendnion may cue m,nmedu'e')before amnxncsmcnt of the w.a or e.u)b.the Grantee 1. Grant"She0 nmm mt rig",o au I"":'ace of Inc<as<m<et n song as such ate I.,not mterfem with In,uaemea
ngtes PraraW is the Goinere.
Gmsor rhwlnw.hewev<q h.the, h'to
is Erect or mantun uY hmldmge"moot.<s a ntm the ettemeut,or
1 b PIenI ua;Nrvb.er vgeun'•lwmg de<a roll
uhPlacedmay uuu danuge n a imerf<rt won nw"ka to beGreene.
vhith
wrdun O«amml pY Me Grurta;or'
t Ue\eloP landsupa a beabn6•IN usmol.ana in
the Granter of aaonng the eaawaent area uW rn M rayun would uomuonaplY tncauethe cots to
Mg. Y pwale smgorcmema tn<rnn
d D twnelwpe,form mhafomsuf ansu+nim ed\itkr on the
properp.w"ch w°utd d,ncrb the tnmPegirn or Mason Gruta',O:di;i"en the—ighbc!-way.or enlan er me I-,,e support hdnnes
e Boor within fihern(15)felt of Ne rg"of wn
This casement shell nn with the land descnbeo he,ain,Slid shell be hustling upon the P11m11,the.,hers•
succrusen in intoese ,it mrigna ';rant".ao"'m ns mu they M the lawful ownen of the above progenies and
tha they have a good and lawful right m execute thit agraanent
By rho conveyance,(I rran
ta on will wat usd¢efecd an,See north)made unto no Ore,w.agemn all and
every Person or,Paromiswhon,and to lawful:y cleimmg into claim the sane This coror," scrt Nall bumd the
heir,executors,admmisrtaon and ustgas forever
IN WfINESS%VMREOF.said Grano,has caused this insntaees:cube uMW this Wl
�2ay of S4�ii IV��
C.I. .TOWS, Inc. ,
-------------
BY: ^ President
a ! ta."Tkoxy 0F4 ek 4 a WU__P_G_A7jXr k.No!yY Seal muss be,within boa STATE OF WASNB:GTON iSS
Cwwry OF I:ING
s
1°min a:I sow°•hx.c Mobaclory evidence Inv
ac"rorkd __1.gn<d No uis ummt and
gad n Io o htvnnMelr fix and\otuyr an f"uu use sad Purlrows
rtenhonM m m<In<buenum
i
Nmam Public m and f"the Slate of Washington
Notary(Priml
I M)appointment exp"s;___
U hV _
H UUluasWCSo CURj•FASExfFM,DSc,
Sim
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K'
OS/20/aT I2:de FAX 206 235 2541 RENW% I'/WPN
--- STATt Of WARN GTOI; I WL£OCMEA'T
Naery Sul must be within Wx STATE OF WASHINGTON )SS
' I COUNII'OF KING )
1(miry tbn I Vow a havc mnfeemry eviden:e dun_ _
— - — _stance dais itsswmms end
.11.1d In it I,be hiNmrltlwar free and uolunWTas for the uses end purposes
asevsimed in the Inswmem
Notary Public inand for the Suit of Washington
Notary(Print)_
MY appointment expires:
Dated:
RafRf_ffMA 21VE f0 A a'LEOGNEM
Nossry Scef muse be within box STATE OF M'ASNINGTON I SS
COUNTY OF KfNG I
I mdih Wn I grow or Nvr utrshssory endeoa tin
signed this inan"on ,on ath
sired lbat ha/slwUn wea'ww uNnntai tv eeaum the tmwment end
eeLwsNedaed n u she_._ andfin -
of
- to be Ne eil end vaumen'ct ofmN
_ MrMNdesla the uses nd purpdsa ma�tionW iv de ivnmR(
Notary public in and for the State of Washington
Notary(Print)__
MY appointment expires:
Dated' —
.-�(ORIORw IE fOR.N OIy('RA'O EU NEAT e
N'e'ry nt N;mro m. 155 State of Oregon
1 Co mty of Clackamas
On thiI TLl t1\ :9 ,befa<me pmsonYiY appeared
Norman Daniels z i be in me Inmwe 20 w m;o9 YFw Ps-rei/lont of the ww.ia.thr
a mo execuusd the wlthm:mwmrnt,esd esbrrowltdae dse utd lustnsmeet W be Ue fro
C,<D and vulunsary ea asd died of Sal =p9m.oa fa dm uses and purposes titan '
v m v aT e'ahe was euNonssd In I..,,vid
r; meobosRd,and arh Co oW erreC Ihu 1
Imisz�s� iCanne"mand maltlN We Ifiktd isn"curpve[e seal ofaid Witaenm '
' COn3la tt t
agar ! G : 6 `.
f�em Notary Pubic in and fm the:Sum of
Oregon
N'1 Y`< Notary(Prinl).a')'L aN Ill N11
My appoinm2ent expires: 3_1j 11T7 -.
Dowd: .q
l;VORMStKCRECOR2xEA5EMlM.Okx\ r,ser FORM m 000a.WA:t.21.91
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EXHIBIT A
UTILITY EASEMENT LEGAL DESCRIPTION
(GI JOE•S PARCEL)
THAT PORTION OF LOT I,BURLINGTON NORTHERN BINDING SITE PLAN,PER MAP
RECORDED IN VOLUME 161 OF PLATS,PAGES 8 THROUGH 11 INCLUSIVE,UNDER
RECORDING NO. 9206302696, RECORDS OF KING COUNTY, WASHINGTON, LYING
WITHIN A STRIP OF LAND 15 00 FEET IN WIDTH,HAVING 7.50 FEET OF SAID WIDTH
ON EACH SIDE OF THE FOLLOWING DESCRIBED LINE.
COMMENCING AT THE SOUTHEAST CORNER OF SAID LOT I; THENCE ALONG THE
SOUTH LINE THEREOF NORTH 87"50'47"WEST 165.00 FEET; THENCE CONTINUING
ALONG SAm SOUTH LINE NORTH 02'09'13'EAST 20.00 FEET; THENCE CONTINUING
ALONG SAID SOUTH LINE. NORTH 87°5947" WEST 22344 FEET TO THE POINT OF
BEGINNING; THENCE NORTH 02*09'37"EAST 48.04 FEET, THENCE NORTH 47°09'37"
EAST 27.59 FEET; THENCE NORTH 42°50'23"WEST 89.95 FEET TO A POINT ON THE
WESTERLY BOUNDARY OF SAID LOT I AND THE TERMINUS OF THIS LINE
DESCRIPTION. THE SIDE LINES OF SAID 15.00 FOOT WIDE STRIP TO LENGTHEN OF
SHORTEN AS NECESSARY TO TERMINATE AT SAID SOUTH AND WESTERLY
BOUNDARIES OF SAID LOT I
Horton Dennis&Associates,Inc.
0 Aj` 320 Second Avenue South
4y` 'o w h7+tn� Kirkland,Washington 98033-6687
y� (425)822.2525
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CITY OF RENTON
IPLANNING/BUILDINGIPUBLIC WORKS
MEMORANDUM
I
DATE: July 18, 1997 _.
TO: Beverly Nelson Glode
FROM: Dee Beedle\
SUBJECT: Certificate Of Liability Insurance Farwest Steel
Attached please find a certificate of liability insurance required by the pipe line agreement on file in
the City Clerk's Office.Farwest Steel installed a water line under BNSF's railroad tracks.As part of
the requirement for that iroject insurance had to be provided to BNSF. A copy of the insurance
certificate has been attached to the license.
If you have any questions place call est 2631.
Thank
cr
H'MW60DOTMEMO.DOTah
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' .�. '.:^_I'ek Mti. .;.,... �+blf'Rn ♦�..�^M�'iNnl.'��!I'V° {��F�R YthF o
PenAalkgon Associates Consulting Engineers, J.c.
f Engineering• Planning•Sunnring•(on.ullioF DeU , 77
71O Sixth Slice( South, Kirkland, M N 99031 "M 110. /70
Phone:120at 827-2014 a Fax:120e1$27.50.1 ra. � : P TO
ZcbO �//7iLG LJv� S
c�nI TOJ .v,a. Pn LuA 4- I -.:iA
9io53 I Aio * LM
'1q WE ARE SENDING YOU b&IIII& had Under separate cover via _ the following Items.
I i Shop drawings Print$ Plana -: Samples C: Specnleations
C Copy of letter Change order _--
povin I DATE rp, - �n.�,J ,�DESCRIYnON rL'
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THESE ARE TRANSMITTED as checked below:
❑ For approval L] Approved as submitted C-' Resubmit_copies for approval
O For your use G Approved as noted -'Submit—._copies for distribution
❑As requested ❑ Returned to corectiOns C'. Refrain_corrected prints
❑For review and comment ❑ ----
❑ FOR BIDS DUE
_IS_ PRINTS RETURNED AFTER LOAN TO US
�y
REMARK 1C?c_l1/t L.! 46g
✓C .cam✓F�✓C'L7 77/E��E L>bLJ.►sCwlt'�� A.P.t4=T.4 __..__ �.
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AJG�.e /sI//eLelaXa T�/�'
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COPY TO
SIGNED:
11 encWI m nm e+none.ordir n u",us er wp.
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CITY OF RENTON
PLANNINGIBUILDINGIPUBLIC WORKS
MEMORANDUM
e
DATE, July 18, 199'
TO: City Clerk
FROM: D Beec!E
ee )
SUBJECT: _ Pine Line License
Attached please find a.au executed cop}of the Potable W'uter Pipeline License Agreement
If you have any questions please call ext.2631
10
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ACs2EQ. CERTIICATE OF UABILJTY INSURANCE PAGE 1 OF 1 GAYAA";I;I
ANODAPAR 994% THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bill'. C. room Corpor.tim of ERe.ne ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. 0. boa 13e7 MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ELT,srr OR 91 ALTER THE COVERAGE AFFORDED BY THE POLICAM BELOW.
IbITI 667-2222 COMPANIES AFFORDING COVERAGE
CourwY oa w Business Iruuraws Co.
V., Bost -. - ----- � A
-.
col►wr Bsesar IMsrx lNra leswarr CaEa.ny
I 9
FAIREST STEEL CORPORATION cONrwv
P.O. wx ss9 C —
EUGENE OR 97410 corwr
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Certificate Holder 's Interest is Included Per Form GL2008 10/93 Attached.
RE: Construction of Renton Warehouse.
This Certificate replaces evidence typed March 31 , 1997.
CERTIFICATE HOLDER CANCELLATION dept lO Dsy.PY M.peeRIYIL
M.O.RNY of TnE Aso"OraQl.m.AMas r aw04E0 UPON[T"
CITY OF RENTGN BASHIMOTOI nrw.TgX CATS rNMser,TH,sissi.e.la.NY YNA NWMNIWM esa
ATTI. BABY 46 eAYa RSIrnNRaTgr TO YXaE�IeYNHNBEII e.rEMnwMIIT,
MUNICIPAL BUILDING iL"DIL ResaYAaa
200 BILL AVENUE SOUTH eA"ANWVW-NW" WX
RENTON BA SM5
ACCORD 2e•E 11E4 AOOLINN" jo ACORO less ,
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t
1
Policy numb"' 232700055527
This endorsement is effective 6-30-% and will terminate with the policy. It is issued by the company desigaated
in the Declarations All other provisions of the policy remain unchanged.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Additional Insured Endorsement
Written Contract
This endwsament modifies uuurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following paragraph is added to SECTION 11•WHO IS AN INSURED:
S. Amy person or organization other than a joint venture,for which you have agreed by written contract to procure bodily
injury ar property damage liability insurance,but duly for liability arising out of operations performed by you or on vow
behalf,provided that
` a. This paragraph 5,does not apply w znv agreement to provide inswance to:
(It An"employee.'association of'employees'or labor union,except with respect to work perfor tied by or for you + '
or for such'emplowe;association of-employees"or labor union under direct contract between you as
contractor and such-employee,*association of'employces'or labor union as owners;
h
(2) Any railroad company except with respect to work performed by or for you for such railroad company under
direct contract or agreement between yeu and such railroad company; ,v
(3) Any person J organization whose profession.business or occupation is that of an architect,sw,,ym or engineer
with respect to liability arising out of the preparation or approval of maps,drawings,opinions,reports,survevs,
change orders,designs,specification or the performance of any other professional services by such person w
mganl:atwn.or
(U Any of vow subcontractors,or any partner,officer,agent or'employee of such subcontractor.
�a
h. The insurance afforded to any person or organization as an insured under this paragraph 5.shall include only the
insurance that is required to be provided by the terms of such agreement to procure inswanee,and then only'to the
anew that such insurance is included within the terms of this policy.
e The limits of insurance applicable to such insurance shall be the lesset of the limits required by the agreement
between the parties w the limits provided by this policy.
it. Additional exclusions. The mourance afforded to any person or organization as an insured under this paragraph 5.
does am apply:
41) To"bodily injury'or'properry damage'which occurs prior to the date of your contract with such person or
organization;
(2) To bodily injuW or*property damage'included within the'produces/completed operations hazard'unless such
coverage i•:cquircd by an'insured contract"between you and the additional insured.
� r
e
GL300S
Issued: 10-03 ,w
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AC CERTFICATE OF LUBILITY INStNtANCE DAT.I
milli.T r r
xaaorv.l
. PAGE 1 OF 1 6-MAv-1997
P. .. C000n Co.por•rion of Eugene THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
EU 0. aoe 1367 ONLY AND CONFERS NO RIGHTS UBON THE CERTIFICATE
EupPlu OR 97140 I HOLDER T THIS CERTIFICATE DOES NDT AMEND, EXTEND OR
(541) BB7-21I2 L..LTER THE COVERAGE AFFORDED BV THE pOUCES BELOW.
COMPANIES AFFORDMq COVE1IADE
Mary Boer COVAxYoY MMr... Ir.uranca Ce `.
_ CeAPAxr Ewwey IMBsrerfln� Imuranw.e Ca�ap, t
s
FMBEST STEEL CORPORATION tzAPANv
P O. BDe a89
EIMfNE OR 97440 _--_—
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MCAMCWTWITHATTNEPOUCIE6OFINSURANCEU6TEDBELOW HAVEBEENnBUED TOTH NSVREDNAMEDABOVEFORTHEPOLICYPERIOD
ei01CATED,NOTWITHBTANDWGANYREOUNIEMENi,TERMORCON TIONOFANYCONTRACTOROTNERD000MENTWITHRESPECTTOWHICNTN16
CXCLL C*M NAY C IUUED OR MAYUCHPOPERTAIN,THE INSURANCE AFFORDED aY THE POLICa9 DESCRIBED HERE W 13 SUBJECT TO ALL THE TERMS,
B1tClUSIDNB AND CONDITIONS OF SUCH POUClES urArts NgWN AMY NAVE BEEN REDUCED BY PAID_CLAUS_
_
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BCMmLLED.AUTOS BOpLY IxAMY
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AL mN
Certificate Holder 's Interest is Included Per Form OL2008 10/93 Attached.
RE. Construction of Renton Warehouse.
This certificate replaces evidence typed March 31, 1997.
CERT6ICILTE NOLD[R
CANCELLATNN/ ExRPpt lu Day.For
CITY OF RENTDN MASNINDTdi e...AxY er Tx.Ago'CIS-aEo ralr CIS/AS C.CQy{D nron TMR
Ate; aNly uraArax Pxn rxq.or,rx.a.uao eeNrAxr au IaRWTFR6a
MA
MUNICIPAL BUILDING !S eA'S wAlmxnenn Ta mcnnrcAn xoLgA Bes" oral uA
200 MILL AVENUE SOUTN IIrFiSeeelMreA1AIJISeORWerMMBBSeSr1aW11MTeSYeMBMATaIYaMM3etA3FF
RENTOM MA sBOB6 Au ereFBNNIMMaINN4SM.BWABY/YMABr!aAeY41BBrFexMIFxASrMIMMri1ASSr 1
I
ACORD IS.S r 11" /
ADOL IPM004
• `-�, ACOIID CORPOR/ATMNe ISBS
~ J 1
k
A
r 7-... y
;J#
,t POhcynumber 232700055521
This endorsement is effective 6-30-96 and will terminate with the policy. It is issued by the company designated
in the Declarations. All other provisions of the policy remain unchanged. 9
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Additional Insured Endorsement
Written Ccntract
This endorsement modifies insurance provided under the following:
V �
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following paragraph is added to SECTION II-WHO IS AN INSURED:
S. Any person or organiation other than a joint venture,for which you have agreed by wine-contract to ptocure bodily
injury or property damage liability insurance,but only for liability arising out of operations preformed by you or on your
behalf,provided that:
e
a. This paragraph S.does not apply to any agreement to provide insurance to: a
v (11 An"employee;association of'employees"or labor union,except with respect to work performed by or for you
Of for Such"employ", association of'employees-or labor union under direct contract between you as -x j
contracor and such'employee,"association ofemployees'er labor union as owners;
(2) Any railroad company except with respect to work performed by or for you for such railroad company under
direct contract or agreement between you and such railroad comp: i
(3) Any person or organization whose profession,business or occupatioi is the of an architect,surveyo• engineer
with respect to liability arising out of the preparation or approval of maps,drawings,opinions,reporu,surveys,
change orders,designs,specification or the performance of any other professional services by such person or 9
organization;or
(4) Any of vow subcontractors,or any partner,officer,agent or'employee of such subcontractor. r
Is. The insurance afforled to any person or organization as an insured under this paragraph 5.shall include only the
insurance that is required to be provided by the terms of such agreement to procure insurance,and then only to the ".
extent that such insurance is included within the terms of this policy.
c_ The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement
between the parties or the limits provided by this policy.
d. Additional exclusions. The insurance afforded to any person or organization as an imwed under this paragraph 5, j
does not apply:
(1) To-bodily injury'or"property damage'which occurs prior to the date of your contract with such person or
organization',
(2) To'bodily injury'or"property damage'included within the'produus/completed operations hazard'unless such
coverage is required by an'insured contract'between you and the additional insured.
GL2008
t (.cvued. 10-93
0
Y
'f
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I
CITY OF RENTON
I PlammngjBuilding/Public Works Depammem
Jesse T..,,Mayor Gregg Zimmerman P.E.,Administrator
February 27, 1997
Bob lama
Environmental Hza;th
1511 Third Avenue,Suite 719
Seattle,WA 98101
SUBJECT: DOH Construction Reports
Dear Mr.lames:
Attached are DOH construction reports as required by WAC 246-290-040(3)for the I.ilc Ang private
development projects:
Farwest Steel-SW 34th St w/o East Valley Road -
Copies of the purity tests and pressure tests for these new water mauls are included with each report. If
you have any questions regarding these reports,please call me at 277-6178.
Sincerely,
Neil Watts,P.E.
Plan Review Supervisor
Development Services Division
aucmm�sr s
a: J.D.t17�
i
i
I
110X-RPI'.n0r.A 1
200 Mill Avenue South-Renton,Washington 98055
®rm.o.o«caxn..sm..cycae m.w.zP.om�«w•.,
J
CITY OF RENTON
Planningi y Building/Public Works Department
1 ' GmU Zimmerman P.E.,Administrator
Jesse Tanner,Mayor
February 27, 1997
Bob James
Environmental Health
1511 Third Avenue,Suite 719
Seattle,WA 98101
SUBJECT: DOH Construction Reports
Dear Mr.James:
Attached are DOH construction reports m required by WAC 246.290-040(3)for the following private
development projects.
Faovest Steel-SW 34th St w/o East Valley Road
Copies of the purity tests and pressure tests for these new water maim are included with each report. If
you have any questions regarding these reports,please call me at 277-6179
Sincerely,
Neil Watts,P.E.
Plan Review Supervisor
Development Services Division
to
a
nsucMusa.
ac rQ WN.
s.
1 U0H.PYT.
200 Mill Avenue South-Renton,Washington 98055
J
i
v7K 2-72Z85
CONSTRUCTION REPORT FOR PUBLIC WATER SYSTEM PROJECTS
Effective September 9, 1983 the following Regulation applies: WAC 246-290-040(3)-A construction report
shall be submitted to and accept(d by the department within sixty days of completion and prior to use of any
project for which plans and specifications have been approved by the department for projects designed by a
professional engineer. The construction report must be signed by a professionai engineer. The report shall
state in the opinion of the signee whether the project has been constructed in accordance with approved plans
and specifications and the installation,testing and disinfection of the system were carried out in accordance
with depar-mnt regulations.
a) If a project is being completed in staged construction,attach a map and description of portion of project
being certified as completed as approved on date given below. AL
b) As future portions of staged construction projects are completed,each must be certified as required by
WAC 246.290.040(3).
c) Additional certification forms are availab'e upon request from DOJI offices listed below.
n.
City of Renton DOH Water System No. 7185PL
200 Mill Avenue South
Renton,WA 98055 Referendum No.(if any)
p
PROJECT NAME AND DESCRIPTIVE TITLE: Date Specifications Approved
City of Renton Water System by Department of Health
King County August 18, 1993 ,w
Renton Project Number VJ7 R 27 2_g5 (1990 Comprehensive Water System Plan)
Project Title: Fnvv,!CsL flee ( — Sl✓ 31� 5"t `//a tas7t, 11n Pcc,l
The undersigned engineer or his authorized agent has inspected the above-described project,which as to
layout,size and type of pipe,valves and materials,reservoir and other designed physical facilities has been
constructed in accordance with specifications approved by the Secretary,Department of Health,and in the
opinion of the engineer,the installation,testing and disinfection of the system was carried out in accordance
with the specifications approved by th ry.
1 /
r�� �sCr v^ a Engineer
Eaglater's Saab
Fc b 2 7 I 1.1 i.
Date "
Please return completed form to DOH office checked below: - -
NW Drinking`Hater SW Drinking Water Eastern Drinking Water
® Environmental Health ❑ Environmental Health ❑ Environmental Health
1511 Third,Suite 719 Mail Stop 7823 1500 W Fourth,Suite 305
Seattle,WA 98101 Olympia,WA 98504 Spokane,WA 99204
X.DIVISIONS W rt LM ESDOCA%46].DOC
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CITY OF RENTON WATER DEPARTMENT
Pressure Test 6 Purification Test Form
PROJECT NO.
NAME OF PROJECT Y 5 '
I
PRESSURE TEST TAKEN BY 6F CL.'K4 ON 7
AT A PRESSURE OF 44) PSI, FOR I3U MIN.
TEST ACCEPTED ON '7
PURIFICATION TEST TAKEN BY CF 1169U)b ON
PURIFICATION TEST RESULTS, SAMPLE N1
SAMPLE x2 UlI/-
SAMPLE 03
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[CA
rt Plat (SHPL M )
REQUEST FOR PROJECT M im. Plat (PPM \
LM
To. Technical Services Data JJ WON 7 f- - GrmnM
From: Plan Revtew/Prcject Manaver ;}C,.•.4, �
Project Name
(Te cluncas mu)
Description of Project:
i
Circle Sae of Waterline: 8" to- 1�2 J Circle One: N� or Extension
,Circle Size of Sewerline: ` g" ) 10" 12" Circle One: _flew or
Circle Size of$tormline: 12" IS' Ib 26' Circle Orc: Naw or .�renswn�
Address or Street Name(s) - Jti—
$I'LYI.I BRGT uAz,LEy,
/� 1�
Dvlpr/Contntt w orrOner/Cnslt r\V V 1 1 C1JN6T/.t.�r M. ) Cn
(gaY.rw�q
Faie\IjFST srgr[ P1J10/ P )
Check each discipline involved in Project Ltr Drwg M 0(shoeb per discipline
J J
Trans-Storm .�., r,
(Rosdwsy/Dra..ge) OS.nc Mwu•snwtuXlrct.de w.m el (Muds TESC swsu)
i9
O Transportation (Si�i.v a iv. uvo c
C) Wastewater -
(srwrr s..e wsin)(irctrs
l Water
ii-- r _ ct�.wd...pra,dt onstw0
iS Use only I,=- 40- d 1S
IJT/1 _ a-7- ;L KL W - nays
SwA - 77 - a�' 85 4e_. e)--
Approved by TSM Date:
r mwmaavxmo.o0c:co�
1
4
I
" is Z5 sY-'Ql:esPn'AcYS =ca+siacrTw
P.2i2
Hornbeak Irrigation, Inc. 13 DATE: -- !I�SA?7
a57 I36thn.S Brr/ry�
Bellevue.WA 98005 WATER MTRR:T.
(206)641-0734 FILE ND,
cH.am.xosxm•1eo® L.
BACKFLOW PREVENTION ASSEMBLY ^4+cltr.TP/Y C/3/47
r TEST REPORT
NAME: 64.4 '�d S r S�r t L PHONE NO.:
ADDRESS: 3- O/ S.(✓. �' . .
CITY: A m
LE�t�j%�`d`i� —RIcfD PRUSURE a.cIawW ASSEUJLV
a ZIP; I G'r`� oovua CHECK VALVE AGSEKM.Y MI URE VACUUM BREAKER ASSEMBLY
NAKEOFASSEMBLY FrlCu MODEL: r" ri B __SERIAL NO. h'OD
SIZE; - / e'`&,/ WATER METER NO.: __ LWE PRPSSURE_ PSI
LOCATION OF ASSEMBLY: hrLri 56rer'�. J'd✓T(j/ TiOv' dof ✓ pr• �
REDUCED PRESSURE ASSEMBLIES PRESSURE VACUUM BREAKER
COVBLE CHECK ASSEA®UES RELIEF AIR'L ET CHECK VALVE
.a-,CHEc: H I eNOCHc,;I VALVE
BMW TEST DCdaew pDN �}` _ Dpenw et ,pm
F^ Pee
'..wfw __............:: Dom*W.____.0 LUK......
_..._...._.O
PSAARS
YCRV Arrs11 Ol'�».n eeN rLMMI eeM_..._._n OOffi Ou+ewM
REPAIR PP pW ..-_-MM __ryM
AIR GAP INSPECTION. Requi o YMMum Wr 94P sePanem Provided......... Yes __ No
PLUGSIN TEST CCOKS.. ..................................._.................................I.....Yes NO
REMARKS
1 RTIFY S REPORT TO BE TRUE AND TESTED•V:
SIGNATURE
A.STATE CERTIFIEO TESTERS FOR NORNBEAK IRRIGATION ANO CERTIF.NOS.
�AV NORNBEAK(.BAT D_]O) __.. ROBBIE JUSTGLEN(.BAT 13")
CULVID-RED"CIMSUREK(mB^TO533)-_ _GREGORY GALBRAITH(.BAT 16De)
1 } � t "
rr ?� ati�r+91q
Ri
E nT4'ed O—At r b/;/Y/
ORCA "" �3/97 Water Purveyor:
Backflow Testing Services 917,1-74-6e1
P.O.Box 41 •Buckley,WA 9E,21
T%r (206)863.7001
NAME: F—qc 3.Sf_-fitL _ FILE NO: c Z'
SERVICE ADDRESS:� ,<`JF1:_/ j! � i6p,7z.-,
LOCATION: M��sie1L� .T� ( Kr (-�Q')'"• 5.5.'J—
CROSS CONNECTION CONTROL FOR:_Qb�"tC S. 3d/s TYPE ASSEMBLY: RIW
MANUFACTURER: Fa4C6 MODEL:82� SIZE: P �/ SERIAL NO: 8 h/3 E.2 y _.
--Awftanu,Tw R AFTER REPAIR OR OLEANINO
U.R aat . _
Aesetas pop Avon. P..pap Across
M.l Check VW. 7. J —_ urd No.I Chsclt Vwe . __ Pad _
PAW VWe OpeneE 'AS .ra pad A"VaNs OP d pad
No.I Chsde: Closed dpla..........................q No.1C Cb..d lipe......._.................0
Lexted ._............................❑ Leaked .........0
No.2 Cl sdk: Closed her,.........................4 No.2 Checb Cbaad twe............_.........—0
Lasked_..----...I.................0 Leaked ........._.....................0
Peered Tex: Yee—*No— Peeasd Test. Vat—Nn_
L)le Resetas
Ne.I Qvida, Cbsad Goo................._.....0 No(;he*: Cbsed aye................._... O —.__pad
Leaked..................._.............❑ L.W d........................._......❑
No.2 Ow*: closed UVN.........................0 W2Chede CbaWBd7__.....................
0
taatad..._ ............... L..kad..............._.................
0
Passed Tex: Yes_Nn_ Prsed Tesl. Yas _No_
Lkw Pwawn
AF Iran: Opened R, A.bkt. Opened —"id
Fs.Ndb opxt......_.__.._.....❑ Fasts urn......................❑ pad
ctleelt Ve *: _ —_Rio check:aNe. _. _Paid
Laskad _____._.❑ Leaksd......... .._...................❑
Pbmd TW: Yes No_ Pittard Teat Yse_No_
kthkasn Sepnabn. Yes—
No-IS THIS A PROPER INSTALLATION Yea NO -
Water Service Fond: On ,X Ott WaW Service Lek: On —( On
REMARKS. �St'4��� -tom• c�nc. 77 c_ ._/A. Ccs T 'Z
Teat EQupnwnt: Mate cr Mods R _ So ial a 23 Y'a�_Accuracy Vnil'nMipnT Dw
Assembly Tested: rAt atactcrdy ) Faisd
A
I CERTIFY THE ABOVE REPORT 70 BE TRUE '
Gmlrotl Al:�41y''.JT°• /moo•T-'/Kn 2[J6 �863��uar ':�..xj,
Initial Test By!`�'1'ad�( Cart No f?78 Dale .5A/9� Z — -
Repakod By: Cart No. Dee ..
Repar Test By: _ Cast No, Daft
W+sa
tit _..... ... ._.:..,. ,,. .:.,...,:.....u.;+ .... . _._. �
L_ �
1
I
3>si c llnt:oyl (e�3I9'] .
ORC A t� c-i3i4� Wait"Purveyor:
Backflow Testing Services c-Ty
tee„ra
P.O.BOX e1 •Buckley,WA 98321
(206)863-7001
NAME: Fa^-. 'i-f _ S 7`Q� FILE NO: 1( 2-
SERVICE ADDRESS:_2,Q I S W 3 Sim
LOCATION: r. . t( T 7'r�nl ! t S •.,� e� ljm �d'�
3n 77� h .4ss Pam¢ ie sue- --
CROSS CONNECTION CONTROL FOR: DaMocT.'C SSE ,T TYPE ASSEMBLY: elpdyi_
MANUFACTURER: F 4c, MODEL:R2 ti r SIZE: 2 �� SERIAL NO:ZOy%;,/^
NITiA4TEST REMOM AFTER REPAIR OR CLEANING
Fewae.Dmp A.s / Pr.se.Drop A.,
ND.I Clerk VaN.—_. 115, P.O W.1 CI aoI _. paid
A"VareOpered -- -�- Pso Rotor VaM Opened
p� — psd
* NP.tCMck. cwwtyx....__.__. ._... W.1 Cneck. closed tpx _..........._..._._..❑
l«ka. . ....._.._...,...___.❑ Leaked _._.._._.._...............0
No.2 deck: Clowd rant ............. .........4 r10 2Check Cwscie hi ...........-_........❑ 4
jL.kw _.. .._..__ _ ❑ Lsakea _.... ..........0 s
I. Teq: Y. No—
Passed Teel V._Np_
Lan P ewes
W.1 Chock: Cbeed Yya.........._.._..........0 No CMa Ckaxdl i
_.....0 p.ie
W.2Cnedc: Card Yye...._....._.__.._0_. No Check Closed tiplN __.___...._.....❑ —
lasMd.........................._._.O Leek.d._ '_"___.._......_...__.❑
Pawed Teel: Yes_No_ Passed red Yes_W_
lateealaa Ne _
Aa a11a1: Cored B r$'� Ar Inlet Opened _petit
FaMdbePt......................❑ F.4*d b apen.......__...........
0 peq
Check VeOl: RIO Check Vehe._
L.eked._............._...............❑ L«k.d.................................0 pea
Passed Test. y._No-- Passed Test Y._NG._
kWv Separator: V"_W_ _
IS THIS A PROPER INSTALLATION? Yes 0No �l
Water ServiceService
Found: On r—.j� 08"-1— Water Left: Oo/r_ ON _
REMARKS: PYr-IL eI sue.. CJou te -Assn.v_'f_1Qq.Joa..
Test EVNcTlste Make Model 83� $arialp 3�r_ u7 Accam, 7 VoreYjpe Oats Z.�'/al2
Assembly Tested. Satislxtarry Failed_ '
I CERTIFY THE A E REPORT TO B TRUE:
Centilied N11
�� i+�^. g212 n _ ��" )8�_7 �c��✓�/��
Inalal Test By/Q.s,aod!C":�.:, Data
Repay By: Can No. Data
Repair Test By Cal Ne Deb
J
F
Gn'+�apA Owrcr �/3/5)
OFA _i soil n L/3/V7
11,4 6/3/57 Water Purveyor:
Backflow Testing Services f,, „�
P.O.Box 41 a Buckley,WA 98321
(206)863.7001 d
NAME: Trf-e/ FI'_E NO: ? I I2
SERVICE ADDRESS:201 SW �Y� Re T n
"ese w
LOCATION: Sp,ijkja/ C' r4
CROSS _
CONNECTION CONTROL FOR: 9.rd 50ni>t AAE_ .STytSf_ TYPE ASSEMBLY: L)c-/).a
MANUFACTURER:EM&Q MODEL: A55'i<_a=: G a BEAL&NO: ?KZZ19/Y/L/
FND-
aTEST RESULTS T AFTER"EPAIR OR CLEANING wrd
LMa Flswee
Plosome pW Press..pop Across
No.1 Cerck Vpaid tb.t Ctuck Vwe_ psid
Pe�M yWe Op __ pid Relol VWe Opeded paid
No.t Check d M1pfM....__........ No.1CMck. Cbeadd�e ❑........_................
ed.._.._................_.......0 Looklml_............._......__..._.❑
No,2Ciedc: ed sqN.................._..._.❑ rb.2Clnck CbecIl*d ..................._0
ed _. ....................❑ LeNad.............._........_........❑
Paeaed Tell: Yes__No— Passed Test Yes_Na_
LIN,Paeanaa
No.l Caadced aid e.....__......._......,,@�.�_ NO lctp ckwwsgN_._._.._._...........0 ped
d................................❑ Leaked _..._..._._._.............0
No.l GLNIcsOddd.......................�d �,. M 2Check. Cbood...........................❑
passed TactNis_ Passed Test Yes__No—
uses PremiseswId
At bed: ned We Ar Mkt Opened paid
d*4*m........_.............❑ Faeedbmp n.......................❑ Paid
C hade WNe: ch VeNe. Psq .a....
Looked. . ..................._❑ Looked _.__..... ❑
Passed Toot Yes_Np_ Passed Test Yes
aNmm^aparakpc Yoo_Nb_
IS THIS A PROPER INSTALLATION? Yes 1_ No
Water Service Found: On)— 08 Water Service Left: On g Off
REMARKS:
Test EOuilxrent: Malin n. c-/ M0"Aln Ssna1 a 2 /7 Ax,@cy V,, WI Deb 7
Assembly leered. Sabstacto*�71y-- Failed
I CERTIFY THE ABOVE REPORT TO BTUE:
Cenitkd tit r_,a/ . /c-1-21%ra
Initial Test By"T Sit)_ Cot No. Date TI'/^q,
Repaaed By: Carl No. Dab
Repek Test BY: Can t.10 Wb
i
S�
J
ww"'A"
s7 .1
I
F
F ^1 �s1�U41ion 3 4ry /
On Water Purveyor:
ll Lf
Backflow Testing Services
P.O.Box 41 •Buckley,WA 98321
(206)863-7001
NAME: forlu.Q s*2a%/ _ _ FILE NO: —
SERVICE ADDRESS:_ 20� S W
�, cy J m
LOCATION: �O .�khL- Ge�Y" U� »7 S tS S d �.�_/s h rt
7
CROSS CONNECTION CONTROL FOR:B Da6S o jafp4,�n a.+ - HA/6- TYPE ASSEMBLY:
MANUFACTURER: kAln MODEL: $, _SIZE: SERIAL 140:410 1�33
ITIAL'�TEST:RE8UG TEST 9iMRAEPAIR'OR ?.. "...
Lbs P,pwa
Pres.Drop Aawa pneave Drop Awaa
No.l Cl V.N* paid No 1 Cta,.k VSNe _ pad
R*W VaNe Osrod peld RNe1 VsNe Opened_— _ - Pad
No.1CMck. cored sye ................._......0 No tcnedr Coral aye_.__.. _.❑ '..,
L**9d......................._.........o Lcked- _❑
No.2 CMck- Cbsdede... ..........0 klo 2CMd CbeWlrpa __..❑ •
LeY,W..................................0 Laskad..............
.___.._,_...,..D
Passed Teat Ys_Nil_ passed Test. Yee_Ns
Lin p,wwaa
No.t C, Clow bpN .................. No ,CM Clond t 9k .........................0 PsA
................._..._..0 Lsakw.___....................
......0
No.2C Chad fig" ._....................A /•5 No 2Ct k CbsadlpM_...._....._...........0
Lacked_.........._......__..._.....❑ Leskad. .........__.................0
Passed Teat Yaa No_ posed Tw Yn
the prsave _
AN Inw Opawd 88,i? Ai Ir':t Ope sd_— pas
cord bepan............._........0 Fmisdbopm ..-........-0 pad
Gleak Very-. Pilo DNeckVWa. — pw
LeYnd..................................0 Lsakad _... ....... _._...❑
lased Teat. Yes No— psaad Teel. yap, _No_-
Iii,ssn separarm Yes_No—_..
l8 THIS A PROPER INSTALLATION? Ye•. No
Water Service Ford: On 11 X —WSW Service Lett: On Se 08
REMARKS:
Test Equiprrer,,' Make Mode Sarol a 2S?YZ Accuracy Vereiceeian Deis
Assembly Tessad: Sekslaclarily�_ Failed
I CERTIFY THE ABOVE LE REPORT TO TRUE: [Y
Certiilad In r �.c/ r. mac.7��sCrl —
�rdry�yg wyek.s ^"'ke
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Repay Test BY- Cart No. Date
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Hornbeak Irrigation, Inc. DATE: Y/ �Ag2
857 136th N.E.
Bellevue,WA 98005 WATER DISTRICT:
(206)641-0734 FILE NO.
Con.Llc#HORN BI'191
BACKFLOW PREVENTION ASSEMBLY
/ TEST REPORT
NAME: /'/M✓mod f! PHONE NO.: _.
ADDRESS: f J • Y /�OS�__ _
CITY: �N�/".IJ'i� r - -f
_REDUCED PRESSURE BACKROW ASSEMBLY _
ZIP: O J J _ DOUBLE CHECK VALVE ABB RIEL•YY PRESSURE VACUUM BREAKER ASSEMBLY
MAKE OF AlSSENSLY: ( ke-g .7 MODEL: "'J S SERIAL NO.._�oy/y Y�
SIZE: 6.. t'vGN WATER METER NO.: LINE PRESSURE_ PSI
LOCATION OF ASSEMBLY: IAI rlQ6 S/l'! Sd✓7eV SYpr
REDUCED PRESSURE ASSEMBLIES PRESSURE VACUUM BREAKER
DOUBLE CHECK ASSEMBLIES RELIEF AIq INLET CHECK.VALVE
1STCHECK 2ND CHECK VALVE
Opened at
INITIAL TEST CCdpaW bghl tight C lw al S• y. •,ps4 _ Dsi4
RP, paq lstik4tl ....] _pKE
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REPAIRS
TEST AFTER DCcioee4 light ] CloseUeghi ] Op#tr4M OP#m4 at psm f
REPAIR RP, "d _..PM
AIR GAP INSPECTION: R utretl minimum air gap separation provitleD..-_.......Yes No
y
PLUGSIN TEST COCKS:...................................................................................Yes No
REMARKS:
RTIFY REPORT TO Be TRUE AND TESTED BY:
SIONA ___
A.STATE CERTIFIED TESTERS FOR NORNSEAK IRRIGATION AND CERTIF.NOS.
JAY HORNBEAK(#BAT 0274) ROBBIE JUSTESEN(KBAT 1344)
DAVID 'RED'CIMBUREK(#BAT 0533) GREGORY GALBRAITH(#SAT 1609)
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Loucks Tasting Leboretotkfs,Inc.
NOS Narw Seanle WA WOOS
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION'.READ ONSTRWTIONS ON BACK OF OO.DENIMOOPT
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MTE Cd1ECTE0 TNECOki ECTED COUNTY MIME
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5A05 Ramey Seame WA 981M
WATER BACTERIOLOGICAL ANALYSIS
I SAMPLE MIECTION READ W RUCTIONS ON BACK OF GO(UENROD COPY
a kTFbuoNonF w TW ICIIaTNN,FFnTPY*0 M Nloolod
o DATE COLLECTED TNAE COl1ECRD COLINry NAME
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D DS Haney Sean WA WIN
WATER BACTERIOLOGICAL_ANALYSIS
SAMRE ODLLEf,T70N'.NEAR MSTWCTM ON SMX OF GILDENNDD COW
a NMMMMMMaMMW WNMISM MPNPe.MFIPMPNMMRpMMl.
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1 SWRCE TYPE OR0NE YMIEN LWEE Su«ACE Of UF110E
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