HomeMy WebLinkAboutWTR2702716 WTR-27-271 6
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WATU ATMODEN CREEK PLAT
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PROJECT NAME:
ALIAS: 141c>Vs 3
CONTRACTOR(IF KNOWN):
PROJECT NUMBER: pWTQ 2�7 2'7 t 10
WORK ORDER NUMBER:
STATE CONST.REPORT
SIGNED BY: N14 WW4, flo a1z81��
YEAR PROJECT TAKEN INTO PLANT: 1911b
RECORDED BILL OF SALE:
RECORDED EASEMENT:
COST DATA INVENTORY: PIPE$ 5z1 O? r HYDRANTS
BACKFLOW TESTS: Y N
PURITY TEST: no.taken 2 Tat No(s) �� 3 Z•
PRESSURE TEST: - ZV`Ie , 44111
�'RO,j�GT WIANACsP�z: kn`{Pk'AJ �LrC((ZIG�
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Rums Adrbess:
City Clerk's Office
City of Renton
1055 S Grady Way
Renton,WA 99055
20000202000f186
PMf.E aet or
Real?et.az.teee ests
CITY or REMTOtj a5 to 00
BILL OF SAL6 Properq Tex ParW Numbar. o
ao Projen ile M:C 0 / �• 0� 9e7
Soy 5 d D1W 1 Pp�• SE m Raferouee mumbar(s)of 041cm11emj osssmed w Maased:Addinooal se•aepce numb¢•ate o0 o Grantor( vaic_
0 I. C o2�ietk PaJttrtULA L.L.C.. Graeotee(a):
0 2 1. City of Renton,a Municipal Cotpotatioo
t� The etor,at earned aba' fw,eM N m...�
Nc Gnn 4 deradea o mutual bmeGts,heroby gmnn,W4.p s,s is and W.,•.to o taa,Me named oboova the following cibd personal properly: �t
Por-1 iCti e� • k4 sit -H, 330 it, a
� s-f
fJ04- +1-,- L.)I + sow+ht2aS+ eyuant�
Tcae� k• p a3 A)o Pio,�je S ECLs+ LJ.M
kt `' C Dom. y rJaY/`t OOOQ110 ly;, - W�d{s,��
4 1 (W� ai-{-&jcII I sI$,, 13 F 0'A u e x.,.e
CArt
G I I C a.t..ot 40 . .S C_'7 0 1 1(p� ;
nEx a°P+ Se 44,, 3 0 �u•�
vun�IN QX +Pi-e t_,t4a- 6T- R1-114 ur Vod-X
CM UIVJeA. kta,j C(,t,, � fLLLdtd(rtq No.
"1 4D9sor r31�
BY elite tonveYum Grantor will wararr and dduW the sale hereby made wlo the Geetstee or persona,wtmmsoever•lawfully claiming or to Uwn the smx. This ada Atunal all and every person
admipi9"t m end assigns fenver, veTanee shall bind tM bail,aaewrory
D.WV4\lg0SDB.D0,%
Page I
W a o00
WI7i�ESS Wf♦ERHOF,I6ave daeuuW xt my hand and wl the dry and year as wcitrc¢below.
Notary`SWmi STATE
OF WASEEN T O�
Notary$al mart be within box STATE OF WAST$iGTON )SS
COUNTY OF KING )
I°utitr ttat I know or harr satis6cto ism thm_
Pared this InWumeat and
acknowledged it to be h" ,their free and voluntary w for the UM ted pmppstl
nitadoned in die' ant
Notary 014C in and for the State of Washington
Ao (Print)
appointment expires:
ted
A77i'a FO (OfAGCNO Ivr
Nogey Sc`l 'msvigro box STATE OF WASKNOfON )SS
II tCOUNTY OF KING )
11 t /f 1 catib"I know or have satisfactory evidecce that W� -l i ma
QaI
m iyy 7 aj MLOU
1 "� Q"�n atEetd this kaMmmC on Dash
sr=cd that balshamb, waUwal. fired 10 excage the iafeumeot and
o 4=3T s wlap it at th< rtltTb m and
o % tJ F +t o Pa t be Nc and vo:uoLry am d ttte6
c� r hti�= _Patp'/Datatl far the utc and PuspoRs in the mSY1�faG
rl � �4Nwssw
�.+c,fwe.( (Zt-Qkta�. l7
F ary Public in 6 for the State of W
o Notary('mot)
--- r
o My aPPoiovnant�ires:_ e Y
CV aAr8 F0 A NO
Notary SW mtut be within box STATE OF WASIENGTON )SS
COUNTY OF KING )
Go Nis__day of 19__,before me personalij,appeared
me known to
of the corporadon that
"Oni ed the within Wuromant,and acknowledge the aid lasasime d to be the fsce
and VQluotary am and deed of said corporation,fa the uses and purpoon therein
mentioned.and each on oath stated that helshc was antheriaed to eteatc said
uutrurneat and that the seal affued is the corporate seal of said earporation
Notary Public in and for the State of Washington
Notary(Print)
my appointment expires:
L nae& --
u
�y�y iEl
x V j :
a
t
Return Address:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton,WA
PAGE Oel0210 000"00�12 00E187
CITY Or RENTON trs 9 ee
BILL OF SALE Property Tax Parcel Number:101305_go•ty
Project File a. ;,,i'rlw SVeet lnterxetion: AJGr.\!,j (A16t.f1d PLAffi
GFGrzntor,
Graotee(s):
1aEE.PS PARTI,4E4L!> t u 1. City of Renton,a Municipal Corporation
r Tamed above,for,and in consideration of mutual benefits,hereby grants,barg .s,sells and delivers to
thamed above,the following described personal property now located ar.ATE.S AT }ItDt,7Ea CSt.EEK
o in the City of Rcnton,County of King and State of Washington,to-wit:
cmv 1 (PWF-) 5R2EET Ll6414T STA1,30ARD ArJO ASblx\ATEO \TET^`.o
c 1.00 tZATt• fjOD%0M JAPGR osAo.
N
O
O
O
o By this conveyance,Grantor will warrant and defend the sale hereby made unto the Grantee again all and every person
N or persons,whomsoever,lawfully claiming or to claim the same. This convcya.ree shall bind the heirs,executors,
administrators d ass' s fore
IN WITNES OF,I ha hereunto set my hand and seal the day and,year as written Selow.
911
fAPt. GREEN F�ARTtJERb,wc
Notary Scal must be within box INDIVIDUAL FORM OFACXNOWLEDGMENT
STATE OF WASMNGTON )SS
..xxvss COUNTY OF KING )
Qn t t I I certify that I know or have satisfactory evidcace that a O V H
r h,�r,O raa G �O• f I� sired this instrument and
`,• 7��� aclutowledgedd\it to be his/her/their free and voluntary ac:for the uses and purposes
mentioned in the instrument
a
X N64,Public in utd for tiro State of Washington
rtrt +�'htw„„` Notary(Print) DAY
JARRIG
ttttttOl M1"`.�� My appoin nt ex tires 0'Y
Dated: ISp
rr.
H:IFORMSU:CRECORDtBOS.DOObh Page I
1
INDIVIDUAL FORM OFACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON )SS
COUNTY OF KING )
1 certify that I know or have satisfactory evidence that
signed this instrument and
acknowledged it to be his/ha/their free and voluntary act for the uses and purposes
mentioned in the instrument c
Notary Public in and for the State of Washington
Notary(Print)
My appointment expires:
Dated:
REPRESENTATIVE FORM OFACKNOwLEDGAIENT
Notary Seal must be within box STATE OF WASHINGTON )SS
COUNTY OF KR G )
I certify that I know or have satisfactory evidence that
a\ signed this instrument,on oath
m stated that he/she/they was/were authorized to execute the instrument and
o acknowledged it as the and
0 of_ to be the free and voluntary act of such
a parry/parties for the uses and purposes mentioned in the instrument.
N
O
o Notary Public in and for the State of Washi,rgton
Notary(Print)
o My appointment expires: _
N
Dated:
CORPORATE FOR.N OFACKNOWLEDGaIENT
Notary Seal must be within box STATE OF WASHINGTON )SS
COUNTY OF KING )
r On this r_Z�*day of 19 511 before me personally appeared
q i t 1y�a 11�P:a N 4_` C� •It rt t— to me known to
be of the corporation that
executed the wi n instrument,and acknowledge the said instrument to be the free
0 and voluntary act and deed of said corporation,for the uses and purposes therein
mentioned,and each on oath stated that hdshe was authorized to execute said
it •'• 46e�QS"f instrument and that the seal affixed is the corporate seal of said corporation.
tttaar""��� Nq1tqt Public in and for the State of W gton
Notary(Print) JANICE REBE CA DAY _
My appoint ert a pares: id 03—
Dated: ► a e
H.tFORMMKCRECORIhBOS.DOCIbh page 2
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1111000000�� � 5355�S S $ $ ° h t
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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 submitteu to and accepted by the department within sixty days of completion and prior to use of any
project f 3r 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 professional 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 aril disinfection of the system were carried out in accordantj
with department 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.
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 available upon requ-tst from DOH offices listed below.
City of Renton DOH Water System No. 71850t.
200 Mill Avenue South
Renton,WA 98055 Referendum No.(if any)
PROJECT NAME AND DESCRIPTIVE.TITLE: Date Specifications Approved
City of Renton Water System by Department of Health
King County August 18, 1993
Renton Project Number ln/jjZ 2127 ;� (199�mprehensiveWaterSyctemPian)
Project Title: Estate, of tl i d t o Ue e k Plug"
The undersigned engineer or his authorized agent has inspected the aboN e-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 the,4ec5 ary.
Engineer
Engineer's Seal
ei.t
Atf �8 (�� 8
Date
Please return completed form to DOH office checked below:
NW Drinking Water SW Drinking Water Eastern Drinking Water
I] 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
H:DIVISIONSUUTILITIES\DOCS\96-367.DOC r
r
1
+4254307300 RENTON DEV SUCS/PLPIN 490 P03 PLG 17 • 15:29
PROJECT'CLOSING fLUR9C«l I)th
PNA Mff Uh AND INVENTORY and lo.mmn
SUBJECT: CITY PROJECT NUMBERS: WIR-
I
� WWP-
a'�'akc 2 Rudd]Lao.- SWP-
Name of project
TRO-
TJD.
TO: City of Retuoo FROM: COeO Y aJc ,✓�VTf is !�
Ptah Rtvier Section In I n ATF f--M 51 S Hr IDf
Pl+nmag/Bwl6owpubLc Work' F]9JlC✓ue, LVA RE,00ta-
200 Mil)Avenue South
Renton,WA 96015 DATE: 7
Per the request of the City of Renton,the following information is furnished concerning final costs for improvements
installed for the above ro(cretued projeu.
WATER SYSTEM CONerv(rr ON COSTS
Length Size Type
L.P.of L2
� P.of RATFRMA
— . � WATFRMA
LP.
�a.LL LF.of
LF.of �— . L DO WATFRMAIN
WATERMAININ
�( off HACRof
GATE VALVES
EACH of - . GATE VALVES
GATE VALVES
Z EACH of FIRE HYDRANT ASSEML IES S 21e o
(Cott of Pine Hydrants'be lifted separtte))r)
(Indude Pagioxaiog and Sales Tu if appliuWe S
SANITARY 1
TOTAL.COST FOR WATER SYSTEM S
SYSTEM
S10RM DRA_MAGB lYSTRM;
L.mph Size Type
15p LF.of ,m Siu ,
ypo
�� LP.of ��4�f SEWER MAN 7 Y 9 L.F.of _I
/ S / 1pd
7a LP.of SEWER MAIN —.t- 0 L.F.o! �_ �—A4 SWIM LIMB
Inc LP.of _, �,-,�4 STORM LINE
i PA of • DIAMETER MANHOLES -- I EA of 72 y?O •6LU.T STORM B JZrRovnET
BA of DIAMETER MANHOLES �_ EA of T� • �X_ STORMCAICMAS04
(LucivGng Psglnm(ng and Saks Tan _�� EA of _ •U o =STORM CAT0$ASRi
il applicable) S ()aeWQr>q Pnpaeciog and Sala Tu =ar
TOTAL COST MR SANITARY SEWER SYSTEM S � _ 0. '( itapphae{e) S
TOTAL CYST TOR STORM DRADIA@SYSTEM
STREET IMPROVENMNTS: (Including OAb,Guroe.Sidewatk,Asphalt Pamaucat ad Sne<t Lighting)
Curb_SS yc_ rim sr a� IKs //6oLF
SIGNAII7ATION; (lndudiog Eng.Dulgn Conn,City Permit Fee,,WA St Sala Tu)
STREET LIOHTING: (includint Peg.Dui Cost,.tiny Permit PM.WA St Saks 7Le)
l ' TOLE —T1 t�2 o c)
W I L I- I i} /i f N, wl
Print a(goatory name
��d'r Pb°°a�
(Mod0DSTDAT2D000b6 (STGNATVRE)
(SignatorytrasctMAodwc¢cdagad .
or ow of mbject developtwtt)
Short Plat 'at Y )
RE OR PROJECT H Prelim_ Plat (PPk `I 7-CSU )
9 �!�',✓V� CAGa
k"To Technical Services Date WOb.S GreenM LUq -
0SO
S
ccl7o c)a-
From: Plan Review/Project Manager
Project Name +✓STATE$ AT k 1pbiz N C12C W- eL4T"
(70 ch r mu) -
Description of Project: 17l!>7 l f A YZ yc&AC F-ri 1 NC �(]I Ntl WY1T P , SA�I i A� �
STbtCf-1 VfW�Ti �AVINh Ir„r� C�4iTtl2i � nr_,.at�� flf. )�� l(()�LJJ
Circle Size of Waterline: D8 10" 12" Circle One: or Extension
Circle Size of Sewerline: 10" !2" Circle One. (n�e_w) or Extension
Circle Size of Stormline: 15" 18" 24" Circle One: ew or Extension
Address or StreetNd e(s) e1fl0 C V\e_\4AJ Ayc (St /N P'It Sl
DvlpriContractor/Owner/Cnslt ICI, TIl11AC�Am � TlA1MA k + ASSUC
o chuvars
�IMNhf-LE ENI�I AI F--c=12.1A��
Check each discipline involved in Project Ltr Drwg #of sheets per discipline
J J
®" Trans-Storm h1Q(XE�y� p v
'/ (RoadwayMrainage) t 3 'u:improvemmnNindude bum (include IESC Y¢ela)
G'7 Transportation (Siv iizli n Ctumrcl"ua t,01,g) V
fib' Wastewater r
(Saniury Serer Main)(include buin name)
C Water (Maim,Wd ,Hydnnu)
(Include composite k li r mul Cul Sheen)
TS Use Only -40-,n.V6 -2716
IRO - 4l -2716 T- 271
YVWP- 27-21 r6 S 27,6 --
W17R -Z7-2-7r6 W-27/G
Approved by TSM Date.
faeem/misu9T-090.[>OC/CDhh
M
Loucks Testing Laboratories,Inc.
940 S.Hamey Seattle,WA 98108
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION.READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If WNWINIaMM M na11a1bwU,arnPIO WIN be
DATE COLLECTED THE OOLLECTED COUHIY NAME
tldxM DAY YGII
TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLETE:
CI GROl1P
1 LD.No.INOIVNXIAL J '� �j JB I.
NAME OF SYSTEM
tic 5 EI�SMgE 00 TELEPHONE NO.
DAY /t -7
EVENNOI ) I
SAMPLE OOLLECTED 6Y:0LMms1 SYSTEMOWNERAIGR.:06m)
i
, S I
r) k
SOURCE TYPE U GROUND NITER TINDER SURFACE INFLUENCE
❑SURFACE —YIFl1 F FEW ❑SFRIFvG ❑KIFICKTEHIHAESED m []COMBINATION
S�ynEpORr TC}.IPAM w+ yyr�naZIP
.ZUC7 Mi I I A t'JL c�
TYPEOMRFFpSSUIlI ATER ❑AMPLE(sI
mNaIIEMYOW NMn•caunn)
❑Dp CN Na aNL (P**",._TOW_FW)
tlIMIM[M'aMEMA - ❑FWANd
❑REPEAT SMILE
NMiNFOOMMI PNwlos labs
Dow I I
❑RAW SOURCE WATER Soup E a m ❑TM1 ow".
F.W CONSTRUCTION M REPAIRS ❑FwlCaaam
OTHER(Spwfy)
ILM USE OILY)Opoo q WPM RILLIe
[]UMRATISFACTM..Cdknm OIEM.A ❑
SAMPLES
❑E.00lp%moM ❑E.CON sOaNA
RFAIANIB) ❑F-w PIESNM ❑FgIa1wIM
OTHER LABORATORY RESMle
TOTAL Or.•IFORM_,4_,/1O0 N E.COU-A-I100mN
FECAL COI:.-ORM_n00M PLATE COUNT_AM
ANOTHER SAMPLE REOURED
SAMPLE NOT TES'EO BECAUSL TEST UNSUITABLE BECAUSE:
❑Swr&MOoom ❑CMs.MpmWl
❑WWp ONMiw ❑TNTC
❑MmIONMF form ❑TUMd OJWn
❑ ❑ELCFM Atolls
SEE REVERSE SIDE OF GREEN C(`PY FOR EXPLANATION OF RESULTS
Lmmvowm DATE,TIME RECEIVED 1EWVEDr
QS! ti Jam + I Z ��
DATE REPCRlED LANORK711W: _C r
7h
- WATER SUPPLIER COPY
mucks Testing Laboratories,Inc.
940 S.Harney Seattle.WA 98108
I
W R BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION READ INSTRUCTIONS ON BACK OF OOIDENROD COPY
N NgYRPOPm m not/pbRRl,.ARIMM M n�leYE.
GATE OdLECTED THE COLLECTFTI OOUNrY NAE
NNINm RAY YlM . .•y I:'
VN l J ❑PM
TYPE OF SYSTEM IF PUBLIC 15Y91'EM.COMPLETE:
iwmairi+VYW L�.1�D. RC 8
NAME OF 3Y3Tm
SPECIFIC IOQOMg1� ENE. COLLECrm TELEPHONE NO.
fv
EYEFr•NGI 1 I
SAMPLE COLLECTED BY:#I'm" SYSTEMgNNBlum:olml
SOURCE TYPE GROUND WATER UNDER SURFACE FAIMEWX
[]SURFACE PW %ELD ❑SPRING ❑ a ❑OOMMATM
SEND REPMTTQkfflii�A NM �INapPOPbj .
TYPE OF SAMPLE(�0*arR in#aRounNs
uoMnn)
❑DRI LONG WATER ❑Clft*w110 MW&wt-11411111_Fmo)
d"Pen ma - ❑FBNOC
❑IIIpMNdnOlrr
rJ REPEAT SAMPLE
` P�aRbm pnwnca ltl P
0111% i
❑RAW SOURCE WATER Sam..a = ❑TdW Gomm
a+EW CONSTRUCTION or REPAIRS ❑FmM OHMam
OTHER(SINNIHy)
(LAID LATE ONLY)GBBNLNHG WAIM RPJILTS
.❑UNSATISFACIORY.C4PaIIIR aAF.N ❑SATISFACTORY.
coBnnRA.M.N
REPEAT [SAMPLES _]E.CPPprMrM ❑E.CCP AOMMIM
REQUIRED ❑Feet PRPRIU ❑FmY.DPwN
011E911 LABIWTOWINASKYS
TOTALCOUFO{W—A—n00m1 ECOLT--,&noon
FECAL COLIFORM_n00 no PLATE COUNT Ant
ANOTHER SAMPLE REQIRED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE-
❑Swrpb wow ❑COnRNMm Wr
❑wmv aXNuwTNTC
❑MmlpYr aim ❑❑Tww awn.
❑ _. ❑EAowalem
SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION EV Ti Sul.
UB NO n ONPTEI DATE THE REOFNED RECENED ev
DATE REPORTED IACIIRTORY
N
NIOINIRI
WA/EH SUPPL!EH COPY
CITY OF RENTON WATER DEPARTMENT YJ
Pressure Test 5 Purification Test Form
moo. l=e1
NAME OF PROJECTjd
PRESSURE TEST TAKEN BY
AT A PRESSURE FOR—Z_A IN.
TEST ACCEPTED ON S �/4P AF
PURIFICAT ON /
PURIFICATION TEST RESULTS, SAMPLE 01_ Y
SAMPLE •2
SAMPLE •3
REMARKS:
a
CITY OF RENTON WATER DEPARTMENT Uf Z1
Pressure Test 6 Purification Test Form
Bk
NAME OF PROJECT
PRESSURE TEST TAKEN BY� f./lkX1�W� ON
AT A PRESSURE OF Z4r, PSI, FOR Z 11L0 MIN.
TEST ACCEPTED
PURIFICATION TEST TAKEN BY� T�i1IL ON
PURIFICATION TEST RESULTS, SAMPLE M1 1
SAMPLE •2 ✓
SAMPLE M3
REMARKS:
k