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HomeMy WebLinkAboutWTR2702814 WTR-27-2814 BEGINNING OF FILE r , a WATER PROJECTS Cet SIERRA COURT SHORT PLAT r 20000127001060 Return Address: e i i7�ieeoF ix City Clerk's Office etrr eF RiN70N gas KING COUNTY tia, UN City of Renton 11.se 1055 South Grady Way Renton OVA 98055 Title: UTILITIES EASEMENT Property Tax Parcel Number: Project File M: LUA-99-006—. Street Intersection or Project Name:--Union Ave NE _ Reference Number(s)oe Documents asri3ned or released:Additional reference number are on page—. Grantor(s): Grantee(s): I. James R. Hawley 1. City of Renton,a Municipal Corporation 2. Katherine L. Hawley The Grantor,as named above,for or and in consideration of mutual benefits,hereby grants,bug,Lu,,ells mtd delivers to o the above named Grantee,th9Yollowing described property. Additional legal is on page 3 of document. (Abbreviated legal description AfUST go Ana) LEGAL DESCRIPTION: SEE EXHIBIT "A" 0 0 c� PORTION OF LOT 21 SIERRA TERRACE DIVISION NO. I VOL.76,PG,53 AND Si. 0 o ALSO A PORTION OF SOUTHEAST QUARTER OF SECTION 4,TOWNSHIP 23 RANGE 5. 0 0 N:IFOP.\IS`XCRECORD\EASE,\tENT 000 Pas,I FOR.\I 03000"h'CA2.21 9: �t g That said Grantor(s),for and in consideration of mutual benefits,do by these presents,grant,bargain,sell, convey,and warrants unto the said Grantee,its successors and assigns,an easement for public utilities (including water,Wastewater,and surface water)with necessary appurtenances over,under,through,across and upon the following described property(the right-of-way)in king County.Washington,more particularly described on page 1. (or if full legal is not on page 1--Exhibit A) For the purpose of constructing,reconstructing,installing,repairing,replacing,enlarging,operating and maintaining utilities and utility pipelines,including,but not limited to,water,sewer and storm drainage lines, together with the right of ingress and egress thereto without prior institution of any suit or proceedings of law and without incurring any legal obligation or liability therefor. Following the initial construction of its facti: ?•c Grantee may from time to time construct such additional facilities as it may require. This easement is granted subjt•t to the following terms and conditions: 1. The Grantee:hall,upon completion of my work within the property covered by the easement,restore the surface of the easement,and my private improvements disturbed or destroyed during execution of the work,u nearly as practicable to the condition they were in immediately before commencement of the work or entry by the Grantee. 2 Grantor shall retain the right to use the surface of the easement as long es such use does not interfere with the easement rights grafted to the Grmtee. Grantor shall not,ho aver,have the right to'. C Erect or main apt any buildings or structures w„Fin the easement;or b. Plant trees,shrilbs or vegetation having deep rw,u.snems which may cause damage to or interfere with the utilities to be placed within the women[by the Grantee;or c. Develop,landscape,or beautify the easement area in my way which would unreasonably increase t:,e costs to the Grantee of restoring the easement area.and my private improvements therein. d. Dig,tunnel or perform other forms of construction activities on the property which would disturb the compaction or unearth Grantees facilities on the right-ofway,or endanger the lateral support facilities. o e Blast within fifteen(1 S)feet of the right•of•way, c This easement shall run with the land described herein,and shall be binding upon the parties,their heirs, o successors in interest and assigns. Grantors covenant that they are the lawful owners of the above properties and that they have a good and lawful right to execute this agreement. N By this conveyance,Grantor will warrant and defend the sale hereby made unto the Grantee against all and o every person or persons,whomsoever,lawfully claiming or to claim the same This conveyance shall bind the heirs,executors,administrators and assigns forever. IN WITNESS WHEREOF,said Grantor has caused this instrument to be executed this Gda)of 2.Jcw f,�bIt7OC'A(.!'OR4 OrACax'OUIF.DGdrFA7' - Notaro Seal must be within Fov STATE:Ol'WASHNGTON )SS COUNTY OF KWG ) N' I certify that 1 know or have satisfactory evidence that %%go i�, Ja i Q 4 KGttwit.xa � signedWsinshvmentmd �t1 ��sa a ay,Qg. ecknow1edged it to be hisAter yeji fan and voluntary act for the uses and purposes gL • Ot afrlr rr ! mentioned in the instrument - . wOl10�x� 1e r% t1'�;��r Notaryry Publi the State of\VasluO ngton t0♦ �►5N . Notary (Print)_ -$r•P Fr'%*_SJO� My appointment expires $ 4A• a.AO3 Dated: 1 19 >-OGV N:rF'OR.USUxRECORDlF:49EWNT.DOC% Past 2 I EMBIT"A" LEGAL DESCRIPTION (Must be stamped by a P.E.or L.S.) A PORTION OF LOT 21 OF SIERRA TERRACE DIVISION NO. I ACCORDING TO THE PLAT THEREOF AS RECORDED IN VOLUME 76 OF PLATS AT PAGES 53 AND 54,RECORDED OF KING COUNTY,WASHINGTON.ALSO A PORTION OF THE WEST 120.00 FEET OF THE EAST 150.M FEET OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 4,TOWNSHIP 23 NORTH,RANGE 5 EAST,W.M.,KING COUNTY,WASHINGTON DESCRIBED AS FOLLOWS: COMMENCING AT THE SOUTHEAST CORNER OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SAID SECTION 4;THENCE NORTH 88009'40"WEST ALONG THE SOUTH LINE THEREOF 30.00 FEET TO THE WEST MARGIN LINE OF UNION AVENUE N.E.;THENCE NORTH 00058'38"EAST ALONG SAID MARGIN I INE 354.68 FEET TO THE MOST SOUTHEASTERLY CORNER OF SAID LOT 21;THENCE CONTINUING NORTH 00*58*38"EAST 7.16 FEET TO THE TRUE POINT OF BEGINNING OF HEREIN DESCRIBED UT9LITY EASEMFNT;THENCE NORTH 89026'59"WEST 124.90 FEET TO THE BEGINNING OF A CURVIf70 THE RIGHT HAVING A RADIUS OF 73.00 FEET;THENCE ALONG SAID CURVE THROUGH A CENTRAL ANGLE OF 19002'17"AN ARC LENGTH OF 24.26 FEET TO THE POINT OF A REVERSE CURVE TO THE LEFT HAVING A RADIUS OF 47.00 FEET;THENCE ALONG SAID CURVE THROUGH A CENTRAL ANGLE OF 17049'50"AN ARC LENGTH OF 14.63 FEET;THENCE NORTH 88014'32"WEST 31.59 FEET TO THE POINT OF A CURVE TO THE LEFT �., HAVING A RADIUS OF 22.00 FEET;THENCE ALONG SAID CURVE THROUGH A CENTRAL ANGLE OF 90046'30"AN ARC DISTANCE OF 34.86 FEET;THENCE SOUTH 00058'58"WEST 52.69 FEET;THENCE NORTH 88014'32"WEST 15.00 FEET;THENCE NORTH 00058'58"EAST 42.99 o FEET;THENCE NORTH 88014'32"WEST 11.00 FEET;THENCE NORTH 00058'58"EAST 10.30 �' FEET TO THE BEGINNING OF A CURVE TO THE LEFT HAVING A RADIUS OF 22.00 FEET; THENCE ALONG SAID CURVE.THROUGH A CENTRAL ANGLE OF 89013'30"AN ARC �+ DISTANCE OF 34,26 FEET;THENCE NORTH 88014'32"WEST 10.29 FEET;THENCE NORTH 0 00058'58"EAST 26.00 FEET;THENCE SOUTH 88014'32"EAST 112.24 FEET TO THE POINT OF A CURVE TO THE RIGHT HAVING A RADIUS OF 73.00 FEET;THENCE ALONG SAID CURVE o THROUGH A CENTRAL ANGLE OF 17049'50"AN ARC LENGTH OF 22,72 FEET TO THE POINT OF A REVERSE CURVE TO THE LEFT HAVING A RADIUS OF 47.00 FEET;THENCE ALONG `" SAID CURVE THROUGH A CENTRAL ANGLE OF 19002'17"AN ARC LENGTH OF 15,62 FEET: THENCE SOUTH 89026'59"EAST 125.10 FEET TO THE WEST MARGIN LINE OF UNION AVENUE N.E.;THENCE SOUTH 00058'58"WEST ALONG SAID) F1FTC-TFTC-T,T 'TTjE POINT OF BEGINNING. i. " ,; N IWO& 11 TOPWMCRECOMEASEMENT.DOC\ Pape-3 FORM 030000/bh'CA241-97 I 000 012 1001065 I I I I 104' ------ --- -- -- -- - � 1.)<' F. s si' n -GF wo o . 6&3S I AooREss{� ADpRE=S� 1 6,150 p.Tt. 6,263 RM1. u 1 0.14 aun GA4 p.R. 01A O.tA Dues • .. 3 $ 2 0 1 v r8 ! P Z R.l0.00 AREA FOR PRIVATE EASEMENT FOR k1GESS. EGRESS k AODRESSZ� G�Ly.'�°;r 5001 U10.1TES F[� )D ! 26'E REMAIN N ).W WDSCAPE EASDACWT PLACE 123RT _ • t WS9S^ta__ M` - IIRiO[ _ ___ }f4L2i� O 4'1135 -- _ _ — IL.JJ' 30.M :I if e w 100. „ S W1s72' E 6).OT M l9Z6'S9� • _i-Mffti-r _ - 1.11 LANDSCAPELANDSCAPE EASpIXT n 55. I�As% a g / Kf+ L-I .dF"+r ZY.e�NElt _-�u� ADORE w ifij_______ L�1QfiT ♦�1.. T N 997659 • 12Q w ).35) s ft e I • I T-1Te9'YY r ! 0.1) onasse+e+rt sasr� ; 5 _ AEA OF EASEIEMT FOR �yrt L__ ---1 13.a3 s ft' INGRESS. EGRESSUT SS k RJTES 1 h: 0.30 ovn TO THE a"OF RENTON PER 4 1J W RECORDING NO. '' \\` ` L��+ p � MORESs•�Nil I S e y �31w 40.7. E'1 Egg 1 1 p WW z ! I FEMCE y el �rwSE SEWER y 0. 6FT •000 sY0 I ! j g` It W11-3 w' SGAO' — iSIERRA TEKn, CE DIV. NO 1 , I "FT wDCO FENCE I 0 10 20 40 VOL.76, PG. 53 I 1CIT,'Tarr EASEMENT PER I ! if STREET VACATION ORR0. /3370 I SCALE 1- = 400 I I I ! I Return Address: CiTY CF MNTON K t� N City Clerk's Office City of Renton 1055 South Grady Nay Renton,NA BILL OF SALE Property Tax Parcel Number: 779100-0070 Project File M: LIIA-99-006—PP Streatimcnection: Union Ave NE Grantor(s): .Tames R. Hawley and Grantee(s)t 1. Katherine L. Hawley 1. City of Renton,a Municipal Corporation o The Grantor,as named above,for,and in cr nsideration of mutual benefits,hereby grants,bargains,sells and delivers to o the Grantee,as named above,the following described personal property now located at: .n Sierra Court Short Plat. See Exhibit 'A' . in the City of Renton.County of King and State of Washington.to-wit: N Water Main d Sewer Main. See Exhibit 'B' . 0 c+ c , By this conveyance,Grantor will warrant and defend the sale hereby made unto the Grantee against all and every person or persons,whomsoever,lawfully claiming or to claim the same. This conveyance shall bind the hews,execu'on, administrators and assigns forever. IN WI •SS NVHEREOF,I haav%e hhereunto et my hand and seal the day and year as written bolo%,, Le Notary Scat must be within box INDIVIDUAL FORAf OFACKNOIVLEDG,s1EAT STATE OF WASHINGTON )SS COUNTY OF KING ) 1 certify that 1 know or have satisfactory�evidence that �0► FAf 1a` 0.'M`!S �Q' X :t A6,16� signed this insintment and acknotsiedged it to be hi lthei a and voluntary act for the uses and purposes`aas/a��.,'• mentioned in the Insuument i w'. ♦`L\L w f e r Notary Public in and fp(iNe Sute of 1Vuhington a Notary(Print) PJ'fCtAl�4 \ V 0� #I Malw•d My appointment expires: �°)_}O��j Datcd t. M—aU60 H.IF0RaISV:CKECORD:B0S.DOC11bh Page 1 � 1 - I EXHIBIT "A" LEGAL DESCRIPTION TRACT 21, SIERRA TERRACE. ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 76 OF PLATS, PAGE 53. IN KING COUNTY, WASHINGTON; EXCEPT THE NORTH 73.53 FEET OF THE EAST 5 FEET OF THE WEST 210 FEET THEREOF; TOGETHER WITH THAT PORTION OF THE WEST 120 FEET OF THE EAST 150 FEET OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER, SECTION 4, TOWNSHIP 23 NORTH. RANGE 5 EAST, W.M., IN KING COUNTY, WASHINGTON LYING NORTH OF LOT 21.-SIERRA TERRACE, ACCORDING TO TH= PLAT THEREOF RECORDED IN VOLUME 76 OF PLATS,.PACE 53. IN KING COUNTY, WASHINC'ON, AND SOUTH OF THE FOLLOWING DESCRIBED LINE: BEGINNING AT THE SOUTHEAST CORNER OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SAID SECTION 4; THENCE NORTH 82'09'40' WEST .',LONG THE SOUTH LINE THEREOF 30 FEET; THENCE NORTH 00'58'58" EAST PARALLEL WITH THE EAST LINE OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 4, 39'� FEET TO THE TRUE POINT OF BEGINNING OF SAIL, DESCRIBED LINE; THENCE NORTH 89'26'59" WEST TO THE WEST LINE OF SAID EAST 150 FEET AND THE TERMINUS OF SAID DESCRIBED LINE. 'UBJECT TO AN UNDERGROUND ELECTRICAL EASEMENT AS RECORDED UNDER KING CO. ..a RECORDING No. 7910310734. o (UNABLE TO LOCATE) n SUBJECT TO AN UNDERGROUND COMMUNICATION LINE EASEMENT AS RECORDED UNDER KING COUNTY RECORDING No. 8003050545. (AFFECTS THE. EXTERIOR 5 FEET OF FRONTAGE BOUNDARY LINES) SUBJECT TO RESTRICTIONS AS CONTAINED ON THE FACE OF SAID PLAT. o SUBJECT TO SLOPE RIGHTS AS DEDICATED IN SAID PLAT. SUBJECT TO UTILITY EASEMENT GRANTED TO THE CITY OF RENTON AS RECORDED UNDER o KING COUNTY REC. No. c� I i 1 EXHIBIT "Bit PRO) T txOsING to Fleei �•- • FINAL COST DATA IINDINVHNTORY eee L2=0 HUHIKT LuL-00-O+few....MtueCT NUAtRW: Wrl,• 5 Wd A 1rYrp r.� �•� ,�M S:lme ef3nfw -MO. 10. Qpo!Renton IROSI', IIa+Rndw Seetien I4Wn�uddinSlvS3<\YadO - SOO SLII A•uwe]tuN R,nlon,WAf1O11 DATE: Per the request of the City of Renton,LAe following Informallon Is tumL h,4 eoncomflg Ontt eosD for ImprOvamenls insoUed for the above nterenced project. WATER SYSTirst m4SMUcrimLWTS, }-MO doe LRN N'AIITUTAII:WADMAIN LF.et WATMIAM I HACK of `OATH VALVES ' i o HACHeel • sbn OATHVAL%Ts 1 c HACS et _may_OATH VALVI I [A41 of FRHHYDRA:.,ASSEAIBUES S r (6st efHn Ns'drva mmoh nWepveW-;`- 3 N (Inelud.LV.,wdnsmd3du Tefiftter Ole t — r• 7OTALCOTr FO0.W'AT6RSYSTEN 1 O $AbjTARY eRWaII SYSIESf' $()ZRM pRA1NAOR 9Y.t'r'R\I- IAe Sir, TT Leedlb Sit. T lf'' byl LT.oI 4 SM ALVt1 _704 LRef 17 CAI STM%' r.n `., �_LF.of iMlR1AAi:r .yam LF,of •'_(i`T STourtZim n Ll.st • $MAR NALv -TvQ STORM LM HAef �$TTUSiLI ALLViJLIf T SA eI t i1DRAl t\IiTNYiut � t-F.Aof • p,A,vlr{R ALUNOl61 HA of TORTICATLttaASN w.n+,n]Hn/ne,hl a.�u HA of STOM1 cATC1bA3N 101q NU 1 Dn, cW re"S ailil aab Tu-- TJTALCOSTIOAIANRARYSMl!tSTSTOr f ItyeLu3L) 1 _ • MTAC QViPoe ITOMIpMNAet{Y1TRU 3 lTR3q MIROYla13.\'i3"(Jnela,n3 Ct+R,Ouu<o ilee.ale,ApSJl Hvtmtm enn T+n�4yluep SICNALUATIQC, (LwW4iq E,g.D.A,fi CO.%Qlr Famil FMr.1YA It Sshs 7aJ 3TRE[TLIOH-75O (1,04m3liq DWI,Cori,Ctk Temdt F,ea,WA SI S,te,TaO pe".sis'W")nnnr Imns e vu (SIO\ATUM itIuWMMA'rt1]OOct eery munhn:S3r4eW&Itn: - • _ - er n.wre!wej v;e,nlepwNl f i A I 1 12/02/1999 13:35 2062712623 .IIM HAWLE\ PAGE e2 PROJECT CLOSING H lral Dw 1 FINAL COST DATA AND INVENTORY Old 8UE1lCI: 'XfityYti Lqi✓} (Ys YFROn3CTNi)MRRRS: WTA _ .� . 5 •t PIA} wwp. fflale0fgq�IR SwP- / Ina TM To. (3ty of Rinow _ Plan Revisr.Seeuon FF')M, PIR WWRuildinelPrMic Works 100 Mill Avenue Smnh -- RCeten.WA 98033 DATA: --- - , Per the request of the City of R. on.the following information is furldshed c000 ardng flnv eats for im rov installed for thi•Rhove roferenced Project, P ertxntS �1A°1,11h She Type LP.of �� : wATEI(MAIN .S2 LP •,r Q Lt. _ • WAIBUUIN .. Y— WAI MAIN EACL.F.H WAMMMAIN �-r--- °( OATS VALVES EA of %tin OATS VALVES EACHCH of Iwn GATE VALVES --•� EACH of �. ' FU HYDRANT ASSM,311P5 S L ODU (Cat of MM Hydrants mun be tined repreldy) S D 1(Incfudo Eyln"id,y and 5WU Tax if sgdiahle TOTAL COST FOR WATER SYSTEM S D O L, sin SA�TA@Y MRH DEAlKM=yn; pe ��— fy( S!t'Vllt MAIN %I* Type LF.of M i6W611 ill MAW . I.M.of I1 SmxM tlNlt LP.of MAIN -0U LF.W ��r. STORM UM LP,of v _ STORM I.R�EA of • 01,00q�R MANHOLFS `�— STORM IN13111OUTIFT MU � � • EA of DIAkW.TaR MAtn10LPS _ 2 EAd STORM CATtIMMI1 I mWRerrM1� � RA of STORM CATClIBASM IfggSenpy) t�) ,. —�1 �d�Tag YOTAI.CT)ST IS)R SANRARY SRWaR SYSIL'A S �_'___. Its"lloklk) — TOTALCOrr vOR eTORM DRAO(AOa sYSNrM S STRl3wr T()VRMRM'S')(lncludre)f(Aube OvIlcr.Sidr�alk.Acph01 A amen,and St w I.IRhunA) SIONALIZAI 0N: (twtudiN EW Damp Oath.Imo'Puri,,pe ,WA St SJa TW -- STV=UMMNO: (inchdly EoF DWSn Cons,tlq Permit Pan,WA 8,Salt,Tlu) ��, ��7a�i,� �__ _ tips-y��•ss�� MM eiprwgy eepe - fnn.RY1eTnAnm(Id (Sa 1Rq - - — wlhebsriMae/wYee flrM w ow"C of saEfat tAmMeofan) Short Plat'(SHP( ALS ) REQUEST FOR PROTECT 0 Prelim.plat (PPN__•�_ ) CAG N ) Io: Technical Services Date /,s WON R8YOY GrectiN LUq y=S- From: Plan ReviewlProject Manager -E,,A -taPA AL. Project Name ScQlza ecluQ.T SV+vrzT pIAT (r0 chu+elen maa) Description of Project: OTku1y tNpg�u�Ne�t� Fov2 StEtAA Ci L SN0I-T 1 /Ale Lu,0rN/l�S:.t�S� , T-r—z' Circle size or Waterline: (Dr 10" 12" Circle One: New or Este 'on Circle Size of Sewerline: Cr) 10" • 12" Circle Coe: New or Extension Circle Size of Stormline: 12" 15" W 24" Circle One: New or Extension Addressor Street Names) _lLr?ro.� AVc t x c MC t /VE � Dvlpr/Contractor/Owner/Cnsic: �Jut-1 ,(/,r„„ ,.v (70 eha cten mu) Check each discipline involved in Project Ltr Drwg N of sheets per discipline J J ,W Trans-Storm ❑ CI a (Kaadray/Ocainage) (On riv in�pmecmrnn)(inelude buin none) pnclvde TWC shuu) L Transportation (SianmaadonChu diudvn.ughdna) ❑ ❑ _ Wastewater ❑ ❑ Saniwy Sewn Ma)n QnJude buin name) -- Water CbWmi,Yalvu,Hyd,au) ❑ ❑ (Include wmpuiu 4 H>rimnW Cvl Si�ul Surace Water D ❑ Improvements in<�ude buin n,me) p �f,, TS Use Only w- at 4 5• �81� Loucks Testing Laboratories,Inc. 9406, Harney Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COI IF CT ION READ INSI AUCT10NS ON RACK OF GOLDENROD COPY N Inflictions am not toRoYme,ample WIN be migoWd. DATE COLLECTED TInCOL F+ CTEU COUNTY NAME AgNiM W,r YEAR 1 L_ 1 3 i17 uAM �PM , . r TYPE OF SYSTEM IF PUSUC SYSTEM,COMPLETE: Dn PUSLIC INDIVIDUAL LO.Ra. 7 / CIRCA[paROUP NAME OF SYSTEM SAMPLE OQ LFCTED TELEPHONE NO. fi)ty (% • k + Q DAY LL1'r t+ l7J1 4A +iuw � K J f f EVE 1 Is TEU an,oftnet SV OWNERC err SOURCE TYPE L.J GROUND WATER ON)E—RZWk INFLUENCE ❑sxrACEpWEILFI [)SPRIN3 []PLllr,:1/+ gwDarOwmany N SEy UFW ]pWEI I FIELD M1�fTI M1,t..%R07T "Iu%A F.0NeIA'Soeep0,7rd P^E OF&AMR F.tchwk mIV nn♦w NNF ookWA I lJ ROUTINE I GRINNING WATER 13CaN1MIENdpEaelSwY:_..7MY—FER :pAaA IryinwM PaeleE L]1AeealFsaroaw �._c ---.. REPEAT SAMPLE Prowaa cWlyrm Dmaanta LAb a Date �UW SOURCE WATER Some® W (1 TAM ooma EWCONSTRUCTIONINI) MN�`�� Few of w,[,OTHER(.44I ffd�' �eLL qq 7L PMiMARh�. N."UYONLY)DRINKING WATER RESULTS ~TNIVACTOIR,rkeaow P".'f 0GC TMaWTOMY. REPEAT []f.c"PlesNll [a f Coa olw l REOUNIEO SAMPLE ❑F PwawN E]FaW aoawa .. _--- OhINIWDMTORvaaan TOTAL COLWORM A/100" '—^E. t A/, sML FEMCOUFpIM _ naoml PLATE COUNT An AIWTt1E"SAMPLE REQUIRED SAMPLE NOT TESTED secattaE: TEST UNSUITASt E SECAURE ❑swo*too am []Conffi nt wowth C]w"contaww, n INTO C3 TwA, eL�il%,hd c,& n E..cwA doom age REVERSE SIDE DP GREEN COPY FOR EXPLANATION OF RES LTS ,AS NO II DIOITSI OATS Tw RECEIAD T RFCFAED R '; tI I' 'L�I 1.1 DATE REPTwiEU LAaDM/0M OaeiR W IIEV Nw WATER SUPPLIER COPY i Laucks Testing Laboratories, Inc. NO Hamby Seattle,WA 9811% WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLtt CTION.READ INSTRUCTIONS ON RACK OF GOLDENROD COPY If WmAn tams ON"t falkiwed,NfflPls WIN be falaatall. [ATE COLLECIEO 1NAE CU 41ED COUNTY NAME MONTH My KM .�` r-J" iY ,�1 ❑AM L IPM �Cf n TYPE OF SYSTEM K PIMLIC 6YST[M.COMPLET& -� ©Push 1 ❑NIDMDU/a, L••-....�I 7 3 S Ci C�ORWP Iww MI,�y NAMEOF SYSTEM ��c-,� ." v� VECKICLdWil ftfill C[COUECTED TELEPHONE NO. -_ r �J��1LN Q i t •V 1 AY E * 51 JI MCOLLECTED SY N'IraO) SYSTEM OWNFANGH.(NraO) SOURCE TYPE GROUND WATER UNDER SURFACE WLUENCE -- — ❑SURFACE Z]WELL w ❑svRRm tpY PUACFASED w p COMSNATIDN WEI L FIELD NTFRTIE MOTHER REPORT TO(PMK FUN NrAe,Agd aM Z npN ) - r a. TYPE OF SAMPI f(MIOOA OOV o M UKO OOAam) 1 [,ROUTINE !) DRIWOY)WATER ��C;hw n•tW(R.4" TMaI Free) c.Mck 1."~t ��Flaw•tl p nI Nl•U M Ogw - �At PLAT SAMPLE Fwlw•celaMm we•PLLv labY _ ....._. ._. U HAW SOURCE WATER SMirta f DS m p TMaI CONMtm I NEW CONSTRUCTION of REPAIRS p heal Cowwn [I oTHtR(sPaMN) /-,.c'j' - REMARKS 0 / _ fLAS Use Own imam Rs"" L_)UHMTIS_FACTORY,CWEOII sMum p Fir LFS ElE.Cali weasm ❑E.Cgs aMwlt RILQUOI EO ❑F"m PFOOOra p FOcal Arita OT"M EASOMTORY PAI"TS TOTAL COLOORM JA 1100mi F. CoLl&IIOD MI. FOCAL COLIFCRM /100 ttu_ PLATE COUNT mU ANOTI/ER SAMPLE RNOIARED .. SAMPLE NOT TESTED SECAUU TEST UNSUITASLF SFCALkW ❑sue-.m [ 1ConMum W"Ib p Wmjw,aakw UINtC rp I ham [�TNmNY a:unun L .. ❑6COrO tklDns TIES REVERSE WV Ot DRISOIN COPY FOR RESULTS PAS ND RMWTM —� OAR.No ANXMD prCAIVED gv I MR"par" IAUU1UIlYry F Q ,y NP m gfla]NtW 111FV 69N WATER SUPPUlR COPY f Laucks Testing Laboratories, Inc. 940 S.Harney Sealue WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLL COLLECTIOC READ INSTRUCIIONS ON BACK OF GOLDENROD COPY N NatruollDm w not NMbwed,ynWN WIN be FelEDted. TIM�COLLE TED COUNTY NAME DAM OPM E l at.IC SYSTEM,COIM/LETE. I . Ns. '1 i �' S O C `�'OF SYSTEM I gpOCIEC7 NN-E�Ref.SNiLF COIIECiFD TELEPHONE NO, �� �✓^.., +.i i DAY •.,, c�cT:. N n L EVE * bINRLE COLLECTED BY tNarwl SYSTEM SOURCE L ar WATER UN R SNRRICE INFLUENCE ❑SURFACE ®WELL FI ❑SPRING p O a MURCIRASE _ WELL FIELD INTERTIE ❑aTld+ s�RRE 10 FUN Na,, YD2 CaWI f E OF SAMPLE O tY b^,In this cok~l ROUTINE DRINKING WATER U Oab mOte711F:�tduall _� check tawtmsnlFik,aMEl REPEAT SAMPLE l t—w Revxwe cdNu,m Pnnawa lob N one U RAW SOURCE WATER Spxtts F Q I T1 O��� C�NEW CONSTRUCTION m RE 1 1 I Fwal C,NM ❑OTHER(SPec11q) REMARKS ..`` (LAB USE ONLY)DRINKNp WAIN REEULIN ❑UNSATISFACTORY,CdaXms asnnt gA SAMPLLES ❑E.CoN pn>.sM [�E,CON IIDNNIN REOURED L]Fsnl Ww O FNW NMalt OTHER LANDRAT'OM REEIRTN TOTAL COLIFORM /tollml E,COLI /100 NIL FECAL COLIFORM /IOD nN PLATE COUNT ANOTHER SAMPLE RFOUIRED _ SAMPLE NOT TESTED BECAUSE TEST UNSUITABLE SECAUNE, ❑SanPN I.atl �CPnAant piown, T❑Wrap emtamk TNTC Li hm-PMe Inns %DW edtUn ❑ . _... LJ Ea CNbIH SEE SEVERS E SIDE DF GREEN COPY FOR EXPLANATION OF RESULTS LAE NLl 1T GIGITSI MtF..1-1MF_gFcuVF.P RFGErvI:'U By MTe RLAlN1ED IABOIWTOPR: I>a„wwFn NNI WATER SUPPLIER COPY