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16748 72ND AVE W.PDFIIIIIIIIIIII5621 6748 72N D AVE W City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number. Issue Date: 02 [ A. Address or Vicinity of Construction: 6'24 -1224�e A 18 9 0 1 9 C B. Type of Work (be specific): �i9Yfi Gt/ NYS ENTERPRISES INC. -:57- C. Contractor:/1C 7p27 - 1651h PI. S.W. Contact:* lEt. ti L45 Mailing Address:k Edmonds, WA 98026 phone: - — f-7 State License #:7e qS f tj 1 1 o rJ () (, Liability Insurance: , Bond: $ G D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE,;WNG, CABLE, WATER) ❑ Multi -Family . #'dingle Family ❑ Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut: ❑ Yes ❑No G. Size of Cut: x H. Charge $ APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by,his'signature to this application, agrees to hold4he.City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever.; for eseei`or'unforeaeen,-that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE, TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at. all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read t en s an. un a permit requirements and the pink copy of the permit will be Signature: at all times for inspection purposes. Date: (Contractor or Agent) DTG-P-RIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY - TIME AUTHORIZED: VOID AFTER DAYS SPECIAL CONDITIONS: !ot' �l� , l✓�%U Y RIGHT OF WAY DEPOSIT TOTAL FEE: .. t COMMENTS: RECEIPT, FI DATE: ISSUED..:;BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE .. Engrg. Div. 1991 FIELD INSPECTION NOTES Comments Diagram CONTRACTOR CALLED FOR INSPECTION Partial Work Inspection by P.W.: Work Disapproved By: FINAL APPROVAL BY: (Fund 111 - Route copy to Street Deft \_. ❑ .YES. Date: Date: ❑ NO YXID ZlAlt- APPLICATION for The City of Edmonds SIDE SEWER PER IT EASEMENT No . .......................................... !ZEW CONSTRUCTION Bwo� REPAIRS El OV*rNER, ... ........ ------------- ADDRESS ... ............. ,ppROVED AUG 2 5 1970 CONTRACTOR .4. ... j6e-4wov-el PERMIT No. ............... K LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ................................. NAME OF ADDITION .......... Approved: DATE 9-7-2 97...020............ .4?7 7.a,r�.r-- f i ..___.__...__.__._..._._._.____..._..._mow.. �...,_.._....__....__.._..,_._..__•..._�_._.__.__.. ,:.. j { w •'0 UMConsultants Inc. e£POZI *.SE?A January 18, 1991 Robert and Maudine Fayer 12029 - 42nd Drive S.E. Edmonds, Washington 98208 Subject: Geotechnical Evaluation Single Family Residence 16748 72nd Avenue West Edmonds, Washington Dear Mr. and Mrs. Fayer: At your request, we went to the 16748 72nd Avenue West on geotechnical evaluation of the SCOPE OF WORK STREET RLF Geotechnical Engineers, Geologists & Environmental Scientists G-0024 single family residence located at January 17, 1991, to perform a property. Our scope of services include a visual site reconnaissance of the property and structures, and to prepare a written letter report with our geotechnical evaluation of the property. SITE DESCRIPTION The subject house is located on the west side of 72nd Avenue West in the Meadowdale area of Edmonds, on top of a ridge overlooking Puget Sound. The house is a two level structure with a daylight basement layout. The entrance to the house is on the north side. The garage is located on the east side, and the backyard faces south. A number of decks have been built facing south and west toward Puget Sound. Steep slopes are located south of.the house, beyond the small and level backyard. The slopes are covered with ivy and blackberry vines. A number of Douglas Fir trees and deciduous trees are located on the slope. The slopes immediately adjacent to the backyard and below the decks are at an inclination of 45 degrees. These slopes flatten to an inclination of 30 degrees some 20 to 30 feet south of the yard and decks. 13240 NE 20th Street, Suite 12 Bellevue, Washington 98005 Phone 206/649-8757 FAX 206/649-8758 Page 2 GEOTECHNICAL OBSERVATIONS 1. The driveway at the north side of the house is in very good condition, there were no signs of cracking or settlement. The driveway to the garage at the east side of the house was cracked, with the cracking at the south edge of the pavement. 2. The house was inspected from the outside to look at signs of possible settlements. No signs of settlements of the house were noted from the outside, however, an inspection of the interior should be scheduled to supplement these observations. 3. Roof downspouts had been replaced around the house. One of the downspouts drained into a clogged -up drain, another downspout at the southwest corner of the house drained onto the concrete deck, a downspout at the south side drained into an open pipe that discharged water directly beneath the deck area. At the south east corner of the house, a downspout drained directly to the ground. 4. The decks on the south side of the house are supported on treated timber posts resting on cement pads/footings. Some of the posts were not centered on the concrete supports, and the wooden posts did not seem to be attached to the concrete supports, other than by resting on them. The footings for the decks consist of cardboard formed 8 inch diameter short piers, and concrete footings poured into the ground or prepared with ready mix. These footings were supported on relatively loose soils, as I was able to probe beneath the footings with an half -inch rod. 5. The slope immediately adjacent to the house is covered with ivy and blackberry vines. With the use of a probe, it was noted that the clean sandy soils on the slope were loose, as it was possible to probe 3 feet into the ground (the length of the probe). In addition some 6 inch holes were observed in the slope below the deck area that may be caused by burrowing animals. 6. Some of the trees on the slope to the south of .the house were straight, but many had curvatures on the trunks of the trees, indicating past slope movement. 7. The surficial soils on the slope consisted of silty and clean sands, without cementation, fitting the description of a Vashon Outwash deposit. 8. The existing house has been built 21 years ago, it appears that the daylight basement was created by excavation into the original slope, and the excavated material was cast over the slope. One original deck is still in place on the south side near the east end of the house. this deck shows signs of settlement. Page3 CONCLUSIONS AND RECOMMENDATIONS Based on the visual site reconnaissance performed at the site, it is our opinion that the subject house in founded on dense soils and is stable. This conclusion was reached by observing the condition of the house and layout of the daylight basement with respect to the slope. The site reconnaissance also revealed that the new decks are supported on shallow foundations, on a slope where the surficial soils are loose and subject to movement. Therefore, we conclude that the deck foundations may need to be underpinned in order to prevent future movement. The slopes at the south of the house exhibit evidence of shallow surficial erosion and movement. This was concluded by observation of the trees on the slope, the steepness of the slope and the looseness of the near surface soils. The downspouts of the house need to discharge to suitable drains, or erosion and settlements may occur, as in the south east corner of the house (see observation of driveway to garage). Based on the above conclusions, we recommend that the following measures be taken: 1. That Geo Consultants, Inc. be afforded the opportunity to observe the interior of the house to look for any signs of settlement and drainage problems. 2. To prevent future settlement of the new deck, we recommend that the footings be underpinned with pin piles installed with a jackhammer. A knowledgeable contractor should be retained to do the work. The specific underpinning program should be designed by Geo Consultants, Inc. and coordinated with the contractor. This work is not within the scope of the current evaluation. 3. Since it is the conclusion by Geo Consultants, Inc. that the steep slope (45 degrees) immediately adjacent to the house, was fill that was pushed over the bank by the original developer, care should be taken to prevent water from eroding it and to keep a mat of vegetation to protect the slope. 4. Drainage improvements should consist of the following: a. open clogged drain receiving water from the downspout. b. extend or replace the flexible pipe discharging rainwater from the downspout draining below deck area to a point further down the slope. Page 4 c. the downspout at the south east corner of the house needs to be tied into a tightline and discharged further downhill, or storm drain system. d. if discharging storm water further downhill, this needs to be done through a section of tightline from the downspout to the discharge area, and then connected to a perforated line to properly dissipate the flow. If you have any further questions, please call. Sincerely, GEO CONSULTANTS, INC. }#! P pJl lk William Chang P.E. a Principal �: Z 'vl . v If!1 Consultants Inc. February 1, 1991 Mr. Bob Kennedy 16748 - 72nd Avenue West Edmonds, Washington 98020 Subject: Construction Observation Underpinning Support for Deck Footings 16748 - 72nd Avenue West Edmonds, Washington 98020 Reference: Geo Consultants, Inc. Letter dated January 31, 1991 Dear Bob: Geotechnicai Engineers, Geologists & Environmental Scientists G-0024 At your request, Geo Consultants, Inc. has been retained to provide consultation and construction monitoring of the underpinning effort for the deck footings at the subject site. We have coordinated our efforts with Howard Clark of Clark's Concrete Construction - a specialty underpinning contractor retained for the project, to monitor the construction of the deck underpinning. The design of the underpinning was presented in our referenced letter. We were present at the site on 1/31/91 to observe that the excavations were properly performed and that the pin piles were properly installed. On 2/1/91 we observed the pouring of concrete below the footings and around the top of the pin piles. A total of thirteen (13) piles were installed, and that corresponds to the number of individual elevated deck footings. Based on our observations, it is our conclusion that the work performed by Clark's Concrete Construction is in accordance with our recommendations. Sincerely, GEO CONSULTANTS, INC. �Xe- a_u_ ez-5� William Chang P.E. Geotechnical Engineer \\' WAS�' a i a�V 20i11 �v"ONAL fit• !/'' 13240 NE 20th Street, Suite 12 Bellevue, Washington 98005 Phone 206/649-8757 FAX 206/649-8758 Geotechnicai Engineers, Geologists U1 Consultants Inc. & Environmental Scientists January 30, 1991 Mr. Bob Kennedy 16748 - 72nd Avenue West Edmonds, Washington 98020 Subject: Underpinning Support for Deck Footings 16748 - 72nd Avenue West Edmonds, Washington 98020 Dear Bob: '.� § IM11 At your request, Geo Consultants, Inc. has been retained to provide consultation and construction monitoring of the underpinning effort for the deck footings at the subject site. We have coordinated our efforts with Howard Clark of Clark's Concrete Construction - a specialty underpinning contractor, to provide an underpinning design that the contractor is familiar with and that it will be effective. The recommended design will use a 2 inch schedule 80 iron pipe, jacked below the footing and grouted in place. Details of the proposed installation are shown on the attached drawing. The completed underpinned footing will have a rated capacity of 2 tons, which will exceed actual support requirements for the deck. Sincerely, GEO CONSULTANTS, INC. William Chang P.E. Geotechnical Engineer Doff" %AM CNy� it S�F WAS8/ vG, k:. o .yam .`.: ,9 20114 t 13240 NE 20th Street, Suite 12 Bellevue, Washington 98005 Phone 206/649-8757 FAX 206/649-8758 1111111116 MUNI SURFACE SCREW JACK ASSEMBLY O EICAVATE 11 E1POSE FOOTING. O2 DRIVE 1 IN. STIR PIPE USING PNEUMATIC JACK NA"(11 TO SUBSTANTIAL REFUSAL. IF POSSIIIE BREAK OFF 1061 OF FOOTING 10 KEEP ►Ilt AS CLOSE TO CENTER LINE AS ►OSSIILE. LOAD TEST ONE Ill( 10 PROVE 1 TOM DESIGN LOAD CAPACITY: SUISIANIIAL REFUSAL DEFINED AS ONE INCH OF /(NEIRAIION FOR ONE IINUIE OF DRIVING. O ALTER DRIVING TO Suiltiw IAI 1IIUSAL. CUT OFF PIPE SEVIRAL INCHES BELot 101101 OF 10011119. INSTALL SCREW JACK ASSElllll AND THEN JACK Pit[ LAIERALLT INTO POSITION CINIERIO IINIAIN FOOTING. O USE 1-1/4 INCH IIANEIEI INAIADIO STEEL 000 AND HUTS 101 SEMI JACK. USE 1 INCM 1 1 INCH 1 1/4 INCM STEEL PLATES AT TOP AND 101101 Of $CREW JACKS. TURN U/ SCREW JACK 11 SUPPORT FOOTING. SCRIP JACK SHOULD lE LONG ENOUGH SO THAT THERE IS A 1 INCM NININUM LINGIN OF IHAIADIO 100 INSIDE IKE PIPE AFTER LEVELING OF FOOTING. Q LEVEL FOOTING 111111 SCREW JACKS. PAINT SCREW JACKS IITN COAL VAN M ICK 01 EQUIVALENT MASTIC. !1 SEDGE STEEL SJIIJIS TIME AGAINST UNDERSIDE OF Fooling. SBACIFILL - 1NOR000ILT NANO LAN► IN PLACE. PLACE A IACKIILL Of CEMENT IONIAN AROUND JACK, 01 KNIM. ANN I0► of Pitt. OI COSPIEIE IACKFILL'- INOROUGILT NAND IAMB IN PLACE. Kill 10 SCALE UNDERPINNING DETAILS SHIM ASSEMBLY 91191ING GROUND SU1IAC( ®1 Consultants Inc. Geoteehnleal Engineers, Geologists 6 �— Environmental Scientists i W I I aVSrPT REC"o vF.D FEB it PERM G-ou f}- js MQ IL,iZ r4,:LT ,L c.,04. , C- hF- - G oe2 o e�S G A-1z-B' F-7r" e�7 f '44 y')-:-,p L 1V c ii-A )lt (-4 F/+ I " TK- v A VIV );-:�P C -A-,L/ G-,F-t2 ® Af C A-t rF-jv 1.1-6 14T "F�T G L � a e0z-S L FEB 8 - 11 L- P lI COUKTFR C %J-aV-F- C H A w 4- A-T C. �H c-- �� a T� R Al ( --�w L, L X-S c 4bKi ILD c._iG14)- FEB p UNTER S i li AV v i t . ¢F-3 C- A Iz-p°C--T G- xo A t".. Rz riViF.D Pitt MU l� ly( 6 U C-t9 Jul --A v-fzv .tJ w V- ) L 3 T ZiL I ~i :: D FEB ZPVM1T COUNTER lz � GLv (All E 7- 7-)EAo 7- 1 /10 z ? / T- F E B 8 li -1 Hf<-- -S 4L a w.ErC L c I- b �J IIE-7— �.v T Ati" AlLa FILE# N/A DETERMINATION OF NONSIGNIFICANCE Description of proposal Room Addition, single family Proponent Bob Kennedy. Location of proposal, including street address, if any 16748 72nd Ave. Edmonds, WA 98020 Lead Agency Edmonds Planning Division The lead agency .for,this:proposal.-has de.termined.that.it does'not have a probable significant adverse impact on the environment. An environmental impact statement (EIS) is not required under RCW 43.21C.030(2)(c). This decision was made after review of a completed environmental checklist and other information on file with the lead agency. This information is available to the public on request. X There is no comment period for this DNS. _ This DNS is issued under 197-11-340(2); the lead agency will not act on this proposal for 15 days from the date below. Comments must be submitted by Responsible Official John Bissell Position/Title Code Enforcement Tech. Phone 771-3202 Address 250 5th Ave. N., Edmonds WA 98020 Date December 21, 1990 Signatures y 1),47 X You may appeal this determination of nonsignificance to Hearing Examiner at 250 5th Ave. North, Edmonds, WA 98020 no later than 5:00 p.m. December 31, 1990 by filing a written appeal citing reasons. You should be prepared to make specific factual objections. Contact John Bissell to read or ask about the procedures for SEPA appeals. There is no agency appeal. Complete this checklist for nonproject proposals, even though questions may be answered "does not apply". IN ADDITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D). For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as "proposal," "proposer," and "affected geographic area." respectively. A. BACKGROUND 1. Name of proposed project, if applicable: Fy-,l (— t- b 5 J; d0E- C_ K- 2. Name of applicant: k;O y 3. Address and phone number of applicant and contact person: 6-7. 7 -%-P4 a V-r �w, V3 . 4. Date checklist prepared: 5. Agency requesting checklist: c i f? %,-J r 6. Proposed timing or schedule (including phasing, if applicable): 10 oy&,­1 s 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. " b , 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. �,( O 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. N 10. List any government approvals or permits that will be needed for your proposal, if known. 11 b u , L-P T 11. Give brief. complete description of your proposal, including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You'do not need to repeat those answers on this page. (Lead agencies may modify this form to include additional specific information on project description.) 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related to this checklist. / TO BE COMPLETED BY APPLICANT B. ENVIRONMENTAL ELEMENTS EVALUATION FOR AGENCY USE ONLY 1. Earth a. General description of the site (circle one): Flat, rollio ,hilly steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? 6 —7 OD c. What general ty es of soils are found on the site (for example, clay, sand, gravel, peat, muck? If you know the classification of agricultural soils, specify them and note any prime farmland. (5 /�-i-(/� irLj'tC1 L d. Are there surface indications or history of.unstable soils in the immediate vicinity? If so, describe. A/ e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. lVirr%-(-E f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. —�-- i G c g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? y Proposed measures to reduce or control erosion, or other impacts to the earth; if any: 2. Air a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities if known. b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. u0P4 c. Proposed measures to reduce or control emissions or other impacts to air, if any: 3. Water a. Surface: 1) Is there any surface water body on or in the immediate vicinity of the site (including year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into. ! t 0 N )E- 2) Will the project require any work over, in or adjacent to (within 200 feet) the described waters? If yes,, please describe and attach available plans. 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. J " ,4 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. % 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. l) b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities if known. / V `' 2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: Domestic sewage; industrial, containing the following chemicals...; agricultural; etc.). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable), or the number of animals or humans the system(s) are expected to serve. c. Water Runoff (including storm water): 1) Describe the source of runoff (including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow?Will this water flow into other waters? If 0, describe. 2).Could waste materials enter ground.or surface waters? If so, generally describe:' d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: 1 ` 4, o- 4. Plants. a. Check or circle types of vegetation found on the site: /deciduous tree: alder, maple, aspen, other evergreen tree: fir, cedar, pine, other —ishrubs morass — pasture _ crop or grain wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other _ water plants: water lily, eelgrass, milfoil, other other types of vegetation b. What kind and amount of vegetation will be removed or altered? c. List threatened or endangered species known to be on or near the site. d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if /any: g� 5. Animals a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: S awk, heron, eagl Wego. other: .................... ......... s: deer, bear, elk,er: ..................... fish: bass, salmon, trout,hellfish,�other. b. List any threatened or endangered species known to be on or near the site. c. Is the site part of a migration route? If so, explain. V 0 d. Proposed measures to preserve or enhance wildlife, if any: 6.. Energy and Natural Resources a. What kinds of energy lectri tural oil, wood stove, solar) will be used to meet the completed projec s energy nee s? Describe whether it will be used for heating, manufacturing, etc. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. h c. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: �i- V- L '0'�—T-T 0 /� 7. Environmental Health a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe. 1) Describe special emergency services that might be required. /;7 2) Proposed measures to reduce or control environmental health hazards, if any: b. Noise 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? / 2) What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (for example: traffic, construction, operation, other)? Indicate what hours noise would come from the site. /,` 3) Proposed measures to reduce or control noise impacts, if any: 8. Land and Shoreline Use a. What is the current use of the site and.adjacent properties? b. Has the site been used for agriculture? If so, describe. c. Describe any structures on the site. l-)(f) (-) d. Will any structures be demolished? If so, what? e. What is the current comprehensive plan designation of the site? ` r T7 A L h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? k. Proposed measures to avoid or reduce displacement impacts, if any: A %� 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. ` r 1 1141 %7 b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. / A l/ c. Proposed measures to reduce or control housing impacts, if any: � Y /"!+ 10•._ Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? r ` T—fJ*S V �� b. What views in the immediate vicinity would be altered or obstructed? c. Proposed measures to reduce or control aesthetic impacts, if any: A r 11. Light and Glare a. What. -type of,light-or glare will..the. proposal .produce? What time of day would A. mainly occur? b. Could light or glare from the finished project be a safety hazard or interfere with views? A r c. What existing off -site sources -of light or glare may affect your proposal? d. Proposed measures to reduce or control light and glare impacts, if any: 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? H A , b. Would the proposed project displace any existing recreational uses? If so, describe. I , //�T/Y c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: 13. Historic and Cultural Preservation a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known to be on or next to the site? If so, generally describe. jy ,A b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. / " a "C'IL c_ Proposed measures to reduce or control impacts, if any: 14. Transportation a. Identify public streets and highways serving the site, and describe proposed access to the existing street system. Show on site plans, if any. Ty ( .S 7` 1 1-4 6, -7 -z fqo b. Is site currently served by public transit? If not, what is the approxim to distance to the nearest transit stop? Y � O �73 c. How many parking spaces would the completed project have? How many would the project eliminate? d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). 'O e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. t g. Proposed measures to reduce or control transportatiion� impacts, if any: 15. Public Services a. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally ' describe. b. Proposed measures to reduce or control direct impacts on public services, if any. x � 16. Utilities gZruse Curren aila elite: lectricit natural ga se e e ep on nitary sew ,septic sys em, other. b. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity which might be needed. v / CA-, — C. SIGNATURE The above answers are true and complete to the best of my knowledge. I understand that the lead agen is re ing on them to make its decision. Signature:...... .. ..// ...... .... ... .... .:............. Date Submitted: ...... ,1.....�::�.�./ .�.. 0......................... 0. Supplemental Sheet for Nonproject Actions (Rezones, Code Changes, Annexations, etc.) -- Do not use this sheet for project actions. Because these questions are very general, it may be helpful to read them in conjunction with the list of the elements of the environment. When answering these questions, be aware of the extent the proposal, or the types of activities likely to result from the proposal, would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond briefly and in general terms. 1. How would the proposal be likely .to -increase discharge to .,water emissions to air; production, storage, or release of toxic or hazardous substances; or production of noise? Proposed measures to avoid or reduce such increases are: 2. How would the proposal be likely to affect plants, animals, fish, or marine life? Proposed measures to protect or conserve plants, animals, fish, or marine life are: 3. How would the proposal be likely to deplete energy or natural resources? Proposed measures to protect or conserve energy and natural resources are: 4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designated (or eligible or under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered species habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands? Proposed measures to protect such resources or to avoid or reduce impacts are: 5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land or shoreline uses incompatible with existing plans? Proposed measures to avoid or reduce shoreline and land use impacts are: . I 6. How would the proposal be likely to increase demands on transportation or public services and utilities? • Proposed measures to reduce or respond to such demand(s) are: 7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws or requirements for the protection of the environment. ENVCHK3/PFORMS v COMPLAINTS MUST BE WRITTEN: NO VERBAL COMPLAINTS WILL BE ACCEPTED. THIS FORM MUST. BE COMPLETE. DATE CITY OF EDMONDS ClLyui� a 1►1 : 0.�7�7�i7 COMPLAINT SUBMITTED BY: ~' Name Address: ADDRESS OF PROPERTY TO BE INVESTIGATED: Name of Owner: 4.Pgre es r :� Address: Phone: DESCRIPTION OF COMPLAINT: ®j�/rlgs Gad a7o �J� d ZD DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY CODE SECTION VIOLATION: TYPE OF ACTION EXPECTED: TIME REQUIRED TO INVESTIGATE / ACT ON COMPLAINT: RESULT OF INVESTIGATION: DATE: TIME REQUIRED: INVESTIGATED) BY: ,, � /1, 0 //,, 72 Ai�p RSA . - ,o...r1..-�-c. �7�+ �1c,. a...lv'.�r•?t7C'";if4, 'a ,,yy,, y,,.,r•�+Wy��r!C.rix�L�rrr*'�.��Y5Y(�;.�1J1'. 4-' " ti•"t.XLvs�',ul . n .�� � i � �q ��.• �C'..p .T i o�..�s":.'A� T � �t �ASr '�'X'�`�' �' .tom � :j}•�X,f;,�Y '�`i.-.`Ji^N'.zt� �'M• ^ws-, k'4�4,�o'hl n.n�aSr h<�.n.+t'F�'�' r i a z 0 W a F- U a O rJ. ( ITV OF'EDMONDS RECEIVED • - Permit No. 'COMMUNITY SERVICES DEPARTMENT 19g1 P 2 ? RIGHT-OF-WAY CONSTRUCTION PERMIT SEIssue Date A. • Owner: QO 60R- ' E61 tr 2 B. • Contractor: P V D Name Name 1 Lo 14-8 77 Z nJ O AV W 2.101 is N wy 9 Mailing Address Mailing Address DMMONDS WA q.9026 Ezthenwns WA 9_907,(. City State Zip City State Zip IMPrWT► tJ boo-3 Zo State License Number Telephone Number C. • Address or Vicinity of Construction: , l,0714-8 "72-m D A\1 (&J Type of Work to be Donee Pv L e -To CA;, D. • Work in Connection With: ❑ Sub or Plat PoS ngl'ejFamily ❑ City Projects ElCommercial•-•-`—J ElMultifamily ❑ Utility E. • Pavement Cut: I!9'Y ❑ N. F. • Size. of Cut: X APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this_a�piicatio ,agrees to hold the City of Edmonds harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR W f 4AN�917- ATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND.).ACCEPTANCE OF THE WORK. Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be processed for issuance to the applicant. • A 24 hour notice is required for inspection; Please call Engineering: 771-3202 • Work is to be inspected during- progress and at completion. • Restoration to be in accordance with City Code. • Street to. be kept clean at all times. • Traffic Control to be in accordance with City regulations. • All street -cut ditches must be patched with asphalt or City approved material prior, to end of working day; NO EXCEPTIONS. I understand the above and that this permit must be available at the job site for inspection purposes at all times. Signature: MA Date: Owner or Contractor This Permit Must be Posted at the Job Site For Inspection Purposes Call DIAL -A -DIG Prior to Beginning Work APPROVED BY: (i'f l.V PERMIT FEE: Time Authorized: Void after (20 days. Restoration Fee: Special Conditions: RELEASED BYs- - Receipt No.: Fund III Fee: Street Cut Dimensions: Date �i� ,9% INSPECTED BY NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE Date Eng. Div. March 1989 FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Mpt.� Comments: Diagram: r CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. Ji 76 . PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY REV. 7/37 LOCATION I (�-7 4-'R —? 2 ►J tD Ali co AREA POLE NO. Nwt/4 S g T Z-1 R 4 DATE 9-111"11 W.O. NO. 3Z-30- -70- I'l SA1 REASON FOR WORK co►jvEP-7 ON SvL TO u6, ENGINEER Mft9_T►rJ DWG. NO. 090959 Fo fz Ro66--2:1 F f'v`16{R Not) • RAC p k_Q CE DRAFTER U.G. N0. W . O , -7 0 l-(=Ary_%wG- XFyv\R _Cs AS SCALE DATE WORK COMPLETED DATE PRINTED QEMav�, L�Pr1�in)G f3.0 , 5a IcvA Fr lZo �Z4^O ��zoo Vvt 2 FOREMAN ENVIRONMENTAL ANALYSIS APPROVE 016T :tt C.Z-S901 -X ® EXEMPT ❑ NOT EXEMPT SUBSTATION FEES -REQ D ®YES ❑NO PARA. 18 ITEM C ��RtJ(, A �Si�vA EZa�z401-7ZC>pv xPMZ. PRIMARY OVERHEAD O.H. U.G. COND. KV CIRCUIT N0. 1Z-14540 PHASE D Isi ❑ RESIDENTIAL ADD CKT. FT. PH N SLf2-. ❑ COMMERCIAL LEO# REM CKT. FT. PH s E L D V ®$ / _ NET CKT. FT. FV S E '(o Pc M P s O.H. U.G. COND. KV - SECONDARY OVE HEAD ADD CKT. FT. PH w_O. 3Z BAST FEE $ - _ ... REM CKT. FT. PH I N S- _ .3SQL SZ�s�2 r�rJ �.X�ST DUST Pot_E NET- CKT.FT. 2METER/CP��6ST�tL �T PQoP - _.. . ❑ TREE TRIM ANTED) PRIMARY UNDERGR UND o - .. i T PERMITS (DATE GRANTED) ' -.�- - - Go 9-S IAJ Q�pt:STAI.; i_ ❑ RESIDENTIAL - T ❑STATE n► ❑ COMMERCIAL ❑ COUNTY f W , 3 C7 .:D -ram o CvST G 'C C Ate% BAJIF/EE $ LEU# ®CITY EDMopOS L V'LvN 1ZS �O .. g FP•om P�Q6S L_ T o 7 EASEMENTS SECONDARY- -UNDERGROUND. 9.5 SA ❑ REOUIRED ❑ NOT REOUIRED . 1 _ _._ _ • BASIC FEE $ 1 `i O --' , - 1Iv� t D At. TXI F0-ow1 eYIS-r UNDERGROUND_ �P 'AT. DATE RELEASED BASIC FEE $ -• ---•• T A` -- FOREIGN CON ACTS --_; L/ $ ❑GTNW. FT. ®�JPN 3 STREET: LIGHTING_ 0 CATV JPN - - - 3 a-►�Sx -t. ❑ JOINT TRENCH GTNW & CATV o ' WORK IN RIGHT C F:-WAY ❑ JOINT BORE G NW & CATV - -- - N ❑ PRIMARY . .... _ ❑ !- ❑ SECONADARY _ . POLE STENCILING - -- -; t FT. O $" , r /' $ FROM TO MISCELLANEOUS FEES TAKE OFF POLE VAULT $ 490 PRE-CONSTR. REQUIREMENTS �OMONLIS PERMIT $ 30 ! o Cl TREE TRIM ❑ PUD LOCATOR - 1 -7 6i SS A COST F_6T $ -zoo 00 ❑ BACKHOE ❑ 9-Ev1 ON Sv(.— $ ❑ ONE CALL DA INDEX I I POLES I PLAT TOTAL DUE $ _,— O_°o LOGS U-MAP DATE PAID XFMR I I C-MAP RECEIPT# _ Q � 13% LOCATION MAP PAGE S3 A-3 _ NEW SVCE APPLICATION# i `db`� 5 _ I MAST �'�;pv>��j'PI�'y"Fj�',�+gd6i�'C�i,f ,..., .�. .. ii+�•�t_•,�'°i1i�-k`U''%'bpi:gnu.��°'^'✓..'��n�ftai+9!'SY`�"v—�F��'�t:Atr'3'vt�"„�;,;rByrt�:4,(.r:Npu.;�aevr'+*�n4,qrm�.r'S.'°�-{�i.�.y'n^.[Ar'1YbrYi„n CIS; Y OF EDMONDS Permit No. ! I -- .9 COMMUNITY SERVICES DEPARTMENT Celt/ � RIGHT-OF-WAY CONSTRUCTION PERMIT issue Date 3-- aZ Ivlr�rt 00 ]yy A. • OWner: WASHINGTON NAT' L. GAS COMPANY FNQ'VM*ctor: Name eMercer .Name Street Mailing Address Cb�n �> i Mailing Address Seattle Wash. 98111 City State Zip I S I C 1 City State Zip Q�" ETE State License Number Telephone Number C. • Address or Vicinity of Construction: 16748 72 Av. West Type of Work to be Done: PermisAion is requested to Insta '2" PE IP Main in 72 Av. W. from 463'S to 763'S of c 1 of 165 Pl.. SW Per Attached Drawing 912-400 %R #6043-3) 1 D. • Work in Connection With: ❑ Sub or Plat KX Single Family ❑ City Projects ❑ Commercial ❑ Multifamily ❑ Utility E. • Pavement CuKX0 Y ❑ N F. • Size of Cut: 1 2 . x 5 APPLICANT TO READ AND SIGN b INDEMNITY:: Applicant understands and by his signature to. this application, agrees to hold the City of . Edmonds harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may be made against the. City of Edmonds, or any of its (departments or employees, including or not limited to the defense of any legal proceedings including defense costs, court tosts, and attorney fees by reason of granting this permit. 31'ni91 THE CONTRACTOR IS RESPONSIBLE FOR WOR MANSHIP AND MATERIALS FOR A PERIOD .OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND -ACCEPTANCE OF THE WORK. Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be processed for issuance to the applicant. •' A 24 hour notice is'required for inspection; Please call Engineering: 771-3202 *Work is to be inspected during progress and at completion. • Restoration to be in accordance with City Code. • Street to be kept clean at all times. • Traffic Control to be in accordance with City regulations. • All street -cut ditches must be patched with.asphalt or City approved material prior to end of working day; NO EXCEPTIONS. I understand the above and that this permit.must be available at the job site for inspection purposes at all times. Signature: AAAAZ Date: 3/23/91 wner or Contractor This Permit Must be Posted at the Job Site For Inspection. Purposes Call DIAL -A -DIG Prior to Beginning Work �. APPROVED BY: VI/ PERMIT FEE:. LTfl .a Z Time Authorized: Void after �UI,1F_ 3 da*s. Restoration Fee: O W Special Conditions: Receipt No.: Fund 111 Fee: — Street Cut Dimensions: U RELEASED BY: Date-_'1 INSPECTED BY Date a;- O NO WORK TO BEGIN: PRIOR TO PERMIT ISSUANCE Eng. Div. March 1989 FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Deitt.1 Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION Partial Work Inspection by P. W.: Work Disapproved By: FINAL APPROVAL BY: ❑ YES ❑ NO Date: Date: Eng. Div. July 1985 165PLSw 30'_E_SMT _ a> ' Z v eIP$�5 q02-67t 16748 27"d 0 t i SOVEEZE 4 SUTT�FUSE EXIST. E.O.M.LOC.j463'S i PROPOSEO Z" PEI /,0 MAIN 14'E i 1 t / I i 1 1 } I 3 2' PE CAP 3' PAST SERV/CE E.O. M. LOC. } ONE Z.'X5' GAS CUT AT WATER I f NO. ._---_--_-_--DESCRIP-! .}ON REVISIONS (a] NOTES: (. FIELD LOCATE ALL UTILITIES CALL 1-800-424-5355 48 HOURS BEFORE PIGGING Z. LAY DETECT WARNING WIRE OVER ALL PE DIRECT BURIAL. PIPE 3. INSTALL ONE POUND ANODE FOR EVERY /000' OF LOCATING W/RE 4. SURVEY NOT REQUIRED 5. MAINTAIN A 5' HO/RIZONTAL AND 3' VERTICAL CLEARANCE FROM ALL CITY UTILITIES to IR # 6 0 4 3 - 3 - 3 I 2" PE CAP- z 300' 4*14 GAUGE -DETECT WIRE, 85-940 -1 3.00' Z" SDR-II PE PIPE------ 70-7-6 0 ITEtn OUANI, DESCRIPTION STOCK NO. �- BILL OF MATERIAL PERMITS. ED M O/JD S l is SEC Nw 8 _ Z7-4 PLAT: IS8.70 ---------------------------- OP MAP: 15 s. s 8 AREA: Z 4 1 TAX CODE:- SEQ. NO: Naturbi Gas AWcist*yjry,Fo-v-�rgrCf-v. ty D.G.R: 3- Z 9 - 9 / Z" 5DR-11 PE 1P MAIN EXT. TO: 16748 72 AV W DWN J- HIRSCH 3 IZ / 91 IR 6043-3—RR- DATE B CN I<-� ---- - ------ -- ---7------------ JOB 912 - 4 O o Y A f (' D ------------- 1VVv I �b / (I DRAWING SCALE! s 0' APR h/v -- 912 - 4 O O ij C%a Gp/-�onlOJ PACIFIC WATER WORq SUPPLY CO.,_ INC. C)t 2900 FIRST AVE. SOUTH •SEATTLE, WASH. 98134 B? RECEIVED BACKFLOW PREVENTION DEVICE TEST AND MAINTENANCE REPORT' SEA 091 STREET FILE...FILE NO. PUBLIC WORKS oEPT. FIRM NAME IJ D !-'A X 6 ' Z S�d yP ••SS. 5ADDRESS I ' . PARTY CONTACTEDO 1-fd h,' REDUCED PRESSURE BACKFLOW DEVICE ❑ G45i•S�j L yMNcva0U e jg DOUBLE'DETECTOR CHECK ❑ c/ 1cfd3( DOUBLE CHECK VALVE ASSEMBLY �] PRESSURE VACUUM BREAKER ❑ MAKE OF DEVICE jc U MODEL 1Sd S� Y SERIAL NO. "�� /3 SIZE _3 BY-PASS DATE INSTALLED $ a METER NO. METER READING LINE PRESSURE PSI PRESSURE DROP ACROSS FIRST CHECK VALVE PSI LOCATION OF DEVICE � 1'Yi- ' DIFFERENTIAL CHECK VALVE NO. 1 CHECK VALVE NO. 2 PRESSURE TEST ' RELIEF VALVE' BEFORE REPAIRS LEAKED ❑ LEAKED ❑ ' ! OPENED AT PSI CLOSED TIGHT CLOSED TIGHT REDUCED PRESSURE PART CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE NEW ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ PARTS ❑ ❑ ❑' ❑ ❑ ❑ AND ❑ ui ❑ ❑ ❑ ❑ REPAIRS ❑ ❑ ❑ ❑ :� ❑ ❑ REMARKS: TEST CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT PSI AFTER REDUCED,PRESSURE-REPAIRS- 'REQUIRED ONLY ON REDUCED PR ES URE BACK L DEVICE (a c� 9 ,/ RETURN. 44T TO: TESTED BY /II C�--7 . / i I�!/�%� DATE ��3- c7/ PACIFIC WATER VI/U RKS SUPPLY CO. INC'. Serving the Water Works Industry Since 1917 REPAIRED BY FINAL TEST BY DATE DATE TESTER'S WASHINGTON STATE CERTIFICATION NO. 0 -3611 WHITE -CUSTOMER PINK -OFFICE CANARY -REPORT FILE j � }7�r�� r. ; ,Lh'�..y� ���k � a.:(e• f i::•`'L:�': y '�� 'i ' 1 •�° t i're i E4 '�4. . �. .s r � z.tle.. t1t . � *•tl' � ;+ia tF', ff'4�r-•,! (4 7 � r n i e,,�. rr . -n y s ti t. �. 1'9'.` 'i� d+•,M^ ;'} { ,�� �} '. k '�- "!. r ✓rt'�� �n \ •+L+2. Y F t -r ✓�y ,47$ `':; ars` c �'.. ".; � i r. 1 ✓' t�� rt`'n£*�.. �`•A a.' Ii. •r� +$yr"i �' i � t s.- n - io +.� �'r ✓t. X.i .i..;.l � s � A} •.ate •�' g�rS,�L�,a�y�.'•� �i� �i;tt t"fj i'i_�.J, .. s. �, r, •>✓a.^:` - � �oi t' cC '';:r S`.`'�p( :'. �P c. • F 'lr Y i. rt''X'a y t• a�.- .t y �,: "�': '�.�!. f:.:.t . 't' r s l rt,; ... t�. `, yt. J'� yt ia' b' ��y. it ! -t, C'wrc r . t;. e:Y "F "�-';�+ ', � . t s 4BY^:m'i<GATriµw` •ta"tIQ��YI�'.50" .J:_Fr� :L 90B: 0... ♦ a . ' aT3L'�•�,5�.ryr�•,',ry Z I� J1 y�/ ¢�., r;d'' j� +a h - -, i' •tr^ j/'� !�` '�i�r/ i'('}��' 'r ,t+� `o. -f� j� C - n il�.�r' 'i,�4�^E' ' r. rFt_A2.-��1:�"�s,, " td t f=x•+: r)'s'iit't 4K�'k C: s 6�, ti t+ �:''�� �. R•�. •' `�. ,� cw •4,: � N .� c - S�,.O� I +fix,«y[ntb G � � d j„t T 'rt `�� a att°.'4Y�j .! � t' {s tr ^;i�-'i,ia ;�. �..-i «qcs ASt` )'41r <Y•'�Ciy yc .ygx�t �T,gf6 't z.`. �,r n JY � 7� ♦ �'At:3,.3�y�,��yrr � 'i �yh4 'Qa'�pt�tiilJa,.: �.sfr,. Jlrl, t1. .. �L '{°a ._tom, '". ~ �' •Pd ya yi� / '#< d• :1` 4 Y'° Y ,: a;. 3{+ t ,I t > R • } Ja f x f r —a n t s `�ByQ '� ! �� t'%�Gi p �� irr_a P. 4.�n� *y '� �?'y tyt•)u si { r t -.y ��'y,.� �/J/�.r tt +.-/,�_ ��)L,4i ��i/f.�t�•� r„�r. 4j ct+,+ "� �Li.,Y�,. 't �i=h✓rt¢y ti!'jj f. ¢Y.G`aJ �A �. ...7,•}� '•4i�yy- } j'� - ~..e` Aj '� �' ..G'fL�I�fKNr%�I £}t�7} .;T•�4SF. art �!'h �! t'.4x yc /. # ; �i d r i. r'„7,4 j >•,ypr. i,Q, r^ a -H'!. +' w'r5 - �' 'R !- sbi.r�.Jgp,.$.r• {ihr .r >� ¢ 'S t • } raR ..y. r�1. v.!` 6r.. '�s` 7 .. S a v - .a •<i :. aI'0/1y'/y� �fI a� j g ^� rt• i +. Y• �`'� t �: b • ! h•. k�. 3 r� * 6ri !► s �y id � fk A . . 5i " 4� y �TJ { r i _ ; s C ♦ ' ��t t •.a Z�a <'y..•a(y� A ,� .�? s•-k t. �'"YY.,r I 'ls •1' t 1�. < r "1 -.f i ' r t': r� t 'F; �• r ax:,' ;,Flr ,' �Jl''a- '� 1• •j, > � 'ur,'7i• ,.4 i��"_+t+ rT �s �. - � r. rrr ; ;t �r'• :?f`,; ,.'�..(��,�yr f VR Ij Af 000000, / Via;: `' !''' � ;• . � ; . Tjo � � .: � .V.:..Q, ..' N. `..<. •, • . ' `, ` �- \� ' - - , Wit. ID, MI OLE ONA ASSOCIATES ,i nsulting noers&land Surveyors 3` trf _ .•7- 324-Mai ••`PR'8-1171 .r..� C*. rIzDMON S, WASHINGTON" Z tC ��. ��: '- 1}� h y ->�'}9� X�. :rsf r.. �. -t_.• : '! 2i'��-" ., 'ty � 'r�.ti t't- i'T�O '`"y4�>•. iz�', t /27, Al � - STREET FILE CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington SEPTIC TANK INSTALLATION PLAN I�(Submit in Triplicate) ADDRESS OF PROPERTYA/le...................... ..�G..��V / 1. Lot No ....................... Permit No...... .. .. . Owner........ Address .............--. Phone........ ............... Builder....-/���--1� / 4 ® ..---- .._ Address/ '/�L.'"A Jt. /% .5 Phone.._Z6.—.J9.VIA of Designer.... . .............. Address. % 447,e?:p. X'1001.--- ... ......... Phone..%.7:.�....:,�z�I Installer-. .. f! ,�I�4&er�/... �,v�-1C . �' Address /. .' y�✓�% -..xo ---------- Phone..P'.%. :. 5-5W I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of grades,_Jills, surface �drains, etc.) listed by me on my sewage disposal system permit application dated ................ `"_ — .0 y......have been complied with. --- -------_---- ......................... ----------- _e�31 1�p Signature of Designer Date TO BE FILLED IN BY CITY ENGINEER ONLY Accepted ...................... ............... Date......... %zl f Not Accepted ........................ Date Signature of Sanitarian....... . .. . ..---- .... . Remarks:...... .................................................................................................... - --........................ INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest . detail and still contain the entire site on one page. ATTENTION HOME OWNER: Your septic tank has limitations! It was designed and installed to care for an average -sire family. Over- loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to remember: 1. Have your tank checked periodically to see if pumping is necessary (2%-3 years). 2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield. 3. Do not excavate, fill, place a structure, driveway or -patio in, on, or over the drainfield. 4. Limit toilet fixture disposal to sanitary wastes and toilet tissue. 5. Detergents and bleaches used in normal household quantities will not liarm the action of the septic tank and disposal field. I ri y fir' Q y� . -..... DATE.:/___l SUBJECT.--PTI(f ---TI�/TiI__-• SHEET NO.--'1--- OF--__�.-- ___ �__-___.--_ CHKD. BY. ------ DATE-------------- - 0��__A//4%/C14F4c,P---- ���'�� /! ----------- JOB NO. I 4-7---------- Sir 77G - 3V I R Q .210 Q �Qo / \ �Iv / f boo. - ,• � �� to 1� � \, Q � � g / Nj V+ h �gl/ jAV71 iv ;.s i CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington SEPTIC TANK INSTALLATION PLAN (Submit in Triplicate) f _"' / .".................................. ir'!614F Lot No ....................... Permit No .................... ADDRESS OF PROPERTY..................................�..... Owner------ ----- . -- --------•------ ._............. Address .------------- ....... ................ ..................... .... Phone----....... ............ . h, 4, �� Builder.` _......ji�.dr...... Address.��� '"��r.,",P �'+�f�� Phone...r.......... 1 r ��0 OY m� i < .G+O f'-^. y. �,.r�j ....T� . b..... 9..:.I':: . p.+>•. 241 Desil,ncr. o�"..... ...� --C�'....'':"""._..-...._....._- Address-,;P..--- - -:..............................Phone... Installer--- ��'-�,�'� �.���-.,��"�-��'.--r*f" Address. y��.��.: "✓1,.%.:---�= f..----.. .. Phone-..��...r'' +�"� •�C� I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of grades, fills, surface drains, etc.) listed by me on my sewage disposal system permit application dated ................ , ........ ...` -".. ' . �' . ........ have been complied with. 0 - - ..................... ' ,,' , Signature o Designer Date TO BE FILLED IN BY CITY ENGINEER ONLY Accepted ...................... .... Date. NotAccepted ............. .......................•- `-- •-------.... Date............................ ......... Signature of Sanitarian........................:.........................I ........................ - :........ Remarks:....................................................... ..... ............................................................................................................................. INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest detail and still contain the entire site on one page. ATTENTION HOME OWNER: Your septic tank has limitations! It was designed and installed to care for an average -sire family. Over- loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to remember: 1. Have your tank checked periodically to see if pumping is necessary (2%2-3 years). 2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield. 3. Do not excavate, fill, place a structure, driveway or. patio in, on, or over the drainfield. 4. Limit toilet fixture disposal to sanitary wastes and toilet tissue. 5. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and disposal field. T` ..... DATE4!7_fJll SUBJECT.__,s_ �� _ � SHEET ♦ CHKD. ■Y------------ DATE-------------- ©A?.Qe y/�!�-- JOB NO. �-` - -- - Nc fir' • 4 �,� - �"oMovvs, �•qr.� � 9oae D /60�.,.. -a- Q q Ile A. a c; t CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington SEPTIC TANK INSTALLATION PLAN (Submit in Triplicate) ADDRESS OF PROPERTY...I4e"9 � !... Lot No ....................... Permit No.... I.................. Owner... Address . .- - --- - ---- - ----------_--------- Phone ........................ Builder 40<. ' ©•vOV ----- .. Address��WV.-40 .."1 !.��9' ! Phone ... 774.,A►j7 a Designer ............... Address. 7 0. - /;p s' ' ---- p AO/* -. 241 Phone Installer .... .Q�rN. ��� � --- � Address. ........... Phone....... '",#.T.5'4r I hereby certify the accompanying drawing is an accurate representation, of the system installed at the listed address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of grades, fills, surface drains, etc.) listed by me on my sewage disposal system permit application dated ................ .....have been complied with. ............. e�I. Signature of Designer Date TO BE FILLED IN BY CITY ENGINEER ONLY Accepted ..... ......... ....... . •. . _. ......... Date ... ... ........ _............ . NotAccepted .............. ........... ............ ................. Date.................................. Signature of Sanitarian..._........................................................................... Remarks:.......... ............ .. ..................................................................................•----...----•-........-----.............................................. INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest detail and still contain the entire site on one page. ATTENTION HOME OWNER: Your septic tank has limitations! It was designed and installed to care for an average -size family. Over- loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to remember: 1. Have your tank checked periodically to see if pumping is necessary (2%-3 years). 2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield. 3. Do not excavate, fill, place a structure, driveway or. patio in, on, or over the drainfield. 4. Limit toilet fixture disposal to sanitary wastes and toilet tissue. 5. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and disposal field. 7�0 DAT6,4!7_V!J SUBJECT,_-�_______ ___ _______ SHEET NO.__,l___. OF.___L___. GHKD. BY. DATE- -- --- O/1GA/Ilj l G -_�eP,?fe T----------- JOB NO. � — ------------- .. --------------- --------------- --- �� .ter. Ao l �O �V14 In ej lip d / ol �+ 1 I N SEWAGE DISPOSAL PERMIT Septic Tank ............. �%�_gals. CITY OF EDMONDS J _/9 No . .......................... Disp. Field ......... sq. ft. Department of Public Works Other --------------------------------------- --------- Name ... 7 ----- --------------­------- --------------------- - -------------------------------------------------------------- is hereby authorized to install/ repair sewage' disposal system at ................ ....................... --------- .......... - ---------_---- ----------- ----------------------.................................................................................... - --- - ----- Date issued on.-_ ... !.: - ----- _'_Z ..... ------- Permit expires one year from date of issue DO NOT COVER BEFORE APPROVED BY DESIGNER OR SANITARIAN I hereby certify this system was installed under my supervision and control and complies with all provisions of the City of Edmonds Resolutions. Signature of Installer ---------------------------------------------------------------------------- Date .................................. Approved 14 Disapproved Date ----- 7_1 ... . ............. 6.!? ----------- By ... ......... Remarks: ............................... -------------------- SANITARIANOR DESIGNER_ ---------------------------------------------------------------------------------------------- Date .............................................. ........... This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed. CITY OF EDMONDS ENGINEERING DEPARTMENT 250 Fifth Avenue North, Edmonds, Washington APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT (Submit 3 Copies) Mr. M.0Rhoad$ Permit to be issued to: ......... -•-•- • -- •...... ---- ---• ..... For installation at: (street address) .... -...... 1671.8 r.44.�'�1.-,..Edm©nds--------------.......................................................... Addition or Subdivision rtion ®f Tr't.-1.0 _Mead®Wdale._BeAch Tra'#s....... Lot... ... ......... Block................ Type of Building: New.... R.... Existing ......... Single family residence yes Number of bedrooms. 5 ............ Other: (specify type or use) ..................................... ........................................................... ....................................................... Builder :..8s..i?hoad Umo d+�................ Designer... Reid --Middleton ©n.. &-. Assoc.# ........ ....... . .......... . Address 3. ...lvlain.. St-, S.. Bd[nOnd....................................... n Soil Log Hole No. ......................................................... SoilLog Hole No. 2........ Sam.e---------------------------------------------------------------------------------------------------------------------- Elevation of Water Table, if encountered. (Distance from ground surface).......1V.ene...................................................... Corrections to control surface water if needed... .....................................................•------------.........................-----..................... Specify if any removing or grading of topsoil in field area.......... N®ne -•.................. Percolation: Test Hole No. 1 —Average Rate...... Q*5......................... I.... .. . (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 2—Average Rate ...... 10+.......................................... (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 3—Average Rate...... 0A8...................... ...... (Fall in minutes/inch-bottom 6" test hole) Average percolation rate on which to base drain field design ..4Q-Pn.+./h....... . Date Taken .710........ Septic tank requirements based on present rules and regulations: REID, MIDDLETON & ASSOCIATES Septic Tank Size..s�©..Flan---....gallons. 7� /�lo Consulting Engineers &lend Surveyors 324 Main St PR 8-1171 Amount of Square .Feet of�Disposal Field...216.................... EDMONDS, WASHINGTON Signature — Designer------.......11...r....... �.......................I .................... Date ........ 4/7/64 --- -_----------------- DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) Permit issued (date) �.°.//. r / -----------------------------Permit Number ..... i' `f ............................ Remarks:...---.. ------------------- ----------------- --- ............................................................ ---......................................... ....... _..................................................................................... v q /YJ Blf.--"_'-"-�o.__.. DATE_�._1__��� SUBJECT.--������/-Q----��-- � �-,-y-�----•------ SHEET. ®Ic�✓l"` ��! /WO.--`(---OF.---,e 0 ------------- W��---------------- - C---H--K--D--.-- -B--Y-------------- DATE- - - ill -------------° P/4 : 774 ' P41 ski Ilk / f r !moo'. ��, a 4 b 21 ilk J{ , r � S v e i v , a ~ EID, MI OLE ON & ASSOCIATES nsulting ngi ers Rand Surveyors 324 Mai S PR 8-1171 °' EOMON S, WASHINGTON