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CITY OF EDMONDS
I -MEET FILEDEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Subinit in Triplicate)
ADDRESS OF PROPERTY_/. ��J ..... —cr ................................. Lot No ....... 7 ............. Permit No...
Owner------ ----- -------------------------------- ......................... Address .... .................. ..... .......... ...................... . Phone .....
Aluorvood ..........
Builder 44, A .... C I .............. . ... ........... Address. Flv� ... Pk_r
..... Phone ........ VIG-1234
.............
Designer ..40!k ... ;5nQ#__40RM0 --- ... jW,.nfflV(MQene ....................
Installer-EVOrgreen --- goncrote --- Pro-d Address --- 1.M.29-12.nd ... W. dMQYW_k9.. Phone ... gk.e-34703
I hereby certify the accompanying drawing is an accurate represe ntation 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.
........ oe0o
-------------
Signature of Designer Date
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted ....... .. .. .......... . ......... .. .. . ate
Not, Accepted.j., ........ .................. ......... ...... Date- . ....................... ...............
Signature of Sanitarian ............................ ...... . ...........................
Remarks: ............................. ................................. ............ ...... ............................ .................. ........................................................
............ .......................... ......................................... I ... .... : ....................................................... ................... ...............................
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 'ifte: on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loadinig 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 (2y2-3 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 ove*r the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not liariii the action of the septic tank and
disposal field.
DESIGNER
449pold Olson'
AS - BUI LT
Installed
goo Gal. So T.'
7W Sq. ft. installed.
Required
900 Gal. S. T.
3W Sq. ft. required.
N
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, -Edmonds, Washinqton'--
APPLICATION FOR A SEWAGE 13,1SPOS,41 SYSTEM PERMIT,
7— (Siebniit, 3 - Copies)
Hearl Clsy
Permitto be issued to: ......................... ...................................................... ..
For installation at: (street ad &2 -7'- .......... ......
................. . ......
dress) .... ........... ................
Addition or Subdivision ............ Admiralty --- Aonq.s ---- .......
...... ............................. ...... Lot ...... ........ Block.. .... 1 --------
Type of Building: New ... x 3
------ Existinj __. .... ... Single family residence Number of bedrooms.... .... _ . ...........
Bssement,�
Other: (specify type or use)... .............. ......... ----------_- ------ ..................... ................ ................................................
Builder .......... fto ...... S.0m.e . ...... Address- _4430- 190 P1. S.rA*
--------- .. ..... ........ ......... I .............. ....... ... ......................................................................................
So Sno.* Septic Tank Desty
Designer ..... .............................. ............................ --------- Address. --- 52018 180 S.W. ........... ........
------------- ---------------------------
0"-12"
Soil Log Hole -No. 1 ..... .................................... - -------- W-24"
30" hardpan
----------------------------------------------------------------------- 7 --------------------------------------- --------------------_--_-
Some
Soil Log Hole No. 2 ............................................................................
............................... .............................. ...........
......................................................................................... ........... ...................................... - ------- .........................................
Nome
Elevation of Water Table, if encountered. (Distance from ground surface) ....... ............................ I .............. ........
Divert footing Arid.downspout drsitii
Corrections to control surface water if neecle& ........... ........ ....................................................................................................
Y
0
away from d r at n fi e 11, are,;Lq.
............. ...................................................................................................................................... ............. ............ ........ .............
me A.
3press excevatioh ' torl I dver
Specify if any removing or grading of tops6ifiri field area ... ........................... ........................................... P
drainfield area,
....................................................... I ......................................................................................................................
Percolation:
Test Hole No. I —Average Rate ........... 5 ........................ ..... (Fall in inintites/inch-bottoin 6" test hole)
5 i-
Test Hole No. 2—Average Rate ..................................... .......... .... _(Fall in iiiinutes/inch-bottom 6" tekt hole)
5
Test Hole No. 3—Average Rate ........... ..................... .............. ....... (Fall in minutes/inch-bottom 6" test hole)
x S 3 -4
Averaje percolation rate on which to' base drain field design ............... ..... .................. Date Taken -----
Septic tank requirements based on piesent rule's and regulations:
1900
Septic Tank Size. ...... ......... ..... gallons.
Amount of Square Feet of Disposal Field .... .... ......
3�24-64
i r Date ........
Signature — Des gne i.- � ----- ----- -------- --- .................. .............. ............. .........
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
/ - ' — - mit Number .........
Permit issued (date) ... .. . ........ ........... /,/- ---__--------- Pei /s.( ........................
Remarks:... ................................................. ", . ................
-------------------------------------------------------------- ..................... ------------
................................................................................................................... .................... ...........................................................
t
EUSIGNER
Harold Olson
5208- 180 - SX.
Lynnwood,, Tash.
I
S.T.
900 Gal.
T2—a Lin.. 'ft*- of 31
50 wide ttehdb.
375 Sq,ft. required
L5
0
Dror
ed
0
0 Per. Hole
Soil Log
4" Tight line
4" Dr,ain tile
70S
Scale 111-201
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds/ its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers) shall be 1--ia-b.11-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
SEWAGE DISPOSAL PERM) IT
Septic Tank ......... /t74-._V ------- -gals.
CITY OF EDMONDS
Disp. Field,.� ..... \J�7_57"
Department of Public Works
No . ...... /5-i�
. ....................
Other
Name ...............
-- ------------- -------------------------------------------------------- is hereby authorized to install/
repair sewage disposal system at
------------ / - ------------------------------------- ......
... .............
----- ------
.................................. ...............
Date issued on ............
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 Cit
of Edmonds Resolutions.
y
Signature of Installer
........................................ Date
ApprovedDisapproved Date --------------------------------------------------- ------------ By -----------------------------------------------------------------------------------
Remarks:
SANITARIANOR DESIGNER ........................................................................... .................... Date :
This permit shAll be posted in a reasonably conspicuous place on the job untif inspection has been completed.
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a
FILE
The City of EMBER . --
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS 0
-3 0�4- Q:q Is 0
.................. .............................. ...........................
OWNER ---------
ADDRESS--C�; J�
......................................................................................................
7,5 "Y Vt/ -
LYNN PLAN?
No. ............................... ..........
CONTRACTOR . ..... . . ... . ..... a PERMIT No.
LEGkL DESCRIPTION: LOT No . ............................................. BLOCK No . ..................
.........................
NAME OF ADDITION .......................................................... .....................................
r�pp)�ovED
Approved:
DATE ............... By ..................
.... ........
NOTICE:
No warranty of accuracy.
The -information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-loyee-s or officer's .1-3halil be liab-,11-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
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CITY OF EDMONDS
Call PRospect 6-1107 when work 1-41
CIVIC CENTER — WATER -SEWER DEPARTMENT 11��
Is ready for Inspection. (No inspec-
tions Satnrday, Sunday or holidays.) N2 1549 cE-0
SIDE SEWER PERMIT
ADDRESS ................................ 18203 — 80th Avenue West 0
....................................................... ...............................................................................................................
E-
OWNER ............... John-E.-Marlay ......................................... CONTRACWR ... Lynnw.Q.od ... Septic ... Tank ... Qo . .....
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Perndssion is granted --.-.January ... ao ................ 196.7---, for ---------------------- days, to REPAIR or CONNECT a side sewer,
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with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CAITED TO THE FOLLOWING:
E-4
NOTE No. I —The owners of the property may obteAn a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
4ce.
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NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
C\1
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at Property line and 12 inches Inside property line; minimum grade of 2
No bends in grade sharper than % will be permitted. rX4
OTE No. 4—Trenches in street must be water settled 0
1-3
and surface of street restored to original condition. Contractors shall be responsible for
faildre due to improper work which may develop within one year of completion.
NOTE No. 5--It� is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or Its ap-
purfenances except to insert the pipe into the wye.
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REGISTERED
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CITY OF EDMONDS BARBARA FAHEY
MAYOR
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
St. Public Works o Planning * Parks and Recreation e Engineering
Letter of Transmittal
Date: April 15, 1997
To: Katherine R. Morley ,
Subject: . Critical Areas Checklist
Transmitting Copy. of the completed Critical Areas Checklist
For Your Information: XX
As you requested:
For your file: _XX
Comment: This1colmpleted Critical Areas Checklist is a
site specific determination, not a project
specific determination. You must bring.in a
copy of the completed critical areas checklist
with any permit application, or your
application will be rejected. Permit
applications include Building permits,
Conditional Use Permits, Subdivisions,
Variances, Applications to the ADB land
use applications, or any other
development permit applications.
Note attachments:
Sincerel
"Diane M. Cunhingh8itn,-Pl�inhiho'Sbd�6ta ry
Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
PLANNING DATA
NAIVIE:
SITE ADDRESS:- I E 20 3 43&_ W,-DATE: !�712-177
ZONING: - P-S - t 2- PLAN CHK#: 9-7 — // c),
PROJECT DESCRIPTION: (2m,4 e,-A a
ewA+m
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CORNERLOT -(Yes/No)
SETBACKS:
Required Setbacks:
Front: '2-5' Left Side: 10' Right Side: I Rear:- 2-5'
Actual Setbacks:
Fron ' t: ff3? 1 Left Side: IS- Right Side: :2,1' - Rear: -76
Street map checked for additional. setback required? N. 641� ntrw)(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED IV -(Y/N)
LOT COVERAGE: (24, ?
(+46
Maximum Allowed: 35'7- _Actual: -
BUILDING HEIGHT:
Maximum Allowed: 251 —Actual Height: Z I
Datum Point: J_n?±L�,q e A&ag& A.,.r Datum Elevation: 0 0. Olb
_j U U
A.D.U. CREATED?: V- IV,.,eA SPA L,
SUBDIVISION:
CRITICAL AREAS#: 97-0 - wev,-,
SEPA DETERMINATION:
LOT AREA: 5go
OTHER:
Plan Review By:
CA FILE NO.
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�tation),,,,
'Si dressqYX� canorr,--.- -AVP." WA.
98026
Y IrA.
�U cc N 110-001'-`007-6208. 19 h'
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P rty F �7
"90T
e"(acres o squ�
BY- 162
W1.
pproximate S'te.
uar,,.,,
A'
1UV FC .;y yezo; no;,.,, 1-
I yes; how is site eve oped?;-.-, -Z� RPqTn
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5. 'Describe the general I site,topograp�y. Check all that -apply.
Ies th�n 5 4eet elevatioi
s
Flat.. i change 6-'Veri emfire site.
X Rolling -'slopes on''site'generally less than 15% (a vertical rise of 10-feet ov'C',r a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15 % and less than 30 % (a v ertical
rise of 10-fdet over a horizontal distance of 33 to 66-feet).
-,,St�ep: grades of Oeater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other.'(please describe):
6. Site contains-areas'of year-round standing water: NO Approx. Dep tih:
7.
..Site.cor� areas.of geasbn�l itandin No' Approx. Depth:.
gwater:
What seas fAh'
qiR(s) e year.,
8. Site is in the floodway-ELk— floodplain__N�A of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? N/A ' Flows 'are seasonal? N/A (What time of year? N/A
10. Site is primarily: forested ;meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) YES
11. Obvious wetland is present on site: N/A
4caL-chk.doc; Rev 02/11/97
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The Cri ,�kieas Checklist contain
ed-- itand-su nut it to th
e The City"
on this form is to be filled *out by any,�-�:; w
e iew the chec'kh'st, make -a
r v
person preparing a Development Permit precursory site visit, and make a
Application for the C ity. of Edmonds determination of the subsequent steps
prior to his/her 'submittal of a necessary to complete a development
development permit to the City. permit application.
The purpose of the Checklist is to enable
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available
from observations of the site or data
available at City Hall (Critical Areas
inventories, maps, or soil surveys).
An applicant, or his/ her representative,
must fill out the checklist, sign and date
With a signed copy of this form, the
applicant should also submit a vicinity
map or plot plan for individual lots of
the parcel with enough detail that City
staff can find and identify the. subject
parcel(s). In addition, theApplicant
shall include other pertinent
information (e.g. site plan, topography
map, etc.) or studies in conjunction
with this Checklist to assist staff in
completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers
provided are factual, to the best of my knowledge (fill out the appropriate column
below).
Owner/ Applicant:
KAT
,PERINE R. MORLEY
X
-4"
Name
18203 80th AVE. W
Street Address
TAR M.H.
4
ature
Dai
Applicant Repre�entative:
Name
Street Address
City, State, ZIP Phone
Signature Date
M 10��
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.,Critical 'Areas
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EDMONDS, WA, 58026
-Tax`A&biihi Number: `3708"001-0074208".
�,2' Pro'p"e'r--ty"'
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3. A proximate Site Size (acres'or square feet): 90" BY 162
PI
.4. Is this 'site currently developed? -X- yes; no.
If yes; how. is site developed?
5. Describe.the general site topography. Check all that apply.
Flat - less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-fee..t over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15 % and less than 30 % ( a vertical
rise of 104det over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: No Approx. Depth:
7. Site coni areas of seasonal standing water:
No Approx. Depth:
"t season(s)'of the y ear? N/A
8. Site is in the floodway-NZA— floodplain N/A of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? N/A Flows are seasonal? N/A (What time of year? N/A
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) YES
11. Obvious wetland is present on site: N/A
mapped soil type(s)?
Wetland:inventor� qr� CA-. inap indicate-5 wetla*nd esen n siie?
pr . to
CriiicalAreasinventoiyorC.A. map indicates . Critical Area on site?
gnated earth. subsidence landslide hazard area?
--site'aesignAted on the Envirohine.fitallySensitive Areas*M�p�
Aca—chLdcpq Rev 02/11/97
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'GOUNJ
TER
T Critic Areas C ecklist-66iftaine 4 The CitY
he al'' d"' - it','�khd-gubmit'it 1-6 lfi� 6
any will review -&c
on this form is to be filled out b�:' Wiliec e-16s"t'l'i�'i e a,--'
ry te-vis;
person preparing a Development.Pem-dt"., 1�.:precurs6 si -iake a
it, and h
Application for the City of Edmonds. deter . mination of the subsequent steps
prior to his/her subn-dttal O*'f a' necessary to complete a development
development permit to the City. permit application.
The purpose of the Checklist i§'-to enable%
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property., The
infon-nation' needed- to - complete ' the
Checklist should be easily available
from observations of the site or data
available at City Hall (Critic'al'Areasi
inventories, map s, or soil surveys).',.
An applicant, or his/her representative,
must fill out the checklist, sign and date
With a signed copy of this form, the
applicant should also suibmit a vicinity
map or plot plan for individual lots of
the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, theapplicant
shall include other pertinent
information (e.g. site plan, topography
map, etc.) or studies in conjunction
with this Checklist to assist staff in
completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers
provided are factual, to the best of my knowledge (fill put the appropriate column
below).
Owner/ Applicant:
KATYERINE R. MORLEY
Name
18203 80th AVE. W
Street Address
City, State, ZIP Phone
S5- GnZature Date
Applicant Representative:
Name
Street Address
City� State, ZIP Phone
Signature Date
REGISTERED
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