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19124 92ND AVE W
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NOTICE:
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The Jnform ation'shown on the attached
piled for use by the City Of
map(s) was com
Edmonds/ its Empl.oyees and Consultants.
Th,.e City of *,Edm.onds does. not. warrant the
n these
accuracy of anything set for,th o . *
map(*�-). Any person or entity -requesting a
copy should conduct an independent
o r
inquiry regarding th*e information shown
-t-He -map(s)/ including, but not limited to, -1
-er stub shown. Suc
the lotation of any sew
ewer stubs may or may not exist and may
or may not exist at the location shown
Neitheir the City of Edmonds nor its
Mpjo-yee-s o-r offi-ce-rs -shal-1 be 11a-b-1--e for the
e
information given' on this map(5), nor for
any one representation provided based
upon said map(s).
APPLICATION
for
SEDE SEWER PERYaT 7
The City of Edmonds t-i"
-ET FILE, EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS 0
OWK
'.' VO4 �IE Rl 1I T N 0.
OWNER .... 1. / ..... .................. CONTRACTOR ...
ADDRESS JZZ P LEGAL 6ESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
!!;/ ....... K .......... !e> ....
.... ......
NAME OF ADDITION .......................... �,Z ..... -l/ .. . .....................................................................
0
4-
Ap�
MAY
Approved:
DATE................................................ By — .......... .......... I ................
APPLICATION
for
The City of Edmonds SIODE SEWER PERMT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
OWNER-------------------------------------------------------------------------------------------------------------- CONTRACTOR .......... ....................................................................................... PERMIT No . ......................
ADDRESS ............ 19124 - 92nd Ave. Vest 51
............................................................................ ................. LEGAL DESCRIPTION: LOT No . ....... ...................................... BLO�CK No . ............................................
NAME OF ADDITION .�4Mqnd-s-.Se-a ... VJ.ev!..Tr.act.s ...... ... D.-.01
-- -- ----- -- .. .. ... . ..... .. .... .. . ..... .. .. .. .... .
beqinninq N.E. corner.
T
Approved:
DATE ........
............................. By ....................... ..........................................
F7 IP
0/,5- 1,),3,1' tJ
j �X, 6 "I�-2
3 7
.,CITY CIVEDMONDS
Call PRO Peet 6-1107 when work
CIVIC -CENTER WATER -SEWER NT is ready fsr Inspection. (No Insper-
DEPARTME
0
tions Saturday, Sunday or holida.ys.) NO: 2949
SIDE SEWER- PERMIT
ADDRESS ............................ 19124 - 92nd Ave. West
..................................................... : ......................................................................................................................
OWNER ................. William M. Fortune
.............................................................................. CONTRACTOR ...... Edmonds Underground
.................................... . .....................................
Permission is granted .... k! 4y ... 1 .......................... 19..U., for ................. ...... days to REPAIR or CONNECT a side sewer
with City Sewers in accordance With application oil file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A
be employed to construct side sewer in street area. licensed Side Sewer Contractor must
Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permIt.
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 shaxper than % will be permitted.
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work wh.1ch 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 appur-
tenances except to Insert the pipe Into the wye.
STREET FILE 00
StIOROMISH. HEALTH DISTRICT
i
Division'of SeLitation
301.1 Rockeff-'Iler Ave., -PLpine 9-2061
Permit No. Everett,." Ww�!,,,iagtva Date
APPLICATION FOR PMMIT TO INST-41-7), OR 1�7
.�Mc.;17.�UCT SWAGE DISPOSAL FACILITIES
Name Addrees
Ad.d--ess of Proposed site 61
.,il Description: Lot Block Addition
o. of bedrooms Lot size X110
T�,-p-a of use
tank Capacity 7
Disposal field length
Sanitarian's Sketch:
K7
Remarks:
D,.%te Inspected by Installer
Ap7,woval- Mailed to
Rec.
i:::;-
STREET FILE
SNOHOMISH HEALTH DISTRICT
Division of Sanitation
3011 Rockefeller Ave., ATpine 9-2061
- Everett, Washington
Pe rmi t No 1) Date
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE, DISPOSAL FACILITIES
K
Name Address VV
Address of Proposed site_
Legal Description: Lot Block
--7-
Addition
Type of use 6Z-�� 1 No. of bedrooms Lot Size
Remarks:
I C�'O' 0 ;--> (;/- A
D a t eg Inspected by Installer
Approval Mailed to Date
x
r
Rec.
I/- �
SNOHOMISH HEALTH DISTRICT
3011 Rockefeller Ave.p
$5.00 fee for permit Everettp Was,hington Phone ALpine 9-2061
LOT APPROVAL SHEET
M/-1-7 7- 'S 0 ADDRESS
ADDRESS OF PROPOSED BUILDING 1-7P le,
LEGAL DESCRIPTION: LOT BLOCK ADDITION
TYPE OF USE R J=_ S NO. OF BEDROOMS SIZE OF LOT 0 0 '�o
SOURCE OF DRINKING WATER: PLIBLIC SUPPLY PRIVATE WELL
A. SURFACE DRAINAGE
1. Is disposal field site well drained?
2. Any water course (stream, drainage ditch, etc.) tlLrough site? 91nL
B. TOPOGRAPHY
1. Any heavy slopes in field area? & It--)
2. Will present topsoil in field area be removed or graded before field tiles are
1. installed? J�') () e?�6 If yes., how much �t4g
Will any fill material be used in the disposal field sit ._
C. SOIL CONDITIONS
1. Has a hole at least 4 feet deep been dug in the disposal field area to determine
the type of soil present?. V"s S
2. After hole is dug record the 'soil conditions at the following depths. (.Record
as sand, gravel, clay, packed sand., loan.. etc.)
12 inches L 0 '�4 ,I �o inches
18 inches 11�/_) Q -., V J_ 0,�? A-1 36 inches
24 inches - it /1 — 48 inches X/
4. Any ground water encountered before reaching a depth of 4 eet?& If so at
what depth?
D. WATER TEST
A simple water test will show how well this soil will drain or percolate water. To
perform this test:
1. Dig a hole at least 36 inches deep. Use a shovel or post hole digger --
size of hole makes no difference --only depth.
2. Fill hole with water. Now let all water run out of hole. This soaks the
ground and will give a more accurate reading.
3. Again pour water in hole to a height of 12 inches from the bottom. Let
water run out until there is just 6 inches from bottom left in hole.
4. Note how many minutes it takes for this last 6 inches to seep away.
Record the time. Number of minutes for last 6 inches to seep away
5. Divide this time by 6 to obtain the rate per inch.
U-e water test was performed,
6, Dal fe-
I hereby certify the above information to be correct and the above tests were per-
formed by me as prescribed.
Signed
Address j-71-4, e�
NOTE: A septic tank permit is issued on the basis of the above information. If the—rc
are any changes or alterations in the above stated soil conditions it may result in
.the installation being rejected at the time of inspection.
t �
0
PLOT PLAN
A detailed plot plan showing pr . opert lines, location of house,. and proposed location
of septic tank and disposal field lines shall be submitted along with the lot approval
sheet. The location of the test holes shall be clearly marked on the plan and shall
be performed in the area of the proposed disposal field.
W,KE SRETCH IN SPACE BELOW: Example.
E-j-
0 1 . 0
'
131-
0
0
H
N
751
0
0
150 tile
0 a)
40
(U -rq
�q W
.rj
50' i-"atc t
Cd
0 - test hole locations
5�00 fcr- 1�jr peruil. HOMISH COUNTY HEALTH DEPAR,
00
2935 Rockefeller .Everett) Wash. Phone CEdar 2061
'LOT APPROVAL SUM
NAME ADDRESS
ADDRESS OF PROPOSED BUILDING
LEGAL DESCRIPTION: LOT BLOCK' ADDITION,
TYPE OF USE NO. OF BEDROOM$ SIZE -OF LOT
SOURCE OF DRINKING WATER: Public Supply.- , - Private Well
IaNAGE
A. SURFACE IIR,
1. Is disposal'fie.ld site well drained?
2. Any water course (str6am, drainage ditch, -eta.) thrQuFhl'stie?
B. TOPOGRAPHY
l.' Any,heavy-plopes. in field area?
2. Will present . topsoil in fiela area bq';euio�red or graded before fieTa tiles are
installed�,.'
3. Will any fill -, material- b--e-usi-ea in' the I dfspoiia'l field � site i ;40 If yes,, how much?
C. SOIL CONDITIONS
l.' Has a hole at least 4 feet deep been dug in the disposal field area to determine
the type of soil present?
2. After hole is dug record the aroil conditions'at th'e following depths. (Record aGJ
sand,, graveli.'elay) racked sand) loan, etc.)
12 inches 30 inches
28 inches 4-- 36 inches
24 inches 48 inches 1��
4.; Any ground wat—er—enicotu—itered b�f-6rd reaching a d;pth of 4 feet?' A" If so at
wbAt depth?
D. WATER TEST
A simple water test will show how well this -soil will drain or percolate water. To
perform this test:
Dig hole at least 36 inches deep. Use a shovel or post hole digger --size
of hole makes no difference --only depth.
2. Fill hole,with water. Now let all water run,out of hole. This soaks thc
ground and will give a more accurate reading.
3. Again pour water in hole to a height of 12 inches from the bottom. Let
water run out until there is just 6 inches from bottom left in hole.
4. Note how many minutes it take's for this last 6 inched to'seep away*
Record this time below.
Number of minutes for last 6.inches, to'geep away...
5 Divide th im6 by 6 to obtain the rate per inch..
6: Dat is t - /,- Z /
e water test was'performed.
I hereby certify the above information'to be correct and the above tests were p4�r-
formed by me ds prescribed. Signed
Address
NOTE: septic tank permit is issued on the basis of the above information, If
are any changie's or alterations in the above stated soil conditions-it-may-r-es.ult in
the -installation. being reje-ated at the t='e.-.Qf, inspection.