20217 87TH AVE W.PDFIIIIIIIIIIII
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20217 87TH AVE W
City of Edmo-nds
Critic -I
Areas..
a
;C h6-
dklist.:
'Me Critical Areas Checklist contained on
this forin is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development
permit to the City.
Ile purpose of the Checklist is to enable
City staff to determine whedw any
potential Critical Areas are or may be'
present on the subject property. The
information needed to complete the
Checkfist 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 it,
and submit it to the City. The City will
review the checMist, make a precursory site
visit, and make a determination of the
subsequent steps necessary to complete a
development permit application.
.4
Mth 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 4etail that City staff can find
and identify the subject parcel(s). in
additiom6 the applicant shall include
other pertinent infonnation (eg. ette
plan, topography snap, etc.) or studies in
coidunction 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:
Street Address N 776-a(71i�
Q (.M rja�r so 4515-#1,66
'City, State, ZIP Phone
tSi Date
tu�re
Applicant Representative:
Nam
Street Address
City, State, ZIP Phone
Signature Date
r
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
L. SiteAddress/.Location: _90DO AU-0 LZE-SC—i
.2. Property.Tax Account Number. oop— C>om
3. Approximate Site Size (acres or square feet):
4. Is this site currently developqd?
—L—yes; no.
if yes; how is site developed?
5. Describe the general site topography- Check M dw apply.
Flat: less than 5-feet elevation change over entire site.
Rolling:- slopeson site generally less than 15% (a vertical rise of 10-feet -over a
horizontal distance of 6&feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of I 0-feet 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 Approx. Depth:
7. Site contains areas of seasonal standing vrater- —No Approx. Depth:
What season(s) of the year?,
8. Site is in the floodway Aa floodplain 00 Of a water course.
9. Site tontains a creek or an area where water flows across the grounds surface? Flows are year-
round? . M40 Flows are seasonal? r..s o (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: X30
1. site is Zoned? For City Staff Use Only
2. �CS ped soil type(s)? lk'z
Map op..
3. Wetland inventory or CA. map indicates wetland present on site? A60
4;��- :-,Critical Areas inventory or C.A. map indicates Critical Area on'site?
5. . Site within designated earth subsidence landslide hazard area?
6. ''gite aes'ignated on the Environmentally Sensitive Areas Map7
DETERMWATION
'"�DYREIQUIRED
W AIVER
Revii.- wed by: — A"�(
Planne,0'
"Ouov%
CONDITIONAL WAIVER
.Date
" r&4
Id
Permit No.
7
STREET FIf ion of Sanitation
1 Rockefeller Ave.-ALpine 9-2061
Everett, Washington
I
Data c: �?' -3
APPLICATION FOR PERMIT TO INSTALL OR RECORSTRUCT SUAGE DISPOSW FACILITIE
19
Name Address
Address of Proposed site
Legal Descri": Lot�_�Block_____,Addition
)� No. of bedrooms Lot size
Type of use(/
r
_r4l --7
Septic tank Capaz-ity- gallons. Disposal field lengt I h-
S;:.�-Utarianls Sketch:
J
Remarks-
6
LAAAA4,?
Da t P,
--?,J*
by
Approval ��ailSd TO De�te
Rec. #
SNOHOMISH HEALTH DISTR'XC*
3011 Rockefeller Ave.,
$5-'00 fee.for permit Everett,, Washington Pbone.ALpine 9-2061
LOT APPROVAL SHEET
A
LFRrAL DESCRIPTION: LOT BLOCK ADDITION
MfPE OF USE
���.4.LNO. OF BEDROOMS SIZE OF LOT /,0 0 A /_2 0
SOLMCE OF DRINKING WATER: Public supply Private Well
A. SURFACE DRAINAGE
1. Is disposal field site well drained?
2. Any water course (stream,. drainage ditA etc.) through site? 2g2_
B. TOPOGRAPTI
1. Any heavy slopes in field area? 2-y,-"-
2. Will present topsoil in field area be removed or graded before field tiles are
installed? ';�&_
3. Will any fill material be used in the disposal field site?zgaif yes,how much
C. SOIL CONDITIONS
1. Has a hole at least 4 feet deep bqen dug in the disposal field area to determine
the type of soil present? ZKI=
2. After hole is dug record the s6il conditions at the following depths. (Record
as sand, gravel,, clay, packed sand, loam, etc.)
12 inches
30 inches
18 inches- 36 inches
24 inches 48 inches
4. Any ground wat—ere-n-coun-tered before reaching a depth o;/4 feet? 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_1-0
5. Divide this time by 6 to obtain the rate per inch.
6. Date water test was performed.
I hereby certify the above information to be correct and the above tests were per-
formed by me as prescribed.
Signed
Address
NOTE: A septic tank permit is issued on the basis of the above information. If
are any changes or alterations in the above stated soil conditions it may result iff-
the installation being rejected at the time of inspection.
SNOHOMISH COUNTY HEALTH DEPARTMENT IVI
Division of Sanitation
3011 Roe' feller Ave.,ALpine 9-2061
Everett) Washington
M. -T4-jFVrML-1M�M -
To:
Address n^4n). tre.- CU% T.----A
Regarding Sewage Disposal Inspection on 12 ./23. 159 by
for
Location Lot J2. Sibou HeigUe
Permit Number—. 6657
The above sewage disposal system was not approved for the following reasons:
Please notify the health department when corrections to the above have been completed
so a re -inspection can be made for final approval.
Snohomish County Health Department
Sanitation Division
County Health Building
3011 Rockefeller Ave.,
Everett, Washington
EET
FILE
APPLICATION
for
The City of Ed
SIDE SEWER PERNaT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS C]
OWNER.................... T)W2.15J.j ............. C ........... �a± - ................ CONTRACTOR .......................... I ........................................................
PERMIT No
........
ADDRESS ......... ...... ... ... .. ................
.... ....... ......... f .... LEGAL DESCRIPTION: LOT No . ............... ...............................
�2
BLOCK No . ............................................
NAME OF ADDITION ............................
..........
A I s 0# .2
.............................................................
�`7 0 --.+
Approved:
'a-14 . ......... .. ... .....................
DATE ... ........ ;By
NOTICE:
Nbwa r.r a n ty ... OT
The information . shown on the attached
Map(s) was compiled for use by the City Of
Edmonds,? its Employees and Consultants.
t the
Th..e C'tY of �Edmonds does not . warran
accuracy of anything set for.th on these
Map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
....--t-He -map(s), including, but not limited to,
th'e lociation of any sewer stub shown. Such
ex st and may
sewer stubs may or may not I
or may not exist at the location shown.
,�;ty of Edmo-nds nor its
Neither the %-A
emp*1,o*yee's o*r office-rs,sh.alfl be l..'la-b-Ife for the
n on this map(s), nor for
information give.
e representation provided based
any on
upon'said map(s).
6�11-0'j Wb Ork
MONDS can P11-spact No inspec, 3335
CITY OF ED DEPARTMENT Is ready for "'Pectlon' ( N?
CIVIC CENTER _ VVATER-SEWER tions Saturday, Sunda$ or holidays-)
SIDE SEWER PERMIT
...............................................
..................... ..............................
202�? --- — --- Sanin�Aff! -------------------------------------------------
ADDRESS ---------------------------------- -------------------------- CONTRACTOR .................. v, side sewer
01"ER ---------- ----------------- 1_9.§%-, for ------------------------ days tO REPAIR or CONNECT
J luly 2 2 ---------- ..........
-permission is granted ------------ - -- wi - t. application on file and governing ordinances
with MY Sewers in alecordance 'k licensed Side sewer contractor must
THE de property linei it has been inspected.
CAI.J,F,D TO FOLLOWING' construct sewer insi r be Ore
may obtain a permit t T)o not cover any Portion of sewe et Permit*
,TTF,NTION IS property street axes- . governing side sewers when You 9 ; minimum grade of 21/6-
-Me owners Of the truct side sewer In d Regulations inches inside property line
NOTE No. 1---!be employed to con ,,, regarding ordinance 11.3-6-030 an property line and 'J2 responsible for
binin full informati t 30 coverage at Contractors shall be
NOTE No. 2-0 must have at I
Top Of side sewer Mill be permitted. red to Original condition.
NOTE; NO- 3--No beads in grade sharper than % ttled and surface of street resto pletion. y work On the at, sewer or its appur-
one y Of co'n
-renches in street must be water se may develop within rmit, or to do an
NOTE No. 4�x oper wO OrIc than is provided for In the Pe
f allure due to impr rk which r w
�r do any Othe th wye.
It is unlawful to alter c into e
NOTE No. 5-- tenances except to insert the Pipe