20607 85TH PL W.PDF11111111111111
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20607 85TH PL W
PLANNING DATA
SINGLE FAMILY RESIDENTIAL
STREET FILE
_]I
.Name:
Date:
Site Address:
Tax Parcel: 6DS �06 C)
Project Description: 6F(2,
Plan Check #:
L-i�) 2-o 6
Reduced Site Plan Provided-6y i)) N 0)
Zoning: '1Z -S-(2--
Map Page:
Corner Lot: (YES ENV
Flag Lot: (YES <:NOD
Critical Areas Determination #:,:::-RA M1 10 7- 7,J
*Study Required
Waiver — �� 4 y vu-- A—J (,J
SEPA Determination:
Exem pt'
El Needed (for over 500 cubic yards of grading)
El Fee F-1 Checklist 11 APO List with notarized form
Required Setbacks
Street: 77
'75 kj
Side: I -S
Rear:
ActualSetback5
Street:
Side:
Side:
Rear:
El Detached Structures:
E3 Rockeries;
F'ences/Trellises:
El Bay Windows/Projecting 'Modulation:
El Stairs/Deck:
Height
Datum Point:
Datum Elevation:
Maximum Height Allowed:,
Actual Height: L4
other
Parking Required:
Parking Provided:
Lot.Area:
Maximum Lot Coverage: 35% Proposed: L -1
Lot Coverage Calculat ions:
ADU Created: (YES AKO->
Subdivision:
Legal Nonconforming Land Use Determination Issued:. (YES /dgo
Comments
L4
3,9
�ef b"�V f C6:3)c- Z 3. �o
Plan Review B y:
Planning Data Form 07-14-09
CA TEGoj?r2SmALL SITE ArojEcT
DiMIANGEREPORT
for
MIE TZNW F Oaf M A A CE SFI?
205XX 85th Place West
Edmonds, WA 98026
CSP Engineering PFN 15-003
City of Edmonds PFN
July 14, 2015
b 9? 1 Y I WE-
(tJ OS
JUL
NO
�,-y C
STREE7 ME
COM i IFES APPLIC/-- :.. -
C - WATWO;-).
CSp
Civil Engineering Design and Consulting
1037 NE 650 st # 153
Seatde WA 98115
Phone: 206 406 9965
email@cspengineering.com
www.cspengineering.com
Project Overview
A single family residence is proposed for a 0.54 acre Parcel situated in the Good Hope Pond watershed. Impervious
Surface for the project will be comprised of NPGIS roof area (3,935 sf), PGIS driveway asphalt pavement (533 sf), PGPS
driveway pervious concrete pavement (682 sf), and NPGIS patio/walkway pervious concrete pavement (266 sf) totaling
5,416 sf classifying the proposed development as a Category 2 Small Site Project. Effective Impervious Surface for the
development will be 4,468 sf. Disturbed site area is anticipated to be —11,625 sf. Soils are mapped as Alderwood
Gravelly Sandy Loam.
Small Site Minimum Requirement #1 — Preparation of Stormwater Site Plan
This report combined with the Stormwater & Grading/Construction SWPP Plans address this requirement.
Small Site Minimum Requirement #2 — Construction Stormwater Pollution Prevention Plan
This report combined with the Stormwater & Grading/Construction SWPP Plans address this requirement.
Small Site Minimum Requirement #3 — Source Control of Pollution
Specific source controls are not required for single family residential sites.
Small Site Minimum Requirement #4 — Preservation of Natural Drainage Systems and Outfalls
The proposed development preserves the natural drainage systems and outfalls.
Small Site Minimum Requirement #5 — Onsite Stormwater Management
Onsite stormwater management BIVIPs have been implemented to the maximum extend feasible through the use of
pervious concrete pavement and the implementation of BIVIP T5.13. Less than 1,000 sf of pervious pavement is
proposed therefore soils testing is not applicable.
Small Site Minimum Requirement #6 — Runoff Treatment
The total of new and replaced effective poll ution-generating impervious surface (PGIS) is less than 5,000 sf and
poll ution-generatil ng pervious surfaces (PGPS) is less than three-quarters (3/4) of an acre therefore stormwater
treatment facilities are not applicable.
Small Site Minimum Requirement #7 — Flow Control
Stormwater flow control is accomplished by utilizing onsite detention. The development will incorporate pervious
concrete pavement for 956 sf of Impervious Surface resulting in a 100% Flow Control Credit pursuant to Table 4 — Flow
Control Creditsfor Permeable Pavement of the City of Edmonds Development Information #E72B. Effective Impervious
Surface therefore is 4,557 sf requiring a flow control standard of 0.25 ds/acre of Effective Impervious Surface during
the 10-year storm (Table 5-3 Edmonds Stormwater Code Supplement).
The site was modeled utilizing DOE's WWHIV13 software with "Puget East 36" precipitation time series. Roof area of
3,935 sf (0.09 acres) was routed through a 60' 24" diameter detention tank with a 1.0" orifice and a bypass basin area
of 622 sf (0.01 acres) representing the asphalt driveway apron was modeled resulting in a 10 year release rate of 0.026
cfs. Allowable release from the site at 0.25 cfs/acre is 0.026 cfs [(4,557 sf / 43,560 sq*(0.25 cfs/acre)].
Small Site Minimum Requirement #8 — Wetland Protection
No wetlands are known to be located within Xmile of the subject site.
Small Site Minimum Requirement #9 — Operation and Maintenance
Operation and maintenance will be performed by the homeowner as directed by the engineer of record upon
completion of the project.
Small Site Minimum Requirement #10 — Offsite Analysis and Mitigation
Due to the implementation of stormwater management BlVlPs and onsite flow control facilities siginicant impacts to
the downstream system are not anticipated.
Small Site Minimum Requirement #11 — Financial Liability
The site in not known to be located within a Critical Area triggering the requirement of a performance bond.
Appen dix
N
A
stream
PROJECT SITE 23Mh S1 SW
am Irr
Good HopePond
L N aawdc,;� A -
she
Vicinity/Basin Map
A tel 4N C
— - - Cffy of Edman
ON NIMP Lkdts
80"AUE
Ah$crx*W Ora
AJder*cod 0
AlderwDoo Ora
I I tri
Ir
Soils Map
Slope Map
zeet, Sk Sw
v
7d
4�
Western Washington Hydrology Model
PROJECT REPORT
Project Name: 15-005 MM 85th
Site Address: 205XX 85TH PLACE W
city
EDMONDS
Report Date
2/26/2015
MGS Regoin
Puget East
Data Start
1939/10/1
Data End
2097/08/31
DOT Data Number: 03
WWHM3 Version:
PREDEVELOPED LAND USE
Name : Basin 1
Bypass: No
GroundWater: No
Pervious Land Use Acres
C, Forest, Flat .1
Impervious Land Use Acres
Element Flows To:
Surface Interflow
Name : NPGIS ROOF
Bypass: No
GroundWater: No
Pervious Land Use Acres
Impervious Land Use Acres
ROOF TOPS FLAT 0.09
Groundwater
Element Flows To:
Surface Interflow Groundwater
Tank 1, Tank 1,
Name Tank 1
Tank Name: Tank 1
Depth: 2ft.
Tank Type Circular
Diameter 2 ft.
Length : 60 ft.
Discharge Structure
Riser Height: 2 ft.
Riser Diameter: 12 in.
Orifice 1 Diameter: 1 in. Elevation: 0 ft.
Element Flows To:
Outlet 1 Outlet 2
Tank
Hydraulic
Table
Stage(ft)
Area(acr)
Volume(acr-ft)
Dschrg(cfs)
Infilt(cfs)
0.000
0.000
0.000
0.000
0.000
0.022
0.001
0.000
0.004
0.000
0.044
0.001
0.000
0.006
0.000
0.067
0.001
0.000
0.007
0.000
0.089
0.001
0.000
0.008
0.000
0.111
0.001
0.000
0.009
0.000
0.133
0.001
0.000
0.010
0.000
0.156
0.001
0.000
0.010
0.000
0.178
0.002
0.000
0.011
0.000
0.200
0.002
0.000
0.012
0.000
0.222
0.002
0.000
0.012
0.000
0.244
0.002
0.000
0.013
0.000
0.267
0.002
.0.000
0.014
0.000
0.289
0.002
0.000
0.014
0.000
0.311
0.002
0.000
0.015
0.000
0.333
0.002
0.000
0.015
0.000
0.356
0.002
0.001
0.016
0.000
0.378
0.002
0.001
0.016
0.000
0.400
0.002
0.001
0.017
0.000
0.422
0.002
0.001
0.017
0.000
0.444
0.002
0.001
0.018
0.000
0.467
0.002
0.001
0.018
0.000
0.489
0.002
0.001
0.018
0.000
0.511
0.002
0.001
0.019
0.000
0.533
0.002
0.001
0.019
0.000
0.556
0.002
0.001
0.020
0.000
0.578
0.002
0.001
0.020
0.000
0.600
0.003
0.001
0.020
0.000
0.622
0.003
0.001
0.021
0.000
0.644
0.003
0.001
0.021
0.000
0.667
0.003
0.001
0.021
0.000
0.689
0.003
0.001
0.022
0.000
0.711
0.003
0.001
0.022
0.000
0.733
0.003
0.001
0.022
0.000
0.756
0.003
0.001
0.023
0.000
0.778
0.003
0.002
0.023
0.000
0.800
0.003
0.002
0.023
0.000
0.822
0.003
0.002
0.024
0.000
0.844
0.003
0.002
0.024
0.000
0.867
0.003
0.002
0.024
0.000
0.889
0.003
0.002
0.025
0.000
0.911
0.003
0.002
0.025
0.000
0.933
0.003
0.002
0.025
0.000
0.956
0.003
0.002
0.026
0.000
0.978
0.003
0.002
0.026
0.000
1.000
0.003
0.002
0.026
0.000
1.022
0.003
0.002
0.027
0.000
1.044
0.003
0.002
0.027
0.000
1.067
0.003
0.002
0.027
0.000
1.089
0.003
0.002
0.027
0.000
1.111
0.003
0.002
0.028
0.000
1.133
0.003
0.003
0.028
0.000
1.156
0.003
0.003
0.028
0.000
1.178
0.003
0.003
0.029
0.000
1.200
0.003
0.003
0.029
0.000
1.222
0.003
0.003
0.029
0.000
1.244
0.003
0.003
0.029
0.000
1.267
0.003
0.003
0.030
0.000
1.289
0.003
0.003
0.030
0.000
1.311
0.003
0.003
0.030
0.000
1.333
0.003
0.003
0.030
0.000
1.356
0.003
0.003
0.031
0.000
1.378
0.003
0.003
0.031
0.000
1.400
0.003
0.003
0.031
0.000
1.422
0.002
0.003
0.031
0.000
1.444
0.002
0.003
0.032
0.000
1.467
0.002
0.003
0.032
0.000
1.489
0.002
0.003
0.032
0.000
1.511
0.002
0.004
0.032
0.000
1.533
0.002
0.004
0.033
0.000
1.556
0.002
0.004
0.033
0.000
1.578
0.002
0.004
0.033
0.000
1.600
0.002
0.004
0.033
0.000
1.622
0.002
0.004
0.033
0.000
1.644
0.002
0.004
0.034
0.000
1.667
0.002
0.004
0.034
0.000
1.689
0.002
0.004
0.034
0.000
1.711
0.002
0.004
0.034
0.000
1.733
0.002
0.004
0.035
0.000
1.756
0.002
0.004
0.035
0.000
1.778
0.002
0.004
0.035
0.000
1.800
0.002
0.004
0.035
0.000
1.822
0.002
0.004
0.035
0.000
1.844
0.001
0.004
0.036
0.000
1.867
0.001
0.004
0.036
0.000
1.889
0.001
0.004
0.036
0.000
1.911
0.001
0.004
0.036
0.000
1.933
0.001
0.004
0.037
0.000
1.956
0.001
0.004
0.037
0.000
1.978
0.001
0.004
0.037
0.000
2.000
0.000
0.004
0.037
0.000
2.022
0.000
0.000
0.070
0.000
Name : PGIS DRIVEWAY IN R.O.W.
Bypass: No
GroundWater: No
Pervious Land Use Acres
Impervious Land Use Acres
ROADS MOD 0.01
Element Flows To:
Surface Interflow Groundwater
MITIGATED LAND USE
ANALYSIS RESULTS
Flow Frequency Return Periods for Predeveloped. POC #1
Return Period
Flow(cfs)
2 year
0.001672
5 year
0.002748
10 year
0.003354
25 year
0.003984
50 year
0.004363
100 year
0.004678
Flow Frequency Return Periods for Mitigated. POC #1
Return Period
Flow(cfs)
2 year
0.019714
5 year
0.023794
10 year
0.026471
25 year
0.029848
50 year
0.032371
100 year
0.034908
Yearly Peaks for Predeveloped and Mitigated. POC #1
Year
Predeveloped
Mitigate
1941
0.002
0.019
1942
0.001
0.019
1943
0.002
0.024
1944
0.001
0.016
1945
0.000
0.016
1946
0.003
0.022
1947
0.002
0.019
1948
0.002
0.021
1949
0.003
0.022
1950
0.001
0.021
1951
0.006
0.032
1952
0.002
0.016
1953
0.001
0.033
1954
0.001
0.023
1955
0.001
0.016
1956
0.001
0.016
1957
0.002
0.017
1958
0.001
0.014
1959
0.002
0.019
1960
0.002
0.016
1961
0.002
0.019
1962
0.001
0.019
1963
0.001
0.019
1964
0.001
0.014
1965
0.001
0.022
1966
0.002
0.020
1967
0.001
0.016
1968
0.003
0.022
1969
0.002
0.023
1970
0.002
0.016
1971
0.001
0.019
1972
0.001
0.018
1973
0.004
0.024
1974
0.001
0.017
1975
0.002
0.016
1976
0.002
0.020
1977
0.002
0.017
1978
0.000
0.020
1979
0.001
0.024
1980
0.001
0.024
1981
0.002
0.023
1982
0.001
0.022
1983
0.002
0.030
1984
0.002
0.025
1985
0.001
0.016
1986
0.001
0.018
1987
0.003
0.022
1988
0.003
0.025
1989
0.001
0.015
1990
0.002
0.020
1991
0.006
0.033
1992
0.004
0.031
1993
0.001
0.020
1994
0.001
0.017
1995
0.001
0.014
1996
0.002
0.017
1997
0.005
0.022
1998
0.003
0.020
1999
0.001
0.019
2000
0.003
0.032
2001
0.001
0.019
2002
0.001
0.013
2003
0.001
0.029
2004
0.003
0.021
2005
0.001
0.015
2006
0.001
0.017
2007
0.002
0.017
2008
0.001
0.019
2009
0.002
0.019
2010
0.004
0.024
2011
0.002
0.040
2012
0.003
0.024
2013
0.002
0.022
2014
0.004
0.029
2015
0.002
0.024
2016
0.001
0.015
2017
0.003
0.023
2018
0.001
0.017
2019
0.002
0.017
2020
0.002
0.022
2021
0.001
0.015
2022
0.003
0.020
2023
0.001
0.023
2024
0.002
0.020
2025
0.001
0.016
2026
0.003
0.020
2027
0.002
0.017
2028
0.002
0.016
2029
0.002
0.017
2030
0.002
0.025
2031
0.002
0.026
2032
0.002
0.022
2033
0.003
0.020
2034
0.001
0.015
2035
0.004
0.018
2036
0.002
0.015
2037
0.002
0.020
2038
0.000
0.018
2039
0.001
0.022
2040
0.001
0.018
2041
0.003
0.025
2042
0.002
0.018
2043
0.002
0.022
2044
0.003
0.029
2045
0.001
0.017
2046
0.001
0.021
2047
0.002
0.018
2048
0.001
0.019
2049
0.001
0.023
2050
0.001
0.015
2051
0.001
0.025
2052
0.001
0.020
2053
0.001
0.019
2054
0.003
0.026
2055
0.000
0.014
2056
0.003
0.027
2057
0.005
0.022
2058
0.005
0.024
2059
0.002
0.021
2060
0.002
0.022
2061
0.001
0.023
2062
0.002
0.022
2063
0.007
0.035
2064
0.001
0.016
2065
0.003
0.022
2066
0.001
0.021
2067
0.001
0.012
2068
0.002
0.018
2069
0.004
0.022
2070
0.001
0.013
2071
0.001
0.016
2072
0.001
0.015
2073
0.001
0.017
2074
0.004
0.023
2075
0.002
0.017
2076
0.000
0.019
2077
0.002
0.019
2078
0.000
0.023
2079
0.001
0.019
2080
0.001
0.019
2081
0.004
0.026
2082
0.002
0.023
2083
0.003
0.020
2084
0.002
0.017
2085
0.002
0.018
2086
0.001
0.022
2087
0.002
0.021
2088
0.002
0.022
2089
0.001
0.019
2090
0.002
0.027
2091
0.001
0.018
2092
0.002
0.018
2093
0.003
0.027
2094
0.001
0.018
2095
0.001
0.021
2096
0.001
0.017
2097
0.001
0.021
2098
0.003
0.025
Ranked Yearly Peaks for Predeveloped and Mitigated. POC #1
Rank Predeveloped Mitigated
0.0066
0.0400
0.0060
0.0346
0.0055
0.0332
0.0053
0.0331
0.0052
0.0319
0.0047
0.0316
0.0044
0.0312
0.0043
0.0300
0.0041
0.0295
0.0039
0.0291
0.0039
0.0288
0.0038
0.0274
0.0037
0.0274
0.0036
0.0269
0.0034
0.0260
0.0034
0.0258
0.0034
0.0256
0.0032
0.0255
0.0030
0.0254
0.0030
0.0252
0.0029
0.0248
0.0028
0.0246
0.0028
0.0245
0.0028
0.0244
0.0028
0.0242
0.0028
0.0241
0.0027
0.0241
0.0027
0.0241
0.0027
0.0236
0.0026
0.0235
0.0026
0.0235
0.0026
0.0234
0.0026
0.0233
0.0026
0.0233
0.0025
0.0233
0.0025
0.0231
0.0023
0.0231
0.0023
0.0229
0.0023
0.0229
0.0023
0.0228
0.0022
0.0226
0.0022
0.0224
0.0022
0.0223
0.0021
0.0223
0.0020
0.0223
0.0020
0.0222
0.0020
0.0222
0.0019
0.0221
0.0019
0.0220
0.0019
0.0220
0.0019
0.0219
0.0019
0.0219
0.0018
0.0218
0.0018
0.0218
0.0018
0.0218
0.0018
0.0217
0.0018
0.0217
0.0018
0.0217
0.0018
0.0217
0.0018
0.0216
0.0018
0.0213
0.0018
0.0212
0.0017
0.0212
0.0017
0.0209
0.0017
0.0208
0.0017
0.0208
0.0017
0.0208
0.0017
0.0207
0.0017
0.0206
0.0017
0.0205
0.0016
0.0204
0.0016
0.0202
0.0016
0.0201
0.0016
0.0201
0.0016
0.0201
0.0016
0.0200
0.0016
0.0200
0.0016
0.0199
0.0016
0.0198
0.0016
0.0197
0.0016
0.0197
0.0016
0.0196
0.0016
0.0195
0.0015
0.0193
0.0015
0.0192
0.0015
0.0192
0.0015
0.0191
0.0015
0.0191
0.0015
0.0191
0.0014
0.0191
0.0014
0.0191
0.0014
0.0190
0.0014
0.0189
0.0014
0.0189
0.0014
0.0188
0.0014
0.0188
0.0014
0.0187
0.0014
0.0187
0.0013
0.0186
0.0013
0.0186
0.0013
0.0186
0.0013
0.0185
0.0013
0.0183
0.0013
0.0183
0.0013
0.0181
0.0013
0.0179
0.0012
0.0179
0.0012
0.0179
0.0012
0.0179
0.0012
0.0178
0.0012
0.0177
0.0011
0.0177
0.0011
0.0176
0.0011
0.0175
0.0011
0.0174
0.0011
0.0173
0.0011
0.0172
0.0011
0.0171
0.0011
0.0171
0.0010
0.0169
0.0010
0.0169
0.0010
0.0168
0.0010
0.0168
0.0010
0.0168
0.0010
0.0167
0.0010
0.0167
127
0.0010
0.0167
128
0.0009
0.0166
129
0.0009
0.0165
130
0.0009
0.0164
131
0.0009
0.0162
132
0.0008
0.0162
133
0.0008
0.0162
134
0.0008
0.0162
135
0.0008
0.0161
136
0.0008
0.0161
137
0.0008
0.0160
138
0.0008
0.0159
139
0.0008
0.0158
140
0.0008
0.0157
141
0.0007
0.0156
142
0.0007
0.0156
143
0.0007
0.0156
144
0.0007
0.0154
145
0.0007
0.0151
146
0.0007
0.0149
147
0.0006
0.0149
148
0.0006
0.0149
149
0.0006
0.0149
150
0.0006
0.0146
151
0.0006
0.0145
152
0.0005
0.0142
153
0.0005
0.0139
154
0.0004
0.0136
155
0.0003
0.0135
156
0.0001
0.0134
157
0.0001
0.0133
158
0.0000
0.0121
Poc # 1
The Facility PASSED.
Flow(CFS) Predev Dev Percentage Pass/Fail
0.0008
13782
0
0
Pass
0.0009
12604
0
0
Pass
0.0009
11500
0
0
Pass
0.0009
10526
0
0
Pass
0.0010
9664
0
0
Pass
0.0010
8891
0
0
Pass
0.0010
8208
0
0
Pass
0.0011
7576
0
0
Pass
0.0011
7001
0
0
Pass
0.0012
6481
0
0
Pass
0.0012
6002
0
0
Pass
0.0012
5503
0
0
Pass
0.0013
5096
0
0
Pass
0.0013
4709
0
0
Pass
0.0013
4369
0
0
Pass
0.0014
4038
0
0
Pass
0.0014
3729
0
0
Pass
0.0014
3464
0
0
Pass
0.0015
3217
0
0
Pass
0.0015
2996
0
0
Pass
0.0015
2796
0
0
Pass
0.0016
2607
0
0
Pass
0.0016
2454
0
0
Pass
0.0017
2279
0
0
Pass
0.0017
2144
0
0
Pass
0.0017
2014
0
0
Pass
0.0018
1897
0
0
Pass
0.0018
1790
0
0
Pass
0.0018
1682
0
0
Pass
0.0019
1596
0
0
Pass
0.0019
1519
0
0
Pass
0.0019
1429
0
0
Pass
0.0020
1367
0
0
Pass
0.0020
1283
0
0
Pass
0.0020
1218
0
0
Pass
0.0021
1153
0
0
Pass
0.0021
1082
0
0
Pass
0.0022
1040
0
0
Pass
0.0022
985
0
0
Pass
0.0022
943
0
0
Pass
0.0023
903
0
0
Pass
0.0023
861
0
0
Pass
0.0023
836
0
0
Pass
0.0024
801
0
0
Pass
0.0024
775
0
0
Pass
0.0024
747
0
0
Pass
0.0025
717
0
0
Pass
0.0025
680
0
0
Pass
0.0025
652
0
0
Pass
0.0026
626
0
0
Pass
0.0026
589
0
0
Pass
0.0027
562
0
0
Pass
0.0027
536
0
0
Pass
0.0027
511
0
0
Pass
0.0028
487
0
0
Pass
0.0028
464
0
0
Pass
0.0028
445
0
0
Pass
0.0029
433
0
0
Pass
0.0029
407
0
0
Pass
0.0029
396
0
0
Pass
0.0030
376
0
0
Pass
0.0030
359
0
0
Pass
0.0030
339
0
0
Pass
0.0031
322
0
0
Pass
0.0031
311
0
0
Pass
0.0032
297
0
0
Pass
0.0032
283
0
0
Pass
0.0032
267
0
0
Pass
0.0033
251
0
0
Pass
0.0033
247
0
0
Pass
0.0033
232
0
0
Pass
0.0034
218
0
0
Pass
0.0034
206
0
0
Pass
0.0034
197
0
0
Pass
0.0035
184
0
0
Pass
0.0035
173
0
0
Pass
0.0035
164
0
0
Pass
0.0036
152
0
0
Pass
0.0036
139
0
0
Pass
0.0037
128
0
0
Pass
0.0037
117
0
0
Pass
0.0037
110
0
0
Pass
0.0038
98
0
0
Pass
0.0038
89
0
0
Pass
0.0038
82
0
0
Pass
0.0039
78
0
0
Pass
0.0039
72
0
0
Pass
0.0039
70
0
0
Pass
0.0040
64
0
0
Pass
0.0040
59
0
0
Pass
0.0040
55
0
0
Pass
0.0041
49
0
0
Pass
0.0041
41
0
0
Pass
0.0041
39
0
0
Pass
0.0042
35
0
0
Pass
0.0042
32
0
0
Pass
0.0043
30
0
0
Pass
0.0043
28
0
0
Pass
0.0043
26
0
0
Pass
0.0044
23
0
0
Pass
Water Quality BMP Flow and Volume for POC 1.
on-line facility volume: 0 acre-feet
On-line facility target flow: 0 cfs.
Adjusted for 15 min: 0 cfs.
off-line facility target flow: 0 cfs.
Adjusted for 15 min: 0 cfs.
Per1nd and Imp1nd Changes
No changes have been made.
This program and accompanying documentation is provided 'as -is' without warranty of any kind. The entire risk
regarding the performance and results of this program is assumed by the user. Clear Creek Solutions and the
Washington State Department of Ecology disclaims all warranties, either expressed or implied, including but not
limited to implied warranties of program and accompanying documentation. In no event shall Clear Creek
Solutions and/or the Washington State Department of Ecology be liable for any damages whatsoever (including
without limitation to damages for loss of business profits, loss of business information, business interruption,
and the like) arising out of the use of, or inability to use this program even if Clear Creek Solutions or the
Washington State Department of Ecology has been advised of the possibility of such damages.
of E04f
City of Edmonds
Site Classification Worksheet
Page 1 of 2 /0C.
The project's Site Classification will dictate the specific stormwater management
requirements applicable to your site. Completing this worksheet will help determine the amount of
regulated impervious surface and whether your project falls into the classification of a Small Site
(Category I or Category 2), or a Nflnor Site. Please reference the Glossaa (DR. 10-11), Figmres Q and
E. (pp. 8-9), and Examples (1212. 11-12). to assist with completion of this worksheet.
1) Is Permeable Pavement' Proposed For Use on this Site? X Yes El No
Refer to Stonnwater Supplement Chapter 5.1
If YES, the subject area is to be considered impervious for initial site classification purposes. Include total
permeable pavement area in the calculation of Non -Regulated, Replaced and/or New impervious surface
areas in the table below.
2) Determine the Amount and Type of Existing & Proposed Impervious Surface for the Site
Refer to Stormwater Supplement Chapter 2 and Fig. C I
Line 1: Identify the Non -Regulated Impervious Surface Area.
Line 2: Identify the Replaced Impervious Surface Area, dividing the total between Exempt and Regulated; either or both
may be zero. Note: For project classification purposes, Replaced Impervious may only be considered exempt
under certain conditions. Refer to the Glossary and Figure D.
Line 3: Identify the New Impervious Surface Area for your project. All impervious areas created post -July 7, 1977 or
after the date of annexation into the City are regulated & should be included in this total unless they can be
categorized separately as a Rcplaccd-Regulatcd area.
Line 4: Enter the sum of the total Replaced -Regulated plus the total New impervious areas.
Line 5: Identify the total area currently mitigated by an existing city -approved stormwater management system.
Line 6: Enter the sum of the value in Line 4 less the value in Line 5 to identify the total Regulated area in which
stormwater controls have not yet been applied.
Line 7: Identify the total area proposed to be mitigated through the use of Low Impact Development Techniques.
Line 8: Identify the total area proposed to be mitigated through conventional Stormwater Management Techniques.
** Provide a copy of the following table on the drainage plan sheet for the proposed project **
Line
. Type
Area (square feet)
1.
Non -Regulated
0
Exempt
Regulated
2.
Replaced
0
0
3.
4.
New (Post 1977) 444 4 4 4 4 4 4
Total Regulated Impervious Area
Mitigation regit red if in excess of 2000sf
+
59416
59416
5.
6.
Total Area Mitigated by Existing Stormwater Management System(s)
Regu lated Area Not Yet NUtigated
0
59416
7.
A a Proposed to be Mitigated by Low Impact Development Techniques
948
8.
Area Proposed to be Mitigated through Conventional SWM Techniquesi
49468
I (e.g. porous asphalt, porous concrete, paver blocks, concrete open celled paving grids, or plastic lattices filled with turf or stone)
Revised on 310512012 E72-SWALErosion_Control-03.05.12.doc Page 5 of 12
City of Edmonds
Site Classification Worksheet
Page 2 of 2
A of E0_4 11
40C. SC)rJ
3) Determine the Total Area of Land Disturbing Activity 119625 sf
Refer to Stormwater Supplement Chapter 8
14) Determine the Quantity of Grading, Fill and/or Excavation 200 CUT/20anLL-cy I
5) Will the project convert 3/4 Acre or More of Native Vegetation to Lawn or El Yes R] No
Landscaped Area?
6) Identify the Watershed the Existing Site Runoff Discharges to
Refer to Stormwater Supplement Chapter 2.3
Based on Site Location and Watershed Map — Figure-C. Check all that apply.
A. [I Direct Discharge B. X Creek or Lake Basin
o Edmonds Way Basin
o Puget Sound Basin
o Puget Sound Piped Basin
DETERMINE PROJECT CLASSIFICATION USING THE INFORMATION ABOVE
AND THE PROJECT CLASSIEFICATION CHART (Figure B, pg 4)
0 Small Site - Category 1 X Small Site - Category 2 El Minor Site
Stormwater Supplement Stormwater Supplement Stormwater Supplement
Chapter 5 Chapter 5 Chapter 6
Revised on 310512012 E72-SW)�t_Erosion_Control-03.05.12.doc Page 6 of 12
City of Edmonds S
,)TREET RE
Site Classification Worksh'eet
J
Page 1 of 2
JUL 20 K."
The project's Site Classification will dictate the specific stormwAN�
of Eb4f
,:k
T
requirements applicable to your site. Completing this worksheet will help determine the amount of
regulated impervious surface and whether your project falls into the classification of a Small Site
(Category I or Category 2), or a Mnor Site. Please reference the Glossaa (P12. 10-11). Figgres Q and
E, (pp. 8-9). and Examples (pp. I 1- 12). to assist with completion of this worksheet.
1) Is Permeable Pavement' Proposed For Use on this Site? Yes No
Refer to Stonnwater Supplement Chapter 5.1
If YES, the subject area is to be considered impervious for initial site classification purposes. Include total
permeable pavement area in the calculation of Non -Regulated, Replaced and/or New impervious surface
areas in the table below.
2) Determine the Amount and Type of Existing & Proposed Impervious Surface for the Site
Refer to Storinwater Supplement Chapter 2 and Fig. C
Line 1: Identify the Non -Regulated Impervious Surface Area.
Line 2: Identify the Replaced Impervious Surface Area, dividing the total between Exempt and Regulated; either or both
may be zero. Note: For project classification purposes, Replaced Impervious may only be considered exempt
under certain conditions. Refer to the Glossary and Figure D.
Line 3: Identify the New Impervious Surface Area for your project. All impervious areas created post -July 7, 1977 or
after the date of annexation into the City are regulated & should be included in this total unless they can be
categorized separately as a Replaced -Regulated area.
Line 4: Enter the sum of the total Replaced -Regulated plus the total New impervious areas.
Line 5: Identify the total area currently mitigated by an existing city -approved stormwater management system.
Line 6: Enter the sum of the value in Line 4 less the value in Line 5 to identify the total Regulated area in which
stormwater controls have not yet been applied.
Line 7: Identify the total area proposed to be mitigated through the use of Low Impact Development Techniques.
Line 8: Identify the total area proposed to be mitigated through conventional Stormwater Management Techniques.
** Provide a copy of the following table on the drainage plan sheet for the proposed project **
Line
Type
Area (square feet)
1.
Non -Regulated
0
7�
Exempt
Regulated
2.
Replaced
0
0
3.
4.
New (Post 1977) 4 4 4 4
Total Regulated Impervious Am
Mitigation required if in excess of 2000sf
+
59416
59416
5.
6.
Total Area Mitigated by Existing Stormwater Management System(s)
Regulated Area Not Yet Nfltigated
0
59416
7.
Area Proposed to be Mitigated by Low Impact Development Techniques
948
8.
Area Proposed to be Mitigated through Conventional SWM Techniques
49468
I (e.g. porous asphalt, porous concrete, paver blocks, concrete open celled paving grids, or plastic lattices filled with turf or stone)
Revised on 310512012 E72-SWAt_Erosion_Control-03.05.12.doc Page 5 of 12
City of Edmonds
Site Classification Worksheet
Page 2 of 2
OV EDAf
', We-
. I %gri
3) Determine the Total Area of Land Disturbing Activity 119625 sf
Refer to Stormwater Supplement Chapter 8
14) Determine the Quantity of Grading, Fill and/or Excavation 200 CUT/200 F1
5) Will the project convert 3/4 Acre or More of Native Vegetation to Lawn or El Yes F91 No
Landscaped Area?
6) Identify the Watershed the Existing Site Runoff Discharges to
Refer to Stonnwater Supplement Chapter 2.3
Based on Site Location and Watershed Map — Figure-C. Check all that apply.
A. n Direct Discharge B. [9 Creek or Lake Basin
o Edmonds Way Basin
o Puget Sound Basin
o Puget Sound Piped Basin
DETERMINE PROJECT CLASSIFICATION USING THE INFORMATION ABOVE
AND THE PROJECT CLASSIFICATION CHART (Figure B, pg 4)
El Small Site - Category 1 X Small Site - Category 2 El Minor Site
Stormwater Supplement Stormwater Supplement Stormwater Supplement
Chapter 5 Chapter 5 Chapter 6
Revised on 310512012 E72-SWAI�-Erosion—Controt-03.05.12.doc Page 6 of 12
FA
.0
201511190085 3 PGS
1111912015 9:59am �75.00
SNOHOMISH COUNTY, ASHINGTON
AFTER RECORDING RETURN TO:
Sean Conrad
City of Edmonds
121 5h Avenue North
Edmonds, WA 98020
Document Title(s): Native ' Growth Protection Area Covenant
Reference Number(s) of Document assigned or released: N/A
Grantor: Mietzner Brothers Properties, LLC
-Grantee: Same
Legal Description: Lot 40, Plat of Pine Ridge, according to the Plat thereof,
recorded in Volume 13 of Plats, Page 66, Records of Snohomish County,
W ' ashington; Except the East 180 feet thereof.
Assessor's Tax Parcel No. 00544600004001
NATIVE GROWTH PROTECTION AREA COVENANT
1&1:�_ THIS NATIVE GROWTH PROTECTION AREA COVENANT is established this
day of NO MJi4� _, 2015 by Mietzner Brothers Properties, LLC, a Washington
limited liability company, ("Mietzner" or "Grantor").
RECITALS
WHEREAS Mietmer is the owner of certain real property located in
Snohomish County, Washington and legally described as Lot 40, Plat of Pine
Ridge, according to the Plat thereof, recorded in Volume 13 of Plats, Page 66,
Records of Snohomish County, Washington; Except the East 180 feet thereof,
records of Snohomish County, Washington; and
WHEREAS Mietzner desires to obtain a building permit for a single-family residential
home; and
WHEREAS Mietzner desires to protect a portion of its property from any further clearing
and development.
NOW, THEREFORE, for and in consideration of the mutual benefits to be derived by the
undersigned and its successors, the undersigned hereby establishes the following covenant:
Native Growth Protection Area. All NATIVE GROWTH PROTECTION
AREAS shall be left permanently undisturbed in a substantially natural state. No
clearing, grading, filling, building construction or placement, or road construction
of any kind shall occur, except removal of hazardous trees.
2. Legal Description of Native Growth Protection Area. The legal description of the
Native Growth Protection Area is described as follows:
The east 115 feet of Lot 40, Plat of Pine Ridge, according to the Plat thereof,
recorded in Volume 13 of Plats, Page 66, Records of Snohomish County
Washington; Except the East 180 feet thereof.
3. Binding Effect. This document shall be construed as a covenant running with the
land, and shall be binding upon the undersigned, its heirs, successors, and assigns, in perpetuity.
4. Governing L . This Covenant shall be governed and construed in accordance
with the laws of the State of Washington.
Mietmer Brothers Properties, LLC, a Washington limited
liability company
By:
Michael MMietzmner, Its Presi"d t
[Corporate Acknowledgement]
STATE OF WASHINGTON )
)ss
COUNTY OF SNOHOMISH )
On this day personally appeared before me Michael Mietzner, to me known to be the
President of Mietzner Brothers Properties, LLC, and acknowledged the said instrument to be the
free and voluntary act and deed of said corporation/limited liability company, for the uses and
purposes therein mentioned, and stated that he/she was authorized to execute the said instrument as
such officer/member.
GIVEN under my hand and official seal this ) 191A day of 52015.
NIN
ON life
10
TA#
0 0
too -
0
11101 Op WAS\AOL
1i "%%%\\
ke-k�,o e-'b A V [Print Name]
NOTARY PUBLIC in and for the State of
Washington residing at F— kmtf
My commission expires b -/ �
OV ED4 0
CITY OF EDMONDS
121 5TH AVENUE NOKIH - EDMONDS - WA 98020 - (425) 771-0220
http://www.ci.edmonds.wa.us
RCW 197-11-970 Determination of Nonsignificance (DNS)
DETERMINATION OF NONSIGNIFICANCE
Description of proposal: Demolition of a single family residence located within an Environmentally Sensitive Area
for slopes. Site adress is 20607 85h Place West. The property is zoned Single Family Residential - RS-12 (City of
Edmonds Plan Check No. 99-257).
Proponent: Jessie Bailey P.O. Box 6098 Edmonds, WA 98026
Location of proposal, including street address if any: 20607 85,h Place West
Lead agency: CITY OF EDMONDS
The lead agency for this proposal has determined that it does not have a probable significant adverse impact on the
environment. An environinental impact statement is not required under RCW 43.21.030(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.
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 14 days from
the date below. Comments must be submitted by '1999.
Responsible Official: Jeffrey S. Wilson
Position/Title: Planning Supervisor
Phone: 425-771-0220
Address: City of Edmonds
121 5th Avenue North
Edmonds, WA 98020
Date: Signature:
XX You may appeal this determination to P)qbert Chave, Planning Manager, at 121 5th Avenue North,
Edmonds, WA 98020, no later than �- i C1 , 1999, by filing a written appeal citing the
specific factual reasons for the appeal. The appeal submittal must also include the required fees and
mailing list. Please contact , the Planning Division for specific submittal requirements.
XX Posted on &W - 5 , 1999, at the Edmonds Public Library, Edmonds Community Services
Building, and the Minonds Post Office.
XX Distribute to "Checked" Agencies on the reverse side of this form, along with a copy of the Checklist
99-257 MDNS.DOC Page I of 4
CREATED ON 08/03/99 10:17 AM
Mailed to the following along with the Environmental Checklist:
XX Environmental Review Section
XX National Marine Fisheries Service
Department of Ecology
Attn.: Steve Landino
P.O. Box 47703
WA. State Habitat Branch Chief
Olympia, WA 98504-7703
5 10 Desmond Drive SE
Lacey, WA 98503
XX Department of Fisheries
XX— Jessie Bailey
An.: Richard E. Johnson
P.O. Box 6098
Regional Habitat Manger
Edmonds, WA 98026
16018 Mill Creek Boulevard
Mill Creek, WA 98012
XX Bobby Mills
8112 206" St SW
XX Department of Wildlife
Edmonds, WA 98026
16018 Mill Creek Boulevard
Mill Creek, WA 98012
pc: File No. If-Z7
SEPA Notebook
Page 2 of 4
99-257 MDNS.DOC
CREATED ON 08/03/99 10:17 AM
1:4
7,d
r-D
'STREET FILE
CITY OF EDMONDS
250- 5TH AVE. N. *EDMONDS, WA98020 - (206)xM90 771-0220
COMMUNITY SERVICES:
Public Works 9, Planning * Parks and Recreation Engineering
890 . 194
LETTER OF TRANSMITTAL
J If
Date: -2/m/f 11
TO: Tessy Ailley
Project: Plan review number:
eZ ce,74" 7 7"' 0 Cd
Address: (,'
4:�eelvlze- A/01J,
Transmitting: Plans & Calcs- Soils Report Other
For' our information:
y �
As requested by your office:
For structural plan review:
Comments:
I le
Ae ZR111'011446 eMx /K5
141%de
rk, 1_),0,4 ",-I ,hAzg
For non-structural plan review:
For Washington State Energy Code review: Am
For Northwest Energy Code review: wkly gLoeuxed
For Fire Code review:
Note attached comments:
For Corrections and resubmittal:
Respond to letter in writing:
Resubmit 2 revised plans:
Send directly to City Building Division: .
to
Building Divi ion
City Official
e Incorporated August 1.1, 1890 e
Sister Cities International.— Hekinan, Japan
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DATE: TIME: FILE: 4fil6fl
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CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works a Planning * Parks and Recreation * Engineering
January 18, 1994
Mr. Ben Bailey
5713 145th Place Southwest
Edmonds, Washington 98026
RE: Abandoned Single Family Residence @
According to Snohomish County Assessor re
at 20607 85th Place West in Edmonds. The
City has received a complaint regarding the c
by the City Code Enforcement Officer reveal
it is not adequately secured against unwantec .
as adopted by the City, requires that structur
insects, vermin or rodents and further, buildij
adequately secured from trespassers. Pursua
any openings (including the garage door) anc
within 10 days date of this letter. *
If you have any questions regarding this lette
Thank you,
Jeannine L. Graf
Acting Building Official
cc: City Code Enforcement Officer
LAURA M. HALL
MAYOR
Is
our RETURN
ADDRESS completed on
the reverse side?
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Thank
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using Return
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Service.
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
-------------------------- : MetroScan/Snohomish : ---------------------------
1*
Owner :BAILEY BEN B
RTSQ :04E-27N-19-SW
CoOwner :
APN:5446 000 040 01 02
Site Addr:85TH PL W EDMONDS 98020
Struct:$96,700
Mail Addr:5713 145TH PL
SW EDMONDS WA
98026
Land :$74,000
Rec Date
Deed :
Total :$170,700
Price
Loan :
LevyCd:00217
Aud Fee
Ln Amt:
1993Tx:$1,900.49
ActualUse:
Lender:
Phone :
Vest Type:
IntTyp:
%owned:
Land Use :11101 RES,SGL
FAMILY RES,DETACHED.,l
UNIT
Vol:13 Page:66
NbrhdCode:500
Easement:
Zoning :RS-12000
ZoningRest:
--Census--
Sub/Plat :PINE RIDGE
Tract:
Legal :BLK 000 D-01 -
LOT 40 LESS
E 180 FT
Block:
.......... ........
Bedrooms :3 Bldg
SF:2,112
........
LotAcre:
.........
Year Blt:1960
Bath F3H :2 1st
SF :2,112
Lot SF :
EffYrBlt:
Stories :1 2nd
SF :
Heating:BASEBRD
BldgGrad:AVG
Fireplace:2 3rd
SF :
Roof :BUILT UP
BldgCond:FAIR
Spa 4th
SF :
View
Wtr Srce:PUBLIC
Units :1 BsmntSF:
WtFront:
Sewer :SEWER
'��l -5- M \-�1'5 I
464,,volowrd
The Information Provided Is Deemed Reliable, But Is Not Guaranteed.
r
CA FILE NO. qq_Z24
I Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soil s/topo graphy/hydrology/vegetation)
I . Site Address/Location: :7 a 6, a I 7j P Z. i _,,�
2. Property Tax Account Number: -5, 'Y e 0 e C', I/ e 0 / 0 Z_
3. Approximate Site Size (acres or square feet): — �2 2 0 r 1 0 C)
4. Is this site currently developed? _YYes; _ no.
If yes; how is site developed? 5,1 A? �,/e r- /,a,
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 I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
1 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: 0 - ;Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year)
7-
0 A�&_ -_
8. Site is in the floodway /Vo floodplain ofawatercou'rse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow_ ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
... ., :1 1! .1
, :. . 7 14:A
'C' �., ;..
tj§a ohtory
^--Chk.d-; Rey 10/03/97
City of Edmonds
RECE1VE:D
JUL 2 8
r
CRITICAL AREAS CHECKLIS f" Ci Y OF E3DTJONUS�Fl
The Critical Areas Checklist contained on this form 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.
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 it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a devel'opment
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent infor in-ation (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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
,Yes s , e-- O�� i L- e-
Name
Street Address
city State Zip
� a!�; - -,) L4 -� - 50 -3 1
Telephone
Signature
Applicant Representative:
Name
Street Address
-6DM01-1J/3-S LW-k 4Reo-A-(,
City �tate
Zip
9 �k �; — -) -) F - - 0,--, ? Lf
Telephone
Signature b4
0
Date
cncepdon�anakacl.doc
Date
(over)
J,
41 '1? C. 1 S91�1
September 1, 1999
Jessie Bailey
Box 6098
Edmonds, WA 98026
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist # 99-221
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
. ... ..... . ........... .......... .............................
.. ...........
........ ............. ....... . . . . . . . ..... .
. ..........................
...... .....
MPORTANrINFORMAV MITO'BE . ....
. . ..... .. .. .....
.............
... ........ .
.......... ........................................ .....
....... . .........
PLEASE EXAMINE THIS" DETERMINATION"FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
you must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
c: Bobby R. Mills
Enc: Critical Areas Determination
* Architectural Design Board
C:Reception\Jana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
A10 r 0 #J 1- r
80-r Iii
CITY ENGTNEER'S SEWER CONNECTION RECOMMIENDATTON PA-r-W=6
Date
Address of Property to be Connected fo 6 o 7- 8
Owner Name & Mailing Address
Legal Description:
LID 161 -3,1
3
Recommendation:
aDd or
SSWar,
6-u 04tA, &4 otap Q),J
umex-
10
rnar. 6/14/74
7-
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015-S C- Sre 2;�
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05 7-H
49
ACTIO'
TAB
To:
From: Dafe--___
0 [1 �FFO rW�TS�
FOR YOUR COMM
E3 FOR YOUR APPROVAL 0 FOR YOUR INFORMATION
0 TAKE APPROPRIATE ACTION 0 NOTE & RETURN
iD CALL ME 0 NOTE & FILE
1 !0 SEE ME C] FOR YOUR SIGNATURE
�'COMMENTS:
C t46 r—k ov, TA
0 r 0 '1 Telva-9
F 004-2 tr. so
(Form OA-4)
(D Copyright 1969, 1970 LaUrel Office Aids, Inc., Bronxvil (0' 10
le, N.Y.