509 3RD AVE N.PDFiiiiiiiiiiii
4892
509 3RD AVE N
ADDRESS:
TAX ACCOUNT/PARCEL #: 7 D -3 7 40 0 Y-6 L[ -7C--)
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: Conditional Waiver E] Study Required F] Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver El Study Required El Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) IIECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
0
BUILT: 1958
LOT SIZE: 7519 SOFT.
LOT COVERAGE: HOUSE/ CARPORT: 1500 SO FT.
DECK 200 SO FT
1700 SO FT 22.6%
IMPERVIOUS: PRE & POST 1977: 1700 SO FT HOUSE/DECKJCP
600 SO FT DRIVE
2300 SO FT .30.5%.
HEIGHT: DATUM: CORNER OF HOUSE 92.01
ALL CORNERS LEVEL AT 92.0'
DECK SURFACE: 100.1 PROPOSED
G"DING: NONE
MIL.M" viui_ir_ MvKM
509 3RD AVE NORTH
EDMONDS 98020
206-71"107
TAX No: 27032400204700
LEGAL: SEC 24 TWP 27 Rr. 03 RT-1 I D BAAP WLY N 3' "E
854.9 FT N29-18-OOE FRM NW COR 3 RD "E & ED ST TH CON T
N29-18-OOE 61.78 FT TH W 123.67 FT TH S30-1 5-OOW 62.46FT
TH S89-57-OOE 125.46 Fr MIL TO TPB.
ZONE: RS-6
,SCOPE OF PRgJECT:
REMOVE I REPLACE 200 SO FT DECK w/ STAIRS.
L A* of#
I'Z-1-43
A
V).
DA,
E)(-CAP-f0fLr IAZWI�WAY-
APPROVED By PLANNING
4
one P-5
�JEQ PECK, Comer Flag
0
-1
N etbacks Amired Actual
Tront P— 110
Sides 11119 6
--ILL �CLI -n
5,5 e> Rew.w 1!6
Other
Rv wo 0,0 <
R-ECEAVE-D.
JUL 0 9 2-010
=2o�-c DEVELOPMENT SEHVICES CTR,
CITY OF EDMONDS 0
4Y -90 - 19, -
STREET FILE
City of E&mon&
Critical Areas Checklist
The'Critical Areas Checklist contained on and submit it to the City. The City will
this form is to be filled out by any person review the checklist, make a precursory site
preparing a Development Permit visit, and make a determination of the
Application for the City of Edmonds prior subsequent steps necessaryto complete a
to his/her submittal of a development development permit application.
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. Ite
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,sigh and date it,
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, the applicant 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:
4�WAI R- AfW�--
Name
,5-49q 3RD r((-/ IN
Street Address
W 1h J K () '�. (4) q C(-�200-?
City, State, ZIP —77Y-3-(00 Pho . ne
Signature Date
Applicant Representative:
Name
Shed Address
City, State, ZIP Phone
Signature
Date
CA I* NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: j5d q 3RO AQ/ - A/ 6VI4A,3vAt9 � Q, 14
2. Property Tax Account Number: q Q 7o 3 — c-A'� 09 1- 000
3. App . roximate Site Size (acres or square feet): L[0 —
4. Is this site currently developed? yes; no. RECEIVED
If yes; how is site developed? e7 MAR 2 5 1994
5. Describe the general site topography. Check all that apply. PERMIT COUNTER
Flat: less than 5-feet elevation change over entire site.
t�-- Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet). I
Hilly: slopes present on site of more than 15%, and less than 30�6 ( a vertical rise
of 10-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: R() Approx. Depth:
7. Site contains areas of seasonal standing water: A10 Approx. Dep�:
What season(s) of the year?
8. Site is in the floodway &IC) floodplain of a water course.
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:
VM
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APPLICATION
for
The City of Edmonds SEDE SEWER PERAHT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS E]
113-05100
OWNER.......... ....................................................... CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
ADDRESS ...... W2 ... 1N.AMe ...... N .. ............................................................ LEGAL DESCRIPTION: LOT No . .............................................. BL4C)CK No . ............................................
4 NAME OF ADDITION ............
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FILE
ILI W
DYE TESTED 6/23/80 - SEWER RUNS INTO M/H #321 SHEET #8
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
CITY OF EDMONDS LARRY S. NAUGHTEN
MAYOR
Rim, _]c:"- 250 - 5TH AVE. N. * EDMONDS, WA 98020 - (206) 771-3202
;: NFIP�
COMMUNITY SERVICES: PETER E. HAHN
Public Works & Planning * Parks and Recreation * Engineering
DIRECTOR
9 0 9 C�
November 13, 1990
Mr. Alan R. Mork
509 - 3rd Avenue North
Edmonds, WA 908020
Dear Mr. Alan Mork:
It has been determined that the city's responsibility for the sewer
main that services your property legally ends 100' north from the S.W.
corner of 427 - 3rd Avenue North. We have installed a clean -out in the
S.W. corner of 431 - 3rd Avenue North property.
If there are any future plugs in this area, please contact us so a
determination can be made whether the plug is on city main side or on
private property. The city crews will maintain the line every six
month with a root cutter up to this clean -out to keep it clear.
Attached is a copy of the easement recorded at the time of
installation. Should you have any questions, please contact me at
771-3202, extension 317.
Sincerely,
Ron Holland
Water/Sewer Supervisor
RH/l k
cc: Bobby Mills
Peter Hahn
Enclosures
Mills
Date
Nis 0 r:,
SEWMAIN/TXTSEWER
STREET FILE
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
" I T
Civic
U T I L I T Y E A S E 0 N T
IN CONSIDERATION of benefits to accrue to the grantors herein,
the undersigned, ALAN W. MORRIS and JOYCE A. MORRIS, his wife,
hereby grant to the CITY OF EDMONDS, a Municipal Corporation, a
permanent easement for the installation, operation and maintenance
of Utilities over, across, through and below the following described
property, and the further right to remove trees, bushes, undergrowth
and other obstructions interfering with the location, construction
and maintenance of said utility or utilities, together with the
right of access to the easement at any time for the stated purposes.
The easement and rigbt-of-way hereby granted is located in the
County of Snohomish, State of Washington, and is more particularl
described as follows: y
A 10 ft. wide easement, when measured perpendicular to the easterly
boundary of the following described property, is conveyed to the
City of Edmonds for utilities.
Part of Government Lot 2, Section 24, Township 27 North, Range 3 East,
W.M., described as follows:
Commencing at a point on the Westerly line of Third Avenue, 854.90
feet North 29018100-1 East as measured along the said Westerly line
from the Northwesterly corner of Third Avenue and Edmonds Street
(said point being the Northeast corner of Sunset Addition to the
City of Edmonds as recorded in Volume 15 of Plats, page 41, records
of Snohomish County, Washington); thence North 8905615011 West for
125.52 feet to the true point of beginning; thence continuing North
89056'50" West for 125.52 feet, more or less, to the Easterly margin
of Second Avenue; thence along said margin North 30048'48" East for
188.00 feet; thence East 125.33 feet; thence South 3004610011 for
187.87 feet to the true point of beginning; EXCEPT the North 80.00
feet thereof;
Situate in Snohomish,County, Washington
The CITY agrees to restore to substantially the original condition
such improvements as are disturbed during the construction, maintenance
and repair of said utility or utilities; provided, the grantors, their
heirs or assigns shall not construct any permanent structures over,
upon or within the permanent easement.
DATED This Z-7 day of —Aj
STATE OF WASHINGTON)
)ss
COUNTY OF SNOHOMISH
.,On this day.porzonnally appeared before me ALA14 IV, MORRIS
JOYCE A. MORRIS, his wife, to me known to be the indivrd—ual(s)
described in and Who executed the within and foregoi'
ng instrument,
acknowledge� �hvaotlALAN W. MORRIS signed the same as JOYCE A. MORRIS
his wife, free untary act and deed, for the uses and puj;po's
L
therein mentiona-& /* ...
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CDM NOTARY PUBLI'C/In -ECn d to r*. Z'
F.. State f Va hington"".**
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NO SAL.ES TAX at
REQUIRM
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City -of Edn'ior*
RIGHT -OF -,WAY CONSTRUCTION
PERMIT Permit Number: 3 2 -7
Issue Date:
A. Address or Vicinity of Construction:
509 3 Avenue North
B. Type of Work (be specific): Install New Service
C. Contractor: Naahtngton Nat'l. Gas Co.'
Mailing Address:815 Mercer St. Seattle, WA
State License #: 98111 1
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. .'M Commercial E] Subdivision El CityProject 6j�xUtility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family n Single Family Other
INSPECTOR: INSPECTOR: Vj
F. Pavement or Concrete Cut 0 Yes MNo G. Size of Cut: )Q H. Charge$
APPLICANT TO READ A GN
Ci'y
INDEMNITY. Applicant understands and by his signature to this �application, agrees hold rhof Edmonds harmlessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen", that maybe made against the Chy of Edmonds, or any of its departments or 'Ploy-
ees, including or not limited to the defense of any legal proceedinO including defense costs, and attorney fees'by reason of grafiring this'permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA 7ERIALS FOR. OD OF ONE YEAR FOLLOWING THE iRAL INSPECHON,
A AID A CCEPTANCE OF THE WORK ES77MA 7ED RESTORA 77ON FEES, WILL BE HELD UN77L THE FINAL STREET PA TCH IS COMPLETED BY
CITY FORCES, A T WHICH 17ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE A
PPSTREET FILE
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-3202.
Work 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 & City Engineer.
A)l street cut ditches shall be patched with asphalt or City appro*Ved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements apil the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: K _,71,11_4Date: 12/5/92
(Contractor or Agent)
CALL DIAIA-DIG PRIOR TO BEGIDMING WORK
Engrg. Div. 091
V..
FIELD INSPECTION NOTIP (FuAll - Route copy to Street Dep�e)
Comments:
CONTRACTOR CALLED FOR INSPECTION 0 YES No
Partial Work Inspection by P. W.:
Work Disapproved.By: Date:
FINAL APPROVAL. BY: Date:
I M
r.ng. utv. i
50� � - AV 0
WNG to window
Water main depth
unknown
-A-11 gas main
Addendum to : City of Edmonds
Right of Way
Permit Application
Submitted by: h," AQD
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 9W—I(,BG
-w-
water
-9-
gas
-ss-
sewer
-e-
water hydrant
0
water valve
815 Merce'r St. MO. Box 1869), Scattk. WA 98111 (206) 622�6767
:n=:
Nahrij
50� �. AV 0
a
WNG to window
Water main dep
unknown
A-11 gas main
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: HIL-L-AQD
Engineering Aide
'Washington Natural Gas
622-6767 x2761
pager -qW-j(,5G
00 cuvs
t--rr
-w-
water
-g-
gas
-ss-
sewer
--e-
water hydrant
0
water valve
815 M=cr St. (p.O. Box 1869), S"ttic, WA 98111 (206) 622�6767
I
C I T Y. 0 F Diplo N D S
SEVER DEPARlMf-Nr -
STOPPAGE OF SANITARY Sr.,jvj:R gAIN Rr.poRT
DATE:
TIME CALL'RECEIVFD:
vy
LOCATION OF STOPPAGE:
TIME OF -ARRIVAL ON THE JOB SITE: 7' c) o
TIME NOTLmAL FLOW OF SANITARY SEIVER REESTABLISHED: oc)
CAUSE OF STOPPAGE: 1'� o
V)
ACTION, REQUIiRED TO CI,EAR NIAIN AND'/OlZ LAIT.M.:
_KlQ
c
kj V*l
7", -�Z 7.
H'rf+ �../q
CITY CREW ON STOPPAGE CALL OUr (Persowiel Involved):
vv--,
LOCATION OF RESIDENCE AFFECTED:
tv, WE, ADDRESS, AND P1 IONE NUMBER OF PROPERTY ONNF-11:
M -7
0 r2' 3 ro-3 - G9 9 G
DESCRIBE DMtAGE TO PRIVATE PROPERTY:
75 4t, So
MEMO FOR RECORD
MEMO TO: File
FROM: Larry Oqle
December 15, 1980
SUBJECT: PLUGGED SEWER - 509 3RD AVENUE NORTH - ALAN MORK, OWNER
On Sunday, December 14, 1980, at approximately 12:00 noon, I was notified
by Alan Mork of 509 3rd Avenue North, that his side sewer was backing up
into his shower drain.
At 12:15 p.m., I arrived at Mr. Mork's residence to make a visual inspec-
tion of his stoppage. The toilet was full as well as the floor of the
shower stall. I then went and checked the manhole that serves the Mork
property approximately 150' to the south. There was a small amount of
flow in the manhole coming from the direction of the Mork property. I
then checked the neighbors property to the north and south and they were
experiencing no difficulty with their sewers.
j�'
I advised Mr. Mork to call Roto-Rooter to deroot his line. At 3:00 p.m.
the Roto-Rooter company arrived and began to deroot the line from Mr. Mork's
clean out inside hit house. The company rodded approximately 150' and found
no obstruction that would cause the problem and left the Mork residence at
about 4:45 p.m. The Mork property was still backing up, but the Morks had
not used any water. It is my opinion that the stoppage then was past the
property to the south.- 431 3rd Avenue North. The Ci*ty's responsibility
ends at the southeast corner of the 431 3rd Avenue North property (see
attached drawing). I then called two other employees, Jim Jensen and
�John Koyles, to assist me with Unit 40 and we rodded from a manhole on
Second Avenue North through that manhole approximately 40-45' and hit
a stoppage of toilet paper and sludge. That broke loose and Mork's
property drained immediately. The stoppage was on the City side. (See
attached drawing to indicate direction . rodded by City and approximate
location of stoppage).
Normal flow to the line was re-established at 8:30 p.m. and I then checked
the Mork property to double check that his sewer line was runnina at a
normal rate.
Mr. Mork asked about a reimbursement for his Roto-Rooter charqe and I
advised Mr. Mork to go to the City,Clerk's office and file a claim for
damages form for processing.
I left the Mork residence at 9:15 p.m. and returned to the shop.
LARRY D.,OGLE
LDO:jky
Attachment
r-4)
�Ari
-7 PC
EDMOND
CIT s
CW CENTER E WASHNG-70N 98020 (206) 77&2525
PURCHASE REQUEST VEN 0 Q
IN T 'RY RE UEST
V
ENDOR,NO.
N � Nw, - 1 M, Wa- -, N - 2 / 7 50
E ')NFIRMATION
R
"f, H!S NUMBER� MUST: P
T Tv
�OWALLANVOICES,c,"'
PACKAGES, BILLS 0 'L' I
F . .
WORK REQUEST ",.;'�Nd'CORRESPONDENCE.;�fl,�-IF.1'
SHIP PREPAID TO (OR SERVICE LOCATION)
DATE REQUIRE
HIP VIA �. . .:.. I
-
DOCUMENT NO.
DATE
BATCH. NUMBER-_
[®RDER
PLEASE FURNISH THE FOLLOWING ITEMS:
N
E
QUANTIT)
UNIT
-CATALOG
N UMEIER-.
DESCRIPTION
UNIT
COST
TOTAL DST
ESTIMATED, A PTUAL
Zi
:21� .2-5-0
2-�— -L-Z'S 7-
7— - — Zt,)W
SUBTOTAL
TAX
TOTAL AMOUNT
REQUESTED BY:
APPROVED BY:
BY:
CODE
PROJECT
AMOUNT
ESTIMATE ACTUAL
21
3
4
5
61
71
9
10
11
121
TOTAL AMOUNT
"ECEIV*
I DEC 16 1980
D1r. L)l public Works
NOTICE
CLAV MR DAMAGES
7
R E " r--
�IVED
DEC-1,G7 1980
I lerk
Claim MUST be presented to the City Counci.1 and filed with the City Clerk within 120 days
from the date of Accident or Accrual of Damages.
TO THE CITY COUNCIL OF THE CITY OF EDMONDS:
PLEASE TAKE NOTICE, THAT �C/e/
(if married, give huaband's name)
5-cq
WHO NOW PMIDES AT C- 0, (�o 2 o
Ts—tate present actual address by street, number and city)
AND WHO MR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT 5 V,! I I �'� ;""
(Give residence by street, number and city)
CLAIMS DAKAGES OF AND FROM THE CITY OF E24ONDS IN THE SUM OF S LTZ,
arising out of the following circumstances:
Describe Claim, giving
DATE and TIYX injury or
damage occurred, PLACE
7
and full particulars.
Accurately locate and
describe defects cAus-
ing injury or damage
7-1,) 61"1",
and all acts of negli-
gence claimed.
Fl;
accurately describe
injuries or damage
C.
/V,'� /V T D 4r-' 0 /-",c
State items of damage
C' L--
claimed. Itemize all
/2 7-
crpenses and losses.
(Claim wwt be xwrn to by claimant)
(Signatur* of Claimant)
SUBSCUM AND SWORN TO
before this
me day of
J.,
Notary Public im and for tba State a f
Vaahlzgton, r*aidijzg at
C I T Y. 0 F E D M 0 N D S
SEWER DEPARTMENT
STOPPAGE OF SANITARY SEWER MAIN REPORT
DATE: /4 TIME CALL RECEIVED: IZ--00 MOO^/
LOCATION OF STOPPAGE: 40-46 ' W. 0,c AV14
0321 r,5EE .4777,46A4&b DR4W/A-1C-
TIME OF ARRIVAL ON THE JOB SITE: 12-.-J�5 am
TIME NORMAL FLOW.OF SANITARY SEWER REESTABLISHED: 8: 30 P, M.
CAUSE OF STOPPAGE: —,,5LVD&F—, 70-IL-67- AAR—'—R SMALi— AMOUAJ7-
004,50 ,c44 r -67RAI)E 7'0
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: Zf54ED OAllr- Zt4o
7-0 C-L-6AV r-IrY MA//,/
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved): -Z-AR-A?,Y a-/1-E
ACO YZ-,E:,S / AAID .,//Ai
LOCATION OF RESIDENCE AFFECTED:'
5-0 C?
3 RZ)
4 V.
NAME, ADDRESS., AND PHONE NUM]3ER OF
PROPERTY
OWNER:
A LAAJ MOkle,
-5-
, 062 — &,oe-,D A10.
2��m OA/D-S, &/A - (?9020
DESCRIBE DAMAGE TO PRIVATE PROPERTY: A./O V1518L-,C
CARAE7- WE7' 4AV,0UAJZ)
REMARKS: 15�58- A-1 X:: M
9ALL AMERICAN PLUMBING
BED & 9A.TH BOUTIQUE
659-2671 - 259-6.737- -
10681/2STATE STREET - MARYSVILLE, WASHINGTON 98270
Customer's
Or d or No. Date
-7—
Name
Address
City
State
7-
SOLD BY
CASH
C. 0. D.
CHARGE
ONACCT.
MOSERETD.
PAIDOUT
OUAN.
DESCRIPTION
PRICE
AMOUNT
/y
<
v
THANK YOU
Please keep this copy for reference
TOTAL
All claims arid returned gogds MUST b 0 nied by this bill.
A,
N2 002004-
Rec'd By
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60, 7o '-i. W.
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431 A/P.
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C I T Y. 0 F E D N1 0 N D S
- SEVER Dr.PARDIENT -
STOPPAGE OF SANITARY SEIVER MAIN RE -PORT
DATE: n - - - r-),
_-A
TINTE CALL PECEIVFD:
LOCATION OF STOPPAGE: �J.
TIME OF -ARRIVAL ON THE'JOB SITE:
TIME NORMAL FLOW.OF SANITARY SEIVER REESTABLISHED:
CsXUSE OF STOPPAGE: ITO
to
ACTION REQUIRED TO CLEAR MUN AND/OlZ LAT`ElW,:
jerKz
vv)/, 7
c
6 To
v
CITY CREll ON STOPPAGE CALL OUr (Personnel Involved):
LOCATION OF RESIDENCE AFFECTED:
NAME, ADDRESS, AND PHONE WIBER OF PROPERTY OWNER:
_77q_- -7/0?_
DESCRIBE DMAGE TO PRIVATE PROPERTY: p 0 j�j�_ AV-:\ -f(�
u
F-A
I-REC�--iNIF-D
,=r_F:i ED x
,JAN 2 7 1981
STREET FILE CLAIM FOR DAMAGES J il� 19. (11 4")
Ninonds WY Clerk
NOTICE
eworki
m MUST b e presented to the City Council and fi-led with the City Clerk within 120 days
Clai
LIZ'
from the date of Accident or Accrual of Damages. Z'
TO THE CI7Y COUNCIL OF THE CITY OF EDMONDS:
PLEASE TAKE NOTICE, THAT A�z W/V R.
(if married, give husband's name)
WHO NOW RESIDES AT '50 � - 3,qb V, r= 6imj H 0 �' (<41. 9�620
(State present actual address by street, number and—C-1-7
AND WHO MR SIX MONTHS PRIOR TO DATE OF ACCIDENT RAS RESIDED AT
3f/) A/. coa. cl
___7Give rvaidence by street, --ber and city)
CLAIMS DAMAGES OF AND FROM TEE CITY OF EDMONDS IN THE SUM OF 5 il 3 � S �)_
a.rising out of the following circumstances:
De3cribe Claim, giving
ON
DATE and TIME injury or
dazage occurred, PLACE
and full particulars.
Accurately locate and
114ck q/.1
-r �i 7-(.2 i�7
describe defects caus-
ing injury or damage
eff f.D
and &U acts Of nLegli-
gence claimed.
/2 fiv
OF P /5 7. 957- WIVO (,v4�
Accurately describe
injuries or damage
V 11c 6� I-s,
_�'IY 114 V 6VV r7 0 0 4.) /,/
L,) q 3
State items of damage
claimed. Itemize all
kc
axpenses and losses.
(Cla.im must be mmrn to by claimant)
-T C 0 kk-\- 0 64
�_U
tO 6 _T 7-
(Aignature of ffaimant)
SUMUM AM SWORN TO
before me this Of
Slotary,:Pu-blic in and for a�*t at 7 a f
Van.Ungton, residing at � �"'e '-7 ( e _'
WWI)
kl�i Y� C'� i.
0
STREET FILE
C I T Y. 0 F E D M 0 N D S -
- SEWER DEPARTMENT -
STOPPAGE OF SANITARY SEWER MAIN REPORT
6 1p
107'.1
DATE: - Doe7c-- - /�"'
ZQfo TIME
CALL RECEIVED:
IZ:00 AIWAI
LOCATION OF STOPPAGE:
Appp-ZW1A4.4-rt-�L*,1"
40-46 ' Af.
Oc /W/4
0321 65A=-C= .477,0414&b DE4W/NC,
TIME OF ARRIVAL ON THE JOB SITE: 1Z.-45 A4
TIME NORMAL FLOW OF SANITARY SEWER REESTAB LISHED: 8:.30 P, A4.
CAUSE OF STOPPAGE: IffLoDe7g, MIL-�Er ;7AR-6-R FMALJ- A-MOUAj7'
Roor's ,ck-4 r &-QAL>E zo 4-IAIA=— c 540K/ =L-OVV
INEVVanla
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: U54ED 0A11 r Ot4o
rO 6L.6A1-,1 ClrY MA/A/
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved): LARJZ.Y Cj!�rZ-F-
JOWIV 14CO YZ-,E,5, AA1 D JIM JtF" So!�-,q
LOCATION OF RESIDENCE AFFECTED: 5-09 -3 RD .4
NAME, ADDRESS, AND PHONE NMER OF PROPERTY OWNER: ALAsd Mok4
6-0e.?- &RD A10.
�6PMO-,VD-S, &/A -(?9020
DESCRIBE DAMAGE TO PRIVATE PROPERTY: -/-../0
CARAEr WE7* Ae-QUAID
REMARKS: - S45ES A4.4=7-M 0 e-0- 04e�e-Z>R,10 -
U.
LU
cc
I—
U)
e', 4,1
Alv)
MECAD 7-
DEC 16 1980
Dir. 01 pubix works CLAV MR DAMAGES
NOTICE
RE C E I V E 0
D E 0-1, 1980
0
-'MW9nsiC1erk
Claim KUST be presented to the City Council and filed with the City Clark within 120 days
from the date of Accident or Accrual of Dgmages.
TO THE CITY COUNCIL OF THE CM OF EOMONDS;
PLEASE TAKE NOTICE, THAT llelqlAl Iq /Y/O Ifk
(if married, give husband's —me)
WHO NOW RESIDES AT I? /V� �7 /) /-,10 � I P, -', u �1 . q <0 ;-> 0
(State present actual address by street, number and city)
AND WHO MR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT K11+1 C t L)
(Give residence by street, number and city)
CLAIMS DAMAGES OF AND FRCM THE CITY OF MKONDS IN THE SUM OF S
arising out of the following circumstances:
Describe Claim, giving ON
DATE and TIME injury or
damage occurred, PLACE
and full particulars.
Accurately locate and
describe defects caus-
iA9 injury or Aiama e /,!-I 7-L;l C /7� L /7/
and all acts of negli-
gence cl&imed. F/) ��M�'
Accurately deace.be
injuries or damage
State items of damage
cl-i d. Itemize all
expenses and losses.
(Claim must be sworn to b7 claimant)
b-) /-/ F(V oc� . 6" 1"W_ 0
'7-1-167 C /1,7-�'
-7�7�'7- 7//67- C',1c)6
-a-/\/ 74rr C/T�`
A�A/c,'N NOT DIV Pkopce�-V,
TIV C- C- cr` 7721,�--IV �2- h C rjea c,
/-- I (__ � 0 C( 7-
A" N Q 91r 7-
r� (5c / r('16 C 0 �m /P if 0 ti
Y C-,< A�:� ��
(Signature of Claimant)
MUM= An SWORN TO
before me this iiay Of
Optary Public in and for the I t* of
t§"hi;4ton, residing at
0
MEMO FOR RECORD
MEMO TO: File
FROM: Larry Ogle
17A
December 15, 1980
SUBJECT: PLUGGED SEWER - 509 3RD AVENUE NORTH - ALAN MORK, OWNER
On Sunday, December 14, 1980, at approximately 12:00 noon, I was notified
by Alan Mork of 509 3rd Avenue North, that his side sewer was backing up
into his shower drain.
At 12:15 p.m., I arrived at Mr. Mork's residence to make a visual inspec-
tion of his stoppage. The toilet was full as well as the floor of the
shower stall. I then went and checked the manhole that serves the Mork
property approximately 150' to the south. There was a small amount of
flow in the manhole coming from the direction of the Mork property. I
then checked the neighbors property to the north and south and they were
experiencing no difficulty with their sewers.
cl�"
I advised Mr. Mork to call Roto-Rooter to deroot his line. At 3:00 p.m.
the Roto-Rooter company arrived and began to deroot the line from Mr. Mork's
clean out inside his house. The company rodded approiimately 150' and found
no obstruction that would cause the problem and left the Mork residence at
about 4:45 p.m. The Mork property was still backing up, but the Morks had
not used any water. It is my opinion that the stoppace then was past the
property to the south - 431 3rd Avenue North. The Ciiy's responsibility
ends at the southeast corner of the 431 3rd Avenue North property (see
attached drawing). I then called two other employees, Jim Jensen and
-John Koyl-es, to assi'st me with Unit 40 and we rodded from a manhole on
Second Avenue North through that manhole approximately 40-45' and hi.t
a stoppage of toilet paper and sludge. That broke loose and Mork's
property drained immediately. The,stoppage was on the City side. (See
attached drawing to indicate direction. rodded by City and approximate
location of stoppage).
Normal flow to the line was re-established at 8:30 p.m. and I then checked
the Mork property to double check that his sewer line was running at a
normal rate.
Mr. Mork asked about a reimbursement for his Roto-Rooter charge and I
advised Mr. Mork to go to the City Clerk's office and file a claim for
damages form for processing.
I left the Mork residence at 9:15 p.m. and returned to the shop.
Z� c] z � - e, &--*--.
LARRY D.,OGLE
LDO:jky
Attachment
191
ALL AMERIC,, AN PLUMBING*
BED & E,rATH BOUTIQUE
659-2671 - 259-6.737-
1068'/2STATE STREET - MARYSVILLE,'WASHINGTON 98270
Customer's
Order No. Date
Name
Address >
City
"Ye--, L State
SOLD BY
CASH
C. 0. D.
CHARGE
ON ACCT.
IVIDSE.RETD.
PAID OUT
QUAN.
DESCRIPTION
PRICE
AMOUNT
kA .1,
v
RTREFT
_FF
V �- 7r.—
TH AN K Y OU
P lease k eep th is copy for reference
TOTAL
All claims and return
;.d 1) d NAUST b 0 d by this bill.
P �o
NO 002004- . �g
Rec*d By --g
7
f
Ma:771- 1;1
M
nmiqmn
CIT EDMONDS
CIVIC CENTER ECMONDS. WASHINGTON 98020' (206) 775-2525
REQUEST INVENTORY REQUEST
zz PURCHASE.
10
FI�MATION
E*DER
WORK REQUEST
.,.,THIS NUMBER: MOST,APPE4R:,�'
'6NIALL INVOICES,-""'.
PACKAGES, BILLS OF LADWIS"
AND
-SHIP PREPAID TO (OR SERVICE LOCATION)
WE -REQUI.RE
SHIP.VIA-.-'
CUMENT NO.
DO---
ORDER DATE
BATCH,NUMBER
n17P(�
PLEASE FURNISH THE FOLLOWING ITEMS:
L
'
N
QUANTITN
1!
-
UNIT
-CATALOG,
'DESCRIPTION.
1 '. -
UNIT
COST
TOTAL OST
ESTIM ATED., ACTUAL
sinne&!!�g=-- ew,
Z_ 5: 2 2,, 0
(,"�2,1 7-1.1
All ef ziez
SUBTOTAL
TAX
TOTAL AMOUNT
/s
REQUESTED BY:
APPROVED BY:
RECEIVED BY:
CODE
PROJECT
AMOUNT
ESTIMATE ACTUAL
2
3
4
51
6
7
8
9
10
11
12
vp)
TOTAL AMOUNT
-57 -5-
C CITY OF EDMONDS
I FOR INSPECTION CAR 4.0
PUBLIC WORKS DEP T Permit N? -6487
PU DE SEWER PERMIT 775-2525 Ext. 220 Issue Date
S,
hZ PERMIT MUST BE POSTED ON JOB SITE -*-I
E-4
0
0
EA
b W
1. Address of Construction-,50!7
2. Property Legal Description (include all, easements)
3. Single Family Residence Multi -Family 04ki- tnny-r-
Commercial
4. Owner and/or Builder IYORk-
5. Contractor & License No.
6. Invasion into City Right -of -Way: No Yes (If Yes, Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes X No Easement required -
attach legal description and county easement number
READ THE FOLLOWING AND SIGN:
C)IAAL DI
a. Property owners must ob in rM imfgll ide sewers on
their property. A licensed sid sew t ac oopfO V,
.A e emp oyed to
construct side sewers in the pub i -0 -w Y%0
b. The side sewer contracto ss, 1 ility or each
installation for one year.
C. Commercial establishment e a ch (611)
side sewer line. 0MIS ou%al
d. Side sewers may not be in 911%, os inches (30")
to any structure. AV 0
e. Side sewer lines must be at a minimum grade. of 2% (1.15
and maximum grade of 100% (450). 0 .
f. No turn in side s8wer greater than 45 (1/8;bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is require d for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for ri Pol0hy failure
y1h
due to poor compaction of fill. pproved
k.. Side sewer must be left uncovered un �J,4 d a ed
by the City. AV
1. Inspection during normal wor:Wkiin,,,(ho Fohly. eo (2) working
days notice re uled.
DATE: __/7
I certify tHat I have read
and shall comply with the above
PERMIT FEE: 62_�
CONNECTION FEE:
DISAPPROVED BY: Date:
By: Date:
APPROVED By: Date:
-#- _50,�z
BE POSTED ON JOB SITE *
- -).k�
MORM MIMI �r ...... ------
..........
PS AAE4eE
Acne" "41L. I I i - I
040' AO(114 3Z/
A
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