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<br />SS.00 fee for pei�it
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<br />SNOH(�MZSN HEALTH DISTR1Cf
<br />3011 Hockefcl_xc �vosvc+
<br />Everett, Washington
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<br />Phone ALpine 9-2061
<br />LOT APPROVAL SHEET
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<br />NA!!& /�'o�. ��%[v.'i�2�i � ADDRESS -:ZyC.%' Cy�.�a.�i��' -.�
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<br />ADDRESF OF PROPOSED BUTL'DING ,f���',f �z,,.!„����
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<br />LEGAL DESCRI£TION: I10T -� BIACK ` GDDITI"Olt �.,c-,,�i C(��
<br />TYPE OF USE Ht.a�c Np. (�.��DRpp�S_ ,� ' SI�E OF LOT !�%X il v
<br />SOURCE OF DBINKIN(i;WATER: PUBLIC SUPpLY X PRIVATE WELL —
<br />A, SUFiPACE D� INpGg
<br />1. Is dieposal field site well drainedY !� S
<br />2. 'A�y water course (s,tccec{,�rginti�e ditch, etc.) through site? o
<br />S. TOPOGRAPHY
<br />1. My heavy slopes in field4a�c'eaT /yo
<br />2. WL11 present topsoil n;field area be removed or graded beYore field tiles
<br />are install,�dT �a
<br />3, Will any fill material be used in the disposal field sitel NcIf yes�howmuch
<br />C, SOIL CONDITIONS
<br />1. Has a hole at least 4 feeC deep been dug idnthe disposal'field area to deter•�
<br />mine the type of soil present! y s
<br />2. After hole is dug record the soil conditions at CIYe following depths.
<br />(Record as sand, gravel, ch'�y, packed sand, lo'am, e[c,)
<br />12 inches_/oy.y 30 inches Sw..,%e G,a,ri
<br />18 inchec 5.�..r ��,,,�.� " 36 incher•
<br />24 inches • � • 48 inches ��
<br />4. Atty�ground water encounte�ed �ore reaching a depth of 4 feet? Ne
<br />If so� at what depthZ •—� '
<br />D, WATER TCST
<br />A simple water tes;t will show how well this soil wiA1 drnin or percolate water,
<br />To perform this test:
<br />1. Dig a hole at least 36 iqcbqs deep, Use s s�tnvel or pos: hole digger -
<br />size of hole makes no difference - only deptlt.
<br />2. P111-�hole with �►a�er, Now let all watar run our of hole. This soaks the
<br />ground and will give a more accurate reading,
<br />3. �qgain pour w.ater `ih hole to a height of 12 inches from the bottom, Let
<br />water run out: until there is just 6 inches from bottem left in holc�,
<br />4,• Note how man}� minutes it takes for this lact 6 inches to seep away. /$
<br />5. Divic�p���,�ame by 6 to obtain the rate per inch, 3,u
<br />6. Da�i��b�e{� C�sE, was performed. <�.,�C •; 2, /9�2
<br />I her�� er�Ey rhe above information to be correct and the above tests were per-
<br />farme me assptpscriqed,
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<br />: Signed�v-[�,.+,<. � %%%� ��2�
<br />j' Address �yrs F .
<br />a �� ._� J: �t�'s,-i..r- 1w.r.�/
<br />NOT..: � Petic [anlc permiC is ic;sued on the basis ot the abo e information. If
<br />there aYe•,auy chengea.or alteration in the ahove stated soii conditions lt may
<br />result in 'tNP.� 1.p$!-.�q'ation beinE .-ejected at the time of ineoection.
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