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i <br /> � <br /> .!:' ; � <br /> ' � �S� �- ���c eP�..� �'(.�-�..�-% � `/a-� _ <br /> � CITY OF i:VEREI'� �d — y—� ° <br /> City Hall PI-URE: A�pin�. �-i1J1 <br /> �vereit. '�Jashinston <br /> INSFECTION UEPARTIaiENT LOT APFFt)VAL SFIFEi <br /> fdAiv�E�,��i1 /'L?�r�' � s�ta . 7 . ADDFES:i �7�x/` �i1�K /�J%nM,(CZL-� /��. :,d(,2,�� <br /> f ---T �'�,�^ t , <br /> AilDNc55 OF PF�:IiOS[U BUIL� .�.��aT.Q.�i r����t-�- �i�tty�ri"rl, �!'�I/ __ <br /> LLGAL DESCRIPTION: LOT �iLOCK �DITION v <br /> iYFE �F USE 1��0. GF. � SI ZE OF L;IT � � - <br /> �OURCE UF llRINKIiVG �JATFR: FUBLIC SUPFLY �1' � FRIVATE dE�L _ <br /> A. SUFrACEU'rRAINAGE <br /> 1. Is disposal P` �'.d site well dratr.ed: ��'�- <br /> 2. Any water coursa �strean� drain.Zge ditch� etc.) through site`? nL�' <br /> B. TOFOGRAPHY <br /> 1. Any heavy slopes in field area? /!L''— ' _ <br /> 2. 'Jill present topsoil in field area b: removed or oradad 'oefore field tiles are <br /> ins'talled? ,�4�-- '— <br /> 3. Jill any fill�material be used in th : disposal Pield site? If yes� how <br /> much <br /> C. �IL IX�NDITIOP!S <br /> 1. Nas a hole at least 4 feet deep been dug in the disposal field area to determine <br /> the type of soil present? <br /> �. tifter hole is dup record the soil conditions at the following depths: <br /> (Record as sand� gravel � clay� packed sand� loam� etc. ) p <br /> 12 i nches r n�1 30 i nches 1 , ; � . �: 1 1�(.��' <br /> 18 inches ^..�', 4�,:', 36 inches ' . - , , k. il� (�}<1�� <br /> 24 inches j���� .Y�w.�ti :�•�� 4E inche> <br /> �. Any ground water encountered before reaching a depth of 4 feet'? _ <br /> If so� at what depth? <br /> D. �1ATFR TEST <br /> A simple water test will show hov+ well this soil will drain or percolate �•iater. <br /> To perform this test: <br /> 1. Dig a hole at least 36 inches deep. Use a shovel or post hole dig�er� size <br /> of hole makes no difference - only depth. <br /> 2, Fill hole with water. Now let all water run out of hole. This soaks ihe <br /> Pround and will �ive a more accurate readin�. <br /> 3. A�ain pour water in hole to a hei�ht of 12 inches Prom the botiom. Let <br /> . water run out until there is just 6 inches from bottom left in hole. <br /> 4. Note how many minutes it takes for this lasf 6 inches to seep away. <br /> 5. Jivide this tim� by 6 to obtain the rate per inch. lofi. .s...F • <br /> � 6. Date w�ter test was performed. `J— :c L — �.S' <br /> I hereby certify tha above information to be correct and the above tests �•:ere per- <br /> formed by me as prescribed. � j�� <br /> 5 i gned �Cl,'z-,-� G.%f2i'b/� � � „�r <br /> Address o0/ •_c__2�_�t�1'�—'1�✓/y, i� <br /> P;OTE: A septic tank permii is issued on the basis of the above information. IP <br /> there are any chanpes or alteraticns in the above stated soil ccnditions� it may <br /> result in the ins+allaticn baino rejected ai th� tin�e of inspection. <br />