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��-���_ . � /� ��3 <br /> 1 - . CITY UF �VER�T1 %�o � b <br /> ' , City Hall Pf-�GNL• A tn� �� � <br /> [verett. '�lashinston ��� ��� �.,` ��/ <br /> IN:.=PEC?IOp: DEP�RT:�EtiT LOT APF" VAL SHFET <br /> NA�viE_ ]'\'�o� a,. � .4 �/����c'ac _ ADDfiESS a?�j�+� --�5� ✓• 7� <br /> /� ��i� � <br /> AilDRcSS OF FFi�J�SED BUILUINGc/�.v� �' „ � <br /> LEGAL DESCRIPTIUN: LUT� BLOCK ADDITION <br /> iYPE �F USE ', �Pc _ �p. OF BEDFCUWS 3 SI ZE OF �UT _ 9��U X %/£�� �'•.�. �� <br /> :�(IURCE UF llRl NK I iVG �1ATER: FUBL I C SUPFLY ��_ rRl VATE dELL <br /> A. SURFACc DRAINA,GE <br /> 1. Is dispo,al Pield site v+ell drainedY �i � s <br /> 2. Any water course �stream� draina�e ditch etc.) {hrough site?_ ,[/n <br /> 8. TO�GPq?HY <br /> 1. Any heavy slopes in field zrea?___ .G't, <br /> 2. ,lill present topsoil in field area be removed or �raded before field tiles are <br /> installed? �i� <br /> 3. ,lill any fill rr��terial be used in the disposal field site? .O� If yes� how <br /> much <br /> C. �IL CUNDITIONS <br /> 1. Has a hole at leasi 4 feet deep been dug in the dispo,al field area to determine <br /> the type of soil present? K e m <br /> �. After hole is dug record {he soil conditions at the follecaing depths: <br /> (Record as sand� gravel � clay� packed sand� loam� etc. ) <br /> 12 inches 30 inches �.�ot.� ,,.:,( <br /> lE i nches �a-,.� — 36 i nches / � � <br /> 24 inches � 48 inches / • <br /> �. Any �round water encountered before reachinp a depth of 4 feet?_ •" .U� <br /> If so� at what depth? — <br /> D, flATER TEST <br /> A simple water test v+ill show i�ow well this soil will drain or percolate watar. <br /> To perform this test: <br /> 1. Di� a hule 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 ot hole. T��is soaks {h� <br /> �round and will give a more accurate reading. <br /> 3. A�ain pour wrater in hole to a height of 12 inches from the bottom. 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 last 6 inches to seep away. <br /> 5, Divide ihis time by 6 to obtain the r�.te er inch. �4 '� <br /> 6. Date water test was performed._ /�%/o�, r= <br /> I hereby certify the above information to be correc he above tests were per- <br /> £ormed by me as prescribed. <br /> S i�ned��j�i���Z�i �,� <br /> Address +=Lq'�t�-- �h� �'. .� <br /> 10TE: A septic tank permit is issued on the basis of the above information. If <br /> ihere are any chanpes or alterations in {he above stated soil conditions� it may <br /> result in the installation being rejected at the time of inspection. <br /> —cc <br />