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$5,00 fee for permit <br />;.� <br />Sb:i�Hl�M,'CSII IIEALT;1 DIST:2ICT <br />3U11 Rvckefclier. aveaue+ <br />Everett, Wa.shingto:t Phone AI,pine 9-2061 <br />IAT .1PPROVAL SHEET <br />��, I fr .1-�-> R I t� �'� ��e? <br />NAME ��� w.. �c,�, n� F` �� � ADDRESS `.S� � i-�r=i-a�`=r—:� �' l P <br />�' /-4'v �— <br />ADDRESS OF YROPOSED BUILDINCy .S C� � � C' � c� �: -��.-{? �_` �._p_ ___ <br />LEGAL DESCRIFTION:• IAT BLOCK ADDIT <br />T7tPE OF USE t,�' S. N0, OF IiEDR6bMS ��3 SIZE OF IAT h' 3 X 1'� n <br />SOURCE OF DRINKINC WATER: PUBLIC SIIPPLY �"�� PRIVATE kBLL ' <br />�' A, SUBFACE llRAINAGE <br />�S <br />1. Is disposal field site well drainedY S�c' r <br />2. Any Yiater course (s,kC�artj, drainage ditch, etc.} through site�_ �� �l <br />B. TOPOCRAPHY <br />1. My heavy slopes in field area? ,l;l <br />2. WL11 presen[ topsoil in field area be removed or graded before field tiles <br />are installedT h�� <br />3. Will any fill material be µsed in the disposal field site?�iIf yes,hw much_'— <br />C, SOIL CONDITIORS <br />1. Has a hole at least 4 feet deep been dug id,i[he disposal fiel,d area to deter- <br />mine che type of soil presentT �,��:" <br />2. After hole is dug record the soil conditions at the following depths. <br />(&ecnrd as sand, gruvel, caly; packed sand, loam, etc,) <br />'.� �- '� 12 inches__ •/{ �.� l 30 inches : i� i.- <br />18 inches '; � 36 inChes �. .; �. <br />24 inches 48 inches ';r�, ,-_ <br />4.: Any ground water encountered before reaching a dep:h of 4 Eeet21;,,;� ' <br />�� If so� at what depthY_ -- -- <br />D. WATER TEST <br />A simple wate�� test will show how well this soil vil..l drain or percolate water, <br />To perform [his test: <br />1. D1g a hole at least 36 inches deep, Use a shovel or post hole digger - <br />eize of hole makes no difference - only depth, <br />2. Fill hole with wa�er. Now let all water run our of hole. This soaks the <br />ground and will give a more accurate reading. <br />3, Again pour water in hole to a height of 12 inches from the bettom. Let <br />water run out until there is just 6 inches from bottem leEt in hole. <br />4. Note how many minutes it tak4s Eor this last 6 inches to seep away,�;i r^'� <br />5. Divide this time by 6 to obtain the rate per inch, /�; ,;.,',,, <br />6, D:,te water test Was performed� /�� ( l_� ;; <br />I hereby certify Che above information to b�e cor.rect`and the above tests were per- <br />formed by me as prescribed, <br />� <br />Signed ' �_ /i.; . �.>�. ; ( � <br />Address � �,</ ..--rC:.':.,c•.. �_, r <br />NOTE; A septic tanlc permit is issued on the basis'"of the above informution. If <br />there are any changes or alteration in the above stateii soil conditions it may <br />result in the installation being rejected at the time oE inepection, <br />