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CITY Cf EVEREI'1 <br />City Hall Pi-�:%i`;E: i+��im� i-il!l <br />�vereit. '��asnin��it <br />I NSPECTION DEP,1RTfa1ENT LOT APF� CJb'�1� SHEET <br />fVAm�E , c �l -�,� .� ADDRESS ' % ��� , - �, r� r <br />AJDR�SS UF FfiOFOSED BW LUI PJG '�'" '' <br />LEGAL DESCRIPTION: LOT BLOCK ADDI'TION <br />TYFE ��F USE:,t;�,,<" t- ;' i��: GF E3EDPC01�15 -- -- SIZE OF �OT �% `'� <br />�1URCE UF fiJ�i)NK�iVG ��'ATER: FUBLIC SUPFLY i u��=-� <<-.'=� - FRIVATE s1ELL <br />A. SURrAC� Dr�AINP.Gc_ <br />1. Is disposal field site vrell drained� �1�� �� <br />2. Any water coursz �str�am� draina�e ditcii� etc.) fihro�;yh site? }� � <br />8. TOFOGRArHY <br />1. Any heavy slopes in Pield area? �+ � <br />2. '��lill present topsoil in Pield area be removed or �raded before field tiles are <br />installed? fl � <br />3„ �Jill any fi�ll� material be used in the disposal field site? (fn If yes� how <br />much . <br />C. ;OIL G�NDITIUNS <br />1. Nas a hol� at least 4 feei deep been dug in the disposal field area to determine <br />the type of soil present? �^ <br />2. After hole is du3 record thci soil conditions at the following deoths: <br />��ecord as sand� Erave,l� cla;� packed sand� loam� etc.) <br />12 inchas t�- L� 30 inches '(' , �1 �,l ;: % "� � <br />18 inches �T— 36 inches �' <br />24 inches �' 'r i'i >�, � ':`. -' 48 inches ' 1 <br />s, r�ny pround waier encountered'be.`ore reaching a depth of 4 feet'? � v _ <br />If sa� at what depth? <br />D. ':ATFR TEST <br />A siinple water test v+ill sliovr how w� li this soil will drain or percolate v+ater. <br />To perform this test: <br />1. Di� a hole at least 36 inches deep. Use a shovel or post hole dieger� size <br />of hole makes no difference - only depth. <br />2. Fill hole with �vater. Now let all water run out of hole. This soaks the <br />�round and will give a more accurate reading. <br />3. A�ain pour water �n holh 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 iakes for this last 6 inches to seep away._� <br />5. Divide this time by 6 to obtain the ra#e per inch. r <br />6. Date water test was performed.� �b /� � <br />I hereby certify the above iniormation to be correc't and the above tests were per- <br />formed by m�> as prescribed. , j,r, <br />5igned � rt,�.-., �.'• '% <br />Address %� ��- ^ L:- �.— � � =�'' <br />�OTE: A septic tank permii is issued on the basis of the a6ove information. If <br />there are any chanPes or alterations in the above st+nted soil conditions� it may <br />result in the installation being rejected at +.he time. of inspection. <br />