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;� �� r, iCj` 1 \�� �a� .,'�'/n <br />L�� �. � <br />"' v UF EVEREIi <br />City Nall P�fiE: A�p�,x 'i-rl '1 <br />EVE'P.{t� ��ashir�ton <br />IPJ;PECTICN DEP,IRT�+iEPiT LOT APF�C7GAL SHEET <br />, , ��, �� �� ,cf <br />(JAm�E �U• -�� J .-/ ,/..� - ADURESS f=i --�'•��, _ — <br />AilDR�SS UF PFurOS[D BUILL! <br />LEGAL DESCRIFTION: LUT___ BLOCK__ AilDITI(,iJ <br />TYPE �F US� ���'/_' RC. GF E3ED�G(u9S �_ SI ZE GF LOT 2 A-�r�s ^ <br />5.1URCc OF llRl NKI iVG dATcR: FUBLI C SUPFLY =� <br />A. oURrAC� Dr�AINAGE <br />FRIVNTE .iELL <br />1. Is disposal field siie creil drained: <br />i2, ��ny water wurse istreaRy drainage ditch� etc.) throu�h site <br />B. TOFOGRAPN'f <br />1. Any heavy slopes in field area`' <br />2, ':lill present topsoil in field area be removed or praded before f!eld tiles are <br />insialled? <br />3. �lill any fill material be used in the disposal field site� if yes� how <br />much <br />C. :;OIL CUNDITIOP!S <br />Nas a hcle at least 4 feet deep been dug in the dis,,o>al fi�ld arca to determinr� <br />the type of soil present� <br />i�fter hol� is du� record the soil condi:ions at 'he iullowin� deptl�s: <br />(Record as sand� �ravel� clay� packed sand� loam� e{c.) <br />12 inches 30 irches <br />I!8 inches 36 inches <br />24 inches 48 ir�ches <br />s. i\ny ground water encou�{ered be£or=. reachin� a depth of 4 feet? _ <br />I f so� at v+hat depth? <br />D. i;ATFR TEST <br />simple water test e+ill show hov� well this ;oil will drain or percola'te c�3ter. <br />f perform this test: <br />1. Di� a hole at least 36 inches deep. Use a shovel or post hole di�ger� size <br />of hole makes no difference - only depth. <br />1 Fill hole with vrater f�ow let all �vater run out oP hole. This soaks the <br />�round and will �ive.a more accurate readinv. <br />3. <<pain pour �vater in hole to z heiPht of 12 inches from the bottom. Let <br />water run out until tnere is just 6 inches fron bottom left in hole. <br />1. IVote how manv minutes it takes for this las: 6 inches to suep awaq._ <br />>, Divide this time by 6 to obtain th�; rate per inch._ <br />6. Date water test was performed. <br />I hereby certify the above information to be correci and � he above tests �•�erc per- <br />%/�- J � . <br />formed by m�� as prescribed. �/ „ <br />,1;[,/�:I � . . l/�..;,. <br />Si�ned 'K � - <br />Address��,•of"_r ��cL ✓-�.� - <br />�OTE: A septic tanl< permii is issued or; the basis of the above information. If <br />therc are any chinr�as or alterations in the above staied soil conditions� it ni�y <br />rusuli in !h�;� ins�_allation bcinq rejcctcd .it iho time of insf:°ciion. <br />