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�L L� .yiv�r <br />�/��. Lc�ri� � <br />7✓"- i:17Y UF �Vtfitl � <br />City Hall PH�P'c: A�_ �,�n�_ �-�1 ��1 <br />�varett� 11'ashin�ton <br />INSFECTICN DEP,3RT'iEieT LOT APFF�b'dL :;HEET <br />c��, ) e „ <br />i�1;1��.E_/..Lct�i•-c ��/ir�ci � ADDfiES� oid�'-�� �kC� / v�t�%f- <br />NilDR�SS OF FnUrGSED BUILLIPIG ,/� Qt���,�, ��/,� <br />��GAL DESCRI PTION: LOT.�_4�3LOCK_,�_ ADDITIOiJ �� I <br />�-wZ—�, .c: �-w <br />TYFE �F USc �� r:. fCO. GF BEDFCGi',SS - SI ZE OF LUT i S ���� <br />�1URL'E OF ilRIiJKI�lG ,JATER: �=UBLIC SUF'FLY . <br />A_3l!RFA.C� D�i.41 NP.GE <br />;�ril VtiTE .iEl_�. <br />1. Is disposal field sit� c:rll drained: %`� -� <br />2. :{ny water coursa (stream� drain�pe ditch� etc.) through site'?. '' <br />B. TOrOGRAi'Fi'! <br />1. Any heavy slopes in field area? � e Al 7 L C S �,� %L �' ', ; <br />2. :li11 present {opsoil in field arr.a be removed or Praded before field {iles ara <br />inscalled? A/ C <br />3. �dill any fiil material be used in the disposal fi�ld ;i'te`?_��`_> li yes� how <br />much � % �� ' <br />C. x�IL �NDITIOP�S <br />1. Nas a hole at least 4 feet deep t�een dug in the disposal field area to delerminc <br />the type of soil present? Y e S <br />�. �;fter hol� is dup recurd the soi? conditions at .he follotvins dcpiLs: <br />lRecord as sand� �ravel� clay� packed sand� loam� etc.) <br />12 inches 7 0/' s olL 30 inches � <br />18 inc��ec � _, 36 inches _ <br />24 �nches ' 48 inches L �� ='�:L! <br />., i;ny ��ro�,nd waier encount.ered be`ore reachin� a depth of 4 feet•' �'� � <br />If ;o� �t what depth?_ <br />D. h!ATFR TEST <br />+� simple water test v+ill sF,ow hoe� well this soil vrill drain or percolate riater. <br />To perfnrm {his test: <br />I. Ui� a hole at least 36 inches deep. Use a shovel or post hole di���ry si�� <br />of hole makes no difference - only depth. <br />2. Fill hole with eiat.er. Now let all water run out of hole. This soaks the <br />f,:round and will pive a r�ore accurate readinp. <br />3. +��ain pour water in hole to e heinht of 12 inches from the botiom. Let <br />water run out until there is just 6 inches from oottom left in hole. G����� <br />i. IVcte how many minutes it tzkes for ihis last 6 inches to seep away. <br />�. Dividc: this time by 6 to obtain the rate per inch._ � f�U 'J <br />6. Date viater test was performed. h1 A� � <br />I hereby certify tha above ,i��ormation to be correci and ihe above tests v�er per- <br />formed by me as prescribed. L"7 / / / <br />Sisned ��4i._.� GC�+.�ZL� <br />Address�_n f_.-�---="-zu.lz;�4? r�= <br />�:OIE: A s�ptic tank permii is iasued or the basis of the above information. IF <br />t!�era „re, nny chanpas or a!teraticns in the above stated soil ecnditionc� it rnay <br />r�:sult in the installation being rejected at ihe iime ef inspection. <br />