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A <br />- • ,, . <br />�ITY OF tVERETI <br />City Hall PhO�'E: A�ptn� 'i-71 !1 <br />[verett. '�dashin�ton <br />INSFECTION DEPARTfa1ENT LOT APFPO�'AL SHEET <br />� <br />iV,1iv,E L� u �• i I. � L J! o� C ADllFiES5 S� 1 i� "' "' �� /% ✓ L �%1��' .'' <br />� '/ <br />AilDRcSS UF FFiOFOSED BUILLING � � I(o h', %i C � 7 L � il �- � <br />q'„�+ qs�- , ; � . .�,,.' � . � �. .• •�r'�� � <br />LEGAL DESCRI PTIUN: LOT BLOCK "` ADDI TIUN Cr A V'�"''' �� `� C i�� �� <br />�YFE �F USE J�I n f., r f�0. GF BEDFCOf.iS %� SI ZE Of �UT ��/� X/( D <br />� <br />.`�URCE OF llRINKIUG ,�ATER: rUBLIC SUPFLY i( FRIVATE :;ELI. <br />A. �URFAC� Dr�AINP.GE <br />i � <br />1. Is disposal field site c:•_11 drair,ed: •-• <br />2, Any water course istrc3m� drain��e ditch� etc.) throu�h sit�? �"' <br />B. TOFOGkArHY <br />1. Any heavi slopes in fi�ld area? /'� � <br />2. ':lill present topsoil in field area be removed or graded before field tiles are <br />installed? /l�i> <br />3. ��ill any fill material be used in the disposal field site?, C� �f yes� how <br />much �-rrn� ��dT lQ`' In �,1'D�' W��(��7 <br />C. �IL CUNDITIORS <br />1. Has a hole at least 4 feet deep been dug in the disposal field area to determine <br />the type of soil present? Y�'-� <br />�. �\fter hole is dup record the soil conditions at :he following depths: <br />(Record as sand� gravel� clay� packed sand� loam� etc.) <br />12 inches L.OAn-r 30 inches <br />18 inches 36 inches � vn v r!- <br />24 inches 48 inches <br />�. /�ny ground water encountered before reachin� a depth oP 4 feet? /�/ D _ <br />If so� at what depth'? <br />D. F!ATFR TEST <br />A simple water test v.�ill show ho�v well this soil will drain or percolate �vater. <br />To periorm this test: <br />1. Dig a hole at least 36 inches deep. Use a shovel or post hole digger� size <br />of hole makes no diPference - only depth. <br />2, Fill hole with ��+ater. IVow let all water run out of hole. This soaks the <br />�round and will �ive a more accurate readinp. <br />3. A�ain pour water in ho1= to a hei�ht of 12 inches from the bottom. Let <br />water run out until there is just G inches from bottom left in hole. <br />4. Note how many minutes it takes for this last 6 inches io szep a��ay.�� <br />5. Divide ihis time by 6 to obtain the rate Per inch. /. l,G <br />6. Uate water test was performed. 1�— F' <.- ? <br />1 hereby certify the above information to be correct and the above tests �vere per- <br />formed by me as prescribed. - ' ,• _ <br />Si�ned �' %,- .. . �', . <; <br />Address C��L �� ] `1 ' l� /�.,i� /•. ,,c, r' <br />�UTE: r\ septic tank permii is issued on the basis of the`above informatiun. If <br />there are any chanpas or alterations in the above stated soil coriditions� i'. may <br />result in {he installation bein� rejected at ihe time of inspeci�on. <br />