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CITY UF tVERETI <br />City Hall PI-,O�E: A�pin� 'I-�1J1 <br />Everett, '��ashin�ton <br />INSPECTICN DEP;\RT��iFNT LOT AFFidJVAL SHEET <br />NAiviE �� � ' ��1 i'il � �-i�' ADDRESS 7"; �� /�-.', ^ � _ n --•- "� <br />� <br />AilDRtSS UF PfiO�SED BUILUING 7r'% �I ��' �- ;- ���v <br />ri � �'�' - <br />LEGAL DESCRI PTION: LOTI�d �7 �BLOCK '� ADDI TIUN �'�� • ' -� � � - <br />J <br />TYPE �F USE .,1a1.�. f�. GF BEDF�OMS ? SIZE OF �UT 7D X'� o <br />y:JURCE OF llRII�KING dATER: FUBLIC SUPFLY //� FRIVATE cJELL <br />A. SURFACc DRAINAGE <br />1. Is disposal field site well drainedF "'�-L <br />2. Any water course �stream� drainage ditch� etc.) throu�h site? '=-� <br />B. TOrOGRArHY <br />l, An�� heavy slopes in field area? 'iL'D <br />2. ',�ill present topsoil in field area be removed or �raded before field tiles are <br />installed? �I �? <br />3. ��ill any fill material be used in the disposal field site? 7%f If yes� how <br />much <br />C. �JIL CUNDITIONS <br />1. <br />z <br />Nas a hole at least 4 feet deep been dug in the disposal field area to determine <br />the type of soil present? <br />i\£ter hole is dug record the soil conditions at the Pollowing d=ptlis: <br />(Record as sand� gravel� clay� packed sand� loam� etc.) <br />12 inches "G- ,� �_r-, l 30 inches ; / :!. % � �� <br />18 i nches �' " 36 i nches -' `� "%-" ' %% -" <br />24 i nches � �-,. �[r i d_1-�� l- 48 i nches ' ;�-• ,�- % <br />Any �round water encountered before reachin� a depth of 4 feet? % � _ <br />If so� at what depth? — <br />D. PJATFR TEST <br />A simple water test will show how well this soil will drain or percolate water. <br />To perform this test: <br />1. Dig a hole at least 36 inches deep. Use a shovel or post hole dig�er� size <br />of hale makes no difference - only depth. <br />2, Fill hole with water, Now let all w3ter run out of hole. This soaks the <br />Pround and will give a more accurate readina. <br />3. Again pour water in hole to a hei�ht of 12 inches from the bottom. Let <br />water run out until there is just 6 iiches from bottom left in hole. <br />4. Note how many minutes it takes for this last 6 inches to seep away.��_ <br />5. Divide this time by 6 to obtain the rate per inch. � <br />6, Date water tesi was performed.,�} .-'/; '" ✓ <br />1 <br />I hereby certify the above information to be correct and the above tests �vere per- <br />formed by me as prescribed. � <br />Si ned/.`�', :J�ii; •` <br />Address 7"' � - <br />KOTE: A septic tank Fermii is issued on the basis of the above information. �F <br />there are any chanpe= ar alte�ations in the above stated soil condition',� ii may <br />result in the installet�on being rejected at the iime of inspection. <br />