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� .'���� �� <br />,��;. ti�� � , <br />AilDR�SS OF PF,OFOSED BUILDI <br />�,vi,�z.:�� � `I io <br />/z�.�o _��' <br />CIT', UF �VEf�.ETI <br />City liall Pf-A�P;E: N��,�n. l-!1 J1 <br />�verett, '�7ashin�ton <br />L LOT APFi�)b'AL SHf_ET <br />LEGAL DESCRI PTION: LOT BLOCK ' ADDI TION Nc. i� ��r-�,2. �� r <br />/F•llp <br />TYFE uF USE F� ic� fCO. GF �EDf�'OI�iS --�� — SIZE OF LUT � Af.�'eS <br />SUURCE UF llRl �vKl NC� �VATER: FUBLI C SUPFLY PHI VATE riElL �ST//.(_. <br />A. �l!Rr ACc DriAI NP,G`t <br />1. Is disposal field site vrell drainedY _ L, e 5 <br />2. Any water coursa (stre3m� draintge ditch� etc.) throu�h site"? O _ <br />B. TOr=OGRA�H'/ <br />1. Any heavy slopes in field area? <br />2. ';lill present topsoil in field area be removed or �raded befure field tiles are <br />installed? c'S <br />3. �lill any fill�be used in the di;posal fi�ld site?� If yes, ho�ti <br />much <br />C. �bIL OU�!91T10�!S <br />1. Nas a hole at least 4 feet deep been dug in tF�; di:;p��nl Pi�ld r.r�a to deicrniine <br />the type of soil present? c.i�,S <br />Z. �lfter hole is du�r record the soil conditions at :he Pollowin� depths: <br />(�ecord as sand� �ravel� clay� packed sand� loam� etc.) <br />12 i nches _�oa ��� � 3D i nches .,S�r.✓�s` .:a � e� <br />18 inches a is� / 36 incfies �� �� <br />24 inches _ :at�i�c�"S.o�✓�1 48 inches %i��P �S.oNoO <br />s. Any �+round water encountered before reachin� a depth of 4 feet'?�__ <br />If so� at what dcpth'?_ <br />D. ''ATFR TEST <br />A simple water test will show ho�v well this soil will drain or percolate water. <br />To perform this test: <br />1. Di� a hole at least 36 inches deep. Use a shovel or post hole diggar� size <br />of hole makes no difference - only depth. <br />2. fill hole with water. Now let all water run out of hole. This soaks the <br />ground and will �ive a more accurate readinp. <br />3. A�ain pour water in hole to a nei�ht ef 12 inches from the botiom. Let <br />water run out until there is just 6 inches 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 t e rate per inch._ 30 <br />G. Date �vater test was performed. �.��.e: 9 <br />I hereby certify the above information to be correci and ihe ab�tests were per- <br />formed by me as prescribed. � <br />5i�ned <br />Address �fj 2J9.'L�ieT WN <br />f�;OTE: 1 septic tank permii is issued on the basis of the above i�formatiun. If <br />there are any chanc,es or alterztions in the :�Love statcd soi] conditions� it m�y <br />r�.suli in thr, insta ll�ition beio� rejcctcd at th� {ime of inspeciion. <br />