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� <br />/.? / `/ ��.,.�,�,.� <br />CITY UF e.VERETI <br />City Hall PI-,O�E: N�p�n,- �-il J1 <br />�vereit� '�7ashin�ton <br />INSFECTICN DEP,\RT�.��NT LOT APFr�iJAL SHFFT <br />f��Am;E LO�/� i`/. G!/✓`�I�2.v�.i2._ ADDFESS I�ZQ ���;.S �'-� ��L, <br />AilDR�SS UF FfiUFOS[D BUILI�IPj��9 i�'� ���� �o.t/ �'/U C' <br />...ia_ � � � l �..Gi. [),)/ <br />LEGAL DESCRIPTIUi�: LOT'.lofz�OLOCK � ADDI'I�^: f7F'dPA-' Y U/Etn; r1.voS __ �_ <br />107•7/ X / ' �� , <br />TYFE �F USE 'Ou s I�O. OF E3EDFCOfd�S Z SIZE OF LUT x ZOO _ /33 <br />�)URCE OF llRINKING �IATER: FUBLIC SUPFLY �_._.__ rHIVhTE r!ELL <br />A. SURrP.C� DriAIfdAGE <br />1. �s dis osal field site vrell drainede �G,S <br />2. :�ny �vater cuursa lstream� drain�ge d�tch� etc.� throuph siie'� N� <br />1 <br />2 <br />3. <br />g, Tp"rOGRAPHY <br />Any heavy slopes in field zrea�_ NO - <br />';lill present toesp0il in field area be removed or �raded befa e f�eld t�les are <br />instal led? N �0. I f es hov; <br />�Jill any fill material te used in the disposal fiald site? Y� <br />much <br />C. �IL d�NDITIOP!S <br />1, tias a hole at leaGt 4 feet deep_b�en dug in the disposal field area to determine <br />the type of soil pres=nt? Y�' ` <br />2, Hfter hole is d�g record the soil conditions at the Pollowin� depths: <br />(fiecord as sand� gra:^1� clay� packed sand� loam� etc.) / <br />12 inches S�o 30 inches r�^ •' �'�� S2'•'t <br />18 inches �i���� ���^�" 36 inches �' '� <br />24 inches >i%�-r' �<�:.� -- 46 inches ('��tcl� SQ-"'! ^✓�r`��.G <br />f. Any �round water encountered before reaching a depth of 4 feet? /t'�0• — <br />I i so � ct r�hat depth'? <br />D. ��ATFR TEST <br />A simple water test v�ill shovi how �v�ll this soil will drain or percolate v�ater• ��Z � <br />To perform this test: '� <br />1. Di� a hoie at least 36 inches deep. Usa a shovel or post hole di�gar� size <br />oi hole makes no difference - only depth. This soaks the <br />z, Fill hole with water. Now let all water run out of hole. <br />�round and will �ive a more accurate readinp. <br />3. A�ain pour wa'ter in hole to a hei�ht of 12 inche�� from the bottom. Let <br />water run out until there is just 6 incnes from bottom left in hole. Z� �`c�,L <br />q, Note how many minutes it takes for ihis'las: 6 inches to szep away• <br />5. Divide this time by 6 to obtain the r ie per inch. y j� <br />6. Date water test was performed.�''=`(1��Z <br />I hereby certify iha above information t� be correc't and the above tests vrere per- <br />� i' � y /. <br />formed by me as prescri6ed. Si�ned +'�� ��/l� l�''� ����� �� ��� <br />Address_,/ 7�7 U ,� = ✓ "-s-�c " <br />KOTE: A septic tan�i permi't is issued on the basis of the above inPormatiun. If <br />thera are any chanras cr alterations in the above stated soil wnditions� i� may <br />result in the instsllation being rejected at the time of inspection. <br />e <br />