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CIIY uF �VEAETI� <br />City Hall <br />�o_rAtl� ��ashin�len <br />It!S('ECTIOM DEFARINEPJT <br />FHOiJ'�: M_pine 9-7101 <br />�Oi APPR�VAL SHCET � '�' �u`{l <br />_ , / /��/O c9t y /'' <br />��IANE �/�%/lfs' �� i��%I/�I1�1%//l� AD�DRESS '���, <br />J� �21�7 - SZr1Y ' S�, <br />;+DORESS OF PRq�USED RU I LC I fJG � ��j�� - - <br />LEGAL �ESCRIPTIIXV: LOT�BLOCK <br />� ADD 1 T I IX� �E7/��D�f <br />TYF� OF 1�5E /1 �'s��r���1�• � BEDRO::fvS � SIZE OF L <br />�,�°,% . <br />/���x/60 <br />,Ca)RCE �f DRIMKIPlG ..ATER: PUELIC SUFF�Y �x F�+IV��1� .�LL <br />A. SURfACE DRAIPIAGE <br />I. Is disposal field site well drained: �/�s � <br />�, i,ny water course (stream� dr�ina�e dilch� ^tc.) �hroun,h s�te`: .� <br />t <br />C;. Ti;PCGRA.�NY <br />Gny hc�vy slopc; in ficld area':^/� ). _— — — <br />;,;�] �resent tq�� o�l in field ere2 be remove� or praded before field tiles �r� <br />insialled? Y<'S <br />�.ill any fill material be used in the disposal Pield site?�/vlf yes� ho•v rr'��I <br />C. SOIL CONDITIC��S <br />Nas a hole at least 4 feei de�p��een dup in the dis�.osal ficld area to detern,in� <br />the type of soil present': � <br />Pfter hole is dug record ��� s'uil conditions at fhe following depths. <br />(Record as sand� pravel� •ca�y� racked sand� loam� e c.) ��� ������ . <br />12 inehes �iw��'% 30 inehes �f � �� <br />1F inches � F 36 inches �2/�'� <br />24 inches 2i v�'l 4F inches (irL�N'�r � �,' <br />Any cround �vater encount;red before reachin� a depth of 4 feet? '���' <br />If so� ai v;hai �;c�th? <br />p, VvATER TEST <br />� �,�i�!� �;:;,tcr {,-,s{ �•,ill shov; hovr well this soi] will drain or percolate �"�t^'• <br />�� ic��form ihis {e�t: <br />). Dlg a hole .�t least 3(i inches deep. Use ? shovel or post hole digger.=iac <br />of hole nakes no difference - only depth. <br />�. Fill hole with weter. Glow lei all water run out of hole. This soaks 11��r <br />sround and will giv� a more accuraie �eadinp. <br />�. Apain puur waier in hole to a height of 12 inches from the bottem. L�i <br />water run out until there is jus� 6 inches from bottom left in hole• r,2 J <br />�. Rcte how many minutes it takes for this l:�st b inches to seee avax.___ <br />�. Divide tl�is time by 6 to obt2in ihe rate per �nch. ZI m�v <br />� nc <br />r,. Date v:ater test was perforn�ed. 8-4 •62 <br />W6RfL�;rZ- r �ty <br />i + �,6ove inforrralion to be c rr ct and the a e tests �•�� �- ;" <br />t i���r�;y ccr ify th� � � <br />f�,�nr�ri L�y � rr._,crit,��i. �a��� r!!iL' L � <br />�� Sia,�e � � ., <br />Addr ss � ' il�fs' .. ��___- <br />!��ril�: G �. ���;ic i-:n4 rcr�-il is issued on the . is of ihe bove inform��ti�^� If <br />•I���>r, ar�_ any channes ur altcrations in ihe .�bove stated soil conditier,��; it �--^y <br />��-s�lt in thc installaiicn beinP, rejected at ihe {�ma of irspection. <br />_ ;� , ;l�,Z _� i <br />1' � � " � � � - � <br />�; , , <br />