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CIlY OF EVERETT <br /> ' City Hall <br /> � Everett� �ras��inQlon <br /> FHONE: pLpine 9-'!]O1 <br /> INSFECTIOM DEFARTNEMT <br /> (13 u i L �C:R � LOT APPP,"VAl SHEET �T � , C� oZ I �;G'E�'�• J7" <br /> � � �� <br /> �.inn�.t ��Il � � /P L� X-� � L AODRESS--��- — � = � <br /> FDDRESS OF PROP(�SED EUILDI�K_ "�` �� D � ��y� � c� �� / <br /> ' � - <br /> LEGAL DESCR�PTION: LOT ` � BLOCk '- ADDITION ' <br /> 1 <br /> TYPE �'� USEF1+��v acw�..NO. f� BEDfiOIYvS�_SI ZE OF LOT I l_�.�� I O Ci <br /> -�- �� <br /> SOURCE OF DRIMKIPlG ,.ATER: PUP,LIC SUFFLY�—PRIVATE v�FLL <br /> A SURFACE DRAIPIAGE <br /> 1 . Is disposal field site well drained�� k S <br /> �, Any water course (stream� drainage ditc � etc.) through siie? � O <br /> B, TOPOGRAPHY <br /> 1 . Any heavy slopes in field area': <br /> � S <br /> �, ;.ill present t/o9soil in field area be removed or graded before field tiles a�P <br /> insialled"i „c`' •` �If yes� how much <br /> 5. �. ill any fill r�terial be used in the di5pnsal field site? <br /> C' SO�L COtJDITI0IJS <br /> ; , Fias a hole at least 4 feet deep beer, dug in the disposal field area to determin� <br /> the iype of soil present':_�-5,__-- <br /> �, Pfter hole is dug record thc soil condi + ions at the f'oilowir,� depths. <br /> ( Record as sand� pravel � s�� packed serd� loam� etc.) <br /> � �} ,�� 30 i nches <�i •�— - <br /> 1� i nches �. � --a <br /> 36 i�ches ��� ' � ��rt�+� <br /> ]E inches t f-�•t 'ii —r—�--- <br /> 24 inches � Ae? iL 4� inches�?�t � r: Z.L� +% �� <br /> , Any ground water encountered be_ P��eaching a depih of 4 feet7 �� c'� <br /> If so� at what depth7_ D q�ATER TEST <br /> A. simple water t=st Hill shan how we ll inis soil will drain or percolat� water, <br /> To t;erform this test: <br /> � . Dig a hule �t ]east 3G inches deep. Use e shovel or pust hole digger: size <br /> of hole makc_ no difference - only depth. <br /> �. Fill hole with water, 'dovr lei a11 water run out of hole. This soaks the <br /> �round and will oiv� a more accw'ate �eading. <br /> 3. Aoain pour water i� hole io a hei�ht of 12 inr.hes from the boitom. L=t <br /> waier r�n out u�til there is just 6 inches £rom boitom left in hole. <br /> 4. Note hov� many minute� it takes 4or this 11st 6 inches to seep away•�� <br /> �. Divide this time by G to oblain tha rate `er�; ,l L� � � � <br /> 6, pate v:ater tesi was perforn�ed._��.- - <br /> lJ� V� <br /> I herely certiPy the abeve inforrr�' ion to be correct he above i ts were per- <br /> Pormed by me as p�escri�ed. S�Qned � � ���-,T'�- `�"7-�'�I� <br /> Address�.���L1 � v��'F-7l� <br /> Di�TE: A septic tar permii is issued on the basis of ihe ,I�ove inPerrratio�• �f <br /> 'here are any changes or alteraiions in ihe �bove stated soil ronditions� ii «ay <br /> rc-s��lt in the install�tion beinp rejected a' {he � �n:� of insrection. <br />