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CI1'r GF tVERETT <br />City Hall <br />Everett� �iashington <br />INSFECTIOPJ DEFARTNEPlT <br />�OT ApPRG4A� SHEET <br />FHOt�!E: �Lc,i,�_ ;-'101 <br />NAN,E.r � ��,� ADDRES�� h ; , " > <br />ADDRESS OF PRCPUSED NUILDING � ��'% �=�i�� <br />LEGAL DESCRIPTION: LOT B�.UCk ADDITI <br />TYPE OF USE_i%�/.o�� NC. :lf� FFDROl7vS '� SIZE CF LO7 j''v' r' �;��__ <br />SOl'RCE OF DRINKI�.�G ,.ATEP: f'1ELIC SUFFLY � FRIVATE i�ELL <br />A. SURFACE DRAIDINGE <br />l. Is disposal fie!d site well d�ained: ���-� <br />1. Any wa{er course (stream� drainag� ditch� etc.) throu�h site? �/� <br />[. T�CGRAFHY <br />I. �ny heavy slopes in field area': � �� � .' � � ,%,-: <br />�• •ill present topsoil i� field area be removed or Eraded before field tiles arP <br />insialled: �'i> <br />,i. �.ill any fill material be used in the disposal field s:te?i�l� If yes� how m�ch <br />� <br />C, SOIL Cl�1DITI0iJS <br />ha= a hole ai least •9 fcel dee been dug in ihe disposal Field area io d�-lerminc <br />ihe type oi soil present% �cti <br />A`'ter hole is dug record ihe soil conditions ai ihe following depths. <br />�qecord as sand� ravel�•`��� packed sand; loam� etc.) <br />.� i nches � C J/» 30 i nches ti r i I<i <br />lE inches Lc n%�'� 3b inches_S,�t: <br />24 inches /. �� n,%�' 4� inches ;�� rl <br />Any ground wat�r encountered before reachinQ a depih of 4 feet? fj/(� <br />If so� at what depth'? <br />D. t4ATER TEST <br />�' simple water test ��ill shovr how weli this soil will drain or percclate �vate�. <br />"c �erform this iest: <br />1. Die a hole at least 3G inches denF, Use � shovel or pus{ hole div�er:site <br />of hole rm�kes no diiference - only depth. <br />�. Fil] hole with wate�'. Plow lel all water run out of hole. This soaks the <br />5ro��nd and will give a more accur�ie rc:ading. <br />j, Ap��n pour waier in hole io a I�eight of 12 inches from the bottom. Let <br />waier run out until there is just 6 inches from Loitom left in hele. <br />4, �ete hov.� many mi�utes it lakes for this last (; incF�es to seep away. �� _ <br />�. Divide this time bv 6 to ob{ain the raie per inch. /'� <br />b. Date vrater tesi was perforn�ed. d'-/7 —� J _ <br />! hcre�y certiiy ?he above inforRation .o be correct and the above tests v.are per- <br />fcrnmd 6y m= as prescri6ed. .-� •' <br />�'./ �. <br />Sinned�_'"��-<==`. ��-:.s� :c <br />Address /�i/17_�,'r;�G',/ t•L 2-.i'''!' <br />PiCTE: A septic tank permit is issued on the b�sis of 'he .�LcvA jniorma .. If <br />'h,re arc any chanpes or alterations in ihe ahove stated soil condition. .t rr�y <br />����s��lt in �he insi.�ll�iion heinp rejec;ted at the tirte of insreciion. <br />