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<br />City Hall
<br />Everett� �dashington FHG,'fi: bLpine 9-7101
<br />II'SI ECTI01' DEP(iRTtiEI�T f� � /�j
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<br />L03 APPRGJkL SH�T � `
<br />I2AI-fE� l.'. L) � i�rJ-'Cr'�—�, ADDRI�SS `�Lf� �" �/ z�.- f7'` �y��^-�5���.
<br />eDDR�55 Or YHOPOS�ll BUSLDInG � Q/L/ ,�-/
<br />ILGAL D�SCRIITION: IATz,Y . IIIACK�_ADDITIOI;__,✓.(��;L !� .��,,Y P�
<br />TYYE OP l?SEi� O cn PG. CP DLDROOiiS�_SIZE OF LOT
<br />SOURCE OP DRIY.KIFG l•IATER: YUBLIC SUYPLY /% PRIVATE ' BiL
<br />A. SURFAC� Ui'JtI]'kGG
<br />1. I3 disposal field site tirell drained?�� ',
<br />2. An,y wr�ter course (stream� drainage ditbh� ete, through site?_ �L' c
<br />k3. TOPOGitAI iiY
<br />1, !my heavy slopes in iield area; �-� [�
<br />2, ':lill pr��e�it topsoil in field area Ue removed or eruded Ueforr field tiles are
<br />installed? ,� ' d
<br />3. �dill .�.ny fill rnaterial be used it. the disposal field site? �'If yes� how much
<br />C. SOIL CCI�DSTIOI;S
<br />1, Nas a hole at least 4 feet deep been dug in tt:e dis,osc!. field area t�� dctermine
<br />the t,yFe o£ soil pre�enti
<br />2, ilfter hole is dug record the �oil conditions at the :ollo�ring depti�s.
<br />(Hecord a� ,and� gravel� cla,y�. packed sand� loar� etc,)
<br />12 inches .f=4� %J -� (�' a�EC 30 inches_
<br />18 inches 96 inches
<br />2!y inche^ Q8 inches
<br />3, Any i;round water encountered before reachir,g a lepth of 4 feet?_ %�-'
<br />If so� at �ahat depth';
<br />�. W4TER TSST
<br />.. ;imn'e uater test will shota }iow vell thia soil ari:]. drnin or percolatc watei•,
<br />io �.criorm t1�ic te;t:
<br />1, Dig n hole at leaet °6 inches deeP, U�e a sho•rel �r pcst hole dip,�erg
<br />size of hole �:�akes no difference - onlp depth,
<br />2, �11 hole irith �iater, I'oir let nll truter run on* of hole. T];is soakn t1�e
<br />�round and itill give a nore accuratc readinp,
<br />3. %+Paln pour ;aater in hole to a heieht of 12 incltes frot.i ti�c cottom, Let
<br />taater run out until there is just 6 inches fro:n bottora left in hole.
<br />%,. I'?otA hoi; many ninute� it tnYes for this last 6 ir.che3 to ,eep ai�ay, �.�',
<br />5. Divide tL•is time Uy 6 to obtain tl�e rate e� inch. _�
<br />6. Date wnter tect waa rerforr..ed.__� -� �� - `�yS
<br />I i�erelry certif�� t};e abovr, i;�for: ation +o '�e co:rect �+�d t,i�e �' ovc iests �rere per-
<br />forr. ed in� '�e as �;rescriUed, �yy���,jj �
<br />Signed� ��• -�`o-�_
<br />Addrees��/i �/fi 1'r. L � ti�,rl�
<br />1'�Tt:: ,1 se;�tic tan]c permit is iss�:ed on tnc Ur,si: of the �.�ove information, IC
<br />t��ere are anp change:. or alterations in i,he above :tated soil coi.dz.tion�, ii r:ay
<br />result ir; tLe ir.stallr.tin�; ' einp rel�cted at +l�e ti:ie o; ii,s;,ectior„
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