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�17Y UF �V�i�_� i <br /> City Hall i'rAir.'L: ,+. ; i - ;! ! <br /> Lveret t. 1V�shin�lo�� <br /> IiVSNECTIGN DEI'�iRTi;iEiJT Lvl APfM1VAL �HEEI <br /> .'i��v:E /1 , �. . l(��, � Ic�' ADDREJS S��IOS �5�... s�� L=., .t <br /> <"' <br /> �ilDIitSS Uf rFfJ'rOSEll BUI W I IJG S�U� .) � �. ���� s�— _ <br /> �EGAL DESCRIPTION: LOT 3� BLUCK ADDITIUN ��� ,. �� �.�� /�s <br /> IVPE UF USE /� f�. OF BEDf�UIdS f;-� � n SI ZE OF �Ul C'�. s x 3y� 'i`� <br /> :;UUkCE OF DRI NK I iVG dATER: F=UBL1 C SUPFLY L�� _ i�Rl VATE �rELL __ <br /> N. SURFACE DRAINAGE <br /> 1. Is �iisposal field site well drainedF �� '� S <br /> ?, Any water course �stream� draina�e ditch� etc.) throuph siie? "� c <br /> B. TOFOGf�ArHY <br /> l, Any heavy slopes in Pield area'? k [ <br /> i. :1i11 preseni topsoil in field area bo removed or QradeJ before field iiles are <br /> installed? n � <br /> 3. .�ill any fill terial be use � the disposal ficld ;ite: F S � f ves� how <br /> RillCfl L��� rc fYlc .�. ...� <br /> C. SDII OGNDITIONS <br /> I , iias a hole at leasi 4 Peet deep been dug in the disposal field area to determinc <br /> the type of soil present? .r � <br /> . \fier hote is dug record th soil conditions ai the followin� dupihs: <br /> (Hecord as sand� gravel � clay� packed sand� loam� etc, ) <br /> 12 inches /_� ...� 30 inches ---���%' � �—'�-n/—%--• - �'�r <br /> 18 inches � •� -�^ 36 inches �s` '" <br /> 24 i nches 5<< ..-� 48 i nches �' �« � <br /> . Nny ground �+ater encountered before reachin� a dept of 4 feet�_[7L_ _ <br /> If so� at what depth? <br /> �1, i^IATER TEST <br /> � simple water test will shov� how well this soil will drain or percolate water, <br /> To perform this test: <br /> 1. Dig a hole at least 36 inches deep. Use a shovel or post hole dig�er� size <br /> of hole makes no difference - only depth. <br /> 2, Fill hole with water, Now let all ivater run out of' Ihole, This soaks i5e <br /> ground and will give a more accurate reading. <br /> 3, A�ain pour water in hole to a heipht of 12 inches from the botiom. Let <br /> water run out until there is jusi 6 inches from bottom left in hole. <br /> 4, Note how many mi�utes it takes for this last 6 inches t seep away, J1 7 i•.�_,� <br /> 5. Divide this time by 6 io obtain the rate per inch, . S <br /> 6, Date water test was performed.��.2_ <br /> I hereby certify the above information to be correct and the above tesls �vere per- <br /> iormed by me as prescribed. <br /> �igned�� C / <br /> Address e — —�—�C� <br /> ;;CTE: A septic tank permit ia issued un the basis of the above information. If <br /> "�ere nr�_. :iny c,hanpes or alterations in the above stated soil conditions, it m.ay <br /> . .-•.iil ' ir th,- i�sf�ll.�4inn beinp re.lect��d �1 tl-,r: 1imN of inspection� <br />