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CITY OF EVERETT <br />City Hall PHONE: ALpine 9-7101 <br />Evereit� Washingion <br />^; 1(JSFECTION DEPARTfuf(dT �OT APPrlJVAL SHFET <br />NAmIEs��1= ET l��ial��,�,s /�� � ADDRESS i7� -ioY'�if�� N� dr�r cca� g.��.� <br />NilDfi�SS OF �ROi-0S[D BUI LUI IVG 7.�''T %"�J S% ���Rl- �% <br />�tGAL DESCRIPTIOti: LUT� BLOCK�_ ADDITIUN t�Y/J��1 �R�S% <br />TYF[ UF USES;C�F„� fi�y�n. OF �EDF�`(1(JiS 3 SI ZE OF L(1T ��" J� �-s v <br />90URCE OF DRINKING �lATER: FUBLIC SUPFL't � rRfVATE JE�L <br />A. �URFACc DRAINAGE <br />1, Is disposal field site vrell drair.ed:' �� '� — <br />2, Any w��ter coursz istream� drainage ditch� etc throu�h site? �� u' <br />p. TOFDGRAFH'r <br />l. �ny heavy slopcs in field zrea? <<' � <br />7. ':lill present tcpsoil in field area a removed or r,.raded uefore field ti;es are <br />installed? -v-�s' <br />3. '��ill any Pill material be used in the disposal field site`' '�•�' S �f yes� hovr <br />much / S'?1 i/Q',_ — _- <br />—T— C. SOIL WNDITIONS <br />1. Nas a hoie at least 4 feet dcep been dug in the disposal Pield area to deiermine <br />the type of soil present? _ <br />�. After hole is duE� record the s tl conditions at the following depths: <br />(Record as sand� �ravel� clay� packed sand� loam� etc.) <br />12 inches �>.� 30 inches (a,�.J(��-.---�/_ <br />�� <br />18 inches /.+ a,,� 36 inches /�-�� F�!l An>�� <br />24 i nches Sa ,„1' ��a � 48 i nches � <br />, Any pround water encountered before reaching a depth of £ect� '7'�-�� __ <br />If so� at what depth? <br />D. �:lATFR IEST <br />simple wafer test will show how well this soil will drain or percolz�te �vatcr. <br />, perform this test: <br />1. Lig a hola at least 36 inches deep. Use a shovel or posl hole di��erg size <br />of hole makes no difference - only depth. <br />2, fill hole with wat:r. Idow lei all water run out of hole. This soaks the <br />�round and will give a more acr.urate reading. <br />3. A�ain pour water �n hole to a heighi of 12 inches from the bottom. Lei <br />watc�r run out until there is jusi 5 inchcs from bottom left in hole.� �/ <br />4, Note how many minutes ii takes for ihis last 6 inches to s�ep away. <br />5, Divide this time oy 6 to obtain the rate per inch. � <br />G. Date waier tesi was performed. / y Fl��l3 L�i <br />' hereby certify the above information to Le correci and the above tests were per- <br />ormed by me as prescribed. n�� (���� <br />Si�ned �( <br />Addres�!_J? -iOJ'' N�;� .l'Cvt'L-LGFo•:+C <br />^TE: A septic tank permii is issued un ihe basis of the above informstion. If QG y-7 �eJ <br />�ere arc �iny chin�as �r alferations in ihc a6ove stat�=d �oil conditions� it may <br />�_,ult : thu insl_allation bein� rajected a{ ihe time of ins�,�ction. <br />