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^,.l CITY OF EVERETT <br />�//'' I Ci{y Hall PI-�NE: ALpine 9-7101 <br />�r% ��1' � 4 Evereti� �'�ashingion <br />I � �� � I i�SPECTION DEPARTf;�ENT I.OT AFFrUV�1L SHFET <br />Y �. � , ,� . <br />� Arv�E�fL�S� T /�'ii .-R 5 /.�'�' ,1DDRESS %7Z /d���.�d��Gl= �i'G«I'E-aC- �dc".� <br />AUDfitSS OF rFiOrOSLD BUI W I NG J� /.3 y/��L1 S/ �G��ll!' %% <br />�EGAL DESCRIPTIUN: LOT,_%� BLOCK�._ ADDITION ��� C'��yL— <br />TYF[ OF USESLcU6%F-f�.i,IW. GF BEDFCOf1S -� SIZE OF LUT ��� J� �s�� <br />9�URCE OF DRINKIiVG ��AiER: 1=UBLIC SUPFLY �� FHIVNTE ��ELL_ <br />A. 3URFP,C� DRAINAGE <br />1, Is disposal field site well drainedY �r•S <br />2, Any water cour,e �stream� drainage ditch� eic.) through site`� -�'LC� <br />B. TO�GRA"r'H'i <br />l. Any hezvy slop�s in field area? �-� t <br />2. '��il] pr�sent topsoil in field area b removed or �raded bePure field tiles are <br />install�d? -��`-+' <br />3. '��ill any °ill rt��rial be used in ihe disposal Pield sitc?� If yes, hov+ <br />much �� <br />C SOIL C(iNDIiIONS <br />1. Has a hole at least 4 feet deep �een dug in the disposal fiald arca to determine <br />the ivpe of soil present? �� S <br />2. �3fter hole is dug record the oil conditions at the following depths: <br />(Record as sand �ravel� clay� packed sand� loam� etc.) / � <br />12 i nches Z c d�n 30 i nches � E�,<I S� ,�� <br />lE i nches L� ���2 36 i nches %��' %r� d-fa��-l� <br />24 inches�L`�� 48 inche ,_ <br />, Any �round waie� en uniered before reachinp a depth o 4 feei� �"`-�'___ <br />If so� at what depth': <br />D. :IATEFt TEST <br />simple water test will show hotv wel] this soil v+ill drain or percolate water. <br />� perform this tesi: <br />1. Li� a hole at least 36 inches deep. Use a=hovel or posi hole diF�ger� size <br />of F�ole makes no differenca - only depth. <br />2, Fill hole wiih water. Now let all water run out of hole. This soaks the <br />�round and will give a more accurate readinP. <br />3. Again pour water in hole io a hei�ht of 12 inches from the botiom. Let <br />water run out until there is just 6 inchcs from bottom left in hole. <br />4, Note how many minutes it takes for this last 6 inches to seep away.�� <br />5. Divide ihis time by 6 to obtain the rate per inch. 5� <br />6. Date water test was performed.� /-.t+� �'� <br />� hereb ceriif tha above inform3tion to t� correc: 3nd the above t�st� vere per- <br />�rmed by me asYprescribed. /J��j��J � `^�y <br />S i pned. /� <br />i+ddress i7� /o,f`�/JG'F�Y-- 14LL,cu=�.f/-- <br />"TE: A septic tank permii is issued or the basis of the above information. If�� y- ,7G� <br />,er�, are sny cf��nges �r alterations in thc above stated aoil co�ditions� it may <br />:suli :� the installation heinQ rejr-ctc.d ai the time of irs,�ection. <br />