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r, <br />CITY Of cVtRl,l i <br />City iiall Pf��E: A��:trn_ 1-ilJl <br />rverett� '��2shinsion <br />INSPFCTICN DEF,1RT,iFi�T LOT A?FrO6�L SHFET <br />. ��� •. r i�� • 11 � :• � •�� ' �� <br />-- TL1T.'1 <br />AJDfi�SS UF FFOiGSED BUILDI <br />LEGAL DESCRI PTI(NV: <br />LOT]2_ BLOCK�__ ADllI IIUv 5►lvan oresG <br />TYFE �F USE res. , K0. GF f3EDF�U615 �_ <br />`OURCt UF llRINKIiVQ i�ATER: FUBLIC SUPFLY <br />A. �l'Rr A.L'c Di�Ai PIAG^ <br />SI ZE OF �C'T fi0 Y� 2� <br />'rRl VATE c(E <br />1. Is disposal fi�ld site v:ell drair.�d': — <br />2. �ny water coursa �stream� drainage dit�h� e:c.) throuph site?_rn <br />8. TOr'OGRaPHY <br />1. Any heavy slepes in field zrea� nn _ -- <br />2. SJill preseni topsoil in field area Le remov�d or �raded before fiel.' tiles are <br />instal led'?_yes <br />3. �lil� any fill n�aterial be used in ihe disposal fiald site� "� If yes� how <br />m��. ti ^�Qn.p,. ,.��_,-. <br />c. �ri� a�n�oirior!s <br />Z <br />'i. <br />Has z, hol� at le�si 4 feei deep been dun in the disposal field area to determine <br />ihe {ype of soil preser�t? nr.a <br />�ifte� hole is duP record the =oi1 conJitions at .h�� Pollowin� dcptf�s: <br />(�ccord as sznd� gravel� clay� packed sand� loam� atc.� <br />12 inches t.op +�iL_ 30 inches BS'j,_me <br />18 inches �3� Q�a�e1�loam 36 inches _^ <br />?4 in�hes. n n n 48 inches ° <br />Any �ro�nd water encouniered before reachin� a depth of 4•feci'•_ ao __ <br />If so� at c+hat depth'? <br />D. 4;ATFR TEST <br />A simple +va{er tesi v+ill show how well ihis so�l v+ill drain or perc�late waier. <br />To perform tliis test: <br />1. Uio a hele at least 36 inches deep. U;;e a shovel or posi hole dippar� sizc <br />of hole makes no difference - o�ly depih. <br />2, Fil] hole with e+ater. Now lei all water run out of hole. This soaks the <br />�round and will pive a�rore accurate readinn,. <br />3, ,1�,ain pour water in hole io a hei5hi ef 12 inches from the bottam. Let <br />water ru❑ out until ti�ere is ju=_t 6 inches `rom bottom left in hole. <br />•9. Note how m�ny minutes it takes for this last 6 inches to seep away.�.2.sn3.ri. <br />7. Divida ihis !ime by 6 io obiain the rate per inch. 2 __,_ <br />G, Date water test �vas performed. 5_l_6$ <br />I hereby ceriify the above inPormation {o be correci ari jla abuve test= �vere per- <br />formed by re as prescribed. �� � / �� <br />� Si�ned y LT1���•�; � , � "' �y�[g <br />' Address�:,p��o7G2D1�-Starl on ( �% }� <br />ROTE: !1 septic tank p�rmii is iss�.d cn the besis of the above informatiun. f�L9? <br />there �re any chanvas nr ��lt�raticns !n lhe above staied soil conuitions� it may <br />resuli in the installation baing rejectc�i nt ih�� tirie of inspeciion. <br />