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- CITY OF E4ERETT <br />City liall PHJNE: ALpine 9-7101 <br />[verett� washin�ton <br />INSPECTION DFPAi3T(d�ENT LOT APFFOVdL 5liEET <br />NAml��i.i: ;c i ��,i�r.i n � ii � � ADDRESS% % ': ,t "' i c :' � c ;i,�i: -; <<. 5 ', � <br />AUDRESS OF Ffi{1i�S[D BUILUIIdG %����' % J�� <<' `� � <br />�EGAL DESCRI PTION: LOT� BLOCK,� ADDI TIUN ��'t' C �`, �.' � <br />TYFE UF USE.fi.Cr.',i,i //��,ND, OF BEDf�IJ�S _�1 <br />�URCE OF DRINKING JATER: rUBLIC SUPFLY Z <br />A. SURFACc LNAINAGE <br />SI ZE OF LUT �_� _ l5 �� '' �' <br />FRI VATE rlELL _ <br />1, Is dispcsal Pield site well drained� ��' f <br />2. Any water coursz istr=sn� drainlpe ditch� etc.) throu�h site'? •�?'�-� <br />B. TOFOGFAPHY <br />Any heavy slopes in Pield area'? �' <br />iJill pre5ent topsoil in field area h removed or �raded before field iiles are <br />in�!allec'? '`�'��P <br />��il: 3ny `ill mat rial be used in ihe disposal ficld ,it '_',_ 1'S If yes� how <br />much /__c'� d • <br />C S�IL WNDITI�tJS_ <br />Has a hole at least 4 feet deep becn dug in the dispna,�l field area to det��rmine <br />the type of soil pr�sent? -.� <br />After hole is dug record the oil co�dilions at the f'ollowing depths: <br />(Record as sand� �ravel� clay� packed sand� loam� etc.) <br />12 inches �n�ir,� 30 inches L/��i- <br />lE inches /, a'�+� / 36 inches � �� f�_�,� �� <br />24 inches f�i��.t 48 inches �ar.C'_��c��7 <br />Any ground water enco ntered betore reachin� a depth of 4 fect'�_ __ <br />If so� at what depth? _ <br />�,,_tJATf_R T(:ST <br />simple water test wil! 5�10N' IIOY' well this soil will dr�in or percol,le r+atc-r, <br />� perform this test: <br />;, Lig a hole at leasi 36 inches deep. Use a shovel or posi hol� di�eer� size <br />�f hule makes no differenca - only depth. <br />2, Fill hole with water. Now let all water run out of hole. This soaks the <br />�round and will give a more accurate readin�. � <br />3. Aqain pour waier tn hole to a heighi of 12 inches from tl�e bottom. Let <br />waior run out until there is just 6 inches from bottom left in hole.� <br />4, Note how many minuies it takes for this last G inches to seep away. � <br />5, Divide this time by 6 to obtain the rate per inch. �/. L' <br />6. Date water tesi was perform. d.��/' f% i% �'�_ <br />hereby certify the above information to be eorrect and th_ above tests were per- <br />�rmed by me as prescribed. •/ ',' ,�i' �/f�" <br />S i r�ne� � : % `�i-1 < � /!�� <br />Addressi�x -a`� "�Ac�Y ,f`/ ��i <<� G:��4 <br />^TE: A septic tank permii is issued on ths basis oP the a6ove informat�on. If,.,c��-,•J� / <br />:ere arc iny cF_inras �r alteralions in the a::ove stated soil conditions� it rn�y " <br />sult : thc installation being rejected at il�.e time of irs�,e:;tion. <br />