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' � �,� <br />C� <br />!ti� <br />y � I:�u�.�.'�:u- <br />' ` � ;I TY OF EVERETT ��yb '�''�%� <br />City Hall P!-pNE: ALpine 9-7101 <br />Everett� '�Yashingtc�n <br />I�JSPECTICh' DEF,�RT�,�ENT LOT APf-rOV;�L SHFET <br />IJAiviE�.SL/.1��;!`J .��/i�O,�,�,5 /.f��. �1DllRESS /�,?-/G`Sr� �'!r i/� .9fi.i _FGir� <br />AilDRcSS OF r=FiQr-uS[D BUILLIIJG 73/.s i'E�c.l •S% . <br />LEGAL DESCRIPTIOiJ: LOT /� 3LOCK_� ADDITIUi� ��� C%�F.S % <br />TYPE UF USESi�t-'44c:�PEsf�. GF BEDf�;047S 3 <br />SOURCE OF DRINKII!G �JATER: �UBLIC SUPFLY <br />A. SURFAC� DRAINAGE <br />SIZE OF _UT G�G X /S� <br />�RIVATE <br />1, Is disposal field site well drained? �« <br />2. Any water course �stream� drainage di`,ch� eic.) thro vn si{e? n <br />B. TOFOGRl,�H'I <br />1. Any heavy slopes in field area? l�v <br />2. ':Jill present tuAsoil in field area b remoced or nraded beiore field tiles are <br />installed? /I/[. <br />3. '�lill any fill mater ial be used in the di posal fieJd ,iie?� If yes� ho,v <br />much l d <br />C. 901L Cp��DITIONS <br />1. Has a hole at least 4 feet dAep been du� in thc dispo�al fi�ld area {o determine <br />the type of soil pr�sent? V.i � <br />2 rlfier hole is dug record th� soil conditions at :he following depihs: <br />i. ��ecord as sand pravel� clay� packed sand, loam� et .) ��- <br />12 inches > • 30 inches % - <br />18 inches 36 inches �' v , , <br />24 inches � �.,% 46 inches%, �-���1/��.-a �` <br />?. Any ground waier encountared before reachin� a depth oP 4 Peci'? �j�__ <br />If so� at whai depth? <br />D. !:ATFR TEST <br />� simple water test will show how weil this soil will drain or perw late water, <br />o perform ihis test: <br />1. Lig a hole ai least 36 inches deep. Use a shovel or posi holc dip��.rg size <br />of hole makes no difference - only depth. <br />2. Fill hole with water. Now let all water run out of hole. This soaks the <br />�round and will �ive a me�re accurate readinr;. <br />3. A�ain pour water in hole to a hei�hi of 12 inches from ihe botiom. Let <br />vrater run out until ihere is just C incnes £rom botton� left in hole. <br />4. Note hov� many minutes it takes for ihis las: 6 inches to seep away. l�'� <br />�. Divid� ihis time by 6 to obtain the rate per inch. / L� <br />6. Date water tesi was performed. -�J��•!i L- S' <br />I hereby certify ihe above informa{ion to be correct and the above tests were per- <br />%ormed by me as prescribed. J��"•— <br />Si�ned �� ��� (�(� <br />Addressll.2-i�' S' .�Cf= .LF ✓�,L�eL Ec'«s, <br />�?TE: A s=ptic tank permii is issued un the basis of the above information. If <br />�ere are iny changes or alierations in thc a6ove stated �oil ccndiiions� it may <br />���.sult :�� ihe installation bainp rejectcd ai the time of ins�,eciion. <br />C�L 9-T761 <br />