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• CITY OF tVERETT <br />� City Hall PHOfCE: ALpine 9-7101 <br />� Evereit� '��ashingion <br />INSPFCTICN DEP,\RT'AFNT LOT APPrOV�L SHFET _ <br />FLLF L'�/!= <br />f�!A�d,Est "'�`7 ,y�i<.o<!25 /A"C ADDRESSL7� /cg �sJtE�f� ✓� <br />AJDRtSS UF FFU"rOSED BUILUIfJG 7�3 "�� � W `S � <br />ci v��AL' Cl�t S � - <br />LEGAL DESCRIPTION: LOT � aLOCK Y ADD171UN � <br />TVPE UF USES/.�K/f ES W. Gf BED('CQf�1S <br />3 SI ZE Of LUT �4�3 X/I6 <br />SOURCE OF DRINKING �JATER: FUBLIC SUPFLY <br />� PRIVATE ;:ELL�� <br />. A. SURF'CE DRAINAGE <br />�� � <br />1, Is disposal field site vrell drair.ed`� U _ <br />2, Any water course �stream� drainac�e ditch� etc.) throu� site� <br />B. TO_ F_ �_ GRAPIiY <br />�, Any heavy slopes in field area? <br />?, :lill present top�suil in field area be emoved or oraded bePore field tiles are <br />installed� �� <br />3, 'Jill any Fill material be used in the disoosal fi�ld site'•' If yes� how <br />much � �IL dJ��DITI�hS <br />1. Has a hole at least 4 feet deep been du� in the disposal field aren to deiermine <br />the type of soil resent� <br />?, After hole is dupPrecord the soil condiiions at .he following depths: <br />(Record as sand� �ravel� clay� packed sand� loam� etc.� `� L <br />12 inches / e n�= 30 inches � t ^� <br />18 inches .Cy�✓ 36 inches <br />24 inches 48 inches <br />���--- <br />�, A�y �rou�d ,yater encountered before reaching a depth of 4 Pect' <br />" I f so � at �vhat depth? D ' A�ST <br />� simple water tesi �eill show ho�� well this soil will drain or percolate vialer. <br />-o perform this test: � , � <br />1. Li� a hole at le.si 36 inches deep. Use a shovel or post holc di p�r• size <br />of hole makes no difference - only depth. This soaks the <br />2, Fill hole with wat"r, i�ow let all water run out of hole. <br />�round and will Pive a more accurate readinp. <br />3, A�ain pour waier in hole to a hei�hi of 12 inches from the botiom. Let <br />water run out until there is just < inches from bottom lef't in hole.� <br />4. IJote how many minutes ii takes for ihis last b inches i s ep �LY• <br />5, llivide ihis time by 6 io obtain the rate per inch. <br />6. llate waier tesi was performed. �'�'�"'� �' �� <br />I her�by certify iha abo`e information io Le correct and the above tests were per- <br />r � c <br />�ormed by me as prescribed. ���,ned ?/u �` <<�'�"`� <br />Addre�c i 72 i r`'r l+r a(°� .r�E' ,AG�Lt•�L'a�•E <br />1!TE: A sep�ic tank permii is issued un t�e basis of the above information. If <br />»ra a'c in ch.�nczs or alteiations in {hc a ove stated �oil c,nditions��lm�yl77L / <br />,:sult :�� lhe installation beinp rejectcd zt the time of ir.a,�ection. <br />