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SNOHOMIS H HEALTH DISTRICT <br />3011 Rockefeller Ave.p <br />$5.00 fee for permit Everett, Washington Phone ALpine 9-2061 <br />LOT APPROVAL SHEEP j <br />NAME � =111�t " ��Gy p ADDRESS 2 iZ `�/ O % i 4L L <br />y; /�I• kto�fr/ lj s .rc+ ..� <br />ADDRESS OF PROPOSED BUILDING y �7 1/i S 'icdc t��14"a <br />i �i�l�/q!�!`-•6��f/��/G�/rS� �/VG"sS'tr'F �rf Lc f3 S:c3/T1AA'�C.SEtc A// <br />LEGAL DESCRIPTION: LOT BLACK ADDITION &,.A4 s. %3:b. �lCf. e.+e!•c//N/a jo�r raRr <br />TYPE OF USE /ia�nec NO. OF BEDROOMS SIZE OF LOT 6 x /22•.5'L� <br />SOURCE OF DRINKING WATER: PUBLIC SUPPLY[ X PRIVATE WELL <br />A. SURFACE DRAINAGE <br />1. Is disposal field site well drained? <br />2. Any water cow !!e (stream) drainage dit , etc, through site? / c• <br />B. TOPOGRAPHY <br />1. Any heavy slopes in field area? NO <br />2. Will present topsoil in field area be removed or graded before field tiles are <br />installed? /Yo <br />3. Will any fill material be used in the disposal field site? /Ye .If yes, how much— <br />C. SOIL CONDITIONS <br />1. Has a hole at least 4 feet deep been dug in the disposal field area to determine <br />the type of soil present? i 'J <br />2. After hole is dug record the soil conditions at the following depths. (Record <br />as sand, gravel, clay) packed sand, loam; etc.) <br />12 inches /darn 30 inches Pe.k�.� Su Grcvf/ <br />18 inches : So" "Ttwr/ 36 inches <br />24 inches '• -• 48 inches <br />4. Any ground water encountered before ree.ching a depth of 7eet?4/o If so at <br />what depth? <br />D. WATER TEST <br />A simple water* test will show how well this soil will drain or percolate water. <br />perform this test: <br />1. Dig a hole at least 36 inches deep. Use a shovel or post hole digger -- <br />size of hole makes no difference --only depth. <br />2. Fill hole with water. Now let all water run out of hole. This s <br />ground and will give a more accurate reading. a� <br />3. Again pour water in hole to a height of 12 inches from the bottei� <br />water run out until there is just 6 inches from bottom left in o e. <br />4. Note how many minutes it takes for this last 6 inches to seep <br />Record the time. Number of minutes for last 6 inches to seep a / <br />5 Divide this time by 6 to obtain the a per inch. .3 <br />6. Date water test was performed. <br />s. <br />To <br />I hereby certify the above information to be correct and the above tests were per- <br />formed by me as prescribed. p � .",� D 4 <br />Signed Uea <br />Address /S ` ' e+l• <br />NOTE: A septic tank permit is issued on the basis of the aboveinformation. If there <br />are any changes or alterations in the above stated soil conditions it may result in <br />the installation being rejected at the time of inspection. <br />