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ClTY GF �VEFiEI�i <br />City Hali PI-,OhE: A��,in, �-il_ll <br />f=verett; '�Y�shin�ton <br />IPI5PECTIGN ilEF,14T,�iEfuT LOT APFr=UUAL SHEET <br />NA�vIE�c�-?L�, ¢G }' ADDHESS <br />NilllR�SS UF PF.Or05[D C3UILllING 3� �% .�~����� <br />c �7 �� <br />LEGAL DESC�IPTION: LOT_� BLOCK ADllITION ��r,�.(/ ��Q�J�� _ <br />Tl'PE �F USE a� �0. GF �EDFDOf�7S �) SI ZE OF �UT <br />:UURCE UF liRll�KIiVG �lATER: FUBLIC SUPFLY X FRIVATE <br />A. SIiRFACE DRAIPIAGE <br />1. Is disposal field site well drained� yV.� <br />2. Any water coursz (stream� drainage ditch��etc.) through site? •�_ <br />8. TOFOGRAPHY <br />1. Any heavy slopes in field area? /7//� <br />2. :lill present t psotl in field are; b_ removed or oraded 6=fore field tiles are <br />installed? �� �/�, <br />3. ,�ill any fill material be used in the disposal field site?_�v � If yes� how <br />much <br />C. SOIL CUNDITIONS <br />' Nas a hole at least 4 feet deep been du� in the dispo;al field area to determine <br />the type of soil present? <br />1_. After hole is dup record the soil conditions at the followin� deptfis: <br />(Record as sand� �ravel clay� packed sand� loam� etc.) <br />12 inches r-4=� 30 inches <br />18 inches _=�1���-¢qr2w�, 36 inches <br />24 inches �i' d 48 inches �,�¢. �v <br />�. Hny ground water encountered before reachin� a depth of 4�` eet? <br />If so� at v+hat depth? <br />D. 41ATER TEST <br />A simple water test will show how well tt�is soil will drain or percolate water. <br />To perform this test: <br />1. Di� a hole at least 36 inches deep. Use a shovel or post hole dig�er� size <br />of hole makes no difference - only depth. <br />2. Fill hole with r+ater. Now let all water run cut of hole. This soaks the <br />�round and v�ill �ive a more accurate readinp. <br />3. A�,ain pour water in hole to a hei�ht of 12 inches from he bottom. Let <br />water run out until ihere is just 6 inches from bottom eft in hole. - <br />4, Note how many minutes it takes for this last 6 inches tu seep away. 3 O.��uresc�a�, <br />5. Divide this time by 6 to obtain the rate er inch. �%r�ic=�� <br />6, L4te water test was performed_��=J_1� J46� <br />I hereby certif)• ihe above information to b�rreci and the ab ve tests �vere per- <br />formed by me as prescribed. ��--,_, <br />Signed 1�.��i r//�,,�.� <br />Address <br />{�OTE: !1 septic tan� permit is issued on the basis of the above information. If <br />there are any chanpes or alterations in the ahove stated soil conditions� it may <br />nasult in thr irutallation being rejected at ihe time of inspection. <br />�-r-�wut� `/,zy9- �,��G l <br />