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"'—� <br />oo' ,��:�''� , �- <br />� �� <br />� j ,. <br />/ <br />�•� <br />CITY OF EVERETT <br />City Hall <br />Fverett� �+ashington <br />INSFECTIOM DEFARTNENT <br />LOT APPRUVAL SHEET <br />FHONE: ALpine 9-"l101 <br />1 � <br />. '; <br />;� ., ; , � , , <br />NAN.E - �' ' '� ; ADDRESS ;, — <br />ADDRESS OF PRCPOS[D BU I LD I �JG n' �'' �' ' <br />,. , n �, � ;—� L <br />�EGAL DESCRIPTION: LOT_^�? BLOCK ADDITI <br />T`!PE OF USE �-< N0. OF E'EDFOCMS �' SIZE t� LOT �f �- X���' <br />SOURCE OF DRIP!KI�!G �.ATER: PUE;LIC SUFFLY n�' .• PRIVATE v+ELL <br />H. SURFACE DRAINAGE <br />1. Is d�sposal fieid site well drained% "� `�' <' <br />[. Any wate� course (stream� drainage ditch� etc.) throuPh site? %�.'•" <br />B. T�CGRAPI;Y <br />1. Any heavy ,lopes in field area': '/' " — <br />�. i+iii preser�t to�suil in field area be ruR�ved or graded before f�eld tiles are <br />ansial.ed? 7�i .� <br />.i. o:ill any fill material be used in-.!;= disposal field site?':: If yes� how much <br />C. SOIL CONDITIaJS <br />1. Has a hole at least 4 Peet deep been dug in the disposal field area to determin� <br />the type of soi] present? �/,::-� <br />2. After hole is dug record ��ie s6i1 conditions at the Pollowing depths. <br />(Record as sand� pravely ca�� packed sand� loary etc.) <br />12 inches �.i� �+ ,.,+ 30 inches � r� � — <br />lE ;,:ches ,� _ 36 inches �• <br />24 inches _ , 48 inches � <br />,, Any ground water encounte���a beiore reachin� a depth of 4 feet? �%.'- <br />If so� at what depth? ��"�'� ._. <br />D. �i�ATER TES'i "- - . <br />_._.. <br />A simple v.�ater test ni]] show how weli this soi] will drain or perco:�+F wate�. <br />To perform this test: <br />1. Dig a hole ai least 36 inches deep. Use e shovel or pust hole di�ger:size <br />of ho!e makes no difference • only depth. <br />2. Fill hole with water, fdow let all water run ou+. of hole. This soaks the <br />�round and wil] �ive a more accurate readin�. <br />3. Apain pour water in hole to a height of 12 inches from the bottom. Let <br />v�ater run out until there is just 6 inches from boitom left in hole. � <br />4. Nete how many minutes it takes for this last b inches to se=p away..3�; <br />7. Divide this time by G to obtain the rate per inch. � <br />6. Date v+ater tesi was perfcrrt�ed. i:'���' �' '`� �` �'�� <br />I hereby certify ihe above �nf.�rrration to be correct and the abeve tests were per- <br />. � <br />formed by me as i_„=i ibed. � i_, ' ' <br />S i gned // !: f•l� , �'� '^I` <br />Address <br />DiCTE: P septic 'tan;: permit is issued on the basis of the above inPormation. If <br />there are any changes or alierations in the �hove stated soil conditions� it may <br />re=_ult in the installation beinp rejecled at the time of inspection. <br />