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r <br /> L� TY �.f L�'L11t� i <br /> City Fiall Pf-UP,[: H��,irn. �-�1 '1 <br /> Lve; e{t� "lashin�ton <br /> IGI�PECTIGPJ DEP�RT�iENT LOT (�PFPU��AL SHEET <br /> id Puv F ADDRE SS � <br /> �iuDR�SS UF PfiUrliS[D BUILUING / ° `� `� `' _ „ �;'�� � '-�-- <br /> LLG,4L DESCRIFTIUN: LOT r-- BLOCK ADDITIOfJ ` ��� � �,1� � ��' -� /��:.:" '� <br /> � <br /> TYF[ �F USE (C�' =. ICO. GF E3EDFCOf�?S • SIZE OF LOT �'�-'��� �= ' <br /> `uURCE OF llRl WKI �1G �,JATER: FUBLI C SUPFLY � ��� ' � ' � - FRI VATE �,;E�L �`1 -'� <br /> l+. SURFACE Di?AI P�AGE <br /> 1. Is disposal field site ti�ell drained: �r `�. <br /> 2. Any water coursa (stre�ms drainape ditchT etc. ) throuph site� "� ' <br /> 8. T0=0GkAPHY <br /> 1. /1ny heavy slopes in Pield erea? i ��� <br /> ?_. ';lill present topsoil i1�fi,eld area fie removed or oraded before field tiles ari- <br /> installed? <br /> 3. �lill any fill material be used in the disposai field site's If yes� hovr <br /> much <br /> C. :�IL CUNUITIOf!S <br /> 1. Nas a hole at laast 4 feet de�p been dup in the disposal fiald area to determinc <br /> th= type of soi: present? �/ ' <br /> 2. ,lfier hole is dug record the so`il conditions at the followin� deptf�s: <br /> ��ecord as sand� �rav�el� clay� packed sand� loam� etc. ) <br /> 12 inches �•':��•� ��� , 30 inches L. <br /> 18 inches _ � ' 36 inches _;',' � - . <br /> 24 inches ' 48 inches >' : <br /> 5. i{ny �round water encountered before reachin� a depth of 4 feet'? _ <br /> I f' so� at what depth'? <br /> D. ':!ATFR TEST <br /> A simple water test will show ho�,v well ihis soil will drain or percolate waier. <br /> To perform this tesi: <br /> 1. Di� a hele ai least 36 inches deep. Use a shovel or post hole dip��r� size <br /> of hole rtiakes no difPerence - only depth. <br /> 2. Fill hole witti v+ater, f�ow let all water run out of hole. This soaks the <br /> �round and will �ive a more accurate readinp. <br /> 3. A�ain pour water in hole to a hei�ht of 12 inches from the bottom. Let <br /> v+ater run out until there is just 6 inches from bottom left in hola. <br /> �i, Note how many minutes it takes for this last 6 inches to seep a�vay. <br /> 5. Divide this tiine by 6 to obtain the rate per inch. <br /> 6. Date water test was performed. � 1 �: - � '1 <br /> I hereby cer{ify the above information to be correct and the above tests �vere per- <br /> formed by me as prescribed. <br /> 5i�ned �., t�� • , <br /> Address <br /> {:UIE: A septir tank permit is issued on the basis of the above information. If <br /> there are any chanPes or alterations in the above siated soil conditions� it n�ay <br /> rusult in the install�tion beinQ rejr_-cied at the {im�� of inspection. <br />