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CITY OF -XZRETT <br />City Hall <br />Everett, Washington <br />INSI ECTIOH DEPARTHUFT <br />PHOKEs Alpine 9-7101 <br />LOP APPROVAL SHMT <br />VIM ADDRESS <br />ADDRESS OF PROPOSED BUILDIFG <br />LEGAL DESCRIPTION: LOT BLACK ADDITIOV <br />TYPE OF USE NO. OF DLDROOiS 7mu OF LOT <br />SOURCE OF DRIIxKIFG WATER: PUBLIC SUPPLY PRIVATE '.'ELL <br />A, SURFACE DRAIi4GG <br />1. Is disposal field site well drained? <br />2. Any water course (stream, drainage ditch, etc.) through site?_ <br />B. TOPOGRAI•HY <br />1. Any heavy slopes in field area? i>_ <br />2. Will prese,st topsoil in field area be removed or graded before field tiles are <br />installed? <br />3. Will any fill raterial be used in the disposal field site?__ If yes, how much <br />C. SOIL CONDITIOKS <br />1. Has a hole at least 4 feet des been dug in the disposal field area to determine <br />the type of soil present? <br />2. After hole is dug recoM the Joil conditions at the following depths. <br />(Rocord as sand, graver, clay, packed sand, loam, etc.) <br />12 inches 30 inches_ <br />18 inches 36 inches <br />24 inches 48 inches Xf <br />3. Any ground :cater encountered before reaching a depth of 4 feet? <br />If so, at what depth: <br />D. 1IATEh T?ST <br />is simn'e eater test will show how yell this soil will drain or percolate !cater. <br />to perform this test: <br />1. Dig a hole at least 36 inches deep. Use a shovel or poet hole digger; <br />size of hole makes no difference — only depth. <br />2. Fill hole with Crater. Foil let all Crater run out of hole. Tl.is soaks the <br />ground and idll give a more accurate reading. <br />3. Again pour water in hole to a height of 12 inches from the Uottem. .et <br />water run out until there is just 6 inches from bottom left in hole. <br />4. Note how ninny minutes it takes for this last 6 inches to ceepa way._ 5 0 <br />5. Divide this time by 6 to obtain the raise ;er inch. <br />6. Date water test was rerforred.Gf <br />I uereby certify the above inforviatios; in be correct and the wove tests �rere pnr— <br />formed by .is as proscribed. �O , <br />S1N:iod 7n..ttt)nn 4 r -(-I; LYId <br />Abrain ! 19 ..� <br />KOTBt Aseptic tank permit is iasr.ad on the ix;si❑ of the above infor men. If <br />there are any changes or alterations _n the olx)ve stated soil co:.ditinnr, it may <br />result in the irstnllntinn ' eing rc jnetmi nt fiic tine. o, i.ia,,e&-or.. <br />