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CITY OF EVERETT <br />City Hall <br />Everett, dashington <br />PHONE: Al -pins 9-7101 <br />INSPECTION DEPARTMENT <br />Q� LOT APPROV 1 SHEET r,ll -7 q a UJ <br />NAN.E - VU-4'X6iL ADDRESS — r <br />ADDRESS OF PROPOSED BUILDI - -W `''y /. S.M. <br />LEGAL DESCRIPTION: LOT_'LBLOCI ADDITION\1, &�St W>WtL& <br />TYPE OF USE NO. OF BEDROCIVS .3 SIZE OF LO `71 K I I O <br />SOURCE OF DRINKING i.ATER: PUBLIC SUPPLY x PRIVATE nELL �w <br />A. SURFACE DRAINAGE <br />1. Is disposal field site well drained? <br />2. Any water course (streams drainage ditch, etcf) through site? -yte <br />B. TOPOGRAPHY <br />1. Any heavy slopes in field area'r " kt0 <br />%ill present topsoil in field area be removed or graded before field tiles are <br />installed? �. <br />J. '011 any fill materiel be used in the disposal field site? 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? <br />2. After hole is dug record t,, soil conditions at the following depths. <br />(Record as sand, gravel, , packed sand, losing etc.) <br />12 inches gti�_et 30 inchesoz.<Wy <br />18 inches 36 inches <br />24 inches i' 48 inches �r <br />4. Any ground water encountered before reaching a depth of 4 feet? -xv. <br />If soy at what depth? <br />D. WATER TEST <br />A simple water test will show how well this soil will drain or percolate water. <br />To perform this test: <br />1. Dig a hole at least 36 inches deep. Use a shovel or post hole diggerisize <br />of hole makes no difference - only depth. <br />2. Fill hole with water, Nnw let all water run out of hole. This soaks the <br />ground and will give a more accurate reading. <br />3. Again pour water in hole to a height of 12 inches from the bottom. Let <br />water run out until there is just 6 inches from bottom left in hole. <br />4. Note how many minutes it takes for this last 6 inches to seep away. <br />5. Divide this time by 6 to obtain the rate per inch. (e <br />6. Date water test was performed. ­72" IQy <br />I herebyy Signed certify the above information to be correct and the above tests were per- <br />formed by me as prescribed. <i!i �tiu l <br />%�,� � Iij _ <br />Address <br />NOTE: A septic tank permit is issued on the basis of the above information. If <br />there are any changes or alterations in the shove stated soil conditionsq it may <br />result in the installation being rejected at the time of inspection. <br />