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CITY Or -:vERETT <br /> City Hall <br /> Everett, Washington PHONEt Alpine 9-7101 <br /> INSI'SCTION DEPARTIIENT <br /> (J nFjpq„�Q�,�� IAT APPROVAL SHT= <br /> /Y <br /> NAME 'kr ith 221,2ur ADDRESS �i 7 _--� a f-4. <br /> ADDRESS OF PROPOSED BUILDING <br /> LEGAL DESCRIPTION: LOT­.'j .BLOCK ADDITI0I; iYd <br /> TYPE OF USE .SO (.4 NO. OF BLDROOiS 3 -SIZE OF LOT 7?�/34. / <br /> SOURCE OF DRIhKI1'G WATER: PUBLIC SUPPLY L— PRIVATE '1ELL <br /> A. SURFACE DRAII-AGE <br /> 1. Is disposal field site well drained? )Ze S <br /> 2. Any water course (stream, drainaea ditchjAtc.) through site?. <br /> B. TOPOGRAPHY <br /> 1. Any heavy slopes in field area? —2l b <br /> 2. Will present topsoil in field area be removed or graded ' efore field tiles are <br /> installed? 12Z/2 <br /> 3. Will any fill material be used in the disposal field site?+If yes, how much <br /> , <br /> C. SOIL CONDITIONS <br /> 1. Has a hole at least 4 feet deep been dug,4n the dispoenl field area to determine <br /> the type of soil present? r^ <br /> 2. After hole is dug record the soil 6onditions at the following depths. <br /> (Record as sand, gravel, clay, packed sand, loam, etc.) <br /> 12 inches 30 inches__ <br /> 18 inches 36 inches <br /> 24 inches 48 inches <br /> 3. Any ground water encountered before reaching a depth of 4 feet? <br /> If so, at what depthZ <br /> D. IL:TER TEST <br /> is simp'e water test will show how well this soil will drain or percolato water. <br /> t To perform this test: <br /> 1. Dig a hole at least 36 inches deep. Use a shovel o.- post hole digger) <br /> i size of hole .lakes no difference - only depth. <br /> 2. Fill hole with water. You let all water run out of hole. TId s snake the <br /> jround and frill give a more accurate reading. <br /> 3. Again pour water in hole to a height of 12 inchos frora the bottom. Let <br /> water run out until there is just 6 inches from bottora left in hole. <br /> 4Note how many minutes it takes for this last. 6 inche3 to seep array. /2&/-a <br /> 5.. Divide tus time by 6 to obtain the rate ; or inch. g. <br /> 6. Date water toot was performed, <br /> I hereby certify the abovo information to be co rest and the a ova tests -/ere per- <br /> forred by me as proscribed. <br /> Signed <br /> Addrees �,tcr(l <br /> NOTL: A septic tank permit is iasned on tnc basin of t a above information. If <br /> thure are any changes or alterations in the above stated soil cor.ditionn, it may <br /> result in the installetinn ' eing rc.inct.ed at the tine 0,7 i.:,spect.- on. <br /> t <br />