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12 VISTA CIRCLE
CENTERVILLE
A= 193 - 257
t tsk APPLICATION FOR PERCOLATION 'PEST AND OBSERVATION PITS �('
LOCATION LAKEVIEW T� C4 7 _ � �_ 1'r It NO. U
VILLAGE CENTERVILLE DATE
APPLICANT R. ARTHUR WILLIAMS, INC. FEE � 5.M
ADDRESS # 2 OAK STREET, CENTERVILLE TELEPHONE NO. 428-5712 (Non-refundable)
ENGINEER BAXTER & NYE _TELEPHONE NO._428-9131
DATE SCHEDULED JANUARY 8. 1986 0930
(Applicant' s signature)
• • • • • • o • • • • s e • o • o e e e o e • o e • • • e e o • o o o • . • • • • o • • • o • • • o • • • • o o o o • • • • • • • o • o • • • o o • o • • • • • •
SOIL LOG
SUB-DIVISION NAME LAKEVIEW DATE JANUARY 8.p 11986 TIME
EXPANSION AREA: YES-KNOS���vcE,,� tbci {�U•{ _ENGINEER
TOWN WATER_X_PRIVATE WELL 1 1��c.��p�,�:Q BOARD OF HEALTH
ALFRED FtT .T.F.R EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES:
36,
G ex�Lx- 7a -
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PERCOLATION RATE: �2M�'�-1 P�fL�cyUCc
TEST HOLE NO: - ELEVATION: TEST HOLE NO: ELEVATION:
i 2 2
3 C—:0 3
4 wl 4 -
'; 6 ��M G 6 •
7 Gil_ 7
8 8 -
9 9
10 10
11 _ 11
12 12
13 U0 { .� 13
15 `F01L(S,_,Ltv-0L-15
16 tE CF-4G t )
16
1 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD YLEACHING PITS Y-
LEACHING TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
i
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH
COPY: RETAINED BY. APPLICANT '
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