HomeMy WebLinkAbout0255 PARKER ROAD - Health DO. ���
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION i �i4 2�E� NO.Vo
VILLAGE CyE,11r=C\A L__C DATE
APPLICANT L.1tUp'A FEE g'
ADDRESS TELEPHONE NO.4•Z$--444 - (Non-refundablc
ENGINEER '5nn 'Eta TELEPHONE
DATE, SCHEDULED Aln .
(Applicant's signature
r • : • • • • • e o e o 0 0 • e •,e o n e o e • e o • • • o o . . . . . . . . . .
o • • • • • • • • • • • • e e I e •.• • • • • • e • e • • • s O • e • o • • a
ASSfiSSOR'S biAP 6 LOT NU: `c,
SOIL LOG
SUB-DIVISION NAME f�A DATE TIME
EXPANSION AREA: YES L NO _ 34411ul& ' �V�/� l,<C— ENGINEER'.'N. • '
TOWN WATER PRIVATE WELL BOARD OF HEAL?
L ATU EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
NOTES:
..i 1 65
,
PLO xt>
PERCOLATION RATE I '04 Zhu 6ML
TEST HOLE NO: ELEVATION: TEST HOLE NO: �" ELEVATION:
1
i 2 2 �$
3 7( L 3
5 Sj 5 _ S�
6 6
�� . n
9 9
10 10 .
• ' 11 11 5�,,�
12 12
13 13
14 14
15 15
16 16
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD V, LEAC G PITS
LEACHING TREN:CHE§
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION
. ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTI
COPY: RETAINED BY APPLICANT