HomeMy WebLinkAbout0081 BLOMIDON CIRCLE - Health S'I 13L6mi'd-rrt Cl
APPLICATION FOR PER(:OLATION TEST AND OBSERVATION PITS
LOCATION ) -- �Z'i�'iL
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VILLAGE E , DATEz
APPLICANT IT� FEE
ADDRESS Nog-refundable)
� TELE71iONE NO.
ENGINEER
TELEPHONE NO.
DATE SCHEDULED
(Applicants Signature)
................. .....................................
'� .......... ........... ....... ................................
ASSESSOR"S MAP & LOT' NU: ��� �� %�,��Gt'� /QO � .....
SOIL LOG
SUB-DIVISION NAM E , �i C�'//� DATE � z.� TIME
EXPANSION AREA:.YES _� NO �_ 04^ ENGINEF,R
TOWN WATER _� PRIVATE WELL _ �Q �a� - �I3 ) 1.) OF III3ALT11
�r C - AVATOR
SKETC1-1:.. (Street name, etc.. dimensions of lot, exact location of test holes aid percolation tests,
locate wetlands in proximity to test holes)
/ CB FND
308.62
y 3415
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46,798 SF tiQ/�
N. 20.57 r
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• `� ��� F2AiN/F�43/9 w I Z
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LATION RATE: 2 ` \7
HOLE NO: .� ELEVATION: TEST HOLE NO: ELEVATION :
2 — Z 2
3 3 �:1'T.
4 4 SGC--- \" 17
6
9 9
10 10
11 �O.S' 11
22 t1 12
13 NU l� i�f'�, 13 '
14 ' .. 14
15 35
16 16
BLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS uZ
LEACHING TRENCLIE9 p�
TABLE FOR SUB-SURFACE SEWAGE. REASONS: I�ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
NAL: COMPLI3` TED IN E-NTIRETY BY P. E. AND RF.Ti1RNED TO BOARD OF HEALTH
RETAINED BY APPLICANT o0