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HomeMy WebLinkAbout0344 ANNABLE POINT ROAD - Health (2) Pmy-lc4lollt,, Cervip-r'u� lle� Al.'PLICATiuN l,'Uft PERCULATION 'ZEST AND OBSERVATION PITS LOCATION �' � ir/�//- � j� l NO. VILLAGE - - t'-" Lr p DATE APPLICANT IGL,�-,�.d lv�L.s�` FEE----lC�< ADDRESS_33`��9�u/U4��LL� �4f �� TELEPHONE NO. j Sj�� (Non-rfunda._ble ENGINEER .cf TELEPHONE NO. 3W-0 DATE SCHEDULED - 14A p C� l�)_ PCZ' 7 Applicants sig ature 11SSBSSOR'S�b���'6i�.oT NO .2i�/7 . . . .. . . . . . . . . . . . . . . . . . . . . o. . . . . . . . . . . . . . . . . . . . . . . . . SOIL LOG SUB-DIVISION NAMELG O° 4 %?- DATE EXPANSION AREA: YES NO _��'e�! ��'l��:� _ENGINEER TOWN WATER-le—'PRIVATE WELL BOARD OF HEALTH t--\� � — 1�*Gw�-� EXCAVATOR SKETCH: (Street n�me,etc. ,dimensio.ns .of holes LZi:lot, exact location ' of test h 4 i.i r.�.� 4 pelcolatio tests, locate wetlands in proximity to test holes) NOTES: 70 d • r �.. Abri- �4�d of 40,0 yf/' i/tJ PERCOLATION RATE. iy,/Z - AT zX& TEST HOLE NO: ELEVATION. TEST HOLE NO: ELEVATION: CA F 2 I 2 - 4 1 z-/ M���� wK. , 4 6 r.11 6 8 C ✓�-t�- 8 r �Q w��6b 9 7 9 11 11 12 ' 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FI NCRING PITS Z " LEACHING TRENCHES Cry UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: A'. NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P. F AN URNED TO BOARD OF HEALTIJ COPY: RETAINED BY APpTJCANT