HomeMy WebLinkAbout0051 BLANTYRE AVENUE - Health (2) SI `(?�IGtn�fe �.v�tae��y�}e/�iII
aa� J ���
��
APPLICATION Folt PLRCOLAT1014 'PEST ANli �JSERVATION PITS
LOCATION
DATE
VILLAGE
APPLICANTf�t 14� �`,y FEE
ADDRESS TELEPHONE N0. 7.0>" refundable
ENGINEER TELEPHONE NO._�IZ
DATE SCHEDULED - -
(Applicant' s signature)
• • •• • • • • 00000 • e • e • • eo • woe • •.• eoe • eoe • • • • • • o • • • o • • • a • • • • e000 • • • • • • • o • e • • • eo • o • • • • • •
ASSESSOR'S btAP 6z LOT NO: SOIL LOG
SUB-DIVISION NAME DATE TIME
_TIME
EXPANSION AREA: YES ,/NO _�Ax tiA! _ ENGINEER
TOWN WATERJ/PRIVATE WELL 0��- +'�_ (z� -u fv� BOARD OF HEALTH
EXCAVATOR
SKETCH: (Street name,etc• ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity .to test holes)
NOTES:
F2::,LfY� rt-t
13Co.00 ' Df�
Y
r 0 3s' nu - r
35,
v'
O
L orr-�
�_A 4 AA 1 i-d
PERCOLATION RATE: -�'� �_ R
TEST HOLE NO: ELEVATION: TEST HOLE NO: 2 ELEVATION:
1 F 0 '- N -Z " 1 7_7>
4 4
5
7 C 2 r,, ...� :c 7
• MAD�v nn
8 8
10 10
11 � 11 I
12 12
13 13 2
14 14
15 15
16 16
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELDL-�EACHING PITS
LEACHING TRENCHES 1_
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: �Ya
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY DY P . E , AND RETURNED TO BOARD OF HEALTH