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HomeMy WebLinkAbout0186 CEDRIC ROAD - Health (2) Ivo ce&,-C, kc--)4I 1L4cl 10�3 1 V/ APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION Lo`r . lsnz `De Ce_:fDrz1C_ 2,c> NO.� VILLAGE C'k5m recy 1 l-t-S DATE APPLICANT CVA 4r)L, YL. 150sW02r4 FEE `0 tADDRESS QaX 68S cemEevILLA TELEPHONE NO. (Non-reftindabl( 1 i ENGINEER 't 4XT3L _TELEPPH�OyN,E NO. ' 4W--j 13 DATE SCHEDULED / AAP Qip� 83' (Applicant's signature • [1SS ESSOR'S ObiAPO_. LOT NV• . O O . O O . . . . O . . O . . . • . • . 0 . . O 0 o. . O . . . O O O . O O•0 0 0 0 0 if 0 0 0 SOIL LOG SUB-DIVISION NAME DATE -/0 �9 f TIME /0 /'''L' EXPANSION AREA: YES ✓NO _�t�+crm2 c r� ��/�� ENGINEER:! * ; TOWN WATER PRIVATE WELL stir vc/.✓iNG , BOARD OF HEAL'. EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) I NOTES: Z, o 26, . PERCOLATION RATE:_ , Al LAA& M C,gg$ ' TEST HOLE NO: , ELEVATION: TEST HOLE NO: ELEVATION': 1 8-0"2" &W wie- 1 O O,^2, oiGa�r� 2 -Z'=8'' S . 4 •S"-24= �o � SM►o 3 �j•• 2= 5 Ft1J6"S/1 NQ ^ 6 /0,0,!v• f ANr, 7 9 C'z F� ,fo.�.t� 8 10 11 •: 11 12 12 13 13 14 lq 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD_ LEAC G PITS LEACHING TRENCHES* UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER- ASSIGNED -ON PERC TEST APPLICATION • ORIGINAL: COMPLETED IN ENTIRETY BY P COPY: RETAINED BY APPLICANT E. RET URNED R TRNED TO BOARD OF HEALTH