HomeMy WebLinkAbout0186 CEDRIC ROAD - Health (2) Ivo ce&,-C, kc--)4I
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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