HomeMy WebLinkAbout0620 CRAIGVILLE BEACH ROAD - Health (3) C���v�ffe
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LOCATION lJ� NO. l" ~ .
VILLAGE C EhJTE2✓/ LE_ DATE --!7
APPLICANT FEE flt� 4t ,
ADDRESS TELEPHONE NO. (Non-refundable ; `
ENGINEER CIc L A k)OF-93 — CA U TELEPHONE .
DATE SCHEDULED
J Applicant' s signat re
LOY Ab* . . . . . .
� SOIL LOG
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SUB-DIVISION NAME . DATE '%� �'PIME
EXPANSION AREA: YES NO e _ , Lar�derc- oa,u ENGINEER ?
TOWN WATER V PRIVATE WELL , (I VA ( ,ryu BOARD OF HEALTH
21;1r� 0 EXCAVATOR
SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
NOTES:
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PERCOLATION RATE: 2m.%n
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TEST HOLE NO: ELEVATION: TEST HOLE NO: 2 ELEVATION:
(LIB
J 1 _t_oo.rY\
Jr.2J 3.o
4 - - a _
5 5 fy\ec k n e e�
e \A0.rle l {�h
1 8
9 %",a j I Cc.� g
10 10
11
12 fy\ urn 12 —�
13 S 13
14 14
16 z 16 /
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD EAC 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 AY P . E . ANJ2 RETURN_ D TO BOARD OF HEALTH
COPY: RETAINED BY APPLICANT