HomeMy WebLinkAbout1204 CRAIGVILLE BEACH ROAD - Health (3) i a b4 11-0-
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F,•�e Z �?8./ PPLICAT I oN vi iii PERCOLATION TEST AND OBSERVATION P T /*m6
)GOf'ATION J C�' �
NO. ! Cf 3
DATE
APPLICANT r ���f �.
Q ADDRESS FEE
TELEPHONE NO. (Non-refunds le
ENGINEERf-..�,. TELEPHONE NO ��1y (�
DATE SCHEDULED
Applica is s at e
• WAMAIJAV4 MAN.. . . . ... . . .. . . . . . ... . . . . . .. . . . . .. .. . .. ...... .. . . . . .. . . . . . .
20K701r—�101 SOIL LOG
SUB-DIVISION NAME : DATE
TIME/`✓
.EXPANSION AREAL YES NO t
TOWN WATER PRIVATE WELL„� C EON BOARD OF HEALTH
i''? �(efi Co us EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location. of teat holes and
percolation testa, locate wetlands in proximity to test holes)
. :NOTES:
Z 4 GAL, 1,3 Aid.
PERCOLATION IRATE: L Mu"k.-Ari 6
h
TEST HOLE NO: /' ELEVATION: TwBST HOLE NO: ELEVATION:
1 T° 1 �F
2 2 -.6S6;l
3 3
5
4 -
6 d4d S
9 9
10 10
11 11
12 12
13 13
14 14
15' 15
20 -T
16
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS
LEACHING TRENCHES' ,,--
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED TN F.NTTRFmY nY P. R A�vI) IjE ,
COPY: ZURNEp PO DOARI) OF IlEALTII
RETAINED BY APPLICANT -