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HomeMy WebLinkAbout0055 CRESTVIEW CIRCLE - Health (2) ss �s�u���,v G'��le C�,t�cJ► l l� �v� o�i � o� �- � �- -__ _ —_ _ � APPLICATION 'FOR PERCOLATION TEST AND OBSERVATION PITS r LOCATION ` V1G ;1�11� L). -t4tiC N '. VILLIIGE� 11PPLICIINT DATE Ca; luc• ADDRESS FEE , J , ,P-3 F � ' TELEPHONE NO. `771-10� (Non-refUndablE ENGINEER l��CIUL ye C_ TELEPHONE N0. 'L�•ZB-9/31 DATE SCHEDULED l.�. r �APPlicant' s signature) ASSt,SSOR'Sbi P &: OT No: ' ' • . . . . . . . . . . . . . . . . . . . . .. . . . , r. . . . . . . . , . , . '. . , , . ; . . . . SOIL LOG SUB•-DIVISION NAtdE �S(g OOV — DATE TIriE l/G�. E.�PANS ION AREA; '.YES ✓;NO_^ TOWN; WATER ✓PRIVATE WELL 'S ( !3 JL Y ENGINEER:;���' ' BOARD OF REAL? SKETCH. (Street name etc. EXCAVATOR ,dimensions ,of lot, exact location of'',test holep and percolation tests, locate wetlands in proximity to test holes) a NOTES: 1'vI C�� t v PERCOLATION,`,RATE Z 'VEST. HOLE NO..: ELEVATION: T TEST HOLE N0: ELEVATION: 2 1 3 2 4 3 Sa ,y 4 .. 6 6 8 7 a 10 Af 9 1;i�',* Z4 .r /T�..✓ .4t.�........ .;'<a _y,.� 4.:1 0 3 -.e...«a ,' r -iz._. ..,r ,,+_Y A-y. u u. * �... . k 13 12 14: s 13 14 -• l 5 • 16 ` SUITABLE -FOR :,SUB-=-SURFACE SEWAGE: LEACHINGIFIELD N% LEACHING TREN:CHES�E��' G PITS ;UNSUITABLEjFOR SU$-SURFACE SEWAGE. REASONS: . le , : EN.., " BRING PLANS 14UST SHOW NUMBER- ASSIGNED .ON PERC TEST APPLICAT ION -ORIGINAL*: , +COtdPLETED N ENT RE p COPY: : ' RETAINED BY APPLICANT RNED TO BOARD OF HEALTH