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Home My WebLink About0067 CRESTVIEW CIRCLE - Health (2) C� NsA u i b-A) a.� 5 'APPLICATION 'FOR or .. PERCOLA`,r _ .. . . TIO EAN E TION PITS LOCATION AIL . V+V�PSfC3 ,....... VILLAGE �-I YA4J Q K� C 2 t L-Le 6� N 0._ �J 'APPLICANThySIDC�VItAlkl�, �, (fJC DATE/,'�.• `„ ADDRESS _ FEE TELEPHONE NO. 771-/0t�o (Non-reftindablE ENGINEER ' TELEPHONE NO. '420-7/31 D11TE`��SCHEDULED � ----_._ . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . `Appli�cant, s• signature)ASSESSOR'S b1APC LO'T NU; SOIL LOG SUB'' DIVISION NA2IE 144W Is( KIUoODS DATE -�� E? PANSION :AREA: .; TI YES ✓.Np ME , �® s TOiIN WATER_✓PRIVATE WELL . 13Pfz4z, BOARD OF EZEAL7 V1Zl5G�iEB EXCAVATOR SKETCH: (Street name,�etc. ,dimensions .of lot, exact location of ' test hol • percolation tests, locate wetlands in proximity to test holes) es and h NOTES: CA e2c o`34- � E� t 103 PERCOLATION RATE?' ' '" �� I� Ga- `i'EST HOLE No: . ,. ELEVATIO :.- TEST HOLE' NO: L�Qwy 1 ELEVATION! 3 ------- Z 4 S;4W> 3 5 � 4 6 S 7 7 10 - g (' 10 : 77V.' - 12 13 13 14 1 14 • - 15 " 15 '16 . SUITABLE FOR SUB-SURFACE; SEWAGE: '. LEACHINGIFIELD LEAC LEACHING TREN:CHE§_ NG PITS :UN I SOITABLE 'FOR SU$-SURFACE SEWAGE. REASONS. MOTE EN"'. .' RING. PLANS 14UST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION ORIGINAL': , " COMPLETED N ENTIRETY COPY: RETAINED BY APPLICANT RNED TO BOARD OF HEALTH ... ...... .rL �=..m2•±" Y "1J 2!` a .a:'3 �`% —