HomeMy WebLinkAbout0072 CRESTVIEW CIRCLE - Health (2) are-5+ v i aj O(de,
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APPLICATION FOR PERCOLATION ST AND OBSERVATION PITS
' 1 . (/
LOCATION
•VILLAGE_ Cew 1=—oL E, — T
DATE a /
APPLICANT �gySiI�C�V!'lmC{ Co. �u0
\ADDRESS FEE
i • ' TELEPHONE No. '771-10� (Non-refundable
ENGINEER ' ttl-o
TELEPHONE NO. `410-1/31
DATE SCHEDULED0S bi ,
. . • . . o i . . . • . ce . . . . . . . . a . . . . a �ApP1cant.s s�gnatu.r )
ASSESSOR'S bit�P,&_ OT N `
1,��/ SOIL LOG
SUB--DIVISION NAME �S(rg Y�/ODDS '
DATE TIbiE��Ir P11NSION. AREA:':;YES ✓ NO
' ! YU' C- ENGINEER:'?�� .
TOWN', YIATER ✓PRIVATE WELL —
BOARD OF HEAL?
� ,: EXCAVATOP.
SKETCH (Street name, etc. ,dim`ensions;of' lot, • exact location of- test h
percolation tests, locate wetlands in oles and
proximity to test holes)
NOTES:
48
013
PERCOLATION_ RATE �` �IJ ZMii� oe, Lfn5s q
'VEST HOLE: N0:'`. � ELEVATION
1 TEST HOLE NO• ELEVATION:
• 2 Lt4-A,,�, 1
3 5�35�i(.> 2
3
S
4
7 7
8 8 •
9
'10 g
L �
13 . . . .. 12
:14 a • 13
15 ." 14 ,
•1.6 ,
15
SUITABLE FOR .SUB--SURFACE SEWAGE: .. LEACHING
LEACHING FIELD LEA PIING PITS`_
LEACHING TRERCHES�
'UNSU•ITABLE FOR ,SUB-SURFACE SEWAGE. REASONS:
NOTE: `;ENGINEERING PLANS MUST . SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION
ORIGINAL' COMPLETED IN ENT RE P .
COPY: RETAINED BY APPLICANT RNED TO BOARD OF HEALTH
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