HomeMy WebLinkAbout0050 HOLLY HILL ROAD - Health (3) rD HIIW W I PW-et)
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(APPLICATION FOR PERCOLATION TEST AND OBSERVATION HOLES)
LOCATION V'7 1 J OLD T- 101_c_ PERC. #
TOWN FEE: LL�o• ��
VILLAGE DATE: 6--
APPLICANT t''1/l T I E L i
ADDRESS '+3 sNAw 1`117Zrj RD , c-1AITOW !711 07-0a1
ENGINEER 'D0—A' C ALE &:-:A/CZA/E1E Rd,/G � I lyc
DATE FE I3 r v i 9 s //,-Go AW
ASSESSORS MAP 1 a'�, -PARCEL_1 0 1 SUBDIVISION
LOT # 't-7 NAME:
TIME i n.,0 0 TOWN WATER: N,'WELL:
ENGINEER: JA C-5 C ToLYCE
BOARD OF HEALTH: t-40
EXCAVATOR: E02-FO ci;r I
TEST HOLE LOG DATA:
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5vC,sOft_ Sv4s AIL
MED. T� P E D TJ
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G-R,AVeSLY GRhVELL�i
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SUITABLE FOR SUBSURFACE SEWAGE: YES_v_" NO REASON —
SKETCH: (STREET NAME, DIMENSIONS OF LOT, EXACT LOCATION OF TEST HOLES AND
PERCOLATION TESTS, WETLAND LOCATION IN PROXIMITY TO TEST HOLES)
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'O9 L-0 1 �t
ENGIgEtAR DATE n ' rNl J
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down cape engineering, inc. Zz '
H O L L
CIVIL ENGINEERS
' LAND SURVEYORS
FORM MUST BE COMPLETED IN INTIRETY BY
e� 39 .main st. yarmouth, ma P.E. AND RETURNED TO THE BOARD OF HEALTH
t JOB NUMBER �-
PERCOLATION FORM
(APPLICATION FOR PERCOLATION TEST AND OBSERVATION HOLES)
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LOCATION Z- Lt 7 NOS!)' Pf(-t- PERC. # gym
TOWN 9 rk VS TA rat FEE: $fr1�n.nn
VILLAGE C-`I--i Elllvr�-r r- DATE:
APPLICANT NA-RI
ADDRESS Lt-j `HAL-v FliT<n Z > > G 9NT fir✓ nd C�zQz!
ENGINEER Do—s' G A EFF t=a'C�iA/FERMIG i AZL
DATE F=E-La r y , r 9 s> s
ASSESSORS MAP / Sf"- —PARCEL I a/ SUBDIVISION
LOT # `,-7 NAME:
TIME r," TOWN WATER:.N�WELL:
ENGINEER: .Tft-t--7Es C
BOARD OF HEALTH:
EXCAVATOR:
TEST HOLE LOG DATA:
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' TOF 4rv0
7 0? 4 N'•�
SvG5'1 -
s PED r,o
G�ARsc L,')kRsc
GRt vt L LY GR A vEL O'
S'c�/7 sftniD PERC. TEST AT
4� _ < 2 !'7rA/ //NC-/t
C�r�tN
7 a h/tv(C
CL�hN 11ED.
vro ,E sstwb
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Tn '1v D FavN b
I
SUITABLE FOR SUBSURFACE SEWAGE: YES-V—" NO REASON
SKETCH: (STREET NAME, DIMENSIONS OF LOT, EXACT LOCATION OF TEST HOLES AND
PERCOLATION TESTS, WETLAND LOCATION IN PROXIMITY TO TEST HOLES) f
iESSR 1►1 0; �- �; `J L
ENGINE ENGINEM DATE
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pis LOT �'7 ,
n,
ar 5x-see-4641 r
to eca W-w
i down cape engineering, inc.
CIVIL ENGINEERS
' LAND SURVEYORS
FORM MUST BE COMPLETED IN INTIRETY BY
939 main st. yarmouth, ma P.E. AND RETURNED TO THE BOARD OF HEALTH i
JOB NUM,BEP, �.L