HomeMy WebLinkAbout0015 LINDA LANE - Health (3) i� L,r' n A6 lane,
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS 4
LOCATION] Li kt/->A 4 - �zg-
VILLAGE_G�.l�/• -� DATE ��„�= F's=
APPLICANT FEE
ADDRESS_ / TELEPHONE N0. 7? y Zq-(Non-refundable
ENGINEER :_/� 1 �'L/���� _TELEPHONE NO.�7S-aos F'
DATE..SCHEDULED
(Applicant's signature
. . . . . . 0 0 Oe'O O • O . 0 0 0 O o • 0 0 0 . . . 0 0 0.:._O . . . ... . O..'. .,O .....,C . . . . 0 0 0 0 . . . . .,. . O . O . ... O,0 • O . . . . .
• ASSESSOR'S b1�P C LOT NO:
SOIL LOG
DATE 9v `�-
i.
SUB-DIVISION NAME Gz�Js _/ a.�; ��TIME
EXPANSION 'AREA: YES INO . ,- 3F(. „'Ir nl,_ ENGINEER .
TOWN WATER /PRIVATE WELL �\. �,L,. , . BOARD OF HE4TI
/a>k 2 EXCAVATOR
SKETCH: (Street name.etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes),
NOTES
27—so
31•7,
La;— <07
t'�� 1 i... �• 0 M
a IQ-
.�J,�• ,Ifs. ,, oo J
PERCOLATION RATE: Z L-/f 1• j ►>�� I
TEST HOLE NO: l ELEVATION: TEST HOLE NO: Z ELEVATION:
1 1 -r s
2 2
4
$ 8
10 10
12 zo 12 /Jo
13 13
14 . 14
15 . 15
16 . 16
SUITABLE"FOR SUB—SURFACE SEWAGE: LEACHING FIELD LEACHING PITS
LEACHING TRENCHES ✓
UNSUITABLE FOR SUB—SURFACE SEWAGE. REASONS:
VOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
)RIGINAL: COMPLETED IN ENTIRETY BY P. E. ANp RETURNED TO BOARD OF HEALTH
'OPY: RETAINED BY APPLICANT