HomeMy WebLinkAbout0006 OLD FARM ROAD - Health (3) _ ._ _ - - -- c��lZl - ---- -- ---
AVl'L1CA'1'lUN NUIZ PERCULA'1'I0N `1'LS`1' AND OBSERVATION PITS
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LOCATION c C� oGt��► {K�40.
VILLAGE _ � DATE_
AD APPLICANT_ ��•, '�A,�,<,� , , � FEE /dj�
DRESS_ � TELEPHONE NO. Non-refundable
ENGINEER y � _TELEPHONE NO.�kD
DATE SCHEDULED
(Applicant's signature
ASSB3S0*AVb1AP*&0LOTN0� SOIL
000 0�-aa � •LOG000 00
0
00a0000a000000000000a00 400
SUB-DIVISION NAME . DATE
EXPANSION AREA: YES N0 _ ��
ENGINEER .
TOWN WATERRIVATE WELL BOARD OF HEALTH
EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES:
,Z3.O 0 1
Low A �
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PERCOLATION RATE:
TEST HOLE NO: ELEVATION: `7.\ TEST HOLE N0: ELEVATION: 4��o
1 +
2 2 s l�
3 FiN 5 _ .30„ 3 1
4 4
5 - 5
6 6
7 7
8 8 •
Sfs �l
9 9
10 �D+0 10
11 �o �
12
11 �o 1 �
12 Wt
13 13
14 14
15 15
16 16
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LE,HING PITS
LEACHING TRENCHES
UNSUITABLE FOR SU
B-SURFACE SEWAGE. REASONS:
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY BY P E_ ANn uFTtrRNED TO BOARD OF HEALTH
COPY: RETAINED BY APPLICANT