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HomeMy WebLinkAbout1041 OLD STAGE ROAD - Health (3) C��v i�� . 1' --- - - ---- - A/ LOCATION (O/(A� o ST Czas 6t NO. VILLAGES �TfY y� � DATE APPLICANT 7/, /so ti FEE ,ADDRESS ' TELEPHONE NO. (Non-refundable 1 . ENGINEER � 2s/�.�,r� E.. TELEPHONE NO. -1/77 V,Z- ? z DATE SCHEDULED (Applicant's signature) ASSBSSOR'S*AA* P& LOT NO.-- nc•_P 11?.PG, 1 SOIL•LOG• • • • •' .Q1� • . • • • • ;�• • • SUB-DIVISION NAME DATE_ = TIME EXPANSION AREA: YES ✓NO ENGINEER:*R " TOWN WATERPRIVATE WELL Ewe BOARD OF HEALTH 2 s �- n a t-�• EXCAVATOR SKETCH: (Street namesetc. ,dimensions of lot,. exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) • NOTES: w 1 PERCOLATION RATE: 'y TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 2 2 3 L o k�, 4 CJrk..�ll� SQ ..o� C 4 _ �r4�sl�Y S4�P 5 i�q� c�bb�-P !o v C ,�hl.�f C� 7 7 � � .. 2 10 Sa, 10 11 11 12 12 13 • 13 14 14 15 15 ' 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD C,LEACHING PITS' LEACHING TRENCHES ci UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED -ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P._E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT t � WWI SSACHUSETTS " F) fps.84 II 180 h•175.J! 4.r79'dG e 14Q /00 • ��.e - M • 4 Sr.38 OHO 'J •,�♦e - ° lA4 • 1IIa � � .../Oe is E .•° yE 4` / ash ` V � •J > � t ° as. °^^ vi �• , ,a,° O 1'� • 'jai / 10 3sor goo % �l .J°♦_t 161 Ad 10 It (10 Aso • / /GS 1 / t9 / i es aan� io1 /6� •° s ' �a Ait .�r�.. /- ; 4a r1.54j, .a a .313 of r E. S ♦All 0 6 • s 1 I © � •47ac '�4� � Doti si �y° ` "tQ 354C ° 49 u q' 8 °�pPI''GQst �� ♦` 4AC./ / A� . .?14 e O 153 Y �~ 004 00 Z15 u )Z I At trr. s tiF °° v 11t lei 29AV 49 ® 3s♦c a �o >9 1.09AC. z rRitiq s 41 Ac a w arc 3g u to4p� ,v 'O1 v ° 'O �♦O �3t C I ISAG o 3q,� 8� 3q 1 1.09AC ` 4C V 1Q4 ° Iaa ,z8 0 ° ZSmc a9tt ® 96 / V ° � 3 eo,