HomeMy WebLinkAbout0040 WHITE PINE LANE - Health (3) �0 White fine Vie,
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AI'1'L.LCA.IIUN UJl PERCOLATION .1L51 AIqll OBSERVATIOdPITS
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LOCATION L67' w ls'. //>TZ 1P/.t/e �/a'�/� NO. IP-9477
VILLAGE. C�'�/7��?�/iG6 DATL ���
APPLICANT CWX7AeGE3' FEE_
ADDRESS leJVA/T�"�/n/E�Pve C�/T�11i4GGs TELEPHONE N0. (Non-re�undoUle�
ENGINEER eY. e6-�ZZLZ TELEPHONE NO.AZ-2Z66
DATE SCHEDULED 1-1412CII
(Applicant' s signature)
. . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AS S LSSOR'S MAP d LOT NO: . . . .
/yj4p /8.7' �,eG� 37 SOIL LOG
SUB-DIVISION NAME L�+vp /L7'��/��/ Z7Bo/C DATE /�'l/�i'zU�/ 27 /yy.5' TIME /v:oo .9��y
�— -- --
EXPANSION AREA: YES ✓ NO &Z>1�// ENGINEER
TOWN WATER ✓PRIVATE WELL G,� �e e ��'� BOARD OF HEALTH
EXCAVATOR
SKETCH: (Street name, etc. ,dimensions of lot, exact: location of test- holes and
percolation ion tests.-, locate wetlands .in proximity to teS t. holes )
NOTES :
3
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O
0
0
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W � i or'75 00;
' .}Crss,DOC
36/ p6 In Oo
2 N J r7
n / P m (�
5 5J U
r
u _Q S S 40 E
WHITE PINE LANE
4O FT. �.lCE�
'3 JJ 5C -3p ♦�' h0
e �� 44.57 •.'��.. 3> Jp i �•
40.
PERCOLATION RATE:
TEST HOLE NO: ��/ ELEVATION: Z .Zo TEST BOLE NO: ELEVA`l'ION: .Z,Z.00 .
236
C-Z Zo.Zv
4 4
ACC c. 5! 6 LZ. 0 6
I7 7
8
8• S���� 9
10 10 .
/3L=11 11
/Z.
12 Ez, Zo
12
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 :
NOTE: ENGINEERING PLANS MUST SHOW NUMBER .ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY DY- P . r . AND JIETURNED TO BOARD OF HEALTH
COPY: RETAINED BY APPLICANT