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HomeMy WebLinkAbout0042 NIGHTINGALE LANE - Health (2) n qqal e !.wile � S r ._-.. ._-- ii A 'PLICA'1'lUiv FUR PERCOLA'1110N 'PEST AND OBSERVATION PITS v LOCATION �' 2 tir 4 �e 7 q! •Z P VILLAGE NO. �7 <� APPLICANT �. DATE ADDRESS / 4� -fin _ PEE �_6 ,S-:( �oo TELEPHONE NO. Non-refundable ENGINEER Lo _� c� .S� p� C� TELEPH NE NO. DATE SCHEDULED scant,s signature ... . . . O . . . . .. so 0 0 0 00 0 ** a * * * 0 # of * 0 a * * * as as* 0 * a * 0 0 to 6 . 3i/ o gg L <a7- SOIL Loa SUB-DIVI8ION NAME . DATE, /-- ----- TIME EXPANSION AREA= YES_ TOWN WATER/PRIVATE WELL 'S aNaINEER !� ��- S9 �Agg HOARD 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: �® A -4. G,A ' •,` �,.� `� �'` s�c,r P r c -S 10 Co.It ' v C PERCOLATION RATE: L• TEST HOLE NO: ELEVATION: T ST HOLE NO 1 Tb - v L� 1 ELEVATION. 2 3 2 . 3 5 4 6 © m./'S e SQna/ 5 . 9r 7 ' 8 8 9 9' 46 l u 12 12 13 13 14 14 15 15 16 SUITABLE FOR SUB-SURFACE SEWAGE: I LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETEDLETY BY P COPY: RETAINED BY APPLICANT 0 BOARD OF 11EALT11