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HomeMy WebLinkAbout0021 REGATTA DRIVE - Health (2) ap m I'S APPLICATION FOR` PERCOLATION ST AND OBSERVATION PITS LOCATION '�" sc�. 'titln�ps VILLAGE 1 NIA440LS G' I�� vt t_ LFi DATE 11PPLICIINT _ ySTDC�VII�IIJ. Ct�. �{JC 'ADDRESS FEE V � 1 - ' TELEPHONE NO. 7/-10�(O (Non-reftindable EIJGINEER CVerL TELEPHONE N0. L�z�-9/3I DATE SCHEDULED . . . . . . . 1. . . . . . . . . • • . . 000000• 0 0 0 d�.�n: �� (A PPlicant s signature) •ASSESSOR'S,biAP,6� OT NU: • • �• • • •�. . . . , , s• , 1,�� SOIL LOG SUB.-DIVISION; NAIdE �SLg wi:ODS DATE EkPANS ION`ARI;A "YES ✓.;NO l3 G.TO ENGINEER:"RTOWN. YtATER ✓PRIVATE ..'WELL �� � --BOARD OF HEAL? ---------------------- " �,, x: EXCAVATOR. SiCDTCH: .:(Street rname etc. ,dime'nsions ,of lot, exact location of'!`test 'holes and •, percolation tests, locate wetlands in proximity to test holes) NOTES: rq 0,41 r .� oo ►.'ERCOLATION ,RATE: (� 'PEST. HOLE ELEVATION: 1 TEST HOLE_ N0: ELEVATION: 2E (-e3 A,n,� 1 ------ S;NsoIL 2 3 4 3 5 , 4 _ 6 5 7 8 . 7 F3 10 , 1 12 13 12 • 13 14 . � 14 15 ` 15 .16 ° SUITABLE FOR;SUB--SURFACE SEWAGE: LEACHINGIFIELD LEA ING / PITS y LEACHING TREN:CHES�� _ UNSUITABLE FOR.'SU$-SURFACE SEI- AGE. REASONS: NOTE: . . -.ENqINE2RING' PLANS MUST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION ORIGINAL.:, C014PLETED IN ENTIRETY P . E. COPY:. RETAINED BY APPLICANT RNED O BOARD OF HEALTH