HomeMy WebLinkAbout0050 REGATTA DRIVE - Health (2) In"
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APPLICATION FOR PERCOLATION TEST AND OBSERVATION, PITS
LOCATION
.. 1-AK.�`�SLP. '�/VdpP S - �-.c�"r` �2 ��p�A �2. • ,
VILLAGE_ H`{AtJIJtS CE NOZ2
�VI LLB
11i'PLICANT` ySfDC�VIIDikI� Co �uC• FETE��' ��
'ADDRESS E e
TELEPHONE NO. T71-l0vfo (Non-refti- n dl(
ENGINEER � ter c-
TELEPHONE N0. L�Zg-9/3l
DATE,;-SCHEDULED
22' �1 253 9 (Applicants signature ASSfiSSOR'S�bil�P�& LOT NU: • ` . . . " "�o " -• • •i. . .���. . . . . . .
O . . . '. . . O . O
SOIL LOGSUB-DIVISION NAME
DATE d TIME EXPANSION AREA: . YES '✓,NO .
<_ TOWN WATER ✓PRIVATE ,
WELL Y ENGINEER:')��'
BOARD OF HEAL?
DI'1. 1S .Z�!, r ;:EXCAVATOR
SKETCH: (Street name, etc. ,dimensions .of lot, exact location of test hot
percolation , ests, locate wetlands in es and
g proximity to test holes)
• NOTES :
PERCOLATION RATE:
`VEST HOLE NO: ELEVATION:
TEST HOLE NO: ELEVATION.-
3 2
4 3
5
6 S�O. 4 _
,7 6
CFR�RJ��� 7
8 8
10 �; 9
10
12
1
3
• 12
14 • 13
15 14
•16
• 15
SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHINGIFIELD LE
LEACHING TREN;CHE r NOG
PITS`_
'UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
NOTE: .ENG,INEE�RING PLANS 14UST SHOW NUMBER- ASSIGNED .ON PERC T.EST APPLICATI
ORIGINAL': COMPLETED IN ENT RE ON
P RNED O BOARD OF HEA
COPY: RETAINED BY APPLICANT LTH