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HomeMy WebLinkAbout0051 REGATTA DRIVE - Health (2) asa JoS � �x o�- APPLICATION FOR' PERCOLATION TEST AND OBSERVATION PITS Y II ••� ,�L/ LOCATION ! SAIL!✓. '�SLP• V oo e vrm rx i'IT N O � V � ILLAGE �YA-tdW(,S C� . VtL A DATE Z `�- APPLICANT . . �VJlAlkl•. �, IuC �� � VADDRESS FEE ' TELEPHONE NO. `T-/0(�0 (Non :reft:ndable ENGINEER ' ( Vff TELEPHONE N0. DATE,`•'`SCH//EDULED •� .� • �6 �� Z 9 (APPlicant' s signature) ASSESSOR'S MAP,6 LOT NU: .�. . . �./.�. . d . . . . . . . . o s. . . . . . . . . . . . '. . o. . o ... SOIL LOG SUB-DIVISION `NAME l5(g VVQDV . DATE D PANSION AREA: ..YES ✓ NO ., 4l� G ENGINEER:7�' TOWN. W1�TER ✓PRIVATE `WELL_r �� — -� OF ` EXCADVATORH L7 SKETCH. (Street name, etc. ,dimensions%of- lot, exact;°location of" est holes and .' percolation - tests, locate wetlands in Proximity to test holes) NOTES: r PERCOLATION RATE: : '-1 2 Lar s 'VEST., HOLE N0: ., V ELEVATION: �.... 1 TEST HOLE NO ELEVATION: 2 s�"+3Sc�t 3 2 4 4 3 7. 6 8 7 Ji 10 � 10 12 ' 13. 12 13 �•'�� 14 " " 1 15 4 • 15 16 ' SUITABLE'"FOR .SUB-SURFACE SEWAGE: LEACHINGIFIELD LEACHING TREN.CH7 E✓ PITS UNSUITABLE .FOR SUB-SURFACE SEWAGE. REASONS: P1OTE: ENG,IN ---------------- EE�RI.NG PLANS 14UST SHOW NUMBER- ASSIGNED .ON PERC TEST APPLICATION ORIGINAL': .- COMPLETED IN ENTIRETY P . COPY: RETAINED BY APPLICANT RNED TO BOARD OF HEALTH