HomeMy WebLinkAbout0067 REGATTA DRIVE - Health (2) C��i i� a� s��� �ar�n�'S ��,
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APPLICATION 'FOR PER TEST AND� OBSERVATION PITS
. LOCATION ' SCE r �21i/�
r N o•
VILLAGE
1PPLICANT DATE
�Vlawi • C 10C
ADDRESS FEE gow
TELEPHONE NO. •7_71-00o (Non-reftindabl
ENGINDER � '� (, �
DATE;:SCHEDULED ' AV,
TELEPHONE N0. L�?6-9/31
vwo� (App icant' s signature)
0 0 0 0 0 0 •'L one-o e • o o • • • o 0 0 • o 0 0 • • • • • • • • o • • • • • • • • o o d o • • • • • • • e • o • •• • o o ) • • • •
�'ssLssoR's biAP & LOT No;
SOIL LOG
SUB-DIVISION', NAME
�S(f3 YlUoppS DATE
E?�PANSION ,AREA: .YES ✓:Np I TI1SE��,;
TOWN..WATER'✓PRIVATE' WELL a,p Y ENGINEER:'�Q' '
I BOARD OF HEAL?
SKETCH• (Street ,;,. �5�� ,.. ,EXCAVATOR..
"name,etc. ,dimensions , of lot; ` exact `location of tesµt holes -:and
percolation tests, locate wetlands in roxi P proximity
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NOTES: Y o test holes)
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PERCOLATION RATE: ' G�J �- AA 1)4 OIL J_�r
`PEST HOLE NO: ELEVATION:
1 TEST HOLE Nr0I: ELEVATION:
2
1 3 '�iGT 3
g S
4
5 �3 Siil� 6
7.
10
g - �.Gri�..v g �•t� ..
1'•.�i.,, ._ c".x. - 5 � 3.,.r+anao-.. u ....w.fi. :'l1_. ...,.-a,.� ..`r �-V'�V� ..staff�- .,_ta'�3 .:r-,..+�. .:�' h
2
13. 12
14 t • 13
• 14
•16
SUITABLE FOR SUB-SURFACE SEWAGE: . . LEACHING�FIELD LEA Llo
" LEACHING TREN:CHE ING PITS__
UNSUITABLE FOR SUB`-SURFACE` SEWAGE. REASONS:
.
110TE:': ENGINEERING`PLANS 'MUST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATIfl=ORIGINAL: COt4PLETED' N ENT RE N
P RNED TO BOARD OF HEALTH
COPY:`. RETAINED BY APPLICANT
_
s
LOtCATiON, j SEWAGE PERMIT NO.
VILLAGE '-
IN/STyA�ILE/R'S N,f/A1,4Ap'E & ADDRESS
B U 11 D E R OR OW`N1W
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /° _ -
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