HomeMy WebLinkAbout0093 REGATTA DRIVE - Health (2) r9r9 r � �
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APPLICATION FOR PERCOLA TIONTE ST AND OBSERVATION PITS "
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LOCATION_ �-�{Lt✓. �SC�. WODDS i 11c4kTrA_ G1�i �IF3� �}
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VILLAGE_ ��'t.YAdJ 6�lS C EIJTL-- yl l..l.�
SID eulLpl1JC{ C'. for DATE w
APPLICANT
'\ADDRESS FEE_/D�.
1 1 TELEPHONE NO. `771-iO4 (Non—refUndabl
ENGINEER Yi, I L TELEPHONE N0. L�?,8"9�31
D11TE`'SCHEDULED } o J �` .9
y k' 23 `� oZ( �S � (� Plicant 1 s sign ....................
ature
O . . C CC . C q e V e . C C Y C . C Y C . . . . . . V . J. C . . . . . .,C C .V . . . . . . . O . V . .. . Y C . C
ASSbSSOR'S biApo or Nv:
1,�� SOIL LOG . .
SUB-DIVISION:NAJJE l$( Ytl/opps DATE '°' 1
E.tPANSION- AREA: .;..YES ✓;NO . . TIME /G,P�
TOWN WATER ✓PRIVATE WELL - yD ENGINEER:*?Q. • •
BOARD OF HEAL?
SKETCH EXCAVATOR
(Street °"name,etc. ,dimensions ,of lot, exact' lo'Cation of test" hole"s an
percolation . tests, locate wetlands in d
proximity to test holes)
NOTES :
15o lov
41
1.k0
6,®VtZp � _
AMA-
PERCOLATION RATE 114 okj 0a L.Cs '
TEST HOLE NO:—
..... ELEVATION:
1 TEST HOLE NO: ELEVATION:
2
3 Meg> 2
4 Sa 3
4
6 5
7 Me6 6
8 S440. 7
9
10 L41 9
eft 10
12
l3 12
14 13
15 14
,l6 ,
15 ,
' SUITABLE','FOR SUB-=SURFACE SEWAGE: 16
LEACHING FIELD_ LEA NG PITS
LEACHING TREN:CHE§
UNSUITABLE .FOR 'SUB-SURFACE SEWAGE. REASONS:
MOTE: ;ENG•INEE�RING PLANS 14UST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION
ORIGINAL': C014PLETED IN ENTIRETY p
COPY: RETAINED BY APPLICANT RNED TO BOARD OF HEALTH