HomeMy WebLinkAbout0096 REGATTA DRIVE - Health (2) I v
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APPLICATION FOR' PERGOLA
ION TEST AND OBSERVATION PITS
LOC11T202t 'rkK LSCc�. VVdOPS `'�T' ,j2: && FL
VILLAGE --
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APPLICANT DATE .�
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iADDRESS FEE
' TELEPHONE NO. ' _P-/0�(o (Non-refUndabl
ENGINEER Oyer TELEPHONE N0. 'L1'7.8-9/3/
DATE,`SCHEDULED /,®�
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Z� q QS (Applicant s signature)
ASSESSOR'S°2fAP�& L°o"rNU: ° ° ' ' ' ° ° ° • ° °
SOIL LOG
SUB-DIVISION `NAl E l$(g oppS DATE �� r
EXPANS IOtj ARL`A: . YES ✓NO � ,, �� TIME Ao�
`"'lam ��-- ENGINEER:'��' '
TOWN WATER ✓PRIVATE WELL — �-y
BOARD OF HEAL?
SKETCH: (Street name etc° EXCAVATOR
,dimensions ;of lot, exact location of test holes and
percolation tests, locate wetlands in
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NOT5�ximity to hest holes )
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PERCOLATION RATE: J",A1 2.i4,14 02 6r<S'
TEST HOLE_ NO:: ELEVATION:
1 I TE5T HOLE N0: ELEVATION:
3 2
3 4
' /V 5 SM�_Jq 4
5
8 Ga.Oi/ 7
9 B
.1010
g
11, ry s4w
. 12 •• .
13 w, 12
14 . 13
15 14
16 15 '
SUITABLE FOR SUB-SURFACE SEWAGE: . . LEACHINGI FIELD
_ LEA I/
LEACHING TREN:CHE§ ING PITS
UNSUITABLE FOR `SUB-SURFACE SEWAGE. REASONS:
2IOTE:ORIGINAL':EtI.1...- �- PLANS 24UST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION
ORIGINAL': C014PLETED N ENT RE p
COPY: RETAINED BY APPLICANT RNED TO BOARD OF HEALTH