HomeMy WebLinkAbout0103 REGATTA DRIVE - Health (2) you Nanyli�
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-`APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION IC �SCP dOPS '4o 2e4 A-rT- `b2•
N O.
VILLAGE N Y�tJ tJ�S C -y`V t l.trE
APPLICANT DATE�•�-� p
\ADDRESS FEE / ice
' TELEPHONE N0. `171-10t� (Non-reftindabl
(ENGINEER W --
L _TELEPHONE N.O. L�Zg_9/31
DATE,�S CHEDULED • r�
252��1 253 9 ^\JJ ��� (Applicantis signature)
0 . O . 0 O . . .1 O . . . . . . . . . . O . O Y . .'V .
ASSESSOR'S ?•iAP � LOT No
SOIL LOG
SUB-DIVISION NA14E l$Lg VVQpps ' DATE S�7 /y
EXPANSION AREA TIME
YES ✓.:NO
TOWN PLATER ✓PRIVATE WELL Y ENGINEER:*R*
BOARD OF HEAL?
SKETCH: (Street name etc. EXCAVATOR..
,dimensions tl not, exact location of test holes and
percolation bests, locate wetlands in
a proximity to test holes)
• NOTES:
D•31 �G r
If
7o�p A-VT %bQ
I?ERCOLATION RATE: t 14 O,Z L�IlS `
'VEST HOLE NO: ELEVATION:
1 TEST HOLE NO• ELEVATION:
2 l�,Awi 1
3 2
4
3
5 AA�
6 + _
644eL 5
8 tics 7
9 Said a
:10 9
10
12
13 12
. 13
15 14
16 15
' SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHINGIFIELD_ , LEA LNG
LEACHING TREN.CHE PITS
UNSUITABLE FOR 'SUB-SURFACE SEWAGE. REASONS.
NOTE : ENG•INE2RING PLANS 2dUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION
ORIGINAL': 'CO1.1PLETED TN ENT RCTv my p
COPY:. RETAINED BY APPLICANT RNED O BOARD OF HEALTH