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Home My WebLink About0129 REGATTA DRIVE - Health (2) l 1� 3 Z. APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION IC>r'�sc� Wd0h5 VILLAGE `T � �ArrA iy� NO. NY JQ�S C� v'f APPLICANT ADDRESS FEE i,- t.- TELEPHONE NO. '?7l-�0� (Non-reftindabl ENGINEER TELEPHONE N0 •78-9/3l DATE.;'-S CHEDULED �- 22��9qSa f�.l (Applicant' s signature) i1SSi;SSOft'S�b111P�& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s. . . . . . . . . . . . '. . . . . o . . . . o'r No: SOIL LOG SUB-DIVISION`ANAt4E [S(F3 VVQODS DATE EXPANSION ARLA: : YES ✓.:NO TIMEAge- T019N STATER ✓PRIVATE WELL Y� C- ENGINEER:'R, ' �A0,2 n BOA.R.D OF HEAL? .EXCAVATOR SKETCH: (Street name etc., ,dimensions .of lot, exact location oftest holes and percolation tests, locate wetlands in proximit NOTES : y to test holes) • A` PERCOLATION RATE: TEST HOLE NO: ELEVATION: - __. 1 TEST HOLE NO: ELEVATICN: 2 F- 4NIA +S� 1 3 2 2 4 M ot> 3 5 7Avl. 6 g 7 • 9 B ' l p � 9 10 12 11 , S 13 12 14 • 13 15 14 .16 15 , % SUITABLE FOR SUB-SURFACE SEWAGE: LEACHINGIF11. !FLEA G PITS IN I1- LEACHING TREN,Cff UNSUITABLE FOR ;SUB-SURFACE SEWAGE, REASONS: NOTE : ENG•INE2RING PLANS MUST SHOW NUMBER. ASSIGNED ON PERC TEST APPLICATION ' -ORIGINILL': CO14PLETED IN ENTIRETY P . R. AMn TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT RNED