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HomeMy WebLinkAbout0130 REGATTA DRIVE - Health (2) w. �Z- APP ERCO ATION TEST AND 'OBSERVATION PITS / LOCATION M '�-�41Cfr �st�. 170P5 31 rr4• _Djz1vu _ �?3 VILLAGE NO. 7 j •NY�tJWt-S C V't�..l.Fs D /�- ,�j�9✓� APPLICANT_�/SIp��VllbI1JC; � hie ATE %ADDRESS FEE / 2?•5�e 1 ' TELEPHONE NO. •7"7)-10t/o (Non-refundabl ENGINEER TELEPHONE NO. ,4.7 -9/3/ DATE"SCHEDUL (APPli n si . . . . . . . •ASSESSOR S bS�P,& LO'T NU: . . • �"• y•I.O•I• • • • . . . . . . . , ;,, . . . . . . . ,9 o ature) 0 0 • O fi SOIL LOG / SUB--DIVISION NAME Ism WCODS ' DATE / `" EXPANSION ARL`A: ..YES ✓;NO - -�, TIt1E .�-- " - y _ C- ENGINEER;'R' TOWN. YIATE ✓PRIVATE 'WELL` d`r BOARD OF HEAL? �filSE_ni— EXCAVATOR SKETCH: (Str`eet .name, etc. ,dimensions.;of lot, exact location of test holes a percolation . tests, locate wetlands in proximity to test holes) nd NOTES: PERCOLATION RATE: i `.PEST HOLE NO:,,' ELEVATION: 1 TEST HOLE N0: ELEVATION: 2 L+5 1 3 2 Moo 4 6 S"o 5 --- 7 &AAV 6 8 k� 7 9 s�+•»y�n•W• a 10 9 UcYltti+.+r 10 ..... "..._.. _. .. �_._. _. . .. ...-. l2 Swan.. ll` . 13 12 14 • 13 15 14 .16 15 1 SUITABLE TOR SUB-SURFACE SEWAGE: LEACHING FIELDT LEAC G PITS v LEACHING TREN:CHEbT UNSUITABLE FOR,'SUB-SURFACE SEWAGE. REASONS- NOTE: ';ENG,INE2RING PLANS MUST SHOW NUMBER. ASSIGNED -ON PERC TEST APPLICATI N ORIGINAL': COMPLETED- IN ENTIRETY p COPY RETAINED BY APPLICANT RNED O BOARD OF : HEALTH`