HomeMy WebLinkAbout0484 CRAIGVILLE BEACH ROAD - Health (2) C9 c )j()o
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APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
,OCATION:
IILLA E ."": •% - :�i�,<� �' ._ ',DATE 2
"FEE Z4te-GZ�
�PPLIaNT'
- �'%DDRE TELEPHONE N0. (Nonrefundable
S.`` %¢- C i. / /�fit�.✓i y./>:; _ r,
�'INGINEE ��ri'� �.��' � /yI�C n/ice TELEPHONE N0.
-)ATE P.CHEDULED `S I - 1 S.- ±M 9•:
(Applicant' s signature
AS SE SOR'S bil�i' & �.OT NO:
SOIL LOG
DATE <57 �` t���-� 9;4�
SUB-DIVISION NAME TIME
3XPAN8IO1i:AREA: YES ✓NO _ S.r-i �fi ti� ENGINEER .
COWN'iWATER ARIVATE WELL X / BOARD OF HEALTI
EXCAVATOR
SKETCH:. (Street name;etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes) .
NOTES:
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411
1ERCOLA12< ` RATE:
LEST ROLE `NO: 1 ELEVATION: TEST HOLE NO: ELEVATION:
� .
4
7
..'8 $ tea!
s 9
10 10
12 12
13 13
14 14
15 15
16 EL
16
;UITAgLE''FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS
LEACHING TRENCHES
INSUITABLE;:,FOR SUB-SURFACE SEWAGE. REASONS:
IOTE:;.. ENGINEdRING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
)RIGINAL`:. ::.COMPLETED N ENT RET P
AN ETURNED TO BOARD OF HEALTH
PY:` ; RETAINED BY APPLICANT
Completed by JiL�c1F
}{!Gti GROUND-WATER LEVEL cotihuTA7 t ors
�$¢ c� Lot N o. /
Site Location: Z-:v Pt.•
�►= l��'u = Address: , = s��.cav��c-�. •� �: ..
Dwnec: Address:
Contractor:
Notes:
-asure depth to water table 1�/ �
STEP l Ne 0 ft. /
to nearest 1/1 • . . . . . .. .. .. . ..
date
STEP 2 Using Water-Level Range Zone .
and 11,1 de x We 1 1 Hap locate
si-te and determine: Y- _
A) Appropriate i ndex .we).).. , .. .. . . .. , . ,• .
B) Water-level range zone
STEP 3 Using monthly repo rt"Current
Water Resources Conditions" / ? a
determine current depth to
water level for index well . . .. .. . ./y�
mo yr
• ' Table .of dater-level
STEP � Using .
Ad'us
tments for index well
STEP' 2A , current depth to
j water level .for index well
.-ISTEP 3) , and water-level
i
zone (STEP 2B) determine
water-level adjustment - ...................... .......
STEP 5 Estinate depth to high water
by subtracting the water-
level adjustment (STEP �) •• • /
from measured depth to water
.....
level at site (STEP I) .... .. '.
.. .
_ - • Figure n j:t',��`�
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