HomeMy WebLinkAbout0009 CRESTVIEW CIRCLE - Health (2) � f
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• ' ,
=APPLICATION FOR PERCOLATION TEST AND QBeERVATION PITS
LOCATION
t � 41Ct✓• JSCP. BOPS C4A` A- G2e�5��/)L
VILLAGE; rtYAtJWLS C� N0.
V t l.lrs a-° ��•�
APPLICANT DATE
StbC�Ulcoiga C. �uC
iADDRESS FEE sue ,
' TELEPHONE NO. `7�71-10� (Non-reftirfdabl
ENGINEER Oyer L TELEPHONE N0. LFZg'9/3I
DATE SCHEDULED 'r `
Applicant' s signature)
• o 0 0 0 o s o .` e n e o a
nSSESSOR'S biAP LOT No: e e • • o 0 0 . o 0 0 . . . . . e . . . a . . . . . . . . e o do . . . . . . . o e.e . v . . . .
SOIL LOG
SUB'-DIVISION NAidE �$Lg Yy/ODDS
DATE �g ' TIt1E ,�=�t-�EXPANSION "AREA 'YES ✓:NO
TO{4N. WATER ✓PRIVATE WELL tr G
Y ENGINEER:
BOARD OF HEAL?
SKETCH: EXCAVATOR
(Street name etc. dimensions .of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
a NOTES:
• �P�a SP�-e�
l°Za 4A rnko
• •.., /per
1.38 M,dl-
PERCOLATION RATE: I" `mim 6iL
'VEST HOLE NO: ,, 1 ELEVATION:
r 1 TEST HOLENO• ELEVATION:
2. l 1
3
id
Pia
2
4
3
5 4
5
' 6
7
9 � 8
_10 9
i lllrt... 10
12
13 12
t: 14 13
14
y - • •;�. 15 15
5UITABLE `FOR .SUB--SURFACE SEWAGE: . LEACHINGIFIELD LEA
LEACHING TREN:CHE§ G ITS
'UNSUITABLE FOR. SUB-SURFACE SEWAGE. REASONS:
NOTE ENG•INEE�RING PLANS MUST SHOW NU14BER• ASSIGNED -ON PERC TEST APPLICAT
ORIGINAL': C614PLETED N ENTIRETY ION
P RNE
COPY: RETAINED BY APPLICANT D TO BOARD OF HEALTH