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HomeMy WebLinkAbout0020 CRESTVIEW CIRCLE - Health (2) cis 04-) f ORz 3z APL'LICATION FOR PERCOLATION TEST AND OBSERVATION PITS .LOCATION _ ' N O VILLAGE �YAtJ{JlS CElJ �2�/tl. DATE �,��'•� APPLICANT_ ys�p��VJU�UJ� Ca �uC ADDRESS - FEEeed"`-Z�> ' TELEPHONE NO. T71-i0t,(0' (Non-reftindabl i ENGINEER ` — TELEPHONE NO. D11TE;`-SCHEDULED `: ''� J , ASSESSOR'S bi1Z . . . . 0000000� I0L "�APPlicant's signature)if • • • • • ; s, . . . . . . . 0 . 0 . . . 0 0 . ; . . . . 1,��/ SOIL LOG SUB-DIVISION NAME oor,S DATE EkPANS ION -AREAL YES ✓,.:NO 4.l3 �- ENGINEER:7�' ' ' TOf9N YIATER`✓PRIVATE" WELL�� � BOARD OF. HEAL7 SKETCH (Street `nama etc. EXCAVATOR: ,dimensions ;of lot, exact location Of - test holes and percolation tests, locate wetlands in proximity to test holes ) A-3 NOTES: : .'c•. ,...h` r '1'.;.. t c - - .pper� ,/�" , '�',��-i. '.. .. , I i ... PERCOLATION .RATE:• ` 1�d ZMiid OLU6a . VEST. HOLE NO: ELEVATION: 1 TE5T HOLE N0: ELEVATION: 2 1 ------- 3 S;r3 4 3 5 Mw, 4 _ 6 AtJ°� 5 7 . .... •. 9 a . 9 10 r i; a<.. � .,a:?• ?'•`r-1 1 ;C'.`.',, n..._. i fk bR^•;,�rt V, `•i 3, '`• „ y� 1. 12 13 12 13 14 14 • .• 15 16 15 ' SUITABLE':'FOR. SUB�SURFACE SEWAGE 16 LEACHING FIELD aECIG PITS. LEACHING TREN.CHES;_✓ UNSUITABLE FOR,SUB-SURFACE SEWAGE. REASONS: 170TE: ;ENG,INEE�RING PLANS MUST SHOW NUMBER: ASSIGNED .ON PERC TEST APPLICAT ORIGINAL; C014PLETED N ENT RE IQN P RETURNED TO BOARD OF HEALTH COPY: ' RETAINED BY APPLICANT