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HomeMy WebLinkAbout0030 CRESTVIEW CIRCLE - Health (2) Sa/oEI ,�� , APPLICATION FOR' PERCOLATION TEST AND OBSERVATION PITS LOCATION } ' 41 .lsc� '�i(/aop5 Lr 43 4 2 t 11LCT N O.6 VILLAGE E-lYJia�S C �ltl. s APPLICANT' -•� " / DATE ' . •�, �Si'bt✓�Vll�Ik1G �. I IJC / i'ADDRESS FEE ° TELEPHONE N0. `771-ioto(o (Non-reftindabl ENGINEERerr , TELEPH y ONE N0 L� .DATE.:'5CHEDULED oZ � ] 2pplicant� s signature) �'ss�asoR1°s`ri�LP` Lor Ho: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . . . . . o . . . . ` 1,��/ SOIL LOG SUB'7DIVISION NA14E _*�' ISC.� 1[�/oppS DATE ��•` �— �'`�j ' EXPANSION."ARIA* : YES %.:NOS_ TIME _ - tr TOWN WATER ✓PRIVATE `WELL r Y ENGINEER:')Q' BOARD •D�liScBt.t� OF HEAL? SKETCH: EXCAVATOR (Street name etc. dimensions,,of lot, exact location of test holes ' a • percolation -.tests, locate wetlands in and proximity to test holes ) NOTES: 1. � SPA • PIZ, „ 50 PERCOLATION RATE �(idJII1J t�rL �z TEST. HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: .2 3 -- 2 T►2 w g- op 4 7lLAi� 7i • 8 B , 9 10 7 9 �� 10 (:. E.•-i.S .k .,, .�1t {'1 s ,e_3<.s _. icy fir, fv ,.+s 12 13 12 14 7 ' .. • 13 ,15 14 ' •16 , . • 15 SUITABLE FOR SUBSURFACE SEWAGE: 1F / LEACHING FIELD Lit! PITS`_✓ LEACHING TREN:CHE ✓�✓ UNSUITABLE FOR ;SUB-SURFACE SEWAGE. REASONS: ;ENGINEERING PLANS 14UST SHOW NUMBER- ASSIGNED -ON PERC TEST APPLICATION ORIGINAL':. •COMPLETED IN ENTIRETY p COPY: RETAINED BY APPLICANT AND RETURNED O BOARD OF HEALTH } _