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HomeMy WebLinkAbout0037 CRESTVIEW CIRCLE - Health (2) --poll ",IIIIIIcan IIIFIT.......... II"Its 1 0 AS..........IAso It 515 Vol 00", "Yaj pop R mot one city ItIIIItoo Ig9l II1 1 nasal; IIItam wm5we's No too IIOle hNnnfan Wk 1 Vey I,My Wssol' I*IIIv fm&WON M�w vast, T� n T&,Man E it,M ow _q,0 0 not it, yV400,11 a V C Aso &j&X:'lion 0 quo!of III"A POO 1 1 I K . `» ' APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION J -AILt; �SLBUQPS �'L Ott -uZzC6 N 0. _VILLAGE �YAtJtJ�S: C Vtt_ 1PPLICANT DATE /�- 1- �4St't��WabI1JC; Ca, (fJC'ADDRESS FEE 1 : ' TELEPHONE NO. `7-71-lot�o (Non-refundabl ENGINEER W Y5 C_ TELEPHONE N0. L�•70-7/31 DATE SCHEDULED . g / 9 �1 z'``"` (� 3 (APPlicant' s signature) �1ASSLSSOR'S�bil�P�& ° - ° ' " • . . • • • . . oT Ho: �. . . . . . . . . . . . . . . . . . . o do • • • • • • • o • o • • • o o • o • • • • ' `•� ` SOIL LOG SUB'' DIVISION NAidE �Ak� [Sus Qpps 'DATE-- A TIME.1/% EVANSION AREA: ,�,Y,ES %N0 TOWN WATER"✓PRIVATE WELL Y ENGINEER:'?Q* ' 40F�y BOARD OF HEAL? SKE ' , •. ., ���E�1-C�. .EXCAVATOR TCH:` (Street I•namfe;etc. ,dimensions-.of lot, exact; location of ' test' • percolation ,.tests, locate wetlands in holes and s NOTES: to test holes) Q�, I f \ �C9 C; �C 774 - ,, , � � __ e��l •Spy-e,� _ � . PERCOLATION .RATE: 1Mti'J fin-Uup% 'VEST, HOLE NO:-: ' ELEVATION: 1 TEST HOLE N0: ELEVATION: 2 A.4,4 1 . Sv ��cd 2 4 SAW 4 .. ' 6 • , ls��� 5 , 6 7 ' 8 a • 9 10 Saw 0 12 V• _ 13 12 . lq . ` . / . 13 15 14 15 SU'ITABLE`.FOR ,SUB-SURFACE SEWAGE: . LEACHINGIFIELD EAC�iING PITS` ` LEACHING TREN:CHES� ✓ UNSUZTABLE . FOR 'SUB-SURFACE SEF�AGE• REASONS: NOTE:' .;EN- .1 E RING PLANS MUST SHOW NUMBER• ASSIGNED .ON PERC TES T APPLICATION ORIGINAL': . COt4PLETED N ENT RE p COPY RETAINED BY APPLICANT AND RNED : O BOARD OF- HEALTH