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HomeMy WebLinkAbout0009 DACEY DRIVE - Health DctcN H-vicAvi Pi 3z "4 APPLICATION FOR PER CO`: CATION EST AND OBSERVATION PITS LOCATION � VILLAGE APPLICANT DATE ��'I�-^•�� _'�/S�`�VdlblklCt CA (IJC iADDRESS ` FEE Gy � . ., 1 ' TELEPHONE NO. '?7/-low (Non-retUndabli ENGINEER � TELEPHONE N0. L�Zg-9/31 D11TE SCH/EDULED .:' �1 � � ,� � 4(Applicant�s si ,AS SLSSOR'S�1UP0 0 OT NOc ` ... . ° ° °�- ' " •�•I -- . • • • • . . . . . . . , , ,, . . . . . . . ,9nature) SOIL LOG / SUB--DIVISION NAtdE ISLE VVOOV DATE !� �� s' E !'ANSION ARL;A; ✓ NO . . TIrJE YES .. TOWN WATER ✓PRIVATE WELL � ytr C' ENGINEER:'R' ' BOARD OF HEAL7 SKETCH: (Street name etc. EXCAVATOR ,dimocate w'. tl lot, exact location of".,test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: • \ 60 t .35 . C'ERCOLIITION .RATE: Ii� LA ik p-i- f TEST HOLE N0:'" ELEVATION: TEST HOLE NO• ELEVATION! 2 2 3 3 � 4 5 4 6 � 5 S 6 8 7 • 9 9 . 10 12 13 12 lq . 13 15 14 .16 15 ' SUITABLE FOR. SUB-SURFACE SEWAGE: LEACHING IFIELD LEA ING PITS LEACHING T UNSUITABLE FOR `-SUB-SURFACE SEWAGE. REASONS; N'CHES�_ .> , NOTE : ENG,INEE�RING PLANS 14UST SHOW NUMBER- ASSIGNED .ON PE ORIGINAL°• RC TEST APPLICATION COt4PLETED N ENTIRETY ICATION COPY: RETAINED BY APPLICANT P , RNED TO-BOARD OF HEALTH