HomeMy WebLinkAbout0025 DACEY DRIVE - Health (2) a(V(2,, N CAV)n i�
/C
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION LA& kS woop
VILLAGE H fA44QLS C
-� �t Ll DATE� //,JP�1PPLICANT 51'DC`�UllAl1J., �, �WO
k'ADDRESS FEE`�-/'
TELEPHONE NO. 1-71-ion (Non-refiindabli
. EIGINEER_ � TELEPHONE N0. [�•zg_c1/31
DATE,`S CH/EDULED �•; �p. -�
ZT 9 :1�0_;�) (App�_icant, . signatuAbS�;SSOR'S IIAP 6: L
SOIL LOGSUB-DIVISION 'NAtIE �S(g Y�/opps DATE
EX,PANS ION AREA: , YES ✓:NO TIME
TOi4N WATER ✓PRIVATE WELL � yO � ENGINEER: '
�r BOARD OF HEAL?
SKETCIJ: ' . ,. EXCAVATOR ,,
(Street name etc dimensions .of lot, exact location o
percolation tests, locate Wetlands in f test boles and
NOTES:
proximity to test holes)
,'.
40
ass Ae-
PERCOLATION RATE:
TEST HOLE NO: ' ELEVATION:
1 TEST HOLE NO:
2 L�� l ELEVATION:
3 2
4 3
6 W d 6
7
8 13
9 DU2�L' di1FA.. M•b g
1p A4e
10
12
13 , .. 12
14 . 13
15 14
16 .
• 15 '
' SUITABLE 'FOR. SUB-SURFACE SEWAGE: LEACHINGIFIELD
LEACHING TREN:CHEb EA NG 'PITS`_
UNSUITABLE FOR'`SUB-SURFACE SEWAGE. REASONS.
NOTE : ENG_INEE�RING PLANS MUST . SHOW NU14BER• ASSIGNED .ON PERC TEST APPLICA ORIGINAL': C014PLETED N ENT RE TION
COPY: RETAINED BY APPLICANT RNED O BOARD OF HEALTH