HomeMy WebLinkAbout1979-9-4 - 230 Burnham Street - Percolation TestsAPPLICATION FOR SITE IiM STIGATION AND PERCOLATION TEST
Tnfvrmation to be supplied by A licant:
Name and Address of Applicant
Location of Property
Name and Address of Owner
Site of Lot
Address, Street, Lot Number
Type of Water Supply
Signature of Applicant
Information to be supplied by Health Department:
Description of Property
Soil.Conditions:
Observation Pit #1
t
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i
40 to
.Q
to
Low of Percolation TPstc-
Observation Pit #2
t 0--
to
to
to
to
Test
ole 4r
Depth
Time
Water
Level
Tine
Interval
Drop
Rate
IMlin. /In.
Al
Observation Pit Yi3
to
to
to
to
to
Test
ole #k
De th
Time
Water
Level
Time
Interval
Dro
Rate
Min./in.
Design Rate Design Rate
Remarks 0
tests conducted by
%pproved for septic system - yes no
Date
Signature of Sanitarian
Date - _7
03 FUSSLuQ'NEILL PREPARED DATE CHECKED DATE PROJECT NO.
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BY BY
` consulting engineers ��
SUBJECT: SHEET NO.
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