PERCOLATION TESTING I HEREBY APPLY FOR THE NECESSARY TEST PRIOR TO APPLICATION FOR PERMIT TO CONSTRUCT (OR RECONSTRUCT) A SEWAGE DISPOSAL SYSTEM.

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1 , 1.1 ".. ' t..:: :. " f......, APPLCATON PERCOLATON TESTNG P HOWARD COUNTY HEALTH DEPARTMENT BUREAU OF ENVRONMENTAL HEALTH 3525-H ELLCOTT MLLS DRVEELLCOTT CTY. MARYLAND TELEPHONE: DATE TO: THE COUNTY HEALTH OFFCER ELLCOTT CTY. MARYLAND HEREBY APPLY FOR THE NECESSARY TEST PROR TO APPLCATON FOR PERMT TO CONSTRUCT (OR RECONSTRUCT) A SEWAGE DSPOSAL SYSTEM. PROPERTYOWNER t:>r A=-( ADDRESS W"4 AOENT OR PROSPECTVE OlJ'fER c:..5. PHONE ADDRESS 377CJ J. PHONE_'f.:.-CJ_----=-tf-=-r9L-'-63O PROPERTY LOCATON: SUBDVSON --'-R;V 5 ;_-- :r-""1f-'lot, NO. ROAD AND DESCRPTON... (...Qti_.;:... -a-a... 4"fe40oo"l... oo<...j&1l...::.:...:...: TAX MAP ---':2-=== ) SZE OF LOT t !; wt..-d TYPE BLDG ;;;:=:;-;::-::-:-::=_:::_:::==7.'7---- (SNGLE FAMLY DWELLNG OR COMMERCAL) THE SYSTEM NSTALLED UNDER THS APPLCATON S ACCEPTABLE ONLY UNTL PUBLC FACLTES BECOME AVALABLE. FULLY UNDERSTAND THE FEE CONNECTED WTH THE FLNG OF THS PERC TEST APPLCATON. COMPLY WTH ALL M.O.S.H.A. REQUREMENTS N TESTNG THS LOT. -...J...L.:..!:!=---:-=!::::="'7::'C:_:_::: APPROVEDBY FOR DATE DSAPPROVED BY...!FOR --'DATE HOLD PENDNG FURT'tER TESTS REASONS FOR REJECTON OR HOLDNG PERCOLATON TEST PLATPRELMNARY PLAT - TTLE OR.D. # DATE STE DEVELOPMENT PLANFNAL PLAT - TTLE OR.D. # DATE THS S NOT A PERMT HD-216 (392)

2 0' " 2 5' 5 B.oQtD COUNTY # SOl ').7 OFLE ie::p" red :::;en Cl 'Y'o pale. rg trf) ' 0' ) SOL PROFLE,. o' r--";::';::: fop et:) 1 0'"8 brl) 2.5 ell..,., pole org b: ' 50. 1m NDCATE NORTH NAME ADJONNG ROADWAY AS BASE LNE. DATE TEST NO. DEPTH PRE WET START STOP TEST 1" DROP START STOP TME '(D-5-Q '0 V'5lJa) -Ok ') >'o 5.0' - F 2'1 0.5')) VSl..:X1J -OJ< REMARKS TYPE OF SOL, $)e, TESTED BY D..=.;:-= ALSO PRESENT C'.5J;cu-o TRENCH DESGN DATA: AVERAGE PERCOLATON TME TRENCH WDTH NLET DEPTH MAXMUM BonOM DEPTH SQ. FTBEDROOM

3 Howard County Health Department APPLCATON for PERCOLATON TESTNG AND STE EVALUATON TEST DATE(S) -'--_---- TME AlP AGENCY REVEW: DATE HEREBY APPLY FOR THE NECESSARY TESTNGEVALUATON PROR TO SSUANCE OF SEWAGE DSPOSAL SYSTEM PERMT(S) TO: CHECK AS NEEDED: CHECK AS NEEDED: C CONSTRUCT NEW SEPTC SYSTEM(S) C NEW STRUCTURE(S) C REPARADD TO AN EXSTNG SEPTC SYSTEM C ADDTON TO AN EXSTNG STRUCTURE C REPLACE AN EXSTNG SEPTC SYSTEM C REPLACE AN EXSTNG STRUCTURE CHECK ONE: S THE PROPERTY WTHN 2500' OF ANY RESERVOR? C CREATE NEW LOT(S) C YES C BULD ON AN EXSTNG LOT N A SUBDViSON C NO C BULD ON AN EXSTNG PARCEL OF RECORD THE TYPE OF STRUCTURE is; C RESDENTAL WTH PROPOSED BEDROOMS in THE COMPLETED STRUCTURE (NOTE UNKNOWN F APPROPRATE) C COMMERCAL (PROVDE DETAL OF NUMBERS AND TYPES OF EMPLOYEES CUSTOMERS ON ACCOMPANYNG PLAN) C NSTTUTONAUGOVERNMENT (PROVDE DETAL OF NUMBERS AND TYPES OF EMPLOYEESUSERS ON ACCOMPANYNG PLAN) PROPERTYOWNER(S) DAYTME PHONE CELL FAX MALNG ADDRESS _--:===- --:-==-=:--:-:::-:-- ---:-:=--::-::=- --== STREET CTYfTOWN STATE ZP APPLCANT DAYTME PHONE CELL FAX MALNG ADDRESS --;;:;::;:;;:::;::;::;:: ;:;rr;;;_;_-----_;;:;:;::_---_:;;:;_;: APPLCANT'S ROLE: DEVELOPER BULDER BUYER RELATVEFREND REALTOR CONSULTANT PROPERTY LOCATON SUBDVSONPROPERTY NAME LOT NO. PROPERTYADDRESS --==_ = STREET TOWNPOST OFFCE TAX MAP PAGE(S) GRD PARCEL(S) PROPOSED LOT SZE AS APPLCANT, UNDERSTAND THE FOLLOWNG: THE SYSTEM NSTALLED SUBSEQUENT TO THS APPLCATON S ACCEPT ABLE ONLY UNTL PUBLC SEWERAGE S AVALABLE. THS APPLCATON S COMPLETE WHEN ALL APPLCABLE FEES AND A SUTABLE STE PLAN HAVE BEEN RECEVED. ACCEPT THE RESPONSBLTY FOR COMPLANCE WTH ALL M.O.S.HA AND "MSS UTLTY" REQUREMENTS. APPROVAL S BASED UPON SATSFACtORY REVEW OF A PERC CERTFCATON PLAN. TEST RESULTS WLL BE MALED TO APPLCANT. HOWARD COUNTY HEALTH DEPARTMENT, BUREAU OF ENVRONMENTAL HEALTH, WELL AND SEPTC PROGRAM 3525-HELLCOTTMLLS DRVE, ELLCOTT MARYLAND (410) FAX(410) TDD (410) TOLL FREE MD-DHMH HD-216 (203) PLEASE SUBMrT ORGNALS ONLY (BY MAL OR TN PERSON)

4 AlP 0? O l,, "5' 6 0'! - DATE TEST i # DEPTH START BREAK STOP TME OF PFH 1" DROP 2" DROP 2nd NCH ('2--- JtjJOb (@ n, Sb p;,jfn' (,J... 8' -,;> P REMARKS 8' : SANTARAN : i.o. 60J u {""..,... J ' -. O,A.. 4oU'O r:w A a BACKHOE!eOO OTHERS TEST HOLES USED N SDA. -f- -'-_ AVG. PERC TME SQ. FTBR ')00 T5ENCH WDTH L. NLET DEPTH :f MAX. BOT DEPTH, EFFECTVE SN "Z.. ' f 1'1 "To t, v e f""-v'.. vvvty. Ml)

5 " :1 " 1 ",.' -"5 ' :. '. APPLCATON PERCOLATON TESTNG A f09{, P HOWARD COUNTY HEALTH DEPARTMENT BUREAU OF ENVRONMENTAL HEALTH 3525-H ElLCOTT MLLS DRVEELLCOTT CTY. MARYLAND DATE TELEPHONE: TO: THE COUNTY HEALTH OFFCER ELLCOTT CTY. MARYLAND HEREBY APPLY FOR THE NECESSARY TEST PROR TO APPLCATON FOR PERMT TO CONSTRUCT (OR RECONSTRUCn A SEWAGE DSPOSAL SYSTEM. vv4 PROPERTY OWNER D, ;:to1s'::-"' ADDRESS AGENTORPROSPECTVE6UYER c.. -'5 PHONE ADDRESS 377ez 92."'tJM,.,i. PHONE_'f._CJ_--...:..Lf--::'-L.9-,-'H---=---..:...3--=O,-- -, :Ll,& cg PROPERTY LOCATON: subdlvlslon l_--.ll.!...r;v:... :_--!".,.---.,-...LOT NO. ROAD AND DESCRPTON -----o(... QtiffC'--'rlA'""""";.(e40o'1.o:,...-;('--.3""-JM'-=_!o.-. TAX MAP _---"2..'"",_-_' PARCEL # B...,,-. ) SZE OF LOT ' 1.,; wt. A TYPE BLDG. ----==:7:''::':'''':";-:::::-:::=.,...,.,.,_:::_::c=_:c::_:::_:==7:'7-- (SNGLE FAMLY DWELLNG OR COMMERCAL) THE SYSTEM NSTALLED UNDER THS APPLCATON S ACCEPTABLE ONLY UNTL PUBLC FACLTES BECOME AVALABLE. FULLY UNDERSTAND THE. FEE CONNECTED WTH THE FLNG OF THS PERC TEST APPLCATON COMPLY WTH ALL M.O.S.H.A. REQUREMENTS N TESTNG THS LOT. _-'-...2.=_--:=!:::::=:_:_:::;:;.: PLCANT) APPROVEDBY FOR DATE DSAPPROVED BY -!FQR ---'DATE HOLD PENDNG FURT'ERTESTS REASQNS FQR REJECTON OR HOLDNG PERCOLATON TEST PLATPRELMNARY PLAT TTLE OR J.D. # DATE STE DEVELOPMENT PLANFNAL PLAT - TTLE OR.D. # DATE THS S NOT A PERMT HD-216 (392)

6 COUNTY #,. SOL PROFLE 0'.--- -, F 1f -,...!8 QS7 z : 5' "d?.o' QO itj". 1 "-,,5 2'+F, &5-2Co T ',----'-- v - 15'± A.s;-... _--' NDCATE NORTH - NAME ADJONNG R0r,DWAY WCf LNE. W WOiefSv lie 1(j... 1 PRE-WET TEST - 1" DROP DATE TEST NO. DEPTH START STOP START STOP TME (o-5-q )5:;>"'0 5' F 22 q.5 l '- b >50% R"'J-@ c; F 25 2'8 S,' 1:32. 3 ): 5(0 2.'i 9.5' D 24 q"o'd G. S ' ,' 4iJ J: 52 ): 52 2: O.5'D VSLXl} -Ok 'S 2.1 : z, " '.2 :, J.' 37.g, 1 O, O'!) V,Sual -Ok. t= REMARKS +es+ area rrodetaje4 uxx::x:fea TYPE OF SOL TESTED BY ]),.scc. ALSO PRESENT C, Etatp TRENCH DESGN DATA: AVERAGE PERCOLATON TME 15. TRENCH WDTH...3""-- NLET DEPTH.2. 0 MAXMUM BonOM DEPTH 4:.. 0 SQ. FTBEDROOM " 24-0 '

7 , '' --j-- ( 1, ( ' ' ' ". " _.-_.---._-,.._ ,; ". '-- i. '-'r "- " f - r:: ". -J..!... - ;.: -- '- '. i "'f- ',,- l.r)! '!til " "") Q)! f C) '. 1.' : - - ; ", CHARLES ALAN SHARP i '... and... ' '-oj...j f, DENSE DOERER SHARP 6 c&p Liber 4552 Folio 289! 139,680 sq. ft. " '-.. " ' ',,' or _ AcC sr rj1.p ':! -- ' ' ' ' - r ; j 1 r---,.. ( ' ' ' " "", ' ' ). {! (. ' "-. CHAiRLES ALAN isharp. '- ',, ". ' and ' '. CHARLES'- <. DENSE DOERER SHARP.. - Q ',, Liber 4252 Fo1io " :::_.- --,,- D>ENt [-.,DO sq. ; ft. "- 00 t.. or ". lliber "4:.252 A 0? Acre$± ' 2,22 i;5t - --?-S"f '. Jr' -z." t.1 9