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BOX 9
�
T
00771
� K y
PUTNAM COUNTY DEPAM
'Rev 3/86 Divlelon of Envlroamenta! Heilt6 See
CER TE OF CONSTRUCTION COMPLIANCE FOR SEWS
�:I,ocated at [f zp. ' Pw4vfz��_: V ,
Owner/appllcaat Name '�D ��D� Formerly'
llZalung Address
+
� Sep rag
arate Sewee System ballt by,n
^
"i
I �
ter Sapplys Public Supply From
'{
Pdvate'SaPPIy Dillled by�
;Buflding'Type E Hue Erosion Ca
i Number of Bedrooms Q', o- 5t Has Gsubago G
i Otber Regniremente .t;i '-�' � ` ,� 7
i.3 certify that Elie systam(s) ae listed serving thejabove premises
Ofiwhich, are attached) and in acwrdance'with. the standards rut"
Putnam County partmen `'Of Health ,
t + ytj i t
Cart iIF
Atldreis r�
Any person oecuDYingJpnmises'served by theiatiove systems) shalhp
conditIons r-y' gIr!q from such usage Approval of the separate si
s`vailaDle, and tha approval, of therD!iwte water supply slnsll become r
wbjeef 'to modlflutlon of ehange iwlien in) the juagment of the 6
. '
Oats
0
tt +
y � %
+
k
t"I.Irt
Su, "Aslon'Name' "'Sub
"' Date Permlt leaned 4
6cted essentially as ehoim on the p .._s of the. completed t copies °' ',J
"�6_..,
ntione in ac`coidance ;with the fil la-n' an the perrnii i'9sued by. th �
4 P Eff A.!p
jwch,actlon ss'may W neuasary to weun the eorre -tlgn of any unsanitary
ntshall b�coms null and Vold �s won as' a pui - anitasy `ewer becomes
wheh a puplie wale` aupplY;''.tiecomei'. avallablo. , ^Such 'apprpvajs are
Of klealth, - -wch revoeatbn;rmoellfico4ion or •ehirl e. is necessary.
Title S
i
.+
i
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RJFNAM COUN'1'X DEPAiTMEN'T OF HEALTH
DIVISION OF ENVIRONiMMAL HEALTH SERVICES
'F1 I a-/ki:�;PTN M1*�prr -�-i�
owner or Purchaser of.Building
� o -�( Alc. L, - C,
Building Constructed by
ad
Location - Str
Municipality
Building Type
Section Block Lot
t, C7 13 1
Subdivi ion Name
Subdivision Lot #
GUARANTEE OF SUBSURFACE SESTGE DISPOSAL SYSIM
I represent that I am wholly and completely responsible for the location, .
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has -been constructed as shown on
the approved plan or approved amendment thereto, and in accordance.with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good,
operating condition any part of said system constructed by me which fails. to
operate for a period of two years immediately following the date of approval of the
"Certificate of Construction. Compliance" for the sewage disposal system, or any
repairs made by me to such system, except whet`&_ •the failure to operate properly °I
caused by the willful or negligent act of the occupant.of the building utilizing.'
the system.
-;
The undersigned further agrees to accept as conclusive the deteination -:of 7)
rm
the Director of the Division of Environirnntal Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate :•was
caused by the willful or negligent act of the occupant of the building utilizing . ;_J
the system.
co
Dated this 12 day of A 19 `63
�oss
Ahpt ov---
A,
Genezzi Con actor (Owner) - Signature
_ X20 55 A t4t,-e- .
Corporation Name (if Corp.)
.Address 61 N_ \1/
rev. 9/85
mk
Signature X 444
Title
Corporation Name ('" Corp.)
N�
5-
Address
.1-1 V U'\
3 /6V
WELL C0MYLt11V1v xZrVNL Office Use Only
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNA-'1 COUNTY DEPARTMENT OP HEALTH
STREi T AQUAE 5: NNr � _ TAX GRIO Nut -iW.
WELL LOCATION
P r a = 2 C-/ - / --
NAME: ADDRESS: PRIVATE
WELL OWNER
:Aa PUBLIC
USA Or `jr L
RESIDENTIAL G FUBLIC.SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
1 - primary
❑ BUSINESS O FARM C3 TEST/ OBSERVATION ❑ OTHER (specify)
2 • secondary
C3 INDUSTRIAL O INSTITUTIONAL_ ❑ STAND-BY ❑
4MOUNT OF USE
YIELD SOUGHT — gpm. /N0. PEOPLE SERVED _/ EST. 0E DAILY USAGE Qo gal.
C� FPLACE EXISTIN(, SLTPLY [�'rEST /OBSErtVA,r1ON ❑ADDITIONAL SUPPLY
REASON FOR
OPIUM
gNNPW SUPPLY (NIEW DWELLINQ Q DEEPEN EXISTING WELL
DEPTH DATA
WELL. DEPTH ft. I STATIC WATER LEVEL_ _ft, GATE MEASURED
- -
DRILLING
0 ROTARY VC 0MPRESSEQ AIR PERCUSSION ❑DUG
EQUIPMENT
❑ WELL POINT Cl CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
D SCREENED O OPEN END CASING iOPEN HOLE IN BEDROCK 0 OTHER
TOTAL. LENGTH ft. MATERIALS: eSTEEL ❑ PLASTIC 0 OTHER
CASING
LENGTH BELOW GRADE Ott,
.JOINTS: ❑ WELDED T . EADED O OTHER
DIAMETER in..
_
SEAL: C]_CEMENTGROUT... 8e'NTONITE._0OTH R
DETAILS
_
WEIGHT PER FOOT 1b./It,
DRIVE SHOE EYES ❑ NO
I LINER: 0YES NO
DIAMETER (in)
5L0" E
LENGTH pt)
DEPTH TO SCREEN (it)
DEVELOPED?
SC4 EN
ETA
sr
— --
0 0 NO
$E NO
t URS
DIAMETER
P
SOTTO
GRAVEL PACK
° 5
GRAVEL
❑ NO
SIZE:
OF PACK in.
DEPTH -tt.
DE;:t}i
WELL YIELD TEST ' !t detailed pumping
!WELL LO )f mare detailed formation descriptions or sieve analyses -'
are available, please attach.
k�MOO: 0 PUMPED i tests were done is in-
}
OEPTH FROM
1y�ter
W -11
0 COMPRESSED AIR , formation attached?
0 NO
'
SURFACE
"
Bear.
Ong
04"
FCR1AArON DESCRIPTION
q0E
BkiIED OTHER YE
Invtar
WELL DEPTH
DURATION
DRA+110Q11
YIELD
S2111Ce
It.
hr, mill,
A.
aL
Z25
"1
_
r ER CLEAR TEMP,
UTY 0 CLOUDY HARDNESS
O COLORED ANALYZED? OYES 0140
STORAGE TANK: TYPE
CAPACITY GAL..
ANALYSIS ATTACHED! O YES ONO
PUMP INFORMATION
TYPE: CAPACITY
WELL MAHYATT & SUNS, INC.
MAKER DEPTH
ADDRESS Well Driliing 5IGt17lTtlR£
MODEL VOLTAGE HP
Rte, 311 R. R. 2 Box 171A
P.T7kr:' •r,A. NEW Y^F;K_1 2363
3 /6V
YML ENVIRONMENTAL SERVICES
321 fear street
Yorktown Heights, N.Y. 10598
( 9 14) 245-2800
Albert H. Padovani, Director
LAB #: 93.007490 i_LIENT #: 99 NON _;TAT PROC. PAGE 1
RO_;_; ALAN INC:. DATE /TIME TAKEN: 04tO5/93 11:00
5 BYRAM LAKE RD DATE /TIME RECQ: 04/05/93 12:42
ARMONK, NY .10504 REPORT DATE: 04/06/93
PHONE: (914)-279-5180
SAMPLING SITE: LOT 2— BIG ELM SUB DIVISION •SAMPLE TYPE..,. POTABLE
WATER TANK BIG ELM RD PATTERSON, NY PRESERVATIVES: NONE
i_ QL' D BY: ROSS ALAN TEMPERATURE..: < 41--:
NOTES... : C! �L I FORM METH: MF
DATE FLAB: PROCEDURE RESULT NORMAL — RANGE
04 /06/9 MF T. COLIFORM NEt /100 ML NEB
COMMENTS:
BAC:T THESE RESULTS INDICATE THAT THE WATER (WA'-, , (WAS NOT) OF A
SATISFACTORY SANITARY O IAL I TY ACCORDING TO THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, 'FOR THE PARAMETER'S
TESTED, AT THE TIME OF COLLECTION.
SUBMITTED BY: - -- — ---------------------
Albert H. Padovani, M.T. (ASC:P)
Director
ELAP# • 1032
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- DldMsd�lB�iltMe�.`CL�I.N? �iSlt
OP COiQUAlIQ .
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J' ���� � l �► .' F� � 4'� _ 1f1� � - ape' "�
C r r nata.� Perlw Aawd
YY
cu, 4 �P r r.A)J %DS
`2 d
rte. �-
.. date Su'bdivsion.:Avnroved. t�'_.d.- -ee "Enclose A;,,�,,;,r
y;• i d Piny a 1 w wt. / " <l�c P s.etl. ob D,f� �,i■,
lilt�iiae at L+�■ ° �7 Daa�a pMw G P D �o � t ®NNmUN Ir Spiro �Yrw l� Y;a�M�i ..
T: r...afef.S
w�raa 4 Paa� Add"
s
.j
I iMiwt that 1 an�who11Y ani eOmtMMNY tapoedeN forth Aasian ana- location of_tM o.00eaw t1►ttuln(tIt 3) that tM. M ata AI Yt, atam •i
Meio 4illwil" w111,M Cenftruetad as tl wwn•oi� tM app►ovsA•an1 WmMlt.tlivi t'044 'in accorA�np witA;3Msta�dNAa, ruNs a .►qu
plfllty OM Mt11w1t N "nab. aM thit <ea eaMNtbh t1ia��ef a �CwtifkatY of Ca u tlon C~I"Oe' athbetwy to tM;t:otmnWbnarw'Ma ItIlVA 1 `
M .MlnittM M tAt iOMMtwMa1N. aril :i wrRfM tawanlN wW tN 1wwl�MA
the, owwa►. M!'MKeaMOn�_harao►'attiynaiY tM N,MNr. fMtl Yl/ frtlNM wIM `.
tl�Of1 M }taM� NMaNINE aMl/Rb11 aoY'MiR N: ,MN swtura �kpMl systaii+ Aurina (M oarOd of twee( =) yaartNnroaOlitafy folowwwy tMMto N:tM Wow 1
atta N a W tm N * _b6ho4oti N :CO **!l. of tAi orlyi,Islsy�w'a any fwMa tMritot 2� fMt tM ArNIM wNl_Mtp, aiwa
- rrw'ffa IOaib� as.atltrwl M'tM aM/oW ^i�IM.awtlithat saW wN1 w � .in ,ticoorOanoY w tM;' �uNa �at,N rep the
taunt el tMa1tR �
ittl•Mp1/[O`,f*OR CONiTRtJCT1pN:7t + li aYMOViI auapina twe yyr fnsnl tha AaM Ntuatl untm eonatiuetbn Of tM tiuilOho has IMM unN►takan aM is !�
IotrepRN fM'taYaa M;I,lay M olaa�ar er IIIaQHM wMn'eenYdMaO nat3aaYry tly. this C"fW$ io„a► .oi' NMtth Any ehsnp a ikaratbe of esMteuetlon
fNrNra au aurn/1t. A _ m Mr RkMaN e/ a awaalk aMlhiY MWa/R a or w a wata► autiob mob•
le
TRIG I
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�)3;2
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #x'36`90
WELL LOCATION
Stree ddre
s Town
'�
ty Tax Grid Numb er
WELL OWNER
Name
Mailing Address
1^ n l I `a
c -e
ry _ Private
F1,t O Public
E OF WELL
primary
2- secondary
ViESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
D PUBLIC SUPPLY
O FARM
b INSTITUTIONAL
O AIR /COND /HEAT PUMP ❑,ABANDONED
O TEST /OBSERVATION 0 OTHER (specify,
O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT_ _gpm /# PEOPLE SERVED_! -6 /EST. OF DAILY USAGE �'o gal
❑.REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION d ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
e
WELL TYPE
WDRILLED
DRIVEN
DDUG GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t4 Pvt
Lot No.
WATER WELL CONTRACTOR: Name %'� Address: ,
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: IVIA TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PR ED
M ON SEPARATE SHEET
(date) ( ignature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
t- hirt;r (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant
any and all water or waste products from such well
property and in suc a manner as not to degrade or
Date of Issue:
Date of Expiration 19�
Permit is Non - Transferrable
3/89
shall take appropriate action to assure that
drilling operations be contained on this
otherwise contaminate surface or groundwater.
r--
Permit f fi al
White copy: HD File Pink copy: Owner
Yellow copy: Bldg. Insp. Orange copy: Well Driller
YMLTR S. Y
—J.777
>�0 = U 1R lawli. Paa�IC/ ,
rtrt DNYw a[ �dYu�tadl � Salnlaaa. 4aaiai, ILY l�
•
- 11QI1ANC�
C�IG►
FCO
Refit /,�
�-
1
COM
T.w.io
r ,.
p�bdi�sion'.An/nroyed �- 9d Fee Enclosed Am'n;,nt
.� l sO �a +fiC. Pm>s«tle.. eq, � � V vela.e
r
P D '•PC®Ne/deitlob`la Yegsi>eed Wraa FID la aipii�sd '
to R 0 Sw!nla SrM. a aNil a[.J ZS6
x -✓b
r ,
• Adlhala
wool
1 iaoiaant that 1 am who11Y
-at rasponsibN far EM Msi/n and location of tho proposed sYStnsts)s 1) ,_that tM'aparata "saw 'di "'sal s Elam
S_ ._y-.
a6ow daeribdd willibe 60hstruacii at :wwwn on;thsi a'vorosiap amanuniant tMi to and ,in accord%nq,with tM sgndard ;'iruN `a ►pu, ns; nam
Comm y : pputnwst '.of MaaRls an0 tMt on eonipNtion tlia►aof r'!Cntif" of Cori�tructlas Complianq" titistlatto►y. to tM Commissioner of MaaKhwill
M- ;'sisbmttt�d to tM !Oapartuiasst in0 a, wr{ttan`,`yuannta will bi' furniflsW tM owner hif qugporf, ;"WS Ora • bY'tM bsilldi► that .ai0' bu {IOM will
sips
Mac! NI pod OP!►a1tN!/ oo"ItiOn any' oa►t ofx nW favirip ditOOOI system durinj!t,M perzb0 of two l21 year `Nnsna0l fily followNq me sake of 64 issu.
M. app►oeal 01 tfsi Cartilkata o1 Conftrsretbn.`Canpl of th orpNsal °system op any rao NS thaieto, Y) that this A►NIiO wN1 Abpibad'abow
wfll M IOCatiA M showwi on tM plena sw.tlsat slid mall ill'M inst in fdanq w . Eta 6. rules dnd'ra/'uiai o�of. tM Putnam
COUntY Oapartsrsant of MYlth. t � £ - - - �+
d.. /
ab
Licarsf. fro-
A►PROVEO fjOR CONSTRUCTION: TpM appoval supNaf two yaa►i, from the dati,�ifMSad unless conshuction , of the, bu Wire hat,tiean unAa►takan and is
rairocabN fore N M y a ateswsdad or modMiad wMn eoe b' ry by t :•C mitfiomr ot: Mwnh Any chan/a oor alteration of construction
eaOvNas: a perm �4Paored ter Afspogl of dock r y s(iwaN /o► at soppy only. / �D '
%8S, Datfr J 1Y �/Jl Y {tN
}
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914).225-0310
APPLICATION TO CONSTRUCT A WATER WELL P
PCHD PERMIT #
WELL LOCATION
Street Addres
illage City Tax Grid Number
WELL OWNER
game
�.
Mai i
I PX U
ddre
Dl.
Private
E3 Public
E OF WELL
V--primary
2- secondary
Jd RESIDENTIAL
D BUSINESS
D INDUSTRIAL
I- PUBLIC SUPPLY O A R/COND /HEAT PUMP '
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify,
O
AMOUNT ,OF USE
YIELD SOUGHT gpm /#,
PEOPLE SERVED /EST. OF DAILY USAGE Sal
REASON FOR
DRILLING
O REPLACE EXISTING SUPPLY
SUPPLY NEW DWEL ING
13 TEST /OBSERVATION` Gl ADDITIONAL SUPPLY
D DEEPEN EXISTING WELL .
;DETAILED
REASON FOR
DRILLING
'WELL TYPE
RDRILLED
DRIVEN
[]DUG
[]GRAVEL
OTHER
'IS WELL SITE SUBJECT TO FLOODING ?. YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �►Gi �I m
Lot No.
6
!WATER WELL CONTRACTOR: Name
Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES k NO
NAME OF PUBLIC WATER SUPPLY: y)t a— TOWN /VIL /CITY
.DISTANCE TO PROPERTY - ..FROM• •NEAREST WATER MAIN: -a y.424. - -• . I -e,
LOCATION SKETCH S SOURCES•OF CONTAMINATION PROVIDED
M ON SEPARATE SHEET
F -3 -9v
(date) ignature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty. (30) days of the completion of water well construction, the applicant shall:
1.' Pump the well until the.water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a anner as not to degrade or Wer e contaminyat'esurface or groundwater.
Date of Issue:_ 19 U�%y??�'�'�"
Date of Expiration �� 19 P rmit.Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
APP -rNDDC B
COUN'T'Y D.y A `C'T OF HEALTH - DIVISICN OF 2WIR0N.ML I-L ?-. ��I,T:i SEi VIGS
120IV D' ?l, tom' _� SUPPLY
& SUPSURFA(✓
Sa%AGE DISPCg -L SYSTEMS
DATE
BY: J1 '
-roc: tics )
Pernit Ap pl ic= tion
Corporate Resolution
Plans - ':fee sets S/S
Encinee<rs Authorization
Design Data Sheet (DDS) Si.'_ _\7--, SION
De °p Hole Log Pere
Consists 'It Perc Res,—,It--s (3) Fill
Perc Hole Depth cd
Haose Plans - Two sets
Wall ✓ p- :nit; Piz le tt _r
Variance Remilest
Leal Subdivision
Subdivision Aooroval Check-=d
Ex-approv-al SSDS Adj . Lots Checked
1'7etland (Toor.1DFC Per-nit R & D)
rata On DDS Plans & i er-mit ✓-.l,?_
REQUI M, T--)Er-LA-!:,S ON PLTLNS
Swage Sys Lem Plan - (no. -th arrow)
�. wage Syst°[t Hydraulic Prof—i-1° - (rra: _ty F1cw
Fi11 Profile & Dimensi^ns - Volu -i-ma
D or J Fox;Tranc:n /Gallery; P-L-mg pit ..e=ai1s
Septic Tc.2{ - Size, Dail
'
Well Detail, Service Lire if over
Construicticn motes (grinner rate)
resign Da-- - _o`rc and . deeo res',�1ts
Ccn:ours aci JL-ing & ?ro w
Driva.vay & Slo_C✓s Cut
Footing/Gatter,C:r, in Drains (disc_.= 3' OR)
Perc & Deep Holes loc tea
=� °pr e:, tr Live of priT rj and e_� on
Er anion -A-re. -; shower; gray =i ty flow, SU =. size
if P=uped ?lt & D Box Shy l & DaLa -, :
House - No. oi-Bedrocr's
hails & SSDS's w /in 200 i. of P_oTxs=-5 Syste,s
Pr :A=rty :' = -'es & Bounds
House Se- E:ac'c Necessary (Tight lot)
House Saver - 1 /4 " /ft. 4 "0; Type pl`r
No Bends; Max. Bends 4o' w /cle- -n--ut
SEpPLRATION DIST_ ' .S SPEC=-1-7D ON PLA.,,
Fields
10' to P.L. , Drivewav, large Trees, Top of
20' to ro -maaticn Walls
100' Lo 4re11; 200' In D.L.O. D, 1�0' J_Ls
I Lam-- T1'3terCrJ!?rje Lake (_:... ?awn)
100 o S
15' to Dram -c-O rtain, Leafier, Footing
35'to C tcn sin, st-ormdrain,DiDe:3
(,a of Owner)
CC?
(S
I Y=-
treet
NO
1
I
I
I
I
Pre -1969
1
I
Nei bor notification
I
I
LF trench provided
r i red
60 f t. Max.
Parallel to Conzo'ars
' 00% e-=—
,
I
1
I
1
1
r ^ILL S YS ^:S I
cla �rr e_r I
10 ft,
fill rot °_s 1
new sue.
depth causes I
100 vr, flood elev. (
I
-
200 lt. reservolr, etc. U
1>0 ft. trricall- ,�a11. I 1
-
10' to hater Line (pits -20')
50' :ntj- d tent dra:rLace course
Septic Tans `- -
10' "Eran F=,ndation; 50' to well
1 j' We l to 7T 9
I
I
4I
1 1
Pr'?.t OO= DEPAR'II+ EW OF REAT,TF
DIV3j OF BEALTH S
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM. FILE N0: -
Owner o s S 4 Z- A I Address 2 -5-,9 %I'A i'% C 4 A"E ` /?D, A�P' ONk /V .,V /a so ,� Jk'
Located at (Street) j( /o . 2 2 %g /G EL rvt Ro 4 D Sec- 6 q Block .0 5 Lot 7- z
(indicate nearest cross street)
Municipality IV
Watershed
CR-b % o 4/
SOIL PERaQLATICN TEST DATA PSWitED TO BE SUE-U= WITH APPLICATICNS
Date of Pre - Soaking 7 ?/ $ Date of Percolation Test
HOLE
NOMBER CLOCK TIME .. P-r2COLATION
PERCOLATION
Run Elapse Depth to Water Frcm
Water.Level.
No. Time Ground Surface`'
In Inches
Soil Rate
o 7- O# Start-Stop Min. Start Stop
Drop In
Min/In Drop
Inches Inches
Inches .
4
9
z4
%'` 2.6
5
1 •
2
3
4 �•
5 ..
N=: 1. Tests to -be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to' be sutmitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
Z/D
L2 -3 : to o
5
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2
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N=: 1. Tests to -be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to' be sutmitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
_ TEST PIT DATA RD�UIRED TO BE SUBMITTED WITH Av'OLICATION
DESC�tIl'- )N OF SOILS ENCOUNMMM IN TES ALES
F912*2 -2
G.L.
2'
3'
5'
6'
7'
8'
M-h
HOLE NO. HOLE NO. Z�> HOLE NO.
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T y GoAWI
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F SAti�
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INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED IV6I V,c
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: /-// rC 1/ C u C fi DATE: 7 Z Le
DESIGN
Soil Rate Used V- Min/1" Drop: S.D. Usable Area Provided Qo a v
No. of Bed roans Septic Tank Capacity /2-!;_0 gals. Type C<,nI C-
Absorption. Area Provided By _ 6 7 L. F. x 24" width trench r - -
pF NEW
Other 11V6 OR SAZ /T sY5rE-M u /11f'EO P wILLIA O
a 1 l
Name /A t4FA /r 01C,11,E7"IM6 /AsSoC.. /?C,Signature
Address 73 F41A'AiEG12- ,OX-' SEAL ��Fa No e�
N�ld
THIS SPACE FOR USE BY HEALTH DEPARMWr ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
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