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HomeMy WebLinkAbout1466DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-2-57 BOX 13 01466 Is ir ' - ti ir r- 'i 01466 g r PUTNAM COUNTY DEPARTMENT �a_� DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #u==. Located at r //zL -A-S C094645 P—,04A Town or Village Owner /Applicant Name NW-?g Q� 4omes Tax Map —34 Block 2 Lot Formerly _ Subdivision Name C14 jol4 m /v% aq oTTT� Subd. Lot # / Z' Mailing Address l Oi'/'f % [Jl� ]J , yb►2 -/-eti l yet !i'f� _ �� Zip % oszcq Date Construction Permit Issued by PCHD Separate Sewerage System built bySo v�1 kii< -' C-0,7 ST Address I 90 80X'3 ¢4 41z-'V(W1e Consisting of d® Gallon Septic Tank and -'-33 6 r�r O -rol a - 7X "c A4 Other Requirements: Water Sunp"I : Public Supply From, or: Private Supply Drilled by Y yQrr Address 19,q rr""S'ot, Building Type_ Gq Ni Has erosion control been completed ?__� Address Number of Bedrooms 3 Has garbage grinder been installed? l�!. I` I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: % Certified by Address 190 Ito X 9S-'0 Bly P.E. R.A. Professional) ���,✓ L[. V f OS�¢ ] License # J Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Director /Commissioner, such revocation, modification or change is necessary. ff A 7 h copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ell Well Location Street Addre Well Type Well Owner: Name: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Town/Village: ress: Map Block A � Use of Well: _Residential C/ _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion 1compressed air percussion_Other(specify) Well Type _Screened _Open end casing _X Open hole in bedrock _Other Casing Details Total Length ft. Length below gradit. Diameter Tin. Weight per foot Ib/ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout XBentonite Other Drive shoe: 9 Yes _ No Liner: _Yes XNo Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Developed? First I Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours Yield a4b gpm Depth Date Measure from land su ace - static sped ft) zf 7 During yield test (ft) Depth of completed well in ft. Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing in Formation Description information Land s„rfacP ' descriptions or sieve analyses ' are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump T pe Capacity during drilling Depth Model '9' J; list: Voltage a2o HP Tank Tvpes Volume NOTE: Exact Locatr0661 well with distances to at least two permanent landmarks to bit provided on a separate sheet/p ✓✓ P. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 C�11111111111111 PUTNAM COUNTY DEPARTMENT OF HEALTH TS'IS 0N- nF .ENVI ONMENTAT; GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM A ofix s 34 2 �� Owner or Purchaser of Building Tax Map Block Lot Building Constructed by - F1gG-0-5 Corn er^s o Location - Street Building Type C Town/Village ram /vr&o Assoc., Subdivision Name /Z Subdivision Lot #. I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is 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 fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is 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 determination of the Public Health - Director 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 ofAthe7lding utilizing the system. Dated: Month —A-- Day I- Year 11— G er 1 ContVactor (Owner) - Signature Corporation Name (if corpor ion) Address: State Zip ©si Signature: Title: .- Corporation Name (if corporation) �tc� gdx Address: Y State L Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL- HEAI..TH SERVICES 4 ie ysto) e WELL COMPLETION REPORT . jiN R w h i e Well Location Street Addre Fir -& 6ryev Town/Village: A Tax Map # .3 M (s) Well Owner: Name: Address :: AIJ.b%+Ij 14A Use of Well: 1- Primary 2- Secondary Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion lycompressed air percussion Other(specify) Well Type _Screened _Open end casing . Open hole in bedrock _Other Casing Details Total Length 2�ft. Length below gradgQft. Diameter Tin. Weight per foot a lb/ft Materials: Steel Plastic Other Joints: Welded YThreaded Other Seal: Cement grout XBent onite Other Drive shoe: Yes ' No Liner: _Yes ANo Screen Details Diameter in Slot Size Length ft Dept to Screen ft Develo ped? First I _No Hours Second __d_Yes I Well Yield Test _Bailed _Pumped Compressed Air Hours _� Yield gpm Depth Date Measure from land s7 face-static spec ft 7 z Dunng yield test (ft) . X dr- Depth of completed well in Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well iameter in Formation Description ft. ft. h6d"Sbdace r'.. ` } If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump T pe Capacity 1A 6 IM Depth O Model 1&0 Voltage •jam HP Tank Type Volum Dae ,II ampleted . �xFb. %'4i.tt': �i• ':i x , "X vr� w YII „ iI 1xY z M --44 i�J i K ur l :i:N i EIFDr(fler P Cert)ficate# tSfate #` ' ° Q q �R� Qr't' r i P.� ._.. ..I... . � S` v ...i. 5..�. .. * .e �c. l�'A.V-i 1T�l .n QI ..+#. �: �i e.:.yp-9f� ss�r m 3 V x '. ..E . F�1�/V Y'.y:.�.�:. 4>�{�Y %.M�'}JI.x I. 3�� iw�.: ((V �� �t M 1�-./✓� . ' i - ._.. . x. ' grx ''S : �m9i�'. s %.# i ..�t ..✓: ...� v x - ..... ... -r r... rw k.0 _.x.....N xr..r„. ” ten.... :. �:�hry+ • ■ry.� w �'Yk k (y]' �qi:l �xr'L: 'fix A *' ?:ll.{y��'3�`'��II Y� � Y. 9 k "Sk "r pMT �.i^�341; 3. .. 1 ki�,Llr .IEir f.�.. �! - 1 ry'� 5 }!M r �� n� £ k $�� : a s■ j!y d. M�. Ems' m: � ..; 1 it vl n ':r �� k�. J'�`V, '�`.,. n eta '1 * .r• k I�,k ] Y . - i Mn M K }� RImInstaCle� lam it s. are1j{{' � '. .'4k.�.. i��•R: "F�4��9 ;�Sx { Ix �..�"'N" jggC �:gt K:. -. � �. �' .ri�i: X }~' x'� 7�` }.. '. �M1 k�. f' jl �V� k4- s4'F�, a- .�,x:i k, L�.. .q� :kxp: ¢ �.?> _.- i `.''�' :t'v� _ '� irkM k ' +6� �. 4 yx•�k ;,";wd NUTS: Lxact Locatiotot well with distances to at least two permanent landmarks to bit provided on a separate sheet/ r. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 IS YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (91.4)_245 -28_00 Abert H- Padovan," Director ** TEST REPORT ** LAB #: 1.203383 CLIENT #: 6471 NON STAT PROC PAGE: 1 of 2 NORTH COUNTY HOMES 156 TOMAHAWK ST YORKTOWN HGTS, NY 10598 DATE /TIME TAKEN: 08/28/12 05:00 DATE /TIME RECD: 08/29/12 09:53 REPORT DATE: _ 09/07/12 PHONE: (914)- 447 -8780 SAMPLING SITE: LOT 12 FIELDS CORNER RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: HNO3 COLD BY: JOE FESTO TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/29/12 0500 08/30/12 0500 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 09/05/12 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B 08/29/12 0350 08/29/12 0425 NITRATE NITRO 1.94 MG /L 0 - 10 SM18- 20450ONO3 08/29/12 0325 08/29/12 0350 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 08/31/12 IRON (Fe) <0.06 MG /L 0 -0.3 mg /l SM 18 -20 3111B 09/07/12 MANGANESE (Mn 0.02 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 09/04/12 SODIUM (Na) 19.50 MG /L N/A SM 18 -20 3111B 08/29/12 0430 08/29/12 0433 * pH 7.5 UNITS 6.5 -8.5 SM18 -20 4500HB 08/31/12 HARDNESS,TOTA 180 MG /L N/A SM 18 -20 2340C 09/05/12 ALKALINITY (A 104 MG /L N/A SM 18 -20 2320B 08/29/12 1000 08/29/12 1001 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC T a liform = This result indicates that the water (was), 'was not) of a satisfactory sanitary quality according to w York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10W of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and ' . anganese are present, their total value combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director ** TEST REPORT ** LAB M #NM1ry203383- -M CLIENT -----M6 47lM------------------ STATM-------- -- --- -MM PAGE: - ---------- -- ------ NORTH COUNTY HOMES 156 TOMAHAWK ST YORKTOWN HGTS, NY 10598 DATE /TIME TAKEN: 08/28/12 05:00 DATE /TIME RECD: 08/29/12 09:53 REPORT DATE: 09/01/12 PHONE: (914)- 447 -8780 SAMPLING SITE: LOT 12 FIELDS CORNER RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: HNO3 COLD BY: JOE FESTO TEMPERATURE..: <20 >4.00 NO TES--- COLIFORM METH MF -_--__..__--..___-_-_-.,_ _________ ____ __..------- __ - - - -- --N._MNNN__---_----- START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. * pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANTAAND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. pH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. pH REPORTED FOR REVERENCE-ONLY.. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) ALK (ALKALINITY REPORTED AT pH 4.5) IMS IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINUMUM OF 6 HOURS OR OVERNIGHT) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELAT ONLY TO-`THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: SA)"D Albert . Pa ovani, M.T.(A CP) Director ELAP# 10323 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN; MSN Associate Commissioner of Health OWNER'S. NAME: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10 09 L.; E911 ADDRESS VERIFICATION FORM ROBERT J- BONDI County, Executive ROBERT MORRIS, PE Director of Environmental Health )A,,� — L ct TAX MAP NUMBER: ,I zl / E911 ADDRESS: % ���•�,� /`�� _ _ TOWN: AUTHORIZED, TOWN OFFICIAL: (Signature) The Putnam County Department of Health will note issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. a E911 addressverification Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5118 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care .Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY HEALTH DEPARTMENT LICENSED SEPTIC SYSTEM CONTRACTOR License # 1227 The contractor listed on the back of this card is duly licensed i Expires on: January 17, 2013 Licensee Name Anthony Lupinacci f Business Name & Address South Lane Construction Inc. PO Box 344 Amawalk, NY 10509 Any questions call Putnam County Health Department 845- 808 -1390 ALLEN BEALS, M.D., J.D. Co=Wauer ofHeahh ROBERT MORRIS, P.E. September 10, 2012 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 MARY1i.LLEN OD&Z County Executive Re: Field Inspection — North Country Homes Fields Corners Road (T) Patterson, TM 34. -2 -57 A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw r u tINAM CU UNTY DE+ PARTIYIENT OF HE'ALT'H DIVISION OF ENVIRONJ.VIENTAL EMA LTH - SERVICES FINAL SITE 3NSP]ECTION y /7//2 c /C Date- 3 Street Location,,,- Inspected by-,— - . _ ... Permit # -- o -3 —i � TM # Subdivision Lot # /z 1. -Sewage System Area a. STS area located as per approved plans ..........:........ b.. Fill section -- date of placement 3:1 barrier Lgth. - ' Width . Avg.Dpth_ c. Natural soil not stripped...... ............................... d. Stone, brush, etc., greater than 15' from STS area.. e. .100' from water course / wtlads .......................... IL Sewmee' Sytem en . ' . a. Septic tank siz .- 1,Pe6ov-elf .....1,250 ......... other....... b. 'S eptic tank ........................:._.......... .. c. 10' minn=7rn -from foundation .......................... d. Distribution Box 1. A2 outlets at same elevation - water. tested....'...... 2-. Protected below frost .... ............................... 3. .. Minh rum 2 ft.Original soil between box & trenc e. Junction Box properly set ... ............................... 6. Trenciftes 1. Length required ­33,6 Length installed 3 2. Distance to watercourse measured j o d Ft......... 3. Installed according. to plan .....:.. ...................:.. 4. Slope of trench acceptable 1116 - -1./32Vfoot....... 5. 101 from .property line - 20 ft.- foundations..... 6. Depth of trench <30 inches from surface ............. 7. { Doom allowed for expansion, 10.0 % ......... :.......... 8. Size of gravel 3/4 - Ph" diameter clean ............... 9. Depth of gravel intrench 12" minim„m ......::....... 10. Pipe ends.c Aped ::::............................................ . -g: ,- urn or... Dose vstems _. 1. Size of pump chamber . ..... ................................. .2. Overflow tank .... - ... I ................... ...... 3 . Alarm, visuallaudio.. ' ....:..... ... :........................... 4. Pump easily accessible, manhole to grade.......:... 5. First bore baffled ...:................. . ................:............. 6. Cycle witnessed by H.D.estimated flow /cycle...... IIL House/Buflding a. house located per approved plans. b Number of bedrooms ........................ f: : IV. wen Well located as per approved plans ................................. b. Distance from STS area measured c. Casing. 18" above grade ..................... d. Surface drainage around well acceptable ..... :............. V. ' Over-all WorlaaanshiD . a. Boxes properly grouted ............................................. b. All pipes partially backfilled ....... ............................... c. All pipes flush with inside of box .............:................ d. Backfill material contains stones <4" diameter............ e. Curtain drain & standpipes. installed according to plat f. Curtain drain outfall protected & dir.to exist waterco g. Footing drains discharge away from STS area........... h. Surface water protection adequate..... � .:.................. i. Erosion control provided ......... ............................... Rev. 12/02 PUTNAM COUNTY DEPARTMENT OF HEALTH '`Y " - i►?ir? -R. NTAL_ ALTH SERVICES .ATTENTION d JOSEPH L ' ENE Ford' Fill VEST FOR FINAL INSPECTION Trenches All information must be fully completed prior to any inspections being made. PCHD Construction Permit # (T) (V) Located: TM —34— Block Z- Lot Owner /Applicant Name: o `� Subdivision Name: — Fomaerly: Subdivision Lot # Is system fill completed? Is system complete? Is system constructed as per plans is well drilled? Is well located as per pi s? lace? Axe ezosion control measures in p Date: Date: — Date: I certify that the systeM(s), as listed, at the above premises has been coWtrnrcted ana l have.inspf,-md and verified their completion in accordance with the issued FCHD ConstajuctionPeand f approve Department d plans and the Standards, Rules and Regulations of the Putnam County Health. Cul tulcu vy: tf Date: De gn professional Address: 90- Form FIR -99 ZO /ZO 39Cd 9NIJ33NI9N3 d3M3NS C6Z9LLV -8Z5 Lb:6t ZIOZ/50/60' 07/27/2012 11:02 518 - 4775233 BREWER ENGINEERING. PAGE 01/02 .. ,... - __.��..._,_..:,.....:... -- UTNAlvZCO�CTNTX� ._:._. �. .. - _ .�.�. :�__...._ .._ ...,.. . _ ..... ._. _. ... B DEPARTMENT Off' BE ALTH DIVISION OF ENVIRONMENTAL HEALTH SER"CES ATTENTION Cl JOSEPg 91ENE Fob; Fill VEST FOR INAX. INS ECTI N Trenches All information must be £illy completed prior to any znspecfions being made. PCIiI7 Construction Permit # �.-„ / (T) (V) �— a Located: ��- TM — Biocic Lot Iicant Name.. Dwner /APp Subdivisioij Name: Formerly: Subdivisiozx Lot # Is system fill completed? Is system complete? �^ Is system constructed as Per p Is well drilled? Is well located as per plans? osian control measures in place? -- — Date: Date; Are er stem s), as listed., at the above premises has been coast Co truct on ptm-dt and the issued PCHD Y cez-tify that the sy � and -verified their completion in accordance Red at oms of the put am County Department of .. _ . ed plans anu the - cr�y.ti :'TO , R ales and _ . .. _ - - appzov .. - - IXealth. Date: � certified by: C, — D gn Professional f f / ` Lic. Address:` comments, Form FIR. -99 ALLEN BEALS, M.D., J.D. Commissioner of Health B" ERT 'IWORRIS, F:E: Director of Environmental Health July 31, 2012 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: MARYELLEN OIDELL County Executive Re: Field Inspection — North Country Homes Fields Corners Road (T) Patterson, TM 34. -2 -57 The above referenced separate sewage treatment system can be backfilled. The following comments need to be addressed: A bedroom count needs to be completed by this Department upon further completion of construction. 2. The well needs to be inspected by this Department upon completion. If'you'iiave ariy further questions; please coritac2 me at(2f45)- 808 =13y0; ext: 431(iI: -- Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT Located at 9—! 61_DS (�O-p_i4 e 2S tZo.4 D Town or Village `fig r7-,r mso /,1 Subdivision name SOICa gsSoc- , Subd. Lot # 12 Tax Map 34 Block Z Lot ti ;7 Date Subdivision Approved &5' 'o I Renewal Revision Owner /Applicant Name 14oiz:rli Cw!�q Ma - Date of Previous Approval Mailing Address / � 7`v � '1 7-o 0-1 14616* 04 t-ky- Zip . t6 -f 3 Amount of Fee Enclosed -r,50 Building Type (fo l- cX414L Lot Area 12'!� &NO. of Bedrooms Design Flow GPD 600 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of DOO gallon septic tank and F!`' o 2 Fr l.J �Oe `� 2bf- tJ c14C -3 Other Requirements: To be constructed by Water Supply: Public Supply From - ori+_ f` Private Supply Drilled by Address Address / ,(� i _ , - • -.. -' Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment sy sv tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. ✓ R.A. Date Y2 !Z License # 5-050-S' APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en considered nec ssary by the Public Health Director. Any revision or�alteration of the. approved plan requires a new pe it. Approved fo d scharge of domestic sanitary sews a only. By: Title: Date: White copy - HD File;%Y]ello cop - Building Inspector; Pink copy - �yGner;/b ge copy - Design Professional �� // Y �J Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL M - please print or type Weil Location Street Address: Town/Village: Tax Map # r14C0S C-J94GL 091 -rer ,101-4 Map 34 Block Z.Lot(s) g ~7 Well Owner: Name: h-toxrkl Address: Phone #:94 P 07,4,-4wl< S1 y0ek rC'&A•t H 249^ -Wro r Use of Well: esidential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling ✓ / New Supply (new dwelling) Deepen Existing Well Detailed Reason Tu,! 4005C LE%'' /S` arc+ r1Ov1 for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No L/ Is well located in a re It subdivision? .................. ............................... ....................... Yes 1GIQo Shy f Name of subdivision �1�''1Rj'�}n d r, Lot No. Water Well Contractor: 7"f31� Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ No e/' Name of Public Water Supply: Town/Village Distance to property from nearest water main: ^ Proposed well location & sources of contamination to be pro ' ed on crate sheet/plan. Itp 3�'Lv %l2� Applicant Signature:. - -- -- , -. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmei take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed,and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam gounty. A Date of Issue ��� Permit Date of Expiration Title:9 Permit is Non-TrallsferilbI6 White copy - HD file; Yellow copy - Building Inspector; Pink c4J - Ovnier; Orange copy - Well driller Form WP -97 Rev. 3/06 c REBECCA WlTTENBERG, RN, BSN r Public Health Director * ' 1VIART ODEI.. Executive TMORRM. PE. County Director of Fnvirortmerltal Health �> _ DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: JAM At /�Ots/D FROM: 41C "ASK DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM REVISION m JOINT REVIEW PROTECT; LOCATION: �Ft&s TOWN: 6tp 4j-176,eNo,4(TM#' DATE: 6--/ REVISION JOINT REVIEW + I Environmental Protection Carter H. Strickland, Jr. Michael Budzinski, P.E. Commissioner ! Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Paul V. Rush, P.E. ' Re: North Country Homes Lot # 12 —SSTS Deputy Commissioner Fields Corners Road, (T) Patterson Bureau of Water Supply prush @dep.nyc.gov TM # 34 -2 -57 Middle Branch Reservoir Drainage Basin 465 Columbus Avenue DEP Log # 2012 -MB- 0219 -DJS.1 Valhalla, New York 10595 T:(845) 340 -7800 F: (845) 334 -7175 i Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above- ; referenced application, received by the DEP on May 21, 2012, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment Plan, North Country Homes Lot # 12, Fields Corners Road, (T) Patterson, Putnam County, New York ", prepared by Roy Fredrikson, P.E., dated March 20, 2012, last revised May 9, 2012. If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2055. `J J Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review ! c: Pamela Young, NYSDOH Putnam County Health Dept. I Geneva Road Brewester, N.Y. 10509 Att: 1W. Michael Budzinski Dear Mr. Budzinski Consultant Engineer 278 Rapp Road Valatie, N.Y. 12184 May 11, 2012 Re: Proposed SSTS for North County Homes Lot No. 12- Gramatan Assoc. R. S. Fields Cornors Road Patterson TM 34-2-57 We have reviewed NYCDEP's comment letter of April 24, 2012 and have addressed their comments as follows. 1. The property lines were labeled on the SSTS plan. 2. The septic tank access covers were shown on the septic tank detail to be 20 inches minimum. 3. The driveway was relocated to be 100 feet from the watercourse. 4. The proposed driveway was labeled on the plan. 5. The watercourse was labeled on the plan. Ve truly yours Roy A. Fredriksen REBECCA WITTENBERG, RN, BSN Public Health Diredor — =`- ROBLItT MORRLS, PE Director ofEnviromnedd Health April 24, 2012 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Ezecudve Re: Proposed SSTS for North Country Homes Lot 412 — Gramatan Assoc. RS (T) Patterson, TM 34 -2 -57 With reference to the above referenced project, please find a comment letter, dated April 24, 2012 from the NYCDEP. ... Upon completion of the above, and the submittal of revised plans, this Department will continue its Kindly advise us if there are any questions. Director of MJB:cw cc: D. Alderisio, DEP • I �- •.._.._:_.. .. �. .. _ _. _ _... �. ... ..._ � _ ._.. .. ._.. .. v.... -r0- ..-... . -_... ->.... ... ,.._ .. .._ ..... .__ .. 1 Protection. I April 24, 2012 Carter /L SbicMamd, Jr. Michael Budzins1d, PE. COMMIssioner Putnam. County Department of Health 1 Geneva Road Brewster. New York 10509 -Paul V. Rush, RE Deputy Commissioner Bureau of Waber Supply prushadep.nyc gov 465 Columbus Avenue Valhalla, New York 10595 T. (845) 340-7800 P (845) 334 -7175 Re: North Country Homes Lot # 12 — SSTS Fields Corners Road, (T) Patterson TM # 34 -2 -57 . Middle Branch Reservoir Drainage Basin DEP Log # 2012 -MB -0219 -DJS.1 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on April 19, 2012, is incomplete. The Ifollowing information is required before the DEP may commence its review: • Label the property line on the site plan. Provide a detail showing the septic tank cover a minimum of 20 inches. As the driveway is within 100 feet of a watercourse, an Individual Residential Stormwater Permit (IRSP) may be required to be submitted to DEP for review and approval. Please contact Mary Galasso at (914) 773- 4440. �, bel the proposed driveway on the site plan. site- plari.. _. If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2010. c: Pamela Young, NYSDOH Sincerely, (-t " A'44�' David Alderisio Associate Project Manager Wastewater Design Review mi Environmental Protection April 24, 2012 Carter H. Strickland, Jr. Michael Budzinski, P.E. Commissioner i Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Paul V. Rush, P.E. i Re: North Country Homes Lot # 12 - SSTS Deputy Commissioner Fields Corners Road, (T) Patterson Bureau of Water Supply TM # 34 -2 -57 prush adep.nyc.gov i Middle Branch Reservoir Drainage Basin DEP Log # 2012 -MB- 0219 -DJS.I 465 Columbus Avenue iValhalla, New York 10595 T: (845) 340 -7800 F: (845) 334 -7175 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on April 19, 2012, is incomplete. The following information is required before the DEP may commence its review: i • Label the property line on the site plan. • Provide a detail showing the septic tank cover a minimum of 20 inches. 0 As the driveway is within 100 feet of a watercourse, an Individual lResidential Stormwater Permit (IRSP) may be required to be submitted to DEP for review and approval. Please contact Mary Galasso at (914) 773- 4440. ! • Label the proposed driveway on the site plan. - - • -,Label -the wateicotifse'bn the -site pldh. ' - - ' .. -- - -- _. - If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2010. Sincerely, David Alderisio Associate Project Manager Wastewater Design Review c: Pamela Young, NYSDOH PUTNAM COUNTY DEPARTMENT OF HEALTH .N-.- IRONM N.TAL..H.E ALT.. _- .EItgy LETTER OF AUTHORIZATION RE: Property of Located at I=i gLOs (r4, S 9-�Ar, ' T/V F'igTTifZ_<�ohL Tax Map # 34 Block 2. Lot ' -7 Subdivision of C7 P_14m 4,x44 4goc� -s:mc -sS G. �✓ l v�c°P�n`'"T C�'`{� Subdivision Lot # % Gentlemen: Filed Map # Z� Date Filed This letter is to authorize 4 -x a duly licensed Professional Engineer aim Registered Architect to apply for the required wastewater treatment and/or water supply pen-nit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and.to supervise the construction of said wastewater tretment and/or water supply systems in . con %rmity.with,the - provisions ofArticle 1.45- and/or 147_ of the Education Law, the Public Health___4 Law, and the Putnam County Sanitary Code. Countersigned: P (21 .E., R.A., # 0 Mailing Address P© Igo X 96-0 State _Zip Telephone: Very truly yours, Signed: — (Own r of Pro erty) d Mailing Address: /So '10®o k*wx ST 'G4g:i"d wt? ►-� ��� n State �. Zip Telephone: / I� 2�c� -- S 34& romi LA-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR _ -F- PROv .A.T, -vF: n� -tN A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 144=, Z rl� y 0,i I- y tOi►'lc".,S 2. Name of project: 3S.,'.nb 3. Location TN: �y 1 F F-.sof'[ 4. Design Professional: Roy 5. Address: PO f3 ox. q�S- 6. Drainage Basin: _44AL 13�rg1c� P) 9 7. Type of Proiect: __,Clsrivate/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ................................................. Type I Exempt 9. Is a Draft Envirormer_tal Impact Statement (DEIS) required? Type II Unlisted y r 10. Has DEIS been completed and found acceptable by Lead Agency? 11. Name of Lead Agency r-- 12. Is this project in an area under the control of local planning, zoning, or other. - officials, ordinances`?- ................ . - . - -.- 13. If so, have plans been submitted to such authorities? ........ ....:.......................... S 14. Has preliminary approval been granted by such authorities? * Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water _groundwater 16. If surface water discharge, what is the stream class designation? ..................... 17. Waters index number (surface) ...... ............................... 18. Is project located near a public water su y system? _ ....... ............................... Flo 19. If yes, name of water supply Distance to water supply -- 20. Is project site near a public sewage collection or treatment system? ................ c� 21. Name of sewage system ---- Distance to sewage system 22. Date test holes observed 10/2(0/00 23. Name of Health Inspector 504-"47R64" 24. Project design floe s S/� o JK (ga lons per day Qv i��asai ....... ............................... ........... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... p 26. Has SPD ES Application been submitted to local DEC office? .................. 8/99 Form PC -97 2 Is an onion of this proj ect located within a designated Town or State wetland loo 27 y p — 28. �dvetiands 1D NutnL�............. �t required? ............... ............................... 29. Is Wetlands Perm q ............................... orLow-al DEC- office. •••••••••••••• .......I......... Has application been made to Town Disturban:.e Permits ........................ . 3G. Does project req�aire a DEC Stream + location of 31. Is or was project site used for agricultural activity hazardous waste disposal, pesticides to orchards . or other crops, solid or h Yes/No l�-o lication or industrial activity? ............................ ...••••• •••••••••• landfillind, sludge app - 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site y .... Yes/No other potentially known source of contamination? .............................. ... . ...................... DESCRIBE: ' Teem or Village? ......................... 3?. Is there a local master plan on file with the g 3 community water and/or sewer facilities planned to..be developed within •e comrn r 1-40 5 years in or adjacer_t to project site? ................................ ............................... _ • I %l o 35. Are any sewage treatment areas in excess of 15% slope. ................................ ••••• a � 4 Block 2 Lot 7 36. Tax Map ID Number .......................... ............................... M p Applicant ✓Desig_Z Professional 3'7, Approved plans are to be returned to ..... Pp — �- _•. _ _..M to be located withn tr�e rTYC Watershed shall NOTE: All applications for mvievv Gci3 :.°yyl�� -• =�_ = nPUT - may require be sent to the Department, and need rot be sent in d�:plicate to the DEP, although Pi°e project a shed may also hin approval of the SSTS prior to final approval by the Department. Project :eauire DEP review and approval of other aspects of a project, such as stormfs fora su h or the activiries from impervious SI aces, and the project applicant should obtain the appropriate DEP and submit those forms to DEP for review and approval. If the application is signed b;� a person other than the applicant shown in Item 11'�with this application roves o be accompanied by a. Letter of Authorization (Form LA-97). Failur� to comply may be grounds for the rejection of any submission. �na1 o er u , that information provided on this form is true I Hereby affirm, under pe ty b J rJ' to the hest of rr�,� &no�vledge and belief. False statements made herein are, pur��'hAble as a Class A .- isdemeanor pursuant to Section 2 5o th enal La x.. SIGNATURES & ®P'FICUL TITLES: PO J2 % Mailing Addfess :.... ............................... ?.. :t • , ... P. Notes t, Tests. to tie repeated at same depth until approximately equal percolation rates are :otitamed` at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg 1 of 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: !v 012-1 q C-0 0A P % 1"0OICS ,- �lc Address: %6-6 7'01KIA 114 UJC ST, yo2KTbw� ��yTs Located at (street): Flg'GOS (Soi2NrzRS X2640 Section: 34 Block Z Lot s 7 Municipality: Rq T -faes© k( Watershed: Hf 001e- ,99A11c14 SOIL PERCOLATION TEST DATA Date of Pre - soaking: 5 "Z`° -! D Witnessed by: M14 9aL 13c�� i�lski Date of Percolation Test: S ` Z7 ^10 Hole No. Run No. Time Start— Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop Water level drop in inches Percolation Rate min /inch — i _64 2: 03 0 2 2 c3 L:16 fS 20 `¢ =? 3 ?_:/2 Z-'36 ?_0 2 5` 4, 2 :3 Z•.-6 22 2r-- 93 7.3 5 :ov 3:2 2 20 2: - Z 1 I : 5" Z: i i 14 2-0 Z3 4 b 2 '2'1 L Z.' 3 i 7 Zo 23 3 3 4 2:32 Z"5¢ /a 20 23 3 !a. O 5 ` J 1 �r�p •7,o 2• i � ,( �I ,( // 2 ( 4 3-5;_ 2 2: 3 0 t o 21 ? 'LSD S. 3 :3 Z:I; ij L .3 4 2- 53 ./ 2- 2 2d o 5 1 2'ao Z i.7 17 22 2 2 i 2: 2,3 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH - HOLE NO_ G HOLE NO HOLE NO HOLE NO HOLE NO G.L. 0.5' 'VOP ' OP So, L ine, S4 n .o 1.0' 1.5' Rgc> or ✓1 arh 2.0' Snd It SI(' 2.5' 3.0' 3.5' e lbw 6rq line- Sond 4.0' -some, slit- 4.5' 611 Urz- orti /O C @G Ile S fio 8 5.0' So n0l i & I T-- '(�r►� �/IGt 6e lv w 4-.9" 5.5' ' r4 Ge VzW4 6.0' rb o co&3 /C-s `fo 6.5' 7.0' 7.5' _ 8.0' 8.5' _ 9.0' 10.0' Indicate level at which groundwater is encountered C9 e— Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: gDA w2S1"e-1 Gc 11 h ti Date ol26& o ,Dod `fes`rs Con dvcj eJ Cif Mn kssacg, L1- P Design Professional Name: F4o sa^( Address: PC9 60 � tJ-Y 1054f T a� z $, Signature: a = Wd L I ddb Design Professional = Seal REBECCA W1Z°l' WBERG, RN, BSN Public Health Dfrector - 1tOBERT 1VIORRLS, PE Director of Enviromnental Health DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 16, 2012 phone # (8457 808 -1390 Fax # (845) 278 -7921 Roy Fredriksen, PE PO Box 950 Mahopac, NY 10541 Re: Complete Application Determination for North Country Homes Inc. Lot #12 - Gramatan Assoc. (T) Patterson, TM 34 -2 -57 Middle Branch Reservoir Basin Dear Mr. Fredriksen: MARYELLEN ODELL County Executive The Putnam County Department of Health (Department)'has determined that the above referenced application, including fee, and received by this Department on April 12, 2012 is complete. The Department will notify you by May 6, 2012 of its determination. O The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑x Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10' days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department--of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808=1390 ext. 43148. MJB:cw t REBECCA WffTTENBERG, RN, BSN Public Health Director ]EYOBERT IVICDRRiS; P� Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MAP-YELLEN ®DELL County Executive TO: NVCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW Ate: �A� F A Llac 0-1 Sl r7 FROM: M II� rc�JUZI/I�S�I DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT ICE VIE New Application'y Renewal 11 A LOCATION: c M TOWN: ? SLTB'D APP DATE -Z6- a l NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner or Croton Falls Reservoirs. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. 7K Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992 ❑ Design flow greater than 1,000 gallons /day. ❑ Commercial SSTS. JOINT REVIEW j I L, -_. .._ PUTNAM COUNTY DEPARTMENT OF HEALTH` .s DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: . Address: Located at (street): �� � � TM # Section: Block Lot Municipality: (zn4 ;�- . ` �— Date of Pre -soy dng: .2011 1740 Z11 5C 1 Watershed: SOIL PERCOLATION TEST. DATA Witnessed by: � r Date of Percolation Test: �) . Notes: 1. Te: is to be repeated at same depth until approximately equal percolation rates are ob iined at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch). Al. data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg 1 of C �i zy 3> V/ .0'3 3Z / t� i Water Percolation— i - level drop Rate in inches min/inch ELI■ 1 ���7■�rri , 12,E •its/ � - I��r.'ii ' ^I� .�.i �j:�/!i�� -- 1►L MPH Notes: 1. Te: is to be repeated at same depth until approximately equal percolation rates are ob iined at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch). Al. data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg 1 of C �i zy 3> V/ .0'3 3Z / t� /Q Jr' CA V, O C4 I� I� 1 f l i jjss f000 � 9 4�. 5 a+ G i' Dwelling 3 ?�,EoiLoc M Elov. 641 is 1 V>9.09',2?"' l r f78. 35' 11 �Z0.83'56p A' 1 R ;y I. -S FIELDS L 3 !0 3l0 -32 -G 48' 43-6 10 132- 401 L