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HomeMy WebLinkAbout1500DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -42 BOX 14 r` In L 6T6 r -. - �116. � = Its �. 01500 Re 86 " PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Healtb Se vices, Carmel, N.Y 10S12 EngineerMastProvide P44; -85 r \Cn1 P C.H D Permit o �f! 17 T P a t t e.r s on Y� .. t _ Located at Bul let - H61e Road Tax Map Owner /applicant Name 'Michael Finney Formerly Perez SabdlvlsioaName8`tt nehedgeSnbdv. Lot N '3 Mawng.Addrrese 76 Entrance Way, - Mahopac NY 10541 Date permit Issued .- ,5/21/'87 Separate Sewerage System balltby D_E.W. Construction'. Inc. Address -Box 847, White Pond Rd.., Stortnville,N' Consisting of `1000., Gallon Septic Tank and 300.': -X24" •wide. X 18 ". deep laterals 12582 Water Supply: Public Supply Fions Address or. % Private Supply Drilled byAlber Hyatt & Sons . Address Rte. 311, Patterson; NY 12563 Frame Has Erosion- Control Been Completed? a r e qu i s red Build" Type , . . , .. Number of Bedrooms Three Has:Garbage Grinder'Be-en Installed? No :. Other Requirements R =0 B . F.i 1. Section: 140 + ,cu,. yd-s . x 18'.' deep (3000 s.q. ft .) I.certify that a:he syetem(s),.as listed serving'the above.premises` were aonatracted.esaentiblly ' as shown on;tfie plans'of the completed.work ( copies .: of which are attached) 'and in agcordance, with the standards .ruleE and raga ations, in accordance 'w the filed plan, and the permit :issued by the Putnam Countye Iimenb Of ilealth. Date Certified Addraa RD9 .Fair St Ca "e1, ...NY .._ 10512. ueense no. 29206 , Any person occupying premises served by the above "system(s) shall.,promptly ',takb such action as maybe necessary to secure the correction of any unssnitary conditions' resulting from" :such ;usage.,' Approval; of, the :separate - sewerage system shall become null and void as soon is. a pubt'= sanitary sewer becomes avaikDle and the approval of .the private water supply shall become null and' void whera,a public .water -supply becomes available. Such, approvals are subject to modification or cc /haange /w /hen,([i�nl t tjro )udyment of the�6mr'nisiioner of Health, such revo ten, modltication or change Is necessary. Date cl II. IV. V. VI. ' ME OfIowe ! FINAL SITE INSPECTIO 'Date ` ^ I spected b WCO �Z,A . # IM # OR SUBDIVISION LOT # - 1 _......._....._.,. _...._ . :._...: _._ YES NC j , CO VENTS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans 0 I b. Fill section ate of p nent I V 2:1 barri LGTH WIDTH �1 AVG.DPTH� �2 i c. Natural soil of stri d.* Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10 minimum► fran foundation d. No 900 bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost — 3. Minimizn 2 ft. original soil between box and trenches f. JUNCTION BOX --'properly set g. TRENCHES 1. Length required - Length install - 2. Distance to watercourse measured_ ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for on, 50% 9. Size of gravel 3/4 - 1 diameter 10. Depth of gravel in tr ch 12" minimum 11. Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size- of pump chamber _ - 2. Overflow tank 3. Alarm, visual /audio 4. PLunp easily accessible manhole to grade 5. First box baffled -� 6. Cycle witnessed by Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as per approved plans b. Distance fran SDS area measured _ ft. c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled c. All 2ipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall rotected & dir.to exist.watercours •--- 0.1001 g. Footing drains discharge away from SDS area h. Surface water protection adequate i. Errosion controi provided on slopes greater than 15 %. 10 -t A C, WELL COMPLETION REPORT ij Office Use Only CIO DEPARTMEN'l: UY HEAL•1i _Envirorimental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH V" WELL LOCATION WELL OWNER STREET ADDRESS: TOWNIVILLACIR111 W'GRIO NUMBEk- IV &Net- kLde &crJ - 2:,&6�ensvol 1A11: ADDRESS-. -ATE -a ry-w- w4v , PBIV el 76 AG-6 �r,,PUBLIC USE OF' WELL 1 - primary 2 - secondary _V RESIDENTIAL 01UBLIC SUPPLY ❑ AIR/COND. /HEAT PUAP 0 ABANDONED 0 BUSINESS ❑ FARM ❑ TEST/OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT S gpm./NO. PEOPLE SERVED �/ EST. OF DAILY USAGE A-6-4) gal. — REASON FOR DRILLING NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑ TESTIOBSERVATION ❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH cl r_0 ft.1 STATIC WATER LEVEL __16a ft. I DATE MEASURED - DRILLING EQUIPMENT ❑ ROTARY P(COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 911OPEN HOLE IN BEDROCK 0 OTHER . TOTAL LENGTH —xia— ft MATERIALS: VSTEEL ❑ PLASTIC 0 OTHER..., CASING LENGTH .BELOW GRADE 2- ft. JOINTS: 0 WELDED THREADED 0 OTHER E' DETAILS —DIAMETER —in. SEAL: 19 CEMENT GROUT ❑ BENTONITE 0 OTgHER WEIGHT PER FOOT Ib./ft. DRIVE SHOE: YES ❑ NO I LINER: DYES NO NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED'. FIRST . -O. YES: QN0 HOURS SECOND GRAVEL PACK 11 YES 0 NO GRAVEL SIZE DIAMETER OF PACK in. TOP OEM fL BOTTOM I OEM it. WELL YIELD TEST If detailed pumping pFHOD: 0 PUMPED 1 tests were done is in- lb COMPRESSED AIR formation attached? 0 BAILED 0 OTHER OYES 'ONO 1p It more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. DEPTH FROM SURFACE wale, Bear- ing Well Ora- m tef ine FORMATION DESCRIPTION WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD 9PM- d Lan Suriall Ft# --.1 Flo WATE)I iVCLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE X CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY DEPTH MODEL S�- -,Z- 1 44- VOLTAG42,_8e2HP_,T_ WELL DRILLER NAME DATE 7 Vim" ADDRESS SIGfff(TURE P0_-#eLr5nM 0 N. Ad&— ING ADD.R,ESS. 13FECALCOLIFORML COUNT M.F.T 0 FROZEN DESSERTRLATE COUNT 7 a:*.c�o 43-.-b 9, 1 -n'., 'ROBINSON 0'0 09 LANE, R.-D.6 L 1�AI?P[Nd'ER P�� _'S L 'N N.Y. 12590 SMPLE N A o. (914) 221 4 5 L 1w - DATE RECEIVED A� bb k9 SS: . - -A - -HE L T-, DER-T. K ING ADD.R,ESS. 13FECALCOLIFORML COUNT M.F.T 0 FROZEN DESSERTRLATE COUNT _V . - -A - -HE L T-, DER-T. K PU NAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIROi�rAL HEALTH SERVICES Michael Finney Owner or Purchaser. of Building Owner Building Constructed by Bullet Hole Rd. Location - Street Patterson Municipality Frame Building Type 79 2 11.2 Section Block Lot Stonehedge Estate Subdivision Name 3 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM 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 whe '0- the failure to ope rat e properly - s' 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 Director of the Division of Environinental 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 the system. j Dated this 1p day of June 1987 Signature /'- Title. General Contractor Owner) Signature Corporation Name (if Corn.) Corporation Name (if Corp.) w Address rev. 9/85 mk �- 74/. Address tj ENGINEER TO PROVIDE, PERMIT # f ie PUTN AM : COUNTY DEPARTMENT OF HEALTH oN cERr F I cAT 0 0 ,P L I ANCE Division of ',Environmental .'Health Services, Carmel N .. Y 10512 PERMIT.- —� �CONSTRUCTSON PERMIT FOR SEWAGE DISPOSAL SYSTEM T Patterson o c - Town Bull:et`'iiO.le -•Rd -• <— - •hTexo,,MaP Block cut 'or illa9 79 2 .1 23 Located Subdivision StoneHed �e Estates File_ �i`178 d t n 3' Renewai ❑ Re4ision ❑ n}LkS n -9 j79 a a Perez, �r opolitan Ave , Bronx,: Owner /Address Date of- Previous Approval Modular 1 98? acres `Fill'Seotion Only Building -Type Lot.Area: Three 600 D Notification Required yeS ,Number of Bedrooms Design Flow c /P /u.' P c ".• Separate Sewerage` :System to consist Of . : 1-60 Gal Septic Tank '• and ` 300 �` X 24" :Wid'e: laterals To be constructed by Address' Water Supply: 'Public Supply From X Private-- SuOoly to be drilled by - Address < R -0 B Fill Section:. 3414 sq: ft .: x 18' -' Deep (1'56 cu, 'vds ) & 5 r d ep curtain- drain' Other Requirement; �— `l represent that I'am wholly and completely responsible for the desighand location of `the" proposed system(s):.•1) that the separate sewage, disposaI..system above. described will be constructed as shown on the- approved'_amendment thereto and in accordance with the standards,.rules an regulations o e, 'Putnam County . Department of Health,, and Ithat on,Completion thereof a 'Certificate •of Conitruetion Compliance'. satisfactory -to the Commissioner of Heimthwill be. submitted to, the_ Department; and, a, written'_gua►antee will be ,furnished the owner his successors, heirs or assigns by 'the builder. that said builder will P' 'in ,good operating_condition.`any, part of said, sewage disposal system,au ring , the wl'bd of.two,(2) years immediately following the date of 'the issu- , that the drilled well. described above ante. of the approval of the Certificate .of Construction Com Hance:.of the; original ,system or any repaus thereto ' ) :will be locatetl as'shown on the approved plan.and. that said well will be, installed ,,l accordance :w¢h the'standards; rules =and .regu, a ons `of the; ;Putnam, County Department_ of Health ;Date 14 AugitSt 1985'­,_ .5�gnetl r' PE. X R.A. RD9 Fair St Carm NY 10.512 29206. i Address > > License, No. APPROVED FOR,CONSTRUCT10N- This approval „expires one yea►.from the -date issued unless construction of the building has been undertaken and is . ievo'catile for Wuse °or may ame "nded;or. modified whery,co id tl necessary !by th omm�ss oner,.of Health., Any than alteration of construction requires 6 naw perm�t.1A�p/p1Croved for disposal of d'omast c' dary', wage; and/ r'p wa water d�pply, only. Date 9 ^IA V " ;BY' Title _ DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATI'ON•,T0''-°CONSTRUCT -A---WATER WELL - PCHD PERMIT~ WELL LOCATION. Street Address Town Village City Tax Grid Number 1011;\ CA Name Address Private WELL OWNER Address: 4: .' _ .,. �� . ,C�• 0Public: USE OF WELL RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 1 - primary ® BUSINESS O FARM O TEST /OBSERVATION O OTHER {:specify, 2 - secondary ® INDUSTRIAL M INSTITUTIONAL O STAND -BY sE [ f []ON REAR OF THIS APPLICATION ON AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE t gal REASON FOR rUr9EW SUPPLY 'OPROVIDE ADDITIONAL SUPPLY ® TEST/ OBSERVATION DRILLING 13REPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL DETAILED `= REASON FOR = TO CONSTRUCT A WATER WELL DRILLING This permit to construct one water well as set forth above is granted under the WELL TYPE La DRILLED ®DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO- FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 1r--\ V i Address: 4: .' _ .,. �� . ,C�• IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY `- - - DISTANCE TO PROPERTY FROM-NEAREST WATER >MAIN•t - - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED sE [ f []ON REAR OF THIS APPLICATION ON SEPARATE, SHEET n (dAte`Y (`sign 461rea�l 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 e Health Department. Date of Issue: 19 Date of Expiration: �: -:�/ 19 Permit Issuing Offi cial , Permit is Non-Transferrable 8/86 PUTNAM COUNTY DEPARTM�+ OF HEALTH DIVISION OF ENVIRONMENTAL; Tj HEALTH SERVICES COUNTY OFFICE BUILDING, CAR(, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISP(; AL SYSTEM FILE NO. Owner Peonez Address; 8 ,,f (.+ -oej Located at (Str&et Block 2- Lot 11, indlca&A. nearest cr-Q-rs. HFFETJ 5;,6 Municipality (2 Watershed d So om crbz- 11 SOIL PERCOLATION TEST. DATA,REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Numb e r CLOCK TIME PERCOLATION PERCOLATION Run Eiapse. Dep o Water Water Levei 'No. Time Frqp ,Ground Surface in Inches, Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inchas, Inches Inches — - 2 78,41 Q�trA"-a 3 .4 2 3 4 5 11110 IIIS 21118 k&* - -3 46 (t . - 4 74 2 Notes: 1) Tests to be repeated at same depth until ijpyjpoximat �q.� ; equal soil rates are obtained at each percolation test hole. a-ta::to e submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTEPM IN TEST HOLES , DEPTH HOLE NO. HOLE NO. HOLE NO. 611 12" 18" VIA 3011 36 fl 4 it 54 AV 60° 78',.. 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY eewc.(J.1d.(j� .. Date 8 g� _ DES SIGN Soil Rate Used -8 °16 Min/1 "Drop: S.D. Usable-Area Provided No. of Bedroo�zc T re Septic Tank Ca pacity Gals. Type' Absorption Area -Provi ed By. oo L. F. x2 " jam- width, "trench. A� F Csr�� Oveni•v ; .Other I- . Name JUKN M. 1' 1J R09 FAIR ST 914 -878 -517" Address CARMEL, NEW YORK 18512 nn THIS .SPACE FOR USE BY HEALTH DEPAR F 'bNT2y'4°1O �F rHE ST�t�O Soil Rate Approved Sq. Ft /Cal.. ed by Date A be submitted to the :Oepartment; and a written' guar ►t of Baca s ( place '.in. good operating - condition any 191 the,-approJai of tfie_ Certif�cate'of Consfiucti will be loeated,as shown, on the approvetl plan and that l:ounty Department of .Health. _� o.ee, 1.;1 May 19.87 ' Address RD 9 F APPROVED. FOR CONSTRUCTJ_ON This approval ?exp reJocable for. cause "or.,may be.amended or: rnotllliied Wh requires a, new• permit. Approved for disposal of,;;do Rev. Ellis/ 1/87 Oats .11 B on GOmpliance of'.the.orig said well will be installed ,jry Signs . air.. :Street ri ires two years from the dal en cons�deretl,necessar.y. `by mestic'samtary'`•sewaje •ane yam.-= L---- -=.��� vner, his successors heirs or assigns by. the builder, that said budder will i,the period -of two (2)`�yaars immediately following the'Qate of the-iisu , 1 1 system or any repairs theisto; 2) that the 67illed well descritred above it - - :ordance wh t e; sta s rules and iegu a ions of the Putnam ' - P.E.. -X— R.A. .. 29206 issued unless- construction of the- building has been undert aken and,is is Commissioner of Health. Any change, or alteration of construction r "Drivatewier su pl?IY only. t ___i�" Title PUTNAM COUNTY: DEPARTMENT OF: HEALTH � 7Rev. 3/86 Dlylsio i of Environmental Heath Serylcee: Carmel N.Y. 1051? S eer ��de Permit p on CERTIFICATROF COMPLIANCE `. CONSIRUCTION,PERMIT FOR SEWAGE DISPOSAL' SYSTEM Permit q �f-'f= Low .tfd at a ( 1 e- Q - 14r. to e4 Town or Vulage Subdivision Name 0 �ubd. Lot q " Block Z Lot pp AA ']Renewal_ Revielfin Owner /Appllceat Name ' i•'1 i`�l� �{L' i ' "�� � � ` . `' Date of P/r�evdious Approval MaWngd I C e ��i -lf Town Address �—: _ ..: —r -1-T� Building Type t Lot Area .Jf -E FW Sectlon Oely DepttiVolume Number of Bedrooms 66ill a Flaw G /P/D t PCHD Notlflrstlonds Regtdtred When Fill le completed $eparate Sewerage System to conaiet of on Septic Tank ena ©a_ To be consiructed by 1V A P8^ Addeees Water;:Sappij Ppbllc Sppply From Address or. Private'Saatppp -ply DrWed by — Address Other Requirements '`� f3 G�i 1 C' ®1�,:. �Ti represent the 1 am wholly and completely responsible for the design and location of the. Droposed sy te`m(s) 1) that the separate 'sewage disposer system above described w41 be constructed as shown on the approved amendment thereto and m, accordance wdh''the standards rules, an regu a_ ions o a , ,u nam Counfy Department of :Health 'and that on completion thereof a Cerfitcate of ConstrucLon Compliance' satisfactory to the Commissioner of'Healthwill Pe :.submitted -to, the Department and a wntten guarantee will be furmsnetl the owner „his wccesso►s heirs or assigns by:`fhe bwider that said'.Duildar will place in good operating :.condition any.•part of said sewage.dispbsafsystem during the -- period of two (2)',gears inroad iately follow ing'thedate of the 1 - ance of the ,approval• of, the Certificate zof Construction Compiiince,of he"originariystem or, any repairs thereto; 2) that the -drilled -well: described above Will be locetedas shoWnon the approvadplan and that said well will beinstalleft accordance with`' the ndards rules an0,`ragua. -ons of : the Putnam County Department of Health ii S P E • A.A. — Date Z. �� igned l� Address $ Licenser No�.LFca f� APPROVED FOR CONSTRUCTION This' oval expues one year from the date Issued unless construction of the building has been undertaken and is revocable for cause or maybe amended oiniod fied when cond dered necessary, 'try the,-. Commissioner of Health. Any .change or'alteration . of construction reouiies a new. permit. Approved for disposal of !domestic %sanda►yysewage nd r, water, su ply only: ” Date rte fp Title qV M PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIROIMIML HEALTH SERVICES INDIVIDUAL VWTR SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS .. ...:._. _ _ FIELD= INSPECTION REPORT / DATE: 12,04 41 INSP. BY: (Name of Owner) �, 2 _ (Street Location) INITIAL SITE INSPECTION % ` 1,:- .. ".... YES NO — =- Wetlands -on/or proximate_to.property. Property lines'or corners - found..:........: .... Can e' stimate house location .....................,... Willriveway need cut ............................ _ Must trees be removed - note these.................' Deep holes representative of entire SDS area......' Additional deep holes needed ...................... t Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D. H. 1 Lot Depth to G.W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft D. H. 2 Lot Depth to G.W. Depth to rock Soil Descri ptic 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 5011 Vescr DA'L'E: FINAL SITE INSPECTION INSP.BY: YES NO C 1MENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded........................... :.. 10 ft. maintained fran property line and 20 ft, fran house...... ...................... Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft, frcm nearest trench.. ........... 15 ft, of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. /7- IQ 'Ilk 0 o J 01 N Oti Uy(�P -b L4, e" -0 oL, .� > n, d- `I' SoI l01 Fi G If-LrztloN u I� /76'271 \ kk ��. I GXPPOi�hiora N 0 I el A yut+lam l;ounty Lepartmeilc ul neall& 14vt8i.on of Environmental Health Serviose Approved as noted for oonformanoe with .applicable Hulee and Regulations of tho Put em (101AI Health Department., A Ti o j Ate AS BUILD, DATA.' tructure located trom survey by surveyor noted .below®___ ell located by: Surveyors survey.- Well Grillers report - Engineere mesurements 0 - -, - -- - - _ - nIt boxes, pros,gollones a laterals located by:(- .OMractor: Etng tneI I Hedlthdapt: Field inspection by: Health dept P I 'r-� _ ,po- uA I < L e? dl%p""al Sl':;rem WaS construe tf!d as NOTES: indicated on th- is'•plat, and Char the sYstevi w,ts inspected ted I" me Lfbre it was co -!r"d ever. Th" system was \ kk ��. I GXPPOi�hiora N 0 I el A yut+lam l;ounty Lepartmeilc ul neall& 14vt8i.on of Environmental Health Serviose Approved as noted for oonformanoe with .applicable Hulee and Regulations of tho Put em (101AI Health Department., A Ti o j Ate AS BUILD, DATA.' tructure located trom survey by surveyor noted .below®___ ell located by: Surveyors survey.- Well Grillers report - Engineere mesurements 0 - -, - -- - - _ - nIt boxes, pros,gollones a laterals located by:(- .OMractor: Etng tneI I Hedlthdapt: Field inspection by: Health dept dot e:— -(P 787 - lIWVv�rt Engineer Ksl date -4- :..a7 TI: IS Is i.C, l..r:II.C' Char: the sewragc; dl%p""al Sl':;rem WaS construe tf!d as NOTES: indicated on th- is'•plat, and Char the sYstevi w,ts inspected ted I" me Lfbre it was co -!r"d ever. Th" system was cnnsrrur -rvd in aecnrd:rnce with all ` Standard rules :n;rl r.�,ulsCions of the I' C.H.D. n D IMENSIONS A - B - - -- - - / N A - C =_17T 0'�r - C � -_v /__ A - F = r2 L y' Di/ B p n- A - to 77-- " 1j✓.r A K ' -- -- — -B - K d SANITARY SYSTEM DESIGN AS BUILT" LOCATION Street'. T Tow n:�/J��- ' ,o,e?ZO/-/C ounty1��J- �.QStdfe : >BDIV SiON:�%rS- �1�v- ! /ri'_ _s %~r.'7—v -Block'. -- _ _ LOT N4 Surveyor �7 Scale: / /=p /Job N4��2a, JOHN �H� PR ENTISS PE, CONSULTING ENGINEER, '