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BOX 14
01532
, .. ,. ,--• ",. aF77777---,
7777,:;%-. r .... ._ ..
PUTNAM COUNTY DEPARTMENT OF HEALTH
ReV.3/86 Dlvlslon of Environmental Health Services, Carmel, N.Y. 1051.2. Q
Engineer Must Provide P75-86
P C.H D Permit 0—'
--
CERTIFICATE OF STRUCTION COMPLIANCE_ FOR SEWAGE DISPOSAL SYSTEM T . Patterson
Town ar-Village ... ,.. ..:a^ ._
:Located at C l i_f On Court Tax Map--.;—, 7 3 Block 6 Lot 5 r
;Owner /appllcantName Key Realty Corp. Formerly SubdlvleionName=R:rrr1•iCk !ellul Lot, N. -5-
93 Gleneida Avenue, Carmel, N 10512 21'November 1986
,Mailing Addresslp Date Permit issued
Separate.Sewerage System bunt by Owner Address Above
Consisting of 1000 Gallon Septic Tank and 3175' x 24" wide x 1V Deep . laterals
Water Supply: Public Supply From Address
or: x Private Supply Drilled by R oy d G r t e s i lm n W01 1 ,� � Inc. P t n. 22, !' —pL 1�•05 1,2
Building Type Modular Has Erosion Control Been Completed? As .Required
Number of Bedrooms Three Has Garbage Grinder Been Installed? No_
Other Requirements Rtin of Rank- Fill Section- 39 "_deep x 4500+ $q Ft (5nf ± c u lugg i
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulatio a in accordance with he filed plan, and the permit issued by the
Putnam County Department.Of Health. ,
22 December 1986 a.e. X ii,A.
Date Certified by
Address R:D 9 - Fair StrPOt,.('a*TMe1�_IiTY 10512 License No. 292106
Any person occupying premises served by the above system(s) shall promptly take such action es may be necessary to, secure the correction of any unsanitary
conditions resulting from such usage. Approval. of the separate sewerage .system ftiall become null and void as soon as a pubt'_ sanitary sewer becomes
available and the approval of the private water supply`shail,.become null and void when a pu4lic .water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modlifirAtIon or change Is necessary.
Data`�0'G ? /�y By Titl��
a �c
F yV O
WELL L:vr1rLL11V`v rnrVE"
DEPARTMENT OF HEALTH
Division`Of 'Enviroiimen I3ea'%h °Se�v- ices
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADDAESS: WN)YI ! TAX GRID NUMBER:
N .T /64TT�l?SO.,`,I � /Td
WELL OWNER
ADDRESS:
rF REA L.TLJ _
$U!L o kmEp
PRIVATE
O PUBLIC
USE OF WELL
1- primary
2- secondary
XCRESIDENTIAL 'D PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED
O BUSINESS O :FARM O TEST /OBSERVATION O OTHER (specify)
Q INDUSTRIAL O INSTITUTIONAL O STAND -BY Q
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED _5/ EST. OF DAILY USAGE gat.
REASON FOR
DRILLING
)KNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH it.
STATIC WATER LEVEL it.
DATE MEASURED
DRILLING
EQUIPMENT
O ROTARY O COMPRESSED AIR PERCUSSION 0 DUG
O WELL POINT O CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING. WOPEN HOLE IN BEDROCK D OTHER F.
CASING
DETAILS
TOTAL LENGTH tL
MATERIALS: XSTEEL O PLASTIC O OTHER
LENGTH .BELOW GRADE fL
JOINTS: O WELDED XTHREADED O OTHER
DIAMETER 6—in.
SEAL: X CEMENT GROUT O BENTONITE BOTHER
WEIGHT PER FOOT:
Ib. /it.
DRIVE SHOE YES tp NO
UNER:OYES . NO,'
SCREEN
DETAILS -
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELOPED? .
FIAST
-
-
-
_
oM -olo z
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
OEM fL
610TT0111 .•
DEPTH H.
WELL YIELD TEST 1. If detailed pumping
'
METHOD: O PUMPED i tests were done is in-
COMPRESSED AIR formation attached?
O BAILED ❑ OTHER ;OYES ONO
WELL LOG it more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water
Bear.
Ise
Well
Ora'
deter
PoRMATION OESCRIPrtON
ft.
'It.
WELL DEPTH
ft.
DURATION
hr. min.
ORAWOOWN
ft.
YIELD
gpm•
Surface
/O
�n AlaAd ( -/
e a c
�5S
T-bTA ti
ail c/A. C_
-3 o eSc c� do e.
0
WATEA O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
❑ COLORED ANALYZED? O YES O NO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK:, TYPE
CAPACITY GAL.
PUMP IHF.ORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME ,6rnJ6 �� j 0
ADORESSLL �- , j `�77 SIGI We
)�
C
Structure located trom survey by surveyor noted ,below®- - - - - -
ell located by: Surveyors survey.-
FI'v'L �%Lr Well drillers report -- �__ .,• -- ` - --
4 Engineers mesurements.0_' - -- - - - _
.� Tank, boxes, pt4s, gallorles B laterals to -cared by:CQnfroctor:
Ehg tncsr .,.
ti
Health d¢.pt:
L 359•71 Field inspection by: Health deptig do f
�� � �•Zl1�L/a�� -i � �oIICZ�. � I ------- Engn na e r ® data :12 -��
;1 b iY i � 375' TO-t'c.l.. l _ m. ,. ; • . _ . -.
is:..•NU /, "o. d:. ,h 'this i, r.o :•v ri,fj�l 6hnr. [he sewage .
.'VS cunst.ructed ns
NOTES: indioat ed ...n rh isF �, inn and rhat nc�
w•:,s insl+ecj -'pd L% me berore it
\�
1,000 41A L" GJGP�IG- /,��„ - nl was cov—i2d ,vv, The system was
` p p �, coast rur Ced
ill nchurd:,nce With all
on � +`41 G'r• 111 � sCandard ninon uu {It rr:gu I a L ions, of
Q JU rJc Tlv rl
7 4� M Dl a the r+.v.s u.l
�
pox -(i �• � 1 �
3 � o vJ�l�LI 1^ ',
b DIMENSIONS
,
I - - -_
0 I 7 V A- B -- -- 7/ t rt
A _ _ j��j'_ !o g D '_ .���_
D
55,.E ��� h A J ---- - - - --B - j -- - - - - -- 69
IA K - - - --B- K `-- - - - - -- :t
I
chi SANITARY SYSTEM DESIGf "AS QUILT"
T OWry,ER:
Lb•'at-LWUIIL ui healLn d — -- -- — -- . -- --
nv:sion of Environmental Health Services iy LOCATION Street: --
Town:2,5? /�_�✓County:�1 /p14; State:
Approved as noted for conformance with `c� SUBDIVISION: C -
applicable Rules and Regulations of the p Ma V.- jgl"1����— - - --
C : -X� .Z-1 — —�
Putnam County Health Department. '�tl Block., _ LOT Nx
M•
6lanat „re X do . o' r m Surveyor T-
tc
Drawn: v Dote;�2_ /% -may Scole:�ii` ,� Job N$n,/
€� w
JOHN H, PR ENTISS PE-{', g
! frsrate4�” CONSULTING ENGINEER
-.:: RD `�, F�,� 1: CARMEL NY I0512- 1914 1 878.16170.
F.
-R
v..ns v r.rno vr�oanrr ar v . rc} ^un wmp�ouvn u�m wrap
De. "submitted to;lthe Department "and a written guarantee will Di % place, in good. operaGng`jconddion any. 'part o. said; sewage: 'd isp�
anCe • of the 'approval of ,the Certificate of `Constructwn Cornelia
..,0
will be'located -as shown o I the amovetl plan and thataard well.'wJIJ
:4 County.Department oT Health /1 "!
Oate r-140 > Srgna
Adtless�q~
,'•, -, APPROVED. OR CONST-RUCTIOlV Thu 5pproval expires o �e y
revocsDla for' use or y e amended or modified when cons er
requuai`a ''er A oveA for disposal of aomestic n i
Date � by
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YESI NO COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can.estimate house location .......................
Will driveway need cut ............................
Must trees be removed - note these..... ...........
Deep holes representative of entire SDS area......
Additional deep holes needed...... .... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics ............... ... ........
Access to proposed well location for drilling.....
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 Descriotia
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
Sou uescri Lion
0 ft.
3 ft.
6 ft.
9 ft.
12` ft.'
DATE:
FINAL SITE INSPECTION INSP.BY: IM YES I NO CC'S
House SSDS located per approved plan.. ........
Length of trench measured 'J
Width of trench average 7_
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. fran 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....
,es lot drainage appear OK in area of SDS.......
IAL GRADNG OF SITE ACCEPTABLE ..................
t/,
PUTNAM COUNTY DEPARIlME11TP OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
RL�,VIETnI. SHEET - CONSTRUCTION PERMIT _ -
__ b DATE REVIEWED,
BY!
( Name of Owner)
(Street Location)
OCU MENTS
)ermit Application
brporate Resolution
Ilans - Three sets
:ngineers Authorization
)esign Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
df-2-i e---
13
louse Plans - Two sets
I PWS - Letter
Fariance Request
ZBQUIRED DETAILS ON PLANS
)ewage System Plan
sewage System Hydraulic Profile - Gravity Flow
gill Profile & Dimensions. - Volume
or J Box;Trench /Gallery; Pump pit details
) eptic Tank - Size, Detail
fell Detail, Service Line if over
;onstruction Notes
)esign Data
two -Foot Contours Existing & Proposed
)riveway & Slopes Cut
?ooting /Gutter Curtain Drains
?erc & Deep Holes Located
Representative of Sewage & Expansion Area
�)cpansion Area;shown;gravity flow,suff. size.
If Pumped Pit & D Box Shown & Detailed
louse - No. of Bedrooms
Bells & SSDS's w /in 200 ft. of Property Located
?roperty Metes & Bounds
louse Setback Necessary (Tight lot)
louse Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
3EPARATION DISTANCES SPECIFIED ON PLAN
!Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
L5' Well to PL
:F:NF: L
Legal Subdivision
Subdivision Approval Checked
Ex-approval SSDS Adj. Lots Checked
wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
represent that I am an officer or e ployee of the corporation and am authorized
to act for >
having offices at
Whose officers a
President:
Vice - Presid
rporaion
w
Secretary:
(Name and Address)
Treasurer:
(Name and Address)
and that I am and will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subse s relating
thereto.
Sworn to efore me this day Sign
of ct 19P Title:
��y
Notary Public
EILEEN A. IEZZI
NOTARY PUBLIC, State of New York
Qualified in Putnam County
commission Expires March 30. 91
8/84
PU NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF HEALTH SERVICES
DESIGN DATA SHEEN SUBSUFACE S&gAGE .DISPOSAL SYSTkM.. ''FILE 10.7. -
Owner. Rea(-&/ ITC.. Address C H Co .b, )-5,g
Located at ( Street) &11 e'LL 4,. (e sec TN_ Block C Lot _
(indicate nearest cross street)��u�«�� ;feell4a+
Municipality (�4 `rr e r s a a, Watershed Cra %e h ,
SOIL PERCOLATION TEST DATA P30UIPM TO HE SUHMIZTED WITH APPLICATIONS
Date of Pre- Soaking III 13; Date of Percolation "Test 9 B 5
HOLE
NUMBER CLOCK TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water From
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start-Stop Min. Start Stop
Drop In Min/In Drop
Inches Inches
Inches
1
2
3
4 See No&A Mde_ - sAee -6 Z O-P 21
1
2
F4
.3
5 f _
NOTES: 1. Tests to be repeated`,at same, depth 'unt l approximately equal soil rates
are obtained at each percolatonk test *hole. All data to' be suimittod
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS IIMNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G. L. roD Sad
1'
2 �r
o.
3'
41 O � maw./-
5'.�s
61,
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING F.N000NTERED
DEEP HOLE OBSERVATIONS MADE BY : ®L��i,,, ��,�, ,� DATE:
Per- 54(re•6 2 of Z DESIGN
Soil Rate Used _ Min /1" Drop: S.D. Usable Area Provided POP
No. of Bedroans Septic Tank Capacity f 64)0 gals. Type Hasamnt
Absorption Area Provided By L.F. x 24" width trench
Other 19-A -A A: rl - "706 PO r4o,7 YjQ! - mew , an n %-of 2-
N JOHN H. PRENTISS, P.E. tore
R99 F:A;R EARMEL, NEW YORK 10512
Address
2 �p�
N . 06 $
THIS SPACE FOR USE BY HEALTH DEP
Soil Rate Approved sq.ft /gal. Checked by Date
___ J G W. 1 •1 V I•
haute ctinfolcrdcxnen/
pa o
VJe_
A 160V st
.r
Co J1 lalln j or drd/ Ao /tom
e 4 Jrgorer cl/cm.�fhon
i/ ---i he idc c�%�4 ( ?S min. /enq/hf
IY
`t ``
7�-�it
.,�I -- - 20 cfc .+ +• ;
OfES81ON41
tv
11LEO -W
F e
aI - ->
rd � r•,
� 1
"m
. u µ ;�y l -� 01 � /Z��- i✓ U GAS
1.
Pomeha Ise
4lnfUCedmcnlrlob
cc A
�.:jg -u2-oo 1o,�a -yo -tea `� 76. en•reau /,rd 9 mcrilt::o/
F�Q .46]
nl IP– N �'i P17
rop pipe,
Car /ng 0' "1 o tpie-...�.
o orevrer G am. fhvn I'- � �
- .�..�....5v ... . _.�,. - . _ , .._. e /do 4•iilno (75 �m.n. !erarn I
/ -• v ,, � IPucd/aa
I\ _
Nil/
/ZC�"' —�� �lA�'/ �^6(p ' •Gp�.fo I•�j ".; �meni �`._—
r�
T YPTG'AL
LoVt-= yv errr -Ji 11 j rCn,n PUMP
cement
IA
sN
l 11 \\ h i' p/ i c�oT r +r s' TYPICAt Sf CT1071
DAJZLED "WE'LL
Po
t -_ l \t \— � •s r �� t� N
I`�� � Ii. �� � � r •GOB- 1. ^ +.�. ry,E'�.^- ../Li:.2
�l73'z �4'-
3.^'G —r�,Z >,�;d7 574 ro�oFS•25 "l eta-
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f,74
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PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev'. 31 86 I, Division of"Envbvnmeutal Hesltb Services ICY.'
10512 g1n vide Permit q
-on CERTIFICATE O OMPLiANCE `.
Permit
CONSTk6hoN PERMIT-FOR.SEW DISPOSAL SYSTEM
T Patterson
- Locates "at " C l i f ton.: Court 'Town or'- vinage - -�-
Burdick 'W' ods _ . s - - . - .__.....
Subdivision Name Subd. Let o 5
q _ Tai Map' 3 _ Block 6 Lot 5
Key Resit ,. Corp.
Renewal-0 Reylsion I$ i co; Compl.
Owner /Applicant Name y y p rTtr►t.-
' Date of Prevtoae "A p "Nil '" 2 6 S e p t ."A986
Meiling Address 93 Gleneida Ave.;. Town Carmel,Y , 105.12
o :v
1.742 Acres FILL ECTION' _ Oih L TED
Building. Type mn e t i 1 A r Lot Area" F Section Onl % . "
y Dept$r�_'Volume 500 Cu YdS.
Number of Bedrooms 'Three .. DesignFiowG /P/D.600 en Fill la completed
Separate Sewerage System to, consist of 1-000. Gallon Septic Tank end 375 .x 24" Wide. x..18" =Deep
Ui
To be constructed by Address
fir`
Water Supply: Public Supply From Address
Wells., Inc:
Or X Private Supply Drllled by $Odd Art e s i an--Address
`
OtherRequlrements R -O =B : Fill' Section See „'aboye In place
I represent "that I'am wholly - and'completely, responsible for the design and location o s f :the proposed system(s); 1) that the: separate sewage disposal system
above . described will be constructed as shown, on the app roved m
amendment there to and in.accordance.with the tandards, rules and regulations of e Putnam
County Department of Health, 'antl that on com"pletionthereof a .Certificate of Construction Compliance" satisfaitor'y to the CommissiOner..of Health will
be submitted to the• Department, and a•written.guarantee "will be'furriisherd the owner, his'successors..heirsor` assigns by. the bull tler. that said _buildIer will
place in good operating condition any - part -of "saitl "sewage disposal system. during the period of t"(2) years Immediately following thedate of the issu-
ance of the approval" of the Certificate ,of. Construction Compilance "of the original system or any repairs thoieto; 2) that the Grilled well described” above
. will be located as shown on the approved plan antlthaYSaid well will be'Installed,'in a • ' -dance with.'the standard "Wes and regu a_'ons �ot the. Putnam
County .'Department of •Health. - - - • -
Date 20 November 1986 Signed : P.E. X _, R.A.
Ada.e:: RD 9. - "Fair. Street, a ;, NY.. 1051 license No 29206
APPROVED FOR CONSTRUCTION: This appioyapezpires one year "from the date - issued unless construction of.the building, has been undertaken and is
revocable for cause 'or may be amended.or modified when considered necessary by tthe' Commissioner of Health. Any change or alteration of construction
requires a•n /e)w�perrriit. Approved'for. /disposal of. domestic'•sanitary. sewage; antl /or private or supply only. '
Date /' "'i�� /� By e /%
Yorktown Medical Laboratory, Inc
321 Kear Street
Yorktown Heights, N. Y. 10598
(914x245.3203
;o
Dire tor: Albert H. Padovm JAL T..(ASCP�
r /71
LAB I CA.OU35 6
Collection Station Used
Camel Peekskill _
Mt. Kisco Nev City __...
Date Taken:
Date Received: 2 4
Date Repor -t ed :
.Collected By: G II S
Referred By:
L Sample Sourc ,
LABORATORY REPORT ON-BACTER.IOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
YEMBRATIE FILTRATION TECHNIQUE (MFT)
Total Coliform Der 100 .m1
Fecal Coliform per 100 cl
Fecal Streptococcus per 100 ml
`COST PROBABLE NUMBER TECHNIQUF. (MPN)
Total Coliform: MPN Index ner 100 ml
Fecal. Coliform: MPN Index per 100 ml
OTHER ANALYSES
THESE RESULTS INDICATE THAT THE WATER SAMPLE.-(WAS) W 0 (NOT APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED,. AT THE TIME OF COLLECTION.
r
Albert H. Padovant, M.T. ASCP), Director
LEGEND
RDS • Recommend Disinfect -
ing Water Source
< • less than
TITC a Too Numerous Too
= Count
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO
Wetlands on/or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .........................
Will driveway need cut ............................
Must trees be removed - note these...............
Deep holes representative of entire SDS area.......
Additional deep holes needed..... ...... ......
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
0 ft.
3 ft.
6 ft.
9 ft.
'12 ' -ft.
Soil
r-
D.H. 2 Lot
Depth to G.W.
Depth to rock
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.
12-ft.
Soil Descr
DATE: Z
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
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. fran nearest trench ................
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
I/
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..
T id
FS
..1 .10
IIIflrwlNl
Of'f-W DE.CK
TI—IFiT —lilor -I-
6 a-
0
j—
FE
o