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HomeMy WebLinkAbout1608DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -81 BOX 15 1 rm go r IL . ly . a. . ir xt. VA T L IMF, . -77 PUI;NA* COUNTY DEPARTMENT A"R'TMENT Re 3186 Division of Environmental Health Services, 10512 Engineer Must P Provide dn -7 ' . P.C.H.D. Permit -7 IUMON COMPLIANCE FOR SEWAGE DISPOSAL iY9TEM 6'1% V; Owner/applicant Name Mailing Address - 4S S Separate Sewerage System built by V 161 Fl- t:4 rda j Consisting of f Gallon Septic Tank and I T VM or Village- T. Map Pik Bloc -2- Subdivision Name nbdv.16t # 3 Date Perml t . Issued S 9,0 Water Supply: Public Supply From Address I or:�, Private Supply Drilled b, !2r Address IR 14.1 49 Building 1�� 1 -c,-4 C- P— Has Erosion Control . . Been Completedt Y:ze Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were co ed essentially as shown on the Tans of the completed work copies of which are attached), and in accordance with the standards',.rules and r ns*, in accordancewith the f d p n, and the permit issued by the Putnam Cotty Department Of Health. P.E. -.!L�—R.A. Date Certified b gu Address License No.. 5 zx-12 Any person occupying promises served by the above system($) shall.p - ro rnptly,iake such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sew'iera siii I all become null and void as soon as a pubt,-. sanitary sewer becomes available and the approval Of the private water supply shall become null I . ,and.v'_ -w n a public- water supply becomes available. Such approvals are subject to modif cation or change when, in the judgment of the., o Is , nr' f ealth, such r tion modification or change Is necessary. Date By Title f I PU NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONiH TAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by xj, Fa r L-% i ( ke,� Location - Street Municipality GS l 41% IL 11 / - - - -- Building Type vr,,v It 2vel A G U Subdivision Name A- 31 Subdivision Lot # GUARAD7I'EE 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 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 Director of the Division of Environmental Health Services o he tnam County Department of Health as to whether or not the failure of the t to operate was caused by the willful or negligent act of the occupant of ui 'ng utilizing the system.. Dated this day of 190/ General Contractor (Owner) - Signature Corporation Name (if Corp.) M Address rev. 9 /ss mk Signature Title #a 1,14 a f9 Co ration y O 1 "BREWSTER LABORATORIES` . Box 224 - BREWSTER, N.Y. (914) 855 -1930 - WATER ANALYSIS REPORT - SAMPLE NO. 8165 TEST WELL SOURCE: Frank Galizia Steinbeck Hill Brewster, N.Y. 1050.9 COLLECTED: 10 - 5 - 91 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 10 -8 -91 0 per 100 ml. WILL l;UrrLr,11U11 MEXUlc1 Office Use Only DEPARTMENT OF HEALTH - - = Divisioii- Of- Environineiital := Health' -Se—fades -- - - - - -- --=- - PUTNAM COUNTY DEPARTMENT OF HEALTH SiRE�T ADDRESS: WN /VI / I Y TAX GRID NUMBER: WELL LOCATION Steinbeck Hill Brewster, NY WELL OWNER NAME: ADDRESS: LOY"3 I- Frank Galizia 45 Juniper Circle, Brewster, NY O PBIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary M RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING . ®REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ADDITIONAL SUPPLY []NEW SUPPLY (NEW DWELLING) DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 285 ft. STATIC WATER LEVEL 40 ft. DATE MEASURED 6/20/91 DRILLING EQUIPMENT M ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 31 ft. MATERIALS: IM STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 30 ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER 6 in. SEAL: 9CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT I lb. /ft. I DRIVE SHOE G YES ❑ NO I LINER: G YES ®NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST ❑ YES ONO HOURS SECOND - - GRAVEL PACK O YES O NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH it. WELL YIELD TEST pumping t If detailed METHOD: 10 PUMPED t tests were done is in- I • COMPRESSED AIR , formation attached? O BAILED ❑ OTHER YES D NO It more detailed formation descriptions or sieve analyses IELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- in9 Welt Dia- in FORMATION DESCRIPTION tooe it. it. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Land Ce 1 Drl ling in overburden clay & bl rs it rock at 11 285 6 265 7 1 31 Dri ling in rock,set casing,groul.ed 31 285 Drillling in rock granite, WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME P.F. BEAL & SONS, IN O ADDRESS PO BOX B 510,E) TURE Brewster, NY 10509 J /6V �" / • �1L'�L L l /] ' L ^�✓- -� by Tt CR r �riSiGl ICE _ :rte DISer.,�� ac=? c_ Eare lc---tai as per ar-mroyai v-7 nc b_ Fill Data cf- placT -zt G- ITZ ==11 Eci nc -t- rr'' SEE C_ .��.' ° , _. E =G_ C=-= .L.='� L .F—1 13 + ft a.- L -- E_ 100 f t- L-. Nc = =-- G= L= E�:rc =1 arCc - a. 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SSS a,,k'w4 -.Y , ci 74 34- 11 t Grt?. i ny r "h J _ 4 +r 1h yiaar. Aj. "2_.r ., !�; ?.t ^r •Ya�..i. v A5 -- E3..UIL7 DIMENSION CHART W A B I 23 .5` 48.2' 2 32 .3 43.5' 3 3'i • 2' 45.0' 4 37.7' 48.0' 5 41.7' 51.0' G 4ro.o' 55.0' 7 50.5' 58.5' 8 55.3' &Z. 5' 9 coo. 5, 0"7.0' 10 Cp 5. Z' -7 1 .0' 11 "71.0' 15.7' 12 -11.0, 21 .7' 13 -75.0' ZB.O' 14 '7&.o' 33. Z' 15 79.0` 59.0' 1 G 01 .O' 4,q . 5' 17 SCv . 5' 50. 3' 18 89.5' 55.5' 19 27.5' 50. Z' 20 51.5' 52.5' ZI 5G. 0' 55.2' Z2 40.5' 58.0' 23 45.2' a1.5' 24 50.3' C05 . Z' Z5 55.5' COD . I' 26 Cv I -1' 15 . 5' 27 2&. O' 88 . 2' 28 310 - 30.0' Z°1 3(0, . 6" 93 ..,0- - -... . 30 41.5' 95.2' 3 1 41 .O' -37 . S' 32 52.5 100.0' 33 57.0' 102 • O' 3.4 G I . 2' I o4 THIS IS TO GEKTIFY THAT THE SEWACve 01511:�SAL S'1STEM WAS GONSTRUCTTE.D AS INDICATED ON THIS PLAN AND THAT THE S'ISTEM WAS INSPECTEC) 5-( ME 5eFJKE IT WAS COVEIC.EC7 OVeF -. THE SYSTEM WAS CONSTR.(C-TED IN ACCORDANCE WITH ALL STANDARD KUL.e5 AND KEGULATVNS of THE PUTNAM COVNT`! DrPAK1'MeWT of HgAL7H A1,40 THIr NEB/ YOLK STATE DGPAKTMeWT DP HEALTH . - 7x -E1111 M COUM DdFAN2?A*N7�9low seer C1Ri1PfCAM OF 00B91JANC8' Peoria RUCHON 1/N1 AIw 1111 WWAG DISPOSAL SYS!®[ ft.1�+• 1 (�/ I Y IN,t� -icJ'� Y Pr� OM ar --WsN"r. - - i1w cad- Lit I ' T� Mep W, Let ZIP- . 1OS�o 1 rwesant that 1 en wholly Phil completely responsible foi tha daNgn above described will be constructed as shown on the approved amendnia County Department of Health, and that on Completion thereof a "Ce be submitted to the .DapartmaM. and a written guarantee will be ti I11aC1 M S"d .operating Condition anylpeat of 611111.116W61141 :dltliofal ewe Of, the eppsgWl of; the Certifkata of,Construc3bn Complianci wile be bcded.es s- - i on ten approved plan and 1,Mt feW "I will a l Cowley Depaftnriaaht of; Health : t Date I 'l R (j . SMMO: ..r-Al 12-E/1 6A.) lci of the: propop0 system(s); l) that the separate sewage disposal system_ to and in accor0aina with the stendards, rulasano feltuations o of Construction Compliance° sltistaetory to the Commissioner of Maalthwill tiis owns, his sucauon. hairs or anion by the builder. that aid builder will during the period of two (2) yeps brunadletely following the date of the hscu- original tyttem or any.rapeirs t 'etot 2) that the drilled well OespibW above in 'accordan " 'salt ten st A- r nd regulations of , �trhC Putnam P.E. /V A.A. . -Sfl1�i lv Zlicense No 5(o. ( 7, A- AOOraM . APPROVED FOR CONSTItUCTION: Then approval expires two yeM{ JroT ten date issued unless construction of the building has been undertaken and Is revocable f r c use a �maY; or wwdillW when con T�,Oz '►y by fN Coninllefiora� pf MYlth. Any change or aRaration of construction Was Q pprovoil fpOal Of Ooh istI y star or titivate wets supply only 0/88 Date L) 1Y _. Title — DEPARTMENT OF . HEALTH *AAAFL- 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 o ('-71 -9-7 WELL LOCATION Street Address Town `M MAI&W 24, Tax Grid Number 50"1 aO- `Z - LO, I WELL OWNER NTER Name MailIn Address L;jp , 9-0(. Roy, -�� -7-z oaf M1_s t jo0q rivate O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL O INSTITUTIONAL O AYR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED ® OTHER (specify AMOUNT OF USE YIELD SOUGHT _gpm /4i PEOPLE SERVED /EST. OF DAILY USAGEa1 O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION DFADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING WELL TYPE DRILLED ODRIVEN ®DUG ®GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES K. NO IF TELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 34- STATER WELL CONTRACTOR: Name <fb f �7&, p i"l Vje .klIN" Address: IS PUBLIC STATER SUPPLY AVAILABLE TO SITE:. YES �.NO NAME OF PUBLIC WATER SUPPLY: AL Ar, TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST 'WATER' MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID 1 oN SEPARATE SHEET (date) signature) 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 any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: Date of Expiration 19 Permit is Non - Transferrable White shall take appropriate action to assure that drilling operations be contained on this oth se contaminate surface or groundwater. �,z /S124"o Permit Issuing Official copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller ` ° PUTNAM COUNTY DEPARTMENT OF HEALTH fL e V .. 3/ 86 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit q \ m on CERTIFICATE OF COMPLIANCE. �, Permit 0 CO TRUCTION,PERMIT FOR SEWAGE DISPOSAL SYSTEM: ' Located tic , M1�aC --C "QD . � 'catd at � � Towd stIMMMIgs Subdivision Name �E� -� C1 ��-- 6nbduLot q µ Tea Map Block Lott �16 co., L�Q. Renewal_0 Revision ❑ Owner/Applicant Name f�.r� -C�. Date of Previous Approval Mailing Address R•© • $ZX Q-ZCJ Town l�d��- F- 1�J• -• + Zip ` JOS/ Z Building. Type L- Lot Area I •�.���,r�� Fill Section Only Dept Volume Number of Bedrooms Design Flow G /P /D 0 PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of Galion Septic Tank end 07-L LE To be constructed by "rb � _ Address Water Supply: Public Supply From _ Address or: Private Supply Drilled byC)ErC--a- MI'l-A•.S4-Address Other Requirements _ represent that I am wholly and,cornpletely responsible for'the design and location of the proposed system(s); 1) that the separate sewage disposal s stem above. described will be constructed as shown on the approved amendment there. to and in accordance with the standards, rules an regu a ions o o u nam County Department of 'Health, and that on completion thereof a ,Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 disposal system during the period of two (2) years immediately following the date of the Issu- ance of the approval of the Certificate of Construction, Compliance of the riginal system or any repairs t Bret ; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Install in accordance writ the Stan rds ulas nd regu at%ns t the Putnam County Department of Health. Data .L��•1L1. L�� ��� Signed P.E.- �%R,A._ ry �Za Address icense No APPROVED,FOR CONSTRUCTION.- This approval expires ear rum t 'date' sued unless constructio of the building has been undertaken and is revocable for caus&oa be m dedor modified when considered aces by a ommiss a of Any change or alte►atlon of construction requires a new p ro d disposal of domestic sanit' s ge; an ova to pl , on e Date BY Title �e DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL ~� _ PCHD PERMIT #LC� WELL LOCATION Street Address o Village Cit Tax P�Q Grid Number WELL OWNER Name Mailing Address a- o. 1 9A4TTvate 0 Public E OF WELL 1 primary 2 - secondary G- SIDENTIAL ® BUSINESS 13 INDUSTRIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY 0 ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT 'J gpm /# PEOPLE SERVED.4--(p /EST. OF DAILY USAGE `O© ©gal REASON FOR DRILLING MNEW SUPPLY ®REPLACE EXISTING SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ®DEEPEN EXISTING WELL ® TEST /OBSERVATION DETAILED REASON FOR DRILLING --W ► WELL TYPE DRILLED ❑DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -a< Lot No. WATER WELL CONTRACTOR: Name �G t5 = t�f�6- '(I�d� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:'�,jj LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION SEPARA E S T (date) (s ature) X05 7uftA 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 permi . 3. Submit a Well Completion Report on a form pro vi ed b the P tnam C unty Health Depart Date of Issue: 19 i ff Date of Expiration: lg a su n Permit is Non - Transferrable Whi �PY� H.D. File Yell Buildin In ow copy. g spector 2/87 Pink Copy: Owner Orange copy: Well Driller APPENDIX PUITI COUNTY DEPAR04MT OF :1 k: DIVISION OF /' 0 ICI Y HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS A4 Lt::V J (Name of Owner) REVIEW SHEET . - .CONSTRUCTION PEI2NgT p D r BY: (Street Location) DOCUMENrS Permit Application Corpoiate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth (OT 3 y s/s SUBDIVISION Perc 3 (3 ) Fill •--- -- cd House P s - Two sets Well permit; PWS letter Variance Request U( GENERAL - Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc. and deep results Two =Foot Coritours'Existing'& Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If PlmpBa Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout Sr'sPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. eYpan) 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercourse 10' to Water Line (pits -201) 50' intendtterit drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 Putnam County Department of ff e alth Division of Environmental Sanitation AFFIDAVIT• - CORPORATE OWNER-APP jC-ATjt)N FOR PERMIT. APPLICATION SUBMITTED TO PUTN4M COUNTY .1 1 EALTH DEPARTMENT TO: Commissioner of Health In the matter of application for .& Joe . lac (6 FMS L represent that I am an officer or empldyee of the corporation and arm authorlzed-. to act for 40 A)ROe (name of corporatio7n)— having offices at M- Whose. officers -are 4 President 'N—ame and .Address) _ Vice-President DA 0 i 414 7 1. 7— —CNg7me­ and 7A7ddTe3s — — — I — — — -- A — A? _. _ -Z/ — _: Secretary C-0 (Name and Address) Treasurer - — — — — — — - — — — — — — — — — — — — --- — — — — (Name. and Addrie-ss) and that I am and will be individually responsible for any or alliactr f of the corporation with -respect- to the approval requested and 61 l' tiub se*quebt acts relhtin 9 thereto.' - Sworn to before me this /�/Oay Signed of 1987 Title 'Wotary Public ANNE B. COhRIOAN 14 ftm 0 WOW$ g NM v6t Caurdy pg(j my C"M*418n E6kw Corporate Seal f :. . I T PUnM "00_ UMY DEPARI14M OF HEALTH DIVISION OF ENVIRCNHERTAL HEALTH 'SERVICES '.' DESIGN DATA. SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner MgLay-"t L1�0. Address�Pb 1�;oy C 70 CM&SL, N I c6l.Z- Ncm M V.,C --r. Located at (Street) 'Sec.' 80 Block y_ Tlotzra.-L (indicate nearest. cross street) Municipality -18ko.-L Watershed. Ctz� ----) SOIL-PERCOMIM MST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Date, of --Percolation Test .77-11(o157- Holz NCHM C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Su'rface In Inches Soil Rate -Start-Stop Min. Start stop Drop In Min/In Drop Lc5f _34 Inches Inches Inches -2 LZ > 5z 1'7 Z4 7:7. C7 ZA Z-7 4 5 ZA Z6 4 3 J4 1 44 3,o Z,4 24 Z6 3 1 S16 i 3 4 5 Tests to be "repeated at. same depth until apprmimately equal soil xates are obtained at each percolation test hole. All data to'be. submitttd for-review...., -2e" Depth measure dots' to be made 'from top of hole. 4 2 5 3 4 5 Tests to be "repeated at. same depth until apprmimately equal soil xates are obtained at each percolation test hole. All data to'be. submitttd for-review...., -2e" Depth measure dots' to be made 'from top of hole. 2 3 4 5 Tests to be "repeated at. same depth until apprmimately equal soil xates are obtained at each percolation test hole. All data to'be. submitttd for-review...., -2e" Depth measure dots' to be made 'from top of hole. TEST PIT DATAREQUnM TO BE SUBMITTED WrM DEPTH HOLE NO. 1 Sol 2' 3' 4' 5' .611 7' 8' a 10' 11' HOLE NO. HOLE NO. 12° 13' 14' _ INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNT= _ KA& INDICATE LEM M WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY-. DATE. i DES= Soil Rate Used - 3o Min/1" Drop: '. S.D. Usable Area. Provided 5 ©e' Noe of Bedrocros A Septic Tank Capacity 125t2 gals. Type Absorption Area Provided By.:, (o L.F. :x 24" width trench Other w 7 e III � u. . - �. -tom. • -- •,�< � . �� NameP:-�fiitlE��►i�[Ci �SSe�C_ . �.C_ Signature Address SEAL r- a is a Lu ; . No. f THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY.- Soil Rate Approved sq o f t /gal o Checked by _ Date j • ('5321 — '.— ` -.._� j/ rte.'/ i - �' �/� . �, / 1 6-0 ' 4p • < - L�'�• � = f� _ _ _ _ _ .� i i � : / /,tea MEL ^6f D F r / / ( 41. FL7�. G4r� cr / 'd (k�' C -r 4" d X110 4ueJ. bra t, i V`Yi a 4 / O� fql r —7 54 es' 1..1 ZZ. °- oO!int: 11 PROJECT S rrE. PL1�1 Pd� CLIENT.;