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HomeMy WebLinkAbout1703DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -24 BOX 15 1 0 ri ,. 186! a Ir ,■ IN �, . , AA. ♦ L �! ' ��� ' r• ' ���� -'' �� - - , 01703 PUT. AM COUNTY DEPARTMENT.OF• HEALTH Re V . ; 3 / 6 Dlvlsion of 1 nvlronmental Health Services; Carmel; N.Y.10512 a Engineer Mast Provlde PCH D - ermit b CERTIFICA OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTE T Sd / F,F I , . ... r _ _Ta= Map- - Btoc t P . Located at �csf`fi / E� Formed Subdivision Name abdv. Lot # Owner/ Rantame Y �J apP / .. Malllng Address ` Zip- I a J Date Permit Issued Separate • Sewerage S �t6 15, 72 V c' , Address P' d Consisting of I Gallon Septic Tank and Water Supply: 1, Public Supply From ,AldLd_ress / t� or. ✓ Private Supply Drilled. by d" l� l� V / I, It) 6S —g Cgrem U O � ,i7 V �i _ . b S%F� nn �..,, y Yes rv�vl Building Type K 51 %e �,— 'Has Erosion Control Been Completed? Namber•of Bedrooms Has Garbage. Grinder Been Installed? Other Requirements I certify that'th, sy'tem(s) as listed servin9.the above premises aeie-constructed essentially as shown on he plans of the completed work ( copies of which are - attached); and in accordance with the atandarda, rules and re ationa, in accordance with t f ed plan, and the permit issued by the Putnam County.0eparUnen . 'Of Health. �/ Date "`_� Certified Dy P.E. +' R•A. S� Addre ss n J Lice n se NO Any person occupying premises served by the, above systems) shall.promptiy take such action as may be necessary to secure the correction of any unsanitary conditions resulting f, such usige. Approval of the separate'seweraye systsrn shalt become null and void as soon as a pubR_ sanitary severer becomes available an'd the approval of the private''water supply ;hall "become_nulfand,.void w1►en a Dubtle water supply becomes availahang Such approvals are subject to odifiatio or ehinge when, in the. judgment of the Commissioner of Health, such revocation, modlflatlon o► chance is necessary. Date ♦ C��`��t. .,i.w.rT•,T TTTnwT nnnnnm �Gft �j04 WELL LOCATION W�,LL lrVlli'LrJ11V1V 1\P�rVAl Office Use Only DEPARTMENT OF HEALTH Division of Fnvixonme.ntal Healll:h Services e PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: wN/vt 1 1 TAX GRID NUMBER. Steinbeck Estates, Indian Hill Rd., Patterson, NY LOT {31.t' V WELL OWNER NAME: Monroe Heights Developnent 001PORESS: PO Box 970, Car el, New York MUBLIC BIVATE USE OF WELL 1- primary 2 - secondary [IESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED .O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY, ❑ MOUNT OF USE YIELD SOUGHT. 5 gpm.1NO. PEOPLE SERVED 3 to 5/ EST. OF DAILY USAGE 350 gal REASON FOR DRILLING WHEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 280 f WATER LEVEL 3 5 jftDATE MEASURED 10/7/88 DRILLING EQUIPMENT ❑ ROTARY JM COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. .OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 63 ft. MATERIALS: X3 STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE 62 ft. JOINTS: ❑ WELDED jUTHREADED O OTHER DETAILS DIAMETER 6 in. SEAL: OCEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT .PER FOOT 19 lb./ft. DRIVE SHOE O YES ❑ NO I LINER: ❑ YES ❑ NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST. ❑ YES ❑ NO HOURS SECOND" GRAVEL PACK ❑YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. 70P DEPTH 1L BOTTOM DEPTH It. If detailed um in WELL YIELD TEST p p 9NWELL METHOD: ❑ PUMPED i tests were done is in- AkCOMPRESSED AIR , formation attached? ❑ OTHER ; ❑ YES ONO LOG If more detailed formation descriptions or sieve analyses are available, please attach. ROM CE water Bear. ing well Dia- neter FORMATION DESCRIPTION COLE❑BAILED IL . WELL DEPTH It. DURATION min. DRAWOOWN it. YIELD 9c Surface 51 & ��s. 51 280 Medium to hard grey & black gran . 200 1 1 3 200 3 2 -3 4 '280 6 200 60 WATER WLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? AYES ONO ANALYSIS ATTACHED ?JkYES ONO STORAGE TANK: TYPE Diaphragm CAPACITY 86 �'� GAL. 23 WP INFORMATION YPE submersible CAPACITY 10 BAKER Goulds DOH 200 ODEL ? OE610741 2 VOLTAGE24HP� WELL DRILLER NAME MILL DRILLING INC . ADDRESS Putnam Avenue SIGf Brewster, NY Rober . Mil , DATI 0 / 10 / 8 8 es dent 4 .. _ .. BREWSTER._LABORATORIES. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 7108 SOURCE: Steinbeck Estates Indian .Hill Patterson, NY COLLECTED: October 10 1988 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Lot 31 new well . This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 12 1988 0 per 100 ml. �T Roy ickwit P.E. hector ..;r y fi'lfifiStfi �a'e<1., . ... . ... .. .. .. ...... .. ,., .. .. ... ... .. .... ,. .. �,, ....... .. .. .. .... , .. ..... .. .. ...., ... _.,.... .. ... .. ..,... .., ,. ,., .,,. .. ,.._ .. .. .. .. .. ..... .. .. .. .. .. .... .. .. _.. .. .. .. .. .. ..... ..... .. ... .. PURIAM CODNIX.DEP? (r OPT -HEAL711 K._..:�.... __..:. DIVISION OF ENMOiEAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by 'TAVI,410 �41LL, Location - Street Municipality 12eS i 'Pe-A)7 Building Type (\Sr61/)i��IZ-• Ni�L Subdivision Dame �f Subdivision Lot # 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 _.._. ..... ap=t°- for -a years i^madiate :y fol- I-ow ig -tr e da- to -of -app...oval- 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 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. / 14 this day of 19 'Signature A Ufa . Title (owner) - rev. 9/85 mk .r �() 01� FINZ c- r*r r� • �, i�t�� m T CR Su- DI'iSIC-1 L ;T SENAGE DI rCSAL P=te a_= arm lc='- tea as Fir ir�rcved o1 =n5 b. f L se ---iC: - Da s= of places =mot 2 : ? Barr, Ll'="- w DTH XVG . Jp2 C_ Ma:=Z-7-1 Soil nct: st"—Ir ed Q. S:-- -.e, br-a , e , Q z .r t 13- t f =Cm SDS ar=_ e. 1CJ ft- frun WGt=- 10 f -- �:i:.0 °1' `i 1 L•^ - 20 - f_- - I.. DTSPCSA ,, c cT� C_ ��'L'l �C L�11.1 � �-' -• 1,000 , �` v Rcan all cn;aE -r b. v ° =�iC •�r_titi i ^c == i i - le'f� Size of C_-.7E! 3/4 - 14" Cia e—' =- C_ l: ` m.'T*,._a c f in t` -ch 12,11 ^'-- Within 10 Z= C_ C1; hc•'_C e_ G`tyT 1 e� � at- Same L P; CL_=ea Ce-i C v Z'! = -- cric ! SC? TTCN, Ea L . C`v er =! c- taat 3. AI aril, ji_cr`_i /�:,r^_G � = '?ItI? e~S' ' +" aC"'= =- _CFl °_ T,a��Cl- �•.^. �:� =Ce _C•N C e_r c7cie Ec s 1c= ce_ a_crcv DIa -_s / a. as Cam'- cCDrC'vc= D i _nc b_ D: - -=.nce f_- 57- a=_ M. == •rte f C- CaSlnc 18" Wellc= i i_ _ C%i 7. Sti _ b. P_ DlrcS Ca_^ CaC`:�:1 1 cs= C. inside G% Cci ccri— S`: nes < g ++ ir, ClaMet-_ - C_-- n dr _ = , l i U, ^Lea` _ & di-r. to ``!' S t _ Svc _e_'-c" L D4 —t -r C.= 'fi'Gt- ' .--_- - I - - •-• _ _'mot.. L.C.+ 0-1a-- C' r-.. .. c C= � ":'_ ac" -C` ^1E 1/106 - !SSG I' / =CCU. 6 10 f -- �:i:.0 °1' `i 1 L•^ - 20 - f_- - LcL•r- _? C:'°- v Rcan all cn;aE -r .8. c Size of C_-.7E! 3/4 - 14" Cia e—' =- l07LCJI..:l c f in t` -ch 12,11 ^'-- 1 i DiTc L . C`v er =! c- taat 3. AI aril, ji_cr`_i /�:,r^_G � = '?ItI? e~S' ' +" aC"'= =- _CFl °_ T,a��Cl- �•.^. �:� =Ce _C•N C e_r c7cie Ec s 1c= ce_ a_crcv DIa -_s / a. as Cam'- cCDrC'vc= D i _nc b_ D: - -=.nce f_- 57- a=_ M. == •rte f C- CaSlnc 18" Wellc= i i_ _ C%i 7. Sti _ b. P_ DlrcS Ca_^ CaC`:�:1 1 cs= C. inside G% Cci ccri— S`: nes < g ++ ir, ClaMet-_ - C_-- n dr _ = , l i U, ^Lea` _ & di-r. to ``!' S t _ Svc _e_'-c" 0 *4 IV. V. VT_ FINAL SITE INSPECTION Date Insrert- bv�%= ;aTICN " m CWNER tv 4 ® Zit a OR SUBDIV.LSIC q LOT # r ` DISFOSAL PSZI a_ SDS area lccated as per amroved plans b. FT 11 sectica - Datee of placement 2.1 barrier . LGMI Ba-= AVG.DPTH I c. Natural soil nct s tripred d_ Scene, bruin, etc, , e te= than 15' from S7S are=._ e. 100 ft_ fran wat_r course /wetlands. SE VA DISr'�CSA-r, SYSM- i a. Septic tank size = 1,000 1,250 I b. Septic tank instz-lled leve? 1 I I c. 101 minim m f_cn fcnndation d_ Ib 9.0 ° ba ^.ci, cieanout within 1�0 jt. e. D ISTRIt3L-TICN . EOX 1. All °eT . a' same _ =r on - wa art Gtr: I 2. Pro, _ cca I I i 2 f:._ ariainal soil between box an_ ,aq es I I I f. J 7CCT ,CN ZQ9 = creL,,---ly set 2. Dist*ance to wat= rrecur?e me—= re . ft. 9 3. Insta -1 ed ac=rdina- to plan a Distance- center*- to Center - 5 . Slcns of t_ `^.cZ acceptable 1116 - 1/32P'/=L cct ( I �✓ 6. 10 feet f=an pre r`ir line - 20 feet - fcunda ons J. 7. Dem-th cf te=nch < 30 inches free s-=face I 8. Rcan a__C.GaE fcr e-xcansicn, 50% 9. Size of cave? 3/4 - 1 10. Deptn cf crave? in trench 12" m? nhm I ( ` L. Pirz ends cpr ( I ' h: Pa4S OR DOSE TZS IS o _.. :...... �... 2. Ove+ �laq tank 3. Alamo; vis- ml. /audic 4. Ptmm easily accessible manhole to grade, I 5. First bcx 6. Cvc -e witnessed by He= I th De=a--tam--nt estimat- f! oa r cycle - a _ E. ^:se looted per aLrorove3 plans. _' (�3 b. 11 -mce= aIis of be`rc T r a. locates as r oc13 lans b. Distance fran SDS G =�re3" c. C sinq 18" aicve char �. d. S=pace draL*'aae a well acceptable. a_ Boxes op—arlv vrcuted b. rL i-pes -4 ra11y bar-'r-filed I c. Ail pir-es f=ury with inside of box d. Eac'o =i11 materia c ' n ston < di is e. C: -=.ain ara i n ins aAcordi - f . C_T, ai n drain Cu g. Fool nq dre -C d h. S=o water pr i. E._csian conrrol itecte� di:r �o exist _ awav from SDS ar ' adequate cn slakes crztaen,7 tho 1 PUTNAM COUNTY DEPA1tTMENT OF HEALTH ~ Division of EnvhonmenW Hoalth'Servk�e, Carmel 'N.Y 1051? Ftglneer: to Provide Permit,M 77 tJ: on CERTIFICATE OF CID LIAN 1 ;.1 s !; Permit (I �.�. CONSTRUCTI FOR SEWAGE-DLSPOSAL SYSTEM S111111 sMn Name !.i'► i "t`�Gt4 1kI LL, + -, Sabel ,Lot N �T Map Block Lot M • }DN•��' �� ZS w enewal� ❑ Revision OwnerlA' plk Name :> a(.OplVL �P►'� (� LZn, —7 Date of Provioas Approval= ddeeia �' .O � N � 165 ; Maiug A $pjg P.- �srt�rrac: I io3Sc t i Lot Area' FID Section Ody Depth' Volaine.'' Namber Bedeooms Design Flow G P D,• OO -FCHD Notlfkatlon )e Regdlred,W'he-nnF0i I e completed Separate Sewerage System�to�coosist � �'Z�� Gapon Septk Taalt aad. �'� Z - :L� � �SD Ytfa71� f.1 -ti? �- x To be rnns4ucted Addeees Water'Sttpph Pdblk;Sapply Feom' Addreea QD raJi� Dlri on Private SupPly:Drgled by Addreee OfherR!a+#Nremente `. 1 represent'that;l am wholly and- .completely resDOnsible forthe design snd location of the proposetl'syrtem(sl'1') ,that the separate sewage_ disposal s stem , above•.descnbed will be,constrsucted as.shown on'the�approved;amentlment there.'to and :in accordance with the standards, "rules an .regu a ions,o a ,u nam County Department Hof? Nealth, and that on completion theieof a Cert,MUte` 'of Construction Compliance 'sit istactory ,to the Commissiorier•of Health will be sut mitteclAo the Department and..a.'written'quarantee_ will be furmshetl; the ownei his sliccaksors, heirs or,afsigns by`the builder that said builder •Will place .fin ood`operst�n condition an rt of sbtl sews a disposal s item du►i the rktd_of.tvJo 2 earsimmediatel followi the data of, h6,issu- g 9 Y W 9 y rag De O Y Y !�q ance;of the�approval�of thef Certdicste of Construction CompiWnce' ',of.W orpinal-system,omany repairs thereto, 2) that the drilled well desciiDed'above will he looted =as shoavn onithe approvetl} plan mtl that said well will ba insta I �n aceortlance 'with, the stehdard , iul and requZi%ni of •the Putnam County De /partm /en�t of Health Date P E R:A. Atldrass License No Z- AP ROVED FOR CONSTRUCTION This approval expuet; two years :from the .date isiued unless conrtiueUon of the bwlding has .6een'funae►takem and is Tr revouDle fo► cause or may be:amendetl orniodAietl: when consider •necessary`by a Commtisioner of Ith. Any change or alteration of. con truction requires -is new' parms /t) App► ved or isDosal oi. dome sanl ar wage; and pr ate wa only. 81 Date'' v' a BY Title �✓ v al 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 # WELL LOCATION Street Address Town y Tax Grid Number rjM `Ta M &VMet-7 e.ohv p-T7ctt�s; a 0 �1 Ll 125&3 % P 2 `Z0,1 WELL OWNER Name ffi0NQf_ 6W+ Mailing Address PM1EN Co•L P, 0. fso}c y"7© AlPrivate C-All.mFpL IU Ll iog-m 0 Pub 1ic USE OF WELL Q - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL ❑ AIR /COND /HEAT PUMP (3 ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT C, o gpm /# PEOPLE SERVED 4--Co /EST. OF DAILY USAGE j0-" gal REASON FOR DRILLING XNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ®REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 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: - 5-(a(W15r7C4C_ WILL- Lot No. 31 WATER WELL CONTRACTOR: Name 1Z1 6ii_ 'D) �&LtA%tJrzV Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES >C,.NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:% LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION WON SEPA TE S T (date) (s fah ature) 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 s.hall: 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 per it. 3. Submit a Well Completion Report on a form pro ided y he Put am C unty Health Depa tment. Date of Issue: 19 Date of Expiration: 19 mit ssuing ficia Permit is Non - Transferrable t:tewcopy: H.D. File copy: Building Inspector 2/87 Pink Copy: Owner . Orange copy: Well Driller I � �n APPENDIX B PU1'11AM CCL'N - DEPARMUn OF HEALTH DIVISICN OF R4VMCD MMM HEALTH SERVICES 1.1 Iii WIDQAL WATER SUPPLY & S'JBSUMACE WAS DISPOSAL SYSTEMS. REVIEW SHAT CONSM=ION PE`RMST BY: (Name or' Me-r) (S�=eet Loc-tica) CCtSMFI'S . YES ( NO I 1 I I I I I i { I I L=' trench provided 7 r�ui rw J 60 ft. Parallel - contours 100% e I I I I S i7 1 1 clav'rarrier 10 ft. fill note new sue-. deotn uc s I 100 Yr. flc4d elev. 1 200 f t. re ergoir, etc. Li 14 150 ft. tr ig4l /call. I DDS Pe=, it Application Corporate Resolution Plans - Three sits Engineers Aut- horizaticn Design Data Sheet MCS ) Dee: Hole L--g Consistent Perc Re_•.i is Perc Hole Depth s/s SuBDizTiSICN psrc -�- (3) Fill -- cd House Plans - Two set_ Well Fe- *:nit; F;v5 1_rter Variant_ Re uest C . Legal Sdtclivi s icn Sur --t rision A.caroval C:ne kad Ea -a_ prcval SUDS Ad- Lots Che^': Wetl and (Tcw-n/DEC Psr ni t R & D ) Data Cn DDS Plans & P_=ni t Sal REQL= DEZ=TT c CN P1.A1S Se: ace System Plan - ( north c.'=:.Lv ) Z /'3c, S:.gagc Sys an Hvdz u1 1c Prof :'. _ - Gr_=vi tv Flc. Fill Profile & Dimensions Vcllzrz D or J Box;T.rancz /Ca_1_ry;. _Pew pit de*=i1= Septic Tank - Size, Derail We_! Detail, Service Line 1Z over Construction Notes (grinder rate) Design -Data: Perc and-deep re s Two -Foot Contours Existing & P= _ccsi Drive:%-ay & Slopes Out FoctinlCut- er,Cur-t--in Drains (discharge CI{) Perc & Deno Holes Located Representative or pri ffoxy and e - cansicn D=sioo Area;shcwm;gravitJ flcw,suff. size If Pmxd Pit & D Box Shcw-n & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Procosei SystaTl Propert y Metes & Bounds House Setback Necessary (Tight lot) House Sever - 1 /4 " /ft. 4 110; ZvIce pipe No Bennis; Max. Bends 45" w /cle rout SE PaR' ON DISTALMS SPECiF = CN PL?N Fields 10' to P. L. , Driveway, Large Trees, Top of f 20' to Foundation Walls f 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, LaKe (inc. et` 15' to Drains - Curtain, Lade_, Footing 351to mtcZ basin,storl-ndrain,ciped Water= 10' to Water Line (pits -201) t 50' intez mi.ttent drairace course SeDLc Tank- - — l 10' from Foundation; 50' to wil 15' Well to PL I d I / , 4 I Putnam County Department of Health Division of Environmental Sanitation I - - - A `F1DP.VLT - CORPORATE WNER—APPL- TCATT-OW.... T.:.:..: _:.. .:... ._ _._..:.. FOR. PERMIT. APPLICATION SUBMITTED TO • . - PUTNAMOUN.TY }[EALTH DEPARTMENT. The Commissioner of Health - In the matter of application for ` 6,,+ /v _ _ .. _ . -.. _ o represent that I am an officer or employee of the .corporation and am authorised_ to for act RD C L — .1 (name of corporation) having offices at YsL4tt ;&_ Whose. officers -are President C°LOGC�•�!`f--'� Name a *E- Address) slice President l5 _ _ Name and Adress_e _ _�__ Secretary m� /� _ CLo GGO- �¢vt7/ • (Name and Address) Treasurer ------------------------—— , (Nam and Address) -. _ _ r — and that I am and will be individually responsible for any or a,ll,acte of the corporation with•respect to the approval requested and a11•6ub- - sequeiit acts relating_ thereto. Sworn to before me this Signed of 198 Title otary Public Fv ANNE B. CohRIDAN $Mof *W rot my CWM*4he * ' nd wfta n ,o Re. aAad70 �U) w ,, W Corporate Seal I ft D D7 Fa I 74a.713. zo "V3. is; 10 " b; 111,101-7A Led OR .,.--,.DESIGN M2A, -SHEET-,5=_U 9Z.1ZF,SEWAGE- DISPOSAL SYSM- FILE _W Mori HEIGHTS Owner jDrz.\)VLO-jOj^"-T Co., (_-rp Address_ F O . ft. o CI-70 fj i 04�''V Z Fjka_.AA -M I I nn 07 rzo A 9 `Located at .(Street) .* r-0 CPC, (AX i-roN tZzko sec. ko Block 2- rot Z-4,, (indicate nearest cross street)' Coo 3i) Municipality CCU W rJ OF r->/kT-rfMSorj Watershed Cw,-o-roiJ SOIL PERCO=CN-.TEST DATA PBOUIRED TO BE.SUBMT= WI'T'H APPLICATIONS Date of Pre-Soaking 0 E5 Date of Percolation Test' 011497 HOLE A:. PERCO=ON PERCOLATION NO. TiM 'Ground Sukface In Inches .Soil Rate top Drop In Min/In Drop Start-Stop Min. start Inches Inches Inches + 169 2 '3 4 -4 " .2 3. 5 1 31,oP 3,30 2 3'•31 "30 Z SO L 2-+ .3 4 2 3 4 5 V=S: 1. Tests to be repeated: at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitW for review. 2. Depth weasurewnts; to be made - fran top of hole. rev. 9/85 P DEPT.. GoL* • • � 1• S1• • 1 : 1 Y�• • • r: • HOLE NO.- 1 HOLE W. -- MOLE NO. -. .. 1 4 101 111 12' 13' 141 INDICATE LEVEL AT WHICH GROUMQTER IS ENOOUNTERED Al %A _ r INDICATE LEM TO WHICH WATER LEVEL RISES AFTER BEING MMUNTERED DEEP BOLE OBSERVATIONS MADE BY.- DATE: DESIGN Soil Rate Used - Z1 -36 Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms 4 Septic Tank Capacity, l 2 SAD gals. Type Absorption Area Provided By (,-7L L.P. x 24" width trench Other -_- U f� J (," YL rz y 7 aN6.1 nJ gwa i A46, v C • /`Signature ' Address L V Da ; SEAL THIS SPACE FOR USE BY HEALTH DEPARTM= ONLY: �- Soil Mate Approved sq,£t %4a.1m Checked by Date I -el r - ,-- . .. .:. --- -- -.: - HA"( 'e'Loc- 0 Plee. Vs AFT. :1) STONE wa� 21 pG' tl I 22 -R�.- bul LIT e7o^L,r, . 1'. 40, 'TWO SIDE - ALL CU?LE15 Af OAM5, OL,EV- �--R OUT-LOW 570 17IIM09A, VYc*rrM.VM CON TKU01rL7 At iNoioArov ON rHtt PLAN AND THAT IT WA9 lNVFr—C-rr,0 V'f Me, Vl' FOlZe IT N,4,9 C,OVr,Ke,V OVOIt. THr, eqtrTeM VqAV IN AC.0,9Ir0^Nrri MITH AL,L, 71AWV^?-52 KL)L,6:2 ANO ?,eClVLA-fiON9 Ov, -rHl?- ":R^m 00L)N-r-f HIML-TH'AWO NtW '(OltY- Me,I< OF; HEALTH. No,Te: NOU" LOCATION -rAY-rN F; Orvl VUK\MK or rKOrrK7r-(" rl(rrAK60 P%OFL SON 4 lGP.t4 MULMEYZNI, rLeV- -7- M-91-1 %6�titi "� . A-vT®UILr �Ns- A V. -ze; re o 0 -7 l �i - I o' 1911pl,_0 . it, 1,Jw 4 1.5, 1'-0 I Z2 O 11 12S' -0 le I oeA, 20 '11 -o . IOT -0 as 29 ICcfo 0201' -O 195 ; -0 zio'o' eV 1 L3 o. Z I 9, C; Z24-, rry/t,�2l�_ 10 1 ' (62gL -, '�� �" jam_ --