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Home My WebLink About1707DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -28 BOX 15 - r I Ilk - I - ,1 J, 1.6 J9 f IN 01707 I 01707 I ,� � ". -• _ ►own owe' _. I.Mted at D IA i�D I t;l �2,c� 40 A- �w�. A r1 M '1'b 14t,-( :I vl T lei sloe ;. Owner/ Iicant Name -- Sribdivield'n Nam6 i# Melling Addes Se e S stem bullt b tV� N . � N C S, .. 5W. (:L) . � (0'r Address �! t�. iJQ? � b , ( +►1 y Jos 2 Perate Sewerag Y Y . Consisting of j �?,5 b Q". jam" .5sfl1Zf -60t) Tlz "cH" Galion Septk: Tapk and Water Supplyi Public Supply: idm MM Address 'on PiivMe Supply Dd%6dby�'` (1't' � ��{T 0c Address UZl4!". A1/K , v_ gig Type d b 7!!i'L _ Has Ereslomf Control Been CompletedY Number of Bedrooms Has Garbage Grinder Been LietalledY %� a I 1. 0&, R'. I certify that the,system(s) as listed'seing the above premises were constructed essentially. as shown oh the plans of the completed work ( copies of ry which,aie'attached),'and an in accordce with the standards, ruleE and_ r lations, in accordance with a ed pl n, and the permit issued by the Putnam Couunty Department bfi.Health Date Tl C7U Certified by tr✓ P.E. R.A. Address . itl(l r�7 " IJ License No Any,person occupying premisei served by the Abdve,system(s) shalt promptly taice ,inch action as may be necessary to aacuia the eorreetidn of any unsanitary g such,usage.. „Approval "of the ,iepaiate:saweei9e system shall become null and void as coon as a pub((: sanitary sewer becomes conditions resultin from available and the approval of. :6e privafe water supply shall Decome nuh and void :when a . publie.,wate► supply .becomes available. SUCK approvals are subject to o6licition or 'change when; in the .jwornlent ,of, the: d- ommlisionq of Health; such revocation, modllication or ehange Is necessary. Date / Y i? By �,.- Title PurNAM COUNTy DEPARTMENT OF HEALTH 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 !'�eYtif cafe of._o�aGt.r.��ction ..Gampin e ". for. f:he_,sewage disposal s'stem� or anX _ repairs made by we 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 Environinental Health Services of the Putnam County Department of Health as to whether or not the failure f the system to operate was caused by the willful or negligent act of the occupant of. the building utilizing the system. Dai a this day of 9 Signature V ture Corpora �r /L 1! 1 •O - rev. 9/85 mk Title if:. - - ^r�c�=LCQm� ---~~ DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH WELL OWNER NAME ADDRESS: Monroe -Heights Development Corp.,. PO 'Box 970, Carmel,NY PBIVATE 0 PUBLIC U�E OF WELL -0 RESIDENTIAL 0 PUBLIC SUPPLY 0 AIRI ' COND./HEAT PUMP 0 ABANDONED 1 - primary 0 BUSINESS 0 FARM 0 TEST/ 0 BS ERVATION 0 OTHER (specify). 2 - secondary 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY 0 MOUNT OF USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED. 3--!5 EST. OF DAILY USAGE 50 gal. REASON'FOR )G:3NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION DRILLING 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH PATA 1 365 WELL, DEPTH ft. 55 STATI WATER LEVEL —ft. 6/9/88 DATE MEASURED DRILLING 0 ROTARY Ja COMPRESSED AIR PERCUSSION 0 DUG EQUIPMENT 0 WELL POINT 0 CABLE PERCUSSION Ii OTHER (specify): .WELL TYPE 0 SCREENED. 0 OPEN END CASING. xX3 OPEN HOLE IN BEDROCK 0 OTHER -TOTAL LENGTH 6 1 fL MATERIALS: fISTEEL 0 PLASTIC 0 OTHER DIAMETER 6 in. SEAL.M CEMENT GROUT 0 BENTONITE 0 OTHER DETAILS WEIGHT PER FOOT 1 lb./ft. I DRIVE SHOE: 0 YES 0 NO LINEA: 0 YES 0 NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (I Q DEPTH To SCREEN (ft) DEVELOPED? FIRST HOURS- GRAVEL PACK I YE ' S GRAVEL DIAMETER TOP sanom WELL YIELD TEST I , . It detailed pumping It Wore detailed formation descriptions or siLeve analyses 'WELL LOG are available, please attach. METHOD: 0 PUMPED tests were done is in- RESSED AIR formation DEPTH FROM SURFACE Water Well XXCOMP . attached? Bear- Dia- FORMATION DESCRIPTION C00E. in WELL DEPTH DURATION DRAWOOWN YIELD suriace 48 Hardpan & boulders 48 3651 M edium to.hard grey granite 300 2 300 1. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? X2YES. ONO ANALYSIS ATTACHEDTAkYES 0 NO STORAGE TANK: TYPE Diai5hracrm CAPACITY 82 GAL. 26 PUMP INFORMATION TYPE CAPACITY ;1 WELL DRILLER NAME E MILL DRILLItNi C. 20/88 .Goulds 3. MAKER DEPTH — ADDRESS Putnam Ave SIG RE 7EHO7412 23 3/ MODEL VOLTAGE' 30 HP & Brewster, NY t 'o t 11 ---~~ r n ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER - OGY1AlATER PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203 - 748 -7903 APHA - EPA - ASTM NAME AND ADDRESS OF PERSON TO RECEIVE REPORT REPORT OF BACTERIOLOGICAL AND Mill Drilling inc Brewster. N.Y_ 10509 DATA �J SOURCE OF SAMPLE Water Supply Steinbeck Estates Brewster, N.Y. Lot #27 DATE OF COLLECTION 7/ 2 2/ 8 8 COLLECTED BY Mill Drilling Inc. Hydrogenion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (p„) - RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg/l. Mg /L Mg /L NITROGEN Alkalinity as CaCO3 Chlorine Residual CONSTITUENTS Nitrate Mg /L Carbonate Mg /L Mg /L AS Total Hardness as CaCO 3 Conductivity NITROGEN- (N) Ammonia Mg /L Mg /L Micromohos/cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed I MEMBRANE FILTER TEST - Collform Colonies /100ML one— cotony. .pef..100m1__Colilqutt:cplpoiea R&r.s�andsrd. sample _shall,_,not.,exceed- ,3/50ml, ,4lt00ml. 7 /ZOOfnI,.,.pr._1300QM!, vt I in: (a) Two consecutive samples; (b) More than one standard sample when leis than 20 are examined per month: or (c) More than five per cent of the samples when 20 or more are examined per month. 0 AT THE TIME THE SAMPLE WAS SUBMITTED: ® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. D2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. D4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicates the water potable. Certified ... .. ..:.. .. ............................... FDIAL SI'N'G.' LISP` -?'' z a l Ul z QR SZMDI'rslc\i LCT ? SIC) ' - ' a 6 ' f _............. .,-. T L- N , . Wv- I a_ b_ Q. Nr- 90� bands, c_== ._ncUm w r7. 4_ vi_ r C. 2. Prctect- re!2, r-I Cc.e cf ch accer L ble .1/15 - ! 132 C 10 f .vu t.r: "cr i rc - 2Q r =_- fcunda ? cnc I �� S. Rcan c! lr" *& =Cr ex- zamsicr_, c;1�� I C. Size cf cravel 3/4 - 1 -` C?GTG = I' 10 . re tEa c= cnave_ in t_ ` -L- 12" rLr miami I� I RRMI 2 - . Chi a^ =law tank I I �'T..*ilD e__ -_.r cC'-= ccibl? IGc�riC1- t0 CrcC° I 6. C%rc1e by E —I u-1 Ds= ' i:` ^_L I I I Car c,;, =e Z I I fiCL�SfiLL I I I G. Lc.'-C- 1C '•' Lti Car c_C'tcved Plans. b. \u- = =r cf h cc-= `I t -�II I y6 aW lc as c e-r accrcve= D l a _ns b _ E. =t u ce fry SZ are= rr— = =sure C- Cs_r1C 18" ELCVE crad" er�lS_d well ecceCt' b. C_ G. e_ f. Q. h_ l_ Al Dl :.es With ins_ce of bc:,: ;-'a, CCrl Gins 5 tcne5 < 41' in ' C' cTe} C•r ~in drain uror`ctz & c_r.to i'\ CinC C- :Ec:�7crce away f=ail SDS arc= E_ 5- cri C,'=Cl C. _ i Gc_ cn sic- es ca=—= macr t= ^_ 15;. 2: I I rrier LC -'-"P c_ 1 1`1.s_=, -1 scil nct s ir;.=_ d. S S` r_e, brush, et-c. , crEa e_ 1 100 ft_ f -7- un wz_ =- ccur= -G. t t- Se�'L? c _nom s� � _ 1.000 b. S Se::ti c is _t i - -= i le C. 1 1 ri mi. -LaLr a -' r7. 4_ vi_ r C. 2. Prctect- re!2, r-I Cc.e cf ch accer L ble .1/15 - ! 132 C 10 f .vu t.r: "cr i rc - 2Q r =_- fcunda ? cnc I �� S. Rcan c! lr" *& =Cr ex- zamsicr_, c;1�� I C. Size cf cravel 3/4 - 1 -` C?GTG = I' 10 . re tEa c= cnave_ in t_ ` -L- 12" rLr miami I� I RRMI 2 - . Chi a^ =law tank I I �'T..*ilD e__ -_.r cC'-= ccibl? IGc�riC1- t0 CrcC° I 6. C%rc1e by E —I u-1 Ds= ' i:` ^_L I I I Car c,;, =e Z I I fiCL�SfiLL I I I G. Lc.'-C- 1C '•' Lti Car c_C'tcved Plans. b. \u- = =r cf h cc-= `I t -�II I y6 aW lc as c e-r accrcve= D l a _ns b _ E. =t u ce fry SZ are= rr— = =sure C- Cs_r1C 18" ELCVE crad" er�lS_d well ecceCt' b. C_ G. e_ f. Q. h_ l_ Al Dl :.es With ins_ce of bc:,: ;-'a, CCrl Gins 5 tcne5 < 41' in ' C' cTe} C•r ~in drain uror`ctz & c_r.to i'\ CinC C- :Ec:�7crce away f=ail SDS arc= E_ 5- cri C,'=Cl C. _ i Gc_ cn sic- es ca=—= macr t= ^_ 15;. b. C_ G. e_ f. Q. h_ l_ Al Dl :.es With ins_ce of bc:,: ;-'a, CCrl Gins 5 tcne5 < 41' in ' C' cTe} C•r ~in drain uror`ctz & c_r.to i'\ CinC C- :Ec:�7crce away f=ail SDS arc= E_ 5- cri C,'=Cl C. _ i Gc_ cn sic- es ca=—= macr t= ^_ 15;. CPcam f�et/�' aul - wovudl�a � � d �Mfi,441 a^ l � �� Itan lu-a r A rrv.s '.'1"4+F ,frm•' r �,. ;�• •+Tn•..,- �* , r. ^x Kam+ �',."4'+_ \\ PUTNAM COUNTY DEPARTMENT OF -REACT Dlvlelon of k6 Health Se vlcee Carmel, N. CONSTRUCTION PERMIT FOis SEWAGE'DISPOSAL SYSTEM ,A 1 t 10511 Engineer tri Provide Permit q . . ' on CERTIFICATE:OF COMPLIANCE,: ,,, � Located at i 14121L.k7 9 D Tows owe, v Subd Aston Neme n%� N 1 ('1' Sabd. Lot A Taz Q Block Lot M QN 204c- H EA'4r)4T5 ' - - Renewal Cl. _ _ ReyiSlon fl - -' I reprefent' that I'im'wholly and completely responsibletor'theem lgn,and.location of the proposed system(s);. 1) that the separate sewage :disposal system above describetl will be constructed as shown on the, approved `amendment.there to and in accordance with the standards, rules an regu a ions o e u nom 'County: Depaitment;1 of ' Health,'antl itiat on completion thereof a Certificate of Construction compliance' • satisfactory to the Corn missloner of Healthwi11 be submitted to the` Qepariment, and`a writteq'guarnntee will be furnished the owner,, his•wccessors,,heirs o► assigns by the tuilder,•that said bLi•Ider -will place in good operating,'eondit_on any'.part of said sewage' d4bosal`system.duiing'the period'of two (2)'yebrs immediately following thadate of tha•isw- 'ance of the• ';app "rovil. of the Certificate• of Constiuction'-Compliance of the ;origlnaI system or any. repair thereto; 2) that the'drllled well described above wiU lie located as.slioygn on thefiappioved plan sni].that said well will be'i t IeC 'in accordance with the st qar , ,rules and regu aTFToni f the ..Putnam County De' epart ant., f Health Date ,� 8 Signed ` PLE R.A. - Address license No wa APPROVED, FOR.CONSTRUGTION. This:approval expires oI year f om the.date;isiued •unless construction of the building has been undertaken and is revocable for cause. or may_ tie amentletl or modified when considered aces_ by ,t Commissioner, of. ealth. 'Any change or alteration of construction requires new permit. - - -Ap t v for disposal of. d mastic sancta -se e,'ari' r' ate ww su ly onl Date �' 1, . By Title 8 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 #'xi WELL LOCATION Street Address YLM Town/ �T�2 Tax 0 Grid Number WELL OWNER Name pr2ek. 76 Maili g Address r , . ,a gojo q'70 Wiivate (. *-i 10S71. O Public USE OF-'WELL Q - primary 2 - secondary RESIDENTIAL BUSINESS ® INDUSTRIAL ®PUBLIC SUPPLY O FARM 0 INSTITUTIONAL QAIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY ®ABANDONED ❑ OTHER (specify AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED 4--(,, /EST. OF DAILY USAGE /V00 gal REASON FOR DRILLING SUPPLY O PROVIDE ADDITIONAL SUPPLY ®REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL ® TEST /OBSERVATION DETAILED REASON FOR 'DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X,_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME 'OF SUBDIVISION: 5-(W tj 36e4(_ l +(t,1.. Lot No.- 2n WATER WELL CONTRACTOR: Name -ro 5w `D�-(rr, zm ?nf" Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: M /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: P/A- - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION 5f _ ON SEPARATE SH T '2 8 8 (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 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.7erd _t. 3. Submit a Well Completion Report form de by he Putnam Coun y Health Department. / Date of Issue: '' 19 �C Date of Expiration: 19 t Issuin g ficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 orange copy: Well Driller BY: ocation) DGC[JMF�TPS Permit Application Corporate Resolution Plans - Three sets - s/s .- En ,ari�ws•:- :�uthorization:_,_ .:.. ... _ -- -- ........Y,�.�.. Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc U Consistent Perc Results (3) Fill -- Perc Hole Depth cd House Plans - Two sets Well �--' permit; Pws letter Variance Request 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 Flcw - 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 rate) Design Data: perc and deep results Two -Foot Contours Existing & Propose Driveway & Slopes Cut Footin /Gutter, Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed .. House. . -_. Teo- -, f ' Fir_ cans .... _ ; . . . _ 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 45° w /cleanout SEPARATION 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. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 WMm mom required3 60.ft. max. Patellel to codtours MM -M MM IMEME Avg M M= == MAM ._ _, mm MMM WIM «� Own Mm 200 ft. res�Z WAMM 150 ft. .. I - Mim M /Ml dam Elm mm BY: ocation) DGC[JMF�TPS Permit Application Corporate Resolution Plans - Three sets - s/s .- En ,ari�ws•:- :�uthorization:_,_ .:.. ... _ -- -- ........Y,�.�.. Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc U Consistent Perc Results (3) Fill -- Perc Hole Depth cd House Plans - Two sets Well �--' permit; Pws letter Variance Request 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 Flcw - 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 rate) Design Data: perc and deep results Two -Foot Contours Existing & Propose Driveway & Slopes Cut Footin /Gutter, Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed .. House. . -_. Teo- -, f ' Fir_ cans .... _ ; . . . _ 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 45° w /cleanout SEPARATION 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. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 Putnam County Department of Health Division of Environmental Sanitation. .AFFIDAVIT a CORPORATE OWNER. APPLICATION., FOR PERMIT- APPLICATION SUBMITTED TO - PUTNAM COUNTY }[EALTH DEPARTMENT, Tb: Commissioner of Health - In the matter of application for ` &RPf}-„itl l L 7 b ® ® J1 Lie �z (�O��NT.�_.�__ _ —��.o represent that I am an officer or employee of the corporation and arty authoriied�. to act for ,AOA)ROC_ —/✓�&0 (name of corporation) -` having offices at Y_Q!_(VL L_ Whose- officers -are President Q S %? C 1,0O0�� -� T,� _ �reE� S -r �` Name and Address) j �(J Vice- President (o GCS[7� G_ ff�'I/1_�_ C� (Name and Address) Secretary _� } l� _ GLo GG_O L, JiA7/ _ _ G _°'Li EIL _ XJ�_ (Name and Address) (Name- and Address) _ _ _ o. and that I am and will be individually responsible for any or alliacts of the corporation with - respect to the approval requested and all'sub- seque'*t act9 relating thereto. Sworn to before me this `/ day Signed Of 19817 Title otary Public (— I ANNE B. CohRIDAN ' ft-some trAfrY** ROy CaffW44 vn i ma MMith 23 is RBa 0 q 07 6 F% peu) N, o Corporate. Seal LA 0YROV. 0 D1• •N1 1D VA fs; 1:0 d� b: 04,xv "IDESIGN ------ A4 6 0 Rv rz— 419 (6,0 VC Owner 'C)eVaL0PMr--iJT C-O,, LTD, Address F,0-5g* 9'70,- CAZ1N4rzL-, tJy 051 Z. F-, al -ro Located at (Street) ;Irz N� -rzry Sec. 0-0 Block Lot Fo Ca ro i (indicate nearest cross streetY Municipality 'TD VVfJ 0E- f>A-TT6,M—S6A) Watershed C-IeO-ro t-1 SOM PERCO=CN-.= MM REQUIRED M BE..SUBMr= WITH APPLICATIONS Date of Pre-Soaking 10 r i -7 /0 7 Date of Percolation Test '71) .HOLE PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level NO. Time Ground Surfac' In Inches Soil Rater.. Start Stop kn. Start Stop Drop In Min,/In Drop Inches Inches Inches /'I Po4 IS ZI 3. 12A 4 5 -7 S 7 2 24 .3 T3 4 3 4 —5 M —3 4 IXM: Tests to be repeate6 at same depth until approximately equal soil rates are'cbtained at, each Percolation test hole. All data to' be submitttd for review. 2. Depth measurements to be made - fran top of hole. rev. 9/85 MOLE NOa MOLE NO. 5° 6° . e° 13° 14° INDICATE LEVEL AT wHim GROUNDWATER Is mmuamm MIA,. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP ROLE OBSERVATIONS MADE BY; I DATE: DESIGN Soil Rate Used a -)a Min/1" Drop: S.D. Usable Area Provided - No. of Bedrooms Septic Tank 'Capacity 1Z!56 —gals, Type G�ntG. Absorption Area Provided By 4-50 L.P. x 24" width trench Other g�0� f/ ' Name LAU 12�6W( E-N I rU Me (No Signature —4- Address SEAL �eJ'� N®. 56124 FESSi THIS SPACE FOR USE BY HEALTH DEPART ONLY: Soil Rate .Approved sq•ft %gal, Checked by ® Date I-AY6K OF 6^vl HA--f OK TK6A-fi�0 K UN rA Ve, K FV10,9KATCO Pirt (flv c 1J 012 V!, WASHED GRAVEL '00 VVI 6t,6AN VILA, ',AL,T VAA"( UNTREATED f'0Kr-aKATeP flifle rvc) *L�ore - Y�,Z-/rl --CAP 040 Lf) Or EACH Gr, UJ LAT6KAL, JOINT Ae -VUIL;T OFAAV--T NS A 0 NSI 0 H 1�1 4' -70-l' $ 1" �' 161* 5i' LONGITUMMAL, 5f�GTION it 32.4 % 0-1111, C, 17 10 121. 5' No �061 NOT IN _rKFN6H66 W WET 1,011• 6F00�, ",C� TOM OF TKVHCH PKIOK 9' RAKE '511?1�1� A _)6 2r ALA, 1?KTKJ13 TO Ci-A61KC- 6,KAV0L,. 5NL tjwfz!5 'ZI. 4q.0• I I I C,1. '�* q3.0' e�6 CArftP I&CI.fY 1,1.0, I't 11?1.0• 104.0, TYPICAL, AI$SORPTION TRENCH 0 1160 112.0 NOT!."TO 6C_Ajf�_ l),Z-o' lq"q, I& IOD.o' I I ?,. IN 0, v3t- 9, 11 q0.0• loo-r?, I o'.) o, 6AIJ I"IA"" ., Lr N&,' 100' KNOCKOUT 19'1.0• 1 'Zo 01.0 '12.0 ool, r T H 10 151006- THe, 0rWA&r-5 Viii -OW vro�AL, 1�11171r_M WAI�, - _�W-U&TOV A'-- IN1210AT6,V ON THI,, PLAN AND T"A-f -THe� _J 1-,.} --1 ;, J. A L_ LKt,OCK Obf AT 01REf K VA9 OOVCW_2 OVER- -THE WA1 I L t 0ON-2TIZOOTE',12 �N P\LL, 151ANC2,llV-t7 W_Lhe-1;7 AND Or, - ONLY rlml!5HOC) &FZADE?, THE rUTWAM COUNT'( Of' Hf,�AufH AND THe� ME-W 'fOV-Y- -�;IATO VbrAvP--T- 44/ Ts x - REMGIt +A6LE (OVER NOTES : MeNT Of; H6AL;fH ` ONLY THE INLE�l NOTE: H00176 L-00ATION TAKEN �_i 2,4, rvc VIV-0w, or FROM rUMFl_ OUTLET AND ONE 6c)C_ OF L,01 NO El 712EPA12ED r-aiz- I JOHN .P .J� t_4C rA�?_V' �,OW-fCACfO'IZI�,_,L'" rW?A ANC., -CANK V_ v e, u -f H . 4.10 C., HIGH