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AM COIINTYDEPARTNlEP1T OF HEALTH 5 t' °, A � , , . i 5,
,, � Dlvhion of EovlroomenW'Heatth Services, Carmel, N Y 10512 - �. .
t
CATS, OF CONSTRIICTION CO S AGE DISPOSAL SYSTMM S O
Loated u • ,t;-Xr A Tom' M, e K F' r �Df�cT2 Tu; Myr Block �'
OMnee /appOapt N•me f �T`PYti '�cYl•ilt!�IZ° Sabdivlrion N•me 1 �` ��
Mai11oQA�d�ese c.c)cc ► c�g�t. subdv Lot �l '
Fee Enclosed Amount _!>,
Date Permit Issued 2. -.,
aq
Sep�nte Sewerage Syotem boiilt by ��tsOM I V D Address ` rr y ' MoD ( J) C7
Conelbtlng - 2 �� Gabon Septl c Tack and r :c
Watei Soipplgs PabUc SapPly Feom Address `t /�I
o «_ Peivate Sapply Deilled bg1'�.l'` r�' y Addree•
t
'Lot Size 2�/{ias Erosion ('nnfirnl RPPn rn,nnl °erPti? `fS
Ndidber of Bedraome Haa Garbage.Grinder;Beea Inetatle 19
Other Requlremente
I certify that the eyet ®(s) ae listed sezvinq'•the above premises rare constructed essentially as etgvn.on the plans of the completed .work ( copies
of which ere attaehed) and in aecordance with .the standards rules IN nds lations in xccordanca 72, the led an and the perL-8 'sued by the
Putnam County.; Department Of Heblth Dat •►Ufk�tl pE. RA.
Adtlresa
F0. �S Llama No.
Ariy, p•raon ocpupYhl9 pdmiaaa;sarvo by the a_bow tystn+(q sMll promptly �takp weh scion as m•y M naaiii►y to NCUn tM oaradbn of any unYnitaryr
s , ` x s i • pool : onitary awhr h•oom•s
eonditbna nsunlrW from: wch ,usapa. , ApproviP of tM saparats awe► am shalt eacoina null ane void is son a
avill•b1i.,and the approval of,the privbta.wat r:supply (hall hecomb n 1 a ob when a lkF vvatw aupWY bacons avallabW Such approvals are
autUaet tb f bn or.eMnOa whew in the )udgrtiant 01 fhb. o of,rMpit -I- irogtbh,•inoOHkatbn o► eMnOa/)a, iy.
Oats 9Y TRIG „
3/89
PUTNAM COUNTY DEPARTMENT OF HEALTH
r1 DIVISION OF ENVIROi�AL HEALTH SERVICES
Building Construct by
• I�NDrAu �{ida Rom
Iocation - Street
6a 5
Municipality
S° lj6ai A'M&Y �larw
B=zilding T4 pc
Section Block Lot
Nett ! Sr "/ j
Subdivision Name
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
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-=- -to, such - •system.- e<cept�whiere-.the failbare to operate properly - =as
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 deter
the Director of the Division of Environmental Health Services of the Pu-
Department of` Health as to whether or not the failure of the system to
caused by the willful or negligent act of the occupant of tile buildid'i
the system.
Dat this G day of ,'4,lu, 19_!Z_
e
General ZERFactor (Owner) - Signature
Corporation Name (if Corp.)
Signature
Title
f66 r2a c*-wAm_ avl ®, AEML,( cr: dc9-i
Address
rev. 9/85
mk
ination of
County
F�eerate was
utilizing
Corporation Name (if Corp.)
Address
n
t�AM CMG WELL COMPLETION REPORT
W 10
DEPARTMENT OF HEALTH
siog�Of --Envitqnipental Heald Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
office Use Only
WELL LOCATION
STREET AOUAESS: -1-OwNiviLLAcLiCily TAX GRID NUMBER: `Lot ..7
Indian Hill, Steinbeck Estates, Farm -to- Market Rd., Patterson
WELL OWNER
NAME: ADDRESS-.
Monroe Heights Develamept Cn=ration, PO Box 970 Camel, NY
aPBlVATE
O PUBLIC
USE OF WELL
1- primary
2 - secondary
)R RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP O ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST / OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
OFEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL
DEPTH DATA
' WELL DEPTH 325 ft.
STATIC WATER LEVEL 5 ft.
DATE MEASURED 7/12/89
DRILLING
EQUIPMENT.
❑ ROTARY 92 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING -%0 OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH Pis ft.
MATERIALS: :kkSTEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE B_4 ft.
JOINTS: O WELDED ;THREADED O OTHER
DIAMETER _-4 -in.
SEAL:.,6j CEMENT GROUT OBENTONITE OOTHER
WEIGHT
PER FOOT 19 1b./ft.
I DRIVE SHOEQ YES O NO
I LINER: O YES ONO
SCREEN
DIAMETER (in)
'SLOT SIZ E
LENGTH (it)
DEPTH TO SCREEN (It)
DEVELOPED?
DETAILS
-
FIRST
o YES ONO
SECOND .._.
..... __. _
_
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH h,
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED i tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER :0 YES O NO
1�IELL LOG
It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water
Bear.
ing
Welt
Dia-
meter
FOAMATION DESCRIPTION
eaoE
ft.
IL
WELL DEPTH
It.
DURATION
hr. min.
ORAWOOWN
ft.
YIELD
gpm.
$uA7CG
. 54
Clax,..:silt & .gravel.
54
325
MediTTti to :hand . 'te.
0
2
-
300
4
.
325
6
-
250
A5
O CLOUDY HARDNESS
O COLORED ANALYZED? RYES . O NO
ANALYSIS ATTACHED ?JkYES ONO
[MA ] CLEAR TEMP.
STORAGE .TANK: TYPE _Diaphragm
CAPACITY 86 GAILe 23
INFORMATION
su)rmersible CAPACITY 10
_ Cm1ds 0� 200..
10FJ07412 voLTAG> 30. NP3'/4
WELL DRILLER NAME
MILL DRII, ,. INC . / 8.9 ADDRESS.
Putnam Avenue
Brewster, NY rt Mi , Pre i e t
J/ D7
e
Box 224 - BREWSTER, R.Y.
(914) 279 -4945
• - 'i
SAMPLE NO. 7430
SOURCE: Steinbeck Estates
Indian Hill Rd.
Patterson, N.Y.
COLLECTED: 7-12-89
BY: Mill Drilling, Inc .
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
NEW WELL LOTIA�7` �.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
7 -12 -89
Thomas Meyer
Director
0 per 100 ml.
ELLIS A. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER -WASTEWATER
PHYSICAL APHA METHODOLOGY
EPA ASTM
BIOLOGICAL P O BOX 2328 203 - 748 -7903
r REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER
NAME AND
ADDRESS OF
PERSON TO
RECEIVE
REPORT
F Mill Drilling, Inc.
Putnam Ave
Brewster, NY 10509
DATA
7
ij
SOURCE OF SAMPLE
.Water Supply, Schneider
Lot 7 Indian Hill Road
Patterson, NY
DATE OF COLLECTION
COLLECTED BY Feb' 18 , 1991
Mill Drilling
Hydrogen Ion
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
Concentration
LANGELIER
(PM)
RYZNAR
NTU
Mg /L
Alkalinity as CaCO3
Fluoride (F)
Bicarbonate
Nitrite
Mg /L
Mg /L
Mg /L
Alkalinity as CaCO3
Chlorine Residual
NITROGEN
Carbonate
CONSTITUENTS
Nitrate
Mg /L
Mg /L
.00 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 MEMBRANE FILTER TEST
ape.. coWrly.. per_,100m1...CoUIorm,..colonies per. standard".sample._shall•- not- exeeold- 3JSOmF: df100m1r^i /800mk- or- 18 /EQOaII -- -. _.,_ „ColilormCoonlea /t00ML _ !�_
in: (a) Two consecutive samples; (b) More than one standard sample when legs than 20 are examined per month; or (c) 0
More than five per cent of the samples when 20 or more are examined per (month.
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.
2. 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:
F13. 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.
4. 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 indicated the water potable.
v /
Certified...................................... ............................... ........... ...............................
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(ZF N r:;wA-t.—
DEPARTMENT OF HEALTH .
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 '(914) 225 -0310
"PPhYCATION'-T0 CONSTRUCT A 'WATER WELL .• , T w... -
PCHD PERMIT #_ p`b 4-0
WELL LOCATION
Street Address Town -�
W D l dM1
Tax Grid Number
F' O - 7-- Z&, 9
WELL OWNER
Name
MON(URL RT5.
Mailing Address
. C.'r�. L..Zh ,
�t p_ov rr zz. XPrivate
OPublic
SE OF WELL
- primary
2 - secondary
RESIDENTIAL
0 BUSINESS
O•INDUSTRIAL
D PUBLIC SUPPLY
O FARM.
b INSTITUTIONAL
O AIR /COND /HEAT PUMP O ABANDONED
O TEST /OBSERVATION O OTHER (specify,
O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED _± -� /EST.
O REPLACE EXISTING SUPPLY D TEST/ OBSERVATION
XNEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
OF DAILY USAGE 5,0 gal
Q ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
,DRILLED
DRIVEN
DDUG
GRAVEL.
O
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: gT1e11N 6g4jL 1-(>l L-t-
Lo t No. -7
WATER WELL CONTRACTOR: Name -fb Pil"z Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: A / //a. TOWN /VIL /CITY
DIST4Y —CF, TO FROPFFTV _ FP npr,. N . TP,.5T- .[�pTER
LOCATION SKETCH & SOURCES OF CONTAMINATION' PROVIDED .
M ON SEPARATE SHEET f
(date) ( nature
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 shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained . on this
property and in such a manner as not to degrade or of ise contaminate surface or groundwater.
Date of Issue: �� 19
Date of Expiration 19 7 Z-- Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
ove described will be constructed 'as,s Wn on the approved amendment there to
County Department -of Health,- and,
`' -► 't " a`t_
:pi'
n',completion ' a` re a: ' a
"C
e ' .i fi . ' c' a .
t
a c
be . submtted to the Depar man t and a vrittjh guarantee will be furnished th
e
ta ce in gooi operatijg *condition apy..pa t as d sivijs ' disPcsal system .du
ante 04-the 8Pprva.0 1 the :ertficaticf ,C nstru t i n ' Ccmpliance of. t a orf
will be to-' a 0 wthe approved plan grid that WaI Vvi libeInita I in'
County
0' ep a . rt m . . a nt of. Heitth.
I:
Date A7, /Z Sighid
I A
Address 73 - z)rq))Iz
APPROV,Eb'060,:CON,s�fiiL)C716kt This approva . expires two roM the
_. sj=� — I idate isi
revocable for cause or.may be'amended-or mod0i6d;w'hsih"c'on necessary by the
requires a f7rmit.. f-of domestic: sanitary sew
Rev. -
1/87 Data By
or,
the standards, rules'and*regu at ions- of,. Th-6---fluUn—a-m
Ma satisfactory to the j:'omms jjsjcs�Aer of'kialth will
t4li;s6r`iss'i.9n*s by, the bu irldej jilit"siia"bujider will
12 f thi'iate of ihis issu-
ollow
6 ,it described above
a eguWon� of the Putnam
P.i. A.A.
A" Y License No 5 1
ujidd un*ie�i construction' 00 'the 6 It - d I ing tiai been undertaken and is
4omml o r of Hea h. ny ange or alteration of construction
private up Y ni
M.,,.,,
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
,F
.- .,�.:,.:-�:.�:;::Y..•... - ":�P15L-IC:Fi�T=IOt3 �-3 °ti�-^'CON °ST�RTJC1 1�:,.rn7[�'1TER�,GGE��'::..:.: ,:... v;^, �. �::,:., :,.,...;�.:;,.:.- ..�:,.ryry�.��_.,,,
Prue DVPMTrP _4
WELL LOCATION
Street Address Tin Village City Tax Grid Number
l,e v .67- 12 A o-1 5 a y z.sG.S z--Z6.1
WELL OWNER
Name
M
Mailing- Address v. ,a,�>a 7,> pp'rivate
C A)2)k -1 /5'L- V 13 Public
USE OF WELL
vl - primary
2 - secondary
--U, ///
D/USIDENTIAL
O BUSINESS
0 INDUSTRIAL
❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
❑ FARM ❑ TEST /OBSERVATION
[]INSTITUTIONAL ❑ STAND -BY
O ABANDONED
❑ OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT
S' gpm /# PEOPLE SERVED Y -e /EST. OF DAILY USAGE /ucJy gal
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
❑ TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
5 1_C:1'f17///✓C1_
WELL TYPE
(DRILLED
DRIVEN
ODUG
®
GRAVEL
C1
OTHER
IS WELL SITE SUBJECT TO FLOODING?
YES L,/ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S j/ = //LIlon -/r �4,G
Lot No. . 7
WATER WELL CONTRACTOR: Name /, /,0 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V NO
NAME OF PUBLIC WATER SUPPLY: /I /�g TOWN /VIL /CITY
DISTANO:M- TO PROPERTY •FRON,,NEAREf;T T wXYiER° XA1N:: ..._:_.._._..._._......_......_ ... _.......... � ..........►. .._._...._,._._...__....._
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION ON SEP E SH T
2 -z g
(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 pe it.
3. Submit a Well Completion Repot on a form p vi d b th t m ounty.
Health Departme t.
Date of Issue: ' 19.
Date of Expiration: 19 Rrimil Issuing Officialy
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
1
/'--L Jy BY:
(Name of Owner) (Street Location)
• i i� MEN
�J
i
M
T
�IJ1 /MOM
MM
MM
NEI
sM
60 ft.1
"Contours
00: s�
MUM
i�
MM
mom
MM
!inIMM
EMM
.. ..
EMM
mom
MEM
mum
ME
DOC�S
Permit Application
Corporate Resolution
Plans - Three sets s/s
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Films.
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 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 rate)
Design Data: Perc and deep results
Two -Foot Contours Existing & Proposed
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 Pmq:)ed Pit & D Box Shown & Detailed
allilL7C: a \V a of Vlra
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
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
351to catch basin, stormdrain,piped watercourse
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL 9
DIVISION .OF- ENVIRCNMENTAL HFALTB •SEMCES.
...- - ... - -iiF:�IGiv' i'�S()8..�v� <S�t�.'� DI.SP�� �- = .. _. ..- . _ - z�=ILE �:-� - :..�::.�::..,�: •._ -., -,; ..::
/✓ /o / ✓,Pry /�� / < f/7S ..,
Owner J Address
�97o e / Iz /�,c � ivy o.S/Z T7
rA/ei+'i T� 1k- 1/a1ZC Z-T 9,0
Located at (Street) Foc: o / / ✓l Id A/ Sec. e6 Block Z Lot 7-6,1
(indicate nearest cross street)•
Municipality o VVIV o F
M77AC -5101V
Watershed
Cl? 6 Td iv
SOIL, PEROOLATION -TEST DATA REQUIRED TO BE..SUBMME) WM'H APPLICATIONS
Date
of Pre - Soaking 7 Z 9/,g,? Date of Percolation Test
7 Z 9 8 ?
'HOLE
NMMM.
CrM TIME
PERCOLATION
Pk t00LATION
Run
Elapse
Depth to Water Yom
Water Level
No.
Time
'Ground Surface,
in Inches
.Soil Rate, •.
Start-Stop Min.
Start Stop
Drop In
Min In Drop.
L aT
f
Inches Inches
Inches
�•
q'I`/- °6s
z�,/ Z7
3
adz
2
07
4
..
_
_
_
_V�._..r •w...+— •w•'+r.�.u_
T.+ew..wawva.�..�.w+�.
- .. ..y _ P. wy
3
33. - 9= `/ 0 9
z Lr Z7
3
103
4
5
l
2
3
4
5
NOMS: 1. Tests to be repeated* at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to' be suimi.ttod -r r
for review.
2. Depth r asurements to be made fran top of hole.
`; AS
TEST PIT DATA
TOBEf,
1 WITH APPLICATION
20
38
.40
5a
a
70
80
130
140
INDICATE LEVEL AT WHICH GROUNDWATER IS EN000NTERED
r
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENQOUNTERID
_DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil. Rate Used �.' 7 Min/1" Drop:
S.D. Usable Area Provided.
No. of Bedrooms Septic Tank Capacity %Z S d gals. Type CdlVe'. "+
Absorption Area Provided By L.F. x 2400 width trench
Other ......
Name ��U11,��(/j'%V� /�s /��lziiy� ,/�S�oc �� Signature
Address .. 3 �/� /2r�F�/' ,D%l. SEAL
No 4
THIS SPACE FOR USE BY HEALTH DEPAR'ENT ONLY.-
Soil Mate Approved sq.ft%galo Checked by Date
j
130
140
INDICATE LEVEL AT WHICH GROUNDWATER IS EN000NTERED
r
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENQOUNTERID
_DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil. Rate Used �.' 7 Min/1" Drop:
S.D. Usable Area Provided.
No. of Bedrooms Septic Tank Capacity %Z S d gals. Type CdlVe'. "+
Absorption Area Provided By L.F. x 2400 width trench
Other ......
Name ��U11,��(/j'%V� /�s /��lziiy� ,/�S�oc �� Signature
Address .. 3 �/� /2r�F�/' ,D%l. SEAL
No 4
THIS SPACE FOR USE BY HEALTH DEPAR'ENT ONLY.-
Soil Mate Approved sq.ft%galo Checked by Date
GLEAN FILL
LAYeK OF SALT HAY
OK UNTREATED BLDG.
PAPEt2
J'� F'MRFOKATeD PIPe
(PVC.) SLOPE Ys2 "/FT.
�f If2" GKUsHED STONE
OR WASHED GRAVEL
�EGTION
.ITKEATE 0
EK
'MRPOKATMD PIPe
SLOPE - %32'�FT. AP END
I F EACH
ATERAL
GG i' ?I nKI
_ -.. - _._._..... TKEN(51-IE5 M WV Solt -.
'OM OF TRENCH PRIOR
V05 OF ALL DISTRJBUTOKS
)RPTION TRENCH
iGALE'
CKOUT
16HMD GRADE ?.
G4VMR NOTE5:
aLLS
ON THE INLET,
- OM PVC. UTLET AND TWO SIDE
FROM PUMP'- -
�NAM(Z OK OUTLETS t0 C3E KNOGKMD
OUT AS SHOWN,.
=ROM 5
TAN
LP ' M was INSMG
e2Y Me 13e5OIC15, IT wAS COVeKe0 OV.e- K. Tree
S'f 5TEM WAS G0NS'TMUGTr.0 IN ACGOKOANGB V\
ALL STANt ^KC2 IIVLeS ANO KeGULATIONS OF
PUTNAM COUNT f .t9ePAMTME?,NT Of, t- t>✓ALTH At•
THe New'`fOtQK 'Z,TA-Te tJEPARTMENT Or He!A
NOTe HOUSE A N 0 WELL LOCATION TAKe N r- K6
"SUKVE`f OF P1QOreI�TY' rRel°Ar�er Fort
r�TeK SGHNeIt'�Et� �UILDE%I�GONTt�AGTG
INC., DAT>✓D 4-e4-01, I°KEP^Kr-o t3f
TeKR f t'OeRGeNDotC�� GOLI.INS L.S
JJNc
+'lbL.P.A05
TRCNGN (Tie.)
0.
II
i2
13
14
15.
)N
i 1 Ex.
AS - C)UILT
JGALf:: 1% 9'O'
1260 GAL- -
N°
SePT�G TANK
b
\+�Tq
A
t3
1
25.2'
10
7G 4'
85.5
\ ex.
WP.LL•
4GR
\�euc
11
72.2'
7-J. I '
°j
2I.�t'
59',2'
12
r
A5 -BUILT bIMEN510N GNAtCT
N°
A
b
N°
A
t3
1
25.2'
10
7G 4'
85.5
2
2G.7
Go.7'
11
72.2'
7-J. I '
°j
2I.�t'
59',2'
12
73.2'
7&.0'
k
20.0'
q S. I '
1�
75.8'
74• %'
5
21.0'
�t2.5'
I4
75.7'
71.0'
G
22.0'
�.8'
15
-70.4'
70.2'
7
24-1'
32.0
IG
3G.3'
21.8'
8
3o.G'
25.3
11
GI.9•'
So. G'
9
.7G
X0.3
)5-5
,E
r� FINISHED C�RAD>i
Y