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HomeMy WebLinkAbout1724DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4-46 BOX 15 01724 I 17-2 i I IN ., f. .ti's = r ' -, ;� �� F� -� �, . . - N No so IN m a I - ;1-1� t I ■ 01724 77­7777-7777 ��1� 110512 ' D — X, M V1 PAC H lKI, CATlkpv. COCONSTRUCTION -COMOPLUNCE FOR SEWAGE DIS <2 Located at 6 lu i Let oerned t Name Formerly Sabdivlelon Name `f 7: CA -to Ma 0 qj Address P ka Permit Issued_ Fe0_ tiaif �� ose ount e, je .17 septic: Tank sid Supply 10ibUc S# 'wow Address Pri : vii6 V, _�.b . i "_j Wed YbAl bn 4*nl RP qs lrosion Building Numbeed' Bedrooms :1, e, Been Iae111edY ddler Reigairements I certify that the eyetm(s) !r ti"li,is -ah646 Cal as listid'sp7."q.the ibo"6.p. fted essen ellp,ans o the zpidi6A.woq;.( copies of which are attached); 'w a, and in a6 i with the stand fez i ".."im,icrnordari'de Lih: it plan, k permit'is'sued by the the Coon De ram n _-_.lth*� Putnam Of, H P. bl. E Pat* IF Y71 Licenn No Addran on %h by 0 n a" Any i 4y tilha:a6�4i Sy 4 such "MrSt"'corr ck of any ununR&ry SWM­` ' i 1 1. �l .1 .­ ­1 -1 'il.- - __ I _.­ � - bow co6ditigns AOI�ioiv il, of ttia.14 t nullNg ipdld as soon as a ji4tk: sanitary ww" ffm ra 9� syst Vull hen a. lk supply beco"M swallable.' Such 8"roVals We a4a nu ai4: old lVable,#nd"the - ! i_ ­ ­- 'wiR­.­­-­ is nsc�­ r'y wit.6f,thi"C T 7 Ok 3/0 Date Y_ TRIs In WELL U.UF1rLL_11UA MzrVM1 DEPARTMENT OF HEALTH Div1sion _.Of.. JEnvironmenta, rb_servi(zep. pUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TAX GRIO NUMBER: STEINBECK ESTATES, Farm-to-Market Rd. Patterson, NY WELL DINNER NAME: ADDRESS: 1: Monroe Heights Development Corporation, PO Bcx 970, Carmel, NY �BIVATE PUBLIC ❑ 0 PUBLIC USE OF WELL 1 - primary 2 - secondary 101IESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND.IHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm.INO. PEOPLE SERVED j to 5/ EST. OF DAILY USAGE — gal. REASON FOR DRILLING X31 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TESTIOGSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 300 ft. 'i STATIC WATER LEVEL 25 ft. DATE MEASURED 1%25/89 DRILLING EQUIPMENT ❑ ROTARY 91 COMPRESSED AIR PERCUSSION ❑ DUG ❑. WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED EENED 0 OPEN END CASING. fk OPEN' HOLE IN BEDROCK ❑. OTHER CASING DETAILS TOTAL LENGTH _B -L— tL MATERIALS: XXSTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 83 ft. JOINTS: OWELDED JaTHREADED DOTHER DIAMETER .6 in. SEAL:NM CEMENT GROUT OBENTONITE DOTHER WEIGHT PER FOOT 19 lb-/ft. DRIVE SHOE. ❑ YES ❑ NO LINER: ❑ YES ❑ NO SCREEN S-­ BETAIL­-- DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? 'IRS T R YES N 0 OO HOURS " SECOND' GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE, DIAMETER OF PACK in. TOP DEPTH fL BOTTOM DEPTH — It. WELL.YIELD TEST If detailed pumping METHOD: b PUMPED i tests Were done is in- Xx COMPRESSED AIR formation attached? 0 BAIBAILED O .OTHER :OYES ONO If more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water pe2r- ing Well Dia- deter e FORMATION DESCRIPTION CODE ft. it WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD 0M. Land surtace 72 1 Hard an & boulders. 72 . 235 Hard qrqy & white.qKqn'te 200 1 10 200 2 235 300 Medium to hard gre 250 1 30 250 3-1/3 300 6 250 20 WATER )MCLEAR TEMP. QUALITY O. CLOUDY 'HARDNESS,- 0 COLORED ANALYZED? M YES 0 NO ANALYSIS ATTACHED?XX YES 0 NO STORAGE TANK: TYPE Diaphragm CAPACITY 86 GAL. 23 PUMP INFORMATiON TYPE' submersible CAPACITY 10 MAKER Goulds DEPTH -200 MODEL 10Ej07412 VOLTAGE BHP 31A- WELL DRILLER NAME MILL DRILLI 1 C. JR.2/89 ADDRESS Putnam Avenue Brewster, NY lit r DIVISION OF ENVIRONMENTAL HEALTH SERVICES Mom KIW )3NMNwf U94Aq, Owner or Purchaser of Building Section Block Lot SA-M� Building. Constructed by Location - Street P� i YFrE s0 Municipality lzeS (Cc:— -N l l V Building Type FAgm 0 We 5UPOIV164 Subdivision Name Subdivision Lot # 13 GUARAIME OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent. that I am wholly and completely responsible for the location, worknanship, 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 - " _- ��yregairs 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 E.nvironinental 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 o the muilding utilizing the system. Dat�1 this day of I V 19q/ Signature Title (Owner F- Si nature AUIA (- K16Z PR Q okkrd -300 Corporation Name (if Corp.) —� 06 Tb (Wu Address rev. 9/85 mk Q. in,(, Z M lffl bo w,ee ow Corporation Name. (if Corp *41- Address e Sox 224 - BREWSTER, N.Y. (914) 279 -4945 WATER ANALY S REPORT ° SAMPLE NO. 7242 WELL SOURCE: Steinbeck Estates Lot 13 Indian Hill Rd. Patterson, N.Y. 12563 COLLECTED: -1- 2 5 - 8 9 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, . MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 1 -26 -89 r U per 100 ml. Y FINAL SITE INSPEC?'ION Date SZP= TCCATICN = . CWNF -01 SUBDIVISICN LOT A r' � • I. • II. 5. Slone of trench acceptable 1/16 - 1/32 " /=cot. I I 6. 10 fat f_an prcce_rty line - 20 fa=t - fcundatlors I 7. Denth of trench < 30 inches fran s'arface 8 Ream a>> cwt---3 for excansion, JIM 10.. Depth of gruel in trench. 12" aun�m„m I 11I.-Pipe ends ccre3 I Cil' h. PUMP OR DCSE SYSTEMS 1. Size of u chamber 2. Ove_rflcw tank I 3. Alamn, vis•.r i /audio I 4. Pain easily accessible uanhole to grade z v I 5. First bcx baffled 6. Cycle witnessed by Hc--=].th Denartnent estimated flow per cvcle I 1V. HOUSE a. house 1pcated per arnroved PLms. I Zk 1.5 cj, b. Number of bedroms I f/ V. WALL . a. Well 1=ted as per avoroved gLaU b. Distance fran SDS area measured c�ft. I c. Casing 18" above grade. d. Surface dra umce around well acceptable. VI. OVERALL W0,'K; MA.= a. Boxes properly Grouted b. All ipes *=�ia.11y backfilied c. A11 pilDes flush with inside of box d. Backfi_11 material contains sbmes < 4" in dieter e. Curtain drain installed accppffimg to Plan f. Curtain drain cutfall protected & dir.to exist.watercoursd l- g. Looting drains discharge away from SDS area I t YES 9 No CCM_'�sfl'. Sr RAGE DISPOSAL AREA a. SDS area located as per.annroved plans f b. Fill section - Date of plae--Tp-nt 2:1 barrier. LGTH W"ID'I'Ii AVG.DPT:i I IV c. Natural soil not stripoed I I d. Stone, brush, etc., zte_r than 15' from SDS ar =ea. I I e. .100 ft. fran water course /wetlands. I SE1,4A I✓ DISPCSAL SYSTRM a. Seotic tank size - 1,000 1,250 I I b. Seoti.c tank inst-- Ued level I I I c. 10' minim -un f_an four_da -ion I d. No °0° bends, cle=ncut witni,-i 10 ft. of 45° bend I I e. DISTRIBLTICti MX 1. All . outlets at same el evatlon -'water test°._3'' 2. Prot =c'L=-i below frost I 1 3. Minim 2 f_. original sail be t-peen box and trs_nc:-jes ICI' I f. JL=!C.N BOX - properly set I g. MEN 1 . Lan t-h r--L,-;red - 5 0-0 Le*icth installed � 9O I�I 2. Distance Pce LO Wate_rcour.:.e 3. Installed a=rdina to plan 4. Distance cant--- to ce_rnter I I 5. Slone of trench acceptable 1/16 - 1/32 " /=cot. I I 6. 10 fat f_an prcce_rty line - 20 fa=t - fcundatlors I 7. Denth of trench < 30 inches fran s'arface 8 Ream a>> cwt---3 for excansion, JIM 10.. Depth of gruel in trench. 12" aun�m„m I 11I.-Pipe ends ccre3 I Cil' h. PUMP OR DCSE SYSTEMS 1. Size of u chamber 2. Ove_rflcw tank I 3. Alamn, vis•.r i /audio I 4. Pain easily accessible uanhole to grade z v I 5. First bcx baffled 6. Cycle witnessed by Hc--=].th Denartnent estimated flow per cvcle I 1V. HOUSE a. house 1pcated per arnroved PLms. I Zk 1.5 cj, b. Number of bedroms I f/ V. WALL . a. Well 1=ted as per avoroved gLaU b. Distance fran SDS area measured c�ft. I c. Casing 18" above grade. d. Surface dra umce around well acceptable. VI. OVERALL W0,'K; MA.= a. Boxes properly Grouted b. All ipes *=�ia.11y backfilied c. A11 pilDes flush with inside of box d. Backfi_11 material contains sbmes < 4" in dieter e. Curtain drain installed accppffimg to Plan f. Curtain drain cutfall protected & dir.to exist.watercoursd l- g. Looting drains discharge away from SDS area I t IV IWO I :,-MA4tc� Date UM 'a"" 4"awi4 w . ill - lit @10 uiiltwnitt�0` to tRO'rt�l aieq 04 t APPROVE CONS RiBv Z, N- pwiio' Ad - 4A, :zj Enclosed s6illcii ow Lj S4 41-- ,13 zo 7 7j .. . ....... eoa�steudiow o4 71 -U effyWhon and 10 avy 0y the Cominiesiona o1 c iRW Any, eMftoo or altinvoil of cittsir6dion koian'� 177-777 W� PUTNAM;COUNTY DEPARTMENT OF HEALTH� to t.,*Wi4r iProvid DIv1 of E6 H llii ^A�� Ai6 CE CON idCTIOXPERMIT. FOR SEW SAL SYSTEM- _­77_77, wn or u6stea, AtA 'To Map 47 Rinevi 10 —0 Inca o of tha will be located'Las shaiiin'6n.tP - 1.,- 4* � County Department �ptj� ea it 0 a. APPROVED F 0 R 6 0 NS iFt:U revocable for causq or, ,mo;,C, requires a now 6irinit' Rev. 47 1/87 Date "By" Co Sig , ned .df- r Co nstr . u _ ct o , n C:6�m'plij!ri6!1,iitiifi5tory:to the,C9mmlisioner of Healthwill the owner ,his )W` Mein ­i coigns by the 'buil6ir,'that said builder Will Au L in a rij madlitely',f6ilowing theds a of the Issu- Ing if !s 0 that,thi dr filed 'Will I'd'escr itied above I r g sys am- or any,repai - thef t ! �y ner �nai r -W a ance.�',w k1h: A Iii 'stand ru an rellulation.s Bf the 'Putnam JN License No. the buildingFiviis'been undertaken and IS by t mm Si_ " ar.*of H"Ith. Any.change or alteration-of construction and a is y• . Title (Z N k vv Alt- DEPARTMENT OF HEALTH 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 # IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S-TMi0f36z4z_ }}(LL- Lot No. 13 WATER WELL CONTRACTOR: Name `Tb AG, D9_--(kjzm 1,4W Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N► A. TOWN /VIL /CITY DISTANCE TO PROPERTY FRUM WEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 5 I O ON SEPARATE SHEET (date) gna ure) 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 otherw cone minate surface or groundwater. Date of Issue: 2 19 Date of Expiration 19 2— Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Street Address Town Tax. Grid Number WELL LOCATION N01AA R(u­ MO. f 7TTf Ls 0d ko - Z - z&, I Name Mailing Address rZ (, aO Try _" jWrivate WELL OWNER /110NtU16 NYS. 'p�V L--CO . ff>24w'sraeL to ` I o.9'0 I O Public OF WELL XRESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED �SE primary ® BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, 2 - secondary 0 INDUSTRIAL b INSTITUTIONAL 0 STAND -BY AMOUNT OF USE YIELD SOUGHT �5 gpm /# PEOPLE SERVED 4 -tp /EST. OF DAILY USAGE_,�al 0 REPLACE EXISTING SUPPLY [3 TEST/ OBSERVATION 13. ADDITIONAL SUPPLY REASON FOR .DRILLING NEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN C]DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S-TMi0f36z4z_ }}(LL- Lot No. 13 WATER WELL CONTRACTOR: Name `Tb AG, D9_--(kjzm 1,4W Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N► A. TOWN /VIL /CITY DISTANCE TO PROPERTY FRUM WEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 5 I O ON SEPARATE SHEET (date) gna ure) 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 otherw cone minate surface or groundwater. Date of Issue: 2 19 Date of Expiration 19 2— Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number 9 7-0 111 XF5" /L1,7 /2j- X'? 00 - 2- - 2- Co , WELL OWNER Name Mailing Address /0- R -,-r 5'70 4 llama Zlellrs 1,2& V -,vT Gv;. LT% e 171 arPrivate OPublic USE OF WELL 6)_ primary 2- secondary RESIDENTIAL O BUSINESS 13 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT S_ gpm /# PEOPLE SERVEDy 6' /EST. OF DAILY USAGE /000 gal REASON FOR DRILLING MEN SUPPLY 0 PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED1 REASON FOR DRILLING /�,�,t/G WELL TYPE 02�CRILLED DRIVEN EIDUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES L,--" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ;S TCIIVO —C& 1:114 G Lot No. 3 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1,-"-'NO NAME OF.PUBLIC WATER SUPPLY: �/ //� TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: A/� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON REAR OF THIS APPLICATION �N SEP RAT w E 3a Q (d e). 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 b the P tnam C unt Health Department. Date of Issue: 19 Date of Expiration: 19 t rssu iNl- Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 Oranae core: Well Driller Putnam County Department.of Health Division of Environmental Sanitation .._.. p FPID E ---Or - A.n�T.CAT,ION FOR PERMIT. APPLICATION SUBMITTED TO - PUTNAM C.OUN.TY }{EALTH DEPARTMENT. Tb: Commissioner of Health - In the matter of application for . represent that I am an officer or employee of the corporation and arft author]1sed:. to act for 40Al - (name of corporation) having offices Whose- officers -are ._ _mot? 1 • � President O S %% C OGC�, -�!� _ �3,eEc� STEM: � Name and•Address) Vice-President �}j-v j� C (o GC�c.�71� G�W_�- _ (N�me and Address) Secretary G4YQ --o _ /J� ' • _ (Name and Address) Treasurer (Name. and Address)^ and that I am and will be individually responsible for any or all, acts of the corporation with•res'pect to the approval requested and all•sub- sequent acts relating•tliereto.' Sworn to before me this day Signed of 198 Title otary Public ANt4E B. COhRIO M Flbt�y PI+We, wa w mr r� FAY Cif � r,ro . , • ' � � � - Wwch as is Red m alere ` � b . Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS __.._,. _. _. _ ... _ _..r .._ _ ....... .. Rt"E•Jaini oDATE BY: 3 (Street Location) DOCUMENTS Permit �b-r(_3 Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth (Name of Owner) s/s SUBDIVISION Perc 1 (3) cdr d House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tbwn/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) - -- -- - D6tig_ n -hard: " perc and deep resuats��" �,. _...._.. Two-Foot Contours 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 Puffed 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 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 351to 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 RMMM C1MM DEPARM NT OF HEALTH DidsioN IF mvnnm=L FIEALTS •SEmas - __,;,_..�.�- 'a��IGR1' i����` - SF�• -;',�� I����.�PiIS�.:�.: ., <._�._..F.E��A� - - - � .... .., , Owner Co LT/' Address 106 g6X Located at (Street, �oG� /. ✓rc.�� /LO Sec. �� Plock Z lot (indicate nearest cross street)* �® Municipality o F /_1247 ezr Watershed Tvic/ SOIL PER00=0N- -T'E'ST DAM RDQUIM TO BE..SUBMITrED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test 7 �7 'BOLE. Nuom CLOCK TIME PERCOLATION PEROO=ON Run Elapse Depth to Water ftom Water Level NO. Time Ground Surface In Inches • Soil. Rate , Star Stop Piano Start s Start-Stop Drop In Fti.n/?n Drop . G aT l 3 Inches Inches Inches 3,' s o3 ey 03, 4.. 5 L V 5 - 1 a 3 4 5 Y�OTESe to Tests to be repeated' at same depth until approdnately equal soil gates are obtained at each percolation test hole. All data to* be submitted for review, 20 Depth measurewnts to be made frau top of hole. / • • �• 1 1' �i1 • 1 : 1 Y�/ Y: �/ •' 8' 9 1. ,. t i i 10' 13' 14' INDICATE LEVEL AT Wf3 a GROUND= IS EN00UNTERID INDICATE LEm TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEEtID DEEP HOLE OBSERVATIONS MADE BY; DATE: DESIGN Soil Rate Used //- iS Min/1" Drop: S,!:M Usable Area Provided No. of Bedrooms Septic Tank Capacity /Z S:c) gals. Type Co /VC. Absorption Area Provided By, Sv v L.F. x 24" ' width. trench Other Name � dGlzirly1 /- -0zC. j1 C. Signature ..Address SEAL &.�N No. 56124 .:I. rill R sLi x. i THIS SPACE FOR USE BY HEALTH DEPAR'IMEM. ONLY: Soil Rate Approved sq.ft,% . Checked by _ Date . • C V �. � t Yv4, l i i ', # J 1 µVS .: y t , { .0 •4�.e e�` lad . v v,� t a y I �T � r d, r! A. n I• "� '�� � t °k r r� t r e?'y� last '01 LOW nr ; t � h � ' a „•, ""' �`' ' i 1 t »,e a.t z Way, v u '' � KC511�1�iNGf% ,., Y r, 50L.P AO5 , s�W tool x, t OAT ><t:tlCrt Crr {) a .. TWO �T aiPl �r A 0, a 2 6 „•, dt5r.,r���" s v x tt t F M �I }� -�Re°a .;; i t r�"a'�.ywr.9"7E t7ir✓f'S!° 7 { snk, 1 t 9 a 00 CAtN 7 g 4 ,� ,.�t gt •. 7 }; r t "i q4 � ......F� � ^ I x a f.5 rat a4 firl SAO; I •y 7. V � �+v. { l cr . t tru , t; x �. ; t�IN1�N5'lON GNART . • t• it .2.0' 5 5 M Moo a4 firl SAO; I •y 7. V � �+v. { l cr . t tru , t; x �. ; t�IN1�N5'lON GNART . • .2.0' 5 5 M Moo e 4 ° NTH tS'I,r�`TOrG�K7�tF`f'tTl-t'AY THE ✓EWAG> =• L'IISC'D�✓-i4L;r✓'(✓T�t•<ii s � WAS•.GON�✓ZI�IXiT�C A5, INt7.IGAT k�'ON T�(5 ,i°LAJ FANt�