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35. -4 -48
BOX 15
11 r
gi
f.rh%l
� `
01726
P,UTN
Rev. 3 86
CER ATE OECONSTRUMON.COMPI
n Located at : '
OwnerLappllsmnt Name- O �l /0, r.
Malik Address �U '� `o X 9 Td
:. .,
IUNTY'DEPARTMENT OF HEALTH
mental Health Serviceu; Cermel,N.Y 10512 1
Eogh�eer Mast Provide 3'
P G H D Permit IY —
tkNCE ,FOR ,SEWAGE DISPOSAL' - SYSTEM.
T ky`r4p
Tax' Map �. G. Block 2 Lot �° • �;
Foenserly Subdlvialon'Name •'jYz .off 6f' Subdv Lot H��
Date Permit Issued, ' e-c"
Separate Sewerage System bnllf by" Address
_fit SU p �'..o U
Conflating of Gallon Se tic Tank and
If
Water Sapplys Pabllc S1lpply From /� G jO
Address
k ,
ors _T Private Supply Drilled by . - • `� Addresas / !� tii • -�,.!/
Building T . . wi, ?-h HastEroslon Control Been CoptipletedY
Number of Bedrooms Has Garbsge Grbider Been InetalledY' U
Other Regnlrementa
3 certify that `the System 6) as , listed, serving the abova premises were constructed essentially as shgvm on Ehe plans of the completed work ( copies
of which are attached); ;and in.accordance with the standard7d;b
e EiB� t- �`a.cordanca with the filed plan, and the permit issued by the
Putnam" County tiepaitment Of Health
,J
Data . /Sr�� Certii _ a
-kIcenta No.
Address •7z
Any person .occupyfriq Dremises ssrvetl by: the above systems) shall promptly take such action as may be necessary to, secure the correction of any unsanitary
\ conditions resultMq tro al ofcthe'•'�ir vats with su' pt t -salsbecome ull a ofvow haln a• Public Water supply`becomN avai bt;: sanitary Mwer becomes
e
\. �availab'IS' and the,app ov, D .._,,. „ ..PP Y ,., : � ,., , . , _ ... labN. Such aPP ► ovals are
ti)ect to modifiratio ' r change when, -in the jutlgment of the Corrsmissionar of Wealth, revoeatbn, modification or change Is neeena►y.
m
PUR]AM 'COUNTY ,DEPART OF HEALTH
DIVISION OF ENVIRONb=AL HEALTH SERVICES
Owner or Purchaser of Buildin Section, `.. Block Lot
.n g
Al�tid i?-L`t� . 47S. DoyrIi t..orM E. jj . 6k 17 CA�f_mA(
Building:Constructed by
��L1p-1At'IU(, lam,. �jD,,�dj6yL6'7 671l�lC3�iC. �{l4
Location - Street Subdivision Name
Municipality Subdivision. Lot #
Building,Type
GUARANTEE 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 segaage disposal system; or any
repairs made by me `to 9d6h 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 of the system to operate was
caused by the willful or negligent act of the occupant of. the building utilizing
the system. A A /j A
G,
j() 19,�f Signa
ess
rev. 9/85
mk
Title U
WELL UUr1rLh'11UA rLrUA1
C1W DEPARTMENT OF HEALTH
D ,,q4Aon,Of Enviropmental Health._Sgrvice_s
PUTNAM COUNTY DEPARTME NT OF HEALTH
Office Use Only
• Tz
STREET ADDRESS TOWN/ VILUtUICI I r TAX GRID NUMBER:'
Steinbeck Estates, Farm-to-Market Rd., Brewster, N).
WELL LOCATION
WELL OWNER
NAME: ADDRESS: PO Box 970
Monroe Heights Development Corp., Carmel, NY 10512
lw- PRIVATE
70 PUBLIC
USE OF WELL
1 - primary
2 - secondary
aRESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR/C.OND./HEAT PUMP 0 ABANDONED -
❑ BUSINESS ❑ FARM .❑ TEST /OBSERVATION 0 OTHER (specify)
❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED 3 to EST. OF DAILY USAGE 450 gal.
REASON FOR
DRILLING
KkNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
300
WELL DEPTH —ft.
STATIC WATER LEVEL ___1_0ftTDATE
n 8/11/88
MEASURED
DRILLING
EQUIPMENT
❑ ROTARY xQ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING, EMPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 91 tL
MATERIALS: xE] STEEL ❑ PLASTIC 0 OTHER
LENGTH.BELOW GRADE 90 ft.
JOINTS: OWELDED WTHREADED OOTHER
DIAMETER 6 in.
SEAL:; CEMENT GROUT OBENTONITE OOTHER
WEIGHT PER FOOT 12 1b./ft.
DRIVE SHOr*5aYES ONO
LINER: OYES ONO
SCREEN
DETAILS.
DIAMETER (in)
'SLOT SIZE
LENGTH
(11)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
.
0 YES- ONO....._
.
Y�� ONO
HOURS
GRAVEL PACK
11 YES
❑ NO
GRAVEL
SIZE.
DIAMETER
OF PACK in. I
TOP
DEPTH ft
—.
BOTTOM
OEM It.
—
I
WELL YIELD TEST It detailed pumping
METHOD: ❑ PUMPED i tests were done is in-
WOMPRESSED AIR formation attached?
0 BAILED C1 OTHER OYES -ONO
It more detailed formation des6riptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
I
Water
Bear-
i re g
well
oia-
meter
In
FORMATION DESCRIPTION
CODE
ft.
I ft.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
it,
YIELD
gpm.
Land
surface
80
Hardpan & boulders,
80
300
Medium to'hard grey & white
4ra.
240
2 —
240
2�
300
6 —
250
8
WATER M9LEAR TEMP.
QUALITY - 0 CLOUDY HARDNESS
❑ COLORED ANALYZED? X:@ YES ONO
ANALYSIS ATTACHED? PIES 0 NO
STORAGE TANK: TYPE njaphraam
CAPACITY 82 GAL. 26
PUMP INFORMATION
TYPE Submersible CAPACITY * 7
MAKER Goulds 260 ft.
DEPTH
MODEL 7EHO7412 VOLTAGE 2301jp 3/4
WELL DRILLER NAME
MILL DRILL 511 G
ADDRESS Putnam Avenue " : . M' Pr
Brewster, NY
R rt '
seen
ite I
Im
ELLIS A. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CH CaiCAI 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 METHODOLOGY
WASTEWATER
IpIINCA6 METHODOLOGY
DIOLOO,!CAL P.O. BOX 2328 203 - 748 -7903 APHA - EPA - ASTM
NAME ARID (�
ADDRESS 0F. I _
PERSON TO
RECEIVE
REPORT
Mill Drilling, Inc.
Putnam Ave
Brewster, N.Y. 10509
DATA
SOURCE OF SAMPLE
Wat r-.Supply, Steinbeck Est.
Lot , Indian Hill Road
Patterson, N.Y.
DATE OF COLLECTION Aug . 23, 19 $ 8
COLLECTED BY Mill Drilling
hydrogen Ion.
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
CCooncentration
LANGELIER
RYZNAR
NTU
Mg.
Alkalinity as 08003
a
Fluoride (F)
Bicarbonate
Nitdto
Mg /L
Mg /L
Mg/
NITROGEN
Alkalinity as CaCO3
Chlorine Residual
CONSTITUENTS
Carbonate
AS
Nitrate
Mg /L
Mg /L
Mg;
Total Hardness
Conductivity
NITROGEN IN
as CaCO3
Ammonia
Mg/ L
Mg / L
Mlcromohos /c r
Mg /L
Iron as Fe
Mg /L
Mgr
Chlorides as CL
Mg /L
Manganese as Mn
Mg /L
Mg:
Detergent as AABAS
Mg /L
Sulfate as SO4
Mg /L
Mgr
.The orithmotle moan of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST
:ono Colony .ptir lggml.- Coliform colonies per standard sample shall not exceed 3/50mi, 41100ml.- 7/200mi: -or' 13 /SOOmI Coliform Colonloa /100Ml
in: (a) Tiro CohdbcUli VO etimpleo; (b) NlofO than On - standard sample when less than '20 are examined per month; or (c) 0 -
More than five par cent of the samples when 20 or more ere examined per month. I
11T THE TIME THE SAMPLE WAS SUBMITTED:
® 1. The reeulto of the analysis of this sample were satisfactory and met requirements for a potable water.
0 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:
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
undesirable and, while not necessarily Indicating the presence of any disease - producing organisms, does indicate that such contamination might survive lathe 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:
COMGAERlTS
I
The bacterial'analysis showed no organisms of the coliform group at
the time the sample,was collected which indicates the water potable.
Certified 'a
Ii.
IV.
V.
V_Ir.
FINAL SITE ILSP=ICN Date
Inspected --A b_
;CAT= {ON CWNER&2je
TMI OR SUBDIVISICN
ir 17
SgEINALE DISPOSAL A-Mk
a. SUS area looted as - approved plans
-
b.
Fill section - Date of placeneunt
2: 1 barrle,_ WT= AVG.DPIH
-------
c.
Natural soil not strinced
d.
Stone, brush, etc., greater than 15' fran SDS area.
.t
e.
100 ft- fran water course /wetlands.
SF,9 =-- DISPOSAL, SYSTDI
a. Septic tank size - 1,000 �1,250
b.
E,---r)tic tank installed level
c.
10' minij= fran foundation
d.
Nn 90' bends, cleanout within 10 ft. of 450 tend
e.
DISTRIBUTICN EGX
L All outlets at same elevation - va"Cer. tested
2. Protect---' be_-1 c-w frost
3. Mij im 2 ft. oriainall soil between box and trenches
f.
JUNCTION EGX -- properly set-
0 Lent ins -E_--icr;L-ri remuired - C
1. L ----
2. Distance to wa-tarccurse measured
3. Install -i
acccrdna to clan
S ii [.:-I- S,
4. Distance canter to center
LO
5. S-lore of trench acceptable 1/1'05 1/32 "/ZGCr_.
6. 10 feet faun QrcL-f--,-t,7 line - 20 feet - foun(!aL-_iqns
7. Deo-Eri of trench < 30 inches fran surface
8. Rcan allicwed for e-m-amsicn, 50%
I. Size of qmvell 3/4 - 1�" diameter-
10. Devth of gravel in trench 12" minimun
LI. Pire ends mimed
h.
MiLD OR DC)-qE S:,-rSTEY.-,S
- 1. Size of =_Lm c *nber
i
-
~
2. G-v-e----Flc-.q tan]-,
1
/r
3. Alan, v_4s-,-.,.-d/audio
1/
1
4. Pump e--s--,'-',V accessible manhole to grade*
5. First box
6. Cycle wrtre._-Sed by Ee:-7-Ith Denartmemt
es-IC.i.iratea --Lcw per cycie
.HOUSE
a. Ecuse loot= rer- amuroved plans.
b.
Nimber of bee-roans;
I
T
i il'-edA.60�
WELL
a.
Wall local=-, -; as Per auloroved plans
b.
Distance fran' SES area measured
C.
Casing 18" _above grade-
a.
Surface drain_ =Ce around well acceptable.
OVERMIL WORKMASH EP
a. fv--,ces pror-e--i'l grouted
b.
ALII piF:fs Partially backfilicad
c.
AUL, pices flush with inside of boax
d.
EP-6--fill material contains stones < 4" in diamater
e-
C.=�tain drain installed according to plan
f.
00 --fain drain cutfall protected & dir.to e-xisj-.water cour
k- -
9-
F-cotincr drain-- discharce awav fran SIDS area
Surface water protection adequate
tHosion c--n=. 61 provided on slopes creater Lari 15%.
i rn� �� �� �� �.��
•CONSTRU N PERM FOR' S
PUTNAM COUNTY DEPARTMENT OF HEALTH a
Dlvtelon of Pbrohonntental Heslth'SeiAesc Carmel:14 11 2
oa CERTM to ProvMe Peemlt "M
CA COMPLIANCE
GE_ Pem M D
I 3:.
l
Looted u _ . F� : �tTi �.� Town or- =r�lg♦ _ "
SabdMalon Nun'-, ^ Saba. Lot N • ': n! :.. �.._.., -T� Map �� .�, . > 2 ^ Lot Z Co
, pRon��o�. i�izlC�H7S " J ,
Renewal O Revlebn
Owner7Appllgaut Name_�1WUD1° --^ 41'r _60 • . LZV ,
�y Z. o Date` of Pmvione, Appeowl
MaWng Address �, �. r.,.b -1 �L1r(r'd'4rr.C. AJ T i25S 1
- Towns.
Bdllding Type�t DP i�7:1(, Lot Are (��93 /LTG. FIII Section
�9 a �7 Depth Vobtme-
Namtier of Bedroom: 'T Design Flow -G P D' A'O O. PCHD NodSmd� le'Regolred When Flll b completed
Sepae to Sewee"e System to oonelet Gabon Septic T. i&ipd SD . (: t?a' /'O tj "rrL1�P�GK :Q
To to ;pwftasW by . , �1� 'c3Z 1. Address
water Sappll PAUC. Sttppiy From Address
pplyl Drllled:•by (r�7 sddreee
Other:Roodrementa `- . ; • .
1 represent that`I am wholly and.�completely �rasponiiDle for',1'he tles�gn and location, of the •proposed system(s); 1) that the separate sewage dispowl a stem
above describdA will be constructed as shown oo the;approveo' amendment there to and in accordance witn.the standards, rules an regu a Ons o e' u ham
;. County Oepirtment of HeaRh,,_and thsFon comDietion thereof a ;CertiUea'to of'. Construction Compliance ",satisfactory to the Commisalonenot MeaRhwill
txf wOm;ttsd<to the,Qeartment and a` written guarantee .will De• furnished the owner h;s•.wccessoi;, heirs or assigns by the builder, that, sskl,builgei will
place', m good ,operating condition any part of $aid sewage disposal systein during ;the :period'of two (2) yeais, immediately follow Ing. the date, of the )ssu-
ante •of the ipproval',of tM Ce t�fiute of Construction Compliance of the, original system; or any rap>iif$ thereto{ 2) tit theArilted well described above
will be located;is shown`on th0 approved plan andahat sa;d; well wtlLbe install in 'accordance 'with t e standar i s a 0 'regu a� of the Putnam
County Oeartment Of;HeaalQlth -
Date Signee P.E. R.A.
Address 4 -} (/2i FeyLI9 12 License No- S6 Z 7 4-
APRROVED FOR CONSTRUCTION Th�s4approval;exDires, two years - from;the date issued unless 'construction of the building has been undertaken and Is
revoubleslor ca of ma De amended of °modilied when eonsideied nee scary b e C missioner of Health. Any change or alteration of construction
requires a ne 'permit. A o �sposal of domestic san;taiy ge d %oi to ws r on
Rev.
1/87 . Date gy i
Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
c . - _...........,.� _.,.- �. ,. ,... -, -]N,r -T.,. ,,,,,._w.,_.,,. ,
APPLICATION TO CONSTRUCT A WATER ,WELLv-� " � �' a - �+
PCHD PERMIT #_�a
WELL LOCATION
Street A��gqdgqdr��e //s,u�s �i�e Topw�nq/ Tax
d�0BYa �� IYc+ror9� A Y 9 64 "0 1'1W
Grid Number
00-1--us,
WELL OWNER
Name
Q
Mailing Addj7ess i ',D, P ^K -TIO 4fPrivate
;l.�t� GA/1 Q.. NJ JOS'17- O Public
USE OF WELL
0 - primary
2 - secondary
bfRESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP.
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
® ABANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
5;, d gpm /# PEOPLE SERVED 4r-& /EST. OF DAILY USAGE ®m gal
REASON FOR
DRILLING
VNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
® TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
®DRIVEN ODUG OGRAVEL
®OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _JNO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: I�
Lot No.
WATER WELL CONTRACTOR: Name Tb 6%�n py".OA% Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _Y_NO
NAME OF PUBLIC WATER SUPPLY: � �� TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS A,1ON t E SHE
(date) ignature
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 permit.
3. Submit a Well Co letion Report on a form provi d b t Putn C u y
Health Departm
Date of Issue: 19
rmit Issuing fficia
Date of Expiration: 19
Permit is Non - Transferrable Mite copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2/87 Oran a copy: Well Driller
APPENDIX B
PUTNAM COUNTY DEP.MP= OF HEALTH - DIVISION OF ENVIRONMEU'Ar. HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SBPM DISPOSAL SYSTEMS
REUJ�nJ,..S.iE��T _ - GONSTRLIG'.�ION PF�RMZT . _ /`•. f�
DATE vr'� : W ' M
BY:.. - ---__
(Name of Cwner) (Street Location)
CMMIENTS I YES I ,moo I DOCGM= (A� 'r
Lr
FILL SYS
clavbar ier
10 ft.
fill otes
neTa
dep Vude.
1091yr. flood
200 ft. r er
150 ft. iriaa
Pernit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
House Plan - Two sets
Well —pe_rmit; ?NS letter
Variance Reauest
�kL +
Leal Subdivision
SuLivision Approval Checked
Ex- approval SSDS Ad!. Lots Checker:
Wetland (Tcw-n/DEC Permit R & D)
Data Cn DDS Plans & Per -mit Sane
REQU= DETAILS ON PLANS
s/s
S'JBDIVI ICN
Parc
(3) Fill '�-
cd
.red,' W I I Swage System Plan - ( nor 1n a_-rc; )
— Se age System Hydraul i c Prof iI - Gravity Flcw
reto contours Fill Profile & Dimensions - Volu-ne
D or J Box; Trench /C-a1lery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder rate)
L�- ..sig_n...Data.: Perc and deep resul Es , .
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footinr/Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and epansion
Expansion Area; shown; gravity flcw,suff. size
If Pumped Pit & D Box Shown & Detailed
House -No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed System
Property motes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
ev. No Bends; Max. Bends 45° w /clea.nout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fi.
20' to Foundation Walls
ir, etc. 100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expa:
/gall. 15' to Drains - Curtain, Leader, Footing
35'to catch basin,stormdrain,piued watercour:
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to cell
15' Well to PL 9
1 c
I:
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER "APPLICATION
FOR PERMIT• APPLICATION SUBMITTED TO
PUTNAM BOUNTY }[EALTH DEPARTMENT.
Tb: Commissioner of Health - In the matter of application for `
�:,� o�►�Qo E %f� (��ZS � E (/�Go,P�YI �u T_ .�' lyl ���� L 7� � - -
- - -...- _ - - .o represent
that I am an officer or employee of the corporation and artt authorized
to act for�� R4C - -:_1 �� ��!�GD.iY��/✓ % -> L,-t� - -
(name of corporation) _
having offices at �QL( Lc - �1 ✓I/)��j �_ 2 -0-4 -D 32 . tl 2
Whose. officers -are
President _�E� s ?E�!L ,�
Name and Address) I.
Vice- • President, -2)A() C(oCc9L47/- G/fyotocz
-' (NAme and Address)
Secretary ` _ G _®'Li _ �)- - -
(Name and Address)- _
dl'easur ed�
- _ .(Name and Address) _ _ _
and that I am and will be individually responsible for any or all;actp
of the corporation with -resIpect. to. the approval requested and all- sub-
sequent acts relating ttiere,too
Sworn to before me this day Signed
of 197 Title
otary Public
/vet/
0
ANNE B. MiR1DAN
�'1► aMtcou.r
� ConrN��Nn l"
MWA
1e
Rea reba?t.
Corporate. Seal
-1
� •• • � �• •: is v •ry r: �• «a.
S-9 -D POSAL SYST'W±, _
Owner D& rL0pM P-( Ct ., L.L"Ch, Address piD, 160)) C11 y CAME: A) �
r-N,e K zv Mme°( IuA-v r
Located at (Street)Cb1,J"toA1 Sec._ Block 2 : Lot
(indicate nearest cross streetY �_�. 4-16)
miaicipailty N Dr- EE[T f4vs o A) Watershed C.CLo •ro r�
Date of Pre- Soaking $^ - i - I Date of Peroolation Test
SOLE
3
4
Ni�lSER Q
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water rrom
Water Level
No.
Time
Ground Surf�c�
In Indies •Soil Rate'..
Star Stop
t
Min.
Start Stop
Drop In MitVln Drop
715'
Inches Inches
Inches
1 AA-3 - 51.13
'3c
2 4-
+ 2 5:1 - S
21,.4
IM
#_z
�- 3
4 ..
5
yr
✓ i 0� i
25.01 -15TV .
?11
.3 5. d : �3 17,1
4
5
1
2
3
4
.
5
r
NOTES: 1. Tests to be repeated* at same depth until apprcadmately equal soil rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made•fron top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED Wl'I'H APPLIICATION
DESCRIPTION OF SOILS ENOOUNTMM IN TEST HOLES
DEPTH HOLE NO. , _ HOLE NO. N - HOLE NO.
G.L.
1 ° -ro ?so i L.
2°
3°
'o = t s
8° -
12°.
13'
14°
• INDICATE LEVEL AT WHICH GROUNDWATER IS ENICMNTER ED ` ^ IA-
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED Wk
DEEP HOLE OBSERVATIONS MADE BY- DATE.
DESIGN
Soil state Used 157 Min/1" Drop: p, gO S.D. Usable Area Provided .
No. of Bedrooms + Septic Tank Opacity jq gals. Type _COAJC .
Absorption Area Provided By aj a ® L.P. x 24" width trench
Other mF NEVI y �.
.` CN
Name Z,,t}va gm -' 10"WB 6+ Asse c , 10C, Signature
Address '73 f149kLf t*'LV D)zkVrcc. SEAL
No. 56124
�t-r sod VZ643 FESSI
THIS SPACE FOR USE BY HEALTH DEPARZ'r`TIM ONLY.
Soil Rate Approved sgmft%galo Checked by Date
i •' • �• •' 1� Y• 'ly -3117h : zi 2• MD.
i
..;. �_ -DESIGN .DATA..Si EET -SUS UF CE SFi E L�x.SPOS1 •:SXS -.- _ ,E: -
-
&0 �r- "tr-164WIS 2
Owner DWfLOPMraN1 Ce4'L7h, Address C' +O. 6O)o gio (:92 ,C, N11
zn M --( 12-O A-n
l
Located at ..(Street) ..: ~t'"CA1104 O4 Sec. _ O Block _'Lot
(indicate nearest cross streetY
Municipality QbuJ N op PHTTCit-soA Watershed cf,o -ra10
SOIL PIIt0O=CN- -TF'ST DATA REOUIRID TO BE .SUBMITM WITH jAPPLICATIONS
Date of Pre- Soaking $ - % - Date of Percolation Test
HOLE
,
- NUMBER ' CLOCK
TIME PERCOLATION
PERmrATION
Rune
Elapse Depth to Water Yom
Water Level
No.
Time Ground Surface
In Inches Soil Rate:..
Start -Stop
5
Min. Start Stop
Inches Inches
Drop In & /ln Drop
(,oZft
Inches
(' 1 A'4-3 5.(3
.30
2r,%14--5%44 %3e
m
5
4s' -- 6', (5 V90 •:2¢
114 z
13: Oo
24
21 - 3
.3 3 :21 24- 21 3
4
5 - .
1
2
3
4
5
NOTES: 1. Tests to be repeated:at same depth until approximately equal soil rates
are obtained.at each percolation test hole. All data to'be suhnittod
for review.
2. Depth measurements to be made -fran top of hole.
rev. 9/85
TEST PIT
E
.40
5°
7°
M� ! �4 �
I'M
13°
14:
1NDIC,ATE LEVEL AT WHICfl GROUNDWATER IS ENCOUNTER
INDICATE LEVEL TO WHIal WATER LEVEL RISES AFTER BEING EMDUNTERED 6�►/ A'
DEEP HOLE OBSERVATIONS MADE BY; DAE:
_. DESIGN ..
Soil Rate Used 11-15 Min/1Q1 Drop: 0, 6o S.Do Usable Area Provided
No. of Bedrocros - + Septic Tank Capacity ��L,�"D gals. Type
Absorption Area Provided By S° f- L.F. x 24" width trench
Other pf NE Wj,
Name LA4-1a w-r dal A1lr."ny6 . �&O c, e.C. Signature
Address 73 fA-m F t m c e* Dn6 V 1. SEAL 1 ,�
No 56124
�i-`r �o� � l2SG3
� a P
. . A �FESS10� �
THIS SPACE FOR USE BY IMMTH DEPARZMEM ONLY:
Soil Mate Approved sq, f i,% k. Checked by Date
A*
{
13°
14:
1NDIC,ATE LEVEL AT WHICfl GROUNDWATER IS ENCOUNTER
INDICATE LEVEL TO WHIal WATER LEVEL RISES AFTER BEING EMDUNTERED 6�►/ A'
DEEP HOLE OBSERVATIONS MADE BY; DAE:
_. DESIGN ..
Soil Rate Used 11-15 Min/1Q1 Drop: 0, 6o S.Do Usable Area Provided
No. of Bedrocros - + Septic Tank Capacity ��L,�"D gals. Type
Absorption Area Provided By S° f- L.F. x 24" width trench
Other pf NE Wj,
Name LA4-1a w-r dal A1lr."ny6 . �&O c, e.C. Signature
Address 73 fA-m F t m c e* Dn6 V 1. SEAL 1 ,�
No 56124
�i-`r �o� � l2SG3
� a P
. . A �FESS10� �
THIS SPACE FOR USE BY IMMTH DEPARZMEM ONLY:
Soil Mate Approved sq, f i,% k. Checked by Date
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