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PUTNAM COUNTY DEPARTN aM OF HEALTH
DlvidooW Envilu mental Health Services, Carmel, N.V.
rf Eoafineer Mast Provide � 9� . .
CATE,OF CONSTRUCnON.COMPLIANCE FOB -SEWAGE DISPOSAL SYSTEM
^--.
at
Y 4 G Tax Mail
Lot-Nam
?7 lAJd0iV u.4-'x ke-
77ve Fnnlncnri Am' —MMt 'Irf 9-ad
Sq ate sewerage System built by Se4- F SY n T c c_ _ Sc, f Fe�r�,y J 4
Couslating o[ � Gallon Septa Tank and
Subdv Lot
Date Permit Issued `
I certify that, th' lysies(s), as listed..eerving.the above premises vere;const:ucted essentially as shown on a p, of the completed work ( copies
of which are attached) -, and in acwrdence with the standards; rules and r ations, in accordance with fil p and the permit issued by the
Putnaa:Counpty,DepartAment of:8oilth '
Date-
�l P.E. RA.
Address U Y00° Lioansa No.
Any person.. occupying prernises s" bjY the above systems) shall Promptly take much action as may be neoaUry to,
sacwe the t�rredbn of any_unUnttay
conditions resulting, from such usage.. '_APProval of the MParate aweraga fystem• iMil beoolee null and veld as soon As a liubt;7 Unitary pwN beeomU
evallablertand tee ;approval of tM p►Ivate;waNr wPPlyshall bacomo null and void wh" a public water wPPly b»oo nes avallaele.. Such swovals are
subjeet-to modiHcatlon or change whin; in thi judgment of tM C6 6" MpKh revocation. nadHleatlon a Change Is ne�eMUr�ys
3/89 T� y By � Tale
Date
IN
4,> 0 . �Ae 4
a' WLLL t;UF1rLr,11U1v ruxuni
DEPARTMENT OF HEALTH
ri Of EnvlronweetLal't.1 ILYt -��L
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
"— -S
WELL LOCATION
STREET ADURESS: WW NI t 7 TAX GRID NUMBER
Lot #4, Steinbeck Corners, Patterson, New York
WELL OWNER
NAME: ADDRESS:C 0 Banker & Banker
Est. at Steinbeck Corners 777W. Putnam Av,Greenwich,C
p PBIVATE
p PUBLIC
USE"OF WELL
1 - primary
2 - secondary
0 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND.IHEAT PUMP O ABANDONED
O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O
MOUNT OF USE
YIELD SOUGHT 5 gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ®ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) ®DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 285' ft.
STATIC WATER LEVEL 30 I ft.
DATE MEASURED 7/29/94
DRILLING
EQUIPMENT
O ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG
O WELL POINT O CABLE PERCUSSION O OTHER (specify):
WELL TYPE
D SCREENED O OPEN END CASING p OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH 73 it
MATERIALS: I@ STEEL O PLASTIC p OTHER
LENGTH BELOW GRADE 72 ft.
JOINTS: O WELDED ® THREADED O OTHER
DIAMETER F in.
SEAL: @ CEMENT GROUT O BENTONITE ❑OTHER
WEIGHT PER FOOT 19 lb. /ft.
I DRIVE SHOE ® YES ONO I LINER: DYES ®NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (1t)
DEVELOPED?
FIRST
OYES ONO
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK :in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST ' If detailed pumping
METHOD: ❑ PUMPED tests were done is in-
61 COMPRESSED AIR , ! ormation attached?
❑ BAILED ❑ OTHER ; 0 YES 0 NO
WELL LOG If more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE.
Water
Bear-
Ing
well
Dia-
meter
FORMATION DESCRIPTION
p0e
tt.
tt.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
52
Drilling
in overburden clay & boul
er
52
Hi4
r
ck at 52'
285'
6
220'
5
52
73
Dr
11'ng
in rock, set casing, grouted
73
285
Dr
11'ng
in rock granite
WATER ❑ CLEAR' TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? O YES ❑ NO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPE Well Xtrol WX #251
CAPACITY 62 gallons GAI,.
PUMP INFORMATION
TYPE submersible CAPACITY 5c,_
MAKER Gould DEPTH 240
MODEL 5GS05412 VOLTAGE 230HP'15 _
WELL DRILLER NAME P.F. Beal & Sons nc CAT 8 26/94
ADOREss 4 Putnam Ave. SIGHATU
Brewster, NY 10509
�/ iSy
F]
r.
Box 224 - BREWSTER, N.Y.
(914) 855-1930
- WATER ANALYSIS REPORT -
SAMPLE NO. 8 5 2 1 TEST WELL
SOURCE: Steinbeck Estates
Lot #4
Brewster., N.Y.
COLLECTED: 8/ 2 4/ 9 4
BY:P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 mi.
8/25/94
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
PUT .P M COUtgrY DEPAFM -11S OF HEAL'T'H
DIVISION OF ENVIRO\WENrAL HEALTH SERVICES
owner or Purchaser of Buildin,�
cju a�
Building Constructed by
Sri '(I-- .
Locatign - Street
Section Block Lot
Subdivision Nam
TEacipality Subdivision Lot
Building Type
GUARPI= OF SUBSURFACE S��E DISPOSAL SYSTFd
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 shoran on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Deparinent 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 inmediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or. any
sys- -t eX_! -r t where. the fail ur-e •to -3p erate
j
caused by the willful or negligent act of the cccupant.of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environ -�ental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to o was
caused by the willful or negligent act of the occupant of th z Ang a zing
the system.
Dated this /`f day of r, 19 -_ Sigma
Title
Gene Contractor (D*mer) - Signature
Corporation Hare (if Corp.)
C7'
G
1. Y••� -r �, ti,, c•
Address
rev. 9/8S
mk
,3 4 4 l= •-Y, nn s: 14 , GLr � r 3
Corporation Name (if Corp.)
• - �. �`r 2 �/ iS = CE C� J_ % CT C4 L T = I .i __ C•,y'l'�::I
a _ EDE 2 = _-= lc' - DEG-= C=
C_ t C - --
_ _ e _ ^ _
1�
E_ trp f 1 - -�_5
C- n= co W: - I
C -_C�_
nc-
c, a c=
• t'. FCC.' c! sr c!- _C� E�'___ -_Ci_r 51:% I I
1 J . _ trEzC-2 3-1"
.. �_ .�•�ru -'Cyr ..L�y_cc- -C._J; ._ .. - . �.
1 5 =� s p_
pT =fir ri= —��c
V. EC-7--=
- - -= pI-
cazzrcv=-- E
C.
r
L L -r-. =C= �.►=c _T �. I I I
C_ C-___ Z3
CL
a. C= _ _ I
1=:
-
- •_.t^
c-- I I I
4.c-= C`CC =r =_C cr'c -r�_-L 1_3_ I
above described Will be constructed a s she wil'..01i
be Submitted to It h a Department, and a' -wrlit
in any Wt �c
will be located as Shown On the approved linli'
county Dwrtmak of. Health.
ionible for thlicwilina�d location of the, proposed svitem(l); 1) that the- Separate Owego I Istern
With the stind4ro Srules,ano regulations
the bliprov0d amWidnient there to-and in accordance Putnam
ljj� guarantee wil I I b . efurnishad . t1se,"ner. his Suc,cM=prI6 heirs pi assigns by tlie� bulklise.� that aid b"mikW will
aid we w-ililii st=010; Of
i'that if* Insto in accordance with1he ru '. an the: Putnam
$,approve am
w �°ires of d
m�° o
l0/88 -
'— — — -
�.
IE
V.
s-two veers frorn_the date Issued u641. ,construction of, the building has. been undertaken and is
st k: unitary, sevidgej star Su only.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New-York 10509
(914) 278 -6130
ae :APPL_mC.AT10N.. TO
PCHD `PERMIT #
WELL LOCATION
Street Address
1 _Ac
To Village City Tax
, Grid Number
5J - - 6tl/'
WELL OWNER
Name I
I Mailing
Address
)
®Private
O Public
USE OF WELL
Q - primary
2- secondary
( RESIDENTIAL
0 BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT gpm /#
13 REPLACE EXISTING SUPPLY
M NEW SUPPLY NEW DWELLING
PEOPLE SERVED�_15 /EST. OF DAILY USAGE bPO gal
O TEST/ OBSERVATION M ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
®DRILLED
DRIVEN
DUG
�GRAVEI.
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �a
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES `' NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL/CITY
DISTANCE TO- PROPERTY- FROM - NEAREST WATER MAIN: 1 . _ _. - -,._
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON SEPARATE SHEET
(late)' gnature
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
thirt; (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 suc a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: i/ /� 19
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
ri
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
FVV w , . ._,'� RANDOLPH W. LAURENT, PE.914) 278.6108 — (FAX) 278.2658
HARRY W. NICHOLS, JR., PE. CONSULTING SITE ENGINEERS
August 11, 1993
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS
Ice Pond View Estates - Lot #4
Andrea Place
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing SS -4 "Proposed SSDS - Lot #4 ",
dated 8- 11 -93.
2. "Application For Approval of Plans For a Wastewater Disposal
System ".
3. "Construction Permit for Sewage Disposal System ", dated
8- 11 -93.
4. "Application to Construct a Water Well ", dated 8- 11 -93.
5 .- "Design.- -.Data Sheet".
va
>-- q. -- J'Letter of Authorization ", dated 8- 11 -93.
C� -7� C. '
''7. _,. "Corporate Affidavit ", dated 8- 11 -93.
LU
'- B.cjTwo (2) copies of Residence Floor Plan(s), for "Bedroom
�—Count Only",
_
o_ �.9.,,., Cut Sheet for Goulds Submersible Pump Model 3887 Series
Lis No. WS10B,BF.
10. Check in the amount of $300.00, review fee.
We have relocated the SSDS from the location previously shown on .
the "Final Plat" and excavated new deep holes and performed new
percolation tests as reflected in the enclosed.
11
August 11, 1993
Page 2
93046 -4
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Har y W. N' ols, Jr., P.E.
HWN:bd
93046 -4
enc.
cc: mr. Steve Banker w /enc.
PUTP' COUNTY DEPARTMENT OF HEP` -.H
• DIVISION OF ENVIRONMENTAL HEALTH SERVICES
TM t
Re: Property of��
Located at f'�til�'� �'►G
(T) ��c'�"j�DIV Section J Block Lot
Subdivision of ice' �D�`t::� Vl1WT�T�
Subdv. Lot q' Filed clap �Date
Gentlemen:
This letter is ' to authorize
a duly licensed professional engineer r/ or registered architect
(Indicate)
to. apply for a Construction Permit for a separate selvage system, to
serve the above noted property in accordance with. the standards, rules_
or .regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code. O - .,'E #✓
nlc:
Q"
Coun ersig No. 55124
�O Apo so
P.E., R.A.,
0
Very truly yoVrs,
V.
Signed
Owner of Property St�a� cA-ay
FS- C�'1c'S %'�T" �C� I`^%3rc.`L �- Z�"�`4f � F..✓C
Address
/.* Q I;.0 �j 0 6D13G
r�c�i - rIEP -2
Address '
Telephone
Town
K-31 - 3. C,
Telephone
Divisic :)f Environmental Sanitation .
AFFIDAVIT - CORPORATE a-• OER APPLICATIQN
FOR PERMIT-APPLICATION SUBMITTED TO
.PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health -- In the matter of application for
I�' �i�f�tN--- - --- -- ------- - -•--- represent.
— j
that .1 am an officer or employee of the corporation and am authorized'
to act for,
(name of corporate on)
having offices at — �� ! w� r _ ^i���— C� ^oG83o
Whose officers are
President _— Na —
me and Addres —s)— ,
Vice - President ��t'cV ►w d���.�v — _ _. — ._
_ _ i-
^' —(Name and Address)
Secretary — — — — _ _ —
• — (Name and Address) —
Preaslirer _ _ _ _ _ — _ _. — _. , __Z _
^' — _ — — (Name and Address) '
_ a�,d taia�.= am °erred w� li uc `iidivicivaiiy resporisiliie fc;xt ai'1y o1y a °.ap Loy
of, the- corporation with respect to the approval regiies:ted and-all.Sub*7.
sequent acts relating -thereto.
• {' r4�
Sworn! to before me this i � `fi day Signed
of s ' 19�� Title CC=6411�-_V
'_ _
7 .
Notary publ'
BONW J. DAM
NOTARY PUBLIC, SPATS OF HM YORK
REG.14965305
QUAURED IN DU T CNESS COUNTY.
MY COMMISSION EXPIRES AM 1Z �_
Corpor4te Seal
u,,._ . ._ V
Goulds
rr5l_ f-4
omensR
Purhpq
3887
Motor: :
Single Phase:' /3 -'h HP 115V or
FEATURES
23QV, 60 Hz; 1750 RPM; 3 /a -1 HP
Impeller: Cast iron — semi
230V; 60 Hz, 1.750 RPM; 1 HP, _
-open, non -clog with pump -out
230V, 60 Hz, 3500 RPM. Built in:
overload with automatic reset
vanes for .mechanical seal pro -
tection. Balanced for smooth
Three Phase:' /z -1 HP 208/230
operation
40V, 60 Hz, 1750 RPM;1 HP
: Casing. Cast iron volute type
208/230 460V, 60 Hz, 3500,RPM
for.maximum efficiency. 2 ".l'
Overload protection must be
discharge adaptable for slide rail `:
provided in staffer unit
systems;
Shaft Threaded 400 series
:Mechanical Seal. Ceramic vs
stainless steel..:
carbon'sealing faces; stainless
Bearings Ball. bearings upper
steel metal parts, Buna N
and lower
elastomers
Power Cord 15' standard (optional*"
Shaft:; Corrosion'resistant
lengths available). y
stainless steel, Threaded design
Single 'Phase:' /3 -'2 HP, 15/3 -
Locknut,on three phase ,models to
SJTO with three prong plug; 3/a and,
guard against component damage..
1 HP, 14/3 STO with bare leads : =on:
accidental reverse rotation
Three Phase:' /z -1 HP 14 /4STO
- Motor: Fully submerged in
with bare leads.
high grade turbine oil for :.
On CSA listed models: 20' length _.
lubrication and efficient heat.
SJTW or STW are standard. ,
transfer. : -:
Designed for continous operation.
All ratings are within the working
limits of the motor.
Bearings: Upper and lower
heavyduty ball bearings
construction.
Power Cable: Severe duty
rated, oil and water resistant.
Epoxy seal on motor -end
provides secondary moisture
barrier in case of outer jacket
damage and to prevent oil
wicking. .
"BF "and "BHF" Mode have
O- Ring:` Assures positive • .
sealing against contaminants and
2" Companion Flange.
oil leakage.
Effective January 15. 1985
Goulds •
ubmersEbIle
Wr ge.-
`r
Pumps,
MODEL
BF and
Models
4' 7; 3887
, h
53/i '
Rotation
Simplex Ejector Systems: are used I
where drain facilities are below existing ,
sewer lines. Also can be used for septic
tank applications where effluent must be v ry
pumped away from tank for disposal.
0 i.z�b
Kick -Back
Duplex Ejector Systems ottef the A' — All models are .173/4" except 3/4 HIP. 1 m and 1 HP 10 = 2034"
necessary safety required by institutions
Which cannot afford an interruption in Dimensions are approximate: Do not use for construction
their sewage disposal systems. purposes:
. Available Certif( cations!
'"
Sp- Canadian Standards .
Association. -
C
Pennsylvania Bureau of Mines for non -face applications —BOTE 91:
SF_NECA FALLS NEW YORK 13148 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A..
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01985 Goulds Pumps, Inc. Effective July, 1985
PU'Z'N.A.I� CoUN'r�' i�EP.A.�t.TMEN'Y'
- APPLICATION FOR- APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL. SYSTEM,
1. Name and Address of Applicant:
MA
' ► ■ , i
2. Name of Project: t�I�'U(fD°J�t> of�-22b5 3.__,_Location� /C: So
4. Project Engineer: w. Q GNDLs _. 5. Address: 1T��(�1✓I l�t� r'tzlvo
to 1256,
License Number: Phone: o 'i
6. Tyoe of Pro ect:
Private /Residential Food- Service : ....Commerc.ial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject'to State Environmental -Quality Review (SEQR)?
TyQe Status (Check One) Type I.. Exempt ✓
Type II. Unlisted.
8. Is a Draft Environmental Impact Statement (DEIS) required? ..... .., Q U
'9. Has DEIS been completed and found acceptable by Lead Agency.? ......... .
10. Name of Lead Agency
ti. Is this project in an area under the control of-local planning, zoning,.
or, other of*icl3ls� o.•d{�., n . .. ............................... ... . old
�can� c 8
i2. If so, have plans been submitted to such, author .sties ?.....................
13. Has preliminary approval been granted by such authorities ?_ O/A_ Date Granted:
14. Type of Sewage Disposal: System Discharge....... -Surface Water v Ground Waters
IS. If surface water discharge, what is :the stream class designation ?........ 4J /A
:6. Waters index number (surface)
;7. Is project located near a public water supply system? .................. NUJ
S. If yes, name of water supply Q /A Distance td water supply
9. Is project site near a public sewage collection or disposal system ?..... U0
O. Name of sewage system Q/A Distance to sewage system
1. Date observed: 0 -3 cl 23. Name of Health Inspector: A�, 4) .
�. Project design flow (gallons per day) ..................................... bDD
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. pip
26. Has SPDES Application been submitted to local DEC Office? K) 1A
27. Is any portion of this project located within a designated Town or State
wetland ?...... ........... ............. ...............................
28. wetland ID Number ...................... .................:............. . ►J /d
29. •Is wetland Permit.• required?.............................................. . tides_
Has application been made to Town or Local DEC Office? -k\) /4,
30. Does project require a DEC Stream Disturbance Permit? ................... 0
31. Is or was project site used for agricultural activity involving application .
of pesticide$ to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? YES or NO 00
32. Is.project located-within 1;000-feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known - source of contamination? .....'.........YES or NO f)I
DESCRIBE:
33. Is there.a local master plan or file with the Town or Village? ... ......... _
34. Are community water, sewer facilities planned to be developed within 15 years? M KNo100
35.... .'Are any :sewage. disposal areas in excess of 15%' slope? -:.:: Si o
36. Tax Hap ID dumber .......................................................... .*r5. -4 -- P10
37. Approved Plans are to"be: returned to: App-1icant _Y"' Engineer
If the application is signed by a person other than the applicant shown in Item.1, the.
application must be-accompanied by-a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
y1.
I hereby affirm, under- penalty of perjury,- that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Cla s A Nisdameanor pursuan to Section 210.45 of
the Pena 1 Law.
31GNATURES & OFFICIAL TITLES:
':AILING ADDRESS: Kl
DIVISION OF HEALTH SE[MCES
DESIGN DATA SHEET- SUBSUF-ACE Sr`SRAGE DISPOSAL SYSTEM
ME NO.
Owner / t i
{� Address-1 -j K)
5
1
Located at (Street) ���
�, ZI
Sec_ �j5 - . Bloc'C Lot
(indices
nearer 'cross street)
-
t- tunicip3lity �r
I' Ot\j
Watershed
SOIL P=U5MCN TEST
MTA REQUIRED TO BE SUtx'•ff= WITH A.PPLIGATjo iS
Data of Pre-Soaking. Z ��'�j
Date of Percolation Test :7-2--7-
HOLE
m2yrR C= TI2I(--rl
PE'RCQLATIC
PEROC)=C N
Run Elapse
Depth to
Water Fran
Y�ter Levu.
No.
Ground
Surface
In Inches Soil Rate
Start -Stop Min -
Start
Stop
Droo In Min /In Drop
Inches
Inches
inches
2
4
z l : 1 0 9 . -27v .:
r�#
Z��
1 '/14,
. C3 2:��_ �: �2 �o
�I 4�
R,
4
5
1
� •
2
3
4
5
1.* Tests to be repeated at sa. depth until approximately equal soil rates
are' obtained .at each percolation test hole. All data to* be submittbd
for review. -•
2. Depth measurements to be made Fran top of hole.
rev. 9/8S
DESCRIPTION OF SOILS IN TEST BOLES ^�
DEPTH HOLE NO. BOLE NO Z BOLE NO •.
G. L. V
jr
2'
3`
4' c, fit 1�
5'
6'
7'
8'
9'
10`
12'
13`
14 -r
INDICATE LEVEL AT WaICS (MOUNDRATER IS &N=NFERM
11N)ICATE LEVEL TO WHICH F'aTER LEVEL RISES AFTER BEn\1G ENMUNT-IMED
DEEP HOLE OBSERVATIONS M_aDE BY: Hf DATE:.
DES16
Soil Rate Used IM Min/1" Dr(bp: 0.70 S.D. Usable Area Provided
No. of. Bedrecros Q Septic Tank Capacity 1 ZED oats.' Tape
Absorption Area Provided By )�bO L.F. x 24" width trench
Other (eL2 (� 1 fit° GLI tz i �•1 N l�izp�l IJ n N t
Nalre _ 1- lQ600--:2 f Signature
Address ��� 4��11c1 -b D121 V SEAL
THIS SPACE FOR USE BY -HEALTH DEPAREiaM O,,%Y:
Soil Rate Approved sq.ft /gal. Checked by
s. -No. 124
O .,0FESSlot%
r v
Date
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