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HomeMy WebLinkAbout1828DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -5 BOX 16 ml I I I I r L �..., 'i L No W� tier , or Ir r� - ri � PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 \J Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF COMPLIANCE �Q CONSTRUCTION Fl \\ \KNIT FOR SE GE DISPOSAL SYSTEM pmt N T. Patterson Located.at_ B10SSOm Lane a Town or Village , Subdivision Name Apple Hill Subd Lot R 10 Tax Map 69 Block 4 Lot 6.4 Owner /Applicant Name Kathleen. & Louis Marmo Renewal— ❑ Revision p Date of Previous Approval Mailing Address 9 Briga Lane Town White Plains, NY zip 10605 Building Type Frame Lot Area 56681 Sq. Ft. FW section Only O Depth Volume Number of Bedrooms Four Design Flow G /P/D 800 PCHD Notification Is Required When Fill Is completed Separate Sewerage System t o conslst of 2 x 1 0 0 A o n Septic Tanis and 409' toilet & 270' kit r h en_1 1 n tin d v im ' 1n t e r a l s x Pat Tyndall 24 wide x 18" deep Brewster, NY To be constructed By y Address Water Supply; Public Supply From Address or: X Mvate Su ply Drilled by 7 _Address — 22 •�0 x � deep curtain drain Other Requirements represent that I am wholly and completely responsible for the design and location of the proposed system(s) ; 1) that the separate sewage disposal system above described will be constructed as-shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns.by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be install in accordance with the standards, rules and regu aeons of the Putnam County Department of Health." Date 28 April 1987 Signed P. E. R.A. — RD 9 - Fair St e Carme 10512 2906 Address License No APPROVED FOR CON TRUCTION: This approval expires Wly from he ate i us u les construction of the building has been undertaken and is revocable for ca a or ay amended or modified when con id re neces ry he CO ssi nor of Health. Any change or alteration of construction requires a new er pproved for disposal of domestic sa it y sews o,d Xr riv t w r su only. Date By Title PUTNAM COUNTY DEPARTMENT OF HEALTH )Rev. 3186 Division of Environmental Health Services, Carmel, N.Y. 10512 1 Engineer Must Provide P38:#7 P.C.H.D. Permit N— I OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Locatedat Blossom Lane Owner /applicant Name Kathleen & Louis MarrW.. y Mulling Address 6 Briga Lane Min 10605 White Plains, N.Y. T. Patterson Town or V e Tax Map 69 Block Lot 6.4 Subdivision Name Apple H i l lStibdv. Lot q 10 Date Permit Issued 5/5/87 Separate Sewerage System built by Paul Lundelius, Jr. Address Birch Hill Rd. Patterson, NY 12563 Consisting of Two - 1000 Gallon Septic Tank and 400' (toilet) & 270 (Kitchen /Laundry) Laterals x 24" w. x 18" Deep Water Supply: Public Supply From Address or: X Private Supply Drilled by Mill Drilling Inc. Address Putnam Ave. , Brewster, NY 10509 Building Type Frame Has Erosion Control Been Completed? As required Number of Bedrooms Four Has Garbage Grinder Been installed? NO Other Requirements 240' x 7' Deep curtain drain I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department of Health. Date 3 February 1988 Certified by P.E. X R.A. Address RD9 -Fair St., Ca , NY 10512 License No. 29206 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubs %. unitary sewer becomes available and the approval of the private water supply shall become null and void when a public water Supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, Such revocation, modification or change Is necessary. Tit to x, 70 �' -4kr w WELL (JULv1rLtT1UV M.LrUml EALT� DEPARTMENTWffl, Divis.iQu-0f nmental Health Services ,PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only r7 WELL LOCATION STREET ADDRESS: _I1OWN/`v_1LtX1r111_Y TAiGRIO NUMBER:— Apple Hill Sub–Division Brewster, NY Lot 10 WELL OWNER NAME: ADDRESS: Gemini Homes, 9 Briga Lane, White Plaifftia,.NY WSIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary 91kRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRICONO.IHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL -0 INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED '4 EST. OF DAILY USAGE 350 gal. REASON FOR DRILLING VIEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE MISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ' WE DEPTH 300 LL ft. 20 STATIC WATER LEVEL ft. 8 P74 9 7 DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY 30 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. )EI OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS . TOTAL LENGTH 51 fL MATERIALS: Q STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 50 ft. JOINTS: ❑ WELDED iMTHREADED ❑ OTHER DIAMETER 6 —in. SEAL: &CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 Ib./ft. I DRIVE SHOE�EEYES ❑ NO I LINER: ❑ YES ❑ NO SCREEN DETAILS, DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST ❑ YES ONO SECOND HOURS. ..__ GRAVEL I PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. T TOP ft- BOTTOM DEPTH It. WELL YIELD TEST 1. If detailed pumping METHOD: ❑ PUMPED I tests were done is in- ❑ COMPRESSED AIR ! formation attached? ❑ BAILED . ❑ OTHER :OYES ONO 11 more detailed formation descriptions or sieve analyses VELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- in 9 Welt Oia- M ter ine FORMATION DESCRIPTION COCIE ft. WELL DEPTH ft. DURATION hr. min. DRAWDOWN ft. YIELD gprn- L nd Surface 34 101 Silt, sand & gravel — 'A A A01 _yeE 10 1 7Rratm weathered ledcre 250 1 30 250 3-3/4 — 40 3001 61 Mlediun to hard pink, white, & blacl 9v 300 6 – 250 30 WATER y_Q CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS. ❑ COLORED ANALYZED? x0 YES ONO ANALYSIS ATTACHED? j5cYES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE — HP 'U,LjjG' IAIE WELL DRILLER NAME �jLTJ Dp ";V_ 18IA19/87 WGf1ftRE-, Putnam , ' / ) ADDRESS 'UR UO Brewster, Ave. �Y. M. Imi-I–IF lc"� -iite DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATLON,:= -TO CONSTRUCT A- WATER - WELL' "" PCHD PERMIT # �'l� ✓U� WELL LOCATION Street Address Town/Village/City Tax Grid Number Blossom Lane T.' Patterson WELL OWNER Name Kathleen & Louis Address gPrivate Marmo, 9 Briga Lane, White Plains, NY 10605 O Public USE OF WELL 1 - primary 2 - secondary 8'RESIDENTIAL 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED Eight /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING EINEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION O REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING Residential Supply - - WELL TYPE ®DRILLED DRIVEN ®DUG OGRAVEL C1 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATFD fN A ffALTY SUBDIVISION, NAME OF SUBDIVISION: App a Hill1 Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY '- DISTANCE "'TO PROPERTY' FROM- NEAREST- WATER - MAINr-°, --Over one •mile. . LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (See Dwg. #1, Job # S.0.2410 by John H. []ON REAR OF THIS APPLICATION ® 0 SEPARATE SHEyT7 Prentiss, P.E.) 28 April 1987 (date) V (sign ture 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 per it. 3. Submit a Wel Completion Report on a form pr ide by t Putna Cou ty Health Del ment. Date of Issue: 19 �--� Date of Expiration: 19 ermit Issuing fficia Permit is Non - Transferrable 0 R /Rh K t Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - .; SAMPLE NO. 6665 SOURCE: Gemini Hill Development Well Lot 10 Apple Hill Development Brewster, NY COLLECTED: August 11, 1987 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary duality when the sample was collected. August 15, 1987 9 PUTNAM 00UMN DEPARTMENT OF...HEALTH DIVISION OF ENVIRONMENTAL HEAL SERVICES Kathleen fY Tamia Marmn 69 4 6.4 Owner or Purchaser of Building Section Block Lot C1Tri# 4 Building Constructed by Blossom Lane Location — Street Patterson Municipality Frame Building Type Apple Hill Subdivision Name 10 Subdivision Lot # 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 -- .!'Certificate -of Construction Compliance" for the -- sewage disposal.-system, _ or any repairs 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 Environmental 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 , -,,_; lful or negligent act of the occupant the building utilizing the system. Dated this 1 day of Sept, 19_8 Signature IZA. /,00� Title neral Contracto - Signature Corporation Name (if.Corp.) 9 Briga Lane White Plains, NY 10605 Address rev. 9/85 mk Contractor Corporation Name (if Corp.) Birch Hill Rd., Patterson NY 12563 ess FINAL Sim T- NSPEC'ION ate CWNER 1. A— l cLLI c-ts att samz ellevaticn - wa=ar 3 '1_, ,Li, 2 f L _ cric -i nall soil be = aE °-n bcx and t= ' &--es f. J �CC-TICN FOX = crcc =rl v s -T 2_ Dista-ic =_ to wEta =-C L- =C Ira s 3. l -Ls-=i 1 e- ac=:5 -i G to plan 4- Distance ce -ritar to canter 5. Sloe cf tre_rc_r acc_otable 1/16 - 1/32 6- X11�0 fe=w f== crcce_ -y llrie - 20 f�- - fcc�r ^`.t1Cn= 7. LCJI._Z cf: {SGT ch < 30 indnes t -0-11 SV=_Cce 8. Roan allawa I fcr e_YCc_nei GP_, 50% O. Size cf C c'vCl 3/4 - 1 -i d;ag- jer 10- Dcrri Qi C_"'cV e iTl trs-rich 12" win-ire L - pi=e E�.ds Gczra h. RX-0 CR LCEL SYSTEMS - .1-." Size- G'-_ -•- �.Ls " "D -Chia cL"_..-. _ 2. O e_-f aw t=r k -� 3. P l r r Wit, -_1Q d F E c i l y acc= =�s i ble Ir. mhole to Crace 5. First bcx ba 2- 1 A 6. cycl -e by Ec1 Lr D°_i"c_r `u-s t. ectiTr.=-ted fla=w par cycle FAi IV. EG SE I a_ EcLe lade pen a.-=roved plaris. (� b. cf bP-- rata_= j V. �--,r a. wei? lcct a as poF-:- a =ercv b_ Distance fran SLS ar rnaas- r� f t. c. CasinG 18" a__mye crate_ d. Surface Zc1P =Ge arc d well cccest-ah -le Vl . M- E-11AML l ,0EU ;QM- A-rr: TP a_ Boxes rccerlV crcute t b_ P11 pi=es -rtie-lly back=illy c. A-U pires flush wit-'7 inside CL bcx d. E✓ckfill rrata --iCl C :nt- Its stcnes < Cn in Glc l =t-r e_ O „--. a in gain accords c to plari I f. in train cLtfall prat =ctw & (:H, _ to C. FCCt:rG Craicis G'sC"'_^_ -ce h. Sur __c= wa_,_ .prat- _tt_cn a_ i_ E_=Ccicr- Cntrai CiC4'1CU Cn SIC-:ES C =e`Ler 1"14- I � i I I I I I I I I ( I s 1zTIS iCV LCI a a - T OR S'��D _ SL DIS^rOSr� P-RFA a_ L- E7S Z lc=--ea as Ter annroved plans b. Ei 11 secticn - Dam ct plac=rznt 2.1 Ea--zie r . I,GTd Vy u P_VG . DFrr-, c _ I•a:_-s•.r - soil not Strir C3 cr-ter t±lan 15' f_aa EDS c_rea- e_ 100 fL_ f --cm water coo sc /r.�Ct! anGS _ -r-+ D- ='C , c- car SYSrr ._._ a_ Sec�c t~nti s_ -- 1,000 1,2510 C. 10' irimLnumll i =ari fcur( ct4 n d_ No °0° herds, Cl °-= -�-CLt wit_rlin 10 f z. -c-f: 45, han_G e. D15L"u�LZICy ECx 1. A— l cLLI c-ts att samz ellevaticn - wa=ar 3 '1_, ,Li, 2 f L _ cric -i nall soil be = aE °-n bcx and t= ' &--es f. J �CC-TICN FOX = crcc =rl v s -T 2_ Dista-ic =_ to wEta =-C L- =C Ira s 3. l -Ls-=i 1 e- ac=:5 -i G to plan 4- Distance ce -ritar to canter 5. Sloe cf tre_rc_r acc_otable 1/16 - 1/32 6- X11�0 fe=w f== crcce_ -y llrie - 20 f�- - fcc�r ^`.t1Cn= 7. LCJI._Z cf: {SGT ch < 30 indnes t -0-11 SV=_Cce 8. Roan allawa I fcr e_YCc_nei GP_, 50% O. Size cf C c'vCl 3/4 - 1 -i d;ag- jer 10- Dcrri Qi C_"'cV e iTl trs-rich 12" win-ire L - pi=e E�.ds Gczra h. RX-0 CR LCEL SYSTEMS - .1-." Size- G'-_ -•- �.Ls " "D -Chia cL"_..-. _ 2. O e_-f aw t=r k -� 3. P l r r Wit, -_1Q d F E c i l y acc= =�s i ble Ir. mhole to Crace 5. First bcx ba 2- 1 A 6. cycl -e by Ec1 Lr D°_i"c_r `u-s t. ectiTr.=-ted fla=w par cycle FAi IV. EG SE I a_ EcLe lade pen a.-=roved plaris. (� b. cf bP-- rata_= j V. �--,r a. wei? lcct a as poF-:- a =ercv b_ Distance fran SLS ar rnaas- r� f t. c. CasinG 18" a__mye crate_ d. Surface Zc1P =Ge arc d well cccest-ah -le Vl . M- E-11AML l ,0EU ;QM- A-rr: TP a_ Boxes rccerlV crcute t b_ P11 pi=es -rtie-lly back=illy c. A-U pires flush wit-'7 inside CL bcx d. E✓ckfill rrata --iCl C :nt- Its stcnes < Cn in Glc l =t-r e_ O „--. a in gain accords c to plari I f. in train cLtfall prat =ctw & (:H, _ to C. FCCt:rG Craicis G'sC"'_^_ -ce h. Sur __c= wa_,_ .prat- _tt_cn a_ i_ E_=Ccicr- Cntrai CiC4'1CU Cn SIC-:ES C =e`Ler 1"14- I � i I I I I I I I I ( I APPENDIX B PUTNAM COUNTY DEPAR240P OF HEALTH - DIVISION OF ENVIROUVENTAL HEALTH SERVICES / INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ,. • - - R UIFW SHEET CONSTRUCTION - - DATEy BY: ( of Owner) (Street Location) / COMARUS YES NO DOCUMENTS &07. l E Permit Application Corporate Resolution . Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3) Fill iii Perc Hole Depth cd House Plans - Two sets Well/ permit; PWS letter `j/ 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 notes) 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 Pumped Pit & D Box Shown & Detailed House - No. of Bedroans 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' tran Foundation; 50' to well 15' Well to PL LF trench provided required Fd7l v. 60 ft. max. Parellel to contouVK FILL SY TEMS clayllarrier 10 f f il1V notes newlspec. de au es 100 yr. flood elev. E o , I COUNTY OFFICE BUIIDING_ CARMEL, N. Y. 10512 DESIGN n4TA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. :Kg46rine 9 Louis. M Trm- - _.....�04mer�, Address cuo 'Rou-tE 22 Located at (Street Ondicate pmu L Sec. Block z Lot Co nearest cross street) Municipality pg- - TV-W-z,Qm Watershed Crvr6, SOIL PERCOLATIONI TEST DATA RE,: UIRED TO BE SUBMITTED WITH APPLICATIONS LOA 1 12_04 - i2:30 2(0 231/2 2C�2 3 2 .03 30 3 1 :os - 1 :35 30 22,/2 25 2`/2 12 3011 CLAY LQ Wr� SAT�IO,SfQAYEL _ log 1 12 :0[e- 1 :-A o 30 23`/2 24,4 1`/4 2 12: 3Z - I;oZ Hole 202 3 rn !, - 1.3 - Plumber 10 CLOCK. TIME _ PERCOLATION PERCOLATION Run Elapse Dep o a er Water vel No. Time From Ground Surface in Inches Soil Rate Start -Stop 1,LL, n. Start Stop Drop in Min. /in drop Inches Inches Inches LOA 1 12_04 - i2:30 2(0 231/2 2C�2 3 2 .03 30 3 1 :os - 1 :35 30 22,/2 25 2`/2 12 3011 CLAY LQ Wr� SAT�IO,SfQAYEL _ log 1 12 :0[e- 1 :-A o 30 23`/2 24,4 1`/4 2 12: 3Z - I;oZ 3o 23`4 202 3 rn !, - 1.3 30 22 4 23 3rz 11/4 24 5 Notes: 1) Tests to be repeated at san:: depth until apl)roximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be Trade from top of hole. _. FZ11 77- L no ISIAI(i jqoaudia AO q FIVINTA HJ;l Vj as , _K, A I e YA A all ip OP 1444 rtCQ_Ua:F1J=_ TO 13E SUBMITTED WITH APPLICATION DESCRIPTION OF. SOILS ENCOUNTERED IN TEST HODS -E -NO7,. DEPTH HOLE NO. 10 G.L. Ma Rr;zo I L, 6 1211 WL Me 2411 3011 3611 4211 4811 5411 6011 6611 7211 7811. 8411 A, sSr- INDICATE, LEVEL AT VTMCH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO I�FBICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS 14ADE BY tZ_,neM EST -Date 12 IS4 DESIGN Soil Rate Used _2, Mlir/l "Drop: S.D. Usable Area Provided No. of Eedrooms B —Septic Ta_nk Capacity 1,00 Gals. Type QQN�r Absorption Area Provided By_5po!:�L-F.x2411 3 width Name jdnmkl .Addre C&"0\4 MY, %_QnT20 THIS S)PACE FOR USE BY REALTH DEPARTMEM ONLY: Soil Rate Approved - Sq. Fiu-/Cal REG;.:j1V Chocked by Date E: EC 2 ri 198�j . PUTWtAA roUlqry DEPT, OF HEAL-ra