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� 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-
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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-
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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