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HomeMy WebLinkAbout1871DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36. -3 -7 BOX 17 01871 it 1 ' 1 t � ' ,I 1'�� � , I�I•, �1 ' J _ �' ■ �� 1 1 T Pei. .71 .� . rr T 01871 PUTNAM COUNTY DEPARTMENT OF HEALTH V� l Re 86 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P.C.H.D. Permit" V,l- � A-) CER OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ?A � 16 F? So �,i Town.orr Village Located at /`�� r` 'Tax Msp Block xLot r �✓ Owner/applicant Name 0,A P L- i o o A orme Subdivision Name Sabdv. Lot Mailing Address OAD e des /, zz �A� M cz Zp 10E011 Date Permit issued ✓Q fl '6 7 Separate Sewerage System bailt by eE:� �� ��57" Address 8JKL-2! (j Uj )JIw �� �2 1f :F- Consisting of Gallon Septic Tack Water Supply: Public Supply From jA�ddress \ 1 or: Private Supply Drilled bye f% b gl � 201 fdreas 6 X FJ f'zoy1/ pxet✓; ' , Building Type [!'6' 07 Has Erosion Control Been Completed? l Number of Bedrooms Has Garbage Grinder Been Installed? D Other Requirements I certify that the system(a) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department Of Health. Date 1- 11V�-? I � Certified by_ Address essentially as shown on the plans of the completed work ( copies in accordance with the fAed plan and the permit issued by the 2 P.E. � P.A. J� IV License No. 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 pub(': sanitary sewer becomes avallatile 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 Nealt uC ocation, modification or change Is necessary. Title By iJ�~ to s f r iiDntrl FV1MAU COUMM DWAMTNM Ml' OF EMALL2U b Raerlie [aessilt f DlsMas d I�strmimasW 1Haallb Sas�leaa. crawl. N.Y.1f61I �or FS� FOIL SEWAGE DIlR'OM SYSMI M C450LJLJLIFNLA18 OF DO Falk f 1 -g� avers at VSIge Strfll.w w.. %(a/" f 1 n r _ OvsadAppicase p... G�i�L 1U(S2'0M12AUAJ2 S� ❑ 1:ertaMn ✓❑ ZBCJI�. 1gDV. Date of jPievlesa Approval -7 ' 30 - R-7 Nufts E 262igd '"' V X - t -r..0t i -,-7WW 0 N � Tows np D to Subdivision ADUroved -7-7 Fee Enclosed ❑ Amni,nt )!ll/ig Typo 119-0 '7'7 �/r Lot Ana �S 5, / • IP1p Seddon Only Dqpa Vabow Nqugbaa Of 140t71T1 O/U&L` DWV Flow G P D PCB Netldeatloa Is Regdred When Fill la computed Sopaeab Swwge Sym m to casalot dJ.Q00 Gallas Saptte Tank • ld �O J rr Te w e..ed. eat- by '� es . D Address Wahr Supply: jPaSlre Supply lhem Address w&-l() -ST .eft s•wb, Daoed Add. Olbaa IRir4gitemwea 1 represent that 1 am wholly and completely responsible for the design and location of the proposed systern(f)1 1) that the separate saw di sel s stem above described will be constructed as shown on the approved . amendment there to and in accordance with the standards, rules a rpu ens o am County Department of "With, end that on completion. thereof a "Certificate of Construction Compliance' satisfactory to the Commissioner of Meeahwill M submitted to the Department, and a written guarantoo will be furnished the owner, his successors, Mks or assigns by the buikter. that said bulkier will place in good operstkq condition any part of ski sewage disposal system during the period of two (2) yens Immediately following thedate Of the )seu- aaca of ten approval Of the CortNkate Of Construction Compliance of the original system or any rapaNs tMr ) that the drilled well described above WIN be located as sA arm on the approved plan and that saki well w in aotor"46i with lM d iidar ru s and rag s of the Putnam County Oapartwiamt W Health. Date "3114- /� / signed P.E. V RA. Address Ct•� ad jZIS & S License NO APPROVED FOR CONSTRUCTION: This approval expires two yens from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when conskhred necessary by the Commissioner of Hoolth. Any change or alteration of construction es a�j�App��Or a,1 of :OmMStk NnitMy a / prh�te water supply only. EV • ...� � . /"� -� /�✓ � � Title �-. _ PUTNAM COUNTY DEPARTMENT 01 HEALTH U Englnoer M n! 7, cErmcATE,.bF-,t&sTaucnom.cQNPuANcEF.OR;SZWAGE DISPOSAL sYSTEM . ............. _D V Lacow lu BI Lot Polmat N_ 0*061 a' awe'. W-ly. .22p abdivie�n Name SubdV..­ Lbt"k, Issued 6d F6.0-tiicipsed'ET- t 4L. Separate Sewoeige baUt -Sijtqm, by A . 0 11 Septic Took' G-afloak So. 7 0 OPP, y I Waier'Si ".1yt, AAA" Pp Pim Supply —il tic: Lpl-- F-C— 7.— oar Private u - $ Oly 6AU , , p by �li Itr'b"S16- L',intiwnj discs 6601 L 0 Size BWNWj Tyi,. S h Bedroom _Tlo NwMw t,�j� Gambiage GlrWw on plane of .. ihe'co . mpi! I at". vp*k. copies ",ei,��s�.construct.IA- essentially n&ccma of,.Wliic�h imke!4ftiibhid) -1.6..ac6,btdandi�' with -the :iitirifti plan l thecpeiimif issued by the �71e� Putliaii county department .: Health Oats O Vortama by PA __RA. 7; 'Vl.. -Q D rn Add iconso No I I cl Any pa Son promptly OCCLpyinir prinlsiv si�iid 6yr, ,taie uch adbnaa : may . 66: ylo,mow►*'the cmactibn of oily ununRary conditions re�rtifiq f sy'!;_l!q`n"J 1;. p "" ib,nWI, and 4ald, 8, Pibl,-: u-niftry mW w, becornes rom I�ch A evallitift �ond the a006va!, of. t!T,,prlva�j, I I h mocor".:null -id *Wnc t muioily -becoam ovallmbli,- , 'Such ajij�ls are ol` we 4�r I katio of H!� s!!c0,rwoWiop. subjkt to" modif A ov Oonte_� dt'Ahe. ivoifilkation or ch",4. necessary. A k T126 3/89 'to <QAk SC FA DEPARTMENT OF HEALTH Div; s3can, Of., EnvirqAmpptgX -Health -Service;i, PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION 'STREET 600RESS. TOWNIVILUUICIFT TAX GAIO NUMBER'- East Branch Rd., Patterson,NY WELL OWNER NAME ADDRESS: Tavino Cons t., Deans Corners , Brews ter, NY PRIVATE Foo PUBLIC USE OF WELL 1- primary 2 - secondary 0 RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT — gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR DRILLING E3 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH. DATA WELL DEPTH 260 — ft. I STATIC WATER LEVEL ___�_ ft. I DATE MEASURED 5/24/88 DRILLING EQUIPMENT (3 ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER ,CASING TOTAL LENGTH ___aQ_ tL MATERIALS: El STEEL ❑ PLASTIC 0 OTHER LENGTH.BELOW GRADE 29 ft. JOINTS: OWELDED UTHREADED OOTHER DETAILS DIAMETER 6 in. SEAL: 6 CEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT 1-9 lb-/ft-. DRIVE SHOF_f3 YES 0 NO LINER: 0 YES 0 NO SCREEN ....DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH To SCREEN (ft) DEVELOPED? FIRST 0 YES ONO SECOND GRAVEL PACK 0 YES L 0 NO GRAVEL SIZE: DIAMETER OF PACK in. TOP OEM —ft. BOTTOM OEM — it. WELL YIELD TEST Is' If detailed pumping METHOD. 0 PUMPED 1 tests were done is in- AD COMPRESSED AIR formation attached? 0 BAILED 0 OTHER OYES ❑ ONO VELL LOG 11 more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear. in Well Oia-' mete, In FORMATION DESCRIPTION ft. 4t; WELL OEM It. DURATION hr. min, DRAWDOWN ft. YIELD gym. S.rla�e '15 — DrIlling in overburden clay & bi(IrTs xi j rock at 15' 260 6 240 35 15 30— Dr 4 11ing in rock,set casing,grouied. 30 2,60 Dr i lling in rock granite. WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO I —H I STORAGE TANK: TYPE CAPACITY GAL.— PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH — - 'VOLTAGE — HP WELL ORILLER NAME P.F. Beal & Sons, Inc I DATr/ 2/88 U ADDRESS PO Biix B SIGi0tTURE Brewster,NY 1050 FA II IV. PA-A FINAL SITE INSPECTION Date %j r Inspected by OW NER TM # OR SUBDIVISION LOT 4 . -..._ - Sr y�.Gr DISPOSAL ARFA a. SUS area located as per approved plans I b. Fill section - Date cf placement 2:1 barrier- LGTH WIDTH AVG.DPTH c.. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft-'fran water course ands. - . ,/ =� Sr�t C DISPOSAL S�S% -w- a. Sentic tank size-� ,1,:0Q0' -" 1,250 b. Septic tank installed level 4<' c. 10` minimum fran foundation d. Nc 90° bends, cleancut within 10 ft. of 450 bend F, e. DISTRIBUTION EOX 1. All outlets at same elevation - water tested 2. Protected belcw frost 3. Minimum 2 ft. original soil between box and trenches f . JC=ON BOX —properly set 9- 1. Length r---ui rei - Lenath installed 2. Distance to waterTccurse measures . ft. 3. Installer according to plan (fie 4. Distance center to center ,t . 5. Slone of acceotable 1/16 - 1/32 "Arcot. 6. 10 feet fran prcpe_rty line - 20 feet - foundations 7. Depth or tre_ncn < 30 inches fran surface 8. Roan ali awed for expansion, 50% °. Size of gravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12" minimum • r4 L. Pipe ends cps h. PU D OR DOSE SIS� -S 1.- Size of pLup chamber- 2. Overflow tank 3. Alarm, visJal /audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Dement estimated flcw r cycle HOUSr . - - a. Ecuse located per approved plaris. �. b. hi -ice-r of bedroans a. WL1 locates as per approved plan s b. Distance fran SDS area measured % ft/.' C. Casing 18" above grade. j d. Surface drainage around well acceptable. OVERML WORKASHIP a.' EcxeS properly Grouted b. AL i pipes parttially bar-kf illed c. Ail pires flush with inside of box -41 d. Eac�tiill material contains stones < 4" in diameter :.r °. Cj�ain drain installed according to lam E. C, -fain drain cutfall protected & dir.to exist.wate-ccurs 1 3. f-coting drains dischar e away fran SDS area 1. Surface water protection adequate i- E. -osion control provided on slopes greater than 15 %. s 1 _BREWSTER. LABQRATORIES.... Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 1079 9 avino C ons t. SOURCE: Russamanno Residence faucet -well East Branch Road Patterson, NY COLLECTED: September 2 1988 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. September 8 1988 Roy Bi it P.E. Di ctor PUTNAM COUN'T'Y DEPARTMENT OF HEAMH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Building Constructed by Location - Street I I 4 f,. OdV Municipality Building Type ,,I/ Section Block Lot \ /G2A M �T�US�K Subdivision Name I/ ti? Subdivision Lot # GUARAN1TEE 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,_ 'repairs made by me to* -such s'ys'te'm'., 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. Signature Title . Dated this day of �_ 19 e& General Contractor "(Owner) /- .�S_ignature Corporation Name (if Corp.) " 1,01!�FAAA AI -S Addr6ss- I 26�1 S /�Z� =. rev. 9/85 mk y le�el G Corporation Name (if Corp.) ?if a4--c ess t7 3 tin ..j . A_km PPTNAM COUNTY DEPARTMENT OF KEALTH;' ZU of EnviroumenW.14ealth Service;. Carmel. N.Y. 10512 Engineer vide Permit COMP an CERTIFICATE OF Permit: 0 CONSTRU ON PERMIT FOR SEWAGE DISPOSAL SYSTEM or Village "at il jaw's vld=.Name _A1 OC16 Lot T Subd. Lot 0- 'Tax Imp III Renew isiRevon n Owner/Applicant Name 6A.qL:�', R61-$S0 1,A-,k4J:K10 V. Date of Previous Approval Mau Asisirew _S Town . — - ZIP a Y Builldlng_ Type Lot Area volume_ e tA Fill Section Number of I &W.,. 4 Design Flow G P D �6 6 NotfBcstlonlis Required When Fill Is completed SCP!Lmte — — ? Gallon Septic Tank ­A Z&R -C'T� To 11'ponst..tisd by Addr W#- supply: Public Supply From Addre . .. .. . . —0 an by 1?1 D, _-Addre" r _X-2rivate Supply I)dlled Ot er Reaulrements Ireprosent that 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 arid, In accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on comp6t io, n thereof a "Certificate of, Construction Compliance" satisfactory to the Commissioner of Healthwill - be -Submitted to the Department, and a written g"rantee'will be furnished the owner.,his successors, 'heirs or_ assigns by the builder, that said builder Will pLic• in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following the date of the issu- ance' of the approval of the' Certificate -of, -Construction-Complia ce I, P original. system Or any repair; then o, 21 that the drilled well described above I st. �., W- 7ro­n—sot wiIj. be located 46 shown on the approved plan and that said well wui bn• nsta I In. •"!danco with the "V nd i UT& the . Putnam rtTenk ol Health. —7 Zi) County D" Rate n 4 A P.E—K— R.A. Addles= N) 1i x4d P, Itir, 2SYL cons* No-' 5(,12_4 APPROVED FOR CONSTRUCTION: This approval expires two -years from t . ho'glate issu d unless construction of building has been undertaken and Is w a fetkicablo for cause ON, may be amended. or modified when considered necessary. y the, Commissioner. 91 Health. Any change or alteration of construction a navv permij, Approved for disposal of domestic sanitary sewage. *and/or priv t ��t P ly only. Rev.­:". DEPARTMENT OF HEALTH Division of Environmental Health Services �OUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address ;���, Town Village City Tax Grid Number l --- .� _ ! —I' •3 WELL OWNER Name Mailing Address 00 ejF_ ®Private O Public USE OF WELL (Z- primary 2 - secondary C9 RESIDENTIAL ® BUSINESS ® INDUSTRIAL 0PUBLIC SUPPLY O FARM O INSTITUTIONAL OAIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY C3ABANDONED O OTHER (specify, AMOUNT OF USE YIELD SOUGHT_ gpm /# PFOPLE SERVED -4— (p /EST. OF DAILY USAGE 4S0 gal REASON FOR DRILLING ONEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1!�_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name `r �,� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _X__No NAME OF PUBLIC WATER SUPPLY: _J /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: WA LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 00 REAR OF THIS APPLICATION EfONIIEPARATE qHEET,, (daft e) (signa re) 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. Date of Issue: Date of Expiratio�a 19�� Permit ssui al Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller PUTNAM COUN'T'Y DEPAR`DIENT OF HEALTH ` DIVISION OF ENVIRU\�T HEALTH SERVICES �2L �uS50MAN�va . Owner or Purchaser of Building Building Constructed by gA2E ICAO Location - Street P�TT�SoAJ Municipality O -5 /na&ri /,A L Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARAWEE OF SUBSURFACE SEVMGE 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 detennination 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 willful or negligent act of the occupant of the building utilizing the system. Da is day of '7 19 Gen Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signaturem Title 1'"�• Corporation Name (if Corp.) Address ,3 AF�,s Municipality c Watershed CTd � SOIL PERCOLATION TEST DATA R TO BE SUM= WITH APPLICATIONS Date of Pre- Soaking In I e-7 Date of Percolation Test C - 11- 8-7 HOLE NOH3M CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fraa Water Level` No. Time Ground Surface In Inches Soil Rate Start =Stop ..Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2A 2-1 2 V Iko V3B 24 ,7 -L 3 b2 ' 23 2Ar 2,7 27 4 5 5� - t n 7' L 4 ;? 3 r 1 r z' NTESt 1. to lbe repeated' at same' depth until approximately equal soil rates ,.;Tests, are at each percolation test hole. All data to' be subaftUd ,obtaAned �p- _measurements-to be made from top of hole. (.Pik 3' 4' 5' 6' . 7, TEST PIT DATA REQUIRED TO BE SUBMIT'TED.WITH APPLICATION DESCRIPTION `OF ' SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 8' mo WA-(OZ. 10' ' 11' 12' 13' .HOLE M. HOLE M. go y9kr 14 INDICATE.LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE I,EVEL To WHICH WATER LEVEL RISES AFTER, ]BEING ENCOUNTERED �fA DEEP HOLE OBSERVATIONS MADE BY: bea" �k-rc -It LoLK. DATE: a DESIGN Soil Rate Used ( -? �/ Min/1" Drop: S.D. Usable Area Provided (� '?p0 _ No. of Bedrocros 4 Septic Tank capacity jam(Z gals. Type (6LU -T7 Absorption Area Provided By L.F. x 24" width trench Other { Name LAQW&W Assoc 7c. Signature Address :23 ' +;A BFI b "l > VgAqe SEAL `THIS SPACE FOR USE BY HEALTH DEPARDOU ONLY:. Soil Rate Approved sq.ft /gal. Checked by in. •��� , No'. 56124 e .. r .:.,.:.. COUNTY DEPARTMENT OF SEALTH DIVISION OF ENVIFM911M HEALTH SERPICI.-S DESIGN -DATA -,S SUBSUFACE SFS%= DISPOSAL SYSMi -: ; ,= FILE Owner . �' - - kSSO NO Address MWLe WOMS VAczMS 1� P SOiFle •, f4y Located at (Street) �2A� t.I C I� 1� Sec. = Block_ Lot , (indicate nearest cross street) Mu 1 �k'C' MSQ � Watershed nicipality . SOIL PERCOLATION ' TEST DATA REQUIRED TO BE SUF3MI= WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test (D 2 2 111 2:3-1 : zo Z4 5 , SOLE Numm C= TIME ' PERC0=0N � . PERCOLATION Ran NO. Elapse. Time : - Start-Stop Min. '_ Depth to Water From Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop 1 1�ra1a'Z�17 l 1' 2A Z� �•� 2 .Z.Ib- V 39 24 27 4 5 -- 2 2 111 2:3-1 : zo Z4 3 -- 5 NOTES: l.. Tests to. :be repeated at same depth until apprckfirately equal soil•rates are ob'h4ined .at each percolation test hole. All data to' be suimitU d Z "'Depth measurements to be made fran top of hole. 5 , 1 � . 2 3 -- 5 NOTES: l.. Tests to. :be repeated at same depth until apprckfirately equal soil•rates are ob'h4ined .at each percolation test hole. All data to' be suimitU d Z "'Depth measurements to be made fran top of hole. 31 41 51 _. 61 _.7r1 81 91 101 121 131 mo • f•1c� Rl7LJ� 141 INDICATE LEVEL. AT WHICH GROUNDWATER IS I: rWNMMED INDICATE LEM TO WHICH WATER IEVEL RISES AFTER BEING ENMUNTERED DEEP HOLE OBSERVATIONS MADE BY: DESIGN Soil Rate Used ( -i _ Min/1" Drop: S.D. Usable Area Provided '30Of2 No. of Bedrooms Z1 Septic Tank Capacity 17,150 gals. Type tsxvQW-6 Absorption Area Provided By IfJOO L.F. x 24" width trench Other Name L&U2aIT EllloaEEIZI N(o Assoc. [ C. Signature . F or I Clio Address SEAL LU THIS SPACE FOR USE BY HEALTH DEPA UVM fONLY: �. No. sst24 ��► Soil Rate Approved `'` '�' ' PP ��ft/galo Checked by e -,,, N.x, (00 771a ,, L I (NU z m < J0) Z; LU A5 Lv, �e �l� -,,, N.x, (00 771a ,, L I (NU z m < -,,, N.x, (00 771a ,, L I (NU V! ----------- JV > i D Ch M T 4n 608 ;--j CA > C;7 I t JI) If Oj <<-17 61 I t JI) If Oj