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Home My WebLink About2003DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.33 -1 -23 BOX 18 Ism M L -r J �`�, -� ,ti.,, , , 4 02003 OWNER'S NAME SITE IDCATION MAILING ADDRESS PUTHAM COUN'T'Y HEALTH DEPARTMENT r DIVISION OF ENVIR IAL HEALTH- SIWVICES.. (d F. .. , :.� PRONE �z7`I - MIJ TK# PERSON INTERVIEWED PCHD Complaint # ame & relationship (i.e, owner,tenant, etc.) DATE ��Z - 9G TYPE FACILITY Gi�jnt. PROPOSED IlISTALLER G�K &k PHONE 9jy REGISTRATION # A L Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approved & Title Proposal Disapproved s �t proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in' duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, r reported agent of owner agree to the above conditions. SIGNATURE TITLE gAl DATE FMS: White (PAD); YeUcw (Tam HI); Pink (Applicant) BRUCE R...:FOLEY _.- .._.....__ Public Health Director t �!_.,�_.� -_ DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA_.- MOLINARI R._N.,,.M;S;N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Nigel Hopkins 484 Lakeshore Dr. Brewster NY November 27, 2000 Re: Addition- Hopkins - 484 Lakeshore Dr. No Increases in Number of Bedrooms (T) Patterson Tax # 36.33 -1 -23 Dear Mr. Hopkins: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. E.• - The proposal- for - the - addition has -been- approved -as- per -- plans -- bearing the - approval -stamp-form-this - - - -- Department dated November 27, 2000 The addition is approved with'the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this department. 2. The area of the- existing sewage disposal system, and its expansion area, must "be.. maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very trul ours _ -- William Hedges WH:kg Senior Public Health Sanitarian cc: BI • 1 DEPARTMENT OF HEALTH Division . Of Environmental Health ServIces 4 Geneva' Road, Brewster, New York 10509 (314) 278 -6130 BRUCE R.JOLEY. H.S Acting Puhlia .Mealth Direr_tat Putnam: County Dept. of i4eaith 4 Geneva Road B:ewste:. NY 105C9 Re: jle�t�'4� 11L'ael Res' enee Tax Map; &3—I-a�? (.27 —a-CP� To�vn� Gentlemen: - - - -- - - -- " - -- _ According to records maintained by the Toxn, IS •� IS NOT - in compliance v.ith To ,,ti coca and the total number of bedrooms on record This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASUSSORS'RECORD: OTHER r U Building, Inspector C;p, .... BRUCE ...R , FOLEY. - .�_ ..__._�. Public Health Directcr �P DEPART NT. OF I-MALTH Division of Environmental Health Services 4 Ganava Road BTewstur, Naw York 10509 Tel. (914) 278.6130 F=(914)278-7921 N41 PHONi'�� I DESCRLPTiON OF ADDITION NL-MBER OF VaSTLNG BE] (FROM CERT. OF OCC -OANCY OR CERTIFICATION FROM BLILOLNG INSPECTOR). PROPOSED # OF BEDROOMS_ *Any addition which is considered a bedroom zequiro9 formal approval -of Alms- (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Purnam Cozaty Sanitary Code. Please subunit this fern aad the fp7lowing to Putnatn.County Health Dept., 4 Geneva Rd., Brewster, i'IY 10509, Phane -78.- El. ^,0:_ -_._- 1. Certified check or money order.fdr $100.00 A. Sketches of existing floor plan (drawn to scale, all living area Including basement) 0 Non - professional sketch-cs are acceptable 3. Two sets of proposed floor plan (drawn to scare, with name, street, and to ,. map 0) * Nan - professional sketches are acceptable 4. Copy of survey saowina well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office wish any questions. 5. Copy of Cert, of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFF[ ;EE C:ornrne^x:s r:b 9s .K..r ENGINEER MUST PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE 1 Division of Environmental Heolth Services, Carmel, N. Y. 10512 PERMIT # P -28 "84 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE- DISPOSAL SYSTEM Patterson Town or Village _. Located at Take Sh�rP Tlr� i, Rainhr-idg� Rnarl Tax Map 77 Block 2 Owner C & R Hilgers / Formerly A 8 M Vaccaro Tax Map Lot s 6 8 7 subd. Lot s 1727_1_Q 1736 Separate Sewerage System built by Paul Ross Address Farmers Mill Road, Kent Consisting of 1000 Dal, Septic Tank and 72 LF of 41x41 leaching galleries Other requirements Water Supply: Public Supply From X Private Supply Drilled By P.F. Beal:. & Sons, Inc. Brewster_ New Yorrk Address Building Type 1 Family Residence Has Erosion Control Been Completed? Yes No. of Bedrooms. Date Permit issued 8-16 -84 Has garbage grinder been installed? 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 No ember 14,1085 certified by Address P.E. X R.A. License No. 26008 Any person occupying premises served by the above system(s) shall promptly take such action as maybe 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 public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes availabhk Such approvals are subject to modification or change when, in the Judgment of th Issloner of Health, wcb'YevdCatIon, modification or ehangs Is n wary. Rev. 6/85 C OUN'i'Y. DEPP OF HEALTH ^ � Laboratory, Inc. ��'� ��8 ]�� Yorktown - --�_ -_ ~�__~~��» ~~~ 321 }Ccur Street Yorktown Heights, N'Y.l0598 ' (014) 345-3203 - D~e`^`�. -$C-P): — �^ - [- -� v ' LOCATIONS:� � O32nKeAmST.,YmRmrOmw HEIGHTS, N.Y.,osem 245-3203. . uzm BUTTONWOOD Av�pssmonILL.w.Y.10566 737m777 0wee MAIN mT., MT. m/mCO.m.Y.,os*g666-aass �0SvomsmsnsH (NEAR H?SPITAL). CARMEL, N. Y. 10512 on*0000 DATE DATE '_--I'-- -DATE REPORTED: mAMpLs ~~~ L �� o»°oA ` mspenmsD BY ' L.� L- ��^ , ' r� '( ` _J� ooIlactmr: Aa ` REPORT ��LABORATORY �,� �� ^- =2~^-�.� ` ` ~ ~ x mm/L . OAc!o/rY .......................... -'_-^,-.-.-'_--,_-. ' C3 ALKALINITY; �=-' ' PACTERIA, TorAumL ------'--^~--..'--..----' aom.o DAY -.—__.----_---________.____ []BROMIDE ........................................ __________' O CARBON DIOXIDE, FREE ------ .----______'__ OCHLORIDE ......................... '.-'-�'--............ Oc*uon/ms --------_-- ........... OCOo~--.--_.--'_.-`-..~_,,^__ OcoLon(units) ................................................. Oc,Amms ............................................................ Oosrsnsswr Aw/ow/n ........................................... El FLUORIDE ........................................................... OHARDNESS ................................ ........................... Ompwco pon u� Mco»wr/1P4"� .......... ,-='-=-=, �x�ouuponmcoumr/1ounm ................ ` ..00mpmmATonv Tsor --'..-'.--.~.~.....'-..--,'. O NITROGEN, AMMONIA ........................................... O NITROGEN, xjsLoA*L ..-...--.~-,-.----'.-..--' OwITno6sw.NITRATE ............................................. O'wITROg =. ................................. 1) ODOR (uu1to) ............................................... O OIL & GREASE ........................................................ Opo (ooita )-------'-'-..'-^,..,,'____.___,~ OPHENOL ............................. .................................. OPHOSPHATE kxmm> ................................................ u PHOSPHATE (conuv^mu)............................................ u PHOSPHATE xomv .................................. ------. OSOum�ssTTLs*eL�mVL ~---'.-'--------.-.~. O SOLIDS, SUSPENDED ............................................ O SOLIDS, DISSOLVED ........................................... Omz LIDS, TOTAL ..................................................... O SOLIDS, VOLATILE ................................................ [] SPECIFIC CONDUCTANCE (ohmuom/omo) ............... OauLpATe............................................................. []SULFIDE ............................................................ []SULFITE ............................................................. []SURFACTANTS .................................................... OTuna/o|TY (NTU) °' OALuM/wuM '-..'.'..'..~.'--_-..--__-_--- .......... O ANTIMONY '-----.....----_--.-''---'_.------'- []ARSENIC -----.---_..-'--...-----.---.---_-- ` []BARIUM _-- ................. OeenYLuum.............................................................. �OaISMur* ..-------^-.__..____..__._________ `[]BORON .'--~'--.-_--'----______,______`___ OnAow/ww --'.-..~.-.'~.'-~,,^__,^,,^.,_,_.._____ ...... 'OcAuxmw ....................................................... `........... On*nmw/mm("*.) ........................................................... O CHROMIUM (hevav*ot) .................................... ,._____ OogoAcT...................................................... Ouoppsn ---.---',_-'--.-'_--_-__________.. 11 COLD .................................... _[]JnON- ............ []LEAD ............................................................... [].uTn/mw ................... ^............................................... OmAomss/mw ............................................................... C3MANGANESE .. .............................................................. []MERCURY .......... -'----~~--.--'-----.............. `........ O�...-'..'.................'....'''.....'-.-_—..__-_-_ []PALLADIUM -'---'---'_--__---.-----'-_'^---- []POTASSIUM ................................................... :........... un*oo/mw .--'-------'_'_-----_----'-'.-'-----' []SELENIUM ---_'----'-'-----'---_'---_--'------' Omunmm.-...--..----'---'-�----_^-.-'�-�------ []SILVER .-..~.-'.~~.....---~~.~.^..-,'-``^^^----^^^^^^-'.'. OSODIUM ........................................................................ C3TIN ----'~---'----'_--'_----------'------^~`-' [] ZINC ........................................................................... [] ......... ........................................ .................................. [] ................................................. ^................................. [] REMARKS: .................................................................... O................................................................................... []................................................................................... ............. ,__,________________________^____ 0 _....... ...................................................................... []................. ........................_ ' THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WBENTBE SAMPLE WAS COLLECTED.�--- THESE RESULTS INDICATE THAT THE WATER DID MEET TBE SA. ISFACTgRY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART- -72) -FOR THE PARAMETERS TESTED WHEN THE SAMPLE WAS COLLECTED. N/A .= not applicable Albert ".,"dava".M^ `°sm `=~"" . WELL COMPLETION REPORT : PUTNAM COUNTY DEPARTMENT OF, HEALTH 3)71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of . _.__.• analysis. of_ water_ sample.indicatiAg_ water „iL-.oi.patisfactory_:bacterial - quality before.certificate.of_, construction compliance-.is-issued.= REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ADRESS Oak e Rd. NY OF WELL SLOCATION (No (Town) (Lot. Number) Bainbridge & Lakeshore Dr. Patterson NY PROPOSED USE OF WELL BUSINESS a DOMESTIC, ❑ ESTABLISHMENT El. FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHE 0 ROTARY 51 AIR PERCUSSION ❑ PERCUSSION ❑ (specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) 6 �� 7179 HT PER FOOT b S ® THREADED ❑ WELDED (�jE O 1 X 1 YES ❑ NO YES 4 NO YIELD TEST HOURS G.P.M. ❑ BAILED Fx] PUMPED ❑ COMPRESSED AIR 6 12 YIELD (G.P.M.) 12 WATER LEVEL MEASURE FROM LAND SURFACE — STATIC (Specify feet) 301 DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: 1051 SCREEN DETAILS • MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches):. GRAVEL SIZE (inches) FROM (lest) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to et least two permanent landmarks. FEET to FEET -- - - -- O - - - -- 10 - Drill -in g in— over- bu- rden -- clay and boulders - -- -- - � _. Hit rock at 10 feet 10 0 Drilling in.rock,set casin routed 0 i E10 Eivilling in rock ararnite. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 16/85 DATE, OF REPORT 10/25/ 8 WELL DRILLER (Signature) an. M ,g„, £ I ,l 5n '� 9 1 � GOU_N,TY��D�PA�T �EN,T �OE� �HF.�AiT�H '� 1Permit a' �x .'{N1J O��ision of:En�ironmental'Healih Se�l�ices,„. +Carmel Nr'Y f051,Z . Y d '• s d CONSTRU TION PERMIT 'FOR SEWAGE DISPOSAL SYSTEM _ PARSON s T n or Vii age Tgow Located et La1C� tsho�exBinbridge' Roacl TaX Map 2�� Alock Subdivisioh o� PL1t11�T11 Lalde subcj +Lot a f ^to Renewa ReVision� c Owner /AddYss� ac T'l Ca RD' 1 'BOx.- 672$'�Falls ��Pa 1861'SDate Of'Previ'ou`s Approval s,� �- Building +Fam Res LOt Area 0 4_ Ac Fill section onl '(] - - - Number of Bedrooms —, Design Flow G /P /D�_ 600c Hz 'D s oti'fica[ton;Requi'rea' lOQO: Gal , y F fof 2`' wide trench SepaiatesSewerage. System to contist of __ r ,- Septic Tank and 429 .L T,o be constructed by TO be determ7ried Address _ r Water SupplY RUbllc Supply From k ` f _ X To BDetermined J Prwate. Supply �to be drl�letl'by - - — _ s Address i .O.ther Requsremeri'ts I-;reprgsen4, that 1_ air wholly and completely lresponsibte for the dessgn,and location of 'Ehe ' -rop _sed sys# em( s)I lq, that the separate sewage d�3posal system' above'G scrsbed "will bercon'stiucted'Ss shown- on,the a:pprovea smendrnenf the►eo and lih aceortlanee wsfh the stanOards rules an regu a tons o e; .0 ram' f n: �iyF 3pi ':%lf, .p,,. ^'aF'L: County - Departt►lent of Healtt�,fand that �on�comple`tion� thereof a'tiCertrfswte�; of ConitrueUon� Cofnplisnce',tisatisfaetory, to the Gomm�ssione► of,Heaitfiwill abe b`n fitted to;;4he Department 5nd a, vi,Fftten ;guarantee will' De f'u_rn�shed, the ownor his; _wccessors,;.heirs oi,a;sijhs by the'bu`ilder, A' hat said buiider will �plaoe`� in ;good operatm9y,conddion� any pa%t, of said sewage: disposal system�duting'�the period of,two,(2) years immeGiStely- followsng the data of the issu .. �Snce' of �the,ap'q[ovsl of -,Yfie CerLfscate of`Constructwnf C:omplsaoce of tlieto i ;nal�system�'oi any -repasrs }tfie►eto 2) !fist the,diillefhwell described above r. z s w �xr, i Will be located as�shown ort he approved plan and tliai sand well wall be,iinstalled fill accoidane ,with the'�standards rules and regu a ions .toff tthe Putnam x - County Department 'o ,Health.,,, . ? Date MrJ_ ( -` (J Signed Gc!vliC�� P.E. X R.A �. _ _ Carnl _ N Y: LcAdde ensecNo 37 eet_ Z 6008: r APPROVED FOR?CONSTRUCTIOfV Thss`approval ^expires on ea► from the: date issued. ess eonst►uet,on of the tiuslding_h_as been undertaken antl'it . Mir le "Jor cause`or maybe amended r'modsfied when co ere `e essa by the (Co mi, honer "of: Health Any change Iteration of construction requsros a. new p it prov "f r isposal of ;domesti 'sa r sewage a /or r ate er sup ly only Date r� - G+ ,t V. 19CCf f� ? FD-N,D CIII;CI: I;l'ST. . C-A A_ IR1.T.TT11L SI`J'r ?T1.SI'rCT30 ?' Yes No Commcnf.' 1. . ,Proporty lines or cornerc found -. 'Can'. C itinrwte house..locstion . Will driveway, "'cut �. :. .... J�lust 't reps be r_-moved -note thc:se___ -- _. Is deep hole representati ire o? entire_,. SDS area ,Additional deep holes ne6-ded.: `. a Sufficient SDS area available considering driveway cut, house location, separation .. distances, etc. DEEP MOLE DATA f� rylO 5 1l �`1' ,� O a' a06 I ter elevat:i.on: � Rock elevation: "(>`' Soils descr:t:'�t10 �G1 /•G l Pate. FINAL S_T_TL I�dSP)sC_IG�: by:, House located where:'shot:rn on approved plan SDS located wllYere approved. . . . . . . . � 'I ength of trench mca s Wired Wid -h of trench average Slope of the line and trench -. acceptable :.. . . .... I�oarm. �alloircd,.:for expansion .trenches. Over'50 ft. from `swi amp,vatercourse Vatural soil not.stripped'or SDS area tuu1ec:es spa riIy graded a 10 Ft. maintairied from prop.line and 20� ft.. from house . -. _. Sep ration, of area ch frot;i house, well Number" o '' :bedrooms checks . . . . . . . .. , Stones,, Ur i.,h;:.: stu ►..ps, . rubble, etc.. greater than 15 ft.'' from nearest trench 15 Ft . of. peripheral soil. horizontally from trench • . Jmict,ion boxes properly set; Could stirf. ace run off from driveway, roads, ground surface, etc. charuiel near SDS Does l:ot•' dr. a.in fee arrdar 0. K. in area of SDS FINIAL GrMING OF SITE ACCEPMBLE a v ry .t: c c�-� REVI1.;W Ci1I;CK St . ; :T CA�K(c� � C�G-fZ -. • :� IMcets Std. Yes No DCCUPITNTS 'rouse plans O.K. Dr_sien data sheet Peres presoaked? �, i n . ' .30" pert test depth R Cbnst . - results for 3 runs D. Hole Tog 0. K. Corporate Affidavit for other han individual kuthorization for engineer ^ % Letter from Water Supply .if applicable [f variance requested -such noted on plans & apps._ )TAILS ` if change * is proposed.) ;xist�ng contours shown show new - contours) ',lopes for driveway cuts, etc. shown rater service line location 'noting drain, etc. location op slope,, bottom slope of fill ercolation tests ..arid- - deen. -te -st pit Io-catiari - :-ntic° tank size and conformance to std. V B.R. house minimum ! )use setback shown I istribution box ftg. below-frost ► .1 water within 50 ft. of PL shown. r Plan and profile SDS y.. ..... .. . All other wells and SUS closer 200' ;� ` shown or reference made Property boundaries (metes and bounds- clearly .shF • • 11 i Remarks . WA • j ARATION DISTANCES SPECIFIED ON PL4N to P.L. to Fouuidation walls to Nearest well to stream, march, . lalce, etc. incl . expansion to Curtain drain =� to water line (pits -20 to storm drain to larce trees 1'I'01�l IIoundation to septic tazlk to pipe 1'1,0111 leader drain & .1'ooLlne, - w " WASE ) ECG= ( c vR_< ittt F, 0 &T K� G- /0/ 00, /Co. 10' t� 101 f., PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICE- - BUILDING, CARMEL.�r. :. .... _: 1 512: DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner A4k VACZ-'AQ:2 Address `;Zb �� PA /f3 (61 Located at (Street 4dicate �4K Sec. -`� Block .� LotS Cc + nearest cross street) Municipality �T� �-�pJ Watershed CRicrro i SOIL PERCOLATION. TEST DATA..REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role , _ (8 iq ,,vlAJ . . 5 1 X31 - 1 7-5 -44 Number CLOCK TIME PERCOLATION l R 0 „v�Al PERCOLATION Run Elapse Depth to a er a er Level 3 No. Time From Ground Surface in Inches. Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches d 1 .3 1o411 1157 4z, 4 11-3-7 _-�_- 1 Z31 5+ , _ (8 iq ,,vlAJ . . 5 1 X31 - 1 7-5 -44 Z2- 17-15 l R 0 „v�Al 1 955) 101 .? Z ;2."7 2 �� i.�,•y�,�/. 3 Z_ YA� 3 t04S (M5 40 2. /3 '"�'VV/w 4 1 IZ25 5 121 l45 2 Z7 3 Z_ YA� Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ° DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES � DEPTH HOLE : N0 : - -HOLE 'NO. HOLE - N-O . G.L. 6" 12" 18" 2`t" 30" 36" 42" 48" 54 '► 6o" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED, 01r° EA)C1010Arr11et?e=—'C> INDICATE LEVEL -TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERpj TESTS :MADE -BY - ... _ _, .... Date- DESIGN Soil Rate Used ;zej Min/l "Drop: S.D. Usable Area P No. of Bedrooms 3 Septic Tank Capacity /600 Ga Absorption Area Provided ByL.F.x24 L� width trenc . Other 1 7 1z" Address SEAL 0 2— _ THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal: Checked by Date .' 'yam ' ggalt9 oe� L _0 Ser �a�as� 1 gea �itb o'�'�e�ta tae the ell PAPER OR HAY PERFORATED 1 i r` ABSORPTION THE NOTES I. JUNCTION BOX FOOTING SET 1 2. SEPARATION D I S TAN C E -- I5FT. MINIMUM, 3. ALL LARGE TREES WITHIN I, AREA JO BE REMOVED. SYSTEM TO BE CONSTRUCTED IN THE RULE S AND REGULATIONS OF COUNTY DEPARTMENT OF HEAL.TN SYSTEM SHAL.LNOT BE BACKI=ILL: BY DESIGN ENGINEER AND THE LOO MENT IF REQUIRED. SYSTEM TO CONSIST OF A r -a rn FT OF DISPOSAL_ SYSTEM GRADES REFER FIRST FL-00P ELE VATiON , UNLESS %i 1 a i 7 i d ti -� — • 1 A 3i