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BOX 18
02033
III
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17
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02033
OKNER'S NAME
SITE IACATION
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL
� i
16
HEALTH SERVICES
PHONE 9/4/-1-7�- t -X-
TM#
MAILING ADDRESS .ig,.K
PERSON INTERVIEWED �g ,� d�,v � PCHD Caaplaint #
. Name '& Relationship (i.e, owner,tenant, etc.)
DATE C -Id -w TYPE FACILITY {�r, ►t.
REGISTRATION # G r3J or
Proposal (include sketch locating all adjacent wells):
PHONE 2.1y- �'S3 = JS' %.J
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
registered architect.
&y drys 4,41 /T,e t 01
Proposal approved Proposal Disapproved
Inspector's Signature & Title Date
Proposal aonroved 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 ccmponents 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, or reported agent of owner agree to the above conditions.
SIGNATURE Lltb TITLE DATE
3TW: Vbite (PCD); Yellow Mkn ED; Pink Lkl2 cent.)
Rev. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
?, Engineer Mast Provide P 21-84
P.C.H.D. Permit N
:CERTEMAM4r,,�CONSTRUCTION_ COMPLIANCE- FOR;SEWAGE.:DISPOSAL. SYSTEM: .rz,T._ PB:t:texson..
Town or Village -�
Located at Lakeshore Drive & Queensbury Road Tax Map -12 Block 3 Lot 4
Owner /applicant Name Emilia & Patsy R o t t a Formerly ------ Subdivision Name Subdv. Lot N 1191- Inc
Melling Address 572 Lakeshore Drive Zip 10509 DatePermltlssaed 7/13/84
Brewster NY
Separate Sewerage System built by Neal T peregr'J ue Address En et Rrnnr.h Rd-, Pat tarGnn r NY 1 563
Consisting of 1000 Gallon Septic Tank and AO' x 4' w- x 4' D_ ga 1 1 e ri e c w/19" gravel
under & all around
Water Supply: Public Supply From Address
or: x Private Supply Drilled by Milt-on Hyatt Address Rte-. 311, Patterson, NY 12463
Building Type Frame Has Erosion Control Been Completed?
Number of Bedrooms three Has Garbage Grinder Been Installed? -
Other Requirements
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.
May 29 1986 certified by ° p.E._ V. R.A.
Date Y
Address RD — License No.9Q7n�'
Any person occupying premises served by the above system(s) shall pro tly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate saw go system shall beco null and void as soon as a pub(': sanitary sower becomes
available and he pproval of the private water supply shall become nd v who wat supply comes available. Such approvals are
subject to dH lion or change when, in the Judgment of the issio r of It , su rev tio�A, m Ification or change IsyrRCollwry.
Date By
�, Title _ L —`
13
n
.. ,_ <.u.s..:. s:_ ,•.,. -:- .tea ,.. ... -_._,- �r� IES'
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
— WATER ANALYSIS REPORT —
SAMPLE NO. 6144
SOURCE: Patsy Botta
572 Lake ;shore Drive
Brewster, NY
COLLECTED: April 30, 1986
BY:
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Map 32
Block 3
Lot 1
Nose Bibb - VJell
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
May 1, 1986
tK
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
:,._c:., Ttres�xe�oct:as :to:be empleted- bye •welk:drilter, .and- submitte&to Coontl- -H Qeprtment- :together,,4MthAaboratory.r -sport of - -'.X -- _•
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME,
6 5,4;" Z e,
ADDRESS r�
LOCATION
OF WELL�T�
(No. 8 Street) (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (sPeif )
DRILLING
EQUIPMENT
COMPRESSED CABLE OTHER
❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
• CASING
DETAILS..
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
®
THREADED El WELDED
O
YES El NO
G 7
YES � NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC(Speclfy feet)
0
DURING YIELD TEST 1
fleet)
Depth of Completed Well
in feet below Land surface: �
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (toot)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
90
0
look
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL CqMPLETfiD
DATE OF REPORT
WELL DRILLER (Signature)
Emilia & Patsy Botta
Owner or Purchaser of Building
TM 32
Section
owners 3
building Constructed. by._
Lakeshore Drive & Queensbury Road
Location - Street
T. Patterson
Municipality
Frame
Building Type
4
Lot
Putnam Lake
Subdivision Name
1191 -7 Filed Map #149
Subdv. Lot r
GUARANTEE OF SEPARATE SEWAGE 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 success-
ors, 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 initial use of 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 occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
-ation-of -the Director of the Division of Environmental Health Services
of the Putnam County Department of 'Health'as` to 'i h`ether` or °riot -the
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this 5th day of May 19 86 Signature" `
Title Emilia & Patsy Botta
Corporation Name Jif corp.
572 Lakeshore Drive, Brewster, NY 10509
Address
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
Emilia" &'Pats Botta'' TM 32
OVner br Purchaser of Building Section
. ,owners . ... . _.._ .... _.._._.._.. - - - 3 -- - - - -- - -
Building Constructed by Block
Lakeshore Drive & Queensbury Road
Location Street
T. Patterson
Municipality
Frame
Building Type
4
Lot
Putnam Lake
Subdivision Name
1191 -7 Filed Map #149
Subdv. Lot #
GUARANTEE OF SEPARATE SEWAGE 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, rule.s and regulations of the Putnam
County Department of Health, and hereby guarantee to the owner, his success-
ors, 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 initial use of 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 occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin
ation of t7he*- _D1r-e'ct6.r_.of the.. D. ivi.s i -on,._o.f_.Fnv. ronmenta,l.._Hzalth Services
of the Putnam County Department of Health -as to whether or not the fail-
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this 5th day of May 19 86 Signatur�e_� �
Title eragrin
Contractor
Corporation Name if Corp.
East Branch Road, Patterson, NY 12563
Address
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE -OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
f
-CONS. RUCTfON PERMIT FOR
_LocateG: at.. Lakesfio,re Drfve
5ubdipision Putnam Lafce L�
..:, Owner /Mdress Em 1 i aT��& Patsy_
uivisron or; tnvironmenrar_ Ir
Building Type T606,
' �bt Area. 1 6000+
-Number of Bedrooms ,Design Fiow /P D 600` P.1
Separate Sewerage.System to consist of Gal Septic Tank' aria
Pere ine
To 'De constructed ,by Q . Ad
Water Supply Public SuDPIy From
L
Pnvate Supply to 1
y
,,. � Adtlgress p w
Qt her Requirements `+ x 4 x'
I'represent that I am wholly�antl completely re
` atiove,describe I will be co'n`structed as showh;'ol
County: "Department of Health and that ori,<
ale submitted,, to she .Department `and a writ
place in_good operat�ng!eonrlition` any partz
ance 'Of. the approval of fhe Cert�fiwte of, C
will lie located as shown on the approved plan;a
county •Departm - t of .Health _t
��15 INay 1984 = 3'
Bate z
Address RB > #9,
APPROVED FOR- .GONSTRUCT10N., T his tro
appval`<'ezp
revocable for cause or maybe amended
l requires a` new permit pproveq foi
f k
Da. a
3 Rev 9781 -
SL' ned
-:1 91.:,
HEALTH'`' µPermit a �? M .
4 Patterson f
'Town or -'village
Y `
(� 4Q❑(("�� .Revision _❑ _
34Jiuf< A 4
pproval ,
ion ,Diiiy ❑ _
Notification.Required 110 J
East f3tranch Finad-,Patterson,: NJ-'
q.
� a
t
3 3 i
d systems) 3) 4 that the separate sewage. ;disposal system',
a wk4fi. the standards,'r.ules an regu a ions o e'. u nam.
�mpliance •satisfactory:to the,Commissionei of,.Heblthwill.
ssors, }heirs,or assigns by the builder, thbt said builder-,will
f tvgo,(2) years immediately :following'.thedat6of the,issu-
ny repairs thereto; 2)ahat the drilled well desciibed above
_ " ,.
the:'standards � rules and - regu a ons . ^of dhe Putnam ... '
,r
f
P .E. R.A.
t Icense. No 29206
y�nstruetion of the building has been undertaken and, is
I(sr of Health:. Any .change or alteration of construction
it supply only.
BY Title
°i t y
z
CONSTRUCT.LOfy PERMIT. F,OR_4SEWAGE ":DISPOSAL SYSTEM k patt " s
Town or eV I l �e
1 Loeaced • at
,Lakeshore Drive Queeh,bu4 Road - -
sec>ian = r3locrr�el d MZ` #149=
Subdivision Putnam "Lake Lot:11917 rIn`cl yob S81`639
.owner J.erl cho Developers , I-nc. Address Bi you , East Branch :Road
Bu,,d;►,9:TYpe Frame got Area 12000+ P "atterson New ;York J `12563
Number, of Bedrooms ThY'ee Total Habitable Space Square Feet
_ 1248;
Separate Sewerage System to'. consist of . 1000 P 150 36 rich' trench
Gal Se tic Tank lineal feet, X width tren
"To be constructed by' eW. Pereg�ne: Address'. East Branch :Road -: Patterso.n, N.Y.
Water Supp1Y Public SuPPIyFrom
.. -
' .,Private SuPpIY, A' be drilled by
gddress
Other l�equ�rements ffflvent Pump In Pump House
I represent that I `am wholly and completely respohsible for:fhe design antl Igcation' 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 sfihdards,: rules an regu a ions o - u nam
County'`Departrrient of'' Health, :and thatbn completion thereof a "'GerUficate of Construction Compliance" satisfactory tothe,Commissioner. of Health will
be submitted to the Department 'and awrittenguarantee ; wiil be sfurnished the owner, hisauccessors, tieirs'or assigns by the builder;,fhat se id .builder will
place �n.':good operating condition any part of said sewage d�sposel system during. the period of two (2j years immediately #ollowmg.thedate'of the issu-
ance of the approval of <•the'Certificate of Construction Compliance of the original system :or any,repays thereto 2),ahat the, drilled ,well Described above
-Will be located as showri onFthe approved plan and that said well will be installeC in accordance ,with the ids rules and �egu a iTf ons of the Putnam .1 11
County Department of Health
tr _
�4 Anrrl 1976" ,
Date , 5�9ned, P.
X R.A.
r
d 3S3 6 5,12: r 29206 Lice,e No Address RD 1
APPROVED FOR'CONSTRUCTION This approval expires one rom the date issued unless construction of the building has been undertaken and is
,revocable for cause or m0yp. 9'amended orin6difiid_Whbn considered necessary by'the Commissioner of Health. :Any,'chang"e or alteration of construction
requires a new qe mit Ap`prDoved /for disposal of` domestic Oil t or: private wter supply "only. )/ /Date Y 'l Title Pff:' 6.
m
.......... „_ ; >v� . �_ ._ PUTNAM- OOUNTY= DEPARTMENT- OF ~HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner .,�y�i �rr� hc • Address �� •A* --z re
Pn'l�a� S+r,6r�ivisis.
Located at ( Street (Indicate ate ,��
Sec. �� �Lot // •� /— �/.
n ica e neares cross s
Municipality "Z&j P3 se.2 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Water WaEer ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
24 /
2 /3 /s 4z 3
4 ZA12 /x3 f=
5 / ls3 /i5`7
1_
Notes: 1)
rates are
for review
2
Te'Rts to be repeated at same depth until approximately e
obtained a,t'each percolation test hole. All data to be
Depth measurements to be made from top of hole.
soil
tted
TEST,. PIT DATA REQUIRED TO BE SUBMITTED WT_T. jT APP AT�yONi
.-TEST..
-- r.:_ wDESCRIP l� OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.
G.L.
6"
12"
18"
24"
30"
36"
42"
48"
5411
60"
66"
7211
78"
8411
Mf
I1VDICAT LEVEL- AT WHICH - GROUND WARY IS. ENCOUNTERED Alo-ye_ .
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Al®-te
TESTS MADE BY
DESIGN
Soil Rate Used__L-2_MirVl1tDrop: S. D. Usable Area Provided a '0 �
No. of Bedrooms Septic. Tank Capacity 00® Gals. Type �gsoa�ry
Absorption Area Provided By�L.F.x24 width trench.'
Other
Name John H. Prentits. P.E. 1gna ure- -
G'�
Address 71a 0. 6, BOX 3,53 :� _ ..�`
Y i1@ s i' �,t.l OT + 1105 i w !� N PRAtiT�. �'yF
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Chec c� h �° Date
�� No 29Z
�Olt TOE S1 1+�E��i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
� - -. ;COiINTY OFFICE `BUILDING; 24RMET�,
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.. `' R
'L
OwnerTe.l; a Pafsv &±6 Address takesL.",—D ye Cash, 4
Located at ( Street �`;II( Ddye K°� 3 - Block ____1_Lot
�indicate neares cross ss ree Papaw, l.a.ke :.Svbd• .L06 I II -7
Municipality f4 fte $&) Watershed cirbI64 h
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
p
o Water
Water Level-
No. Time
From Ground Surface
in Inches Soil Rate
Start -Stop Min.
Start
Stop
Drop in Min. /in drop
Inches
Inches
Inches
�I 1/139
2
Z 1114/ ! Z 24 /
5
Notes: 1)
rates are
for review
2)
� L# �1� �Ies �Pe -e �gc > c f �Ae �
Tests to be repeated at same depth until approximately equal soil
obtained at each percolation test hole. A11 data to be submitted
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 NO. HOLE NO. HOLE NO"`�
G.L.
6 if
1211
1811 L+, 93 ro
2411
3011
36f'
42ff noe Sawd
48 If pit
54 If
6off
66
7211
7811
84 If
N.
INDICATE L AT WHICH GRO`blq�*"TER S ENCOUNTERED We"le
BEING- ,ENCOUNTERED INDICATE LEVEL ;TO WHICH WATER_ LEVEL RISES AFTER T)�M V kf
TESTS MADE BY „�f
L
J,*uJp -* 14.f.--r) 4-s - -- At Date AWil-2i
1P
)�
Soil Rate Used-&:-i—Min/l "Drop: S.D. Usable Area Provided b�I —
No. of Bedrooms Type "Me
Tank Capacity 0 oo Gals.
A soPption Ar ea r—o-vTd—ed By�L.F.x241 b" width treiff.
her
A
Name
p.E.
Signature
Ike,
Addres
R S T
THIS SPACE FOR USE
} il&, B*RPMENT
ONLY:
"V
Soil Rate Approved
Sq. Ft/Gal.
Checked
,�
b l to
• • { :'.l.J'rl.rl: 1..1 �� rl: J.).; J.
Date.:
Insp.by•
xA►T`i7AL SI`T'E, IT SPi.CT_ OT3
Yes
No
Ccrrrrents
J.roperty lines or corn ers fc•,:nd . ..
Can estirrna.te house location e
VIM r.cel cut
Dust be re,hov ed -note - these .. .
_...
–�
✓'
–
.trees
7s deep hole r.opresent2t_ive of enter° SDS area
o • C
l�dditio� -&,l de en nc�e. n °ec.ed.
Sufficient SDS ar��a available corsideriT_
driveway cut, house location,.separati
•distances, etc. .. .-
DEEP ROUE PIA" -
Depth
Mater elevation: ,
Rock elevation: '` n. .•. ,/
Soils desc~-. ~vti on: ,9 .�+A
Date:
FINAL SITE 'DISFECTIL01".r Ins-j. by:
,
'11ouse located where shoi.m on approved plank ...
_
—
�- - - -
1•Yidth of lei .-ncn Cam. •4 era =G
Slope of, t; le line and trench acceptable . . .
Room _al. _].oT.TC^d i or ex.,c ns on t. ench-eas . •_ __
.._OUel 5�i.. �.t.,....1r C.M...SL -T.a M atercours.-......+ i� _a....•..
Natural soil not strireed or SUS area
tlnnecessari ly �rzJed
10 .tt, u-rainta. =r_e;� ray: uron.lin° and
2Q ft . from house . . . . . . . . • • •
S --paration of trench fro-m house, well
etc . flicas nlan . : . . .
Number
of bedrocms checks .
Stones. brush, s tu=cs, ruble, etc . a;-eat e r .
than 15 ft. from nearest trencn
15 Ft of peripheral soil horiz.ortally from
trench . . : . • . •.
Junction boxes pro -e_�ly set .
Gould surface run off from dri.vei•-ay=, roads, '
grosnd surface, et-c. channel near SDS ,
area
Does-lot drainar;e arlLla2ar O.K. in area of SDS
FIE LL GRADING OF SITE ACCEPTA T,,T,
c -ka 4;k C_ REVIEV CHECK SHEET
(ca Sr �wcwt
(,17
DOCTENTS
House plans O.K.
Design data sheet
Peres presoaked?
Min., 30" perc test depth
Cont. results for 3 runs
D. Hole log O.K.
Corporate Affidavit for other than individual
Authorization for engineer
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps.,
Meets Std.
Remarks
_
es
F o
i
z
/
/
iov-,�
DETAILS `
if change is proposed,)
Existing contours shown show new contours)
..Slopes for driveway cuts, etc. shown
Water service line location
Footing drain, etc. location
Top slope, bottom slope of fill
Percolation tests and deep test pit location
Septic tank size and conformance to std.
3 -3.R. house minimum
House setback shown
Distribution box .ftg. below frost
All water within, 50 ft. -of PI, shown
Plan. and profile SDS
All- other wells and SDS closer 200'
shown or reference.- made
Property boundaries (metes and bounds - clearly shown).
±
r
F
�
h
F
i i
!. ✓
./
�
SEPARATION DISTANCES SPECIFIED ON PLAN
10'
20'
MOO
50'
15'
10'
15'
10'
10'
5'
to P. L.
to Foundation walls
to Nearest well
to stream, march, lake, etc. inci.expansion
to Curtain. drain
to water line (pits -20' )
to storm drain
to large trees
from foundation to septic tank
to pipe from leader drain & foo ing drain
i
z
/
/
tT �
d� ��°✓O
657°.35= 3a "/i/ '
tsar dU11GTlvt4-go�c,
As 8 1 .�U
tiructure located tr.om survey by survoyorr natct�e� d 6olow &•:
Well located by.: -Surveyors survey -
•
Weil drillers report
:k t,
Engineers mesuremands.Q._.-_
�or'(�TiG TAI.IIl.
Tank, boxes, pi46,gaUories a laterals to COted•.Cy:Controctnn
A
e
}
Health dept:
0 (i'
r
J
117807 P.St ;;, fZodi�I � A
'o.c ty - Meff -ttt df r_. h
}
q O T ES ; . +lea as a e for' a ormanoe with
applicable Sines and He4ulltions of the.
He tlb,, Dement.
I
„ r
LL
-o" 2• I
tT �
d� ��°✓O
657°.35= 3a "/i/ '
tsar dU11GTlvt4-go�c,
As 8 1 .�U
tiructure located tr.om survey by survoyorr natct�e� d 6olow &•:
Well located by.: -Surveyors survey -
•
Weil drillers report
xi
Engineers mesuremands.Q._.-_
�or'(�TiG TAI.IIl.
Tank, boxes, pi46,gaUories a laterals to COted•.Cy:Controctnn
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e
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Health dept:
FIre-
r
J
117807 P.St ;;, fZodi�I � A
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}
q O T ES ; . +lea as a e for' a ormanoe with
applicable Sines and He4ulltions of the.
He tlb,, Dement.
I
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Lm 39.'! 1 I°
As 8 1 .�U
tiructure located tr.om survey by survoyorr natct�e� d 6olow &•:
Well located by.: -Surveyors survey -
•
Weil drillers report
xi
Engineers mesuremands.Q._.-_
Tank, boxes, pi46,gaUories a laterals to COted•.Cy:Controctnn
1
e
}
Health dept:
r
Eng "Inv daae
'o.c ty - Meff -ttt df r_. h
}
q O T ES ; . +lea as a e for' a ormanoe with
applicable Sines and He4ulltions of the.
He tlb,, Dement.
I
As 8 1 .�U
tiructure located tr.om survey by survoyorr natct�e� d 6olow &•:
Well located by.: -Surveyors survey -
Weil drillers report
Engineers mesuremands.Q._.-_
Tank, boxes, pi46,gaUories a laterals to COted•.Cy:Controctnn
EnQtneet;
Health dept:
Field tnspoctton by: HeoHh dop41Zl' dnte: _rRar��.:198
Eng "Inv daae
'o.c ty - Meff -ttt df r_. h
Division at a1:H +a1th Servioee
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applicable Sines and He4ulltions of the.
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SANITA', YST a.ESS[ S UjU
LOCATION'Stteet: Wi16N�{"iU/- c�D4lAtgG IZG 4%�'I�G-C
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SUBOIVISION:�i1 ?M � �-°Z• tI91 —?1 1 �.rw�� l4`•
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Block. _ ._ -{ LOT Ns
Surveyor:�►-1���LDO_C?�`�
Drawn': "p. Date:S -Z°/- �5t�1�JoN 2 .
4= I'
40.
DMg.
J.0 H N H PRENTISS PE
of t {E •'
"I 60NSULTINO ENGINEER