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IMAGING & MICROFILM ACCESS, INC.
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631- 589 -8100
45. -4 -6
BOX 18
f R � �
02123
I certify that .the system(s) a8 listed serving the above. :premises were constructea essentially,a9.. shown,on the plans of the completed worx ( copies
of which are ettached), and in accordance with the standards, 'rules'and regulations im..accordance "with 'the filed :plan. and the'pernit :issued by the
Putnam County bepaztment Of Health.
Date /Z•. / Z• �o Certiil P.E. ft..
i
Address !13
ROFESSIONAL.
Any person occupying premises served by the above system(s) shall promptly „take such action of may, be, necessary, to sbcure the.00rrietion” of any unsanitary
_ . ecome null and void `as soon,as a Pub,' pnitary fawer` becomes
conditions resulting' from such usage., ApDroral of. the' separate sewerage; system shall b
iVaileble: end theta
*.approval of the? private `y ter supply shal,f,becoms hull mind .void when a public vratar Supply bewmas avaiNbN Such , approvals are
subject to 'modification or change whon,'in the_Jud�ment of the :6ommissioner of_, h eh revocation, niodlfication or changd it`neciitary.
Title f-
0
� L LVL14
�Yzii, tayr1riar,
CIO DEPARTMENT OF HEALTH
Division- -.Of --,Envixq�ppe�Wt �._,,H"lth. Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AMURESS: wN lull I Y TAiGRIO NUMBER:
. Ice Pond ..Road Brewster, NY
WELL OWNER
NAME: ADDRESS:
Warren Paukner PO Box 226,. Brewster, NY.
111f BIVATE
❑ PUBLIC,
USE OF WELL
1 - primary
2 - secondary
AR RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TESTIOBSEIRVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL 0- STAND-BY O.
AMOUNT OF USE
YIELD SOUGHT 5 gpm.1NO. PEOPLE SERVED 2 _t05 / EST. OF DAILY USAGE . 500 gal.
REASON FOR
DRILLING
AD NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION
0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL.
,DEPTH DATA
WELL DEPTH 365 ft. I
STATIC WATER LEVEL ftj
DATE MEASURED 8/1/88
DRILLING
EQUIPMENT
❑ ROTARY 93 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT O,CABLE PERCUSSION 11 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. :OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH 21 — ft
MATERIALS- STEEL 0 PLASTIC 0 OTHER
CASING
DETAILS
LENGTH.BELOW GRADE 20. ft.
JOINTS: ❑ WELDED fRTHREADED ❑ OTHER
—DIAMETER 6 — in.
SEAL: 5CEMENT GROUT 0 BENTONITE 0 OTHER
WEIGHT
PER FOOT 19 Ib./ft.
DRIVE SHOUaYES ONO LINER:0YES ONO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH To SCREEN (it)
DEVELOPED?
DETAILS-
FIRST
0 YES ONO
SECOND-
_
GRAVEL PACK
11 YES
0 NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH tL
BOTTOM
OEM — It.
WELL YIELD TEST If detailed pumping
METHOD: ❑ PUMPED 1 tests were done is in-
0. COMPRESSED AIR formation attached?
0 BAILED 0 OTHER ❑ YES 0 NO
Ip It more detailed formation descriptions or sieve analyses
I
WELL LOG are available, please* attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Oia-
meter
In
FomtATION DESCRIPTION
cage
ft .
I
IL
WELL DEPTH
IL
DURATION
hr. min.
ORAWDOWN
ft.
YIELD
9prn.
d
Sur Lanlate
4
Cl g` & loose ledge
A
1 f; r�
Medim hard gLgnLt&.
300
1
20
300
4
365
6
365
-20
WATE9)DO'CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? Xfo YES 0 No
ANALYSIS ATTACHEQbQ YES 0 NO
STORAGE TANK: TYPE Diaphragm
CAPACITY 86 GAL. 23
PUMP INFORMATION
TYPE Suhmgm-r-gible CAPACITY 1
o
n— Goulds
I EMAKER DEPTH 2 6 0
MODEL 0EJ10412 VOLTAGE 230 HP
WELL DRILLER NAME DATE
MILL DRILLI C. 811/88
ADDRESS Putnam Avenue SIG
Brewster, NY
Ro t , M. r ent
zf� M
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
W:1 Z2TFi_1 PlkVR0F1P
Owner or Purchaser of Building
FMLInI Co "JTR�lCT1j j0
Building Constructed by
-TCF no,.jo MA T>
Location - Street
FA 7T TFeso)-1
Municipality
i�FS�p.Fi.•��F'
Building Type
Section Block Lot
1 cF p,Jr)
Subdivision Name
.4
Subdivision Lot #
GUARA4TEE 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 systa,, 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 willful or negligent act of the occupant of the building utilizing
the system.
Dated this day of 19 Mo
WARREN PAUKNER
General Contractor Owner) - Signature
Corporation Name (if Corp.)
7-ZT7-1'2-Sd,J , J%JFv/ YOF-K
Address
rev. 9/85
mk
EONARD C LICj Z
Signature (��
Title 7_�a�-
4FIZ32)ec) eoNST. , .T"C.
Corporation Name (if Corp.)
FPFV_ST10 , �J rw yob
Address
_ . _...- RE�VSTER • �e��OF3�T ®RIE - :. - :.. -_ ......
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 7028
SOURCE: Warren Paukner
Ice Pond Road
Patterson, NY
COLLECTED: July 27 1988
BY: Mill Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
well
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
July 30 1988
Roy Bi it P.E.
Dir or
6. 10 feat r== orcr xLV line - 20 fe-- - four_ ^..a. -ions I I~ I J
. Dentz c �nG'1 < 30 LnLnee iron _suirface
8. Rccm ailch fer exransicn, 503 I l
°. Size of c _vel 3/4 - 1 ;" diarznete_r I I
lo. TEntn cf c eel in tr e_nch 12" miriL=.- I
L. Pi re emcs CT:;oea
h. P,asa,OR- DOSE- SISTR5
1. Size of c--,= cna*nber - I
2. Overflow k
3. A-lam,, v_s`:1 /audio I I 1
4. P-mo e _ =__v accessible marhole to crade I
5 First Lax bfl I
6. Cycle w_' e__-:z--d by Ee_a- th Decartz �e_ ^_t I
estimates ==cw � c-,%�e I I i
W. HCUSE '
a_ Ecuse lcc :t=om- ze_r aDnroyea plans_
b_ of be 'ccrL
V. W=
a. A'e-L1 leca -,: as per anoroved plans
b. Dist: nce fraza SLS are= measured ft.
c_ C=sina 18" a:-cve grade.
d. Surface dra_ ---= ---- around well acce T`�t ble.
V l - GVF RAIL, tiVOM LA c T
a_ Eaxes proce_rly arcute
b- AL' pines � tialiy bacfille
c_ A:, pines flus , with ins ide of tex.
d. B.ckfill m b` i al ccntai ns stones < a" in diameter
e. Certain dr`in ins Called acccrdinc to plan
f _ C:r i n drain cut=all protected & di r. to exist.wate_rc
g. r•ting cra_rs c=scnarce awav from SDS area
h. Surface_ wat=r crot= r -icn adecuate
1. F- oslon C^.n=1 nrovid d cn sloces creater t_`'la-r. 15%.
( FINAL SITE INSPECTIGN.
Date
%
Ins--
:�T .`ON LA 0C� CWNER
-:
-A 1... -... _. _�?. OR SJEDIVISICN I=
S vA_GE DISP`'OSAT, A -REA
I I
a-
Su-S area lc=-ted as per annroved plans
I
b.
F,-; 11 section - Date of placanent
2:1 barrier . LG H W-= AVG.DPTH
I
c_
klzt=c-1 soil nct strirced
d.
Steve, brush, etc. , greater than 151 free SDS are=_.
e.
100 ft_ free water course /wetlands.
I
Ii. SE:-uI✓ DISPOSAL, SjSTZM
a.
Sen is tarLk s ze - 1,000 1,2�
I 4
b.
Sentic tan:-, k.s to led level
I �-
c.
10 ` min *mm T_an f cur dati on
I �-
d.
NO gloo cle.ancut within 10 ft. of 45c band
I I
e.
DIS�RIEL"TICN
1. ALI cutlet= at same elevati cn - water te__ =tad
! �S
2. Protect-e-7 ballcw fres L-
I I
3. M- -LL- L-um 2 - oricirtil soil between box and tom anc -?es
f.
JUNCIICN ECX - prcczrly se_
I ✓�
g-
1 Lznc=�n r - -�r -=;.� - `�� Lena` a in =-a 1CL= ti q
2. Dlsunce o water- ccur.= IT. °. su u f�.
3 . Ins- _ 1 ac =rcirc to`nlan
I I� I rvcl
C Distxance Cz.%_r to canter
5. Slane cf t_ inch accantable 1/16 - 1/32 " /fact.
I I'
6. 10 feat r== orcr xLV line - 20 fe-- - four_ ^..a. -ions I I~ I J
. Dentz c �nG'1 < 30 LnLnee iron _suirface
8. Rccm ailch fer exransicn, 503 I l
°. Size of c _vel 3/4 - 1 ;" diarznete_r I I
lo. TEntn cf c eel in tr e_nch 12" miriL=.- I
L. Pi re emcs CT:;oea
h. P,asa,OR- DOSE- SISTR5
1. Size of c--,= cna*nber - I
2. Overflow k
3. A-lam,, v_s`:1 /audio I I 1
4. P-mo e _ =__v accessible marhole to crade I
5 First Lax bfl I
6. Cycle w_' e__-:z--d by Ee_a- th Decartz �e_ ^_t I
estimates ==cw � c-,%�e I I i
W. HCUSE '
a_ Ecuse lcc :t=om- ze_r aDnroyea plans_
b_ of be 'ccrL
V. W=
a. A'e-L1 leca -,: as per anoroved plans
b. Dist: nce fraza SLS are= measured ft.
c_ C=sina 18" a:-cve grade.
d. Surface dra_ ---= ---- around well acce T`�t ble.
V l - GVF RAIL, tiVOM LA c T
a_ Eaxes proce_rly arcute
b- AL' pines � tialiy bacfille
c_ A:, pines flus , with ins ide of tex.
d. B.ckfill m b` i al ccntai ns stones < a" in diameter
e. Certain dr`in ins Called acccrdinc to plan
f _ C:r i n drain cut=all protected & di r. to exist.wate_rc
g. r•ting cra_rs c=scnarce awav from SDS area
h. Surface_ wat=r crot= r -icn adecuate
1. F- oslon C^.n=1 nrovid d cn sloces creater t_`'la-r. 15%.
Y ," � ,- �, -xs.' ..r �•-...; _ :,'- "-a' �.;_ -+^- r��c -iY -- _-*"': -r. ` 'T" ^"t9�r_ t/•r' '�^ K� t f .� n�!
PUTNAM COUNTY DEPARTDMNT 0F,,HEALTH r
N E C O P P E L MA I� _ D vl' top of Eavlroameatel Healtb Seevlcee Cnemel, NcY. lOSl? F�r,to Provide PermltwM '
/J\
lN EERS , P.C.on CERTIFICATE O MPLL4NCE
NG
A: Pit AL SYSTEM
P
Located at /[F Dl7wT7 �O,di�, Town or Ylllage
Sabdlvlsioa Nome Sabel. Lot q T. Map Block Lot _
Owner/Appllcant Name .' ,WAZM gJCi .. ,P,d►U%t
Renewal ❑ Revle1'
i
^:..
Date of Prevloae Approval
MOM Address " fpA{T? �Q�� Town F1A/�T Zlp Jao4
Snlldtng Type �2�Siy Lot .Area" S•O� °' --- FM` Secdon Only Depth Votame
Number o[ Bedrooms Deelgn Flow G P D P.CHD NotiBtxtlon la Regalred: When VON completed
Separate Sewerage System to rnnelst o[ Gpllon so c' Taak nud`'�
To.be eonetiucted by '�J>1 l�;F�' ��. LAddeees e:'.d►�?�1 �' r t!✓ OT�k.
Water Sa
ppb" Publlo-Sapply )~Yom Addrese
or:Prfvate'Sapply DrWod by.
0therRobatremeats l =O" ` l�N glyMC 71Cl:L1 � ' Y3'6 i4 ra
l represent that I am wholly and conipletety responsible for the tles�yn and location of the proposed sysferri(s) 1) that the .separate, sewage' disposal; system
6boVe described will be constructed as s.hown on the approved amendment there.xo and in',accordance with the standards rules an regu a ions'o = the. Tutnam
County Department -'of Health 'and, that o i completion thereof a Certif�cete: of Constiuctfon Compliance' satisfactory to'the Comm ssioner,bt Health will.
be submitteA.to the:Depart- It, and 'a written guarantee will De furn�shTed' he owner; h�S ssors heirs or assigns by the Dwlder;that'seid,bu�lder..will
plate An yood.operafiny condition any., "part of said'sewage.glsposal'system. during ttie.penod of _two ,(2►' years. Immedlately;followirig'thedateof the issur.
once of the approval, of, the Certificate -of ConstrucLOn .Compliance;; of th�o a�l st��O1� S fi�t�reto; 2) that "a1ie.;arilled;well described above
will De locatoq as shorvn'on the approved: plan and that said well will`b "e Installed itra���cppt�AA��qq��ee,,,�µfit� therstai+dards; : rules and ;re ertr f nam
".COUnty.Departmant . of.HSalth''
Date slslt� PROFESSIONAL.' "CORPO
• • 'Address -ry -•' �� v 'r'' License No
APPROVED FOR CONSTRUCTION Th�sapprovai'expiret two years fiom the date issued unleis construction .ot the building has been undertaken and is
revocable for cause or may po amended oc.modlUed when consideregnecessary by the Commfssion_er of- Health. Any change or alteration' of construction
repuires anew per'mmit. Appr ved for disposal of domestic sand y few ,.a /orprivate, at pply only.
Rev. Data ( �� gy Title �j "
..p
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATIONS -TO CONST•RkJCT A4•zVAT-ER
PCHD PERMIT 4
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
ICE F21-04P MPAC? PATTF o M- z LoT 6,z
WELL OWNER
Name Mailing Address
W�iZ�Fr! ;.Av prlZ1M- #C.E Po40, RoArw 0k' -C4✓5T f1Z
)dPrivate
O Public
USE OF WELL
1 - primary
2.- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP
❑ FARM 0 TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
L7 ABANDONED
0 OTHER .(specify
O
AMOUNT OF USE
YIELD SOUGHT
S gpm /11 PEOPLE SERVED -4 /EST. OF DAILY USAGESOo. gal
REASON FOR
DRILLING
X NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
gom A
AkFmtzoom DPQ61LiVCv
WELL TYPE
®DRILLED
DDRIVEN
ODUG
®GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: PoN p
Lot-No. 4
WATER WELL CONTRACTOR:
Name
6;fA' j,C 4 SeN
Address :
ENWyV -97,'cZ _ �, yr
IS PUBLIC WATER SUPPLY
AVAILABLE TO
SITE:
YES x
NO
NAME OF PUBLIC WATER SUPPLY: IVo A o TOWN /VIL /CITY
-- = IIISTA —FrE •TO- PROPERTY FROM NEAREST WATER - MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION E SHEEN
1Z 1S-57
(date)
y
signaturekEANE LOPPl=LMAN
PERMIT H PROFESSIONAL CORPORATIOr4l
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 requiremen of the Putnam
County-Health Department attached to this yermtm!it it
3. Submit a Well Completion Report on a form d b e P t ! oun
Health Depar ment.
Date of Issue: 7i 19 —=t--
Date of Expiration: 19 Is Official
Permit is Non - Transferrable �Py: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
APPENDIX
PUTNAM ACC DEP-ARTMENT OF :1 • Y: DIVISICN • �1 !' !1 iai— Y'T HEALTH "'YJi•.'._.:�I�s
DATE REVf5 ED
.me of • •- r) (S treet Location) f/�
! 111 DOCR4RUS
zs'u C
LF trench provided tj
required
60 ft. n� x.
Parellel to
. ii�✓aE+il�
FILL SYST&%'S 9 I ✓"I I
Permit Application
CE`� irrorate Resolution
Plans - Three-sets--- s/s /
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
House Plans - Two sets
Well permit; PWS letter
Variance Request
Cr'3�RAL -
Leaal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Cheaked
Wet'-and (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Seraage System Hydraulic avity Flcw
Fill Profile & Dimension - Volucre
D or 3 Box;Trench /Gallery; Pump pit details
ptic Tank - Size, Detail
All Detail, Service Line if over
Construction .Notes (grinder notes)
L gn Data c` erc Md —dedp results -_
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Gutter,Curtain Drains (discharge OK)
Perc & Deeo Holes Located
Representative of primary and ercansion
Egmnsion Area; shcwn; gravity flow,suff. size
If Pumped Pit & D Box Shcwn & Detailed
House- No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed System
Property Metes & Bounds .
House Setbac _ (Tight lot)
House Serer'- 1/4 /ft. "0; Type Pipe
No Bends; Max. Ben 450 w /cleanout
SEP..WMCN DISTANCES SPECIFIED ON PLA?d
Fields
10' to P.L., Driveway, Large Trees,Top of fiL
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. eccan:
15' to Drains - Curtain, Leader, Footing
351to catch basin, stonndrain,piped watercoursf
10' to Water Line (pits -201)
50' intemittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Weil to PL /
..-,.,." '�- _•- •-- ...,._..- .- ..�...,.�.: ..,,, :,>..- ..... -: _;... . :R...+. � „x..a:.�.�.x.s- i- ..,r -;�,. _ >er- rn..,,i r. :�:. -... .�. ,,.:.'_ .. rs a ++.- J-- r•s`.:.•''-`”" —�5=
\� ! P PUTNAM COUNTY DEPARTMENT OF HEALTH
`- Division of Environmental Health Services. Carmel. N.Y. 10512 Engineer to Provide Permit N
on CERTIFICATE OF COMPLIANCE
Permit. N
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Town
6A .:� ,.- ....,..- .
>ti.R
Subdivision Name -Sbd. Lot N `T Tax Map Block L tc
i. LA n na+a . ►1 f , , ea r.11 n
N Renewal_ ❑ Revision ❑
Owner /Applicant
Mailing Address
Building Type 1���, i QF'1� Lot A
Number of Bedrooms Design
Separate Sewerage System to consist of GaBc
To be constructed by '2 �+
Water Sapph ; Public Supply From
or: X _Private Supply Drilled by:
Date of Previous Approva,.Il� / q�
Town.
Fill Section Only U Depth Volume
PCHD Notification is Reaulred When Fill Is completed
Other Reoulremente I -' -
I.represent that 1 am wholly and completely responsible for the design and location t . the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to an in accordance with the standards, rules an regulations o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Co truction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished.the own 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 th riod of two (2) years immediately followmV the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original syst or any F"Rthereto; 2) that the drilled. well described above
will be located as shown on the approved plan and that said. well will be Installed in accordant with th,�, standar f �r I sw• d rag a ns of the Putnam,
County Department of Health, KE C.�l�i�1MLIV1K
bate `% \ Signed i`'F -�. n_r1
TV
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless con ion of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner
0!; ealth. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supi only.
Rev.
1/87 Oats By Title
P,14 •A
DESIGN DATA SHEET-SUBSUFACE SIEWAGE�_PISKSAL SYSTEM FILE NO.
Owner .114ozam PAa LA EP Address Fka Ro M Apya 2cAD 9K&-Op-
JI
tea at (Street) jo rjA.Q Sec. Block Lot 4
n d i ca f-6 Fn d dr es t. 6t 9,� g Dieet) l
ty
Watersheciwi
oil • Ivy V2 all 7101w4g:
Date of Pre-Soa-king Date of Percolation Test!
05650 1
1 P92ozzwelftym( • 21• •• •
Run Elapse Depth to Water From Water Levelf
No. Time Ground Surface In Inches Soil Rate
Start-Stop Min. Start stop Drop In Min/In Drop
Inches Inches Inches
1 7�— qz�l Z- I IS ez) IS 3
2 q 2'—c74-Z- 3
3 q47? /
4
2— 1 e2j I'S
5
3 17 /Kz7- 24
N
7—
5
7-0
S I
3
24
4 IC141
�Z,��
5 Y.
ell
NOTES: 1. Tests to be repeated: at same -depth until approximately equal soil rates
are obtained at each perc&atio"A! 'test lhole'',. .. All', &ti to, 86-�submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
T . . �At-,
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF'SOILS ENCOUNTERED IN TEST HOLES
tO�TH
-T
'AA5 - CCU G.L.-
L bc?
2'
31
4
61
71
81
91
.10,
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER
IS
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INDICATE LEVEL To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED'``'
DEEP HOLE OBSERVATIONS ME BY:
Sdil Rate Use(jAZP Min/1"
Drop:
DESIGN
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THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Signat
FOR
KEANE COPPELMAN
:P!, ENGINE-EERS, P.C.
A PROFESSIONAL CORPORATION
Soil Rate Approved -s . q.ft/gal. Checked by Date
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CONSTRUCTION NOTES � kutnam County Department or nealvL
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approved ?as t d /conformance SthS 7 ,
tpplicable Vules• and Regulations of the
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