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Home My WebLink About2144DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -24 BOX 19 02144 rn III, -' ` i ;� J ' Z T 1 '. 7 1 14 160 1' L '4 �' g Is 4. IN . Aim 02144 '3/86 Rev. 4 ,Division T of U CE TE OF. CONSTRUCTION 1 Located at �✓ l . �T/ DYh Owner /applicant Name ✓.3� �) 4 Melling Address /'G /�i�• rvr e '"—ti �e�cia4,°�nrF^ar+R39P°� ^^+'i' K �.._ a 3 ui, . t ,;,,�4 '^""F'..7` Y ^ "'•Y "". .i"'..,i: - DEPARTMENT OF HEALTH Health Services, Carmel, N.Y 10512 � , Engineer Mast Provide P.C. D Permit FOR SEWAGE.DISPOSAL SYSTEM �' dt /7f?C�y, �✓ �!?% . Ta:.Map Block _Formerly Snbdivlslon Name_�''�'Sabdv. Lot q1� ZIP JG .J �� Date Permit � r / Separate Sewerage System .ballt by o �`'` �'" ` �� Address Conslsting of / 0 G' e-' Gallon. Septic Tank and 10 Water Supply: Public Supply From Address or: Private Supply Drilled . by _ Address . • Has Erosion Control Been CompletedY Y Building Type _ • Number of Bedrooms— - Has Garbage Grinder Been Installed?. Other Requirements �/ /! (/ �� ✓ �! i �i I certify that'the system(s) as listed serving the above premises were constructed ease a yea alit s of the completed work ( copies of. which are attached), and in. accordance with the standards, rules and regulations i' C t }sled' an, and•the permit issued by the Putnam 'County Department Of Health. Date ;� /� /' — I C�t(f(e0 by I P.E. R.A. .J` y e Address License N, 2 Any person occupying premises served by th above systems) shall promptly ,take such actin 10 news t the correction of any unsanitary ,�! r_ conditions resulting from such usage. A roval of the separate sswerage, system shell beco i�il Vmsa'•a a puD.,_ sanitary sewer becomes available and the approval of the piivate water supply, shall becoma•:nulI and_.,void•.when a,:pub !_ ea ovailabN.' Such approvals ere subject to�{,modifiutlon or change when, in the judgment, of the C ml ooei of Health' we cation or change Is necessary. Date 'C/(.ar Title r• • Wr,LL U%jr1rLr.11VL14 D6zrVA1 Office Use Only CLI DEPARTMENT OF HEALTH ,; Division Of Environmental Health Services i = PUTNAM COUNTY DEPARTMENT OF HEALTH..., STREET AOCRESS. NWNIL L1.1 c] I Y TAX GRIO NUMBER:.. WELL LOCATION WELL OWNER NAME ADDRESS: PRIVATE 0 PUBLIC USE OF WELL 1 - primary 2 • secondary 114SIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEA PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ 'INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YjI ,I D SOUGHT gpm.INO. PEOPLE SERVED / EST. OF DAILY USAGE.: gat. REASON FUR DRILLING TX SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEWEXISTING WELL DEPTH DATA ' WELL DEPTH. f WATER LEVEL DATE MEASURED 3 DRILLING EQUIPMENT ❑ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT Q G<M PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED EN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH MATERIALS: 04TSE —L ❑ PLA TIC ❑ OTHER LENGTH.BELOW GRADE JOINTS: 0 WELDED FADED ❑ OTHER DIAMETER in. SEAL: SENT GROUT ❑ BENTONITE CI OTHER WEIGHT PER FOOT lb./ft. DRIVESHOE: ❑ NO UNER:OYES SCREEN. "DETAIL DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH CREEN (ft) DEVELOPED? , . .__.. _ - .....- - - - - .. _ _ m. :{3 °YES rt - : HOURS SECOND GRAVEL PACK ❑ YES ❑ NO SIZE: ETE OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST t If detailed pumping METHOD: ❑ PUMPED 1 tests were done is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER i ❑ YES ❑ NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. p y . DEPTH FROM SURFACE water Pear- ing well 0'a- peter FORMATION DESCRIPTION CODE, ft. tt, WELL DEPTH ft. DURATION hr, min. DRAWOOWN ft, YIELD gFm. Surface Q S % L- WATT R EAR TEMP. f' QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ NO ANALYSIS ATTACHED? I ES 0 N STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME H� OAT ., A CRESS SIG? ?ffnRE � i d Ad PUMP INFORMATION /0 _ _ a TYPE c� CAPACITY// 2— DEnT'H MODEL Z I VOLTAGOU2HP C Z �I Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 LAB #1 CA. 00 4950 Collection Station Used: Carmel ti Peekskill _ Mt Ki sc o ,. _.New City n (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) Date Taken: 7/10/87 10/30 T- STAIB THOMAS Date Received: Z/10/87 11-'00 Date Reported: JUL. 1 41987 P.O. BOX 189 Collected By:Staib MAHOPAC FALLS, 11T. .105411, Referred By: Sample 'Source: Sntkbt N. ' 'Richardgville Rd. L -1 Lot 17 Putnam Valley l- bo- - LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA X Standard Plate Count per 1.0 ml (Agar plate L 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) X Total Coliform Der 100 ml Fecal Coliform ner 100 ml _.Fecal Streptococcus per 100 ml MOST PROBABLE NUMBFR TECHNIQUF (?LPN) Total Coliform: MPN Index.rer 100 ml OTHER ANALYSES 23 Index_ per- '100'ml.._...__ 0 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING T TH NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani, M.T. (ASCP), Director ELAP #10323 LEGEND RDS = Recommend Disinfect - ing Water Source TNTC = Too Numerous To Count CONF = Confluent < = Less Than > = Greater Than PUTNAM COUNTY DEPART OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot o® Building Constructed by. Location - Street Municipality Building Type Subdivision Name 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 ` %nd 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 repair- s -.m a:de - -.by :m�e- to su.ch_system, except• ,where- the failure to <operat"6 - 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 Environi►ental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to qperpte was caused by the willful or negligent act of the occupant of the building i izing the system. 'Dated` is day of, 19 Signature �- �i A .6/ Title�A� m .t 7al Contrd6tor I• - • rev. 9/85 mk �d s Owner or Purchaser of Building Section Block Lot VA Building Constructed by �f '2/ 4,6 �� X11 Location - Street Municipality / s Building Type Subdivision Name Subdivision Lot 7 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 -r6peirs- e. by_me,to such systems__except where the failure to operate pro_ perly is I. caused by, the willful or negligent act of the occupant of the buil$inig utilizing the system. The undersigned further agrees to accept as the Director of the Division of Environinental Health Department of Health as to whether or not the fail caused by the willful or negligent act of the occup the system. !� day 'of 19 Cam! Gen al Contracto (Own ) - Signature motion Name (if Corp.) Address rev. 9/85 mk conclusive the determination of Services of the Putnam County ure of the system to operate was ant f the building utilizing Signature . —e- S� 'ENGINEER "70 PRQVIDE BERM T # ,( ®�7NTY ®EPAR�I�1 ® `�I'T$�t "' ON CERT FICA M Mea /th Services, Carme! N Y 10592 'PERMIT` rONSY'R �IOiU, PERiiNhY .FQR_:S I repreSentahat I am' wholly and completely responsible for the des above descnbetl wrll be constructed as shown on the approved amen County Department of Heath, Sand °that on completion thereof a be-- 'submitted to the Department, and a� written guar'anteez�w� ill place rn good operating conddion} anyT part ,of said sewage'tl�5� ance rof the approval of the Certificate of Constructon�Compl will be located as shown on the approved plan and that said well will County Department, °ot Healfh "r Date Sign G Address d (( F W% Date Rev. 6/85 proposed systems) 1) that the separate ''sewage ,disposes` systertl cordance with the standards, rules an tiregu a ions o G e . ,u nam ' Icti$�esg nce' satisfactory to the Commissioner of Healthw�il co@Qij�►s s or assigns byythe budder that ;aid Builder wilt RRr4;A�totk��'� rs immediaceiy following thetlate of`the issu t eto 2) that the drilled iwell; described above R h nt r rul a n &6 P utnam vL p O License IVo. jam" un ss; rda the budding has 'beanFuhderiak in and rs n oPi Any change or alieration�of construction �t a+6 IY t —j, t: �-' tC P A1VI'CO NT UNTYDEPARTME OF,HEALTH e� ,„ e Division of Environmental Health Seevicee Camel N Y 1051? Engineer to Provld Permit q '. , k ;, w oa CERTIFICATEYOF COMPLIANCE CO TRUCTION PERMIT FOR SEWAGEI)ISPOSAL SYSTEM Y Permit q fs/19 *Q6 Town or VWage :. Locetevt at — -- a �x ; =.� Sabdivhdou Name Sabel. Lot q Ta: Map Block rot � Renewal ❑ Revision ❑ Owner /Applicant Names. s� i fy' Date of Prevtoas Approvals Maillog Address" Zip Banding' Type �-� -Lot Area - FVll,Sec on Only Depth Volame .' Number of Bedrooms � � Deslgn Flow G /P /D �'� PCHD Notl9catlon Ib.Regatred When is completed G� a !Sep Separate Sewerage System to consist of Garton tic Took end 7. To be rnnstmcted by . Addreiss" Water.Sappl� Pdbiic;Sapply From or. Privates 1 ,, Drllled by � I represent thpf�l am wholly and completely responsible for the tles�gi and location o} the propoied systemts)�1) .,that the sepa'rato sewage'. disposal• system above tlescr,bed w,ll be;constructe8 as shown onahe- approved;amendmeht thereto and m;accor�iB'' a stantlortls ►ules;an ,regu a ions of e u nom County Department of. Health; and that on compi'efion thereof a Certificite..of Construc C IDJ� t�sfactory. to'the 't nor, Health will tie' submdted:`to the,0e`partmerit; antl a.wntten= guarantee_w�lt be furnished khe owner' to it igns 'by',' builder; that said ouildor will place. <,in good:'operaUng conddion any.'part of said sewage', disposal system During f i inediately following thediite of the Issu• . .,•._ �1p once; of the approvalyof' the Certificate' of Construction Compliance of the ongina yst r{ i t 2) that,the -0rilled well.descritied.above will be located as shown on the approved plan antl,that said well will be`Install ac r the r s and 'regu axons r of the' Putnam County Depsr, merit of Health',; as +� Date �� y .Signed P E R.A. y �s Address ° license No , �� 4, APPROVED, FOR CONSTRUCTION T s approval, expues one year from the date unl 4 onstruct�o t a building has been undertaken and is revocable for •cause or may be amende ormod�fied: when coris�dered nece{sary by -tfie. s rteeat6 y change or 'alteration of Construction requires: a new permit. ` Approvetl for disposal of domestic sandary 'sewage, an a _� el2l `►?/� �,. Data �P Gam/ 8Y -- - . un Title 0 'Y Evlej 05T I- YEW& FINAL SITE INSPECTION LOCATION t0l)c js"I"Ilf, T TH # OR SUBDIVI ON LOT # IV. V. Vi. Date .1 )(j Ins OWNER Pe y Y& NC Callums SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of plA Ement 2:1 barrier. IGTH WIDTH SC AVG. DPTH 7 c... Natural soil not stripped.. d-. Stone, brush, etc., greater than 15' fran SDS area. A-1 e. 100 ft. fran water course/wetlands. S&QkGE DISPOSAL SYSTEM a. Septic tank size 1,000 1,250 b. Septic tank ins led Idyel c. 101 minimum fran foundation d. No 90' bends, cleanout within 10 ft. of 45* e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minim= 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES. 1. Length required - length installed5 2. Distance to watercourse measured: ft. 3. Installed according to plan C- .4. Distance center to center IIA e- CA- 5. Slope of trench acceptable 1/16 - 1/32 "/foot. - 6. 10 feet fran property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Rom allowed for expansiont 50% 9. Size of gravel 3/4 - 1P diameter. 10. De th of gravel in.trench 12" minimum '11, Pipe, ends :capped h. PUMP OR DOSE SYSTEMS 1. Size of pLtV chamber 2. Overflow tank 3. Alarm, visual audio 4. Pm p easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health De estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedrocms WELL a. Well located as per approved plans b. Distance fran SDS area measured ft. C. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WOR1qV1ASHIP a. Boxes properly grouted b. All pipes partially backfilled I--- c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter- e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir-to exist.watercoursE g. Footing drains discharge away from SDS area h. Surface water zotection adequate •. i. PH—Osion control proviae-d on slopes greater than —15%. - PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIELD INSPECTION REPORT _ I r K r INSP.�BY: (Name of Owner) (Street Location) U INITIAL SITE INSPECTION (O Q( - Nt YES NO COMMENTS Wetlands on /or proximate to property ..............j,�; Property lines or corners found..; ............... #- can estimate house location ....................... Willdriveway need cut ............................. _ �- Must trees be removed - note these................. Deep holes representative of entire SDS area...... _ Additional deep holes needed ........... ... 1 Sufficient SDS area available considering driveway cut, house location, separation distances,etc... 1� icy �4-C> p Adjacent wells/ septics ... .........................�"�� G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. 3 ft. f,6 ft. 9 ft.. 12 ft. Soil Description Soil Descr 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO CANTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches ....... :...... Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........... :................ 10 ft. maintained from property line and 20 ft. fran house... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set......... .......... ........ Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. f_ PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES . - - _.. -. _ .... ... _ ._..__._ . _...._...,.... - _ .. Date.. Re: Property of ' ` 5 J7� Located at \ G \Vri. (T) EA-6cuong Section Block , Lot Subdivision of V, Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 7j` 1 7 1 1/Y a duly licensed professional engineer V or registered architect (Indicate to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said 1.' _.._:..:,-- . .'.-- .sy-stem --or•- systems . -in.. aonfcrmity- wit -h -the- provisions- -of Article - 145 -o.r 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Telephone Signed Vt 'A\ Owner of Property VC 4.x vii Address Town Telephone PUTNAM'COUNTY DEPARTMM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT _ .. REV.IE[WEl . _.,... . _.. DATE . �° - 1 -8 A i� �CKrQc0AJ n BY: ( " . (Name of Owner) (Street Location) DOCUENTS Permit Application Corporate.Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan 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 Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area ;shown ;gravity flow,suff° size If _.-Pumped Pit_ °& -D Bo Sh D�ktailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of.Property Located 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 °, Driv Large Trees 20' to Foundation Walls 100' to Well; 200' in D °L °0 °D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fram Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same Rnmm COUNTY DEPARTMENT, OF DESIGN DATA SHEET- SUBSUFACE.SBgAGE DISPOSAL SYSTEM FILE NO. Owners �% / Address Located at (Street) �� G/. ' +gin s' 9 6 Sec. Block Lot (indicate nearest cross street) Municipality �U� �� / Watershed SOIL PERCOLATION TEST DATA RDQIJIRED TO BE SUBMITTEI) WITH APPLICATIONS Date of Pre- Soaking - Ji� -`- 7 Date of Percolation Test HOLE NE74M C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 32/ 4 5 1. Tests to be repeated' are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until apprmimately equal Soil rates percolation test hole. All data to'be submittbd be made fran top of hole. �-4 . _.-. TEST PIT DATA Rmunun To BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 11 21 31 49 51 61 71 81 91 129 13' 141 .-INDIMAXLE' LEVEL 'AT- WHICH -GROUNDWATER' IS ENCOUINTEM- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min/111. Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity gals. Type Absorption Area Provided k By L.F. x 24'' width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARDTM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ - COUYIY..OFFICE`-BUILDING;' ;. CARMEL, N. Y.- .- 10512... ....".. _..._.__.__.__.._......:_ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Ai' � ��--$ � Address A0 Located at (Street ,Z9i�cAl"o yz Sec. Block Lot 7 �Indicate nearest cross s fee Municipality 7i✓,�G Syr Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Ron Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stogy Min. Start Stop Drop in Min. /in drop Inches Inches Inches 5, Notes: 1) Tee :ts 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 SOIL, NCOUNTERED IN TEST HOLES `4 DEPTH HOLE NO. HOLE NO.. HOLE NO.— G.L. 1211 18f' 24'1 3011 3611 42't 78„ 8411 ----Il'rDICATE LEVEL AT WBICH,GROUND WATER IS ENCOUNTERED e7 -RISES"-AFri'ER'--BEING,,-ENE,'OL04TERED.-,,'_.=®' TESTS MADE BY Date Alleokll_ DESIGN Soil Rate Used MirVlf'Drop: S. D. Usable Area Provided No..of Bedrooms "it Gals Type .0 -f ,), Septic Tank Capacity o/oveg Absorption Area Provided *_E�3__:�-L.F.x24 5b" width trench. - Other Address 0 9-0 gnature ,as-* 4 THIS SPACE FOR USE BY HEAALT ��* ��: ,/K DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Cal. Check any v. 245 a- Date