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HomeMy WebLinkAbout2344DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.11 -1 -8 BOX 20 �A1 , .I Krr' r r r . oil m or 1 �' s 02344 l QIl IM[OOU[fR>IPAV2TAP!!W'OFIMALT1H 11matArtusalal � 8�nks•. L1ra�i. K T 186U - . >•a'M Hdvit)e lfaatltlt /'. { w Ct�1>QRGATS OP 601laQUANCB COMM Of 06"k isYtw� ",n `' L•t / rl .•.t ,, tt 1 ,. , ' t� r.�,. 3 e' w Qid j� � L c. ow�r A�iert Ifr. M oc b zz c'. �y J Z 4 �, g '( r J • v`a5 ,a°. ry x " i� 'r 9 ..I�.O ` AV�• -. i ..; k .'x� �i t1ti.� Addter � 15-10 C ° `CR r 4 C Tm., �: �'►•:.�, ; Z � � � "Z Z y 11 x ., Date Subdivision Approved �_' fi .Fee' Enclosed Q' amn„rit 3nuo, _ a«`'r_ Pm s«t,•. , i f` t z ., —' 1N��e of Flow G P D y U PCIEm NM�eitlw is 13eq�eil Wlaai iPf9 b o•yMted: Salt• Sweaep Slti� r aatalat at r�� S•plc Taaili -a y i T be a•rQt+eMd y - AtNeea� { WMr Said: ' Pi■o:St*� Ft� Adler 1 rapraaant =that l am wholly, and =eompNtNy nfponaibh f0► tM dati,n and lecatiohxof tali propoud systsm(q 1) tMt tM - fapswta °saw di ° saP Aem ' allow daaribad will be oonstrueta0 a dawn on the'Si6rOwtbania " , 1: there to ihd ie sccwiaeoa with tM stin id rula>< a r u ns .. nam s, M County ;ONwrtmant et. lMa —'and that on co►npNtion thw`aot a:.. Cnrtitiub s Construction ComOpil u' utipatetory to, tM Cominiaabnir:of Haftlthwill M':wbmlttad "ta tM .Opartmwit, and .a wr►Rtan•«iarantNEwill afern tM ; hif auepaerS ;MMf of assign by, the builder, that:Yld bYildar wilt tea M'pod .eoa►atm/' oonditton any 'Oa►t o1 slid fawaN- alsposaf sy " durirM .t _ period of ewo'l2! years xnm.d�aNy rollowtM tMal•b ofAhe hau- ana o1 the ap"al of tow Cwtf/katn of Comtructbn ComplMnd of M.oryinalsy or nyA► Ms thereto; 2) that the Ai8N0 wall daao►ib�d a6ova t wlN -tie loeat•d:N shorrh0". ao . W pIM ant tlNt wW wNl will M •MSt in n wit ►wlardy runts an0 ,rMuTaiio a Ot tM Putn•m Sill, Addy V.1 Z Lleanta APPROVED foR CONSTRUCTIO Thk_i pp►owt ixpM•a two years from tM ;data NwW unNSS const►uctbn o! •tM buigirp Ms t»ati unOortakin and it " nnof •bN for eat4r e►,,inaY ea �nMnd•A Oi ngdNNO;wMn eouWarad,tipeafpry 'OY tM. Commigiom► of iMaalth Any change 'Or anNatbn of'const►uetbn x r .,. p nOuNy • new- parmlt." Approved ip':difpOYl,Ot' _AOnNllk' anitary NwaN,':in0 /oi. private w�ta wooly only $830ab tsy e Titoo y -J F A I- 'ell Iz Z%l �'� �, ow 00 1 5,79 —79 7 ,.v*^.,..._n.+*. „...•.c..rr « >r. ,. ,..r.c?- „7 .:: vr. ,, tr,; ,: ^"�,. .r,nw -. x• -•k„R �., %�'17' :J "t � x� , 7��5"" � V��y� �yVI;L"`."I�V��Ia�41 +G. s 'Date tLW �j� r T!--yDe R OF . `"C\ ` • at r _ VOID IF ALTERED.' C PERSONAL MONEY ORDER i r sv The customer purchasing this Personal Money Order.ag�ees to � ` Sl,V i ^t,. T complete in a timeiy manner, in Ink the date payees signature and . Pun haler s Address C address. Customer assumes all responsibility for any payment of s . the Personal Money Order caused . by customers failure to do so Pbrchaser.'s Signature, DEPT.. 1769 110 etd.Pt. a L^nr F. hone s14= 225 -f13 0 p �y l Carrtel. yew Yortc 10512. Date 3 19 ,a * JOHN KARELL .Jr., P.E., M.S. e .1- Public Health Director, �W Yoh DEPARTMENT OF. HEALTH__ •. _ _ : _.__ e. . Division Of Environmental Hea�t�i Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 September 3, 1993 Mrs. R. Cocozza 11510 E. Cresent Apache Junction, AZ 85220 Re: Proposed SSDS Cocozza Dear Mrs. Cocozza: I have received your letter dated July 20, 1993 and have reviewed the file. Responses to your questions are.as follows: Q. On April 4, 1993, Robert Morris, Assistant Public Health Engineer., stated that the submission for the construction permit was complete. Then why couldn't the map be found and why are additional percolation tests required ; ?' A. The filed map number (657) had just been provided to this Department by Fred Zenz. This map was not available in our office and a copy had to b:e obtained from the main county office building. When the map was,-,rece:i.yEd , i.. +.+ was realized for the first-time that the map was not approved by==the._Ns::Yori State Department of Health, therefore, percolation tests and deep'test'.ho ?.es. must be witnessed by a representative of this Department. Mr. Hedges,Seni'or Sanitarian, inspected the deep test holes.in the Spring of 1992 "Please ?to'"* _.':_.._...... .. ..... ....... that Mr. - Mbrris requested the..fi_�-e -map- _t_�umber from- Fred Zen -' in "a,- Lett -E ;r - a ._.__.. - .- dated June 15, 1992. At this time this Department is waiting for correspondence from Fred Zen-"Y6t' mutually suitable time to perform the required percolation test. The appli.�vi:. cannot move forward until: this test is completed. If you have any questions, please contact this writer at extension 151. Very truly ours, r John Karell, Jr., E. Public Health Director -J K /RM/ ] p - cc: Fred Zenz ` All r Yo y • ,�Q 4 on-y IVA- L4 La cu 0 I -MA-� rue so o 292 Main Street Nelsonville, NY 10516 Re: Proposed SSDS: Cocozza Pudding Street (T) Putnam .Valley Dear Mr., Zenz: Review of:pians and other supporting documents submitted at.this time relative to the above- captioned.project has been completed. Comments are offered.as follows: 1. Fill section notes as per memo dated September 17, 1992 are to be added to plan (notes enclosed). 2. Septic tank location is to be shown on fill plan. 3. Percolation tests are to be witnessed by a representative of this Department. Upon Receipt of , a submission, revised to refa Oct the above comments, : thi s - application-will be considered,-further.- - Ver truly yours, All Robert Morris Assistant Public Health Engineer RM /jP DEPARTMENT OF HEALTH Division Of Environmental Health Services 4..Geneva Road, Brewster, New York 10509 (914) 278 -6130 July 8, 1993 Mrs. R. Cocozza 11510 E. Cresent Apache Junction, AZ 85220 ra- JOHN KARELL- Jr,_P.,f Pu6lic Health �6irector • ­ t .. —_...- Re: Proposed SSDS Cocozza Dear Mrs. Cocozza: I have received your letter dated June 22,,1993 and have reviewed the file containing correspondence from this Department. Our records indicate that an application for a construction permit for a sewage disposal system was submitted on June 5, 199.2. Mr. Morris reviewed the application and sent comments for revisions to Fred Zenz on June 15, 1992. On January 6, 1993, a copy of the application fee receipt was sent to you at your request. On -April. -i -:; .1 - ..letter -was sent to Fred Zenz, at your.- -request ,,—ask•ing -why there was no response to the letter of June 15, 1992. Fred Zenz then submitted revised plans on April 21, 1.993. Additional comments for revision were sent to Fred.Zenz on May 5, 1993, these comments have not been addressed at this time. If you have any questions, please contact the writer at extension 151. ery truly ours, A �Uohn Ka., a Jr., P. E. Public ealth Director JK /jp DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 15, 1992 Mr. Fred Zenz 292 !lain Street Nelsonville, NY 10516 Re.: Proposed Addition - Coco=a Pudding Street (T) Putnam Valley Dear Mr. Zenz: JOHN KARELL Jr., P.E, M.S. Public Health Director Reviev of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: Design Data Subdivision file map nusber.has not been provided. . Standard form PC 1 has not been submitted. 3 04. Fill plans as per. applicable sections of Putnam county Codes for fill sections greater than 2 feet have not been submitted. _5..:- Fill . is. to ;be nhovn -extending 10 -feet horizontally past edge of trench ::and then extending 3:1 to grade. Upon receipt of a submission, revised to reflect the above comments, this application rill be considered further. Very truly yo�urs,1,� `Robert Morris Assistant Public Health Engineer RM /jp .c. a e � .. .a Y_.w►-sw�s. �r.�e�.a.. �a s � _ . � s • . •I .->tic. a a . ...�a.. �: .1r ai..a �.'c _ i . �'t �J s lo �� ao�195� s- � U V•A y. 4-6 fAt m I DEPARTMENT OF. HEALTH Division Of Environmental. Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 JOHN KARELL Jr., P.E.,. Public Health Director January 6, 1993 Ms. Coccozza 11510 East Crescent Road Apache Junction, AZ e5220 Re: Receipt Dear Ms. Coccozza: As per your request please find enclosed a copy of the receipt of the Septic Sewage Disposal System. If you have any questions please contact the writer. Verry_�rul y/ yours, Robert Morris .Assist'arrt=Publd -Health - Engineer RM /jp Enc. DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Mr. Fred Zenz 292 Main Street Nelsonville, NY 10516 W JOHN KARELL Jr., P.E., M.S. Public Health Director April 1, 1993 Re: CocozZa Proposed SSDS Construction Permit Pudding Street (T) Putnam Valley Dear Mr. Zenz: Comments were mailed to your office from this Department outlining the additional informat ion -- and -- revisions- -requl red-- to complete the-- submiss- i on- ..for.-- the_above - _ .. .... .... . ...___. .__ captioned proposal on June 19, 1992 (enclosed). I have discussed this project with you on several occasions. Mrs. Cocozza has contacted this office numerous times requesting the status of the project. Comments are as follows: - _ th1 .. If there is a- problem w__the.submissi -on notify.this Department immedi- ately a soiut i or`cah be found : 2. Mrs. Cocozza states that you said the application is being held up by this Department, this is not correct. If you have made a submission after June 15, 1992 contact this Department. The revisions are not in the file ar:d .may have been misplaced. 3.1 If you do not wish to proceed with the project please notify this Department. This will be added to the file and Mrs. Cocozza will be advised of your position. If there are any questions I may be reached at ext. 166. V?.Cy truly yours, Robert Morris Assistant Public Health Engineer RM/jp owner 2. +H. Co:�oZ7- Address ..:_�d TA,,,Nti4 Located at (Street) a.t k1.. e /ar4 q1_11 Block Lot 8 . (indicate nearest cross street). Municipality 7.Watershed v, l-s. SOIL PERCOLATION, TEST DATA REQLTIl2ED TO BE SUBNIIZTED `WITH APPLICATIONS Bate of Pre - Soaking 'B 3 q �- Date of Peroolatlori Test 9 f HOLE CI= TIME PEE;CQLATION PEROOLATION Rtzn Elapse Depth to Water From Water Level ' 'Ground Surface In Inches Soil` Rate Start. - Stop Min. Sip �oP: Mu /In Drop. Inches Inches Inches ` 2. 30 3 30 c� z4 4. 5 -. 3 Tests to be re ted' aatt2sametiep test tole l data �' l•peaP Y �i soil rates are obtaine3.at.each . to be submit tad for review. 2. Depthrieasurements to be made from top of hole. rev. 9/85 r • �• r• �+r • J, r ype • o l•�• k r• • • ^ • r DQN •• *4 0 DI r a. : • qq I fill AA "�,11 I -'.�� u� �l �_�� _�L � _i� �:ll _0 III /Y �• /ALL/ pp � �SSI�nR� ���Li OL/ &M, -wo - V I Aw _ if .� �i �a O i OL/ &M, -wo - V I .� -wo - V I M no , W, Elroom I 9A FWA �� 0 1 \I� 1':.1 I�� ��. u �/ ✓' �� .A �/ 1k) J� Q IN E� ��� 1tn h It e c 1 Sk tz q, v 0 dc OS o � _ c Op j'.��2 h V its — y vt DEPARTMENT OF HEALTH- Division.of Environmental Health Services 110 OLD ROUTE SIX .CENTER, CARMEL''N Y. 10512 (914). 225 -0310 q. APPLICATION TO CONSTRUCT A:.:WATER WELL La. WE" OLLD 0VD.JGI11 1V PLVVL1DIlsI 1bJ 14V IF WELL'. IS LOCATED IN A REALTY SUBDIVISION:, NAME 'OF SUBDIVISION: �G j�+ oEf I�NPQ Lot No. WATER WELL `CONTRALTO -- - - - -- - - -- - . - - — __..- - - - - R: -- Name --- - -- - . -Address :- - -- -- - - - -- - -- . IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 0 NAME OF PUBLIC WATER SUPPLY: Wl3 TOWN /VIL /CITY DISTAE d -TO PROPEPTYt FROM- NEAREST - EiTATER MAI?]; LOCATION SKETCH_ S.-SOURCES.OF CONTAMINATION PROVIDED N SEPARATE SHEET C Z (dat) (s PERMIT TO CONSTRUCT A WATER WELL lA` 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or.waste products from such well drilling operations be contained on this . property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PCHD :PERMIT # WELL LOCATION S r et Add ess own Villa City T Grid Numbs "r` tAid A._ U WELL OWNER Namnp M. Coco z Mailin Address �s►�E cr,,� dd �C Ju.,, p.Pfivate. �Z. q Public - .; USE OF WELL SIDENTIAL 13 SUPPLY" Q'AIR/COND /HEAT PUMP QABANDONED. 1 - primary 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2'- secondary: ..O INDUSTRIAL t] INSTITUTIONAL O STAND =BY O AMOUNT OF USE YIELD : SOUGHT 4,4cti S gpm/ li PFOPLE SERVED ., /EST - OF . DAILY USAGE YV 0 gal La. WE" OLLD 0VD.JGI11 1V PLVVL1DIlsI 1bJ 14V IF WELL'. IS LOCATED IN A REALTY SUBDIVISION:, NAME 'OF SUBDIVISION: �G j�+ oEf I�NPQ Lot No. WATER WELL `CONTRALTO -- - - - -- - - -- - . - - — __..- - - - - R: -- Name --- - -- - . -Address :- - -- -- - - - -- - -- . IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 0 NAME OF PUBLIC WATER SUPPLY: Wl3 TOWN /VIL /CITY DISTAE d -TO PROPEPTYt FROM- NEAREST - EiTATER MAI?]; LOCATION SKETCH_ S.-SOURCES.OF CONTAMINATION PROVIDED N SEPARATE SHEET C Z (dat) (s PERMIT TO CONSTRUCT A WATER WELL lA` 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or.waste products from such well drilling operations be contained on this . property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX -3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRU ON PERMIT ZAA ::r.L-r,.r_...re "»� ". _ .- y. . ._. .. ...r.. .r._— ....._.. _ NAME OF O R G�- 5 1:; T Loa floN BY DATE TAX MAP # DO MENTS. Y M PERMIT APPLICATION m PG1 CD WELL P-E-R- TT; PWS LETTER m ENGINEERS AUTHORIZATION_ DESIGN DATA SHEET(DDS) DEEP HOLE TAG . I ; CONSISTENT PERC RESULTS (3) CD PERC HOLE DEPTH m CORPORATE RESOLUTION 2I PLANS THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST GENERAL D] LEGAL SUBDIVISION m SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED m DISCHARGE.(OK) M PERC & DEEP HOLES LOCATED M REPRESENTATIVE OF PRIMARY AND EXPANSION CD EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE ED IF PUMPED PIT & D BOX SHOWN & DETAILED — ED HOUSE - NO. OF BEDROOMS m WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM m PROPERTY METES & BOUNDS m HOUSE SETBACK NECESSARY (TIGHT LOT) ED HOUSE SEWER - 1/4"/FT. 4 "0; TYPE PIPE CD NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS MCLAYBARRIER m 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE m FILL SPECS mDEPTH GAUGES ED FILL PROFILE & DIMENSIONS M VOLUME :m CURTAIN DRAIN REQUIRED LUSTANDPIPES TRENCH m EX= APPROVAL- S$DS - -ADJ-. LOTS - - - - - -- - - - CL7LFTRENCH- PROVIDED---------- - - - - -- m WETLAND (TOWN/DEC PERMIT R & D) m60 FT MAX DATA ON DDS PLANS & PERMIT SAME m PARALLEL TO CONTOURS m PRE -1969 - NEIGHBOR NOTIFIFICATION m 100% EXPANSION PROVIDED — 70 LETTER BMA SEPARATION DISTANCES SPECIFIED ON PLAN 406Yh. . - ' �LE3JD- E-I:EV:�TION__,_,..._...�::,_ REQUIRED DETAILS ON PLANS _� m 10' TO P.L., DRIVEWAY, LARGE TREES, Y6P �F F-EI: a_-.-- ____._ m SEWAGE SYSTEM PLAN - (NORTH ARROW) ®20' TO FOUNDATION WALLS m SSDS HYDRAULIC PROFILE m GRAVITY FLOW m 100 TO WELL, 200' IN D.L.O.D., 150' PITS m D/ J BOX ELI TRENCH/GALLEY CD P- PIT DETAILS ED 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) ZI SEPTIC TANK - SIZE, DETAIL = 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER =WELL DETAIL, SERVICE LINE IF OVER m IV TO WATERLINE (PITS -20') m CONSTRUCIION NOTES (GRINDER RATE) m 50' INTERMITTENT DRAINAGE COURSE m DESIGN DATA: PERC AND DEEP RESULTS m 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS CD TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS m DRIVEWAY & SLOPES CUT CZ710' FROM FOUNDATION; 5V TO WELL C1� FOOTING /GU IMCURTA.IN DRAINS WELLS m 15' WELL TO P.I.: COMMENTS: PC -1 PUTNAM COUNTY DEPARTMENT . OF' HEALTH .;; r;• . i , , :� _ ,� ,: 3 _ A►T —IO ',ftR- A-PPPROVAL -OF •PL•ANS FGR k .*& fkT� DIi�POSAI.,SYMIE W 1. Name and Address of Applicant. r 2. Name of Project: C- c n zz-m. �S' 3. Location T /V /C: 4. Project Engineer: F -R z Wiz. 5.., Address �-�2 r'u°^°' �> License •`'Number: 41736 Phone:' } 6. Time of . Pro ect Private /Residential Food Service:, Commercial Apartments. Institutional Mobi10 Ho herPark Office Building Realty ,Subdi.vision: 4 Other ;(specify) 7 Is t su his project bject to State Environmental.Quality Review'(SEQR)? • , Type- :Statu`s °"(.Check One) TY..' .'I.. Exempt'' Type II. Unlisted 8.. Is :a Draft Environmental Impact Statement (DEIS) requi red? ............. ° 9. Has DEIS been completed and found acceptable ,by1lead Agency? .. U: >, n. ,'4 to. ' "Name bf Lead Agency 11 Is thus project in an area Crider the control of local punning, zonings, ��S �- o�- -mthe- .officials., = orcinarces? :. .... - 12: If so, have plans "tieen submitted to such authorities? ......... 3. Has = preliminary "approval `been granted by "such •authorities? t! Date Granted r #::.. 4. Type.. of Sewage Disposal System Discharge Surface'Water Ground Waters 5. If surface water discharge,' what is the stream' class"designat, on?.:':'.-::'.. _ U A 6. Waters index number (surface),. ..... ..... ......... .... ... ...:...... N) �- 7. Is project located near a'public water supply gystsm,4j • i 8. If yes, name of water supply W l.' Distance to water supply 9. Is project-site• near: a public sewage•'collection or disposal system ?....`: O` 0. Name of sewage' -system r - Distance' to sewage system v" 1. Date observed ` 23. Name df' Health Inspector: • `A `. "'1 `s 4. Project design flow (gallons per day).....` .. .................... .... ... 25 „_Is�tate.- Pollutant Disterge- £1#mihation System (SPDESParmtt required.. F.. ,�t•w, �� 26: Has SPDES Application been submitted to local DEC Offices 27.. Is any portion of this project located within a designated Town or State wetland ?:•.. ........ .... ..... ,, .. .28..-Wetland. ID Number'.. ............ ....... .............. .. ...... 29. Is Wetland Permit requi red? ..:.ti .... ...... .. .: - Has application been made to `Town or Local DEC Office? N'. : -: 3 ©':Does project require a ©EC stream:Disturbanc Permit ?� ,r ................ No n , R ' Is or was project site used for agriculf"ral' activity involving application of pesticides .to.orchards or other crops, solid or hazardous waste disposal,- landfilling, sludge = application or industrial Act'' YES o'r NO 32. Is project located` w i th 16 11000 feet of Xistence,,rof abandoned :landfill, hazardous waste site, -salt stockpile, landfill, sfudge�disposaI site or . .. i 4 any other potential known soui -e of contaipinetion ?' .:.YES `or NO° !. DESCRIBE: t' .. 33. Is there` a 1o6a1 mast r� plan of file with�ktl a Town er Vi "page? ...... `ac$ , . ,, z r' " 4 34. Ar..e. community water, sewef facil'it es planned to be developed -within .l5 years p sew 4 d'�spas &l, ;ar as- c� excess. f 1 `X s�S2Re1'' .; ° . —ir7-� a 36 ..Tax Map ID Number 37 Approved Plans are to 4be. returned :o , . Appl scant Engineer If the application Is si:gned,by .a person other tan the ap scant shown in:Item 1, the pp p - , a lcation must be accom anted "by_aTetter cif A i thorizatl n Failure` to comply ='with this t- , _ proviision maybe .grounds "for the. rejection of,a�y' :submissi' n. I hereby affirm, under% penalty"of °perfui-y, "that tnforination _.provlded'on `this form is true to the best of »y . knowledgep, and; be 1 ief Fa ]se statements; made w , herein are punishaN as' a Class A Hisdemeanor-pZ'r'suant to 'Section `2i0. db of the..` Pena 1 Law. _ SIGNATURES & OFFICIAL TITLES• MAILING ADDRESS: in I lo' � I G, PROPOSED 3 BEDROOM RESIDENCE FF_ 1 I % &Vanslon area DESIGN DATA: DEEP HOLE TEST: DEPTH TO HOLE WATER IMPERVIOUS O 2 �• $' 3 4 Z N � SfREE� PUpOW . PERCOLATION TEST: stabilized rate �I''S min. /in. DESIGN FLOW: Coo gals /day APPI IrATInH PATE. ., e � 1.3 0 1 3 0 O Cr. o Z N Q Z Z R.OJL FILL SECTION 74'x56'x4' 0 REQUIREMENTS: 10D0 gallon Septic tank 3'1s 2' wide abs. trench I distribution boxes )unction boxes cleanouts , .��c. y, ROB. fill c.y. impervtous 1`111