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HomeMy WebLinkAbout2418DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 50.16 -1 -10 BOX 21 02418 or Wo 02418 ZZ FQI .FY.;_..::...:..,.....,..;... Public Health Director Howard Kaplowitz 332 Dennytown Rd. Putnam Valley, Ny 10579 Dear Mr. Kaplowitz: .:.:.T. :N., M.S.N. LORBTTA..MOUNAI Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York .10509 Environmental Health (914) 278 - 6130_ Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 February 8, 1999 Re: Addition- Kaplowits- Dennytown Rd. No I ncreases in Number of Bedrooms (T) Putnam Valley Tax # 50.16 -1 -10 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated Feburary 8, 1999. The addition is approved with the following conditions. 1. The total number of bedrooms must remain atih ee 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 ti. 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 Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges WH:kg Senior Public Health Sanitarian cc: BI 1, -*:. v 31 '2-� 1 Rl' IENT OF HEALTH HOUH PLASI� FOR PcL-DFIO(... SKETCH ADDENDUM. Ruil1 �,rL:�'' "i}.` t 'iitlTibi I 0FHEALTH ROUSE FOR p. U• B E D R Ll 0 i01 GOLI':1 Cl 3B D R 0 0 �rrtat�re u Titl�� ate . ov CL 1 Dct- 31 c.� ray • - CR bizam AT � 0 . I , I- NI -TIAL INDIVIDUAL ADDITION / REPAIR FORM SECTION A. GENERAL INFORMATION Name of Project 3 TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly Molling OSteep slope ❑Gentle slope r1lat 2. 3Evidence of wetlands Clow areas subject to floodin g M-4ies of water DDrainage ditches ❑ outcrops NO.. 3. Property Y lines evident? ❑ LJ 4. Water courses exist on, or adjacent to parcel? U ❑ 5. Existing individual wells within 200ft of the existing SSTS? ❑� ❑ SECTION C.. EXISTING SUBSURFACE SENVAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS.area. A. Clevel Mentle slope 9Steep slope B. oWelldrained' DModerately well drained ❑ Some' what poorly drained OP oorly drained C. Area available for SSTS. (Primary. & Reserve) nExtremelylimited flSomewhatlimited - nAdequate R x R D. INSPECTION ,Date... ,. 2-Alf Inspector G L_JNo evidence of failure Evidence. of failure DEvidence. of seasonal failure . rn --------------------- ----------------------------------- � > � , (Indicate North) r 1 1 n r � ------ - - - -7- Y---------------------- --------- - - - - -- \ (1) Indicate location of SSTS A. Size and type of septic tank Metal Concrete B. Type of absorption area 1. Fields ft. 2. Pits gallons Plastic 3. Gallies ft. (2) Indicate setbacks, front street, - backyard, and'side yard dunensions- (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) SECTION E. EMSTING MATER SUPPLY [jPWS OShared well L JIndividual well Drilled []Dug MCasing above ground COMMENTS • S k.4 L,/ ..._.e,( , G/ - (( ( y r �� °� FEB- 3 -99 WED 4 :44 PM PUNAM CTY ENV HEALTH FAX N0, 19142787921 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 279-6130 Far (914) 278.7921 P. 2 BRUCE. R.. FOLEY Public Health Director STREET � 11 TOWN I TX MAP # 5 0 NAME D W i PHONE PCHD # F�zrz -? I3 - 3 / Phol-e_ -)-i i ? 13 -3733 MAILINGADDRESS )° o- lh rnt pwn Pet tJ4 naeenn - -kA!S J , AM DESCRIPTION OF ADDITION ( \ate P s -e- -vie A4- NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS ��'' --�-- (FROM CE1tT. OF OCCUPANCY OR CERTIFICATION FROM BUILDINO rNSPECTOR) •Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Fleasasubmit- This -fd m and the following. to. Putnam. County Health Dept., 4_Clerieva Rd.;. Brewster, NY 10509, Phone 278 -6130, 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing 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 with any questions. S. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. Q VCE_ZISE Comments Feb 98 FEB- 3- 9 W 4 :44 PM PUNAM CTY ENV HEALTH FAX N0, 19142787921 DEPARTMENT OF HEALTH Division , Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemeh: P. 3 BRUCE R. FOLEY. R.S. Acting Public .Health Director 4 Re: !--0 33 -"- De, r) n y •4� w Y) k 4 Residence V&U,! . Tex Mapl. 01 l7 ` 1 • I y To`vn fv�NA"'7 VA �L1r Y According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is 3 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER 6 I L_ L) i ,q t-) Building Inspector h Opp Ap 6.A:. Lg A Feb -08 -99 05:22A Robar-t Gaudreau 914-628-0908 P.01 putty 0. Yin Lo u A 4 73c.) rte. r(. c �.:. `' N 4z mTt, : --) I � 199 Work nj Ny . . ............. T- spoka of PV `s . Y- bocrd� i ds C)Q r- S t to e (4 CA ck- -y 0 U+ Sham, -dS 0cunle-.do' - Z.oK) tnC 60 of 5 2 (o p � o'er ---w iS Yo u cc-v\ se.ncj, -ff-� Y-, als -6 n,-te-, - ao ct PO -S _(Z C pLin (c .S Yo u Ii ct: -vQ -. C)L/l, Cl L/ :�a fz. o t-%s t P, le o s_ c . V-) 0 t, go- --s- 4<--) CC-.) -�l -fact n-\,(. - tot CL 0 Now or Formerly 17 Edward & Pb+ricio Ruzsbaizky \\ K, /327. Fence 53.3' W. 5.12% 0:1. s W. Dirt r Wire ire ISE; o.TS. N.TZ*14'W. Now or Formerly M6rtin II run only to those All certifications hereon are valid Wj'fhe Stituftons shown map and copies - fhereof Only if said map.-.-or -ifle pCIiGy'-nbrnbFr- ' -- e opie -b'Or-fhe imprer>sed seal of they are, —WH6��e..siano+ure.ovoeors h,�reorr� •VeL)Or it ,--, U--J� & Christine michael l"errin-. 486-50' 01 Ca U) C 0 C (r LL 0) ii C Area = 122,110 5.F. L 2.803 Ac. L -J C 0 NI j -$e 0 C 0 P 4. C .71 637. 36" McGuire N F Fredric Maureen 51o,.e.5ch tot 1 - 4 I DEPARTMENT OF HEALTH Division of . Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 FAX COVER SHFFT Date: 5� To: b0 r,,e e-y. i' a Ce-YJt ,- From: 1�7i .-e- L, Putnam County Environmental Health BRUCE R. FOLEY " '��rib�lc'�FIea ?l5- ZSirector -�W � Fax # 2. 6 Z / 3 4 No. Pages (Including cover sheet) Notes/Messages / In the event of transmission/reception difficulties, please contact this office. i PUTNAM COUNTY DEPARTMENT OF HEALTH s o , f6 - I - ! O Division of Environmental Health Services, Carmel, fll. • Y. 10 12 permit C R FICATE tom COjViOLIANCE FOR SEWAGE •DISPOSAL. SYSTEM Town or Village � n1. °.lL G7a�LJ_ Tax Map.. _ n Block 8 ,._ Located -at -- / -- - G 3. OwnerRE/��P /GK Y�2�/ / Formerly Tax Map Lot 0 - ' 1 Subd. Lot 0 Separate Sewerage Systems': built by 'V'9 Z- �'E�Oy Address .1CDrI ,—f Consisting of �,2 Gal. Septic Tank and Other requirements Water Supply., - Public Supply From Private Supply Drilled By Address Building Type No, of Bedrooms Date Permit Issued im Has Erosion Control Been Complettee�d��?pp�� . I certify that the syst he above premises were constructed.essentially as shown on the plans of the completed work ( copies of which are attached) i a�co to tJw st:andaids, rules and regulations, in accordance with the iled plan, and the permit issued by the Putnain County Depar h. No iii �� Ea - Certified Dy P.E. Y R.A. Date - - rqe X Licsnao No. 2 2 a Any person occupyin r serves a y t� ova stem(s) shall promptly take such action as may be necessory to secure the correction of any unsanitary conditions resulting fr�`�$� the separate sewerage system shall become null and void as soon as a public sanitary sower bscomeo available and the app ro ply shall become null and void when o public water supply becomes available. Such approvals are - subject to modifl tion o i judgment of the Commissioner of Health, such revocation, modification or change Is nocosaary. L Date :;? B Tltlo� 18 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH S3/711 Division of Environmental Health Services COUNTY OFFICE BUILDING • CARMEL, NEW YORK _ �'-- °-•�• °`This report 'into °Ise °comp'leteti:•bywell driller' and slibmifted'fo•Cotiiity'Health ' bepartiiitint to�tli'er`with'latio'�atory report of`• "'�` "•"' analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST. Bit SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME (� j _ L ADDRESS T -0 r A/, / LOCATION OF WELL (No. 8 Street) J� (Town) P' T (L t Number) ..' PROPOSED USE OF WELL (� lam► DOMESTIC ❑ SUPPLY OUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL El (Specify) ) DRILLING EQUIPMENT j_v_1 Vu ROTARY j" COMPRESSED 14J AIR PERCUSSION ❑ CABLE PERCUSSION ❑ OTHER (Specify) CASINO DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT /S' THREADED 1:1 WELDED YES NO CASING YES M TED? NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER, (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GR VEL SIZE (Inched) 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 ........ ... o / Vi _:• Li 6 If yield was tested at different depths, during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) &�- ir / ivnor or 1Lrc)lase�� of building ,o .,r1 O) ul-�v: GG tit l.i.cipal._i Cy )Juildilib Constructed by Srrn� //,Vp .. f��%Y/Siyrt� 6/141 • �0,�© • Location-- TStreet .o ° Building Type Block Lot GUARANTY OF SEPARATE SI:�� AGE SYSTEM I represent that I am wholly and completely responsible for the location, ioorkmanship, material, construction and.drainage of the sec•:age disposal sysi=em serving the above described property, and that it has been 'constructed as shoran 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 guaranty 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 tv.o 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 Lti CEiU✓(?U •UV •Llie willful up ne 11�tllL cll;L GL 1110 .011lij�uil� ut ��iL ..ui��.�+i .���.r� %�••b the 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 .�Iieal_th as to. c hether or not the failure of the system to,_ operate was 2aused by the' willful or negligent act of the occupant of the building utilizing the System. Dated this 3 day of 8 •19 5,7 Signature ,.4L, .Z~ Srrae -ei L. Title (if corporation, give name and addres _----------------------------------------------- --------- -------- ---- - - - - -_ MIREE (3) COPIES ARE I'ZEOUIItED WITH THREE (3) COPIES OF FINAL PLANS' BEFORE CERTIFICATE )F COMPLETION WILL BE ISSUED. .' GUARANTOR TS RFOUIFTI:D TO. FILE NOTICE OF DATE OF •FIRST USE OF - SYSTEM. • ----- a.- ------------------ - -- --- —rrd------ ---- - -- --- --..----------_------------ )ivision of Environmental 11calth Services, Putnam. County Department of Health t o ' Xorkt,,,,vn Medical t0ordtory, Inc. Director: Albert H. Padovani M. T. (ASCP) ,.�.......: , :v.�..� ..,.,,,_..., .,..o- ,.n•.- ..2Q1- I3uttotauu�d �1.cnuc.,., .:,..,- ...��......, >..�........_ g a , 321 Kcar Strcct (Contcrof 202, across from Hospital) (Across from Lloyds) (Corncr of DrcwAflc Road) Yorktown Hcights, N.Y. 10598 Pcckskill, N.Y. 10566 Mount Kisco, N.Y. 10549 C.vmcl, N.Y.10512 (914) 2453203 (914) 737 -8777 .(914) 666 -33'35 (914) 27,89330 DATE TAKEN: —k3 c 7�1 13 Y FF/LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY AS� .......................... BACTERIA, TOTAL /mL ...... .... .......................... ❑ SOD, 5 DAY ........................................................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................. ............................... ❑ CHLORINE ............................ ............................... ❑ COD .................................... ............................... QCOLOR ................................ ............................... ❑ CYANIDE ............................ ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ FLUORIDE ............................ ............................... ❑ HARDNESS ............................................................ i� V MPN COLIFORM COUNT/ 100 ml ......4) ..................... ❑ MPN FECAL STREP COUNT/ 100 ml .................... ........ ❑ CONFIRMATORY TEST .. .. ................. ❑ NITROGEN, AMMONIA ............ ............................... ❑ NITROGEN, KJELDAHL ............ ...................6........... ❑ NITROGEN, NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............. ............................... ❑ ODOR ................................ ............................... ❑ OIL & GREASE ........................ ............................... ❑ pH .................................... ............................... ❑ PHENOL ................................ ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED .............. ❑ SOLIDS. DISSOLVED ............. ............................... ❑ SOLIDS. TOTAL ..................... ............................... ❑ SOLIDS. VOLATILE ................. ............................... ❑ SPECIFIC CONDUCTANCE ......... ............................... ❑ SULFATE ............................. ............................... ❑ SULFIDE ............................. ............................... ❑ SULFITE ............................. ............................... ❑ SURFACTANTS ..................... ............................... ❑ TURBIDITY ......................... ................:.............. AI ert H. Padovani M.T. (ASCP), Director DATE RECEIVED: l '"mil DATE REPORTED :1E�^�-� SAMPLE SOURCE: �� ie�i ;7AW REFERRED BY: ❑ ALUMINUM .....:... ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC . .................................... .....:......................... ❑ BARIUM .............. L....................................................... ❑ BERYLLIUM .............................................................. ❑ BISMUTH :................................... ............................... ❑ BOF1ON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM ..................... ........... ............................... ❑ CHROMIUM (tot.) ........:................... ............................... ❑ CHROMIUM (hexavalent) .................... ............................... 0 COBALT .................................. ............................... ❑ COPPER .................................... ............................... ❑ COLD ........................................ ............................... ❑ IRON ........................................ ............................... ❑ LEAD .......... ❑ LITHIUM , ' .................................... ..:............................ ❑ MAGNESIUM ................................. ............................... ❑ MANGANESE ❑ MERCURY ........ ............................... .......................: ❑ NICKEL ............................................. ........................ ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ..........:..................... ............................... ❑ RHODIUM .................................. .:............................. ❑ SELENIUM .................................... ............................... ❑ SILICON ....................:............... ............................... ❑ SILVER ....................................... ............................... ❑ SODIUM .. .................................. ............................... ❑ TIN ........' .................................... ............................... ❑ ZINC ............................................ ............................... ❑ ................'............. ................... ............................... ❑ ........' ............................................ ............................... ❑ REMARKS: ..................................................................... ❑ ................................................... ............................... ❑ 1 .......................... ..................... ............................... ❑ ..... ............................... ........ ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... H aH a O PG H H Z tl] W P4 4 U) 4 W O 4 a W F 3 W x H x H W E-4 0 rt s H Q G Z H C Cn F E4 0 L0 W 5 H E W w u x ] H 777 71 =PUTNAM C Division of Enure CONSTRUCfiON PERMIT FOR SEWAGE DISPO L�ca+e�9�••r,4 ��arrs� ���.d3,dR%�- f"��� is ,e Subdivision owner dm9'?TYPe Lot Are, 'Number;, of Bedrooms separate` Sewerage System to consist of To be constructed by :Water b . upply.. Public•SupP1y From r ;Prrvate';SUpply ,to, be dr lled by Address.���� Other. Requirements }` `I .represent that I;am wholly antl completely responsible f •above.described'awill be constructed as shown on We -a "•County Department, of 'Health; and that on, comp a be sgbnkittdd to- the `Department 7 `and a ..wrrtten- place m' good operating 'cofndition any ; p5rt 'of ante of= Ehe approval of •the Certificate of Go' Will be iocated'as "shown. on the.approved plan an County Department ofy health Date fD 3, { Address b' APPROV „ED FOR CONSTRUCTIgN This approval revocablepfor ,ca use or may be. emended_ or,mod ified .whe requires 'a ®tiew permit:_. Approved for disposal of dourest Date - B _r OUNTY DEPARTMENT ° -0F HEALTH onmenta/ Health Services Carmel, M. Y, 10512 i SAL SYSTEM rbtlal 3Fu�,�,givl gd..L j% F r Town or tillage 4 SseEren� Block{ -3•h r a Lot.' �j Job ° 7- ? T tal Habitable Spac •% ” Square Feet i'Gal Septic Tank lineal feet• X width trench y Address s e"e' d�-Sd� ate- Al` I cation of they proposed ssystem(s)s; 1) that the. separate, sewage. disposal_, system to.and m accordance with thestandards,;rules an regulations O - e; a ream i f- .Construction Compliance ", satisfactory to-the Commissioner of Health will iI1•.tie`f ;owner, h�s:wccessors, h* 1, signs by ttie'.builder, that,-,said buiider'will 'sy the:pe►;iod of two (2) -years imrtiiediately following thedate of.the issu nil system ,o "r. any repairs flier o,2j' that theAriiled well described above 11' ccordance with the stands s, rules and "r 7— i�f` the Putnam T.E. — R.A. Q License No. % O �q o date' i ued: unless construction of the building has been undertaken and is er' ry,.b ah`e ".Commiss�oner•of'Weajth . Aiiy change >'oi alteration of ohstrJlGEion is ewage n jor. /ri to ater supply only. sz `f -Tale PUTNAM COUNTY DEPARTMFN T OF HEALTH •DIVISION OF .ENVIRO.NNLE4VTAL..HEALTH. SERVIC.ES.... • _. _... ,.. .���..�..iwire..ur_+.+_•�w. ,-.. .. .. _.. � _sw�'�fR.� ._:e.a...n .Y+ .•.::.......C.evC... ... �y _ Date Re:. Property of ,�%lCk�. Located at�'.� 1�'y�'r% Block L'o t -% Gentlemen: This letter is to authorize ��l�i�►lC t % .ly, W01-1' /Z,. a duly licensed 'professional engineerr registered architect (Indicate) to apply. for a..Construction Permit for a separate sewerage system; t'o• serve the above noted property in accordance with the standards., rules ' or.regulations as promulgated by the Commissior_er of.tL� Putnam County Department of Health, and.to sign all necessary pap s -en:my behalf in connection with this. matter and to supervise the construction of said system"or.. systems -in conformity. 14 7, Education Law, the Public Health Law, and.the Putnam County'Sani- tary Code.. } Very,trul yours; J Signed Owner. of Pr perty T' •: � ouritersig d', .-° - Address Q� } ephone -.-z (Seal) Address PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF .ENVIRONMENTAL. HEALTH; SERVICES DESIGN DATA SHEET -.SEPARATE SEWAGE`:DISPOSAL SYSTEM FILE NO. Owner ' 46rtl Addressr-46 Akl L l�3✓icSi Located at (Street) 5,M v ,J Aj 0. -�eM rL3. :Block Lot, (Indic a a nearest, cross s.treet). . f� Municipality 6,,> Watershed SOIL PERCOLATION TEST DATA REQUIRED TO.BE SUBMITTED WITH APPLICATION Hole Number. CLOCK.TIME PERCOLATION PERCOLATION • Run Elapse Depth_to 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 3- ,Sr3,yo /I1� . 4 5 4 5 3 . ,5 Notes: 1) Tests to be repeated at' same depth: until approximately: equal' soil rates are ob- tained at each percolation test: hole.- All data .to be "submitted. for review. 2) -Depth. measurements to be 67d(e -, J:.om .top of hole r TEST, PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH. HOLE N0. -.HOLE NO. ` HOLE N0. fit G.L.. 6T1 nLw Z,, 18'1 lj 2 4" 4811 5 4't 60tt � �►� C 1'� >ny e ` ar 72i1 7811 c+ 8 4t1 INDICATE.. LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE.-LEVEL TO WHICH WATER LEYEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date ,/ S or Soil Rate Used _Min/1T! Drop: _. S.D.. Usable Area Provided `"� No. of Bedrooms Septic Tank Capacity O zo Gals. Type Absorption Area Provided By L.F.x24" 36". trench. Other //-- Name � w,v�-,O'V i 4A-Aii.2'/L Address- %«?` PUTNAM COUNTY DEPARTMENT OF HE '\T'`` Soil Rate Approved Sq . by Date Ag&/V/V f AN 1T ., K� Bay -All cn o �� � r Pi. ti