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02590
TNAM
PU COUNTY DEPT RTMENT= OF HEALTH
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/r
. !'.. DI'vision or, Environmenbl Health. 'Services, G$rme% N Y -1D512 "'
` CE0, 1F1dA-T E'' OF, .COP�SiR':UCTI()N°C�Wfi�CPAfiICE FOR:SEW ►GE.1315P1�SAL Si TEM
Tow- -- {„ VII e;'T
Located atC� t ; t t�LhLi "' 1 ' l i ci "b 'R ' section Block `
,��// l
Owner114 -
A f w ���- �D 6k;i .S'ii 8✓t Lot''��G+rn ;n Job''' /
Separate Sewerage. System built by %.I -?0_L 1a C9 S-. � Address �O �10�. �ct T rtiGivi V4r�Plw
1 T : (95-1Q `TT `.
Consisting of 12 o Gaf septic Tank ' -• ��Q lineal Feel X width 'trench
Other repuuemer6I) %' Su7ciLe `t �� i JE ( 1IJS -tg (.CD 1 Se2�� oJCr SAS
Water Supply: //. Public Supply from
Private suPPly Drilled BY
Address
(wc n_.nu s. i� j No. of. Bedrooms .D =` Date Permit Issued
Building Type. p A
Has :ErOsion Control Been C 0 pieted7 '-N`0 .,Cyci,j;h � ¢� >R -, (�r✓'rwi't i-V '�3� "'�`r .
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., he, standards;::rules and!` regulations :pi, n sled, and the permit, issued. by ..the Putnam County ,Depart Health.
merit of H th.
•
Date Tel0 , `T : ��. Certifie P.E. v R.A.
t
efi �i i k:o 66 3z G
Address ' Q+� License No.
Any person occupying,premises, served by the above systems) she ll_prom y take such action as May necessary to secure the correction of any unsanitary
conditions resulting from' such 'usage Approval ;of the Separate;'sewerage system ihall become n6n and void as soon as a ,public sanitary sewer becomes -•
avallatile and the approval of .the private water supply shall become null and voitl •when a ;pub ' er supply becomes available. Such approvals are
subject to �modification,'or change w- hen, in' the `Judd' ent of the Co sroner of Health, uch revo "lion, modification or thong necessary.
•
_..
Date By V Tit
•
YORKTOWN MEDICAL LABORATORY INC.
P.O. Box 99 321 Kear Street LO .3203
p 321 KEAR ST.. YORKTOWN HEIGHTS, N.Y. 10598 245 3203
'� `` Yorktown Heights, N.Y. 10598 b201 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737.8777
_.� _. O 495 MAIN ST.. MT. KISCO, N.Y. 10549 666.3335
❑ STONELEIGH AVE- INEAR HOSPITACV;;ZIWRMfiti, N;.Y 405'12- 76' -$]•
r _ �
LABORATORY REPORT
mg /L
LAB $ % �--- 0/v
DATE TAKEN: - B �� 40
DATE RECEIVED: - Jo
DATE REPORTED: ?-
SAMPLE SOURCE:
REFERRED BY: C'i�e•SSi� S ._ _
COLLECTED BY: b4eS - 61bU,SG�t1
❑ ACIDITY ........................................................... ❑ ALUMINUM ..................... ....
❑ ALKALINITY .......................... ..... ....................... ❑ ANTIMONY _ ................................................... ��}}••
)0 BACTERIA, TOTAL /mL ........... ....X......:................... ❑ ARSE.NIC . .................................... ...............................
• SOD. 5 DAY ............................ ............................... ❑ BARIUM .... ........................:...... ........... .................
_._
• BROMIDE .............. ............................... ..... ❑ BERYLLIUM ...............................................................
❑ CARBON DIOXIDE, FREE ....................................... ❑ BISMUTH .................................... ...............................
❑ CHLORIDE ............................ ............................... ❑ BORON ........................................ ...............................
❑ CHLORINE ............... .................. ❑ CADMIUM
❑ 60D ......................7 ............... ............................... ❑CALCIUM .................................... ...............................
❑ COLOR ................:............... ............................... ❑ CHROMIUM (tot.) ............................. ,. ..............................
❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ...............................
❑ DETERGENT, ANIONIC ❑ COBALT .................................... ...............................
❑ FLUORIDF ............................ ............................... ❑ COPPER .................................... ...............................
❑ HARDNESS ............................................................ ❑ GOLD .............. ............................... ......................
❑ MPN COLIFORM COUNT/ 100 ml ............................... ❑ IRON ........................................ ...............................
OMFTCOLIFORM COUNT/ 100.1 .. ...................... ❑ LEAD ...........
❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ...............................
❑ N1TRCrGEN;:,MMONIA ......... ...a :........................., Q_MAG�JESI,UM : _sra._.. _....__.. _._. ...
❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ...............................
❑ NITROGEN, NITRATE ............................................. ❑ MERCURY .................................... ...............................
❑ NITROGEN, ORGANIC .:.......... ............................... ❑.NICKEL ........................................ ............................... - ..
OODOR ................................ ............................... ❑ PALLADIUM ................................ ...............................
❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ...............................
❑ PH ........ .... .:........... ............................... ❑ RHODIUM ............. :.....................................................
❑ PHENOL ..............•................ ............................... C3 SELENIUM .................................... ...............................
❑ PHOSPHATE (orthol ................ ............................... ❑ SILICON .................................... ...............................
❑ PHOSPHATE ( condensed) ............ ............................... ❑ SILVER ........................................ ............................,..
❑ PHOSPHATE Itotal) ............ ❑ SODIUM ........................................ ...............................
OSOLIDS, SETTLEABLE, mI /L ... ............................... 0 TIN ............................................ ............................... d
........ s :f ZINC .......,...................................., ............
O SOLIDS. SUSPENDED ....................................
,..........,.......
OSOLIDS. DISSOLVED ...............s..... ci .................................................... ...............................
❑ SOLIDS. TOTAL ..................................................... ❑ ................. ............................... . ...........................r...
.❑ SOLIDS. VOLATILE ................................ :............... O REMARKS:..................................... ...............................
❑ SPECIFIC CONDUCTANCE ......... ............................... ❑ ........................... ................... ...............................
❑ SULFATE ........................ a................................... O ................................................... ............................... . .
❑ SULFIDE ............................. ............................... O ....................................... ...............................
OSULFITE ............................. ............................... O .................................................... ...............................
❑ SURFACTANTS 'O
......................... .•n................................. .....................•............... ...............................
OTURBIDITY ......................... ............................... 0.* ..................................................................................
THESE RESULTS INDICATE THAT THE WATER WAS OF A StTISFACTORY SANITARY .QUALITY WHE17
THE SAMPLE-WAS COLLECTED.' �'
THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY 01'
F�ORYPARAMETEADMINISTRATIVE RULES & REGULAT II�ONS,�f DRINKING
,.WATER STAB ARDS (PART 72).
WELL JOMPLETION REPORT PUTNAM COUNTY 'DEPARTiiIIENT +,iOF. HEALTH
3171 i Division of Environtronal 'Health Sfrvic"
COUNTY OFFICE BUILDING - CARMEL, NEW YOR�
This report is to be completed by well driller and submitted 6 Counter Health Department together with laboratory report of
arolysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliancd is issued.
SUBMITTED_ WITHIN -30- DAYS OF_WELL_,.COMPLETION_
AME ADDRESS
OWNER
LOCA N (No. 6 Street) r ((Town) Plot Number)
Oi Ll ,
BUSINESS j 0 4—V
ILA DOMESTIC ❑. ESTABLISH T ❑ FARM
Pill o ED TEST WEL \
UfF
W PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRI G COMPRESSED CABLE OTHER
ECW ENT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CAM G LENGTH (feet) DIAMETER (inches), WEIGHT PER FOOT =10 CASIN ?DET LS � ice- THREADED. ❑ WELDED NO YES NO
HOURS
G.P M YIELD (G.P.M.)
T
❑: BAILED ❑ PUMPED COMPRESSED AIR. I 'MEASURE FROM FROM LAND SURFACE -STATIC (Specifyfset) DURING YIELD TEST fleet)
WA R j Depth of Completed Well �� >4
in feet below Land surface: .
- MAKE LENGTH OPEN TO AQUIFER (feet)
f EN _
DET LS SLOT SIZE DIAMETER (Inches) GRAVEL SIZE (Inches) FROM (Nef) (feet)
IF GRAVEL Diameter. of well including
PACKED: gravel pack (inches):
Dam / tAND, SURFACE A dlatMCq, to at repat
iE to FEET FORMATION DESCRIPTION,
rm r
Sketch exact location of well with
two permanent landmarks
r
-- -
fA4 _:40��
If yield was tested at different depths during drilling, list below
FEET ' ' GALLONS PER MINUTE
i�
A*
I
G►TE ElL COMPLETED DATE OF REPORT'.. WELL R ILL ER (Si q re)
Q � y
+s,. ,
caner or JWjaser --of Building Section
Building Co.nstructed_.by.___, Block.
Location - Stre Lo"
Municipality d Subdivision Name
c
Building Type 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, 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
_..,__.:.af_.. the..::. P.ut-uam_.C.o.unty_.,DepartmQnt. of Health..a.s-- ..to- whether or- no.t.•�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 day of -�19� Signature ..1,J_tk;1 �
Title !/
� �� C -t� -/� �° ��L✓$ - dye...
• Corporation Name if o p.)
.- a+$` 2
!: �w Address
V d'3L
-- ------- - -���� -- - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQJI II � ITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WI � ,p ISSUED.
g GUARANTOR IS REQUIRED TO FILE NCE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
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SURVEY
CEe7 O O0$v4R.4.I/TEEOTO 7.42.1!49 .1 ✓O.tYV OV OF PROPERTY LOCATED IN THE
SURVEYED SY
jfhLO.ef joe,rw ✓0.6x/97b.GA. f- 4,elVE AMOL4d/O
4eeo 04 �F W o- Ik' TOWN OF
PUTNAM VALLEY
,�E , nor
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PUTNAM
I ALD.AR_t- T.TPe2KSW
COUNTY.
LL'yNY IcSGG
P.G7 fES3 %i/4L L4V/O.rPeYlY X4.r
Oor,41WO /,V TiYE /.2 "COOP OF PegGT /CE
N. Y.
fo,C- G 4.V0 9U.QYE yS,
.....
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OC %OBE.e 20 /9 g4 2t�/ 3,/ <� SCALE: I _ _ .. ... .. ........ ...... ...._
DATE.,._ ............. ............................... t
P. c s �.
s. u o. 5268•r
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FILE ... ... ... BOOK ......... ... PAC;= '
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Date `1 u �ta I q
Re: Property of thooi,.ag J ..�ehn��r� `i �Giwu ��'�In Jolnns-i�en
Located . at ®SCca�enc� i'{�;�k Ro -7,=A
(T) 94A49t4 110 -4 Section �� Block Lot 4.1
Subdivision of L% not a
Subdv. Lot # Filed Map # 14-7-7 Date
Gentlemen: _t \,� /
This letter is to authorize V �rM�s W. _T r;sk SP '
a duly licensed professional engineer V or —'^ +.,
(Indicate
to apply fora 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
system or systems in conformity` with�the provisions of�Artic1e�345"or'
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
Signed
r -of Pr erty
•
Countersigned , p
1-3 O �GGiSv NL'F_.
P.E., , +' Address
13 p t da r CDCJ r+ XXOA) X /v �Z /6 SSG
Address Town
P a Telephone
� S 3s $
Te ephone
-(A t 4-) Aree 4je.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y.0 10512
DESIGN DATA SHEET UPARATE SEWAGE DISPOSAL SYSTEM
FILE NO.
'1L� p rr► a s �.
d h r► sto r�
Owner g
c�,^sue.. Address 13p$ t(isoh
Ave.
ELY, EELY, 1044
Located at ( Street
46dicate Scdzwan.v,i{et 44xR4,Sec . 15 Block
Lot 4-,1 (Par , •n)
nearest cross s reet
Municipality
Watershed
Pce_k-sk m
1(Ci -q,o-F Peekskill 'S Wager- !: t
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED
WITH APPLIMMS
Hole
Number CLOCK TIME PERCOLATION
PERCOLATION
Run
Eiapse. Dep o Water
Water ve
No.
Time From Ground Surface
in Inches
Soil Rate
Start -Stop
Min. Start Stop
Drop in
Min. /in drop
Inches Inches
Inches
5.77 wtiti,
2
-ZS
3
{� 3 �►�, .
3 9 :5? , to; 17
dr
q 22- 2s 3
Notes: 1) Tests to be. repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. Ail data to be submitted
for revieV.
2) 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 N0. HOLE N0:
6"
12"
18..
2411
30
36.11 w
48 . LOAM
60„
66" .
7
� 8411
I �CATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED "he, en c�,,fer41�
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING-ENCOUNTERED
TESTS MADE BY jR rx.e % W. = r i Mw, Date � f 913
Peep 4d
�v
Soil Rate Used Mi '1 "Drop: S. D. Usable Area Provided' d ®® S,'fin$ LL
No. of Bedroo m s_Sept'c Tank Capacity 12 0"0 Gals: Type Pre -cost
Absorption Area -Provided By 40(a L.F. width trencl
®... �pL E .Other
Sys
a
Name t►. PF Signat
W ;.4
Address
Feekskil
THIS .SPACE FOR USE BY HEALTH DEPARTMENT ONLY: s'goFpj;t'
Soil Rate Approved Sq. Ft /Cal.. Checked by Date
Ore.'s u�t �'-rej DISC -L S-eL'S
(5�_r Lcc�cr)
C=
YES ( NO I
I
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1:, ti=. f1ccc alev.
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pCrZi `` p _ ] -f(=- t I-CrI
Plans - Tree sats
E:iCin�r= Pi- `-icr_ --, -' �
rata
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PsT= E✓1_ Oe_ `Z
- or`
L G
W'eil NE
pia _G_CS
R & D Y
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F_ -1 F:cz'_? _ & Di_==
Wei 1 De�i_r S:?_ -J_C� L_-= I= Cvc_
ccls
ar
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is
Tir?ircv & SiC: L
E: <:.�c.as cc 3 _i ^Cx__i = -:• r -r tir 5 = -c
Tf F_- Pit & D Z--x SiiCWTI & CEt—
ECLc - NTc.
& SOS' s w/ i 200 'f-t- c=
Se-
4 „0i
c_ fan;'
10' to ?_L_ Di= l�.dcT� L�:- ?`_-= - T C= -
r
20' t.) cLnc =Zic:: walls loo, tc 200' in D.r .O.D f 1 =0' Pi
100' t= c -rE-`=
F•_�� 13' ttC s - ^ -C
3,,� mss- stcr:- �= _z. ^i__
��
10' t:_— Line (_ci -.= ` )
10' tz
PURQM COUNIT DEPARTMENT OF Y•
• 0' • •R•' ' E W HEALTH SE[MCES
DESIGN DATA SHEET- SUBSUFACE.SEWWAGE DISPOSAL SYSTEM FILE ICU.
owner Jose L�t.UT l M g.L-r o ->7 iP Address 3 �s CQtckt Ci, e • _ .. , _
Located at (Street) W I •C C O R et 4 R cL . Sec. 3r Block _ Lot
(indicate nearest cross street)
Municipality PUJ;nCtM/1 VCLIle%4 Watershed I ee"mSKI• /l
SOIL PERCOLATION TEST DATA PJWI M TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking /I.M.0e./oMw'
S a9
,Date of Percolation Test 'm. QetobeRS -99
HOLE
NIMBER
CLOCK 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.
2
1y246-14YI 17
21 "
z���
3 �,
3
hVIN -13-66 22
2 "
3.��
4
W
1 iW5f6 -�SoC �a " P C 3h
3 Olt t il-a3 J0 .21" a411
5
2
3
4
5
Fj
NOTES: 1. Tests to be repeated-* at same - -depth until appra dmately equal soil rates
are . obtained,, at °eact,,percolat on test hole. All data to' be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85..
04��
6'
7':.
jocon
$'
a, tit
9'
��� (ij►'?Y`
10'
11'
12'
t4b %a;to--f-
13'
14'
INDICATE LEVEL AT WHICH GROUNDWAM IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUNTERID °
DEEP HOLE OBSERVATIONS MADE BY: DATE: Oe, ®*ieR -27-99
DESIGN
Soil Rate Used ® Min /1" Drop: S.D. Usable Area Provided P00 f)c •
No. of Bedrocros 3 Septic Tank Capacity I ®o ® gals. Type Co
(-1-f ro, y cyf- e
Absorption Area Provided By '53 3 L.F. x 24" width trench
Other 'T I -o on
Name
q!t
' , ,
Address
FAIR ST
COWL. "M VaRr 10512
!�
THIS SPACE FOR USE BY HEALTH DEPARDMiT ONL
Soil Rate Approved sq.ft /gal. Checked by Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION "OF ENVIRONMENTAL HEALTH.SERVICES.:
Date 5 October 1989
Re • Property of Joseph & Lauri Martone
Located at Oscawana Heights Road
(T) Putnam Valley
Section 35 Block 1 Lot 4.12
Subdivision of Joseph & Lauri Martone
Subdv. Lot # 2 Filed Map # Date
Gentlemen:
This .letter is to authorize John: -(H. Prentiss
a duly licensed professional engineer X 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 ... -.
system or systems in conformity with the provisions of Article 145 or
147, Education Law,
i
tary Code.
H. PRF,vTF\
�O• 292()
\ THE SVAjt
the Public Health Law, and the Putnam County Sani-
Count r ig
.A. I. #
Address
JOHN N. PRENTISS, P.E.
RD9 FAIR ST 914 -878 -6170
CARTEL. NEW YORK 10512
Telephone
Very truly yours,
Signed
Owner of Property
Oscawana Heights Road
Address
Putnam Valley, N.Y.
Town
(914) -528 -6686
Telephone
PUTNAM COUNTY DEPAFM4ENV OF HEALTH - DIVISION OF ENVIROWNTAL HEALTH SE VICES t4
INDIVIDUAL WATER SUPPLY/SUBSURFACE. SEWAGE DISPCZSAL SYSTEMS
FIII.A INSPDLTION REPORT
CpGr/a � 4. �s `/�` ^ INSP. -
(Name of Owner) (Street Location)e3,,dr
INITIAL SITE INSPECTION NO I COMMIE TS
Wetlands on,/or proximate to property ............... -P V "5- e,
Property lines or corners found......... ........
can estimate house location ........................
Will driveway nerd cut ......................._ ...
Must trees be remved - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed..... ... .....
Sufficient SAS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/septics ........................ ...
D.H.. 1. Lot
Depth to G.W. r'i'm
Depth,to rock
Soil Desc_Yotioy
0 ft.
3 ft.
6 ft.
D.H. 2
Depth to G.W.
Depth to rock
1. Soil
0 ft.
3 ft.
6 ft.
9 ft.
- 12 ft. - _:' . _ .... ... -12 ft.
D.H. - Deep Hol
G.W.- Groundwate
D.H. 3 Lot
Depth to G. W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE:
FINAL SITE.INSPMTION INSP.BY:
YES
NO
MMENTS
House SSDS located per approved plan .............
Length of trench Treasured
Width of trench average
Slope of tile line and trench acceptable.........
Room allowed for expansion trenches. .............
Over 100 ft. fran watercourse ....................
Fatural soil not stripped or SDS area
unnecessarly graded.... ...............
10 ft. maintained fran property line and
20 ft. from house. .......... .....................
Distance well to SSDS (ft.) ......................
Rm-ber of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of. peripheral soil horizontally
fran trench ..... ...............................
Faxes properly set ...............................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SAS.......
FINAL GRADNG OF SITE ACCEPTABLE..