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Home My WebLink About2638DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -34 BOX 22 1'6 I 6j ��_{ ' lovowP VI� r X_s dam% DI•ti •i Hnid+mmoldd Be" Sersloaw cLeme1. p.H.1051? � (��°°R71F PC Pora�k aor�vcnoN r�le�r Fos SaiYAfHS DISlOS�1>r SYSit1S1[ 0 Town or S1.bdfeMw Nr• abd.' Lit t' Tai Mp Bloek., : r.t:_ Relsowd, O Redeka p _alaldr v/! Rev. 10/88 zip_ i Neft Type %3' -sJJ . Let A. Nalmbsr et ��. AU� z Fm Seedon Only Depth Voime e_� _ Design Flow G P D *ecl PCHD Nodladon Is Reawked Wiles FID is eemdebed S"Waft Sewerage System to Comm of C% CA" Septic Tma •.a ati� zva L.: - ), 'Ll" a To be by a !y/7 r-'r- Address wow Svw*. Prbpc SsPPtr Fan Address an wdwab SqM* Dd bd by add.... 011ist 31mmkem•nOr •-� 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the se parate sew • di sal s stem above described will be constructed as shown On the approved amendment there to and in accordance with the standards. rules an ►pu a ens o • nam County Department Of Health, and that on Completion. thereof a "Certificate of Construction Compliancr, satisfactory to the COmmissbnM Of Healthwill be submitted to the Department, and a written guarantee will be furn7l~ the o r so►s. Min a sfsgns by the builds, that said bulkier, will place in good Op•ratlq O•ndltbn any pert of said tawag• disposal system tluri •�rW" (2) years Immediately following tMdat• of the iseu- ant» Of the approval of the Certificate of Construction Compliance of the or irs thereto; 2) that the drilled well a gotbed above WIN be located as shown on the approved plan and that seb well will be Installed i rds. rules nd rpu a�TTWn of the Putnam County Dpartment of Health. tl � � ul 1 APPROVED FOR CONSTRUCTION: T s approval expires two revocable for cause or aY be anlend or modified when consi nouk•s a rrpw �rjnit7,Y _W*ved for disposal of domestic s Rev. 3/86 �V 17o' -& — P.E. c R.A. License No a y �� of tM building has been undertaken and is Any change or alteration of construction — Title PUTNAM COUNTY DEPARTMENT�OF HEALTH !r.. _... D_ i vai.d.. o n .. r of - E_ . n _ v i. r otmental Health Services, °.Car- m el: , N: ._ Y . _ 10512 Provide T // 7� P.0 H.D. Permit . CERTIFICATE //O,��F CONSTRUCTION COMPLIANCE FOR SEW ted at_ 1G Owner /applicant Name . Mailing Address Separate Sewerage System built by Consisting of d GE'DISPOSAL SYSTEM Ile— Town or Village Tae MP —.,3 l `� Block Lot .3.4 Subdivision Name ✓l - U V Sabdv.0 Lot t00 2' Zip �Z y Date Permit Issued Addross�% Septic Tank and �y Water Supply: ,Public Supply From Address ors Private Supply DAW by Address Building Type Has Erosion Control Been Completed? Number of Bedrooms �- Has Garbage Grinder Been Installed? Other Requirements _ I certify that the systems) 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 the standards, rules and regulations. in accordance with th filed plan, and the permit issued by the Putnam County Departmnt Of Health. d % Date�� ertifled by P.E. R.A. L Address Cleanse No. Z' f Any person occupying premises served by the above system(s) shall promptly take such action v* Secure the correction of any unsanitary conditions resulting from wch usage. Approval of the separate sewerage system shall b e of n as a pubt% unitary Sewer becomes available and the approval of the private water supply shall become null and void when a' p bl pD comes available. such, approvals are subject to modification or change when, in the judgment of the Commissioner Of Health; ch r o Ifleation or change Is necessary. ')bl nattAb Located at Subdivision _ ON PERMIT FO 1PUT'NAM COUNTY DEPARTMENT OF HEALTH Permit q i Division of Environmental Health Services, Carmel, N. Y. 10512 4: SEWAGE DISPOSAL SYSTEM Town To or �IIagG e f l Cv G+ tYGL Tax Map.. -S ' ubd. Lot # __ Renewal _ Revision Owner /Address ✓ d�'��`�'�y �'60� 7� �'��/ `� ` Date Of Previous Approval Building Type � Lot Area_ Fill section Only ❑ i t' Number of Bedrooms Design Flow G /P /D Z( P.C. H. D. Notification Required �r Separate Sewerage _System to consist of �✓� Gal. Septic Tank antl�� To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements I represent that 1 am wholly and completely responsible- for,theidesign above described will be constructed as shown on the approved'amentlm County, Department of Health, and that on completion thereof a � be submitted to the Department, andsa'"m rittaen guarantee 'wlll be f place in good operating condition anyXpart)ofk, said sewage disposa ante of the approval, of the Cart ifiUate' of Construction n la Compliant will be located as show on. the approvedapn r dtthat said well will be County Department of Health�� / f h ...+b h Date APPROVED FOR CONSTRU,C' revocabie for cause or may IDWI requires a e Perm t5 ppr Date Rev. 9 -81 t approval expires ye or modified when co Side disposal of domestic sanit By t and location of the proposed system(s); 1) that the separate sewage disposal system A ent there to and in accordangeV,ith the standards, rules an regu a ons o e u nam ertificate rof Construction CIO pliance" NWMtory to the Commissioner of Healthwill uinished the owner, his succtessor vQ(a Ry the: builder, that said builder will 1 'system during the penod of t3 `ebYSaittlhdly.f011owing thedat® of the issu -' 11. e`.of Ane;oiiginal ystem of �bml��gngnr ;? at 4 e'drilled well described above € installed" in accordancey wit the �Sttd�� I oa u a ons of the Putnam, P.E: R.A. )� r 1{ b°ISe a No. ! y, from`the date issued a cf`c iontofithe buiihas been undertaken and is'. 1 essary by the'iCom ssio e�a,JtlY �g�l y @qi' alt n of construction -t sewage, and /or pr`aZa Ywate �mgrjt a boas - t� l Ea ayxaea> F { PUTNAM COUNTY DEPART'MEN'T OF. HEALTH Environmertal Heald? Spridbis,. Carmel, -N. Y. -10612 Permit # ` CERTIFICATE OF CONSTRUCTION, COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM yam/ ry� /p Town or Village Located at Tax Mapes Block Owner `Cj a /Formerly Tax Map Lot # / ® Subd. Lot N -� Separate Sewerage System built, by� Address ' Consisting of '� Gal. Septic Tank and ®� �°sr �� <�e Other requirements Water Supply: Public Supply From _,Private Supply Drilled By Address [ Building Type y�y —: Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed of which are attached), and in accordancii with the standards, rules and regulatio Putnam County Department Of Health. Date / %7� %i`�� er ified by a c Address 1 7�� Any person occupying premises served by the -Hive system(s) shall promptly tad conditions resulting from such usage. Appro(al of the separate Sewerage syste available and the approval of the private water supply shall become null and void subject to modification or change when, in the judgment of the r1immisiloner n -In f>C�7 1 %�h 0 KV"P shown on the plans of the completed work ( copies VciCoi th the filed plan, and the permit'issued by the 000e Gi x. P.E. R.A. License No. �e rn y to secure the correction of any unsanitary n s soon as a public sanitary sever becomes becomes available. Such approvals are A o`dif` ication or change is necessary. e Iv, PUPNAM COUNTY DEPARTMENT OF HEALZT1 DIVISION OF ENVIRONMWAL HEALTH SERVICES owner or Purchaser of guilding 'ng Constructed by Location - S t Municipality Building Type 5-2--- —3 34 Section Block Lot subdivision Name 2, subdivision Lot # GUARANM OF SUBSURFAM -SWiGE "-DISPOSAL SYSTEM I represent that I am wholly ,and ' completelly responsilile €b- ::the- location -, s 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 iumediately following the date of approval of the "Certificate of Construction Compliance" for 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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 �C% day ofz�4_ 19f_.: j GC'a NSA General Contractor (owner) - Signature Corporation Name (if Corp.) �0.. �j v .� 6 _ IV s �4A 541C A, Address �? rev. 9/85 mk Signature � r Title Corporation Name (if Corp.) ess PUPNAM COLWY DEPARTMENT OF HEALTH DIVISION OF ENVIMNMETTPAL HEALTH SERVICES Owner or Purchaser of Building A/ Building Constxucted'by s zLl" Location - S eet Municipality Type �- 34. Section Block Lot Subdivision Name Subdivision Lot # DISPOSAL SYSTEM I represent that I am wholly and " campletely " "7resp'onsible -for.:the locat ion,e _ -- 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 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 3� day of 19V General Contractor (Owner) - Signature Signature Title Corporation Name (if.Corp.) rev. 9/85 mk �- 34. Section Block Lot Subdivision Name Subdivision Lot # DISPOSAL SYSTEM I represent that I am wholly and " campletely " "7resp'onsible -for.:the locat ion,e _ -- 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 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 3� day of 19V General Contractor (Owner) - Signature Signature Title Corporation Name (if.Corp.) rev. 9/85 mk M JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 18, 1993 Patrick & Silvia Kenny Peekskill Hollow Road Putnam Valley, IVY 10579 Re: Addition - Kenny Peekskill Hollow Road (T) Putnam Valley Dear Mr. & Mrs. Kenny: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans have been approved as per plans bearing this Departments stamp and dated June 18, 1993. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at five 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 must be replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. 4. The installation of 200 linear feet of absorption trench as proposed by Joseph F. Sullivan, P. E. and approved by this Department. Approval is granted for sewage disposal only. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of If you have any questions, please contact me at your convenience. Ver truly yours, Now Robert Morris Assistant Public. Health Engineer RM/j P cc: BI (T) FUIV M COUNTY DEPARTKENr OF HEALTH DIVISION OF ENVIRONMENM HEALTH SERVICES owner or Purchaser of Wilding g Constructed by A // 5lity -3 34 Section Block Lot �/-"v Subdivision Name Subdivision Lot # Building Type GUARANTEE OF S.UBSURFAM MME DISPOSAL SYSTEM I represent that I am wholly and completely responsiki ,i:" fbr.* the -locatipa i -- 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 pCertificate of Construction Compliance" for 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 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 ofQ 4 19 Signature Title - General Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) rev. 9/85 Mk ' NICK CUCCHIARELLA INC. GENERAL CONTRACTOR o REAL ESTATE DEVELOPMENT TRAIL OF HEMLOCKS PUTNAM VALLEY, NY 10579 914-526-2203 April 15, 1993 Mr. Robert Morris 4 Geneva Road Brewster, NY 10509 Dear. Robert: _.. __....._ ..... ,_As. per. o. ur... conv. er.,_ sation,.,, enclosed_please_•find.exi septic_. .. necessary septic.. necessar copies i ndi cati•n ro osed -ex ansi-on, -of - the Kenny Property located in Putnam Valley, NY. If there is any further information required•;. please contact me. Sincerely, 'i Nick.Cucchiarella c/c Enclosures DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva -Road, Brewster, New York 10509 (914) 278-6130 Re: AIE-A-11 7 JOHN KARELL Jr., P.E., M.S. Public Health Director Dear Your application has been received by this department on Y dal_? 7j> The application is considered incomplete and the following items must be submitted. Fee, should be paid by Certified Check or Money Order only. ee is not epclosed or incorrect amount. FeE! due is:",,/00-00 New Tax Map designation should be provided. Other: If you have any questions, please contact Robert Morris, ext. 166 or William Hedges, ext. 168 of this office. Thank you for your cooperation. Very truly yours, Christine Johnson Intermediate Clerk JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 18, 1993 Patrick & Silvia Kenny Peekskill Hollow Road Putnam Valley, NY 10579 Re: Addition - Kenny Peekskill Hollow Road (T) Putnam Valley Dear Mr. & Mrs. Kenny: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans have been approved as per plans bearing this Departments stamp and dated June 18, 1993. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at five 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 must be replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. 4. The installation of 200 linear feet of absorption trench as proposed by Joseph F. Sullivan, P. E. and approved by this Department. Approval is granted for sewage disposal only. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of If you have any questions, please contact me at your convenience. Ver truly yours, Robert Morris Assistant Public Health Engineer RM /jp - cc: BI (T) This report is to be completed by well driller and submitted to County -Health Department together vvith laboratory rc(?o:. analy ;i; of water sa`rriple indicating water is of satisfactory bacterial auality.before certificate of construction compliance is REPORT MUST BE S1-113,1*41TTED WITHIN 30 DAYS OF WELL COSIPLETIO:d *WHIR KAJAL Patrick Kenny Route S�..Box.' 23o Putnam Valley, DTY (Ho. 6 'Sue./) (f own) (Lol FiMTD• %f &OCATIOPI Peekskill Hollow Rd, Putnam Valley OF-WILL - O D El r TEST WELL PPQ lQSEG DOMESTIC ESTA tLISHMENT FQStAI ' tiSE L Of WLLl PultiC (J lKD °.15TEIA1 All CONDITIONING OTHfA iSv►cilr) SUPPLY DRILLING 1 x COMPRESSED CABLE D D OTHER TOUIPM.EIIT ROTART AIR PERCL•SSION PERCUSSION (So.uftl• CASING l!nG7H {uLar} I DIAMLiERI,n[:A62) '*iCrbM1 PER FOOT ( 19 a {! rVI E SHO! WAS �A c14G Cf,_�I•t;i :jT C �,� I DETAILS 30h 6 THREADED WELDED .� TES NOI t 7E5 L_1 NO '"ELD � HOURS 7 G.? JA. 30 YIELD (G.P.M.) _ 30 LEST LAILED PUMPED L^_; CDM ?RcSSED AIR 4 WATER )ALASURS :EO+, LAND SUXFACE— SiAi1C(:�0e,ey feel) DU@ItiG TIELD TEST (Icot) Depth oI Completed Well »vEtJ 65 305 In feet below Lend .vrie -c: 305 IAAXE {L:VGTM 0F"4'(d ALi:+1F_-i :sent; (•CREEP( - DETAILS SLOT 1:,.: DIArtETEIt (tnCnei) IF GRAVEL �' Dio.netcr t:f well incivu.ny GRAVEL SIZE tirrcAes) htOM 1[061) IO flaerl IPACKED: grovel pock '(intAet): f _„ Pitt 1`101A .P02MATION DESCRi7TION S+vtCA eraej toca: on ct —0/1 rrrn acsrancct to a' loezt rwAo psr,7!enent lanainuxs. :_.. , - :• :: .. _'... :_._ FEET FEET i 0 201 Soft clay & boulders 0e ll . 20 '.305 Hard grey. & black granite WATER ANALYSIS REPORT This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. &6%.EiVED PU-rjvt DEP-r Coulkiry January'12, 1985 / /,( � 4 '.7 � Z - J2 90, P Owher or Purchaser of B i ding sa Building Constructed by Location - Street _ ' a Munici ality o Building Type Section 1 Block l 4 Lot 'Aq r7 Subdivision Name Subdv. Lot # G1ARANTEE 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, a ....._ _ _ 9. _..... ... ..._�..... _..__.._.R _ .._.. -, . and in.. ?ccordance .with the +standards rules and re ulations of t he Putnam Coiirity Department of Health, and °hereby guarartt-ee -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 of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful negligent act of the occupant of the buil i g utilizing the system. Dated this day of 19 Signature Title RC IV' " Corporation Name if corp. JUL 0 9 71985 � l 900c- / %%� 7i�, Al f l Address PUTNAM COUNTY - - - - - - - - - - - - - - - MP-T,. -F- T6A(_f - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of " j--v- I J\ < -'" arl 1 1 y J Located at � i�� z�-' (IR 0 p j (T) 1 -.j- \/&.I, i ec.� Section 3s' Block � Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is, to authorize C-5 a duly licensed professional engineer or registered architect (Indicate to apply for . a Construction:, Permit for a separate ..sewa.gP - 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, the Public Health Law, and the Putnam Co t Sani- tary Code. Countersigned: 3 L7 P.E. , :r , # � s Address VVA-le W//? Very truly your , MAR 12 1884 o j PUT NAM CC:Ji "3TY Signed DEPT. OF HEALTH Owner of Pro try" a%o p Address % s / �j el Town Telephone : Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING; CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /"G, y, /j C Address /�� /Vy` y C? d //V Located at ( Street Sec. Block Lot J� Indicate nearest cross street) Municipality ,J"r•� c� e•r°� /f'c' //c V Watershed SOIL_ PERCOLATION TEST DATA 11EC ED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 23 _5 4 1 2 12 1984 nvT 3 NAA4 COU &ITV --r MALTH 5 Notes: 1) Tuts to be repeated at same depth until aroximatelyy equal soil rates are obtained at each percolation test hole. All pp data to be submitted for review. 2) Depth measurements to•be made from top of hole. DEPTH G.L. 6" 1211 1811 2411 3011 36" 42" 4811 5411 6011 6611 7211 78" 8411 r. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. J HOLE NO. HOLE 'NO'." e INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED A4,,? 'INDICATE- LEVEL TO WHICH WATER LEVEL RISES- AFTER BEING ENCOUNTERED TESTS 'INDICATE- A-DE, - -a" D6:t6 DEbiUIN Soil Rate Used�Mtn/l Drop: S.D. Usable Area Provided Gals Type No. of Bedrooms s Septic Tank Capacity le�� r Absorption Area ProVided..By3rt.; L.F.x24" 36" width trench. Other gna Address'_ THIS SPACE FOR USE 13Y HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Chec go . A -Date I `� a- 3 r f L --:, �} 4•.y}' T S f > x. b k c- - j 00 S b .r' .y C„ 1 .� - r�• r - 4 - f Cz.. ism ..z '" - 'rte. --- t•-".- -- s'_,•....- w-- °,. - _ 's.' a g - NOR A. A _•..Y ' _ .> •.. ')a'.:Sf _ - p'.. 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