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02672
16
r
m I -
or
02672
3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N Y 1051
r
CE CATS OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM_
T -or Val
4.
n�
Located at C6,- V%e Ti::Msp Block Lot
y e
Gera s � t �t Formed Subdivlslon Name Subdv. Lot # 1. 1 Owner /appllcaat Name —I... Y tt '
Malting Address. Nli11,vsac�T_Zlp u5 7 Date Permit Issned 7I
Separate Sewerage Syetetn;bailt`by Address /
Coneleting'ot Will Gallon Septic Tank'and
Water Sapply: PdbHc Sgpply From Address
:or: PrlvateSapply`Ddlled.by r W�� 1�' �Address`n�� lua�•�( - /2Srf0
Buudhtg Type t'Co 14, Has Erosion. Control -Been Completed? &A
Namber of Bedrooms Has Garbage Grinder Been Installed?
.t7.
Other Requirements
I certify that the system(s), as listed serving. the above premises were cons dted-essent lly as-shown on the plans of,the•completed work f copies
of which are attached), and'in accordance-witti the standards,: rules ind're a cordanc win the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date lilt I i ,.. Certifi d by .. A.
P P.E. R
Address 24 2 ° ". k License No. 3�3
Any person. occupying piemises se►ved by the above systems) shalt promptly take such action as maybe necesfaiy to secure the correction of any unsanitary
eondltions resulting from, weh usage. - Approval of the separatewsewera9e system shall become null and void as soon as a DubR_.senitary aavwr becomes
available bnd the:,sporovil, of the private wateriupply shall'become null a vokf when a public wate supply become walgbN., Such approvals ere
subject to modlh tlon or change when; .in the,ju_ Ment••o1 .:the 'com over of N Ith, ch revoeatlon, modification o► chanpo is necessary.
ZileOats BY Title 43—
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMMAL HEALTH SERVICES
-. ' ?� -_ �. .. x -� - _ -i_�:- <r .� i• _ � .r � •. ..� n, s.:_. .'9. r�._-. �+ ....�. _ ., t...y ..f..t •+:f� sr.. -'.E'- i � a .. �[•.z ... .. � -..
Q
2.1
owner or Puiecha ser of Building Section Block Lot
Building Con tructed by
Location - Street
P k-1, v JL-ar
Municipality
(Ze s : e.A- c e
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, 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 imTedi.ately following the date of approval of the
"Certifica.te of: Construction Compliance" for the sewage disposal system, or any
repairs made by -ine" to '" ch " systdrn, '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
J
tion Name (i
day of _ 19167 Signature
Title
- gnature
Corp.)
L&r)to t l :a I� s L U V
Address
POT OIL �IAX14AI '
rev. 9/85
mk
CQV Name (if Corp. /)
Address
Yorktown Medical Laboratory, Ina LAB ' 320 009169
321 Kear Street _
Yorktown fIei hu N.Y .10 9S _ - -_ - Taken: -
_ _ _ .. 8._0 �...r
Date Ta m .
.5 °d Tim
a (914)245.3203 Date Reported:
Director: Albert H.PadovariM.7°.(ASCP) Collected By:
-� Referred By:
Sample Locations °
bi,( C'a'd -C"�
mil 13 y - u .v
, _
. Phone �
1)71)-L (�Jp� BUJ �l� Phone Sample Type:
°j Repeat Test? one)
LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY. OF WATER
GENERAL BACTERIA
Standard Plate
(Agar Plate
MEMBRANE FILTRATION
Z Total Coliform
Count (CFU /1.OmL)
35 °C)
TECHNIQUE ('MFT)
(CFU /100mL)
Fecal Coliform (CFU /100mL)
Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total
Coliform:
MPN
Index
(per
100mL)
_ Fecal
C'oliforin:
'MPN
Index
(per
100mL) Y
OTHER ANALYSES
REMARKS (For Laboratory Use)'
Potable
Non- potable
STP INF
__. STP EFF
Other:
Sample Status:
(check each)
Otrtgoing
Na2S203
.Incoming
1/LE 4 °C
GT 4 °C
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
LE = Less Than or Equal to
GT = Greater Than
N/A = Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT_Tn TIME OF COLLECTION.
/xl / :: a_4</® / �c
Albert H. Padovani9 M.T.
ASCP)9 D
For Lab Use Only:
H/C to
rector
I..
W.
V.
41.
i
. mTo
APPENDIX C
FIML SITE INSPECTION Date °
� S
GwN� Inspec' by
� ^ U�.
I
- _-. _ .3:i..'a OEt ':.'��t�IV?SIE�1:= i11���:c�= --- >7- ;•�.%. -.._ .. _ ». _. -
�S- DISPOSAL ARF-k
Led as per aonrave3 plans
a_ SDS are; Icca-
b. Fill sectica - Date ct placerfeent
2:1 ba -Trier _ LGTii W"rV= 'I'fi ANG _ D= I
c. I�at7ar l soil nct s -- icce -d I
d- ' Stone, brush, etc-, greater t-L-n 15' fran SDS are---- I/ I
e- 100 ft. f_cn wat.Y tour_ wetl ark�4-s. I I
SErO.G✓ DISPCS ?L SYST --7 c
2 .:;t? c tWnk size - _, 000 1,250
b_ Semitic tank it =�? 1= I I i
C. 10' mixiirn= fran fcuncati cn
d. No go' bards. Cle7--r.cut w? thi 10 ft. of 450 bZrA
e. DIS'L- �'LZIGN BOX
1. All cutlets at same el ev-aticn - Wite - tee t -i4 e-:!�7
2. Prote `e? be? caw frost (
3. M-Linkman 2 f t_ cricin _l soil t_ x and-t= �-�c:-!es
I I
_
✓�
EC
f . JL'I�CTICN X = prcc rl v Se
I ( I
g- TEON -
1. L? ^_c``R r ;= - [,,Jo, A LGnc�L-1 ins to 1-
_
2. Dist -nce to wat =rccr— c mews -a e
•,
3. L-is t=- l l =A actor c- r.:c to pl an
I
a Distance cent to ce_riter
5. Sicce of trench acc=ent: ble 1/16 - 1/32
6. 10 felt fr.on vrct��y line - 20 f fcmr ticns
( ,
7. Deoth cf tancz < 30 inches frcn s•`r_ace
I
I
8. Patna allcwed for ��.�n =_ion, 50%
9. Size of ravel 3/4 - 1j" 4.iZuet°
10. Deot_h of c -avel in trench 12" mi Lama
I I
1 a
.:
._31. 'Pire.Encs = -4e-
PUT OR r, -SYSTD','S ...:_' ... .........................
h.
1. Size of p= chan-b T
_ _...,.. _...
II
2. Ctie.*-fl7.q t=ank
I I
3- Alarm, vis- gal /aL'_cio
I I
I
4 F.mo easily acc= —sible ir`r-hole to grade
5. First box baf_l
I I
6. Cwcle witnes=sed by Ee=1tn Dec* tre.nt
esthrated flc,; par cvcle
I I
I
EGUSE
a_ Ecu<z locrte3 remr accrcve3 laps.
b. NL-.,a:er cf be%roan5
I
firer. sL
a. DveL_ lcc._tea as rx--- . ar-oro ed vlans
b. Dist=ance frc n SUS a*-=—= ft.
c. Czsin 18" ahcve- grade-
I i
d. Surface drai race arcund we-11 accent_ble.
I
GVEZAIL WOMMASHIP
a. Foxes roce-rly crcuted
I
b. Ali pines *-`,-ia11v backf:illed.
I
c. All pives flush with inside of bcx
d. Fackfill material ccnt_=_ins stones < a" in diainater
e. Ca-thin drain inst 1ed according to plan
f. Cartain drain cut.fal1 protect= & dir.to eY ;C.L. ; te-r=uxr -s2
c. Fcctinc dre i r= d; - sc arc` away f_an S"DS are
L
h. Surface wat- -- prct r-`icn adem --- t_
I
i_ F— csion control rrcvlded on slcces cry tee*' ttan 15�.
�I e,
!e
o.
. _. _.._ _� .. ......_.... �....� � � �.. .....:_ _,�_ _ .::._ ...,�. .... �..__. __ _ _. _....._.. _ ._... M_...._ ..._ _. � _._ . �. , .
71T_�91T,_,;=11
.7v m t�zm, 77
57
V; V,
4'
PUTNAM COUNTY,-,6]kP,"�kTM"Nt-O]VHEA'UTH
ie'P. 3186 Dhdidom-bf Environmetltal Heilth`SiMcii.lbrmeI N.Y 10512 Engineer tw
P146VI ie Permit qL
CERTIFICATE OF COMPLIANCE;
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL'SYSTEM,
Located at L.&6- &u 77 Town or _VWege
7
SubdNbfon Name —subd. Lot il -L4)t —
UeWai� 0
Revision.
D -A al
Date 4preil,
PUS. PP
'MalMn -DID O!M
g Ad&ess Town—
P.-
C.
ra –
Y
Bioding ype: Lot Ae
Dcdob Oid*_ L Do th Volt P
Nmnbe r of Bedrooa; Dimgn Flow:G/P/D PCHD Notficaton b Required When Fill Is completed,
Separate Sewerage System to Couilai of Gabon: Spoqc Tan#, arid
To be, ConjtMCWL by if Addirm
Water Suppip
�
or, k��Pdviti�Sa�jl�, Drilled Y, Ued Lddrgss
Tj� IV P
Other
ReIqWre*' ji
iti
_-
repT ra—�t
M Who y responsible . or �the design and ,location ' cilf th,e`.�,proposed system(s); 1) that the separate sewaia,disposm system
w standards, rules andre
constructed - sho ithiha'ila
above described will:Pe'Lc, gulptlqnsoj the..Putnam
.County bipari�naht��.- -�thp� cip co.T61,�tipri t,hereo &.1.1carti icai t j6ce!'� saii'llactory'to the .Comffiissioner, of.:Healthwill
1�4�!t h;", 4 h,� n
be ' subriiitttdL't��tp-��.'06�iiji�,80�::��d' a ,written guarantee �tili, be furnished a he owner,��hliiuciessors.' heirs qr,assjiq�s,by. the builder .. that said 66ilder will.
61, 1 � ; a'L, r, �, _- , , I I . 11, d .
ace in -gocid`,66eiitinj -of,ii;ci`iiwage disposal �systern h"""
e,perood, o two (2 fo(lowing* the dafe�'of the' is!
)years imme lately, .�U7 the r� 'j� a j1 jj&,t hjrajo;"2) that
'ante. approval' Construction Compliance of
_4.- ), 4n the drilledwell described, above
d 'rules 1
will b anti that
.9 iqcatec��!s tq?,approv pjan Said well Oe�i
unty. Dip' t r thal 0 st r S, ,and regiuMoriF of the Putnam
pprn.on
iC
qt ealth.w
-Signed
Data
Fi.k. R:
A
A
-- --------- --- -------
Address ' — + License NoIy
A'PPROV,tD.F0R':CONSTRUC.TI,ON'.. This approval -expirii'6 om7" at oed'�.. 614'ss cRvli�mu.Oorlon �o the building 'has 6ean'undertakah and is
r
.0 d It mis fi eath fA n n o cons ruc
revocable for cause .may be mended change or • i f
are t9,,atio t tion
diS`p'os'ai'of, d0im'esflc iiqlt' s a and/ r only
'�e 'a o l9d,when considered
u i -ne
Date :By it a
Division Of Environmental Hoalth Services
t IWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641
- - -.. APPLICATION TO CONSTRUCT A WATER WELL
Y,� .,-� n -_,`� 2. •___,
-•c!.l
_LOCATION
STREH .
Ca_wo
— - TOWNj VILLAGE) QIV IJAx Q%0 NuMR&
xA k
uS
LL OWNER
NAME. •
�eoc e
AOOaESS:
��z� �`�.�►��,�� �:i_
p- �IVATE
0EUBLIC
OF WELL "
8-RESIDENTIAL
❑• PUBLIC SUPPLY' O AIRICOND. /HEAT PUMP ❑ ABANDUNED
primary
❑ BUSINESS
❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
secondary
p INDUSTRIAL
O INSTITUTIONAL ❑ STAND -BY ❑
UNT OF USE
YIELD SOUGHT
S gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE L 3 v o gal.
ASON FOR
CEW SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
TRILLING-
❑ fiEPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
ELL TYPE I
Ca-DRILLED
E] DRIVEN F] DUG GRAVEL ® OTHER
WELL SITE SUBJECT TO FLOODING? YES ENO
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -AJa
i LOT NO.:
TER WELL. CONTRACTOR : Name 'a o ire dW6vmkJ Address*:
PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES —W-6, -
BE OF PUBLIC-WATER SUPPLY: - TOWN /V /C
:STANCE TO PROPERTY FROM NEAREST WATER. -MAIN
_ ICATIOIv' .'SKETCH ° & SOURCES OF CONTAMINATION,
- - - . -See • n� , .. � :......
(date ) ' 1 ( signature) - -- - - _
PEWiT''
TO CONSTRUCT A WATER WELL
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 thew
.York State Sanitary Code, and provided that.within thirty..(30)
days of the completion of water well construction, the applicant
shall:
to Pump the well until the water is clear.
20 Disinfect the.iwell in accordance with.the. requirements
of the Putnam County Health Department attached to'this
permit.
3. Submit a Well Completion Report on a fonw provided by
the Putnam /County Health Departmen >
Date of Issue: / /7 19 % - ,` 1,?1141 , � .1 -
L
raga "t Issuing Official
Permit is Non - Transferrable
Inches Inches Inches
l 30 23 2 Z S •` 2
_32 13 0 Z3 �.: 2 ,�► 2.2 S V3
3.3
-A'
'Z3
5
3
5
NCri'ES: =:;tip. •Testes tc 1ae repeated at same, Aepth until approximately. equal soil rates
obtiai .at each 'percolation test. bole:
me.
ROLE HOLE NO.
DE:pM HOLE ND.
G. L. ---------------
20 L 9±
30
0 L �
A
13.0
140
INDICATE LEVEL AT Ua87c��!" GRC�tJ[�1i�fT�t "� °:�� �?° "�
INDICATE LEVEL To WHIG WATER LEVEL RISES AFTER, BEING ENOOUNTERED
DATE:
DEEP : BOLE OBSERVATIONS MADE BY
-900TT
L
Soil Rate Used S.D.. 16sable Area PrOvidec ---------
gals ype c
y
Se ptic -Tank Capacity
--No. of--Bedr(=G
..Absoiption Area. provided . .By _,.. ___ .t
Signature
Address SEAL
SPACE TOR USE bx
Son Rate . Approves .
- I -� -i
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMERM HEALTH SERVICES
INDIVIDUAL MUM SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
FIELD INSPECT ON REPORT
_ :-�-X. -tKiV : ._ n. �., - ... - _.. 'DATE:
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO CCMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location ....................
Will driveway need cut.......
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed...... ...
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. - Deep Hole
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
0 ft.
3 ft.
6 ft.
9 eft.
�. t. r,
- .,..... _:_ .:12_ft�. �_:. .._ ....._.� . » - 12;
DATE:
FINAL SITE INSPECTION' INSP.BY:
YES
NO
CAS
Soil Descri tion
Soil Description
Soil Description
Length of trench measured
0
ft.
Width of trench average
0
ft,. ,•
Slope of tile line and trench acceptable.........
Roam allowed for expansion trenches............
•.
Over 100 ft. fran watercourse ....................
3
ft.'
Natural soil not stripped or SDS area
3
ft.,
unnecessarly.graded............................
6
ft.
10 ft. maintained from property line and
6`
ft
20 ft. fran house...............................
Distance well to SSDS (ft.) ......................
,.:
9
ft:
Stones, brush, stumps, rubble,.etc., greater
9-ft.
�. t. r,
- .,..... _:_ .:12_ft�. �_:. .._ ....._.� . » - 12;
DATE:
FINAL SITE INSPECTION' INSP.BY:
YES
NO
CAS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roam allowed for expansion trenches............
Over 100 ft. fran 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 bedrooms 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-11i area of SDS::......:;.
FINAL GRADNG OF SITE ACCEPTABLE::".:. ..............
s
�..
f
PUTNAM COUNTY.DEPARTMENT OF HEALTH
DIVISION -OF ENVIRONMENTAL- HEALTH SERVICES
Date°���
Re: Property of �0�6 E LLN 'D�`C`
Located at C- pt3oFuS rl LL D
(T) ?i.�v.aw. yJVM'N section ,7 Block, Lot 2,1
Subdivision of
Subdvo Lot # Filed Map # Date
Gentlemen:
This letter is to authorize "A - ZE QZ
a duly licensed professional engineer or registered. architect
(Indicate
to apply for a Construction Permit for a separate sewage .system, top.
-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-9or- -sys-t- ems.- i- i-= c-on-formity--with the prcwi� ions - -of•- Article• .145; or -
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very {
9 Signec
Countersigned:
P.E. , R.A. , #
Address
2G s —'fo lid
Telephone
Address
Town.
91.4 6). NS1 ,
Telephone
pUTNAM COUNTY DEPARTMM OF HEALTH - DIVISION OF ENVIROINIENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS 1
'1
F IELD INSP E ON REPOR T ,
(Name of Owner) ( Street I(ocation) )
INITIAL SITE INSPECTION YES NO CCMMENTS t
Wetlands on/or proximate to property ..............
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...... ... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. 1 Lot
Depth to G. W.
Depth to rock
Soil Descrivti<
0 ft.
6 ft.
_ . r
9 ft....F�,`
--- - ------------ Deep D.H. - Hole -
G.W.- Groundwater
D.H. 2 Lot D.H. 3 Lot
Depth to G. W. Depth to G. W.
Depth to rock Depth to rock
soil Descrimia
0 ft.
V
3 ft.
9 ft.
12 ft.l 12 ft.
DATE: _
FINAL SITE INSPECTION INSP.BY:
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of the line and trench acceptable.........
Rosen allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded............ ..... ........
10 ft. maintained from property line and
20 ft. from house... ........................
Distance well to SSDS (ft.) ......................
:Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
fromtrench ..... ...............................
Boxes properly set ...............................
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area... .
`oes lot drainage appear OK in area of SDS.......
'VAL GONG OF SITE ACCEPTABLE.. ...
Soil Descri
0 ft. RQ((
VJ•"
3 ft.
1
6 ft.
9 ft.
12 ft.
GAS
-i
SHEET - CONSTRUCTION PERMIT.
Na a of Own r..
Rv. ` I.' /. DATE
Tax Map # Street Locate on • - -• ,�
CC S YESJ NO D05MTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
- Design Data Sheet (DDS):
Deep Hole Log
Consistent Perc Results (3)
f 30" Perc Hole
Other
ee` House Plans - Two sets
If PWS - Letter
Variance Request
RDQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume _
D or J Box Detail
Septic Tank - Size, Detail
Well' Detail, Service Line if P.gS
Trench /Gallery
Pub Pit
Two -Foot Contours Existing & Proposed
Slopes for Driveway.Cuts.
Footing/Gutter Curtain. Drains.';;:':
Perc & Deep. Holes. Located
—,-Representative of Sewage,& Expansion Area
Expansion Area;' shown; gravity. flaw...
If Pumped Pit -& D Box Shown & Detailed
House No. of . Bec rooms: ".
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds _...-
"� ::.. :..:.-....._ ....... _ .._..,._ _.-_.. -House `Setliack Necessary ._... -- . ...._
House Sewer - 1 /4 " /ft. 4110; Type pipe
No Bends; Max. Bends 450 w /cleanout ' -�
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Stom,Leader,Footing
25' to Catch Basin
d 10' to Water Line (pits -201)
Septic Tanks
c---' 10' fran Foundation
50' to Well -
z. -'' 15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
-, .'" 16n)' f' L.__' r Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
`� Well Permit
ii
0 • DF; A
.n a
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0
T__21
2.. 3- ZI)D 3
-77
4
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2
3
4
ibim T iit tp� 4be repeated at same depth until ?rcxmtely equal soil rates
j)ercb1�L4on*. test,, All- data to'be submittl3d
at'each bole...
vx e
v - nts to 'be maAe 'frcia top of hole.
rev. 9/85
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTER
PUB NO.
Address...
6-6f -f s
4� 1 �A. wcv
Located at (Street) Sec. 51 Block 14 Lot 2.1
( indicate nearest cross street)
Municipa1ity
Watershed AIJI
SOIL PERCOLATION TEST DATA PJ)DUIRED 70 BE SUBMrr= V=
Date of Pre-Soaking ��u Date of Peroolation Test tA!h
ROLF,
NUMBER Cr= TIME PERCO=ON
% PERCOLATION
Run Elapse Depth to Water Rrom
Water Level
NO. Time Ground Siirface.
In Inches Soil Rate
Start-Stop Min. Start: Stop
Drop In Min/In Drop
Inches Inches
Inches
22_-Z
2 23-1
-3
00.)
4- 2y_
0
T__21
2.. 3- ZI)D 3
-77
4
5
2
3
4
ibim T iit tp� 4be repeated at same depth until ?rcxmtely equal soil rates
j)ercb1�L4on*. test,, All- data to'be submittl3d
at'each bole...
vx e
v - nts to 'be maAe 'frcia top of hole.
rev. 9/85
OF
3°
49
59
6°
C7
7°
9
-1a Q -
LU
r_,._ 4
129 Uj z. IQ
_ a® LU
13°
14° -
INDICATE I8M'AT'_WHICH-MUN9AMM IS..R=-UNTEM w�� - ---
I &I M LEVEL TO WMCH WATER I.EM RISES MER BEING ENOOUNTERM
DEEP BOLE OBSERVATIONS MADE M. DATE:
.
DESIGN . �rp 2
Soil Rate Used -to S.Do . Usable Area Provided_.
�9s- t�,/1. - ..Drop: .- - -... _
- b. a..Bedrows -..: tic Wank ca, ta��..
.-- ....__�...� � `�'..... . balsa _ .Type .
- fibs tion Area Provided.
Other .... .... ..:.. '� ...� �. :. -. _
• mow... � ___.._... �. ,._ ._..a..,: • ._._._...�,,.,;•�:•• ..::. V:+:;:.'.,:.....,.:._:___.._.._ �, . -T
Nam& Signature
Address MZ_ SEAL�
AJe
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7HIS SPACE -FUR USE
PRO
Soil Rate Approved ° °? ° g+; .o�gl o"�` dat: �, `u:aW;: �. » ;:
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