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HomeMy WebLinkAbout2828DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.09 -13 BOX 24 �� ��ti - '� . IN �, .. 610 '� 1 � �'6 -' - � -.fee I '� IN .1 �. Ir Tr 4 to Mel I IL vv,w, civv v _. Subdivision to "be Owners Building Types Numb6 of Bedrooms t� Separate ,Sewerage: >Systerr` To be constructed .by Water ,Supply G PUTNAM COUNTY DEPARTMENT OF HEALTH Division of. E vi��nmenia .,Hea /th Se�wces, .Cam% N °Y 10512 MIT _FORASEWAGE- DISP.-.OSAL SYSTEM (TJ Putnam; Valley. "�:Ji i:>,itt�3 °�� J�l�.i.l%.e . -•.•�Y .. Town or `i.Maaa `Tax 4tT ' .. :r - - r �i�t7 �t'!$� Map Block.2 'f 1 & 0 / S i --E tates Lot Job.. AddreSSLonFvue 'Dr ppa.e N. ;10541 Family{8$ d Lot `Area 43,775 S.F �DBax u'eenDeslgnsrFlow. 20�p�d�' Total OV91� ZOO r� torcohsist of`' 900 ��.. -; -Gal. SepticTank Habitable, Space and Square Feet _ ,o bey c�etermine'd .. '• F ^ -- Address Public Supply From ` ao .be r a Pri vate Supply , tobe drilled by aet'ermie ' Address Other Requirements Curtain: drain & .fill section; .see plan & specifications I represent that ,l am wholly and, completely responsible foc the design and,location of the proposed system(s); 1) that = -the .se par ate'sewage disposal system above described White constructed as shown on the . approved amendment -there to and in accordance with the standards, "ruleean regu a ionvo 8.-Putnam ' .County Department . of. "Ith 'and that: completion, thereof a Certificate of Constructio_ n Compliance satisfactory to the Commissioner of Healthwil6 be submitted to the Department,' and a written; guarantee, will be'furnished the owner his successors,.heiisor assrgns.by the builder, .that said tiuildei;wili - place in good .operating condrtion_.any part of said - sewage d�sposal.,system during the period of' two (2) years immediately following thedate.of� the *issu - ance of the'approval of the rti . Ceficate of Construction 'Compliance '. of the original, system, or pny'repairs' thereto, 2) inat the drilled well described above will be located as shown on the approved plan and that said well will belnstalled' -I- Gordan withA 0 standards, .rules n ,regu.a ons.,. of the,' Putnam_ County Department of Health 6 Date Dece)mba.r 9 y 1.976 Signed P.E. -'R'. A. 4` Add ►es: MilltOVUn Rd + .5 . Brewst P , License 1V O. 43952:. >. APPROVED FOR CONSTRUCTION: This approval, expires one year from the date issued unless construction o? hhe building .hes been undertaken'.and .is requires- a.'new permit Approved for disposal of dourest nsidered necessary by.ahe_Commissioner _of`Health: Any, change. or alteration of construction revocable for cause or may be amended or modified when co is sa nary sewage; and /or private water ,supply only. Date 11 (i �R�� BY. l!)/GQ�J1�i Title M ':.,- .._ .. .. _'� - __..�_., . .... .. .. .... .._ ...... .._. e._.,..�.. -' - _. _•. ,� ..__.. ._ ._ .,... .............,...� _._ .moo.... .._...._..�... ...._g. .,.._..�_._ s __... 6OARD, OF HEALTH r RAYMOND S. JONES Putnar President... 1 DAINIEL SELDIN, D.D.S. i ,� Vice President JAMES BENNER, M.D. PAUL CHANG, M.D. SARA McGLINCHY BEVERLY TAYLOR GERALDINE A. ZAMOYSKI, M.D. HON. DAVID D. BRUEN County Executive HON. JOHN MADIGAN County Legislator ;ounty 914/225-3641 JOHN SIMMONS.. M.D. Deputy Conmi.ssioner DEPARTMENT OF HEALTH County Office Building Two County Center Carnel, New York. 10512 February 1,_ 1984 J. ROBERT FOLCHETTI, P.E. M.S. Director Of Environnental Health Services ELAINE K. KRUEGER R.N. M.A. ' Director Of Patient Services Mr. Dominick Bucciero R.D. 4, Box 162 Putnam Valley, New York 10579 Re: Preliminary design submitted by Mr. Joseph Sullivan, P.E. Dear Mr. Bucciero: This division has completed an extensive review of the proposal submitted by Mr. Sullivan, design engineer on this project.. Our review has been based on the question, "is it fear- able that this site can be developed to accept the disposal of domestic wastes in a safe, sanitary manner ?" While it is op ith s- :rritcrs nir•r. t may be conceivable _.-vha i the s ib " ' - can9lend itself for this purpose with the utilization .of good engineering principles and extensive grading, draining and filling a pre- requisite, the end result, to answer the quoted question is that the site would still be very marginal for the intended purpose. The concentration of this review was based solely on the aspect of the sanitary disposal of domestic wastes as was the resulting opinion. I am sure that you are aware that there are other factors to contend with and are of the magnitude that would include not only you, as the owner, but of the surrounding environment and population. Please direct any inquiries to my attention at this division. ly you , Robe tG' I RJT:cj Division of Environmental Health cc: Putnam Valley Wetlands Committee Marvin O'Dell, Bldg. Insp. (T) V.V. IF= CHECK LIST '•R..J.K.. Contracting Corp, IIe December 9, • 1976 (T) Putnam Valley ._- ..TM..47..p_Bli 2, o L.,1&,p1 -07 -- ? tj F tj JJJL 8 IZITIn SITE IMPECTION I(S�QIY�� �{1}S6LkD® q ®(b�/¢�V90 (�¢ pfgF/uLSB u ••0 0 0 0 0 0 0 �11ya qp oot m e hpo6�g�7a 1/pYpV/ca ion � � . 0 0 0 0 0 0 0 . WLSGSGS CW itl�y � bleed cut O� 0• 0 o 0 C 0 0 0� 0� 0 0 t t�� s be removed -note the ;e 0 0 0 0 0 0 I o deop hole /g�/'� representative of entire SM ams L : -= tl pf� dwy hole@ nwded. 0 0 0 0 0 0 0 0 0 &aMoiont Sffi azzaz available • considering dkivVIMY out h0u2s location,, separation . . • alatsnC009 ate. 0 0 . . D D . D . . e 0 0 0 0 • • Eva@9 located Y tiu? I`!= 8 hond : on approved .'. }.. ist .' �n Mocatpul where o , of trench average Mops of tile lim and tr—en—cF —acceptable Duop 50 U 0. 1_ln 'SV iDl: o sbtWQ2 00i1 xiot otrlp3md or 3D5 eras ►� •��`�• t 1 UI�1 � ^ tr :``�` -S Z�X , •,�..� t - foUouo plan 25 no of pgplq�a. LJIPa� lf. C@_�liu N emu• -,tea A 'run ♦I !`,..i i1 1 ... .e - 1:' 1 rczd@g a " a SEE -*' DESIGN DATA SHEET REVIEW CHECK SHEET R.J.K. Contrracting Corp. (T), Putnam Valley Ar..st� TM. 47 - BL 2 -,L 1 Sep /o 7 Te s ...: •m.'"J 1N77k -sa r, ,..: awx -...,c Fr.v..:.. .. >�+:. :: : ., - .�orG�+.:—. :er...:.wy:;:.r _ .,_ . .. House plans O.K. . Design data sheet X Peres presoaked? X Min. 30" pert test e X ConBt. results for 3 runs X D. Hole tog O.K. i X Corporate Affidavit for other v n a Authorization for "engineer - -, X Letter from Water Supply i pp ca e ; n a If variance requested -such noted bh.plans & apps. DErAII:3 (if change is proposed,) Existing contours shown (shoe new contours Slopes for driveway cuts, etc. shown. Water service line location Footing drain etc. location ' Top slope, bottom slope of fill Percolation tests and deep test _p1t locati on Septis tank size and conformance to std. -3: B. R. house Minimum House setback shown L1iatribuLia�� .boac -1't. ow s _ _- • - __ _- .All water within 50-ft.-of PL shove' Plan and profile SDB . AU.; other. wells and SM closer 2M.I. Property boundaries (metes and bounds - clearly s SEPARATION DI3TANCES SPECIFIED ON PIAN 10' to P.L. 20' 100' 50' to to to Pbundation walls Nearest well stream, march—,_1 15' 10' to to Curtain drsla water line (pica 15' to storm drain _ 10' ' ne to large trees ol f to Pipe ader etc. tincl. C M s -- x not in S.D.S. area cow rm lk haven X REFER TO ATTACHED SURVEY X of Ocalu red X y X, PUTNAM COUNTY DEPARTMENT OF HEALTH uiV1�101V "(1r'..EIVViR(?NME1 rAL`&ALTH 'SERViIW3' . ... _ _ ...�._..� r_ .. .. Date T)aasmber 9. 1976 as P� Re: Property of _ �S � J`o� Iss/"vje/� Located at North sides of east Shom Delve, (') PutM= Put VOLI Section 47 Block Loth' /$ 7 Gentlemen: This letter is to authorize Artbu P''W 1 0j&U&hjjn xx a duly licensed professional engineer 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 cvjwCl: LiV11 w1 Lrl Llils ma C Lev anU to. Supervise the construc ciur! of said system or systems in conformity with the provisions of Article 14S or -..._. t,uuva Liuir- -uaw, UiE rti 'aria r.'rie rurrlam t,otxriicy Saris= tary Code. Countersigned: 43952 P.E., R.A., # Address ARTRUIR P. MCLAUGHLIN PROFESSIONAL. ENGINEER MILLTOWN ROAD, R. D. 5 BREWSTER, N. Y. 10509 Telephone Very truly rs, Signed OWTO� 35 of Proper; Address Telephone r Sleet .1 of 9 ARTHUR P. MC LAUGHLIN E,!dgtNIFJR .. LA'"Ip $.U,RVF_Y0R MILLTOWN ROAD, RD NO. S BREWSTER. NEW YORK 10809 SMCIFICATI ONS f or (014) 219 -6086 `s,. k I s S 1. / iv SANITARY. DISPOSAL SYSTEM Prepared for � wag , <roper : an _ e . _or de of West Shore Drives in the Town o Ptam Vall ®y, Putnamotmtg, York, . TM 47':x• Bt 2 -,L-1 & p/o 7 Lot #3 on a:'P- entit.1,ed ."Subdlirigion Map known as K • 8c K s .RBtat ®s SftUQt® in Town of i'utnam .Nall ®';$. 9t4a.�. Offi. ce, ' D :vtie" ee said %p to be fled the tsa� Couz of xad Records, upon Planhihg Board ap k subge-et tb d ® rtaiona,• tion- of bu ldabi39 ty of -this lot* S 1 E. R A L. I3 A InQ ed herewith, and mad' _;part of this: ape oifieit�on, is a ,saal ®, .06 @1' Bach .Pdrt , i. p1 1. e, an ''s eo iaa.ti® , equ �g by ®rn s the work 'to 'be p6rfo do B, . S *g:b`tois� ih�talodcc ©rctic witpki th�j.yee�s,Qe�j�•. t .4ns . of tbs Putnam t�'ouu T QpA t}�ment o:E ea'lth and Eft Do''' , Viibi on o $t ar Bri , 14- &� ` i�, , q.: Stem sharl3 n0 be bso`illed tu3tfl •%atte bir,I� sir 9.neer aAde�: ,I3epa�rt�t± .o bocn %p etd b'fgad e .. the isaoe of a onetrup tiori t�ompli.nce C ®rbPic3t;e�.� tom to dons st of a g0 a11an se _tio is and 3 r3 12xa� , ,e ®t of '' uo ��5ot ta�ah c�a A .maitits c�$/16 pew f ©vt P ►afi` a of the sysbvm ©ba ,i.n Ago. r with, the lth dude, nand t i.�rerta as del#,n ®mot ®d an the scale p1e�n. WHO 4 *L c :ond� wig "N ft .a 4d Re stl.+r ►s .Perta i.x o t Design" noel listat of Iric1�+i.dual, , <ca�leehoi 8 ®fie ,Systems ": . for tgioal detai�.s rereYoe the �tASTi� TAT�N!' Bt3f " era tme 6t ©f ea tdh Di ck4 ion df Sanitary . g er : Att asti6" 'pa,t.ou].arl i°°a114v�irg splioeble; Figures a� /ar tzbl rho ale ;olue+d h�ra zafer ae det�►il;s s . ' ®rVA xlpQ' ®f or tl a Ab$q rbblc Field Separet:ion Rdquareteats r ' f t 1 Serat_om 3?stanaoa: framtastewater Sou�ca ®s 5 f 4 you nab s •ra aid Seere:cti ah .# Q , S �f 6 Tg$oa1.oncete Septic:a° �istributi�m Date�.l 7 D, Drn #mole: DetAi l :8 ( 3.1igQrbtc Tr ®nc�h Deal r . 'xv s.. 9 . r(f �' �: s;�lbrti on' & ;Det�_ For general sait3cts Qn sae elisposal system . refer o RU S Ate_ � M $ z ST u�T � c k. r, r S AG PE SA11 `Y 3'�1V A�TD R `p I 1 ATIC� tB F'�t 'T I i PR4PER' : r� as publlilk d the Putnam ovi� .Npa at o Rea]:t iii or of Eli ?�i -OwLe ±ailt Ser�ia►es, and the :gi`o meat ene�. ? ek. of .tile Sete eeltb�..i)e.pe�tment J - _ i Specifications for R.J.K. Contracting Corp. Sh®et 2 of 9.. Ko•Catalog cuts➢ shop drawings, and /or other descriptive literature, or samples, as applicable, are to be submitted for approval before [,installation of system fors •-t r�:_: _ J y�� aD< F.ct �J,.D` YO' lEll#; �'ok �;t7n.4 ., vl'I,al'.i""":'3�x °zY .. "li 4vC'0..;:7'€''i`'Lia''' ° "L'e3t' =•-.L .- P"9 ii` dated pipe, crushed stone or washed gravel, etco ;I I . ,dap reference a Subdivision Bap known as K. do K. Estates situate In Town of Putnam Talley, Putnam County, New Y'orkO dated Larch 12,184, J. There are no .wells less. than 20304 away at a lower elevation M the 1, aYreet line of drainage. nor within 1009 at a higher elevation, om I! a propose s.an ary; isp0sal system location. 1'Ko Note that the area, reserved for the sewage disposal system can accommodate the the fields and 50% expansion to the system still maint4ining the required set,baoks and separations. All minimums {:ate can be scaled from the 10 scale plan where not noted) are just that; -in any case more separation is encouraged. . Lo goof' and footing drainer ara not to be discharged in the vicinity the selu age disposal sytipm.p and are to be discharged to grade. Said •drains eari be routed into t,;ie curtain draino (or per plan) M. Rouse is to b® .positioned high enough such that wasto'can flow by. gravity from the.lowest house receptacle to the septic tank and thence to.the overflow bones and laterals, in accordance with the grades in the .Code and in conformance with the invert elevations shown on the plan o Ro.Well is to be drilled in a"ccordance with the applicable rules OT the 'Down and County. Bacteria teat, pumping data, log, etc. y are to be furnished to the en6neer for submission to the-Health pops:rtment. 0 "�rive,way accees to the dwell ins is not to encroach upon, or Tn*te-r the area reserv9d for the system. The sewage disposal area is to be thoroughly cleared and grubbed to remove all tree roots and large boul.d rs that might interfere.with the installation P of .the &y.etemo Towever no topsoil is to be ' unnecessarily removed (e.tripped), nor. is the area to reeiev.e. anymora r8grading than is ,- Gt`�'�a�o�s�requ°i� ®a "�3y`" tai®° he�a. th° t�eysa�t�it °az° ®'t:d- t�"ag�ec� -erg` both the general contractor and the septic system installer. It is responsibility of � .t 4,o general contractor to secure the Y3ecgasa.ry pp�rwork from the septic installer., well driller, water labs etco, and see that samis iffi .furnish ®d to the engineer for transmittal to Jl the ft6lth Department with required Q°As- Built" informations. Note Jthe owner can and sometimes doev perform the Function of the general contractor. The flow scheme is as follows- All flows, including laundry wastes V arc to pass through the septic tahk, where the solids settle out. From= there, the.settled sewage flow passes into'the distribution bcxwhere it is distributed equally to the laterals. In addition i- 6 serial dtribution is pro -ided for overflow purposes obis. PrQVif.on .gor, expansion (future5 in the form of additotnal .lateral$, is. as shown on the plan. Ro For,any separation distances that arenot listed on the table, or ° .t Oan.not be ,pealed from the plan, consult engineer or Health k3e;j art ei�t 0 $:. Dil,igencse is to be taken in setting all components of the system, .see that. flows are balanced, inverts appropriate, etco -. Use hydx°su7lic. tests to. verify same. Attention is to be paid in setting the' tbpt o ,tank to verify that the plug in the bottom of the tank re s. n .plat ®, and-it should be grouted in before the house corn- 966tion is mdde. Care is paid in forming the joints of cast iron to maintain watertight integrity, especially in view of pr&mity tojoundation (footing) drains, and curtain drain, The footings for U ecifications for R.J.K. Contracting Corp. et 3 of (contintiation of note "S" ) Tall overflow boxes are to be se# below the frost line. T. All L.k�ctpopz�ecA.�. xis... oc® i?pvpnacspac_: e® �r.., t :ean�, J,.gr�r�thel�u- e�ate�'asi _t�► .: Imiantain required offset distances from foundation, property lines, :space between laterals, etc.. 1;U. In the event that the house and /or well is moved significantly, t1m I alth Deaprtment reserves the right to require a new sanitary dispos -i gal design, together with new test informations, be submitted. Before any chan;,e is contemplated, check with engineer and /or Health Depart - ;(ment. Should the number of bedrooms be decreased to less than three I1(3), there will be no downsizing of the system permitted. "V. Topographic informations, deep and pere hole locations, eteo by Tieodolite /tape /stadia methods. Consult engineer for benchmark infor- �fmations. We The maximum length of any lateral is 60 1.P. unless otherwise ap- proved. X. Consideration of this parcel was initiated prior to the adoption o? the new standards as refehenced at begining of these specifications lTheref ore it js requested that exception be made. 1Y, Sould unanticipated ledge rock interier5 with the installation io? the sy`ste`m, use additional fill, as appropriate, to maintain state standards. �Z. Location of the septic tank can be altered to take advantage of the lust plumbing connection to the building; however the proper offset (distances are to be reppected, and also the grades in the Code. **,The combination of proposed fill and curtain drain ( per 10 scale plan) are intended to lower the maximum ground water table to at (least two (2) feet below bottom of trench, Prepared by, Arthur P. McLaughlin, P.E.,L.S. New York State License # 43952 ' opjRICK M CC 1 14 ,�Decjfjcatjoriz ior oj.i . rl'/ontractinS_gqr I.- p Sheet 4 of 9 fn-Tif-* ET FIGURE I AS3OA.WTWN F!, E LO SEPA RATION P. FQV�V I R C- MEN11 Or- TIN . A. ^p;� �;� LAVA 'RE 9 SiMAL DISTRIBUTION nFT.All- specifications for -'..J.' . `"antrac"ing Corp. Sheet 5 of 9 or F,,,Twm., -ontmctin- 'orpe Z,pectrica4, ions NNEPT 0!-- �NLST Z- ABOVE 77,7 LLV��L AN&T JO , 141 "P"tS P-A V 4M UWD INS-T is AD OIF SAWTARY TiCi 4" L I MIA 0 13 FMI SECTION - Vll:W SCAL kf; BOLTS' PLAr'14 VIEW FIGURE 6 TYPOCA0. CONCRETE SEEPVC TANOK r �', leet 6 cc 9 UF,LMUND A*FAM. MANHOLE COW,"A T� .t=� ET —�i� CAULKED JOINT S&XrrAny ME Mt, 1, TM C KM SS F 0 R PWRE4 ift zILACS C4:Wcn"F - :.,v. . , Specifications for P,J,,� * Contractin7, r7orp* to, wrpaw wo NO wW sfoigat !e P44 `;beet 7 of 9 coo Fj IS,' at 24.0 bvnd,, Rmils of We j%W ar A l4k, 1-P 24" Cl IJ. V cearnem vibestas pipe cjt to 21 Laturals fldieq)v PC, moo* qjrL P4 IV I ')ttOjTj saivala, 141" Jr., f-.*fh!'Iro."t!fil+ --it-'ici.,?eoring ardSvItatw, New York '1972). FIGURE '10 DPOP IMAMIOLE DETAIL' Specifications f,)r ",%,J., o contractiny_- 7orp. 2"lleet C of 9 IOP $C- L rrOA SETTLIN-3 EAPTH "tWILL LINTREAVD BUILDING PAKA fit MAW ____ A_ cKOMSECTIMW vitw a 13 6 n a 4 4 Lip. A) H S2 w- nnrofmrioN 1 4' x4w 4L 0 47 41 Ei q & 41 ell C4 0 rqI Oul C4 t" PE 0 4k 'T 12'* MIN 47 a i> 0 41 d 41 ffi 0 A S!.11 P P1 i u, N T R 'A S' 'j .0 o 43 12 4 I 4) ;01 Y, cKOMSECTIMW vitw a 13 6 n a 4 4 Lip. A) H S2 w- nnrofmrioN 1 4' x4w 3.CjW3sT'JOlMAt. VjM 4L 0 47 41 Ei q & 41 ell 0 4k 'T j) 47 -41 i> 0 41 d 41 ffi 0 A S!.11 P P1 i u, N T R 'A S' 'j .0 3.CjW3sT'JOlMAt. VjM UTT.AiL SV LjING AF - ' STRAW j) n A _'JAl 7WIN -41 i> 0 41 d 41 ffi 0 4p UTT.AiL Speclficat Ions for '..J,. Coni ractinr! Corps Sheot 0 aP -rc OUTLET } L INLET INLET kill PLAN Vf EW N0TIE S; Pipe joints tee be scaitd with asphaltic material or equivalent. ,,.., F Ti ' $i . ' REl•FMOREMOVABLE Outlet pipes leave lox at saw ,...� COVER level on a slope of i,/$" per ft. tip at..� INLET � BAFFLE 7' MIN. OUTLET •' TO 5,. r ti ;ry •9 I .O ly.�f 0� a�,�'_ b j ��,.� i . .Yf O~ti .. PEA GRAVEL Ito ISW FIGURE 8 MSTWSUTIOIN BOX DETAIL PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA HEET- SEPARATE SEIIAGE .DISPOSAL SYSTEM FILE NO.'- �' IZT la L Owner ddress .Lphgvue Drive,, Mahopac, New York 10541 Located at (Street) West Shore DriveSec..47 Block 2 Lot 1 & p/o 7 (Indicate nearer c oss street (Sunset Hill Road Municipality (T) Putnam Valley Watershed Oscawana Lake SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS before test 6) - Percolation tests witnessed by ,1 bole Number CLOCK TIME PERCOLATION - apis PERCOLATION No. Start -Stop apse Time Min. Depth to Water From Ground Start Inches Surface Stop Inches Water Level in Inches Drop in Inches Soil Rate Min. /in drop Hole #1 12 :15 -2 :25 20min. 2211 25tr Off 6.67min. /in. 2 2 :42 -3 :04 22min. 22" 25" 31t 7.33min./in. 3 3 :05 -3 :28 23min. 22" 25tt_ Sit 7.67min./in. 5:.. tole #2 l 2;16. -2 :39 P 23min. , 2311 26" 3" . 7.67miniAn. 2 2:40 -3:05 25min. 23" M26n .e3n.;: Be ~ 3 3 :06 -3:31 25min. 23" 26" 3" 8933min./in. 4 5 .. 1 2 Conclusion - Hole #2 governs 3 use 8 -10 mine rate 4 5 Notes: 1) Tuts to be repeated at same depth until appraximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENV ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Z !, z cc P� Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' / DEPTH HOLE NO. A HOLE N0. B HOLE NO 61' Topsoil Topsoil 12" .1811 WATER zand & Boulde 2411 material uniform' to o om of- 3011 3611 42" 54" 60" 66" 72 WATER 78 fi 84" no water in hole B at time of test later inspection revealed 0.57.o INDICATE LEVEL AT WHICH, GROUND WATER IS ENCOUNTERED HOLE A 1"'. from grade water INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED gg0LE A 1 .15' �e TESTS MADE BY Robert J, Kisslinger. Date July. 19 witnesa ed' by N. C ap s & ns ecL�e- c o a ast iris- ect1*on ovem" sr126y,- `So lRate Used 5-10Y r�/1 "Drop: pTperio yes_S.D..Usable Area Providedplus 50 expansion No. of Bedrooms three Septic Tank Capacity 900 Gels,. N owed cone Absorption Area Pro ded BY333 L.F.x24" xx e e e� Name �c G igna ure ,� i Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENV ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Z !, z cc P� Date