Loading...
HomeMy WebLinkAbout3179DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -24.18 BOX 26 03179 1111, M, 'I Nr !�Ll I r I .� 1 ,` I 1 = oil i I F I ' r 03179 -"x ;., : �'� +��Y .� ..."'_ - „x*- .�-- rs^- tc�.c —�. ^'- 'r"""'c'�._ ;...�-- ,...�._,,.. - x– �--- •---- .- y. -r.-r . ,.. k . 5a '} PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. j/86 Division of Environmental Health Services Carmel, N.Y. 10512 f Engineer Mast Provide P.C.H.D. Permit q I COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM +A �.e�.>�..��w+, a .:: •� � ” r.. ..... -_ .T 1`TO" drJ /t,��G a/o.Ct�� >� . 4 .....•> Tea Map-7 BI - .._Lot-`.1?f Owner /applicant Name �O'n /�� r" y Formerly Subdivision Name Sabdv. Lot N Mailing Address C�iv nc�`f /7d 4 Zip- Date Permit Issued L y i6 Separate Sewerage System built by Address Consisting of /060 Gallon Septic Tank and 3 g © .4 o b✓ , �N Water Supply: Public Supply From Address / , or: Private Supply Drilled by C•r7 d e—r Address Lpa% � `- 7 Building Type �/ Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? AIV Other Requirements I certify that the system(s) as listed serving the above premises were constructed esa �.lAf N the plane of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, 9n filed plan, and the permit issued by the Putnam County Department Of Health. 3/3/ 97 Certified by * P.E. R.A. Date T_� _ Address 2 7 Z r`�� �r�" �� /� , ., License No. Any person occupying premises served by the above system(s) shall prompt to a such act s o ure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewers sytt m shall be Soon as a pub ;%. Sanitary sewer becomes available "and the approval of the private water supply shall become null,an o when a y becomes available. Such approvals are subject to modifies /t /J �n y/•change when, in the judgment of the Commi of Men Ch Ion, modification or change is neCypry, Date ,rte s` By TitM /ryIj` felt" WELL UUMrLhT1UV L'U'ruml DEPARTMENT OF HEALTH "tIv-S 13ivi s- ion"'Of "Envilrolam6itt; al al a PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only <7 4/4/ q WELL LOCATION TAi GRID NUMBER. WELL OWNER AGORU§- PBIVATE 0 PUBLIC USE--OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE —`�0-0 gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY fgNEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH �00 it. STATIC WATER LEVEL I '�16-'-I`LFDATE MEASURED -4 4 DRILLING EQUIPMENT 9 ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING 9 OPEN HOLE IN BEDROCK 0 OTHER CASING TOTAL LENGTH I'L MATERIALS: 8 STEEL ❑ PLASTIC 0 OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED JS THREADED 0 OTHER DETAILS DIAMETER in. SEAL: 9CEMENT GROUT OBENTONITE OOTHER WEIGHT PER FOOT /r Ib./ft. I DRIVE SHOE efYES ONO I LINER: DYES QNO., SCREEN DETAILS .7. DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (11) DEVELOPED? FIRST DYES ONO �-OURS GRAVEL PACK 0 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH —ft. BOTTOM DEPTH WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED 1 tests were done is in- • COMPRESSED AIR !ormation attached? • BAILED 0 OTHER I-] YES ❑ NO more detailed formation descriptions or sieve analyses WELL LOG 'are available, please attach. DEPTH FRO SURFACEM Water Bear- inq well W' Oia- 0' meter meter in in, FORMATION DESCRIPTION COOE ft. ft. WELL DEPTH It, DURATION hr. min. ORAWOOWN It. YIELD gpm. Land Surface -"!-" P -D I 500, 7V- WATER jZrCLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? 0 YES ONO STORAGE TANK: TYPE CAPACITY GAIT. WELL DRILLER NAME,--�,,#� DATE AOORESe /jIGNATURE e PUMP INFORMATION TYPE CAPACITY /C, MAKER DEPTH MODEL VOLTAGE — HP 3/89 YML E"NVIRONMENl*AL SERVlCES � ~. 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 LAB'#: 87.304175 CLIENT #: 7190 NUN STAT PHOC PAGE l MURU, HENRY DATE/TIME TAKEN: 01/15/97 10:15 375 CHURCH RD DATE/TIME REC'D: 01/15/97 10:40 PUlNAM VALLEY, NY 10t,79 REPORT DATE: 01/17/97 PHONE: (914)-528-1975 SAMPLING SITE: 37 HUKTON HOLLOW RD SAMPLE TYPE..: POTABLE PUTNAM VALLEY PRESERVATIVES: NONE COL'D 8Y: HENRY MAURO TEMPERATURE..: { 4C NOTES : DATE FLAO PROCEDURE RESULT NORMAL - RANUE . METHOD 01/15/97 MF T. COLIFOHM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER -- (WAS NUT) OF A SATISFACTORY SANITARY QUALITY ACCORDl TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ` SUBMITTED BY:___________ Albert H. Padovani, M.T.(ASCP) Director - B-AP# 10323 e • PUTNAM COUN'T'Y DEPARTMENT OF HEALTH of 1'." .•��. i/ \ h.....•' ilk'\. \'`. /.T.� T \ .: S. 'i" - ___ _ _ .:� •Jiy:i:il °yiv •=.ii' '�:i•: v it�.v::� u�.\' I'r::�'"1;1'':�^�i�:t•::::il•i: �Lr:1 .,... -. .. r .. _, r° Owner or PurclAser of Building Building-Constructed by ... '4 /,V/,, /,* / /a =1' /�4c� Location - Street Municipality —� Building Type 7 -, L...1 Section Block Lot Ise-lollew 'e!5;r/4 Sub&vision Name y Subdivision Lot # GUARAMTEE 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 oper -itc: fsr .a peri_cdm of .: two years immediately following the., date.. of. approval of the "Cert" fi cateV of Construction" °Compliance • ='or' the 5ewage'di� w5ai 'Sys�a�ii1 or aiiY 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 // day of /��� 19 �i� Signat - �._ c' Title ��Cli�lG� General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk C�/_ / ?c a Corporation Name (if Corp.) Ile- Address �...Q.,- .. Ji."'� FUTNAM COIINi Y Di$ARTbIL�fl OF BOALTH DMdoi d Ohl HeeMh Savloee. Cum" N.Y. 0512 to Pirevltle Paatrllt / — G r t am CBimFWATS OF co 1'1' ML , FOR DISPOSAL STSTM Laeebdatd /f t+/t /a� r i r� eves at V ®sige. >.....:..�» r = .l�jy�, c,;' � �i 3�i'R ib1' j' d ;.'. .:: y��e;;... 'i��? fit,., s •jai `� >�� » . �a; -t•. Otsr/AffEentNaate t,.r y r Y+ yr y Renewal— P p Date of Psevi�oo{ns Approval MMMES ��HN rC�ft /7(i . a1 Town cf' Ti7'2" � b''d /lt✓T ZIP Ldp L �7Gyc �'` �T- I8 �Pe Lot An FE Sectlm Ody Depth Volume Nsber d Be*. _73 Dos4ps Flow G P D � O d FdM NodBmdoa b RegWnd When FM V cosi*kded Saporito uVeasMe Specs to Comm of ya Gages SM& Tank -ad � � d A d= " �4 / -0w,54 eor To bs aes4tzeted 67 O yi/!7 L' F NEW water s�pb= Pie Sppplp Fts� Addmr �� �PpNCI 8G 9� . a on '/ . prsorar. Sslpp� Dt�sd by �!7 �!/1'l D!7 sa.t..,o. Otber Fsgdremants 1 regnant that 1' am wholly and eompNtely ntponsibM fed the design and'lodtion Of the prong { pasta fewaga disposal - system_ above described will be eonstrueted as shown on the approved ama�dment there to and in aecordan an ra0u ns o nam County t)epartment' Of MMRh, and thaton•eompNtion thereof a "Certificate Of Construction Com to the Commisslona Of Mwlth Will M submitted to the. Department, and :a. written guarantee will be furnished the owner, his successors, s by the builder, that laid builder Will place in pod OpaatW4 Condition any part Of .said Sawa" disposal system during the period of two (2) yeas immediately following thedate Of the 10u- ante of. the approval of the Certificate of Construction. Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as sliomn on the approved plan and that said well will be instal in accordance with the standards, rulas and repu e�TFions of . the Putnam County Department of Mwlth: ' Data & �/ 6. Signed f< P.E. R.A. Addresi APPROVED FOR CONSTRUCTION; This approval expired two ra nom the date i unless construction of the building has been undertaken and is 144mable for `use or maybe emended or modified when con . sary by th missioner of Hwlth. Any change or alteration of construction requires a M per Approved for disposal of domestic ar ' sewage, and/ r e water supply only. Rev. / Title lop� /" 1088 Date BY r -' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 -'ti!'P11CAT —L "UN Tll'r(: 1ISTRUeT' -R iryei ER- ;°V1'rtL:G'''�,� PCHD PERMIT 0 WELL LOCATION Street Addp ss 1 To Village CitY Tax Grid Number f % A2 re d'r7 VA / 77t. — i - Z iP. / 7' WELL OWNER Name Mailing . Address rivate r ua• ��' l' O Public USE OF WELL 1 - primary 2- secondary SIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHTgpm /# PEOPLE SERVED_ /EST., OF DAILY USAGE i. va SSl O REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION GI ADDITIONAL SUPPLY jZNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ODRIVEN CIDUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: * 6� 7 /zif/ aa 4/ Lot No. j WATER WELL CONTRACTOR: Name Al. Jr;�✓! -a t!/�10119 Address: )Cc0 . i4,a7 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES k' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DI�`rAtvrR T FROM *1rAx'tf?ST.;.,vATER_MA?Nl LOCATION SKETh0N ¢ SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET Dr' �'"' L �v - (d a ) (signature) PERMIT 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 New York State Sanitary Code, and provided that within thirt;, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril ng operations be contained on this property and in such manner as not to degrade or othe i e cont 'pate surface or groundwater. Date of Issue: 19� Date of Expiration 19 471F Pe it Issuing Official '41 Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller .6 Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278-6130 April 19, 1996 Frank Sullivan 2972 Fer%ncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Mauro Horton Hollow Drive (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above-captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." Due to the wetlands surrounding the SSDS area the wetland boundary is to be clearly flagged and the SSDS area is to be staked by a licensed surveyor. 00 2. Two foot contours are to be shown in the 1" 20' scale plan. i s to. be shown on al 1 - SSDS :plans. , to -pap -Frio, i ng- anci gutter di'tcha:rge i's' to be" shown 7&6­plan. 4 5. Expansion SSDS is to be shown on plan dashed lines are acceptable. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. RM/j p Ver ru t ly yours, I Robert Morris, P. E. Public Health Engineer i! ol PC -1 ____APP_L I CATION :FOR- .APPROVAL -OF PLANS 4..WASTEWATER--DISP-OSAL..,SYSTEM 1. Name and Address of Applicant: Af-,e, W V Z -Za V ro 4 I.V a 144/ 2. Name of Project: 3. -Location: TIVIC:� vkl/ ll� 4. Project Engineer: S. Address: License Number:_,'-�- qj Phone.:&',7- 6. Type of Project: kl*� Private /Residential. Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 1. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One.) Type I Exempt Type: IIII...- Unlisted 8. Is a Draft Environmental Impact I -Statement (DEIS) required? ............. Ale, 9. Has DENS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, Qr , _-, - I/ other i a1s, J.nances?- _Q ff ic rd 12. If so, have . plans been I en . s . ub,mitted to such authorities? ................... Vl 13. Has preliminary approval been granted by such authorities? )/I'- Date Granted: 14. Type of Sewage Disposal System Discharge...... _ Surface Water k-*' 15. If surface water discharge, what is the stream class desi nation? ........ 16. Waters index number (surface) ........................................... Ground Waters R/� 17. Is project located near a public water supply-system? ...... ? ............ A4,-2 18. If yes, name of water supply Distance to water supply I site near a public sewage collection or disposal system ?..... $9. Is prc.iect, ?0. Name of sewage system Distance to sewage system 21. Date observed: 23. Name of Health Inspector: 24. Project design flow (gallons per day) ........... �4 4? ...................... 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. llvd 1'F S'jai ,::is~ro�ts? 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... y z%� S 27. Wetland ID Number ........................ ............................... '- 28. Is Wetland Permit required? ............................................. Has application been made to Town or Local DEC Office? .................. A1%� 29. Does project require a DEC Stream Disturbance Permit? ................... Ale, 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, �o landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination. YES or NO G DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ..........." 33. Are community water, sewer facilities planned to be developed within 15 years? 400' 34. Are any sewage disposal areas in excess of 15% slope? vv. i'an iii3p. •.v -wWuZc'r • .- .. ..e ............. .... • . • ................ 36. Approved Plans are to be returned to: ................ Applicant _i--o' Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Lair. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS RFWEF�`7 c+.. ss'° T• .. °_r,, ".:�±:DdS.:;c:.i;�T�OJ� '"~.'�is..- .,..az:..._ _ «.'c. STREET LOCATION +� E }fEll�� IC /��J/U'C- , NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DOCUMENTS. Y ist, © PERMIT APPLICATION � PC 1 WELL PERMIT =1 PWS LETTER = ENGINEERS AUTHORIZATION = DESIGN DATA SHEET(DDS) = CORPORATE RESOLUTION = PLANS THREE SETS = HOUSE PLANS - TWO SETS = VARIANCE REQUEST SUBDIVISION ® LEGAL SUBDIVISION = SUBDMSION APPROVAL-CHECKED = PERC RATE = FILL REQUIRED DEPTH = CURTAIN DRAIN REQUIRED =STANDPIPES GENERAL = EX- APPROVAL SSDS ADJ�LOTS DATE C TAX MAP # Y = EXP. AREA; SHOWN; GRAVITY FLQMW,,,S._ UFFLSIZ;E'� m,IF PUMP' UMPED PIT & D BOX SHOWN & DETAILED ©,HOUSE - NO. OF BEDROOMS ='WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM ZI PROPERTY METES & BOUNDS =,HOUSE SETBACK NECESSARY (TIGHT LOT). IZIVHOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS. CLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE I FILL SPECS = FILL NOTES 1 , FILL CERTIFICATION NOTE Ul DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA WETl.ANIZ_( )_WN:PEkMITREQ ?) / TRENCH DATkQN DDS-PL"ATTS &PERMIT SAME M -IF TRENCH PROVIDED =60 FT MAX PRE- 1969 - NEIGHBOR NOTIFIFICATION ® PARALLEL TO CONTOURS LETTER BI/ZBA . = l�0 %n FXPANSION PROVIDED C ' 4ZT7DA D ATrlllkr TTTCT A lir-nc cmmfrurrr% cwt rr A wr REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) = SSDS HYDRAULIC PROFILE = GRAVITY FLOW = CONSTRUCTION NOTES (GRINDER NOTE) = D SIGN DATA: RERCAND DEEP RESULTS �T CNTOU O EXISTING & PROPOSED D &- S•LQPES CUT P &UllER/CURTAIN DRAINS EROSION CONTROL; HOUSE,WELL, SSDS = EROSION CONTROL NOTE = PERC & DEEP HOLES LOCATED = REPRESENTATIVE OF PRIMARY AND EXPANSION 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS ffj 15' WELL TO P.I 190 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) L:1_1 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER = 10' TO WATERLINE (PITS -20') = 50' INTERMITTENT DRAINAGE COURSE = 200 FT. RESERVOIR, ETC.= 150 FL GALLEY SYSTEMS = 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% = 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS, SEPTIC TANK =10' FROM FOUNDATION; 50' TO WELL PUIMM COUMT DEPARTMENT OF RIVISION OF ENVIRONMENTAL HEALTH SEWICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM _FILE NO. ..- .1.r...:4`r.aseY.r.:. '. .0 ../���-- .r. -..v. .T-r. .w.ra.4. —ZTf -- C Tom._. .- ...w_M- .-..'•..:!'•/.'�i vim/ ._. �. ,.. .. aat4Q�:•-p-/T�t..+TS. _alK4 Owner ...J7� /'' -�f� �'�% �AddreSS✓�(�/ Gf? G a'/��'- �1,�1f / Located at (Street) 1�11ew /j`°�� W !/�'� Sec. 7.2- Block v'/ Lot ;W-1 J� (indicate nearest cross street) Municipality . /" yA'� !� c� /`� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUB' IITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test HOLE NUCER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop J,4 / Inches Inches Inches - 1/ 67C, / a 1 zs°— 3 /yx gF c3 1 4 5 3 � l 2 , S� 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCyOUNT�3yRE. D IN TEST HOLES . G.L. ✓ v J(J _ 1' 3 5' 6' 7' 8' 9' 10' 11' 12' 13' ,., INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED /iep e INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED '°--,P DEEP HOLE OBSERVATIONS MADE BY: DATE:) DESIGN - Soil Rate Used % Min/1" Drop: S.D. Usable Area Provided 4e�oew No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other ���ic�ira a "7 37-5-- / �� / /mss " • c Name Address THIS Soil Rate Approved sq.ft /gal. Checked by Date J