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BOX 26
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03180
s ,
PUTNAM COUNTY DEPARTMENT ` OF HEALTH
,b. Ce N.'. Y - 10512
Division of, Environments/ Health Services, ' tm% }
,own, of. Putha- `Malley
CERTIFICATE 'OF zCONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL. SYSTEM r
illage � N `-
�� n. T de (� oP he1� r�,�r.. Roadr: _ T K
Located at, p
owner John V. Q 1 Connell - Tax Map iAt.a 2 subs art 2t _
John C'. A�or D. 1 -Mandy Lane, NIahopac,
Separate Sewerage System: built by Address
Consisting ot, 120;0 Qal.'Septic Tank and 480 1, f. 24 inch trench (plan c:a11s' for ;448 -I
Other requirements no21e 2
Water .Supply: Public Supply From
gE S
_ Private Supply Drilled By Anderson Well Drilling
Address Putnam Val ley, N o Y. -
BuUding Type 2 8t!j Awelliinp, No, of BetJrooms, Date Permit Issued 7 26b/79
Has Erosion Control Been Completed? no 1
rf
I' certify that the systems) ag listed,sekving the above premises were constructed essentially as'shown on the plane of.the.completed work- (•copies
of which. are attached), "end -ln accordance with the standards, rules and regulations, in accordance with the filed plany'hnd the _permit issued by, -the
BUtnam County' Department Of' Health
November 27 1979
Date Car Pied by P E A r
Burgess & B h C
Address' ! License No r'
R - n 8r s e ound � Rd' Carmel.; .. Y. 9845
Any person occupy ng :premises served by. the above system(s) shall promptly take such action as may be necessary to secure the 'eorrection of any yrisapttary t
conditions resulting resulting' from such usage, Approval of th .separate sewerage. stem shall become null and vo as so,On,es a,pvblic sanitary sswer'beeomes
available and the _epproval -of the private water supply Shall become. nul4`a oid .when a public water ' Opp, y becomes aysilbble $ueh approvals are
sub)ect to modification or change; when,` in the';)utlgmen; of tHe,Corr► issl or of H"Ith „.such revo to .moditication or.,change I; neee�sary '
!/ G ”
Date .. BY - Title
YORKTOWN MEDICAL - LABORATORY INC.
P.O. 'BOX 99121 Kear Street
Yorktown Heights, N.Y. 10598
.. _.. -- 245 =3203
- - "- --�
ft405, YML#7:999
LOCATIONS:
0,321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 110598_245 -32
El 201 BUTTONWOOD AVE.; PEEKSKILL N.Y. 10566.737 -8777
U 495 MAIN S T., MIC: K'ISCO,•N Y 1:0549 666_3335
STONELEIGH AVE. .(NEAR HOS.PITAU, CARMEL; N. Y. 16512 278 -9330
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED'
John Agor 5/8/80
CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE REPORTED
1 Mandy Lane, Mahopac, New York 5/.9/80
SAMPLING POINT
O'Connell Property, Canopus Hollow Rd., Putnam Valley, New York outside tap
BACTERIA PER'ML. (Agar plate count at 35 C).
COLIFORM GROUP (Most probable N6. /100m1.)
HARDNESS, TOTAL = pprii
DETERGENTS - mg /L
NITRATES (as N).- mg /L
IRON, TOTAL - mg /L
AMMONIA, FREE (as N) -mg /L
pH=
CHORIDES - '(mg /l)
These results indicate that the water was YES of a satisfactory sanitary quality when the sample wds collected.
jr �0, LV4 1AA
A. H. PA VANI, M. T. (ASCP)
�..:.- :....,�s.._.,.w. •..�. ,�..:,:%.5�^,'... �,.�..Z�...: .� - '�:ciw:::�:�:,=- i,::r'.'. -� ;:+,;•.Y �i�'8ts. = c":�g':,,� r v f _ .."r�'.- r- "3::.........�.�.._ «,i
Owner or Purchaserof Building Municipality
John C. Agor
Building Constructed by
Fast side Canopus hollow Road
Location - Street
2 sty dwelling
Building Type
Put valley 57
Section
5 - Parcel 2
Block
Lot 2 of Filed Man 1465
Lot
GUARANTY 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 th.e Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, 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 de-
termination of the Director of the Division of Environmental Health Ser-
vi�;es of the p.:��.tnam Cour�tJ - Department of- Health as to whether or not the
failure of the system to_ operate was caused by the willful or *ne _11 '6nt
act of the occupant of the building utilizing the system.
Dated this 27 day of November 1979 Signature l.._
TitlePres. Jo C. Aoor, Inc.
If corporation, give name
and address)
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,
- - - - -- - - - - - - - -
°�;r- i } ate►
Putnam C .' e�p4ir'tment o Health
UN
IPUTNAM CQUIVTy
AEU1. of HEALT14
� �A! A P4 T94�1 WORT:- 1�0.QT�l 44INT1P �DE�IAE� .47 0 -
Qlvisrlpn of Environmental Hoplot 6QFVWQ
COUNTY OFFIGF BUILDING - OAI1 &954.:: W, YORK
'jhls reDPrB is. E�,bq COTTipI @trod,v:NS�lI Llri�lR3! 8= csfri'�— .'i� 16`F ilgii i'jfilifil 181;]♦a�'Q�11�
arllYsl 4Y
Wq;or sample indicating water Is of satisfactory bacterial quality before Certificate faf construction cptripjjpR Ili Igor .
REPORT MUST BE SUBMITTED WITHIN. 30 .DAY,S OF WELL COMPLETION
Ot;dfa�7
�_
lFTGATLQCB
SIB re" CIA
p" �Q6troaU (TAPn 4bQt NNg3001
LLJ
1'go?OSt:O
I:50 6a
414
(�'�j QUSINESS j'""j
POMF TIC El ES7ARI ISHMI;NT L.J FA B� � TOT W94
PLtlLIG (''� AIR ; OTHER
rSUPPtY INDUSTRIAL Q CONDITIQNINL3 (�pactfy)
�t'16611dQ
I AL11P('.Et3T
Q.IRQTA;Y
COMPRESSED �^j CADLE OTHER
JGJ AIR PERCUSSION El PERCUSSION (6pocify)
CALIhO
CyTAIb$
LF,IyI�Tq (J t)
J,2 /
OIAh1E /TER(inchooJ
{� ��
1WEIG"T PER FOOT
[a TH89ADED Q wopap
Q
YRS NO
W.65 041 PRO
.T44
149
YIELD
TL$T
Noun 0.1,41
l J 9AILP L.J PUMP60 -E1 COMPRESSED AM
wig Q ;W ^V,/
YJATLp
tf3EAS4RR FROM LAND 54RFACE— STATIC(Speclly foot)
DURIN4 YIRLp TORT lingo
Depth of Comp!®fod {Nell c
In fogt Itolo.w Land ;urfgcor . -2
' s;crr�c;i
G;:7AI.$
E!AR6
LgN9TII QFIN to 49VIF411 09910
$LILT OILS
PIAMETER (Inghcv)
LF GRA VEL,
CKEDr
plpmetar of wall Insludinp
gravel pock (Inchon):
G(}41 I. n ppooff)
M AI (9011
P (rQ®U'�'T�
P;?TM FC01A LAKD SURFACE
FORMATION DESCRIPTION
Sketch exact location of wgll With dlalopCga, to of 1909f
two porinangnt /antlmo!ka.
FELT to F2 @T
UTNAM COUNTY.
PREM DE , FBM
If yiold woo Iostod of difforont dopths during drilling, list bolovr
FEET'
GALLONS PER MINUTE
AT4 WEL CQ Lgr4q
6?HTE OR REPORT
YYlsl,l. Da1LL (Sign
114-1
A5,61-111- T
o WELL
Ric /RS
Ay
y t -1 c-, n
t-A. C.
V-'Rn�l T of ?-L
i-14kF-CA cT A
�z 8 LATF ROIL5 C.G�'-o` Lo NC,
[cu C; TANkAtj
24 48o Lf,
1=4)(L 44ei Lr
' ,
IZOC,47-10"
T�Ox E3
f
i NOTE: THIS AS TO CEI.?rlFr THAT 7-1-IE 5&7wA 6E 01,54-IOSA L
SYSTEM WAS CONSTRUCTED AS 1AIDICA TED ON THIS )-I A A/
AND THAT THE SYSTEM WAS /IV Fc>rC rEZ? BYME Bti,!,TOR-- /T
WAS COVERED OV,,=-R- THE SYSTEM WAS CO1V,5r1?e- —7-ED
/A/ ACCORDANCE WITH ALL THE RULES AND RErGU4'Ar1OA1S
Or THE -uTAAA co1A7 r DEPA t T4,v r OF HEALTH.
1.
E)CCE,-r1O1VS 7-0 THE ABOVE, 1,-AoV >,- Ivor--D &ELaAl.
//ONE RECDAAAIFND AppRoVAI-
PUTNAk'COUNTV
ASBUIL 7 PL AA1
OF SEWAGE DISPOSAL SYSTEM!
LOT IVQ-Z
FILED MAP H2 14-r-,5
TOWN OF f A PUrAlAA4 coG,Nrr, v
.SCALES AS NOTED NO V 27 / 7F
IAP '.'44OV'Ll
JU'119
VAL I.IV1511w-ERING 4A"D .5UAIvE)'ING mum cm-
HOR6f,—OC11VC;, ROAD C,4,"?MEL, N
r.
f.
rf
it
n.
UUU '
East sic
SubdivisiontFile
Owner 'T
Building; Type.—
Number ofaBedroc
PUTNAM COUNTY.° L "IEPARTMENT OF HEALTH*
Division of, Environments! Health Services; Carme% N_ ;Y 10512 I
`i Toin of` Putnam - Valle'
OR, SEWAGE DISPOSAL SYSTEM:
iiOoUS HO1 04J OaC3 V Town or village
57 �- lla ? h _19
xy •Sias .__• __ ��"^:•
Ilion Map 1 .65. Narrow' Etal.
Lot
2 � � b B],ock.:5
e11 � _ ,- -
Address 1075 Wash nmton::St;Peeks:klll,NY
sty dwelhn dot Area 2 acres pius..
S7 Design Flo % minut6s: Total Habitable Space Square Feet
"120.0 1Ia 8 1 f 2h inch trench
rTo.hnt of Gal SePtic Tank'' and.•' �.
Separate Sewerage.5ystem to co[hlsjl ^: •
To be constructed by �. A�or., Iris • Address,
t
'hZandy Larie
Water 'Supply: Pub IiC Supply From
X Pnvate Supply to be tlriuetl by none .eT1�a eC� at this t liil$
Address
Other, Requirements-
a 11 spec t£ic:ations: shown. on _plan shall comply
I represent lhat l am wholly :and completely' respon sib le'for_ the design a ndL location of the proposed system(s); 1) that.'.the. separate sewage.disposal system
_above described will be constructed,as shown,on'.the approved amendment there to and gin accordance with the standards, 'rules and regu lat ions of e u nam
County .:Departrh' F! of Neaith, and that :on completion thereof a Certificate of Construction Compliance" satisfactory`to thii Commissioner d. -f °Healthwill
-be submitted to the Department ,and a' written guarantee virill-66 furnished the owner; his successors , heirs or assigns $y the builder,,that said -builder will
place m .,good operating condition -'any, part; of saiq sewage disposal systeM during the period of two (2).years immeGiately following,•thetlate of the issu
ance of the approval of ;the Certificate of Const[uction Compliance "of the be inal system' or any. repairs thereto 2) ihatthe':drilled -well described atio`ve
will be located as shown on the approved Ian and that said well will be ,installed . in .accordance .with the standards, rules and 78gula if the, Putnam 7
- County, Department, of H'eaith '
n
July 16, 1979 x 0 0 Dale ':Behr•; 'LL
Address R' D -8 Hors,epound d, Carmel, N. .Y. 1051 984
icense No ;
APPROVED FOR- CONStRUCTIOIV: This approval = expires one year from the date' issued unless construction of the "building has been undertaken and is
revocable for,, cause. or may ;be amendetl or modified when considered hecessary-'byAhe Commissioner of Health. 'A_ny. change 'or, alteration of construction
regwres..a new permit. Approved for disposal of domesticsan,tar 'seyage;;.a or .private 'water supply only.
BY
Date�_^� !o / Title
ROY BURGESS ALVIN H. BEHR
LAND SURVEYOR
PROFESSIONAL ENGINEER
LAND SURVEYOR
BURGESS & BEHR, P. C.
N.Y.- #9845 N.Y. - #37707
N.J. #2824 PROFESSIONAL ENGINEERING & LAND SURVEYING CONN. . #5394
PA. - #8454E R. D. B - HORSEPOUND ROAD
MD. #3063 CARMEL, N. Y.
LA. #4522
CARMEL 5-3312 (AREA 914)
July 169 1979
Putnam County Dept of Health
County Office Building
Carmel, N. Y. 10512
Re: Construction Permit
Job 1142 -639
Canopus Hollow Road
T. Putnam Valley
Gentlemen:
Please find enclosed, four prints of design of sewage
disposal facilities for lot 2 of Filed Subdivision Map
P,,1465, together with letter of authorization, soil test
design data, application for approval and two copies of
house plan proposed for this lot,
yhi�r
will
Very
BURG:
By°
enc:
roc 7 e-T '�Cle0 i�laZ18_.ti711
be'atly appreciated;
tr/ ly yours,
S BEHR 9 P C .
cc: John C. Agor
tnc;� rcC:tlon :vf- the :site
.Q
i
i`
� r
(Indicate) -
y fo.r alConstruction Permit fora separate
sewerage system ;.to
j the.above noted property in accordance with the standards, rules
ations as promulgated by the
Commissioner of the Putnam County
at of Health, and to sign all necessary papers on my behalf in
with this matter and to supervise the cons- tr.uction. of
said _
systems in conformity with the provisions of Article 145 or
l cation Law, the Public Health Law, and the Putnam County Sani-
�� Very truly yours,
Signed Agent for 01-Connell
Tfe
r of operty
R . P4and y Lane
Countersigned e " "'Z Address
Mahopac, N. Y. 10541
Burgess* & Behr, P. C- (Se
OF N
Ad s�tE f�y
ress P0
R D 5 Horsepound Road o� auR�
Carmel, N. Y. 10512
Telephone.
z� ti'o. Abe
Telephone 627-6761
-
PUTNAM COUNTY DEPART MI T OF HEALTH
lv�`•.L.'ir'Sl. �L •}4y1i.
Date July 10, • 1979
Re; Propert of John V. 0(Connell
y
Located at East side Canopus-Hollow Road _m- hut. Valley
Section 57 Block 5 Lot 2
Gentlemen : '
This
letter is to authorize Roy A. .Burgess
a duly' licensed
professional engineer �_ or registered architect
(Indicate) -
y fo.r alConstruction Permit fora separate
sewerage system ;.to
j the.above noted property in accordance with the standards, rules
ations as promulgated by the
Commissioner of the Putnam County
at of Health, and to sign all necessary papers on my behalf in
with this matter and to supervise the cons- tr.uction. of
said _
systems in conformity with the provisions of Article 145 or
l cation Law, the Public Health Law, and the Putnam County Sani-
�� Very truly yours,
Signed Agent for 01-Connell
Tfe
r of operty
R . P4and y Lane
Countersigned e " "'Z Address
Mahopac, N. Y. 10541
Burgess* & Behr, P. C- (Se
OF N
Ad s�tE f�y
ress P0
R D 5 Horsepound Road o� auR�
Carmel, N. Y. 10512
Telephone.
z� ti'o. Abe
Telephone 627-6761
U
FIELD CIMICK. L* ST
-
Date:.
IN LTTAL SITE INSPECTION
Yves
No.
Comments
. .
Property lines or corners found. . .
V/
_
Can estimate house location . . . . . . . . .
Will driveway need cut . .
Must trees be removed -note these
Is deep hole representative of 'entire SDS area
Additional deep holes needed. . . . . . . .
Sufficient SD3 area available considering
driveway cut, house location, separation .
distances, etc. . e
DEEP HOLE DATA
Depth:
Water elevation: Ar/vAAO
.Rock elevaticn : &1oN,,o
Soils descr:i;Dtior.:
te:
FINAL SITE IItiTSPLCTIO ` Insb�T
Douse located ub.ere shov,n on approved: plan.
SDS located where approved . ... . . . . . .
_
length of trench mcc. ;urea
llidti of trench average
Slope of the line and trench acceptable .
Room allowed for exp- ansion trenches
_
-
... �. ' _
;rh11�se _ •_ ='
- J
natural soil not stripped or SDS area
unnecessarily graded . . . . . . . . . .
_
10 FL-. maintained from prop.line and
20 ft. from house . . . . . .
Separation of trench froin house, tell
etc. follows plan . . . . . . . ., . .
_
Ni- 1,mber of bedrooms checks . . . . . . . . . .
Stones.,. brush.. stur;ps, rubble, etc.. greater
than 15 ft. from nearest trench . . . . . .
15 Ft. of peripheral soil horizontally from
trench
Junction boles properly set
Could surface run off from driveway., roads,
• ground surface, etc. channel near SDS
area
Does lot drain,tiipe anpear O.K. in area of SPS
FINAL GrADING OF SITE ACCEPTANCE
a
7)rjr,'T IT Ij
n datr), sh.-ot;
Cst deli
Min. '-_1'0'" porc t pt
-
D ITO] .- I _e -3 _O, 0.K.. for
Corr,or,ate Af'f'idavJi.'G fc)p otiie
for
fp.tter 1Jatc'3. I
T -0 _Y' If ripp ica --T.'-e
I
varirjmc�- requesiled-s-cic,-1 no,uca ort Plans apps.:
1f chant i.s prcTposod"
Faand,,ation 1."'alls
D,dst-inf; contou-rcs, shown l show, neT,.7 contour's)
to
Slop-s for-driv_--vay culls, etc. shol-m
1-Tater Q'.rv--Lco 1-.n-- location
s - L r L I I I Ili, rch la-ke tc. 3. 17. xpari' -I
0 ic.1- e, :1. 0 1
Footir (brain, etc.. lo'rlati on
to
t
Top slope o
bottom slop- fil
Percolation tests �nd demp test pit 'Loca---i.'on
T7
Septic 'Garhk size and confornocance to std.
t 0
3.B.R, house 1-:1'
[Tot, SC setback s1nown
lan-c trees
V.
1-10 s, tank
vate-i, i-azn111 '"u _T.-u. -of, PL 6flo•i-1-1 ------
tb
Plan and profile Sr q
I_
fill. othor wells and 'ST5,-�Sc-F---- ea, '200 ) --
os
Slim-in 'bii -re-fe,
T 11 6- P3' i ourlds-clearly
shown)
p 7
EPAR)A-l' 1011 DIS"LA-KES SPIE"'C"'ITTE'D ONT PLAN
D t.o P. L.
t C)
Faand,,ation 1."'alls
to
Nezal:'Ost well
I-, o
s - L r L I I I Ili, rch la-ke tc. 3. 17. xpari' -I
0 ic.1- e, :1. 0 1
to
t
.7
Gm,�airi dr_!-!•J.n
'
to
t',?ator Iine
t 0
Storin drain
t o
lan-c trees
1-10 s, tank
tb
10fL60
Pip" 1'1:'01"I _r dl,lain (?,; fckj-U-1-11;
.F
L7 2 of Filed Subdivision Map 1465 ..Sheet 1 of 2
PUTNAA COUN'] -PARTME"�%1' OF. HEALTH
DIVISION OF EN-,.:;1-'?ONMENTAL HEALTH SERVICES
COMM OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NCl.142 -639
ohn V.
_.Ownex(iohn CO.'Agor, Agent) AddressR D 1-Mandy Lane, Mahopac,,NY
Located at (Street East side .Canopus us See. 57 Mock 5 Lot 2
Hollow Road east
aUe neares cross street)
Municipalit y Watershed Town of Putnam Valley New York City
SOIL PERCOLATION TEST DATA REqUIRED TO BE SUBMITTED WITH APPLICATIONS
4,
5
Notes: 1)* Tests to be repeated at same depth until approximately equal soi
rates are obtained at each percolation test hole; A data to ,
e-submitte
for review.
2) Depth measurements to be made from top of hole.
Number CLOCK TIME
PERCOLATION
PERCOIATIO".
Run
Eiapse
De p th
to water
Water-n-v--el
No..
Time
From Ground Surface
in Inches
Soil Rat(
Start7Stop
Min.
Start
Stop
Drop in
Min./in dro,,
Inches
Inches
Inches
9:18-9:2h
6
21L
25
1
6
minutes
2 9:21! 9:28
4
2L�
25
1
-4
9:28 9:33
6
24.
25
1.
6.
4
IJ
19:18 9:,24
6
24
25
1
6
2 9:24 9:28
4
24
.25
1
7
39:28 9-28 9:35
7
25
1
7
49:35 9:4�
7
2)'1
25
1
7„
9:42 9:49
7
24
25
1
7
5
2
4,
5
Notes: 1)* Tests to be repeated at same depth until approximately equal soi
rates are obtained at each percolation test hole; A data to ,
e-submitte
for review.
2) Depth measurements to be made from top of hole.
Soil Rate Used 9 M1.n/1 "Drop: llhb101V S.D. Usable Area Provided 6 000 SF +-
t
No._of Bedrooms 4 Septic Tank Capacity 12.00 Gals. Type Precast cone
Absorption Area Provided By 41 8 L. F. x24 x width trench.
Comply with specs on plan her
Of it EW YOa.
1._ Imme rtoy R. JJUrge s s - Signature
Address Burgess &; Behr, P. C.
RD 8 lorsepoun o
Carmel, N. Y. 10512
i._" THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
5U RV�����'�
+� Soil Rate Approved Sq. Ft /Gal. Checked by `R °FESS►ot�P D
,te
,:,Lot 2 of Filed Subdivis i drj_14ap 1465 ...Sheet 2 of `-2••
_._ _
F ... .�. -.. c_� a1 S• ... .cc
TEST PIT -DATA REQUIRED_ Ti,. _ _'r1BMT.TTFn_WITN gPPT Tr�m-rnrT -
+..,;'� y.i _ 1'.'f •'iJ... �. a 1.Ll.rw _w.H'c+...•... r =. .. .—. ..•.
1`1{x`1 •K, I J1 ,1`1 �lu `/� _ _ A --
. C' -- — L1:JI✓Vlll �l ��/�Y Vl, {.�t/��t ' J'UIVTERED IN TEST HOLES
.t.
'
DEPTH
HOLE NO. 1 HOLE,; NO. HOLE NO.
G.L.3rr
To soil
'
It
611
balance sandy, stony gravel
f
It
E
1211
j
'
i811
It
j
2411
tl
}
3011
1.
_
36tt
'
t
42"
,811
It
L_.
04 11
fi
L..
:60"
P,
6611
P?
211
It
t
ii
7 8 if
1P
nil it
1. :`INDICATE
LEVEL AT WHICH GROUND WATER IS ENCOUNTERED none
;..
INDICATE LEVEL TO WHICH WAZeT LE EL RISES AFTER BEING ENCOUNTERED none
Burgess
TESTS MADE
BY �:: e,�r, Date 6/29/79 '
Soil Rate Used 9 M1.n/1 "Drop: llhb101V S.D. Usable Area Provided 6 000 SF +-
t
No._of Bedrooms 4 Septic Tank Capacity 12.00 Gals. Type Precast cone
Absorption Area Provided By 41 8 L. F. x24 x width trench.
Comply with specs on plan her
Of it EW YOa.
1._ Imme rtoy R. JJUrge s s - Signature
Address Burgess &; Behr, P. C.
RD 8 lorsepoun o
Carmel, N. Y. 10512
i._" THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
5U RV�����'�
+� Soil Rate Approved Sq. Ft /Gal. Checked by `R °FESS►ot�P D
,te