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BOX 26
03209
Y r�
PUTNAM COiJ11
Drvrsron of 'Environtmf
,TPARTMENT. OF HEALTH - - , i' I
PROV.
nth:` Sernrcea, Ceime/ N Y 10612 PERM
AGE `DIStoOSAhaSYSTEM :. PUfiySM`.
MU c
PV 10 86
m
PUTNAM COUNTY DEPAkf 4ENT OF HEALTH
DIVISION OF ENVIROAL HEALTH SERVICES
DAVID GIUSTI 77 2 5
Owner or Purchaser of Building Section Block Lot
OWNER
Building Constructed by
SPROUT BROOK•ROAD
Location -.Street
PUTNAM VALLEY
Municipality
ONE FAMILY RESIDENCE
Building Type
77 - 2- 5 .
Tax Map Number
MAP ##1.3- CONTINENTAL VILLAGE
Subdivision Name
Subdivision Lot #
GUARANYPEE 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 systein 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_ t.Q....such: syptgn,, ,e:K ept. where _.the failure to operate :,prpper -l_y -: is
irf °cam Wit-= i��liyeiiz' =ci%iC rsf =the i of g > ..
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 th building utilizing
the system.
Dated this day of Jut1w-1907 Signature
ED KRISTOFERSON
Title OR
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Name (if Corp.)
DRING LANE., PUTNAM VALLEY,rTY
Address
Yorktown Medical 'Laboratory, Inc
.. Collection Station Used:
321 Kear Street
Heights, . Y. 10598 Carmel _ Peekskill
Yorktown
g Mt. Kisco Nev City _
(914) 245.3203
Director: Albert H. Padovani M. T..(iI�CPJ._ Date Taken: •?
�__._'_ /
-v8te` Received
Date Reported: 3
Y���� �✓ /GL S' �� Collected By:
Referred By:
Sample Source: IK77
1/ L
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY.OF WATER
GENERAL BACTERIA
Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
^ Total Coliform Der 100 ml
-Fecal Coliform ner 100 ml
Fecal Streptococcus per 100 ml
.MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN Index ner
Fecal Coliform: MPN Index per 100 ml
W.OTHER ANALYSES _
a
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) WAS NOT) (NOT APPLICABLE
OF A SATISFACTORY SANITARY QUALITY ACCORDING 0 TH NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT TIME OF COLLECTION.
Albert H. Padovani,"M.T. (ASCP), Director
LEGEND
RDS = Recommend Disinfect -
ing Water Source,
TNTC a Too Numerous To Count
CONF = Confluent
< = Less Than
> = Greater Than
" WLLL L.VP1rLL11V1V A.ZrVA1
Iy :.t DEPARTMENT OF HEALTH
Division Of Environmental Health Services
.i,4
•a
`PU1'NAM COUNTY DEPARTMENT OF "HEALTFi
Office Use Only
i P
WELL LOCATION
SKETAINESS
: WN TAX GRCO - numS
WELL OWNER
AM ' ADDRESS:
o
O PURL CE
USE OF WELL
1- primary
2 - secondary
,M flESIOENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /NEAT PU O ABANDONED
O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED =/ EST. OF DAILY USAGE'- --$aL
REASON FOR
DRILLING
XNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH D 0 ft.
STATIC WATER LEVEL =� ft.
DATE MEASURED
DRILLING
EQUIPMENT
ROTARY O COMPRESSED AIR PERCUSSION O DUG
O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED O OPEN ENO CASING *OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: STEEL . O PLASTIC O OTHER
LENGTH 'BELOW GRADE f .
JOINTS: ' O WELDED )THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT O BENTONITE-liOTHER
WEIGHT
PER FOOT f Ib. /It.
I DRIVE SHO�YES ONO
UNER:❑YES NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRS T
O YES - ONO.
"�
SECOND: _.
_ .. ... ..
GRAVEL
SIZE:
_
- ._ ..
GRAVEL PACK
O YES
O NO
DIAMETER
OF PACK in. I
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST pumping
If detailed
M 00: O PUMPED tests were done is in-
COMPRESSED AIR , formation attached?
O`8AILE0 1] OTHER ; O YES O NO
WFLL LAG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
suaFACE
"'I"
ear-
ing
well
D'a'
meter
FORIAATtON DESCRIPTION
poi
It.
IL
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
9Cm
Land
Surface
r
NEATER ff CLEAR TEMP.
QUALITY O CLOUDY HARDNESS'
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED? O YES ONO
STORAGE TANK: TYPE
CAPACITY a/,O GAL.
PUMP FORMAT101i
TYPE CAPACITY
M DEPTH
MODEL --� - VOLTAGE HP
WELL DRILLER NAME—>,0, Q K_ DATE
aooaES3�� StcrrKTURE _ L�? ,r
`�.�¢� 7.
S
4'
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL VOTER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
FIELD INSPECTION REPORT �- --
:;.� INSP. BY:
(Name of Owner) AStreet tion).
INITIAL SITE INSPECTION YES NO COMMENTS
Wetlands on/or proximate to property .............. L
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 Description
0 ft. e
6 ft.
ft.
2 ft. `
D.H. - Deep 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 Descriotio
0
ft.
3
ft.
YES
6
ft.
House SSDS located per approved plan .............
9
ft.
12
ft.
soil Descr
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
(ANMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.. ....... ... ........
10 ft. maintained fran 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 in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE.. ... .....
��
WLLL UVrirJ,Zlly" rzrvcxt
�� a
p, .e DEPARTMENT OF HEALTH
Division Of Environmental Health Services
COii`ky °DEYAItl'hll;N7` 6F HMTii
Office Use Only
_
WELL LOCATIONoer,
St
ET ADDRESS: TOWNI TAX GRID NUMBER:
WELL OWNER
p ADDRESS:
o 7
O PBBUCE
USE OF WELL
1- primary
2 - secondary
,1E9-RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /CONO./11EA7 PU O A ANOONED
O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT ____ gpm. /NO. PEOPLE SERVED —'"j EST. OF DAILY USAGE — ---- gal...
REASON FOR
DRILLING
NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
0 REPLACc EXISTING SUPPLY J DEEPEN EXISTING W,,E..L-�L
DEPTH DATA
WELL DEPTH 0 D it.
STATIC WATER LEVEL �* it.
DATE MEASURED
DRILLING
EQUIPMENT
`ROTARY COMPRESSED AIR PERCUSSION O 'DUG
❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
O SCREENED O OPEN END CASING. *OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: JZSTEEL O PLASTIC O OTHER
LENGTH .BELOW GRADE ft.
JOINTS: ❑ WELDED tMREADED 0 OTHER
DIAMETER in.
SEAL: O CEMENT GROUT ❑ BENTONITE--aOTHER
WEIGHT PER FOOT �.� 1b./ft.
I DRIVE SHOE;KYES O NO
UNER:OYES NO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
DETAILS
FIRST
❑..YES .. [LNO _...- .
.SECOND-
O YES GRAVEL
O NO SIZE
GRAVEL PACK
DIAMETER
OF PACK in.
TOP
DEPTH R
BOTTOM
DEPTH It.
WELL YIELD TEST if detailed pumping
M OD: ❑ PUMPED 1 tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER 0 YES C) NG
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach. p Y
DEPTH FROM
SURFACE
Walet
pear-;
Bear-
well
Oia-
mater
FORMATION DESCRIPTION
CODE
It.
ft.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
gCm
Land
Surface
i
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE ,Q --
CAPACITY O GAL.
PUMP INFORMATION
TYPE CAPACITY �
MAK DEPTH 14FV
MODEL — � E VOLTAGE 'L HP
WELL DRILLER NAME zC. [DAII
a 3
ADORE SIGI13fTURE f`
0 1
v t V
PROVIDE k6' I F
F
R LM I TUTNAM COUNTY" DEPARTMtN OF IA N
C# E
jFI.
D Iy Isloh :of thvironmental.H641th N.
y 10512
CONSTRUCTION PERMIT E W
.FOR SWAGE � Putnam.; Valley ..
'
Town7q or
r;Village'.
7.7,
Subdivision Ma-. #1.3— Continental Villsyw•
i - , : . , 1-t V Re7 e ial
. 0 Revision 11,
o I "6rA&resp , G�Opt k, Sprout Br: R4:i FU�. , 41 iNY 10 5a9, f
Previ.66 Approval
..
Building Type. Fam-Res- Lot. Area 1 2 3 OAq Fill Section only 0
Number of Bedrooms 3 I.Design Flow G/P/D 600 P.C. H. D. Notification Require
1000 64LF of 41 x 40 'C*
ewerage-Systern.to consist of dal.''S01tic Tank and
Separate S qnp. Galleries
To tie constructed by NOT 'SELECTED Address
Water Supply: Public Supply From
XXX NOT SELECTED
Private'Supply to be. drilled by
�Addreis ti
Other Requirements
I represent that I am wholly and compldtely-rdsponsible!or�the design and location of the proposed, system(s) ; 1)'that the separate: sawage.,disposal,iystern
above described will be r ct'd" shown, '"I %644ppr.64ed amendment - .jhl�rlfl cedidanZ6 With the standards, rules and tions of.-,;the u
q,:const u e as on � i
f , eTe .0, and. n a. nam
e:=a Commissioner County Department o - Health; an a on'completion - -t - hereof a "C"4r,tificat's, 'o'f-Coiisir64ttion.C4DI��plianciD--*saiiifa'ci6ry.tb iii6n 1' hwill
be submitted to the Department ; and 'a,w'ritten-'g'u'a-'r'an't-eit.miill.b6,iurniih4d ihe`6Wnir, his sucdessoiis. heirs or,iisigris by the builder 'tkat""Id- b,uilder will
plate In •good operating conzliti6h,any part of s!,ld, . saW : I - gq iiiij� during the peirio' of..'AWO'(2 ) years'immeCiStely following- thepate of.the issu-
'-o the' Certificate "
arici of 'the. approval 'f o 'Construction onjpkance.-o original' "any repairs 'th- Vito,-,2i JlAit�-thi aiiilid weli'desc►ibe above
P th the standard' rules Will be located ai.ShoWn on the ap'r-o*ved:pIan,#nd't'fiat, said well will _ I* lie , in _ s _ ta , U0, In accordant- and regt a Wlon's --7 the Putnam
county. Department of Health.
11/11/8-5 xx
Date Signed P.E. - R.A.
Add►eATuSC06tt .Nor. - th DJ2 -jrx 48VMah6p ac. ,,NY 416n. No 11056
APPROVED FOR CONStRUCTIOW This approval ex ires'o year construction of t wilding 1 .has been under I taken and is
pe 6 ii� date. I - ed ass constru
:, . %� Co -
- " )sd;
6 for.; i��, or modi led- nsi ss
revocabi' cause or maybe amen f 'wh s by the C issionei of Health. or- alteration of construction
ne permit. provea ]or ispo' do r "V'- e d ter :supply.' only.
requires a disposal of meit
Date 11W By T1
Rev. 6/85
r- A
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
i: x: -aa t'._ .Y��..._ r . ✓ ..a[. 'C _._. .. -�.- c�- .,....£.. .. � ..: q.Ata.' -'11�T r:i@e. .. i�::lrsi' :.4✓":..SUtlOr_v vuiF.'s2..: ��' .9+"tP.:..-.r'r ��.m03 .K. ✓._'r'l
Date 9/10/85
Re: Property of David Giusti
Located at Sprout Brook Road
(T) 77 Section _____..Block 2 Lot 5
Subdivision of Map No. 13 of Continental Village
Subdv. Lot # 41 Filed Map # 372 -K Date
Gentlemen:
This letter is to authorize Joel L. Greenberg
a duly licensed professional engineer or registered architect xxx
(Indicate
to apply for-6 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
connection with this matter and to supervise the construction of said
°corifo Fmi y 47_.ar
147, Education."haw, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
P.E., R.A.,
Muscoot North,RFD #2,Bx 488
Address
Mahop ac , NY 10541
628 -6613
Telephone
Very truly yours,
Signed ,;,,J.
Owner of Property
107 Sprout Brook Road
Address
Putnam ValleV,NY 10579
Town
737 -1779
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
FIELD INSPECTION REPORT
3)- INsP. BY:
(Name of Owner) (Street - Location)
INITIAL SITE INSPECTION I YES NO CQMD'1EN TS
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. 1 Lot
Depth to G. W.
Depth to rock
Soil Descrir)tii
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D. H. 2 Lot
Depth to G. W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D. H. - Deep Hole
G.W. - Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
0 ft._
3 ft.
6 ft.
9 ft.
12 ft.
Soil Descri tion
DATE:
FINAL SITE INSPECTION INSP.BY:
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Rosen allowed for expansion trenches ..............
r
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ............. ..............
J Q G-vr•
10 ft. maintained from property line and
20 ft. from house ...............................
Distance well to SSDS (ft.)
Number of bedroans checks. 1.. I ....
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench.. ...........
15 ft. of peripheral soil horizontally
from trench.... ...........r........
..........
Boxes properly set .. ............:..... .........
Could surface runoff from driveway,. roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE.. ....... ..
✓ i h ; �...
d
7
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT.
`I -YES YNO 1'r
DATE REVIEWED:
BY: J
`DIFe1C,�AS -t'Fl. •• O,..c'ai43Y .rat' /:�..;�:A: r. - �: >h -•:�~i r�T,:vN .-�'.`�w :. K:sf -• -�; w...C�. - -~nC�"
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
.If PWS - Letter
Variance Request
REQUIRED 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-WS
Trench /Gallery
Pun7P 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 flow
If Pumped Pit & D Box.Shown & Detailed
House - No. of Bedrooms
Wells:«. �SSDS'- s .li.?::�ft:::dQ roper tykter3:..�
Property Metes & Bounds
House Setback Necessary
House Sewer - 1 /4 " /ft. 4 "0; `lope pipe
No Bends; Max. Bends 45° 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 Unc. expan)
15' to Drains- Curtain,Stonn,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland ( Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT.OF HEALTH
DIVISION OF ENVIRON61ENTAL HEALTH SERVICES "
COUNTY OFFICE BUILDING,:CARMEL, N. Y. 10512
r DESIGN DATA SHEET- SEPARATE SE;-,'AGE DISPOSAL SYSTEM FILE NO
Owner Mr. & Mrs. D. Giusti Address Sprout Brook Rd, Putnam Valley, NY 105,79
Located at (Street S rout Brook Rd. Sec. 77 Block 2 Lot 5
�Indlcate cross s reet
Municipality Putnam Valley Watershed Hudson River-
SOIL PERCOLATION TEST DATA REQUIRED TO BE-SUBMITTED WITH APPLICATIONS
4 8:46 -8:58. 12 48 51 3 12/3 =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 from top of hole.
Hole
Number
CLOCK TIME
-PERCOLATION
PERCOLATION
Run
No.
Start -Stop
Elapse.
Time
Min.
Depth to.Water
From Ground Surface
Start Stop
Inches Inches
Water Level
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
PTH 11
8:02-8:14
12
48
51
3
12/ 3 =4
2
R�LS_R��7
.12
48
51
3
12/3 =4�
3
8:28 -8:40
12
48
51
3:':
4
8:41 -8:53
12
48
51
3
12/3 =4
5
.
PTH 21
8:07 -8:19
12
48
51
3
12/3 =4
2
8:20 -8:32
12
48
51
3
12/3 =_
1s2 : -
_ n.a. __.___ , __y;_. _......,.v 3'=
4 8:46 -8:58. 12 48 51 3 12/3 =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 from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION .
DESCRIPTION OF SOILS E NCOUNTE?YD IN TEST HOLES
DEPTH HOLE NO. DTH #1 HOLE NO. HOLE NO.
6 Bank Run
1211
18 "
2411.
3011
'31611
`t 2"
4811 „
5411
It
6011
.6611. ..
7211. , ;. ..
.7811. ..
8411
120" it
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED NONE
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NONE
TESTS MADE BY Joel L. Greenberg Date r,12b,1AC;
Soil Rate Used 0 -5� Mir 1 "Drop: t DESIGN-- S. D. Usable• Area Provf&d -'5 "0 SF"`
.No. of Eedrgoms 3 Septic Tank Capacity 1000 Cals. C
' .
;Absorption'Area.Frovi e By L.F.x24
c .
64 LF of 4' x 4' Con �' F�.
,Name Joel L_ Greenberg lgna ure .
Address Muscoot North RFD #2 , Bx 488 SEAL
a opac, NY 10541 h l;
THIS SPACE FOR USE BY HEALTH D4 -PART1 0T ONLY:
Soil Rate Approved 'Sq.-Ft/Cal. Checked by
o o`5"10
01. NEV'(
—Date
ok
Ct
Q)
I
_L07
0'7
LA
<1
E
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13'
ri
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Ogg
311
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