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HomeMy WebLinkAbout3259DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -54 BOX 26 ME I i,y% : . r , : r � i 1 ILI r I i 41 Im I IN ON r ' IN ■ IN 03259 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. John D'Attore 240 Church Road Putnam Valley, NY 10579 Dear Mr. D'Attore: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 3. BONDI County Executive _ ROBERT MORRIS, PE Director of Environmental Health September 18, 2008 Re: Addition- Approval — A- 155 -08 No Increase in Number of Bedrooms 240 Church Road (T) Putnam Valley, T.M. # 71-1 -54 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department date September 18, 2008. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3,--A-11-plumbing fixtures must be updated_ with.water_saving dev1ce5,_i;e. ?.new_low flush toilets, 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Respectfully, l (JoscipLh S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Far (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 V, 0 9-6 0 27 0 PUTNAM COUNTY DEPARTMENT OF HEALTH ROUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDROOMS -73. ALL SUBSEQUENT REVISIONfALTERATIONS. TO THESE HOUFE PLANS MUST BE SUBMITTED TO THE KDOI-I FOR APPROVAL a rt.NATU,�e�� ATE O O ('F,%) 7 PUTNA NI COUNTY DEPARTMENT OF HEAL HZ L ROUSE PLANS, APPROVED FOR U.&DROOM COUNT COUNT -,I 3 BEDROOMi NS TO THF� ALL SUBSEQUE-',- UEVI 0 T PLANS MUST BL �ULIM H FOR IT-T , TITLE ('F,%) 4 t."40 PUTNAM COUNTY DEPARTMENT OF HEALTH WAJSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDROOM; Vko 73. ALL SURSFOr'PNT gUiiD NA%.,Sr HE 'WH TED TO THE PrDoll FOR APPROVAL SI —0 A A)TU ­RF 16 CQ 1 z, i r0 'e^F +MS a � s g .t —rT'fi' _t 3't - r s , f. Rev 3/8 ` PUTNAM COUNTY DEPARTMENP OF Divialon of Environmental Health Services, Carmel, N X.10 512 xi " i Engineer Malt ProvideU 3© iL 4 r a P CA D Permit M _CERM TE OF.CONSTRUCnON COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located et ( `^ Tax-N. Block Lot o Owner /apPllcant'Na me G Formeely Sabdivlsion Name ���!CQr � Subdv. Lot q / Zip v A _. Date Permit Iseaed Mailing' .. ,.. _ . Separate "Sewerage Syetem'bnut by_�p�Q.L�'1V � � n � Adaieis o2 Coneletng of Gallon Septic T and D r 0O Water Supply: Pb Sapply From Address. or Peivate SaPPIYDriBed,by Address gyQ ! ' ; Has Erosion Control Been Completed?.: Zve� ..,g Nmnber,of Bedrooms Has Garbage Grinder Been installed? w other. Regtdrementa I certify that the system,($) as listed serving the above'premiaea:vrere construct entially -ae sh o ;t e p lsrof the completed work C copies of xhicfi' are attached and in`accordance,vith the atnnda ds iules`and,regu ti s' in ac anba:v the fal lan, and the,pe- t issued by the Putnam County Depar nt':Of Health OJ Cartifleb by P E R.A. Address /u l.IgnM No. Any person occ40Yi09 premises served by'the above system s $hail rom tl take such Ion as maybe necesia► to let ure the coirectio� of. an unsanitary O P D y' y y' . y conditions resulting from such usage Approval '.oi. the separate, sews►aye system shall become null and void as vwh.aa a Oubi'o pniiary gWe►<becomes ivanable-and the e= approval,. of the - private vyater supply shall:become:i ull and'voi0 when a ' -public, "vista- wpply:'baconas available Such approvals are wb)eet to inodifleation or ehanq! when ?in the )udgment_'of the Commissioner -at Mestlth,;such revocation, rno0lfkatton or change Is.:heeeuary.. Data -� B r -�� 7 _� Title c3ui APPENDIX N CO WELL COMPLETION REPORT �a Office Use Only DEPARTNPNT..OF; .HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH i.WELL LOCATION 51RE 1 AADURE55: WNIVIL "C' Y b-— TAX GRID NUMBER: U"!& � �C% C!' /7IG�'i� OWNER NAhg(VATE ADORWELL ❑PUBLIC USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRICOND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE / YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE 50 gal. REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH �' ft. ����-�-� o STATIC WATER LEVEL�_ft. DATE MEASURED DRILLING EQUIPMENT `ROTARY ❑COMPRESSED AIR PERCUSSION 11 DUG /O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. OPEN :HOLE IN BEDROCK ❑ OTHER -CASING TOTAL LENGTH ft. MATERIALS: ❑ STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE ft. JOINTS: ❑ WELDED O THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT Ib./ft. DRIVE SHOE: O YES ❑ NO LINER: ❑ YES ONO n�rs �u ncLrY DETAILS - - DIAMETER ti , :. - SLOT SIZE — - I� r tsT'cifft) ;I@ �e't TJ'SGIh~y:(ft) �. e ZE:i fj��R! ❑YES 0u0 HOURS FIRST SECOND GRAVEL PACK Cl YES ❑ No GRAVEL size LDIAMETER PACK in. DOEPTH n BOTTOM It. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED I tests were done is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER i ❑ YES ❑ NO : 'WELL LOG jf more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water Bear- ing well Oia- meter In FORMATION DESCRIPTION coE (t. (L WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD grm. Surface ,:' 0Ff_8S10fVq WATEP O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO ' STORAGE TANK: T ' CAPACITY WELL DRILLER NAME F OF ADDRESS IG RE I •�. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP 1\11� water sapplyi_ Btat 4#, Type Ntrmbe of 'Be" Other:Regttireme� I,certify thgt.tfi Date Address _ Any parson occupying premises served by he conditions resulting from such -usage App ►o available and the.aDDrovel ;of the, private w5tei subiect t4in'' "ificition 'or change' when, .,in, -1 Data !/k±=e 2 z melon Control Been Comi N' age Gunder Been Initi .B3 Address �entially as eh o t e p 's of the completed work ( copies g✓in ac ance w t]t fil " "lam and tha permit issued by the ��/ Pfj R.A. r A °- Umnse No: ' c/o 6 -*(39, 34,- - I APPENDIX N CO WELL I COMPLETION REPORT I?EPAR-TMqT,_O.F HEALTH. . ...... - 17 Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH e Only Office U_' s —r—SIREETAOURESS: WELL LOCATION TOW"IVIL i Ily W GRID NUMBER: -Y-b u" A O'n """ c vc- A, -7 0�- 3 0 WELL OWNER NAM AD BIVATE 0 P USLIC USE OF WELL 1 - primary 2 - secondary RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS 0 FARM ❑ TEST /OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT z:=_-- /I t5 qpm.1NO. PEOPLE SERVED �/ EST. OF DAILY USAGE 50 921. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH f t. I STATIC. WATER LEVEL 3d ft. DATE MEASURED DRILLING EQUIPMENT `ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH fL MATERIALS: ❑ STEEL ❑ PLASTIC 0 OTHER .CASING LENGTH.BELOW GRADE f­L JOINTS: OWELDED OTHREADED OOTHER DETAILS DIAMETER in. SEAL: ❑ CEMENT GROUT 0 SENTONITE 0 OTHER WEIGHT PER FOOT Ib./ft DRIVE SHOE ❑ YES LINER: OYES ONO DETAILS _-I ..,DIAME-11:11jig), �SLCT-SIZE-77 IIIST, 0 YES 0.40 HOURS SECOND GRAVEL PACK CI YES 0 NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH _tL BOTTOM OEM — it. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED i tests were done is in- 0 COMPRESSED AIR formation attached? C1 SAILIfl) 0 OTHER 0 YES 0 NO WELL LOG "more detailed formation descriptions or sieve analyses are available, please attach. — - - DEPTH FROM SURFACE w", u Bear- in.9 Dia- meter In FORMATION DESCRIPTION czae It IL WELL DEPTH DURATION hr. min. DRAWOOWN It. YIELD grM. Land Surface 414 x"ofESSIOP/4' 0 WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: T CAPACITY o, n, WELL DRILLER NAME >r OF %4 OATI ADDRESS RE PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP 1IA N ' fr - %-- ' Owner r or Purchaser of Building Section oc NaN C IK Location - Stre t Municipality j Building VYpe ` Lot Subdivision Name Subdv. Lot # GUARANTEE 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 systetn 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 success- ors, 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 "o'f the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- atinri:... t: 3e. �Drctar_ �of- -�hg,D�v�,sv_n:r"?S'.�irefYt "a1 h`ealth =•ezes of the Putnam County Department of Health as to whether or not the,fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the sys em. Dated this: day of 19. Signatur Title ( ✓ Corporation Name if -corp. Lb 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, Putnam County Department of Health 0#;V rr -Ad oa- ; ner or Purchaser of /Building Bui'lding 'Cons 't ucted by' Section ' t3To•ck Lot Subdivision Name Subdv. Lot # GUARANTEE 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 the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, 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 determin- -- the -D4 r :;ter ;af:tii :L_ vis_xc%i fA Eri'viE ozmP >rta1- eY It Sernzc- es';�_. _.. -- of the Putnam County Department of Health as to whether or not the,fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the sys em. 1 Dated this: day of 19. Signature Title Corporation Name if -corp. _11qo cam-& 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, Putnam County Department of Health YUINAM C AUNTY 1)LPP -C1MrN1 UY HtAuju i DIVISION OF HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SXSTER FITLE, 110- Owner c. C4 4" n' Az xxar Address 1927 Ems, 4o.J a�Jie 13�a� �Y. Io4CQ l Located at (Street) Sec. Block Lot j (indicate nearest cross street) Municipality 2j=t, ,4,M VAA_L.Cu Watershed SOIL PERCOLATION TEST DATA REDUIl D TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test Zg HOLE NUiBER. CI= 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 Inches Inches Inches P- 1 19:07 9:31 Z4 z 3 %g zcQ 'la 3 g _ 2 9 :32, 10:5 43 Z 3 3/4 Z CG 3/ 3 14 3 io. I CP 11:10 C90 Z5 3/4 Z C- 3/q 3 z0 4 1 I. 17 1 Z-, 55 79, Z,�} Z-7 3 Z C9 512 : 3C-P Z,161 85 -,74 Z 7 5 2& � -Z 19 :10 °1',38 Z'5 2A 2 Z7 — 29.�P1 1o.:Z4 45 Z� �. Zg 3 IS 31o:Z5 11:32 C97 25 z8 3 > >- 4 11 :�y3 I ;o0 87 Z� 3A Z7 5 z:3Z. °il z. 4 3/4 z? 1 2 3 4 5 NOTES: 1. Tests to be repeated' at sane depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurenents to be made from top of hole. rev. 9/85 T � 8Y 8�� -�w� ccQ^ - ►v-� TEST PIT DATA REQUIRED TO BE SUBMI WITH APP TION DESCRIPTION OF SOILS EKMIMWIN TEST H DEP'T'H HOLE NO. I:�P' ~-[ HOLE NO. - Z. HOLE NO. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:i 4.}'p DATE: DESIGN Soil Rate Used '50 Min /1" Drop: S.D. Usable Area Provided No. of Bedroans .4 Septic Tank Capacity I Z SC> gals. Type Absorption Area Provided By 272 L.F. x 't P" Other IOOo Name +�� — !! • Address SEAL��; # THIS SPACE FOR USE BY HEALTH DEPARTY1ENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date F-D lP-L c� i-1 -`=_` _�:+ � Cam__ I •� j + CNII;_ a c ve= V11 Dam c= piac=��zL 2:T I I c_ I 1 LL �• fir- �� ar a- i,.'_ .�. �^..r °♦ LT • e_ C,_ ♦ C=am e_ 1 ,0 ft- %- _mil -_C. t:--7 7_' =^ 1 --UT SCI: 77 F- cO� C= et c _ s _� -R. ...._r v -a- - Y• _ ��i =-� - �D T_ i i- -_r• -o icy C? r^ - - C_ �c r "3 -^ i c 1/j 7 I_CG�_ c 10 i 5 = z_ cr r-=— r i �- _ rV . B-- _ . B _ V_ L L„=•-. anz C- C „ �`. -- Cca'— AO _ L l _ c cv_ c_ � �_Ya5 CrCC� -'i C_CL'• �.f.' DER C_ h ush with 1 ^5_Ge OC 11 C s`CL u E _ = = z- 2 ri G:^�_ = i c `1 1 cCC^rG? _ ^_C _ //t� .T T •� _ �= & C- .tC Ev- _cam- � • C C_ i i _ACC. - -. r -- r a y I OM I ! I � I 001_ IF ■ r DEPTH G.L. 6" 12" 18" 2411 30" 36" 42" 48" 5411 60" 66" 7211 78" 84 ff TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE 2NO. HOLE NO. HOLE N0. % �5' P zww I W- INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 'T' -TO %. T i '' _:i IE 1-? T . +T'. TESTS MADE Date _ DESIGN Soil Rate Used OC ?I /1 "Drop : S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /CCC) Gals. Type Absorption Area Provided By L.F.x24— width trench. n ! � � Other � _ Address Signature_ SEAL I� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date 4 FUITGM t=='d DEPARIMN.V OF HhAU11H DIVISION OF EWIRUZ2XML HEALTH SERVICES DESIGN DATA S=--RJBSUFACE SEWAGE DISPOSAL SYST— M FIE-U-NO. Owner J-Ol 4" D'AUKx2r. Address —19z7 e-t%yob Located at (street) Cauj-g=" 17-J77�o Sec. Block Lot (indicate nearest cross street) Municipality Elh2gA4-A VA, L. Watershed. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-soaking Zz. -12>9 Date of Percolation Test HOLE NUABER. C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fraa Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. start stop Drop In Min/In Drop Inches Inches Inches 19:07 9:31 Z-4- 2 9:3,2 10 -* L5 -45 Z3 3/4 Z Cq 3/4 3 14 3 IVIC9 11:10 UO z 5.-3/4 Z C. 3/4 zo 4 11'. 17 1 -Z 1 35 79 Z.4 Z7 5L2'Y-9 V.61 135 Z9 Z7 :,-Z- 1-9: 10 911!5s ziao Z-7 . . . . . . . . . . . . 29',S9 tc>,:z4 4S ze 31o,.ZF:) 11:32 &7 e-s 3 Zz 4 11'.15b I lcc>. 67 7-4 3 /4 a 7 5 L, 01 e-.-bz. % 2.4 "/4 Z-7 'Y4 3 3p 01 2 3 4 5 Nom: 1. Tests to be repeated at same depth until appradzately equal soil rates are obtained at each percolation test hole. All data to' be submitt� for review. 2. Depth measurements to be made from top of hole. rev. 9/85 V-%- �� SY 8AL-Vw10 � cce^),a- ►�'°� TEST PIT DATA RDQUIRED TO BE SUBMI WITH APP TION DESCRIPTION OF SOUS MMMMO IN TEST H DEPTH HOLE NO. HOLE NO. - .Z HOLE NO. Z:�F .- 1' 2' 3' 4' 5' b' 7' 8' 9' 10' 11' 12' 13' 14' ;i- .rsu�(IM'�,s�, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED N DEEP HOLE OBSERVATIONS MADE BY:y DATE: DESIGN Soil Rate Used _moo Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms 6} Septic Tank Capacity l ZSD gals. Type Co►.leAamj'E Absorption Area Provided By 27Z L. F. x 6ftb=tEe91W& �'r P" <A.L.`.EQimA.�, Other looc> 4f AL--. Pc11--►4=- 'I z Address SEAL °° 059111 01 T —r f OF THIS SPACE FOR USE BY HEALTH DEPARD.NT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date i • op, 00 _v a _ t CNl1.E' ^� T. -- CL AREA. 7 r'i - Date of placanzlt Z•1 w;II :E i C_ Mazur'=al scii r_cl C_ Ems^.. -°, t:•T_"•'= _. etc- , C =_C -'� ti�,,=-*1 15' - E_ 100 ft- f =c.. Nc =_ CCt I_ DIc {cs_. crcr a. EEntic t=- _ t11 11 C` sue. C� sG_ _ E� �•JC L�C:I - wa"- L= -C f- -CSZ L f _ j- il-=CN I• -' 1 _ T __C`� ''rte_ _ _' O T i i a_- ���ttGrc C= r7� c= C =_; Zl ii-! t= _ZC-1 1-1 pi re E= °t.= e= C I I i I I ..ice I wm CCI: �? i7` S tc s < 4' i n E _ C'- t i n C`.;_ = i - c `l 1 ; cCC^•rG? ^C LC L' i --m C_ it�CL1_ ^•C Cr� _= C_= C__LC� away f=cm 525 cr C._Cil C_ .- _i C^ S? GLcS C= _t =Y - -x- 5_z_ C_ C= c_ --T - ^ccc- F_= -- _=r,,7. V_ V- w =•- l._ c� =rC� C- C__ c- 18" " 4._ Cv_'�� L. A-1 1✓1Cc5 C:=S f !,�71 W4 th ill--: de of hCL I i I I ..ice I wm CCI: �? i7` S tc s < 4' i n E _ C'- t i n C`.;_ = i - c `l 1 ; cCC^•rG? ^C LC L' i --m C_ it�CL1_ ^•C Cr� _= C_= C__LC� away f=cm 525 cr C._Cil C_ .- _i C^ S? GLcS C= _t =Y - -x- TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRI�PTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO j HOLE NO. J- HOLE NO. % G.L. 6" cSG z r 12" 18" 24" 30" 36" 42" 48" 5411 60" 66" 72" 78" 8411 e INDICATE LLVEL AT WHICH GROUND WATER IS ENCOUNTERED T� k H; r''I' R f C ` M N 1?,T T i, �1 .�. ,,, :_�.._..ji,x, ..._�.r- _L �- � .•G_ _ . �� _.. - j.A ��' °:B NG.:, :-C` �Er_���___ TESTS MADE BY y Date _ DESIGN Soil Rate Use�Min/1 "Drop:. S.D. Usable Area Provided ��1 No. of Bedrooms Septic Tank Capacity �C Gals. Type �.�✓ Absorption Area Provided By�g�L.F. x24" — width trench .^ _ A 1 � �` �/� Other ;, / 1 _ Address >ignature_ SEAL i� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by 0 Date .. — w -� ! -. • . i0 s� -. /' .- c :. .. � r� hr - .� .. \. ec`-s '_ . -+�- . � .1 w�.� .. 'in -.. a.✓ .e'y' vim.''- . v a YL _ M . `M�_ .�(�. r ...e ..�1.'.S•� rc. `yy� �yi�y < ,. -r k R 1000 CAL 5EPTIC TAN JOOO CAL PUMP CHAMBER Q JI 4 (p TH15 15 TO CERTIFY THAT THE 5EWACE DISP05AL 5Y5TEM WAS CON5TIZUCTE0 A5 INDICATED ON TH15 PLAN AND THAT THE 5Y5TEM WA5 IIS15PECTED BY MF_!5EIff9-RjF_ L tv '---D'N-ACC STXNDA - L AND RECULATION5 OF THE PUTNAM CO. DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 0 PREPARED : RAN AN F WLER X. LA co L TH15 15 TO CERTIFY THAT THE 5EWACE DISP05AL 5Y5TEM WAS CON5TIZUCTE0 A5 INDICATED ON TH15 PLAN AND THAT THE 5Y5TEM WA5 IIS15PECTED BY MF_!5EIff9-RjF_ L tv '---D'N-ACC STXNDA - L AND RECULATION5 OF THE PUTNAM CO. DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 0 PREPARED : RAN AN F WLER X.