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HomeMy WebLinkAbout3269DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -74 BOX 26 1E16; -2 ' . w -pi :;; 9 oil r I I41 ' 03269 01/01!1994 21:38 914 - 734 -7320 ALL PRO ROOTER F'41Ut nJ c *Wd'M MW ML -*(=) QW-P IM •PTO PA PMOS 'd QCP tP74% aouePx = UT PMMOJX-d ;gq C4 JTaftz UV4"s •E 'seq= pue am e 1 xaTTnmi •a (Tftimb + -04; auo A pepu=zw sTtwIAIP dkP 19 x *= V +9 4seovxd 81*A3 'XUV4 oTda 04axo *Tub OSZT 408'0) u0r4T=aep W4eAS 'P •(sxaoM asn°q'-b•e) 93UTod PexT3 cmq cq FaT3 s3uavo&w MTe4sut p uoT_Iwol •o 'xaqwm dom =Z pw weq 'OWN loans DTs 'q 'amaa vf.X � •e :BUTMP a3WTIAV UT W40NO JTedaz ;TVq sQ 30 UOTW UW6 'Z "GMMjIdft ;I 'I-4 WMM due 4 WGIM o-M . :BwnTpwo buTAOTTOI wp 41TA PMO xd aim s ' l "i41V paia�eT�ei 20. �ttTb �� gi LWISsSPA pvata�TT =; Tasodoxd 30 TMrn w� a2pbox Am wT;woI �wa�33.TQ •arnam Ta®odstp e6ar as. TauT$T20 M 8d14 amme ;o pae uoT�eol smas uT aq asm xTwdwd :gam iiv Horsdassro�� ne/ - 77V arrmw aasoaaeta AUUM ad" =��a '' f) 'n 7701Y MWA t S�Zffi�D anaaa Nswa Ttgodmia Snew Sw TWOK as Sa:?t MM T M*CBV FH AD ADTSMQ 01/01/1994 21:38 914-734-7320 ALL PRO ROOTER PAGE 02 & A Offices: im -225? 2746 914 nw I�W, 4-232-8888 914-737.8586 I MUM 41jflEKffKML HOLLOW ROAD Ftm" VALLLT PROPOSM Smm ROAM Irm" �- .._ a +.. e^c . ♦ v{. ..� . ..cy:_Y..`Ti�.l: i'v:.C.C"'.•R;. D . .1 -.. .. ... .r ., •.rtw T1Tl;.+ a.�iG.+ +.sc.>.:..I " %X'!'✓^:�VwT T..t T2 -i .7'W :. _ . .. .. PUTNAM COUNTY DEPARTMENT OF HEALTH ]AVISION OF ENViR(JNMENTAL HEALTH SERVICES i INITIAL 'INDIVIDUAL ADDITION /. REPAIR FORM SECTION A. GENERAL INFORMATION i Name of Project�� /'? • S Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Offilly CRolling ❑Steep slope Gentle slope /01 2. ClEvidence of wetlands []Low areas subject to flooding Mrai:nageditches. Clockoutcrops 11lat OBodies of water YES NO 3. Property lines_ evident ?. _ - , a r❑ ' _� 4. Water courses exist on, or adjacent to parcel? / ❑ 5. Existing individual wells within 200ft of the existing SSTS? ❑ f SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS area.. A. OLevel Gentle slope OSteep slope B. OWelldra'i'ned oModerately well drained IlSome"What poorly drained [loorly drained C. Area available for SSTS. (Primary.& Reserve) ' DEx-tremely limited ClSomewhat limited pate ft x ft ap.�... ..,,L _ - i -_—o-ut n. .x••.. ^. �..: a•. ... .. _ w• .. .i � "=..i: i:• - .�.:©, �. <.e:�%<vat.:•r.v'_. o'-�z. wr. _�. -... _ .... D. INSPECTION Date Ins ector . P . 0No evidence of failure Evidence of failure 11videncd of seasonal failure i -------------- -------------------------- --------------- (Indicate North) Y HOUSE (1) Indicate location of SSTS A. Size and type of septic tank gallons ® O Plastic . B. Type of absorption area 1. Fields Pits 3. Gallies fl. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams/wetlands) SECTION E. EXISTING WATER SUPPLY ❑PWS Shared well COMMENTS: 09M.-dual well DDrilled Mug ®Casing above ground