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HomeMy WebLinkAbout3561DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1-43 BOX 28 I ME III 1111111a !!%7- VIM, I I Vl.iI r eet' I ru J z ;4l �r r IN T. L ow 03561 .> f ..�- ^'.�..I - ,a--� , -"^.r "1s-•€ 1." rxr'w+..,� `T+i.",.- ..,'_^+'.« �-ri - '+•rr,.....^.�..t�.'.�,°' imy +5r 5- ,,.. ? y u '� t a 8 ( <A I s t' 5„ ,i"e..'C."" F} .2•�`. ".x�._' �' K 4+.i"' ""�r'^ y k s , .t AI 77, " MkW COUNTY DEPARTMENT OF HEALTH � k 5 y :Rev ' 3 86~ " f,, 1.11 �� r " �I)tvision of Environmental Health Services, Carmel, N Y 10512 x I 1. Engjneer Mast Provide ` r 11- ' P C H D Permit q 'e f� r ',per •. S ;. } ... �l_ CERTIFI 4* OF -CONSTItUCTfON COMWCIANCE FOR SEWAGE DISPOSAL;$YSTEM, �7!7'¢-?.". ,,G? / yr .,+• " ».+e .,� T(.W� .Fli lvffige � �i �. t 1. /� Located at rr T/� G�'� Tsa'Map 2 Block /-_ Loth, Owner /applicant?Name / Formerly Stlbdiviston NagnL� %/O ` Sabdv Lot q MfaWng Address �' r� �dc �p f�s-� Date Permit leaned �y %m Separate Sewerage System bnilt by' °� Address I /' y :+ i Coaelstw of Septa " C O© L + .. Gallon c Tank d l-G� d I ,l . . 5 Water Sup, Pdb F Snpply From' Address; 19. or %- hrlvate SaPP�Y Drilled by � Address Bnlldtng•Type /7 �� j / �t%Y�' ��= Has Eosion Contml Been CompletsdY ' Number of Bedrooms , G InstalledY �� Has arbage Grinder Been .- . i, _.... r....;. 9 cli a lkegaira3ments i' `.I certify that'the systems) ae tlisted serving the above, reiiiies were constructed essentially the plane of the completed work''( copies ` 11 'of whict% are attached), and in accordance with the standard', rules and regulations in acco` c� ed'plan and the permit issued�by the { Putnam Count Departure /nt Of Health ` /. ? I 'pate , , � �f tifled by f °' yy P E /[ ' R:A 1 Address Lfeenu No , f It .. "r ,P, oondit• rave lla! li b i � ,'Oats z I l s , , tail -t spioi y, Q�� /wt•f a: 5 � �. at LSubd. t 9 n, Ili d ltiin A' „ Aallr Stmt_ a ,• � Im _� APPROVED FOR'c IMOiabN Ior OaYN 1 1MYMee ,� Parr 88 yintl premises served py; 87 -._ -- _ __.__�__.. PMAM COUNTY DZPA2Tbfl= OF Divides of EnvImmeiatol Health Services. Carmel, N.Y. 10512 Rughlo a to Pmov @ape permit 0 on CEIrTIFICATE OF C DO DISPOSAL SgSTCO OF PR LOR SEWAGE Peamit d IRmted at %cy �. L] -Sim. Lot t/ ` ' Tau Asp ; Black— sit I z2, Renewal_❑ Ravisltoa ❑ Owner /Applicant Name // ��Cwozr 'IV � Y. Date of Previous Approval k Town 'up Buildiag Type si C� GI Lot Ana -/ % e. pi 0 Section Only Depth dobtnte Number of Bedrooms -3 Design Flow G P D Ca G PLED NotillCation is Required When FM is completed Separate Sewerage System to consist of ° Gallon Septic Tank and To be ombutted by °®° Addmso Water Supply: Pchile Supply. From Address or? Private Supply Drilled by _Addres® I represent that 1 am wholly and completely res"ible for the design and location of the prop �sad aYSie (s); 11 that the separate sewage disposal s stem above described will be constructed. as shown on the approved amendment there to and in eC�cQQf tantlards, rules an raqu a ions o e naM County Department of Health, and that on completion thereof a "Certificate of Construeti p i�ng'satisfactory to the Commissioner of Heanhwill be submitted to the Department, and a written ,guarantee will be furnished the owner, �wc hor assigns by the builder, that said builder will place in good operating condition. any part of said sewage disposal system during the , o o J 8tsrs Immediately following 4hedate.of the lasso• once of the Approval of the Certificate of Construction Compliance of the original.sys k '' A : s iPiereto; 2) that the drifted well described above will be located as shown on the approved plan and that said well will be installed in actor a al { nd�id`, rules and rcgu aaTrons of the Putnam County Oa mont of Health. � vote igned _ P.E. _ R.A. Address • O ��� "' "r License No 2, ,!� fS APPROVED FOR CONSTRUCTION: Thi approval expires two years from the date issued unless nstruction of the building has been undertaken and is revocable for cause or may be amended or motlified when considered necessary, by the Commissioner of Health. Any change or alteration of construction requires a now perrjm /1d.Approved for disposal of domestic sen5 sewage,, and /or priv a water supply only. dflf Date l9r /` r By e+ `%r Title � P14 `�0 2 CE Located in Owner /applicant Nant Mailing Address PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Heeith Services, Camel, N.Y. 10512 Engineer Ntqust Provide • .a• - ....... _ ��'.��: Permit 11 _ F C RNSTRUCTIOPI COMPILANCE FOR SEWAGE DISPOSAL, SYSTEM ✓ � ��� Y �" /�� `'e YJ j� Town or Tillage $ y���i%" Tau Map Blocks _lot Name zl,�,�p �n6 /3 Formerly Subdivision RNaete � 1 �G!/ /✓ Zip Date Permit Issued �� �� J•��� /A Separate Sewerage System built by �"� Address Consisting of V� C/ Gallon Septic Tank and e a� HI Water Supply: Public Supply From Address on OPrivate Supply Drilled by AAA Address Building T pe 1-70 � / c�r�907 e Das Erosion Control Been Completed? Plumber of Bedrooms � Iiss Garbage Gainder Beeq lnst®IledY �� Other Requirements 0' G'� - �� �� J I certify that the syetem(s) as listed serving the above premises w of which are attached), and in accordance with the standards, rules Putnam County Depart�meenn-t f Health. Dote ± � 19d ` r JlCegti4ied Address .LL—� =G,�,� _ -- Any person occupying promises served by th.Xbove systems) shall promptly conditions resulting from such usage. App oval of the separate sowerago t available and the approval of the private water supply shall become null and subiect to modification or change when, in the Judgment of the Commisst as shown on the plans of the completed work ( copies e with the filed plan, and the permit issued by the i t P.E. R.A. A V Lfcensss No LU a a y to socuro tho corroctlon of Orly unWrIKOry old 05 soon as a pubs% unitary Furor WCOmoa supply bocomos ovailablo. Such approvals are ? tlon ✓odifi�cation or chango Is necomry. PUTNAM COUNTY. DEPARTMENT OF HEALTH . DIVISION OF ENVIROiETrAL HEALTH SERVICES Owner or'Purchaser o Building Section Block Lot Building Constructed by Location Street Municipality /1i1el " >x• // Subdivision Name 14 Subdivision Lot # GUARANTEE 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 operate for a period of two years immediately following the date of approval of the "Certificate of Construction •,Compliance" for - sewage_. disposal system, i - -- - repai ra zade by,-re- to-such- sye;w,*;- -except:`wlhere the failure to CSper3te properly. 1:8­-�- - caused by the willful o lige t t of the cupant of the building utilizing the system. �$%`n� q` v��.C1� ' ' ; <, : ; The undersigned further agrees to accept as conclusive the determi i 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 the building utilizing the system. Corporation Name (if Corp.) �3 k4 S `Address rev. 9/85 mk Signa Title SN Corporation Name (if Corp.) Address a PUTNAM COUN'T'Y DEPARTMENT OF HEALTH ...D HEALTH•:SER DIVISION OF ENVIRONMENTAL.. C� � .a � \.•I ... em.+.n.�e >•.. e', :alY �. _ - � Dennis B. & Eileen E. Egan Owner or Purchaser of Building Modulars By Design, Inc. Building Constructed by 253 Wood Street, Mahopac Location - Street Putnam Valley Municipality 2 Story Frame Dwelling Building Type 62 2 6.2 Section Block Lot John Monzillo Subdivision Name 2 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM J 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 operate for a period of two years immediately following the date of approval of the . CAs '�t,, ter- •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 occupant of the building utilizing 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 the building utilizing the system. A' Dated this 18th da of Oct. 19 90 Signature 57 Title S.A.F. Septic Systems, Inc. Corporation Name (if Corp.) P.O. Box 141 Cross River, NY 10518 i.. - rev. 9/85 mk Corporation Name (if Corp.) 253 Wood Street Plahopac, NY 10541 Address m C( , �:6 Ir.TVT T Pf 'LMT VMTnM DVDnDM VVJ.:A.LJJLJ %J%JL-LL L I JKI A. L %JL1 LA4J& %JL%.A. DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only 7 (Z7 WELL LOCATION 'rTA_EET ADORE TOWN/YTILLACEICIM TAi* GRID NUMBER' &,10,2 11 �"4 1�e 4 - UA te 4 WELL OWNER NAVE ADDRESS: A TOOPUBLIC PBIVA TE USE OF WELL"*& 1 - primary 2 - secondary RESIDENTIAL PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP O BANDONED ❑ BUSINESS 0 FARM ❑ TEST/OBSERVATION ❑ OTHER (specify)* 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED �/ EST. OF DAILY USAGE —gal. REASON FOR DRILLING **S NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA i WELL DEPTH ram —ft. STATIC WATER LEVEL —!k— ft.1 DATE MEASURED h5ho DRILLING EQUIPMENT -0 ROTARY _"'aCOM PRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED O OPEN END CASING. OPEN HOLE IN BEDROCK O'OTHER TOTAL LENGTH _3F ft_ MATERIALS: *STEEL 0 PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE 3(P ft. F JOINTS: 0 WELDED 1_5 THREADED OOTHER DETAILS . DIAMETER in.-- SEAL: 0 CEMENT GROUT 0 BENTONITE_%,OTHER WEIGHT PER,F DOT lb./ft. DRIVE SHOE:-RYES 0 NO I LINER: OYES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 YES-.:O.NO..- _HOUR GRAVEL PACK 1. 0 YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK -in. TOP OEM _tL BofTO&I, OEM — it.' WELL YIELD TEST METHOD: 0 PUMPED It detailed pumping tests were done is in- ""COMPRESSED AIR formation attached? . . . ❑ OTHER 0 YES 0 NO 0 BAILED It more detailed formation descriptions or sieve analyses WELLLO G are available, please attach. DEPTH FROM SURFACE M Water Bear- ing OW, ae !I FORMATION DESCRIP'TION CODE. it. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Land uriace k LP pa,,) �c Ax, t2Q� C-17 WATE9 &-CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS 0 COLORED ANALYZE P6 '6ES ONO ANALYSIS ATTACHED? IVYES ONO STORAGE TANK: TYPE 1-7 CAPACITY GAL. WELL DRIV.ER NAME Soo 1713 h 1, /9 o A SIG RE PUMP INFORM TION TYPE TY MAKER DEPTH PT MODEL VOLTAGE ZW—HP -2& LAB # 32.006705 ' /V /7 -9l } Ybrktown Medical Laboratory, Inc. 321 Kear Street Date Rc d. Date Taken: /G / e: Time: U.'3o/� �� �y'I T �o r. Yorktown Heights, N. Y. 10598 Date Reported: 19 (914)..245 -2801 Collected By °, - �e "vecPOr: fiVevt M. 1'cacovarea'Re!! ?: (ASCd9) PO /Client } r Referred By: a VFrA0 Sampling Site: aDu .c s /3 y fir- ri�-�u s i 00a 7Ahl7v 44Z �j' Phone (For Lab Use) REPORT ON THE QUALITY OF WATER SAMPLE TYPE° INORGANICS - m &:I, MICROBIOLOGICAL 10 mL Alkalinity Standard Plate Count o Chloride (CFU /1 ML) .e Copper NA = Not Detergents, MBAS Membrane Filtration Method _ Hardness, Calcium TNTC = Too Numerous To Count o Hardness, Total Total Coliform - d Iron Lead Fecal Coliform _. .Manganese Fecal Streptococcus Mercury _ ,Nitrogen, Ammonia Most Probable Number Method _ _ Nitrogen, Nitrate Nitrogen, Nitrite Total Coliform e Phosphate, Total Fecal Coliform Silver Sodium Fecal Streptococcus Sulfate _ - Sulfide Presence / sip _ Zinc Total Coliform P A SICAL /MISCELLANEOUS KEY FOR TERMINOLOGY PH (S.U.) Color (Units) Conductance (uhns /c) Odor (TON) ® Turbidity (NTU) CFU = Colony Forming Units IT = < = Less Than GT = ) = Greater Than NA = Not Applicable SA = See Attached TNTC = Too Numerous To Count ® REi'MS OMMENT For Lab se (Check One)° �✓ Potable Non- potable OUTGOING: (Check Each) HNO HC13 H2S 04 AOH ZnOAc — Na0203 Other: INCOMING: (Check Each) NYS ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING-TO YORE STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE CO. ION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) T THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE L RINK - ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. X/ /�7, f 7 /87(Rvsd1 /90)RWE A ber Padova ni, o . A erector GT 4/19 200C GT 200C _ epHLE2 epHGE12. Other: NYS ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING-TO YORE STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE CO. ION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) T THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE L RINK - ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. X/ /�7, f 7 /87(Rvsd1 /90)RWE A ber Padova ni, o . A erector DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION .,.TQ, PCHD PERMIT WELL LOCATION Street Add ss Town Vil�age City / Tax Grid Number WELL OWNER Name mail in Address © . 4 _ de, /7" /� e, rivate O Public USE OF WELL 1 - primary 2- secondary ®'PRESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY OABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /46 PEOPLE SERVED 44` /EST. OF DAILY USAGE �a0 gal REASON FOR DRILLING NrN SUPPLY OREPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST OBSERVATION 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE BDRILLED IDDRIVE N ODUG [](;RAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS-LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �d a An /710,7 A; Iva Lot No. WATER WELL CONTRACTOR: Name y/jr w Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE -T -O FR.ONI NEAREST .WATER'MAIN.: - _ .^ - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION ®ON SEPARATE SHEET date) ,, _ ( a 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 thirty (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 requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. ri Date of Issue: 07UNC 19 �✓- -�-°-� -�--�' Date of Expiration:; n/ — /i_19� Permit ssuing f i a Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller 1 FT�]Pr, ,iz � qc =ct =CV cat= ``^.�' s Ins ✓'_� ''�V .•��, OR SUEDIT 5IO Tr.lr' I iC S NO Cam* +qtr_ - =- -? c^•i i 'C: � �+c =" CGC G*?G �_'_c= _Cr'ES 4. M? n L Cr f- s'.:i�it'IC'N E=" C. L Distancz - wG -�'_." L rr L ^s cr 32 C. 10 2D r - rclLr-- ^uCi:c L I . De_ _ cf t_ E _ Rcan al ic-;Ec =cr 50% 9. Size cr cr :e? io . rle�L-hl C-1 C :1-7a in trench 11" n h, T -- -_ - - _ 2. GL c'"L! crV t_ „C r P'= eF- _ c ac-= = -able rm-n- c1e to ode F* TCt LL1 ^• L __ i-a cvcie r7. ECC a_ E us= 1c r=--r a = =•rcca. plans G _ a_ �1 1CC ---z cS L ='' cT::r: Vc_' D! pr's c ancE f= EDE C_ Csinc 18” b. el_' z =c5 r•= '-__c! � •J � C'_�i 1 1 cam•._', c_ P_; pi=es f �•� with ins_ce or bcx iI I rrat_ ccr_t= -ins s- -Cnes < a° to clan to t:Cm C?"r Z 10Ez CP_ 5? cces C; r . C = ;sir_ cr`_ catf =? 1 c EDE as per acorcved 0I2-115 _ b_ F:l1 se— n - Date of piac--rP-rlt 2:1 ha Ty i �,- Lc-T W= siC_DP?F= C_ r�tur�i scii r_ct striLC d_ c` -,ne, br E , etc- 15' f-cm S S arEE- e_ 140 f �_ f =c: Nit —�- cc _!:Yati? and<_ DIE =CEPS 2. - C. ! cr, L �1 10 f _ �..1 e. 1 STT:) -TJ- T'TCNi i - ate e?=_-racn - w�� =rs =. - =- -? c^•i i 'C: � �+c =" CGC G*?G �_'_c= _Cr'ES 4. M? n L Cr f- s'.:i�it'IC'N E=" C. L Distancz - wG -�'_." L rr L ^s cr 32 C. 10 2D r - rclLr-- ^uCi:c L I . De_ _ cf t_ E _ Rcan al ic-;Ec =cr 50% 9. Size cr cr :e? io . rle�L-hl C-1 C :1-7a in trench 11" n h, T -- -_ - - _ 2. GL c'"L! crV t_ „C r P'= eF- _ c ac-= = -able rm-n- c1e to ode F* TCt LL1 ^• L __ i-a cvcie r7. ECC a_ E us= 1c r=--r a = =•rcca. plans G _ a_ �1 1CC ---z cS L ='' cT::r: Vc_' D! pr's c ancE f= EDE C_ Csinc 18” b. el_' z =c5 r•= '-__c! � •J � C'_�i 1 1 cam•._', c_ P_; pi=es f �•� with ins_ce or bcx iI I rrat_ ccr_t= -ins s- -Cnes < a° to clan to t:Cm C?"r Z 10Ez CP_ 5? cces C; r . C = ;sir_ cr`_ catf =? 1 APPamL( 3 Prm7 --. ^_ CE? ? -rT:E.Tr OF EEIL.T'? - D.LTTrSiC l OF ENV = - . Zl—rTDL EF-M-M 5 4� , L'fDr`i7 LTar rivt'1 =? SuZ7Dr,Z & Gay 1A 00 C-1— E�. E CU -_-re of CVner) —° (Street Lccai-- -:c^) DCy, F'%f P__rmiy F=1-4=- Ca cor. -crate Resclstic:i -Plans - ` nr�e I I G.i�+1n�rJ a�tzcriza�._ca I I I I I - I _ (9 0 o LAI I I I Ecusce Plans - T6.ic Jc= �^ }+ Weil I I I ~ I I I RI I I F= SYSIr I C�cVCc_ I I I 10 ft I I fi.j4notes n sze= I I I ct� cauces I i 1.0 tin- flccc el_v. SZ7> I t 1I4 i I I DCy, F'%f P__rmiy F=1-4=- Ca cor. -crate Resclstic:i -Plans - ` nr�e G.i�+1n�rJ a�tzcriza�._ca Des:.cn Pat; Sae== Par= axle D'e''..L_'1 ^ 1/ C. Ecusce Plans - T6.ic Jc= �^ }+ Weil valiance Pe: acs t �iER L 7= =_.' -Cn jYe (Tcfwl_ /r..Ec- - c_ . _ _ R 1 J I Da _ Cn C%c p! yr, c 7c_._il `_ S R :E:C R_E:) D = CN _ ._,7- - 1 Profile & Q;- _-sic,s _ We -1 De vi =, -c e ry i c a Li e 1 cGe- NCL (= '_f1C°.: Lcte) . n�ivF� Nom_rC- �cr1G -G - TWO Fcot Ccnt -ct:rs L:t' -tirlc & P_c_res Dri'Ve';E-Y & Slccec Cat FCOL_ti /Cza _ar,Car� -im Drains (a_scha ce C: {) P°_rc & Deeo E01e5 L:.caL a{_a_ ^-sica Area; s crv-z -7 ravity s . e If Pty`^ Pit & D Ecx Si Lc4 . & De+_;il- EClLC_a ?Na. cf EeL,_-N n. Wells & SSuS' _ w/ � 200 ft. . c= F'rotcsed S =t: & . Ecurc Hausa Sc= c0:{ Necassa •i (rt'_G:. t ! C C } Ecu-se Seie: - 1 /�i �. 4"0; rT:, e pige No -n"C; Max. Ee_rds a ^O C /, '...an w'C_= CLL SLDa?ATICN DIST,tiC = S?EC_ZT77) CN P-T;N F, ,ei cls 10- to P.L. , Dricevav, Lar:e T_ = ,Tc_ cf 20' to Fct:nc. ti ca Walls 100' to Well; 200' is D.L.C.D, 1`0' Pi== 100' to Stream" rcc rc^ T e ( iac. E`_ 13' to Drains C.1r-.3 i n, LGc2 Y, Fc'ct i nc wat C• C- r- ...�.- — .. r -1 3511,c cL �cz y 10' to �t =r Line (17,ite -20 f ) L. _ ?:, ?r. •,.r Lomtsd at (Street) lot Date of Pre-soaking %d „ ,� d` ° Date of PlagaDlation Test HOLE NUMBER b,8.M JCS06'1006MON PEROOLATICN NO. GrGWA In Inches OZ'iAil Rate �o�, ,, �y �a�.A OP..®Ll6 Cv Stop min. min. � cv Drop ,mod Drcp �cs. qs�� Inchds Inches Inches Inches jj �+ / ©�� s� 2,0 v,�d d 3 Ael ►M 1. Tests to be refit' are obtained .a$ each 2. f� bbr�evie@t�o 66A Nev. 9185 - • i :�,..:- '� ' F' ' .' ` � ,. qr� � .ili a i. : -. � i __ y' Q _ .,, � •� ~ - r Dgmu• i 1' 2' 3' 4' 5' 6' 7' 9' 10' no 12' 13' PIT HOLE NO. APPLICATION HOLE NO. -3 JL�f� P 14' nmicAm LE„'EL AT .WHICH INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCbUN'i D -5 4 � DEEP HOLE OBSERVATIONS MADE BY: �u�/ i yo mn: %a 27�7' DESIGN Soil Rate Used C: Min/1" Drop: S.D. Usable Area Provided Gi��' �• No. of Bedroom Septic Tank Capacity gals. Tripe Absorption Area Provided By a L.F. x 24" width.trench Other Zj '4e i i, Name �'�/ i �' Signature Address �G a THIS SPACE FM USE BY HFALTH DEPARD9W ONLY: Soil Rate Approved sq.ft/gal. Checked by _ Date ,gig �„+ ' -•+r+ S _ Y,;,,, •t r G !.; 1;�. t �•C'ti� ,hi t .lei q •,,,Cy�'t. A '..G ` t. ' • 111 N ,,�'k+SSyI ,tSfi � i 4A �;.e8 noted' for"cwda maaoe waw _ ,'• ''y! —w? r m xc.✓. 1 J, ,-a ... _ atlone of tbm t _ ipplioable gitiee' and Hegul Dep >artment. ^� RiO1RZIITA A Titl.P .. �4. ZP •!' a`� i DIY C w.�� S AGE,. D AL TM." _ NQ: DATE. a SULLIVAN ..E YCJi2KTOV�It ....WEIGI -STS. NEW YORK inm k,n S� 1 Li • F ^XXXX� t y a � r 4 �., r.� • `7a t^"' u..� ' GF��- $afr+r"7' ". ..,,ix ,+. 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