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HomeMy WebLinkAbout3594DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -6 BOX 28 IL S' i ; :- ;tF J lL, ML ' ,` rr JL I F1 1 I. -.il , ■ as I 03594 Commissioner ofHeafth ROBERT MORRIS, P.E. Director ofHavironmentEl:Health March 11, 2013 Gerald Jones 22 Butterfly Lane Putnam Valley, N 10579 DEPARTMENT OF HEALTH . 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 MARYELLEN ODkU County Executive Re: Addition- A- 022 -13 22 Butterfly Lane (T) Putnam Valley, T.M. 74.10 -1 -6 Dear Mr. Jones: I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot-be approved for the following reasons. 1. The'second kitchen is considered to add additional flows to the existing septic system at a rate of 150 gallons a day. This is the same rate used for bedrooms. Therefore, the second kitchen is considered the same as or equal to a bedroom. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is. five. ., -_ ...._ ._ .:_.�_ _ :....:, .. . ..._ ..... ... ........ . . _. _:.:.. � ._ 3. The addition of potential bedrooms require this Department's approval- of a revised septic - system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for five bedrooms. If you have any questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:cw cc: BI, (T) Putnam Valley /6 y REBECCA W ZNBERG, RN, BSN1 Public Health Director _ ROBERT MORRIS, PE Director of Environmental Health MARYELLEN ODELL County Executive HEALTH 1 Geneva road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 ADDITION APPLICATION RESIDENTIAL ONLY !�I u L _r_� TO 4.Ndi STREET & Z! t, !4 L-r�-, c TOWN % +n � V4 I CAW TAX MAP #14, le -� 1tAME�'s�,r,1C 1 .fm PHONE 87.5 Z PCHD# MAILING ADDRESS PLJrieLol Vmllenv , A/ / i©.§- DESCRIPTION OF ADDITION n Of A4.5eavolt W C47aoH *NUMBER OF EXISTING BEDROOMS .3 NUMBER OF PROPOSED NEW BEDROOMS * (FROM[ CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Pl.ease.submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, _. _ .. Brewster, MY `10509; Phone: (945) 8U8= 1390.­ I . Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area incRuding Basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin ffA-1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS 4. ti REBECCA W TTENBERG, RN, BSN Public Health Director ROBEgT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845 ) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: Jones (Owner's Name) Tax Map # 74.10-1-6 Address: 22 Butterfly Lane Town: Putnam Valley Year Built: 1986 According to records maintained by the Town, the above noted dwelling, is xx in compliance with Town Code. Is not in compl ante- w Gli Town Code. The Legal Bedroom Count is: 3 This information has been obtained from: Certificate of Occupancy: C 0# 19 8 6- 6 7 21 Other: The plans for the proposed addition are considered: xx Addition to existing house only Teardown and/or build allowed under Town Regulations 315'II -2 Bui mg Inspector , John H. ` an d i Date 5. MARYELLEN ODELL County Fxecut f ye ti' t `.� •,. 7 pp � r gh y - ..:rr.�t�:+.r`.. ° a . • , "V sR �; ..-.'b r'r - •} .r. ` �ri�4 v++.+►1. 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N SA L S rT;"4 S(-• wALL Sp ME F-kE IT 5YSFF-M r:r o < E-F) I T iL U LS (a Q Fow- -'T LAKE 51-vP -TD K LIS �OAHO SAL N. 1054 1 TO,wIA OF V>,AT14hM VR LLE I 9t4• to Z8 • 4392 LO- Lwp, 1,j Y. N :f 1� t� 7 •'. t '!'� i- I- Y� j Z i • ► �� TV.i -"iL i c . Q N � E � DIY'- � ' • •• �W Vii: �.- V p, ` v a � Yea � c O u � f sV w 1-1 =�C O e ( �it:7. O 2 .�., .•err _ . � _ .,.4 ..•.�. -,y � = fir.` -' r: , '• �•. w�o•� wt4 w � w s=4 ® © O TN*S i 1!614115 - i 7 - QLPj1� � ®• _ F.AHILY %ZOOM " - KITCHEN O_ A. 'wrwsw'I aer 1 Fo.YEtz , oil is i LIVING %ZOOM .. �- _a + 6 'Avis Homes .CORPORATION: AVI MODULAR SYSTEM • • t CUSTOM ec-scl o 24 �•4- 0/26 +34 � Vj I '7y j jii . ral P T N COUNTY DEPARTMENT CIE HEAII,'>I'H ENGINEER MUS Division of Environmental Health Servioas, Carme% N. Y. 10512 PROVIDE PERMIT # CERTIEI TI: OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM .W . -•-. .d��ij:..T��%%_y.., .�/�19 .. -.4:. .-.�.c :,: -'sue '•T.orin ,cz. �<a`3 -- ^I.00atBd at �A " E Tax Map �' Block Owner ;t /Formerly _ Tax Map Lot it i p. SubB. Lot p f Separate Sewerage System built by Address A �P' Consisting of 000 Gal. Septic Tank and ® �� Other requirements j B .S o" 61p ill raf � Water Supply: Building Type Has Erosion Cc I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attaached) , and in accordance with the standards, rules and regula�ona , co anca wi A the filed plan, and the permit issued by the Putnam Count y Department Of Health. / / ) Date 9 Certified by U. P.E. ZR.A. Address Cleanse No. Any person occupying premises served by the above system(s) shall promptly take such actio as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate werage system shall become null land void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall becom and void whe. public water supply becomes available. Such approvals are subject to modification or change when, In the judgment of th missh r o4 liwoh, such revocation, modification or chango Is necessary. Date — `�(� By Title Rev. 6/85 1:5" tTa ril rn 3i I rF t/4 8A b�:5 L31 64 bLA,-j lz PLAN TM X3.5 4. J7 fo - 7 :`3 • 1 ^iO r -G �. ! . T,� F•F "T' �F W El_ -L._ f}F�i p l i.i U f 2� LfiJ G��+� la;a 1•. T-0 ' •- fig -�.j 1�� j�%u -;• ,�,� -?T, TO s�toFv P,r�t of l�U TV.EE- 5 Y�r T 0 FELT of !}3so9 —PT /0-, A TO E._. �E�r -� o •v ice. s� Lc) T No- 7 AS s ��c..a w O►4 "10; V- T,T LC foe:aP.J �? T�l G�E2FC� pf"5 MA t-4 X3.00 f.�AL;t> S N r�F ty74. M OF FlI ` N A i-A v, LSE{ m m m "4 + y °: v ® a- 42 M OF FlI ` N A i-A v, LSE{ �m -r4 0 m d. om� 4,3 54 m m � .• 4 C m 5 � C7 G7 y"+ e//�� V4 4 -roTAL LtN6 j*i j7 ,Fi -- U� (— )•_ �.-J' {iii : •�. Tsy'/i '. -I:. ` F • .....! iic_.� Rohr q EST" LAKE M q qo Yyc. r1. 914- & Z8 . 431E ri � • � i V FREUR� IVI _ ,£ = ff � m m m "4 + y °: v ® a- 04 �m -r4 0 m d. om� 4,3 54 m m � .• 4 C m 5 � C7 G7 y"+ e//�� V4 4 -roTAL LtN6 j*i j7 ,Fi -- U� (— )•_ �.-J' {iii : •�. Tsy'/i '. -I:. ` F • .....! iic_.� Rohr q EST" LAKE M q qo Yyc. r1. 914- & Z8 . 431E ri � • � i V FREUR� IVI _ ,£ = ff � ' = WELL,COMPLETION REPORT- DEPARTMENT OF HEALTH bivision Of Environmental Health Services WELL LOCATION STREET ADDRESS: fOWN/VILLA TAX GRID NUMBER: WELL OWNER O.EUBLIC USE OF WELL 1 - primary (SIAESIOiNTIAdr 0 PUBLIC SUPPLY C1 AIR/COND'./HEAT PUMP. 0 ABANDONED 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (Specify) AMOUNT OF USE YIELD SOUGHT - gp,m./NO. PEOPLE SERVED EST..OF DAILY.USAGE gal. REASON FOR DRILLING-- C�XW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TESVOBSERVATION 0 aEPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 2 0e) ---ft. 1 STATIC WATER LEVEL ft. . DATE MEASURED, -7 * h DRILLING EQUIPMENT C"'OTARY 0 COMPRESSED AIR PERCUSSION 0 DUG ' 0! WELL POINT 0 CABLE PERCUSSION C3 �THER (spekifft WELL TYPE .0 SCREENED 9-OPEN END CASING. a'OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH ft- MATERIALS: F? FEE L 0 PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE ft. JOINTS: C]'WELDED 0-TFIREADED 0 OTHER DETAILS DIAMETER in. SEAL: 0 CEMENT GROUT 0 BENTONITE WTHER WEIGHT PER FOOT Ib./ft. DRIVE SHOE. 0 YES P40 I LINER: 0 YES J540 SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST HOURS"' SECOND GRAVEL PACK 0 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK j1nDEPTH TOP -ft. BOTTOM DEPTH - It. WELL YIELD TEST , If detailed pumping mETHoD: &AMPED 1 tests were done is In- 0 COMPRESSED AIR formation attached ? 0 BAILED O.QTHER -OYES ONO it more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water Bear. ing Well Dia- meter In FORMATION DESCRIPTION COOE ft. WELL DEPTH DURATION DRAWOOWN YIELD Land QUALITY 0 CLOUDY HARDNESS ANALYSIS ATTACHED? 0 YES ONO STORAGE TANK:..TYPE -7.,4jj CAPACITY GAL WELL DRILLER NAME DAI PUMP INFORMATION TYPE CAPACITY = 001 Yorktown Medical -Laboratory, Inc LAB § via 025 321 Kcar Street Collection Station Used: Yorktown Heights. N. Y. 10598. Carmel Peekskill K1 Gic.a. We..v ClVy -WW 6s�-i&ht M IAS Q-) Date Taken: 'Date Received: (�r4 L J5 j G- S Date Reported: Collected By: Referred By: Sample Source: L LABORATORY'REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL .BACTERIA AS tandard Plate Count pet 1.0 ml .(Agar plate @ 35 °C) V.EMBP,ANE FILTRATION TECHNIQUE (MFT)— Total Coliform Der 100 m.1 Fecal Coliform ner 100 ml — Fecal Streptococcus per 100 ml Vnc!- IDIDORA PT r NUMBER TECHNTOUE (MPN) 'Total Coliform Fecal Coliform: OTHER ANALYSES MP.X- Index--per 100-z.m1 --,-- MPN Index per 106 ml THESE RESULTS INDICATE THAT THE WATER SAMPL, OF A SATISFACTORY SANITARY QUALITY ACCORDIN WATER STANDARDS, FOR THE PARAMETERS TESTEDo Albert H. Padovani, N.T. U—SCP)" Director (DASD WAS WOT) (NOT APPLICABLE) TO THE EV YORK STATE DRINKING T, XMZ OF COLLECTION. LEGEND RDS © Recommend Disinfect- ing Water Source Q lean than T�TC o Too Numerous Too PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROV14ENi'AL HEALTH SERVICES C�6ra j 00 63 •�.•. -.. .a.i;.7y. v. ..o- .�u.:, .. �:J -Z:r cn .0 -... a m..,a .. .. •.:r .:. .. .� .,�.♦ ���+aA r. z. a. ..... ... . "e eaz : .w- e.. a .. a...... z. •�. .a ... . Owner or Purchaser ofBuis ing Section Block A Lot Tuilafhg Constructed by �h Location - StreeE Municipality ( Building #'csvcl di ew Acres Subdivision Name _ 7 Subdivision Lot # GUARAWEE 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 the ,sewage disposal system, or any r`epairi itiade by ftZ to such - system,• except vahere 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. Dated this —L— day of 19A A"a-el C ` J ",:, General Contractor;,J'Z ner) - Signature Co ration Name (if Corp.) f + J s-q A P Address rev. 9/85 mk Signature Title y �tiJ V rporation Name (if Corp. ess l /,T 7 % lu .i �5r VlE l) CJ1EC1C 1A ST. bite insp.by. INITIAL SITE IJ13PECTI0:1 Y Yes + + No C Comments ,Property lines or corners found . . . . . . . . _ _ _ Can estimate hour,- location ... _ �- driveway cut,house location,separation , distances, etc. DEEP IIOLE DATA= - -exr�rr���'�' Vt 'Date: - -- -' House located when•.- - shot,,n on approved plan x x' - -' ` SDS located �-rl� °re approved - X Room allowbd for e T)ansion trenches . . . . . X Over :�0 ft frflm• s�:Ta�rnp �;�LPJ'CG'1�1�E:_ti .. :�_,.....� :.: � �.. � -- 20 ft. from house Sepo- ration of trench from house, well - -e•tc . - follows plan 1\wtibcr of bedrooms checks PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES •+Si... .m n..t+. r. Y n.; -.T; ,'-v, �.v?r �.... l: -. � .�C+. .t' I _ r,..•.etq C ..e.i .. - • Date O'V(BLI/ Re: Property of Pie- Located at j- �1 (T) Subdivision of Section t05 Block g�_ Lot ao -2, Subdvo Lot # Filed Map # Date Gentlemen: This letter is to authorize��67FUl a duly licensed professional engineer or registered architect (Indicate to apply for a 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 sY GOnfQrmity< with _the . prov _iaibh.�:Q:�;.Ax.ti�lec -�.45--.0 147, Education Law, -the Public Health Law, and the Putnam County Sani- tary Code. Very truly yo urs, Signed Countersigned: Owner rqj5e y P e E o, R a A e, # 5o�to� �6� �� �. . \ Address El ?ee-46S 10r6 0 Addresd Town s E . LSt7 J� Q4C_ elephon:e' . I(- to 2-u -- 4� Telephone i?R ,Ay 2 $Y.. , pUTN&:14 ;,C)UNTY DEPT, OF HEALTH CITY OF PEEKSKILL CITY HALL PEEKSKILL, N. Y. 10566 RF^E:' ENVIRO N "�; :t ±. SERVICE,`)- .';` ; '. , ::i '85 JUL 22 P5:47 July 19, 1985 Mr. James S. Hodgens Assistant Public Health Engineer Putnam County Dept. of Health Carmel, New York 10512 RE: City of Peekskill WS Rules & Regulations Dear Mr. Hodgens: We have reviewed your letter of June 14,.1985 regarding final sub- di.v i s.i.on.. of : Pond. View Acr.es..: i n ..Putnam.,..1.ley:.I.ocated i n the we.tl.and.s.. . Py' V Peel (9ki'il °�iol`iow °Brook'source of"'Ci "ty of Pee�CSkil "T'Waier" Supply. A review of the rules and regulations indicates the City possesses no regulations applicable outside City limits and we therefore would sub- mit no opposition to granting final subdivision approval for the afore mentioned development at this time. We would, however, seek your continuing cooperation in monitoring the development as it progresses to insure it causes no adverse effects to our water supply. Very truly yours, 94John J. Pizzella /nm Water Superintendent cc: John S. Faile, Director of Public Works , Bernis Nelson, lst Deputy Corporation Counsel DAVID D. BRUEN , County Executive COUNTY BOARD OF. HEALTH RAYMOND S. JONES President S. DANIEL SELDIN, D.D.S. Vice President JAMES BENNER, M.D. PAUL CHANG, MD. SARA McGLINCHY BEVERLY TAYLOR GERALDINE A. ZAMOYSKI, M.D. DAVID D. BRUEN SAMUEL J. OLIVERIO JOHN SIMMONS, M.D. Deputy ,Commissioner J. ROBERT FOLCHETTI, P.E. M.S. Director Of Environmental Health Services DEPARTMENT OF HEALTH ELAINE K. KRUEGER, R.N. M.A. Director Of Patient Services June =1985. 7- 3 -r— Mr. John Pizzella 137 -3900 Supt. of Water Supply City of Peekskill Water Supply 840 Main Street Peekskill, New York 10566 RE: City of Peekskill WS Dear Mr. Pizzella: Rules & Regulations Per our recent telephone conversation, enclosed please find a copy of File Map 1360 of Amended Portion of Pond View Acres. As the waterway and wetlands appear to be tributary to your City's Water Supply, I would like to have your comment on the subsurface sewage disposal systems which are being proposed as approved in this subdivision. As the Putnam County Health Department Approval is subject to the rules and regulations of the City of Peekskill Water Supply, any City regulation prohibiting septic system construction in wetlands or wetland adjacent .areas canti& ous with a tributary -to a City water s.upply.could be grounds for denial. of applications for construction permits for sewage disposal systems in -this +' " subdivision. NYS Department of Environmental Conservation is also being asked to comment on State regulated wetlands in this area. A reply at your earliest convenience would be greatly appreciated. You may contact me at 225 -3838 daily between 8:00 and 4:00 (Summer hours). Very truly yours, Aj,�, James S. Hodgens Assistant Public Health Engineer JSH:mk enc: FH 1360 -Ic'c: Pond View Acres, Sect.I1, RS(PV) w/o enc. j sh file TWO COUNTY CENTER — CARMEL, N.Y. 10512 (914) 225 -3641 DAVID 0. BRUEN County Executive COUNTY BOARD OF HEALTH RAYMOND S. JONES President S. DANIEL SELDIN. D.D.S. Vice President JAMES BENNER, M.D. DEPARTMENT OF HEALTH PAUL CHANG, MD. SARA McGLINCHY BEVERLY TAYLOR GERALDINE A. ZAMOYSKI, M.D. DAVID D. BRUEN SAMUEL J. OLIVERIO .., .., JOHN .SINIMONS., Deputy Commissioner J. ROBERT FOLCHETTI, P.E. M.S. Director Of Environmental Health Services June 14, 1985 Mr. Joseph Steeley NYS Department of Environmental Conservation 21 S. Putt Corners Road New Paltz, New York 12561 Dear Mr. Steeley: ELAINE K. KRUEGER, R.N. M.A. Director Of Patient Services RE: State Regulated Wetlands In Vicinity of ML -4, (T) Putnam Valley Would you please offer comment on the westlands east of Butterfly Lane contained in the enclosed approved Subdivision of Amended Portion of Pond View Acres? I believe they are contiguous with the above regulated wetland. My field view of lot 7 indicated the proposed septic system will be located, at best, in a wetland adjacent area, and perhaps within the wetland itself. Please contact me at your earliest convenience between 8:00 and 4:00 (Summer hours) at 225 -3838. Very truly, yours, ames S. Hodgens Assistant Public Health Engineer JSH:mk enc. cc: Pond View Acres, Sect.II, RS (PV) w/o enc. jsh file 1 TWO COUNTY CENTER �- CARMEL, N.Y 10512 (914) 225-3641 DOCLEE- FITS r . MRP . LoCAT-100_ Houses- p]-a ns "iieIle Design data sheet Peres presoaked? !,in. 30 pert test depth Const. results for 3 runs D. Hole log 0. K. Corporate Affidavit for other° than indivi Authorization for engineer Intter from Water Supply if applicable If variance requested -such noted on plans D7-AILS , lmelets-std.f _ Rcmarlcs • i I ✓ i c. • ti� apps. OD . f if change*is proposed,) 1. ,.Exist�ng contours shown show new contours) Slopes for driveway cuts, etc. shown � Water service line location L Footing drain, etc. location Top slope, bottom slope of fill ! ? P- rcolation. tests and deep test pit location I i Septic tank size and conformance to std. 3 B.R. house minim am J I House setback shown i I Distribution box ftg. below frost ,� ! All water within 50 ft. of.PL shown : 18<t 'U)o c�sr, Plan and profile SDS All other wells and SDS closer 200' ! shown or, reference glade -- - -Prgq ej °ty buw- da�ies (metes and- bounds - clearly hown'� ��� i y ► F, r•s L67QOL SU3DIV is 10tZs I ,/ RCALT`( c��S3D I�; IS f L^I�i �F1a r.11rhR_1F� �i/r .. 9crr l ..ore c / Oer MSE 4114TION DISTANCES SPECIFIED ON PLkN ,10 to P. L. �20 to Foundation walls to Nearest well !00t to stream, march, lake, etc. incl . e 15' to Curtain drain 0' to water line (pits -20 1151 to storm drain 01 ' to larce trees 0' froth 1'011114 ttion to soptic tanl: to pilio 1'r0111 leador drain & . fb-o lne, '?5 ro uftrC4 @,A s i to 11aiti on OK AS :a- k- — (22 EL'S. C-13 kj 7.2 Z -85 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CO.UIM -7- OFFICE. BUILDING,­ CA:RMLL, . -pT.: -Y.; •10512 DESIGN DATA SHEET- SEPARATE SEWAGE.DISPOSAL SYSTEM FILE NO. Owner ^� ®�j Address [ 614,") &7TER-94y the. f r- Located at (Street Mfdlc7ate o,•(f►�fl 2� Sec. . ja Block J Lot . 6. Z. neares cross s ree Municipality pirrio-e^ Watershed SOIL PERCOLATION TEST DA A REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION•, Elapse Depth to-Water Water Lev e No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. - Start - -Stop -Drop in Min. /in drop' Inches Inches Inches 1 36 12- Z/-Z- 2 3 30 ���� ,yy� /250*. 4 , _ ��- 5 .. 3 ® t l9lL 5' .3 4 4oLcs- Jere- !RM:5A-rJ@aaQ WC.S %dere- ru!3 1 2 . 4 5 R E C E I� tu r:•�t�Y 2 9 X9,5 Notes: 1) Tests to be repeated at se�r 'apppproximately equal soil rates are obtained at each percolatio e All data to e 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 ENCOUNTERED IN TEST HOLES INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE.- LEVEL. TO WHI H WATER LEVEL RISES AFTER .RED _. ... TtSTS ' 'MAi)EY . DESIGN Soil Rate Used /Li Min/1 "Drop: S. D. Usable Area Provided o Fr Sim No. of Bedrooms Seepptic Tank Capacity i 000 Gals., " � ue� Absorption Area Prov ded 47A L.F. x24" :dt Name S� Signature Address ]M/ fi5e- ?2LJ1> Z. SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by �'��frSSIQN�i. Date CO DO 66 P.Y.C. 7 FE. E�iS% b IPLA S(.ALr. 1 50' k� • TM �3 - 5