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HomeMy WebLinkAbout3647DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -3 BOX 29 F ti ♦Ir V ; Ali �. - r •. , J ;, g - L , 03647 ,. r PUTNAM COUNTY DEPARTMENT_ OF HEALTH_ ,! Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �yn(w,t� �� jc,;;,✓�I; 4�.y catdd' Town o r Village B loch er Subdivision a, ` l J L E! a� - Lot �� Job Owner r � � / �� Address 231g4ek.x �. Building Type _. ►tN�� trlL Lot Area .�i Number of Bedrooms Separate Sewerage System to cJ' nsist of � Gal. Septic Tank To be constructed by Total Habitable Space � 1'ff�' %f �Y`' Square Feet r J! lineal feet / XX width trench Addressy����� Water Supply: / Public - Supply From —4 'Private Supply to be drilled by Address Other, Requirements I represent that I am wholly and completely responsi i c ;of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the n m nd in accordance with the standards, rules and regulations of e Putnam rt County Department of Health, and that on coin r onstruction Compliance" satisfactory to the Commissioner, of Health will be. submitted to the Department, and a written 11 r 'sh wne"F his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of Id+ wa ,� em g the period of two (2) years immediately f6flowing the date of the issu- ance of the approval of the Certificate of Con is on he : al system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and id i Iled i cordance with the stand ds, rules and regulations, of the 'Putnam County Department of Health. � ;rr ✓ A bate 1 J - %, "° / �f �C S i9netl '£ ` P.E. 4-1- R.A. . 3 it y+' - Address License No, :Z APPROVED FOR CONSTRUCTION: This approval expires the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner ealth. Any change or alteration of construction requires a new permit. Approved for dis I of domestic sanitawy-seey e, a d o ivate wale supp y only. o fsi�°t s' .Date �� By C` 41 Title j. . 'Tt'14 L - PUTNAM: COUNTY_ - DEPARTMENT- OF HEALTH. Division of Environmenta/ Health 3ervlces, Carme %N. .Y 10512 ;TIFICATE .OF CONSTRUCTION COMPLIANCE FOR SEWAGE C P Located at L 4- "- ,yrc ; i... ®. Pia Allz-: F S larate Sewerage System built by Consisting of 00 Gal. Septic Tank , Other requirements , ;Suppl... n..r,r: e.....�., e... ,1 1 �TYI lo �t lal it 1 )SAL SYSTEM 7,-bV i i 0f 6; 44i E j -r Town or Village e Block Lot Job /�� �/ Address �✓ d'�}"z. K /t i lineal Feet X width trench P .. .- •.. -..gyp. - .—.._- „,,_,fib -. s.... •:•y- •:..•. -. _” _ _ _. _ _ _ 4870 i YORKTOWN MEDICAL LABORATORY INC. Wed. e 0 Box'99 32 "1 Kean et Atown Heights,. N.Y. 10598 = 245-3203 DATE COLLECTED .RESULTS OF: EXAMINATION OF-WATER 'DATE RECEIVED , JOSEPH MITES, a .10/23/73. LAGE', .TOWN .VOR N'AM8 OF SUPPLY DATE REPORTED GZOEAMORHA ACRES PUTNAM VALLEY 9 .No Y;a.. ; —POINT WETT Al PER ML (Agar plate :count ati'35 C) COLIFORM GROUP (Most probable No, /100m1) RD ; T AL -ppm 4 HESS:. THAN 2 0 2 TS PPM NITRATES (as N) --ppm. 3RON,' TOTAL - ppm. mg' /1 }; dicate.that the water was ova's, f ct shfisfactory sanitcay quality when the sa le was 7011. i A. H. P.ADOVANI, M. T. (ASCP) 0 f CERTIFICATE OF 0C.CUPANCY::z--- -- 7;� Certificate of Occupancy No....1. .b71.71 ..... Application No.737?49 ......... Location of Pre . mises §4a..ar o.. c k.-. D ri v e Gleomorra Acres .. .. .. ........ ... ... .. ....... ... ....................... ....T.Q. 0.0 pla.. Ili 1.0 g i .......... .... of ..............Putnam ...Va1-1e-y,-.-N.-Y ....................... having ..... ........ .... --- - 9 heretofore filed an application fora building permit pursuant to the Z_ oning Ordinance, Sanitary Code and ' the Laws in effect in the Town of Putnam-Valley, Putnam County, New York, having paid' the required fee therefor and the undersigned *having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed struc- ture in compliance with the requirements of the laws ',as aforementioned and that the said work- and materials met every requirement of the laws as 'aforementioned and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law, Now, therefore, thiy;Vificate of occRov pance y hereby ., issued under the seal of the Town of Putnam WD is hereby this ................ day of .......................................... Not valid unless signed in ink by a duly authorized agent- TOWN OF PUTNAM VALLEY— NEW YORK of and under the seal of the Town of Putnam Valley'. B Y� ij is I p fi t. I DEPARTMENT OF HEALTH . .. .:RG _.R:FOL:F'.. Public Health Director. Division of Environmental Health Services 4 Geneva Road q . . ' Brewster, New York 10509 TeL (914) 278-6130 Fax (914) 278-7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY STREET 3 9 S HAS✓! kc' C-4C' Dr, TOWN ,Ov, +( TX MAP # % `�- l 3 NAME PERft_N Vic-T-O PHONE. q / PCHD # MAILING ADDRESS 3 ;5o6m nzv cic bcc've r AA Pre - e)Cf sTt lvr--U "?' ?3 DESCRIPTION OF ADDITION 8 TH Koom 1 ov 3#$ E-M C W T Rao W t a Avm 6111) NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF 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.Puinain. County Sanitary Code: 4. s, please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. ,- 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable ✓ 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. --5. Copy of Cert. of Occupancy from Town or. Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments DEPARTMENT OF HEALTH Division of Environmental. Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Perry Victor- 38 Shamrock Dr. Putnam Valley, NY 10579 September 4, 1992 Dear MR. Victor: BRUCE FOLEY.. Public Health `'Director Re: Addition Victor, Shamrock Dr. Increase in Number of Bedrooms (T)Putnam Valley # 74.14 -1 -3 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 latest revision date of(Sept. 3, 1998)and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at (Three) without prior approval by this DepartmeYt. .f...the_.`exist:incl: s.ewag: cli expansion area, must be maintained. 3. All plumbing fixtures Must be updated with water saving devices, i.e., new .low flush toilets, restrictors for shower heads and faucets, etc. 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. Very truly yours, William Hedges Sr. Public Health Sanitarian WH:kg cc:BI(putnam Valley) a V PUTNAM COUNTY DEPARTMENT OF HEALTH 20T]SE PLANS APPROVED FOR BEDROOM COUI *VT ONLY. Is, 6— Ix E 0 co—I 0 K ITCH 670 a. Aj ,zoo �: , r Dc,ofper VANI� 1V - c. ;n PERRY-VICTOR Pte, DWE 5 TP 12- PUTNAM'VALLEY. NY 1057.c * ? I 'PUTNAM WONTY I)tPARTMENT OF HEALTH . n HOUSE PLANS APPROVED FOR BEDROOM COUNT ONE EDROOMIS 00� -- _ � cam- 5 0 � Signature & Title cr- CL 0 CL UriFiNISHE'l), C-lc,,SCT COLD HOT 1-i ft 6 H Cel ALOP Arc TC -r. Iq TAN I--,' ri boo 4,JN 3 IVI - 0 U w, 311/ IN 3/y lly 6-rA2A6� C- A 2E/4 tj Do L,) ku Ow v `SSA °s <o � %A � . �} LOT /Co `SV'�, JP h 44, 04 Go rvELG -- "It h_rab5 ;;Crtifitlfl trot Inv: •.:.rweY 0• +-�•: ,rep •r•t ,. atcorduneu wtth the - e 0, t of Pr active for Lend n `.:. ;jlo ny the New York St4% (.f on of Pro' rs-.ional :-ac "urvevcri. "All certificatloni hereon art V&M for the snap and copies if .iaid map er c*c., bran tits, i1•t,.lrzsbmf .. ... .:1 iJ; .,.:i :s .i,. •X'flil<. A.Kt.i�f• 1T1;.w. /'. .ir•i:' l SURVEYED & PREPARED BY ALEXANDER BUNNEY LAND SURVEYOR. P.C. 20 WOODSBRIDGE ROAD KATONAH. NEW YORK 10836 PR5PAP ,50 FOR t-/0SEPf N Y- 14 AAZO 71714 Ae 0,4= /Vaew Yo q,< °REM /SES S/10fVN HEREON BE//VG' .LOT I G AS SHOWN ON 5410D /V 1.910.,V MAP OF SECT /ON .S GLOC.4MOI?A?A ACRES = SA ID MAR 5/LED /M 7;YE iCY-177VA M COUNTY CL ERIC S OFF /CE /9i/ AS MAP N ® /222.4. a &I PVEY OF PROPERTY Y SITUATE /N 714E SCALE: 1" =50° A14EW YORK OATE;. / 2-1 I -- W1, 4 PERRY VICTOR _ '38 SlW-- OCK�•ORNE ?U1NAM NY-1-1- 0579 e, -rpi E � rurrp_l w i t,)D;)v,) 0 ` (JDOV/ PUTNAM COUNTY DEPARTN[ENT OF HEALTH " _ DIVISION OF:•EN`,7IRONMENTAL.r -I-[ EAT, TI -I - SERVICES -... - - Date iZXvG G/ ...... . Re: .. Property ,of 1// /'LT' Located atfii�ldJrtck i� 1�f;�1✓ �1��/ ,�F I'��tA?L1>LG Block Lot 6, .Gentlemen: _ This letter is to authorize r ST j° LANDER 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 nece;�sary papers on my behalf.in k�wuteL.: Lav1i w1 L11 L111Z: iiid L LC1• allU Lo. SLIL)e1'V 15e 'Llle Cons- ivucriort of sa.La system or systems in conformity with -the provisions of Article 14S or Education Law; the. Public Health Law, and the Putnam County:,Sani- tary Code. , . Very truly yours, Signed Owrfer of Property Zt Cersigne�% �'C��� u��►r� �,�Lc 1. Address P.E., elephone Add Y NLEY I I Ali' LMM En DM BOX 267 .3 Telephone T `Tim i 0 C T 2 91973 WTNIIA,M COOTY DEPT. Of HEALT•F Sy f ^sw ..r..:�- I ' 1 ".gWNMl1VTAL HEALTH SERVIGR! fl kT. !. this IS-to tolION , that the sewage � 1 S SfBi� W13s constructed as !n - ,`"�`�;_ : idr o this plan �+;t that the' syiterll lttOLPtI 11Y file :.I�tnre it vies cousreo / / ;as rP roles neQ re g E` QPS u file County Beg � �i. \,..a..M l� 4ii� /G;^.' • �' 4'+. �✓� � . ! d"' ": :'_f `toe, �°�..: tl ' ),.:..? , .fir .. r: • T V :_ :: X11-6s _ �. O,aner or I'.?rcl�aser of building J_c %LAS Building Constructed by Location - Street Building Type Municipality a inn j A, /`74 P Block Lot GUARANTY OF SEPARATE S1:1^1AGE 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 guaranty 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 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 occupant.of the building utilizing th ?. S�rgi-om 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. _ r,: Dated this day of OcT 1973 Signatur' Title. (if corporation, give name and address: THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION INTILL 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 WELL COMPLETION -REi'OhT PUTNAM COUNTY DEPARTMENT OF I-IEAL.1' 3j7�. Division of Environmental Health Services COUNTY OFFICE BUIL DING - CARMEL, NEW YOf2j This report is to be completed by well driller and submitted to County Health De} artment together with laboratory report of analysis of wat;:r sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. I REPORT 14�:fST 8G SUENIITTED VdITHIN 30 DAYS +OF VVELL ^COMPLETION OWNER NAME i}� fi � T {f ADDRESS a – — LOCATION 9 ((( &Street) /%� (Town)( (Lot Number) r� — PAGPOSED n USE OF YELL DOMESTIC D ESTABL SHMEN'r l—J FA M r TEST \YELL 7 r� PUBLIC a (� AIR ❑ OTHER {(_�J SUPPLY INDUSTRIAL CONDITIONING (Specify) EQUIIPMENT (L'l El ROTARY ©A Rl P RCUSSSION U P RCUSSION OTpe F.R ) — CASING — "DETAILS LENGTH (feet) DIAMETER(in;hosJ _ �. if WEIGHT �R FCOT �-� DRIVE SHOE �J .� THREADED t_ -i WELDED YES ❑NO1 1VA5 CASING ROIJTED? YES "NO __- j TIEST j{�'�I {(�� I HOURS G.P.M. rl BAILED L-J PUMPED El COMPRESSED AIR ' .,�` _'_ j, f�� C�_ YIELD (G.P.M,) . / J'� — 4':ATER LEVEL MEASURE FROM LAND SURFA'CE--STATIC(SpeclryteeF) _ DUPING YIELD TEST loet) j _ Depth of Completed Well ,/ in feet below land surface:.) SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) _ IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (toot) TO (loot) , .ter DEPTH FROM LAND SURFACE. FORM,�TION DESCkIPTION Sketch exact location of welt with distances, to at feast two permanent landmarks. FEET to FEET _ If yield was tested at different depths during drilling, list below ^� FEET GALLONS PER MINUTE_ ' 1 D'A'TE WELL COM ETE DATE OF REPOR . WLLL LL.En (S /i j�aa,urc)) _PUTNAM.7. C OUNTY .DEPA.RTMENT OF. HEAh DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y, 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0. e -7 Owner Jas6wiy fZi4-6-.l Address 6q,0,6 �/i ti i�'�E> ° /` r,✓ fyi � � y � lnii/ifet �� Located at (Street �iyra��if'v ,G;>i�;�� -Bar, Block -6 Lot G �Indicate , nearest cross s ree Municipality __�, c� lLtA�)-' Watershed la,adV SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION. PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 17 2 1Z 3 ll.-q% /7%:7f l i 2-0 4 R 2 3 4 5 Notes: 1) Te'Rts to be repeated at same deptn until approximatelyy 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. Jyb 2 ,�/ -2, c, /1 ;4df /F' /� d- ly:_- 5 �, o 1 17 2 1Z 3 ll.-q% /7%:7f l i 2-0 4 R 2 3 4 5 Notes: 1) Te'Rts to be repeated at same deptn until approximatelyy 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. 1811 2411 3011 361f 4211 4811 5411. .6011 6611 7211 78" 8411 A ti ti ---------- I, _. TNT)ICATE LEVEL :AT__WBICH GROTJND. WATER. IS--ENCOIMTTERED. V, INDICATE LEVEL TO WHIC$ WATER LEVEL RISES AFTER BEING ENCOUNTERED '*TESTS MADE BY Z­ IYAQW-_A _ Da t � oqaly 311 DESIGN Soil Rate Us6d/J Min/1 "Drop : S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity use Gals. Type a Absorption Area � �Provided By�g�_,/ L.F.x2411 .5b" width trench. Address THIS SPACE FOR Soil Rate Approved -Sq. Al by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION .�DESCRTLPTION -OF *SOILS -.ENCOUNT-E-RE-D,.,.IN-TE-ST -HOLES-`.­-:-­`, DEPTH HOLE NO. R1 HOLE 'NO ., HOLE G.L. 6 121f 1811 2411 3011 361f 4211 4811 5411. .6011 6611 7211 78" 8411 A ti ti ---------- I, _. TNT)ICATE LEVEL :AT__WBICH GROTJND. WATER. IS--ENCOIMTTERED. V, INDICATE LEVEL TO WHIC$ WATER LEVEL RISES AFTER BEING ENCOUNTERED '*TESTS MADE BY Z­ IYAQW-_A _ Da t � oqaly 311 DESIGN Soil Rate Us6d/J Min/1 "Drop : S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity use Gals. Type a Absorption Area � �Provided By�g�_,/ L.F.x2411 .5b" width trench. Address THIS SPACE FOR Soil Rate Approved -Sq. Al by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF' 'E' MENTA "�iEAY,TH` SEIICE COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner IGas�pH l/` /fL s Address y�A'GE2 �/7�'�6� -r c�A�^✓i 14ZI/I ✓ty in7,hA Located at ( Street Oex 0,q j1,e Block r, Lot n ica e nearest cross-street) Municipality o�v„� dF!'�Ti�,4N1 V�4L6!/, Watershed E,,r�GG SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 /v _'30 IV_ / 21 l6 g z 7­9 /nJfG� 777r 17, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF' 'E' MENTA "�iEAY,TH` SEIICE COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner IGas�pH l/` /fL s Address y�A'GE2 �/7�'�6� -r c�A�^✓i 14ZI/I ✓ty in7,hA Located at ( Street Oex 0,q j1,e Block r, Lot n ica e nearest cross-street) Municipality o�v„� dF!'�Ti�,4N1 V�4L6!/, Watershed E,,r�GG SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 /v _'30 IV_ / 21 l6 g z 7­9 2 1,,- -s°7- 11-13 21 17 ,2� 7 3 11-Z4 113 2.y / ¢ ¢ 3 7.3 4 5 4 5 1 F4 3 I /l s %mss f3' ��a, rh f l'e ajeV 17Z� ICA 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. � r 1 3011 36 42" 4811 54 60" 66" . 7211 78'• - _ 8411 ;I - DILATE .I�L_�iT_ TIT -QU GR(D M. WATER. IS EWWWTEREL � __. , ...._._..:__:�-:_ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used_2!�j_Min/l "Drop: S. D. Usable Area Provided `S; X-III •� I No. of Bedrooms Septic Tank Capacity 90 Gals. Type Absorption Area Provided By_/Z�L.F.x24 :✓ width trench. Other Address c THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq. ,pg�aae� Lure 'PENT ONLY:a d by. Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION :. DES.CRIP'I I N: OF .S0MS i�T�CJUN�I'ERED IN. TEST HOJ,ES . DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. TPS0 1, 6" 12" 18" 2411 � a 3011 36 42" 4811 54 60" 66" . 7211 78'• - _ 8411 ;I - DILATE .I�L_�iT_ TIT -QU GR(D M. WATER. IS EWWWTEREL � __. , ...._._..:__:�-:_ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used_2!�j_Min/l "Drop: S. D. Usable Area Provided `S; X-III •� I No. of Bedrooms Septic Tank Capacity 90 Gals. Type Absorption Area Provided By_/Z�L.F.x24 :✓ width trench. Other Address c THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq. ,pg�aae� Lure 'PENT ONLY:a d by. Date 'Y� r• � �, j,l �r ft i z APPROVED ✓� ` t 0 CT2 91973 {JJ // :a OVHEALTF MWNMEWTAL HEALTH SERVIOR rernF o/c9t r40f(E INS 1s- to eeO that the sewage Mostrufted 's k. r 1 , l 'UD this ptan and 022 the systaul � b } me tetare it rocs coueref US car �nctcd c. With a:d the rases ead rec} Tunas of "t Putnam cuuot Bea i j f. � P�tfft r' l "..� �' ,gin �r . �, ,,,�•,.. `r - � ;reed". � �•J/,.yb,_!.Y -N... r -� �. .X•%'Er.: t . a rs Ij o e j� ' ot_• I,� f5+ 'wit P �ROri { -� e;�,<�rrxs•� ff•' i��} �..�+ r.`.2�.1t : � 'u,< .a r•' . ,:, G7 1 t" f ;tic: 4 E 4f $