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HomeMy WebLinkAbout3693DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -25 BOX 29 03693 T, Mr. Robert Morris Putnam County Health Department 4 Geneva Road Brewster, New York 10509 Dear Mr. Morris: August 5, 1993 Enclosed please find the following: 1. our application to the Putnam Valley Zoning: Board of Appeals for an extension; F•.� :'�_, 2. A copy of our survey; w_ 3. A copy of.our architect's preliminary plans; 4. A copy of the Environmental Assessment Form; F�•k !. Please note that I do not have a survey of our septic n -R ...._._ ..:.:.......:.system � Plan -r ..I =n'1s told that : a copy - would.:�be:: on :file with. the..:_. Health Department, so I will assume that you have access to it. I was unable to reach you prior to mailing these items, so I hope I have included everything that you require to make your decision on our extension. If, however, you require anything else, please do not hesitate to call me anytime, (914) 528 -1277, and let me know. I will immediately send you whatever you need. . Understandably, if we need to do too much work (i.e., moving septic, moving fields, etc.) prior to construction, we will be financially unable to do the job. I wish to thank you in advance for your consideration and attention to this matter. Your assistance is sincerely appreciated. Very_ftruly yours. �nLet Serena Pagnozzi Enclosures P.S. Please be so kind as to send me a copy of my septic plan. Many thanks. I could not reach you regarding an application fee, so if you let me know what it is, I will send it right - over. Your reps could not-tell me what it was. ZONING BOARD OF APPEALS PUMM VALLEY, NEW YORK TM # gjag 7 Y. / -� /— TO THE CHAIRMAN OF THE ZONING BOARD OF APPEALS: I hereby file an appeal" 16ak application "for a variation-ftom the requirements of the Zoning Ordinance of the Code of.the Town of Putnam Valley, New York.' NAME AND ADDRESS OF APPLICANT: DATE:_ �'•S'�13 TEL: (Home) C9/` 61J -1�- ?7 (Work) S & ,� DESCRIPTION OF THE F OPE-Ex KXS :�.:�^ "v�aC+ Subdivision: 5 Nearest Interse ion Y� 1- Size of Lot Sq. ft Front (ft.) rcl? Depth (fte) Type of Building. Height (ft. Stories Size of Building incl. pro osal 0108 j �- Location of Well: (,.5-1 jr, oC- . se _ GPM: Location of Septic: Jq ' P<p ,n Vye_t_ Size of Tank: hon s - Size of leaching area: FORMER OWNER (FROM DEED):_ 1_'o v,i $ i- L W 0 Ar C) /U CSC REASON FOR REQUESTED HEARING (State clearly and completely the reason for appeal or application and description of work or use): rD 0 4) /nJ / A) G Ag-V k Z i-4af r G o TIX-t-L Can this project be placed anywhere else on the property so a variance is not required: YES N01V If YES, please explain why you are not placing it in that location: _..:._..._ ._.me— _ . po ..h Name of COntI1CCOi 'or" Person' res nsible •for work:--- 'Sl4- �'•J�. h � 2Z ,•. -. b�S3. K- �1C-�. �....:_ .. , _ Name of Engineer (if any): Name of Architect (if any): A- U.;.eU f0,-z-.D Ins.. Has any prior application or appeal been filed with this Board? !sa If so, give date and decision: Name and address of attorney or representative, if any: W /k Is the property within 500 feet of the following: State or County Highway? NO County or Town line? N 0 Parkway? N 0 Public Lands or Parks? No Is any portion or property within: Wetland Area? Flood Hazard? 90 Has a.Court Summons beer. served relative to this.matter? NO Has a VIOLATION been served relative to this matter? N 0 Has a STOP WORK ORDER been.served relative to this matter? N I, the applicant, hereby gi;e permission for an on -sine iuziPeta,iuc. - Zoning Board of Appeals or Town Planner at any reasonable hour of the day (including Saturdays and Sundays). I, THE APPLICANT, AM IN COMPLIANCE FITH SECTION 55A -4 OF THE TOWN LAW, PARAGRAPHS B & C (HOUSE IMBE ING) . APPELLANT DEPOSES AND SAYS THAT ALL ME ABOVE SUMMITS ARr TRUE. igns tur Pof kant_� r• TOWN TAX MAP.DATA: Section 69, Block I , Lot 15 = Fe I /0 q 0F. P ' 'SOP- iy UT �A� '4CiPE � 2p O 9,S0p O a 0 M 52 49,076 S. F. O �" j 4 Drain i r .. ..... is - - _... .. Netel z lS.g Shed r d ` 44_f2 } Dt •Deck'_ 9� Il /2St Fr Dwelling �j G-3,,, . S6 /ie erse RO 7-u Deek' 53.44 S q *a ,op � nil. ro v d- At No: e!! . ,: to Telephone Service Or ' - Underground e_h F 707 7 -,Talephgne r tip. M eC. PV'mt. Pole Utilitt S. Wir`ea It�x -,i 3iV r1 tx ? t PARCEL SHOWN HEREON KDWgAS LOT No 5.2 ON SUeDIVf310N -MMF-ENTITCED.$^cilon B of Putnam Acres" F n !N .. ^rnNry r! S ��r,^, CERTIf I! ATir�NS INDIG: kTF.0 HF.RFON I .NII`X AS MAP No.815A "Dv•�,iSny vvN? hiC Ak:.0 IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE. FOR LAND SURVEYS ADOPTED BY THE .,,NEW I YOkK STATE ASSOCIATION "UF PROFESSIONAL LAND SUBJECT 1`0 ELECTRIC ANDIOR TELEPHONE CO. SURVEYORS. SAID CERTIFICATIONS EASEMENTS, IF ANY, FOR OVERHEAD AND/OR THE PERSON FOR WHOM THE SURVEY AIS PREPARED`-AND- ON UNDERGROUND SERVICE. HIS 8FHALr TO THE TITLE. COMPANY: GOVERNMENTAL- AGENCY AND LENDING INSTITUTION LISTED HEREON;' AND TO '• SURVEYED AS IN POSSESSION, (No Lines of Possession THE ASSIGNEES OF THE LENDING INSTITUTION, CERTICICAT10NS" Other Than Indicated). ARE NOT TRANSFERABLE TO'ADDITIONAL INSTITUTIONS OR.; i SUBSEQUENT OWNERS. 3 SUBSTRUCTURES AND/OR THEIR ENCROACHMENTS a BELOW.-GRADE; IF ANY, NOT SHOWN. _ SURVEY. OF, RRQPERTY �tO )SE_OF.FSETS ?'A)<F:N TO= FOUNDATION'L'1NE OR SIDING +~ y l t PROPERTY CORNERS NOT STAKED PREPARED FOR 6 ERARD and' SERENA PAG.NOZZ:.I., THIS SURVEY IS HEREBY CERTIFIED ONLY TO: I.GLRARD and.SERENA PAGNOZZI LOCATED IN 2: LAWYERS TITLE INSURANCE CORP. 3. FIRST,NATIONWIDESAVLNGS T(11AlAl A nrrv:.... o " PROJECT I.D. NUMBER NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION • DIVISION OF REGULATORY AFFAIRS ..State Environmental Quality Review - SHORT ENVIRONMENTAL ASSESSMENT FORM' For UNLISTED ACTIONS Only PART 1 Project Information (To be completed by Applicant or Project sponsor) 1. Appl anUsponsor 2. Project Name 7. Project location: YLA-V Municipality f IV\ County 4. It proposed action: r ❑ New m Expanslon ❑ Mod iHutionhltetation S. Describe project briefly: fin iGtC<�I?t ale .r1 4 ►AGE C� n I Yin CcC 0"06L)-1- sa OL-L 646 c6q �, e U�ce n��� ►� c.v �C7 D � • 6 Precise location (road intersections, prominent landmarks, a c. or provide map) 1�Q13-�2_ J �CtC C-Y L•(A rt.LL .' 1' DD (-+)i1 V)6 0 C.-A 7 Amount of land affected: ( f ��x Initially .acres Ultimately .acres g. Will proposed action comply with existing zoning or other existing land use restrictions? aJLr ❑ If No, describe briefly Yes No 9. What Is present land use in vicinity of project? f .. U Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Parkland /open space ❑ Other Describe: 10. Does action involve • permitlapproval, or funding, now or ultimately, from any other governmental agency (Federal, state or Iocalif ❑ 1Yes ❑. No if yes, list agency(s) and permitlapprovals 1v\1 r i �:t ric( �k l�i1 `�l 66 0,T\ 11 Does any aspect of the action have a currently valid permit or approval? ❑ Yes f!o If iist.agency type yes: name and permitlapproval 12. As result of proposed action will existing permitlapproval require modification? ❑ Yes ❑ No I CERTIFY THAT THE INF ATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appliunt1sponsor name: ��' Date: .- , � Signature: ' If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 April 21, 1993 Ms. Pagnozzi Partridge Lane Putnam'Valley,.NY 10579 Re: Addition Dear Ms. Pagnozzi: JOHN KARELL Jr., P.E. M.S. Public Health Director I have received and reviewed.the plans for the proposed addition to the above mentioned residence. The plans have been approved as per plans bearing this Departments stamp and dated September 7, 1993. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. _..._. 2.. T .dxist:ing. sewage. disposal .. system:,: - and - "its expans .onu area-, -must be maintained. 3. All plumbing fixtures must be replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. 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. Ver rLuly yours, Robert Morris Assistant Public Health Engineer RM /jp cc: BI (T) Putnam Valley .4 y` i t 1 .1 FUT,a,'.�i GUMIT� 1�IEF.�RTMENT OF ; ?J; it 1014LY; PFOR"""'AS YJ TAY Da e Sly letllfC % r1tlC P�-o 5F—�p p?.o P oS E p NEw D 12- / KI-r. H EN �e�►TI o f� q 0 O �t b� I ATH 1 1 rX Ie"'r & t- cI? o ro( C G �u N D rLooK- Jacqueline Lynfield, Architect 25 Evergreen Road Putnam Valley, NY 10579 (914) 528 -00018 D Evw I In 1 i 1 i 1 i i I .� old t s It ?A 2ip�� tiN f v1T NAM vL-i �4y Exl S1``� Pg-0 .ros c PLC r� i I luellne Lynfield, Architect 25 Evergreen Road stnam Valley, NY 10579 I (914) 528-0068 f AD'D 1Ti ON t t II Ld . PA-&T , / ob e pIA �� y A Jacqueline Lynfield, Architect . 25 Evergreen Road Putnam. Valley, PAY 10579 — .. (914) 528=0088- - -- A2,; Jacqueline Lynfield, ArchitW 25 Evergreen Road Putnam Valley, NY 10579 (914) 528 -0068 lLE1��? L-i%IA-rlO1-f - peoAgsp- /�2a1'bS�.G TOWN AX -Pr Al' �LIATA: I Section ii 9, Block I ; Lot 15 T/I ON '00, f do DES r �. �„< 00 te ivpm 076 Sf �:LIE7 LT %J t 1993 . I. .-1„Q i. 4 °Drain 6't Shed _ Dk EW Drec Dec 55:,� "11/2 St: Fr. Dwellin xr .. p�.-: J .fin QQ ��r ' �'4 /, I� �. � i / ,:M . �• y. . Teleah07PS �} h �r UD Undafar0 01 DOMMMMMMUM 007 /0/`// 7ele.phone Marker ITT Pota Utrlitp E'_ WirQs C6 t n' P4� f-- BY V G`9 �/. i4ogX y DG D K Jacqueline Lynfleld, Architect ''a4k_To k✓N STS ph lwitm ✓L% 25 Evergreen Road /;p N7 /U57o� Putnam alley, NY 610579 �itT�b �, ISI SZ AA -T.-A1 x2 z-�, X993 LWIFIELa,' p -iclv 1 MM i- I 11 f i PA-- 7-� A- k6 0 7 4-D Gk ' 1� N eW A-Ph 0 tQ 4_D F Jacqueline Lynfield, Architect 1, f?,�ZO�bs 4- 25 Evergreen Road Putnam Valley, NY 10579 (914) 528-0068 CA 4 0 Ab .47 Dec, 2. IP:: -4 'BEOP:00 M CAPE.. COO to far f -'PAD.'GVAN-l-,,�-,M.,V-(A-S -.p zt nN is F 'MEDICAL JLABORATORY N ro p on, IR Maple rr C - p ee S 11 Yor k 8777 -ew , 'fNATION db L12 CMTE D M- OF -A _K" 5 I,Vff-D NDERS 2 T-1'!, V-I-,L,-LA-, G—E-2-tO—W, 'N" R, NAME OF SUPPLY -- "'.1 I A V T---05 -A g E WELL BACTERIA PE.R ML ,.(Agar P-9 te count at 35 - ?"- C - , LI-Fr OZ'R, M,GRDU;P (Most probable RESIDUAL AS AT POINT M ENT. :LESS ,THAN �s _ -c L bkibtS l 5!,j--,z P A, KFLOURIDE (F)-- mg /1 N "kN 4. a, "YES i of a satisfactory sanitary quahtywhen the sample was collected -` far f -'PAD.'GVAN-l-,,�-,M.,V-(A-S -.p ti, WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK '"�' Tfils'r�p6rf is'* to- be coftlefed "by' well °dfi'Ifer"a rid`subinitted to Cciunty 'Health°Departrnentltogether, with 'laborafory� report of `= analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME AD E S 7,3 . 701 Jl� LOCATION OF WELL (No.. & S eet) �� (Towne) (Lot Number) PROPOSED USE OF WELL DOMESTIC PUBLIC 1-1 SUPP Y BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL ❑ FARM AIR ❑ CONDITIONING ❑ TEST WELL O(Specify) DRILLING EQUIP MENT ❑ ROTARY ®A COMPRESSED R PERCUSSION CABLE ❑ PERCUSSION ❑ OTHER ) CASING DETAILS LENGTH (feet) r DIAMETER (inches) !r WEIGHT PER FOOT THREADED F-1 WELDED j—DRIVE SHOE �J YES ❑ NO AS CASING GROUTED? ®YES ❑ NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. Q YIELD (G.P.M.) /Q WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well i in feet below Land surface: 1 d 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET /Q ! �/ `mot If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL C {9MPLETjED / / `� "ij / 1 v DATE OF REPORT WE�,jJ}�I LERJ(�($f�ature) f t n .. ✓�/ / �L�d r• , Owner or Purc aser oT Building Municipality Building Constructed by Location - Street � �FDizol�r/J G.9f' G'�.D Building Type A4 9 - r11V Section G� Block Lot GUARANTY 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 guaranty to the owner, his succes- sors, 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 de- termination of the Director of the Division of Environmental Health Ser- .v.ic -es of :- the p - i_na�m -- County Departrre t 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 syst�,;n. Dated this 6 day of 19%Z_ Signature Title 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 ,PUTNAMS Division of En CONSTRUCTION ;PERMIT :FOR SSE - OE'DIS i .. Subdivision�C. r h ' Bwld�n9 aTYPe, `^ n `•` •��� =` r ^Lot F ' Number °.of Bedrooms ' Separate. Sewerage System to - consist of , To be constructed by f * .'WaterSuPP1Y Public Sup PIY •From Private, Supply to be drilled' � Address �i�A -Other Requirements I represent that l; - wholly and completely responsib above described will _be constructed as shown.-op, le wn on the appr ;County','Department of ;,Health, iand that,'on completioi be submitted 4o•,the IDepartment; `and a written guars piace�in�.good.'operating condition anyYii4i df•_saitl sr i . OUNTY DEPARTMENT OF HEALTH `°� onmenfal �Hea %th Services ..,Camel N Y� ,1:0512 iSAL SYSTEM p Town or Village 'ri /�/•�:. ,�',�. r Lot`.j Job - Address � � - 4 "' L Total Habitable Space Square feet ' �— -Ga1 Septic Tank �' -� lineal feet X� width trench Address - , I the design and location of the proposed systein(s) 1) that the separate sewage disposal system . ={ d m aendment there Wand in accordancg wdh the standards; rulei'and regulations of She u nam' ' lereof a rti 'Ceficate of n yCbnstruct on Compliace 'satisfactory to.the Commissioner of Healthwill i e,will tie- rfurmshed the owner ,his successors heirs: or assigns by ahe builder; that said builder. will •� ige disposal sys_tern duung the period of two (2) years in nrnediately •following`thedate, of the issu- i` f `th' I f r r fherefo 2 that the Ai well described above - ance ;of the approval of the, Certrfficate. -of� Constructic, :Comp fiance o.. , _ e ongcna , system or..any. epa� i � will be located as on the approved plan and that said ;well will be installed in accordance with -the standards, rules and,'regulations of the ,Putnam "shown County Department ofr Health _ � , - - , S gned R A I �� � � i ' 'F%Ucense 42-4140 40 Address . � APPROVED FO,R CONSTRUCTION This approval expi►es one-year from_the date `as unless construction of A he budding has been undertaken and is l revocable for cause or ma be amentletl or,mod�fietl when considered nec Y regwres a new permit Approved fo disposal of domestic sannary sewage a f Health Any change or alteration o 'tonstructwn . ) u ply only /r Date�y�! �. BYk /4 Title ' \ Gent' e,,, - �n : 7 AT Dat e '07 0 Re: ?rope_ t y c 1,"Ineay, //L/c. Locatt ed.- at 7,e 10 s ec t Bl o c z: -10, T'-L-Ls lette -- Is o-" 74� co" Z1= c o 0 C tary Code. v Yol.,,rs, Very t. C) /V C o un t e r s Address p E A 61. d e s s T,= 1 Tel e ,) '-n-,-- n e ......,.....,. �.., _..�,�. �.._..._....��.s.,_= ,..... ..�.......,..�.b....,.4...... L 0T 23 / _�...�...�,a...n <Op 22+,,. �,. .....m..........,...�...a,..... i 9 •0 �• / er � l M 1 I LOT 52 49,076 S. F. s I _ "o 6. , /EP 0pJo �XPPNS�pN 'PP ! !0 LOT 53 _ I 0 r o- I D+ti / Z 3 O 9 TO �Oe M � } 8.350 _ ENVTO 1-9999 5-16= 29-00-E 101.11 V 630"P£RCOLATION TEST "�_ L A EVE 1 ®7' TESL" ,v +' 1 E°r" ( MCP SUTVBfGf Ski �' �'r PARCEL SHOWN HEREON KNOWN AS LOT 52 JJII �c " ON SUEDIV /S /ON MAP SEC. B OF PUTNAM ACRES ti I����►. / _ '— J TOWN OF PUTNAM VALLEY TAX MAP DES/C.NATiON.' PC. -9, TM 069011.5 i _ PUTNAM COUNTY DEPARTMENT OF HEM Division; of Eny�ronmental H4hh Services, _6rme% 'N „� CONSTRUCTION PERMIT FOR SEWAGE :DIS POS AL SY,STaEM " , at Y Section Located CIS r �U7- ,0U7 �C/�La //Uir'� Addres owner­ s Building Type Lot Area Number of Bedrooms a Total �Habltable Separate Sewerage System to consist of O — . Gal Septic Tank 7-7 777 i To be constructed by y�LL�"' Address �f Water Supply:,.,-, Public Supply From 4 ,!c "' Prrvate y5upply'' -to' be drill/e�d � � C Address` �fJ.C�G�.e v /.•/�/I/!9/�i.:, .(/R��� +� Other'Requirements TH } Town-;or' village - t� i 9 Block .GT Job ®dnDace Square Feet meal feet .X width trench ., 1 ,.anov6aascrluCU w,lll.uo.wNaar ua.acu di i VW11 O.i -O jIF! V . cr u n, County ;Department of ',Health rand thet'on completion thereof a :,Certificafe of.Construction Compliance' sat�sfactory,to; _ Ris�b`ti�r' aIthw�ll 1�, b `furnished the owner his successors heir's:or assign's by eq¢ d er will e, submitted to °the 'Department •`and a written guarantee will be place An good 'operating cond¢ion any. part of 'said 'sewage disposal system during the period of two (2);,years immedi f irig the t f t is3u- .: rice of approval of ,_the Certificate .of Construction Compliance of the original system or ariy'repairsj thereto; 2j t t: dr.i e_ 1 ove will be located as.shown on -the approved pliimantl that said well, will be installed tin accordance with 'the standards; .rules eg io f th P� am County Department of Health m y Z. 04 (, Address G r`JLa: !Lt /8���!ieD v tJ s se. o. r APPROVED FOR CONSTRUCTION -.This approval expires one year from -the date •issued, unless construction of .the,bu in��t I)eeP id aR nd is revocable for cause or may be amended •or- modified when considered- necessa_ ry -by the Commissioner•of Health., ;Any chap o %lt �o r coon req NMI uires a new ;permit. Approved fordisposal, of= domestic, upp y only. c. .. Date ^ ! El Title - = o P -,4 7 L. T. D I-, Da Ue__ 5" _199 Re : ?rope li -q4n rope-_-t c' L o C a t- J d' a t PlQlle7�'1064: 0 C - 0//4:1 T 0 4­ "7 :5 sacu'�_n B.I. G n45. 1. e n D t Th-'s dial I ic 7:� a-c--_tec ) a Ij -7 fo a al; a S 1 LZ -LCL S, 0 11 S eC 2 S a - n D p a t 0 CO._ r n Se _17�1 ec n ot 7 e a aT, an d tlne utnar, 'o-n", �:z Ed,-, c a o n ha e p b I c tary-Code. I yours. Very ' .u'. V n e d C o wri t e r s i's 0. n A" 'd-ass Tele, Inc OF NCIV. PO fi� 0 *Avg Address %* T e 1 e T­o e PA 124 10. _.. �....w-- __.... _.._ .........._: _ .. - .... ..... _ PUTNAM .COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET. - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner „v.��» C,? s, 11VC, Address Located at (Street)_ pAeT":q1,CWe' z:�, Sec._ .C= ° Block "Lot h.. (Indicate .nearest_ cross street) . Municipality y��"�'y ;/�f�.� -' Watershed.%�%S% . SOIL PERCOLATION TEST DATA REQUIRED- TO.BE SUBMITTED WITH APPLICATION Hole Number CLOCK TIME PERCOLATION PERCOLATION ..Run Elapse Depth to Water Water Level No., Time. From Ground, Surface in Inches Soil Rate Start Stop Min.. Start., Stop Drop in Min/in.drop Inches Inches Inches sr 3 9= ¢� �_ IS' % `� - 'o-o /1'7141/' 4 5 e 19 CeD 4 5 1 2 3 - - 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are ob- rained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. _r TES .T= sPI.T- -!ATE- ,REQU -I RED._. s0., BE- .SUBMI.TTED,;I �.TH�AP:PLIGAT,IDN� -'.;:. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES l DEPTH HOLE. NO. ;HOLE NO. HOLE .NO,. G.L. -0 f So s.[� 70/' c5'0 7/414> 61r 2 4+' 3 Orr 361T .� 42'T 48.rAyy� 5 4rr �s 60rr 66 Tr 72rr 78f? 841 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFT FR BEING ENCOUNTERED TESTS MADE BY ,� �� 1�,E/Lse 3> 0;1e©,r=A11_06<J_ Date X?06, s. /I P,? Soil Rate Used Min/1" Drop,: S.D. Usable Area Provided boo No. of Bedrooms. Septic Tank Capacity OD -Gals. Type Absorption Area Provided By;?; j 76 L. F.x2.4 +r 36+' width trench, Other Name: �-�..E �°- G�.+�n%ic�L ..7'�E: Signature Address SEAL PEE o m�� 7V W^J i � m PUTNAM COUNTY DEPARTMENT OF HEALTH m . Soil Rate Approved:: Sq. Ft. /Gal'. Checked by °^ ti e �NAI EMGINEE��