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HomeMy WebLinkAbout3716DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -72 BOX 29 03716 0 ' is .416 oil 16 a 11 r 03716 iA TUTNAM `COUNTY DEPARTMENT ; DF f HEALTH - a x Division of E "' Wiiierfial' =, HWi6h = Services Car e% N, „Y 10512 CERTIFICATE :OF CONSTRUCTION COMPLIANCE FOR:SEWAGE DISPOSAL SYSTEM ii? ilPa$e L "ocated of • Tax Map Block ` Owner Z a Job Separate Sewerage „_System built 6y. Address K Consisting of Ga L.,Septic :Tank and SCo © i ► T— `T' a� Z`4' i "� c-r�G t h 6; Other requirets ^ ,. T Men . Yr i Water Supply � Public Supply From Private Supply Drilled 8Y Address _ v Buildin,9 TYPe,a -�I *L- ”' No of Bedrooms' 4-- Date Permit Issued'' 1 kas Erosion Control Been ,COmpletedv certify that the systems) as fisted serving the above :premiseiw re co_A_ i cted essentially as shown on✓' a plans'o completed work (copies of .which are 1 attached), 'and in' accordance with -the stantlarys -rules and regulations plans filed, arid° erm ass by', a tnb County Departm'erit of Health f _Date ' z , "{ ,Address l- btu ` '��n '- � ° . ;' - v •' � Any person occu'pymg premises served by tfi'e above systems) shall promptly take such action as may be_ necessary to secure the correction: of any unsanIta►y conditions !resulting' from 'such usage Approval of the separate sewerage system'shall become null and void' as soon as a public sanitary 'sewer becomes �o available' and the approval` of the private ,water `supply shall ;become, n~ a tl- Goid when a' public water supply becomes available Such •approvals are subject .,to "'mo �f ;cation or:- change when in the )ucigmenf Fof the om ssion of :Healt h revocation ,modification or. change iis; :rnecesim ry t ALBERT H PA L)Oi/ANI M.T. YORICTOWN MEDICAL LABORATORY P O. BOX 99, YORKTOWN HEIGHTS, N. gF 11 Nsyt,,Y�zI: 1056F '1Q59R PE 7 -87 .7 P lski .., RESULTS OF EXAMINATION OF WATER OWNER OWNER ERRE32'U 1/EUlkNPl; LA1r; I1LVG1 VLL CARLO PROIETTI 2 =12 -79 CITY, VILLAGE, TOWN & /OR NAMIr.OF SUPPLY DATE REPORTED WOODMONT ROAD HOPEWELL J.C.T. 2 -14 779 SAMPLING POINT WP..T.T. BACTERIA PER ML. (Aga plate count at 350C). COLIFORM GROUP (Most probable No. /100m1.) 0 HARDNESS, TOTAL '- ppm ` DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL -'ppm FLOURIDE (F) - mg. /1. These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. TEST FOR BACTERIA l�'l�v . IrC�GJ A. H. P'ADOVANI, M. TO (ASCP) :5 WELL•COMPL'ETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK c -report is to be completed by .well driller, and submitted to County_ Health. Department.together_With laboratory: report of- analysis of water sample indicatincj vvater is of satisfactory bacterial quality' before certificate of construction compliance is issueli: 1-1 REPOM MUST SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER LOCATION (No.' Street) / / (Town) % -7 (Lot Number) J f /-C- OF WELL i' 7th 7 rl (� / / 24—t" ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ 1:1 ❑ CONDITIONING ❑ ((SSpe ify) SUPPLY INDUSTRIAL COMPRESSED CABLE El ❑ PERCUSSION El ify) EQUIPLMENT ((SSpe ROTARY ICJ A R PERCUSSION CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT El DRIVE SHOE ® El ASING T 1 DETAILS. �. / 7 THREADED WELDED YES NO ..YES NO YIELD HOURS G.P.M. 'Z � ❑ ❑ ❑ YIELD (G.P.M.) ?_ TEST BAILED PUMPED COMPRESSED AIR t� WATER MEASURE FROM LAND SURFACE: —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well j LEVEL in feet below land surface: MAKE LENGTH OPEN TO AQUIFER (leaf). SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (loot) TO (loot) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET lt «x If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OMP TED DATE OF REPOF:T WE RILLER S)gnat e) c1l. C) G-all'st- Suc .!_oil -M,<ip T>. INT Z" 1"(A represent that I aiid C. 00 p r c., s-11 o, , s location, worl - r-m-anshl), lir"teri"ll. P c. Or' S t l-"L c d2:•aj.no,,r%-_0 of I di -Pos: 0. system serving th,,:.,, --id that J.11- lh�- t' con-sti-luctcd as shovm on s or and in accol-dance t�c s'F,,,-)d,3.i,ds, 1--' U.1-es and 1--c-ul"ations of the Cl Count,y Donanrtmemt Of Health, a.i�d tc) t.he or assi-ils, to z)l Cc, j- 1 Y o o d rc) p c,. r D c 021011 t j -oil -al '-0 operatc,, for. ,Ystcl? constructed b-,,, cd of -v a rs of di." j_--mediate'y 0 _J_ 'a Y s I " c r, i , o a i I y r on, --.s mad­ a i.,L 4-L) act of' tho occu- LIC) Opol"'I'tci i", causccl Or ne,�,,lir,­i OS' t 'I-,.e bu i id i 1-1 rr 11 t i 1 i z Ulu cI 01,sll'rjuu `' CI' the Directoz, c,.-:' -1 vj�celc> col'unty jV4 6 Pe a 1, 7'7: -%:r Of 1, C, L t o I or nlr%t. r, Y t J. j "C 't Of tha occupcimt of the bud-, t i 11 i i 'CLIO 'V ne:: L)- Cn u n C.- S. c 1,; cl,"li day o v 'Ti t 1 c and addre s s - - - - -- -- - - - - - - - - - - - - - - - --- - - TT'j AR F, i C 0 p, I ­,cS -7 TIMEE (3) GOP-LES PLANS B'L"'Foi"z' AF2 R,';"QTLJ I RED (;ERTlYelc;i,,,J,- OF C0i 1-P!__;ETION 13 i s S U­D' �T USE Oj? TO 0 - - - - - - - - - -- - - - - - - T)lvisicn of DIvironmental Holn'l.ti) Sjc:,,viccs, Pu tll71­­ County Depart,,,,,c.,j- *cal it of I'l FIELD CHECK LIST -L. N Date: Insp::by -: INITIAL SITE INSPECTION Yes No -Comments Property lines or corners found . . . . . . _ _ Can estimate house location . . . . . . . Will driveway need cut . . . . . . . . . . `�- Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes needed. .. < . . . . . V -� +� Sufficient SDS area available considering driveway cut,house location,separation . . di stances, etc. -- DEEP HOLE DATA Depth: �f Water elevation: Rock elevation: v Soils description: e C_ Date: FINAL SITE INSPECTION Insp. by: House located where shown on approved plan _ SDS located inhere approved • . . . . . . . . . Length of trench measured Width of trench average Slope of the line and trench acceptable Room allowed for expansion trenches , . . . . Over ._ 50 ft. from swamp, ti,Tatercourse- .Natural soil ° not stripped- "or SDS-area °- unnecessarily graded: . . . . . . . . . _ 10 Ft. maintained from prop -line and 20 ft. from house . . . . . . Separation of trench from house, well _ etc. follows plan . . . . . Number of bedrooms. checks . . . . Stones, brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . . . . . . 15 Ft. of peripheral soil horizontally from _ trench . . ... . . . . Junction boxes properly set - Could surface run off from driveway, roads, ground surface, etc. channel near SDS.,,. , area. . . . „ . . . . . . . . Does lot drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE • A1.1TV.;,LJ C DOCT?l_ /,-' T IT S House plant 0. K. D- .-i ."n data sheet P�er•cs presoaked.? Tf1in. 30 If perc test depth Const. results for 3 runs D. Hole log .0. K. Corpor. ate Affidavit for. other than ind ividl Authorization for engineer Inner from Water Supply if' applicable If variance requested -such noted on plans & CIIECK SITEET 14 Me^ts Str3, . ( Remarks - e 1'do I � t ` t,r.ti'e , DETAILS if change is proposed,) Existing contours shown show new contours) Slopes for driveway cuts, etc..shown I V i•Tater service line location �. Footing drain, .etc. location I U I p, Top slope, bottom slope of fill I Percolation tests and deep test pit location Septic tank size and conformance to std. 3 B.R. house minimum cz f House setback shown I f r ;, . Aii vwater�witin.in "u I1; . or FL 5nown i ✓' i W � � Plan and profile SDS All other wells and SDS .closer 200' I shoj::n o reference made J. Property boundaries (metes and bounds- clearly sho -vnl' i SEPARATIOI\1 DISTANCES SPECIFIED ON PIJAN o 10' to P. L. 20' to Foundation walls i ,00' to Nearest well I V/' 001 to stream, march, lake, etc. incl . expansion ; L- 15' to Curtain drain I 10' to water line (pits -20' Ii✓ 15' to storm drain 10' to large trees I ✓ 10' from foundation to septic tank ! 5' to pipe from leader drain & footing drain l �l/ Secretary i��i° tm wim i Vr ItTERL�! i7.. ELAINE KRUEGER R.N. M.A. County' Office Building Director Of Patient Services. GERALDINE A. ZAMOYSKI M.D. CRIYpej, New. York ALFREDO F. G "' =`;CIA Jr. M.D. PAUL. CHA ld "`M. b . 7051E a JOYCE MILLER M.D. ...i1ILLIAM .ZURHELLFN M.D. 'd - HON. - T.H0MAS BERGIii' .. y Date m Q, 1 -1 _ j �� 4.7, roG -' Re: Ve 9 t I f d,� el LO 3,1 Dear %1�• i'0Q, A.review of the submitted application to construct a sanitary sewage.disposal system for the.proposed premises has been concluded by this department. The plans are being returned to you for the following. reasons. REQUIRED INFORMATION MISSING (1) Completed application �-,1� (2) Design data sheet (3) House plans (2 sets) (4) Authorization-for engineer (5) Layout plans (SDS) (a)- House location (b) Ilan and profile of SDS (c) hocation of- :driveway ......__..... - .(d) . Location-of we7l l -or -public-- water main- (e) Contours of property (f) Location of any water courses, ponds or lakes on property or within 100 feet of property . (.g) Location of deep test holes and percolation test holes (h)-• Location of all wells and sewage disposal systems.within 200 feet of property lines (i) House setback ]Footing and leader drain location (k) 10 feet to.property line (1) 20 feet to foundation walls / (m) 100 feet to nearest well ...LL (On .15 feet to curtain drain .(o) 10 feet to water line (pits 20 feet) (p) 15 feet to.storm drain . (q) 10 feet.to large trees (r) 10 feet from foundation to septic-tank 15 feet to pipe from leader drain and footin drain / ✓" t) Other: i� iO (Jin boom S ��e �� .�� S .c� iQ ►� . �' L5 ray, t (1 . ar;��r►a� soy i yoLi havo. : rty gL10stions concerning this matter, Please feel free to' contact me at this ofiico. truly yours,. ow" Gentlemen: PUTNAM COUNTY DEPAR:i'IvJT:,NT 0F ITEALTIT DIVISION OF ENVIRONN�Ci-NTAL HEALTH SERVICES Date /,.i ,� . Re: Property of f 4F .Lt Located at - Z`7sv"' eel'an Block Lot 76 This letter is to authorize To YJCRAEL DALY P,E 'a duly licensed professional engineer x —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 Commissloner 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 system or systems in conformity with the provisions of Article 145 or 3.47, Education Law, the Public Health Law, and the Putnam County Sani- __.... ta- ry °Codc,.,*- _ .........:. Countersi.gneP �,Z A 4•646S P -4 .E., R.A., Very trul r, yours,' sign d �i F a-iner of pertt,, 243 Shenorcck b,T.y. _ Address 914 24S 7494. lTelephone ss Telephone` i PAUL CHANG .M.D. 10512 JOYCE MILLER M:D,. WILLIAM ZURHELLEN,M.D., HON. THOMAS BERGIN '. Date Dear 2 04 t �� P u r A review of the submitted application to construct a sanitary sewage disposal system for the .proposed premises has been concluded by.this department. The plans are being returned to you for the following reasons. .-REQUIRED INFORrLATION PISSING . (.1) Completed application (2) Desian data sheet (3) House plans (2 sets) (a) Authorization for _engineer (5) Layout plans (SW (a) House location (b) Plan and profile of SDS (c) Location of driveway (d) Location.of well or public water main (e) Contours of property (f) Location.of any water courses., ponds or lakes on property or within 100 feet of , property t ; � . _ .... _ yiq* C. /� � A �' '1 f l A 7 �. (g) y Location of deep test holes and percolation test holes. c7vS� J' r it (h) Location of all wells and sewage disposal systems within 200 feet of property. lines _50 S To 14 J u .1 �` ar.1 L r_ "" r i R t t. c (i) . House. setback JnJ To nME =G' u af- (j) Footing and leader drain location ajn­ N /c ?' (k) 10 feet to property line (1) 20 feet to foundation walls (m) 100 feet to nearest well (n) 15 feet to curtain drain. (o) 10 feet to water line (pits 20 feet) (p) 15 feet to storm drain (q) 10 feet to large trees ;` 1 (r). 10 feet from foundation to septic tank (s) 15 feet.to pipe from leader drain and footing drain (t) Other:. 0 i's P C. J /r-1 c.✓ o / i� X .' r :—,'�11G; �c IL • If you have I any questions concerning this matter,. please feel free to contact me at this office. Very truly yours, PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF" ENVIRONMENTAL- HEAL-THf-SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner L ,, 4a �_t a eJT _ Address 32 8 �..f F �_ �s �� �,� Cz N `C Located at (Street) See, (� G Block G Lot -z (Tn7ica e neares cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 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 I 1 0- to 10 I q Z Z �b ee 1 2 p- tg 1g -Z 7- zs' 3 6 3 Z 2 'L� 26 zCc, 3 7 'L 3 z-3 3 2 Notes: 1) Te'gts to be repeated at same depth until approximately 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. 4 Z51 o —i1 'L� 26 3 I Z 5 2 Notes: 1) Te'gts to be repeated at same depth until approximately 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. 4 Z51 THIS SPACE FOR USE BY HEALTH DEPARTP/NT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUMERFD IN-: TEST;;H.OLES.,;,,. DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. .6" 12" , 18 11 �uw 24" r� 30" 361 42" i1 48" r 5411 `t 60" 66" 72" 78" V 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED C'' ^ " + ` ' INDICATE' LEVEIT TO WHICH WATER LEVEI; RISES AFTER _. BEING �`ENCOUNT `PESTS MADE BY `T o /a Date 3 o I� G 1-7 DESIGN "Drop: Soil Rate Used $ -Lc) Min/l S. D. Usable Area Provided 62 0 Ef- Gbo_O No. of Bedrooms Gi -Septic, Tank Capacity lZDO Gals. Type MA. o,v Absorption Area Pro ded By__.! 51 L.F.x2411 width trench. Other Name Signa ure Address vx 2.x_s SEAL THIS SPACE FOR USE BY HEALTH DEPARTP/NT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date G PUTNAM C017NTY DEPARTMENT Or HEALTII DIVISION OF ENVIRONMENTAL IMALTH S.i RVICES .. .. _ . ..a a r r r v 7_... rv... . : �. ^C r i.. ' .a -..� . _ .r . r ... t`1.v .t .i..r • .. `: Date -y A Re: Property of G° , L� r� >!� �/ Z- Located at A/'Z4/_'9 Mn� fee t � Block t%" Lot Gentlemen : This let��_er is to authorize To MICHAEL DALY P.E. *a duly licensed professional engineer X 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 necesspry papers on my behalf in oorineetion with this matter and to supervise the construction of said system .or systems in conformity with the provisions of Article 14S or 147, Education Law, the Public Health Law, and the Putnam County Sani- tart' Code _ ... _. Countersigned: P.E., R.A., 484.62 2e--3 Shano:coc-k N,. Y- Address �4 Very tru fours, Signed Owner of °Prop rty U All Address I75 Telephone 914 248 7494-7 Telephone _ ~ 1 r FIELD` CI�CK .CYST'' / Date: INITIAL SITE. INSPECTION r Ye No Comments Property lines or corners found e . . . . . . Can estimate house location . . . , . . , , , Will driveway need cut Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes needed... . . . . Sufficient, SDS area available considering driveway cut, house location, separation . distances, etc. DEEP HOLE DATA Depth: Water elevation: , Z Rock elevation: b Soils description_ �-� Date: - FINAL . SITE INSPECTION l Ins , 'by: House located where shown on approved plan SDS located vhere approved . . . . . . . . Length of trench measured Width of trench average Slope of .tile line and trench acceptable . . . Room allowed for expansion trenches , _ �- Over-50—ft'. from swamp,watercourse Natura`1 `soil not stripped or SDS area - - unnecessarily graded - - - 10.Ft. maintained from prop.line and 20 ft. from house . . . . . . . . . . . Separation of trench from house, well etc. follows plan . ... . . , , , , , , , _ 'Number of bedrooms checks . . . . , . , , , , , Stones, brush, stumps, rubble, etc '. greater than 15 ft. from nearest trench . . . . . . 15 Ft. of peripheral soil horizontally from trench. . . . . . . . . . . . .. . .. Junction boxes properly set —� Could surface run off from driveway, roads, ground surface, etc. channel near SDS area.. .. . . . Does lot drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE { RE 3�;�1 CI11�,CY SiTI�E`.r Mods std. e;; 1'Jo DOCUMEO SITS House plans O.K. Design data sheet Peres presoaked? Min., 30" pert test ' depth Cont. results for 3 runs D. Hole log 0. K. Corporate Affidavit for other than individual' Authorization for engineer „ .Latter from Dilater Supply if' applicable �p If variance requested -such noted on plans & apps.' DETAILS if than e is proposed.,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown I Water service line location Footing; drain, etc. loca-,tion t Top ' sl ope, bottom slope of fill ; Percolation tests and deep test pit location ; Septic tank size and conA-"ormance ' td. _ 3 B.R. house riinirrum ; House setback shown V. g.'' _ _ tsi1 water W1LniIl -)u r, . of, rl Plan and profile SITS " All other wells and SDS closer 200' I shown or .refer ace tade Property boundaries.(met.es and bounds- clearly shok.n)l 3EPARATION DISZANCES SPECIFIED ON PLAN LO to P. L. ?0' to Foundation walls )0' to.Nearest well 50' to stream, march, lake, etc. incl . expansion .' 15' to Curtain drain :0' to water line (pi7ts -20' to storm drain 0' to large trees -0' from foundation to septic tank -5' to pipe from leader drain & footiriC c Remark's 0 IA d COUNTY BOARD OF HEALTH. JOSEPH P. CORIZZO Putnam `' v County President DANIEL'SELDYIN D•.D.S: - 4,5�• '` Vice President - PAUL °LAND Seecretacreta ry DEPARTMENT OF HEALTH 'GERALDINE A. ZAMOYSKI M.D. County Office Building ALFREDO F. GARCIA Jr. M.D. Carmel, New York PAUL CHANG M.D. 10512 JOYCE MILLER M.D. WILLIAM ZUAHELLEN M.D. HON. THOMAS BERGIN ,914/225 -3641 JOHN SIMMONS M.D. Deputy Commissioner J. ROBERT FOLCHETTI P.E. M,S. Director Of Environmental HeaZth Services ELAINE KRUEGER R.N. M.A. Director Of Patient Services Date m a u 31, 19-77 n.! ic' Qel Pe. • d. F .Shero�oc i Re: Ve g 1 P aAa, YU-Mnaryl at (i Dear /L. '00, � t A review of the submitted application to construct a sanitary sewage disposal system for the,proposed premises hers been concluded by this department. The plans are being returned to you for the following reasons. REQUIRED INFORMATION MISSING (1) Completed application _ -- 12)... Desicn -dats .sheet (3') House plans-(2 setts) (4) Authorization for engineer (5) Layout plans (SDS) (a)- House Loc«tion (b) Plan and profile of SDS (6, Location ,of. driveway, . (d) Location of well or public water main (e) Contours of property ' (f) Location of any water courses, ponds or lakes on property or within 100 feet of property . (g) Location of deep test holes and percolation test holes (h) Location of all wells and sewage disposal systems within 200 feet of property lines �(i) House setback C) Footing and leader drain location .(k) 10 feet to property line (1) 20 feet to foundation walls (m) 100 feet to nearest well 15 feet to curtain drain (o) 10 feet to water line (pits 20 feet) (p) 15 feet to storm drain (q) 10 feet to large trees (r) 10 feet from foundation to septic-tank 15 feet to pipe from leader drain and Q rc mus�. be footin � dTi Other: O p GLnd & 44om m � S hia rj run � io orjyf%a so, r - If you have any questions concerning this matter, please feel free to contact.me at this office.. truly yours,_ PU`'NAM COUNTY DEPARTMENT OF AEALTH DIVISION. OF F'NVIRONMTTTTAL I-MLTIi SERVICES COUN`1TY`' OFF, TiNJE' PUTLDIPIG, `'CARIN I;; -.- N...Y -. DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO. Owner Address S 1�) Located at (Street AnLcate �L a t 0 �� Sec. 'G G Block G `Lot 3. l nearest cross street) Municipality Watershed ZA c; G-V �o SOIL PERCOLATION 'PEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS . 4 �.7 Notes: 1) Tests to 'be repeated at same depth until a}}� roximatel equal soil rates are obtained at; each percolation test hole. A1y data to be submitted for review. 2) Dc;pth moasurements to be made from top of hole. Hole S o Number CLOCK TIME k PERCOLATION PERCOLATION T lapse Depth to TaLer 3.a- Water r L,eve1 No. Time From Ground Surface In Inches Soil Rate Start -Stop Mina Start Stop Drop in Min. /in drop. Inches Inches Inches z 2Ce Z z L s 4 �.7 Notes: 1) Tests to 'be repeated at same depth until a}}� roximatel equal soil rates are obtained at; each percolation test hole. A1y data to be submitted for review. 2) Dc;pth moasurements to be made from top of hole. 5 o_q S o 3.a- (Q 2 Z Z �, O J 4 �.7 Notes: 1) Tests to 'be repeated at same depth until a}}� roximatel equal soil rates are obtained at; each percolation test hole. A1y data to be submitted for review. 2) Dc;pth moasurements to be made from top of hole. ii TEST PIT DATA REQ UIFM TO BE SMIMI`I`i ED WITIT APPLTCATim" DESCRIPT014 m, SO]Lv I :vC0U1�'.[�PhD IN 'i'E.T iO S DEPTH HOLE. N0. t HOLE N0. HOLE N0. - 6" l 12° ?ow, o #rti r 1811 241! - 361 �1 a 42" � t' 5. " 1� 60" 66" �' 78" 84" i IITDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WBICH WATER LEVEL RISES AFTER 'PEING'ENCOUNTERED - TESTS MADE BY Q Date Area Provided b7, S1 Soil Rate Used 9 -1 0 Mi n/T "Drop : S . D e Usable No. 'of 'Bedrooms Septc Tank Capacity t Z o`o '- Gals. Type -'10 Absorption rE\� a Tro� y c`( B L. F. x2 #'1 e width , r enc � TA b i 7�> . J - i M LleT ame 1 o FT �,� _t gna ure A :,CONSTRUCTION PE i Other 'Requirements will `'above described i el County - spa men ,;APPROVED FOii.GC LL D re - )R -$EVVA!3E 91$ POSAL U I Lot 11 . . . . . . . . . . . . . . . . . . . . . . . ..... ............. o a -,.-Hibititil pplyr'to 4 be drilled 'by(� fi4 ai pletely_ respon5i, e _On and IocaUon, - proposed 4yi elil p: wn or'- Village -' Job v ,-��;,.,t*l ui t 37 the separate "iewage,dlip osaf.systen! ules an r j7e� , Putnom y to the by .,jagtklatiqn� of .� ti b-6 i ia e'r i �fhO,'O tij Id6r i A hit "said W'l 4!iti!jV,fo I,lbw i pq i*h (iia t 9'`o4,t h:e '.i ssu at Iled.,"ll di;scr�i6e' above and .-r64uTaTions of the'-- Wtnam ,PE RA ixi build�nghas been un eh o t6ritibn ;0 r I m 01 19 oll Z PL I. 4,k\- kASO�4 7,N G� PTIC. -7i,w V, ol ttx cz) -L4, 7'Rq-V-A f-4k L%s C 4 197 ,H 6 R, DIVIMO —lVI9JDN.MEN.TA�l HEALTH I Lo'T - THIS NTO l'F,R"iTVf )' •rN AV 't M;- AS )N(,W,0f',D ON TINS PLAN 4NO k;f` SYS'] CM WAS INSIT "I F1', FIN' INIF BFH)W; I, i IT Nxl/�, . :)VER. '111F. Sysl 1"M \IVA,',. CON; I RIJU1,:1) IIN ACCORDiV-4CT, ALL THE RL.O.1"S AND RV�,ULATIONS 017 'ft-II, PU'i\NAPkj a,;QIJIIJTY DEPARTMENT OF HFAU(14. LoclaTI LAS 7. -r;,-A V\ Iz 3 51. -3 46,3' 4 45.6' 61Al n. rz C) r- P,r. Co o -<i., 7.