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HomeMy WebLinkAbout4442DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -15 BOX 34 'Irm ' I r _ J r -, � � r v -zk '+ „t,' �y ,u, s9 ..� "�[ �tir -✓^ -f �„ .AC.F .E .k,,Y °i•;: yFZ en t =2 .a,:n R v 3/ 8 PUTN W COUNTY DEPARTMENT OF HEALTH a r n Y Division of Environmental Heattb Services, Cerntel, N Y 10512 M Engineer Meet Provide �7 j/ 6 �'• _ P C =H D Per�lt N x Ct A G. OP GO I$TRU O i C O11fPE,IAN 1 SEWA- �TGE pjSPOSAL'SYSTEII� -• y,..q�:. �f >SCt'�_T �Li.B�CCi'P" T :•.C6')i� F P .4�iS^�.�ir•'I'� i• Located at s7-OV e Tae Map %J BI k �— Lot 7I Owner /appllalnt; Name Formerly Sabdiylsion Na Sabdv Lot x�1- :IVfalliisg,'Addrese, � " . ' ,. P Date:1'ermlt lisaed _- "Separate Sewerage System befit by Address Consf "sting of J Ga11on.Septic:Tanlc c� �u F_ Water Sappty Palillc Sapply atom Address . or: E' Private Sapply Drilled by d Address 7 Wdb4 /��t�/l� C 'Hsa Eroalon Control Been CompletedY Number of Bedrooms Has Garbage Grinder Been InstapedY� Other Re quhv Wnts I certify ghat Ehe system (a) as listed serving the above preauses,;were COnairuct ��I on ,the plans of the completed work ( copies of which are attached); and in- accordance'with the standards, rules., and;regulaii a E co an" to a Piled`'lan;.and the permit issued by the Putnam County /epar�tmen, Of Health 4 „ i Date Certified by P.E. R.A. Address r W Icense No \v s Any. person oeeupyiny premises sewed by .the above-- system(s), hallpromptly take wch a raY 4_..n iy to mlin the correction of any unsanitary conditions reswOpg, itini weh 'uiage Approval af'the sgparate sevverags iyrtem shill _ id ai.soon:ae a pub,--. sanitary sewer becomes available. and the „app►oval:of the:private water'iuDp�Y shallaiecome;riull and vokl when a p, wiply:beegenes ivallable. Sueh.'approvals are n, Su to modifiut)on 'or change:- when,' in the•:yuayment ':of'the'6ommisaio'Qar of4N th „sYth. revoeatbn,';nioflMication ok change It. Meaifary, 4. Date, � � ', �� BY � Title WELL L;0MYLb-11V1V rcrruicl fs. DEPARTMENT OF HEALTH Di,. &.4_ m Df.:..E.ra. NAM COUNTY DEPARTMENT OF HEALTH PUT Office Use Only WELL LOCATION STREET AOORESS: TOWN /VI 1 I Y TAX GRIO NUMBER' 6 ei ricl L, La a Of WELL OWNER NAM ADDRESS:IVATE v �. , p PUBLIC USE .OF WELL 1 - primary 2 - secondary Ef RESIDENTIAL ❑ PUBLIC SUPPLY C3IR /COND- /HEAT PUMP ❑ ABA N NED O BUSINESS O FARM O TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ❑ PLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY E EW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH °� ft. STATIC WATER LEVEL 30 ft. DATE MEASURED ate. DRILLING EQUIPMENT ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE a SCREENED [2 OPEN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH ____LL_o ft MATERIALS: q SQL O PLASTIC p OTHER LENGTH BELOW GRADE 3 8".S ft. JOINTS: O WELDED BREADED ❑ OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT O BENTONITE D aMR WEIGHT PER FOOT Ib. /ft. I DRIVE SHOE: O YES 0 I LINER: O YES UNO SCREEN �IET�ILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FI O YES .0 NO . .._ _ ._. ,. -FIRST _. SECONO. - -- - - _. GRAVEL PACK YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping MAO: O PUMPED 1 tests were done is in- 2'150MPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG ft more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Wafer Bear- ing Well Dia- Deter FORMATION DESCRIPTION CODE tt. tt WELL DEPTH ft. DURATION hr. min. DRAWOOWN It. YIELD gt:n,. Land Surface �y . zg. 3 0� co WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE I Jjj._ ( -Trd% s-o CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY _� MAKER r ^ DEPTH A 7S MODEL VOLTAGE a3 HP -7'a- WELL ORILLM NAME T GATE ADDRESS > DrM �� S 11tiURE P.0 0 no .x S ( A / 9 t. ti ' n :':wF,: ..:f,: "`..};aii�-- .�- ns�•.c+ Vie-•. f.. PL'UC93IT= �N! �fAfV1MCOUY DEPARTMENT OFHEA�LTH LiTCDL Building Constructed by C;n Location, Street Municipality A-,3 i d e.,t7C� . Building Type Subdivision Name %f Subdivision Lot # GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM //06/ 6/3 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. Rears. immediatelX .f of owing .the: date of_..approval of the "Certificate o -ff'-C -ons riicf o "n' "Compliance'' for the sew�c�e"disposa system; 'cir '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. Dated this 4� day oft 19 %/ Signature Y Title General Con ctor (Owner) - Signature Corporation if Corp.) Address rev. 9/85 mk ll Corporation Name (if Corp.) ess e7 ✓� Z �I Owner or Purchaser of Building Section Block Lot Building Constructed by C;n Location, Street Municipality A-,3 i d e.,t7C� . Building Type Subdivision Name %f Subdivision Lot # GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM //06/ 6/3 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. Rears. immediatelX .f of owing .the: date of_..approval of the "Certificate o -ff'-C -ons riicf o "n' "Compliance'' for the sew�c�e"disposa system; 'cir '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. Dated this 4� day oft 19 %/ Signature Y Title General Con ctor (Owner) - Signature Corporation if Corp.) Address rev. 9/85 mk ll Corporation Name (if Corp.) ess } YML Environmental Services 'ZrX f'Sfte t,' 'Y'drlZf^own' Y, i -M gh 'Nf 1° ELAP #10323 (914) 245 -2800 FEHN, STEVEN 20 CINDY 'LANE PUTNAM VALLEY, NY 10579 COLD BY MR. FEHN NOTES X • ANALYTE RESULT UNITS pH ALKALINITY S.U. mg/L PHOSPHOROUS AMMONIA mg/L mg/L SILVER CALCIUM mg/L mg/L SODIUM CHLORIDE mg/L m7 SULFATE COLOR mg/L Units SULFIDE CONDUCTIVITY mg/L umhos /cm SULFITE COPPER mg/L mg/L i ,C0RROSIV3TY – :` LSI :.:.; ZINC DETERGENTS n-g/L rrg/L FLUORIDE mg/L HARDNESS rrg/L IRON mg/L LEAD rrg/L SPC MANGANESE per 1.0 mL mg/L TOTAL COLIFORM MERCURY per 100 mL mg/L FECAL COLIFORM NITRATE per 100 mL mg/L E. COLI NITRITE per 100 mL mg/L FECAL STREP. ODOR per 100 mL TON LAB NUMBER 32.004495 DATE T/ ,IIv1E TAKEN 9_1 Q.1 q 1 7 . 4 5 AM._ DATE /TIME RC'D 9/9/91 12:15 PM DATE REPORTED SEP. t 1 1991 SAMPLING KITCHEN TAP: SITE For .Lab Use Only ,./Potable HNO3 ` pH LT 2 ✓ <4C _ Nonpotable _ NaOH — pH GT 9 _ <20 >4C _ HCl _ Na2SO3 _ >20C _ STAT,! H2SO4 ZnOAc CC?.IFORM IvpHQT? LISE2 These results indicate that the water sample W4 [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the p a ters tested, at th 'me of sample collection. These results indicate that the water sample [WAS] [WAS NOT] D�11 f a satisfactory chemical -quality according to the New York State Sanitary Code, for the parameters tested, at of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: �y�a %YJ.� P = Present (Positive) SA = See Attachment(s) ` = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than RESULTS OF ANALYTE RESULT UNITS p X pH S.U. PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITI'Y NTU<.._....... :.. _: ZINC n-g/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample W4 [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the p a ters tested, at th 'me of sample collection. These results indicate that the water sample [WAS] [WAS NOT] D�11 f a satisfactory chemical -quality according to the New York State Sanitary Code, for the parameters tested, at of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: �y�a %YJ.� P = Present (Positive) SA = See Attachment(s) ` = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than it: je, X 2v OF HEALTH S", Wermit-#e EPA-1 yvb.s Z KiTNAWC T 6 " 7Y ZTMENT,,,�:� 14 4 Services Ky Mi6j,` W. 44 - CONSTRUCTION O ot�, ,OB IMAQE"DISPOSAL S,.n! TPVP or illags Block 71, * '0 F Subdivision`' ❑ IFOV M 7 1 P-1 n YOV 0, / i 7 s.. , ;:. ,� ahi �h �. -_(`mod C �v?� inr , ., zat �`.. ° f (F Building n 'Type ? e.q,9n �on� , P. C. On N. -�.-,SeparatewSewerage -systemK- G wv -AI 46 De constructed by Address z ,water, supply:-, ,iputilic 4, L Z � i A-v Other t �, 41. Y-K W ?i Vr6ipkss"i,ihat wholly ' and "tcmpi6' ti`- ly ,,reisooni�lhin.f64�'Cie' -Wi location 1 % t ps, 'p ppc�ss. Isy_ em(s). ; " , , g*.,'dIsposaI.-system 1 anci with the standards, ruiei,fndre gulation o ", 4tnaT-,, described ,�ilfbe c6rstru&sd-as,shown or44e— apprqv". amendment 4ieri •to a i icbrd CoLnty4Dij , , - a',',' Certificate ;io Oi�kiti&i6i�'Jt��iianii written e-JiLlriflihid" t,6,aildsirj,t 0. -ppqrq, ing oor r. itb;�2j,that the'd during th - !s,&qMtj _r� or,ag �'j A �Wg e place .An,go'd" — "t" Id PM ante f' �,- a ppi -Ciftiflcati!�6i 'Construction -, Coq;4i et- 2; cql Hied i"iil iia�ii6id A)dvs the; 0 will be located as`shorMn onrthe approved plan and that said well, will be7nstalledr in ec ' r �' i � e,�ei Fys and regu ns � ,, ounty!,Department, of .,Healt Autti h/" A a---- ;f ztd u .7!q the tinder 4n app roy�ari,� e`x'pi!p- �u s d 'APPROVEDTOW't S:jRQC'TION-- Iv, i cdnifiu�tliiii 't ipg, pj,s,4,bee n -�()U, obstruction *VFqns!j essa is tion ' revoca q_ o,,o!!u*!,q�r-Ta b amend �orjWcid iscl6irii'A �hiw �,Permit. �A e p p I y o n I pproveo- on.dis i9l 'Ric-sl -z, U Tit 18 Rev "9' A Ork,.,7 said=& CZMN& M.U. I= a riot ��_g�Rtmo 0 I(bm Ct Cz 'VmIqP AffNamalum MCZ=d Xf 00� nab C2 Mmbm AR�7md lo� Date SubdWsion A88romed Fee Enclosed 13 Amomr -oO� r-4 BRUNS M SCOWISM c* LJ Dva —Vab=o pkmbwdBodfama Dab, Pb, C. P D ?(CZD MagMangm 13 2WR&W WW, m AM— an 3,Q:d tv I repreant'thet I orn vvhosiv and coni"ov rommmemb for tho dosion ons location Of tho Proposed sydekl); 1) that tho above ducribm muma constructor as anown an the epprome arnaftomt thera to arid in accordance with the Standards. ruiasWL,:—:Wj"W'A=, County Depertmmont no "nota, OW that on compietim therew a "Ccrtificato of Co Compliance- 201118faCtory 20 the Commissioner of HmNhwill be VAMMW to the Omportrassa. and a writum Quaram"m will Do QUM It a. helms or assigns by the builder. that aid builder will Otmom in gosid.eMatim @=dMWa . my mt of sto mavM dWoml cy (2) YGIFS IMINISOMMY fOlWWW4 the date Of the Mal- sow 09 the approw at. WA Cat"IMIG of Caomfuction Compliance of:� l In thereto; 2) cleat the drilled well demorlboll above WO be Weated as dbommmi an tea emmvcJ Van and that mid mal will W Indof ROD t do fulm and "GRUIRM07-01 the Putnam C ow" Da me Go "Minsa. R.A. Data r icense APPROVED FOR CONSTRUCT14 v eupirog two yeas ar t s I truction of the buildino has been undertaken and is lovem►le for emu" or Oney Do o oe rroodi9 1 When C009141107CM 6090SM 14 filORSr I MMOIR. Any cftmnp or alisrotion of conetruction ralmirm a now vormIL Aovmmz sonflary eswoM jsupply only. Rev. Oca 10/88 "' ©v �'7' c_ �'Y=S CrCCc_�% CrcL• �._^ C^I:�? -is SCC ^Es < d•• in _ C= --Tn cz-a c----= & c_-.tc c_ vocr, ^c c=_c�a ce awav f_cr, 52 S a_rc C^ 51 cres C=_ter .0 C x --Z /._ Z.i = CR �,��rr l� �G'; LCZ' -•-, -. «... .:r. ',;.�*�lw ..�, <.�` -. ;'fF,a�..e >. etc.' +, -'_.- ;u. :c e.r:;s.r -... _ y�. '} ;. �i�._...� �,.E. �_.;Svctii:. ec '�;�rc%r =i• � -- �rl - a- SE a-aa ic=—t= as ar-proyef DTLnc b_ F:111 5a =-.?cz - Dam c= places- -zt C_ ZTC_Z= =1 Sc1_ act -Nat= E. 1x•10 fl__ f_L. � —I DI S=-U:242-4 crc�r C tank - ? I a. =--tic = IL z_ .000 cn C_ �ti coo L-en zc= r C- __CL•C Witham l0 -_ Ci _ T _ 1 A1 1 CL —�_ . Prc� CIE-" c ti f_--s I I I M" — L -_ cr -c -1 cCi i �c�tic = ^_ C_i c _= T _ CN ta i D_ to CE - riC _E- T -+.-•_ _ u = =C'Tt �� __ I°� 1� I = 5�c c __ -��, == = =t=^� -x/32 ' /=cct- IlL I C _ lO L:J T- -_ -- rCt__'_... - -_ F. RC4 =Cr e=za s_cr-, 50` I l I I A - 1 T 1 C1c__ _ ! I lu_ r`cth C° i_-- t_ez c: !2" - p !Z-=., y-_ a P,zu J E. =' _'% cc" == =_bl- T�"'�C? - tC C =".= - _ - I I I hc-�_ I I E. evcle w_-- = = -_- h-4 E= 1 `-! c?% Cc= CvC <C E / Fl L_•r- a ;r.C'vaa ;r _ ate: "- C_ �=—: -i= I I I • _ V c- 11=._1 1.0 as t _ a ---= ve c_ �'Y=S CrCCc_�% CrcL• �._^ C^I:�? -is SCC ^Es < d•• in _ C= --Tn cz-a c----= & c_-.tc c_ vocr, ^c c=_c�a ce awav f_cr, 52 S a_rc C^ 51 cres C=_ter PUTNAM COUNTY DEPARTMENT OF HEALTH ..• \. .-. i .. �_ T.[` 4._ .. „' .. -. �: w .^. 1,+ q� OL gt ~.D•�'�/'±' :1, 04.. +. ,rte. T;.- .th�� -�. rlsiVi��Il'iT�l VL' rl v'' `2O1W+'ID+'NTA E'%II.�.ALii' sERi CVS:~ Date Re: Property of Located at (T)r.��/� Section Block 1 Lot U _ Subdivision of Zo,, �' dLj� "- Subdv. Lot # Filed Map # Date Gentlemen: f 9 This letter is to authorize C� �,��/ W 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 co�u�a tio�r wi h--Ithis- matter= and toT'supery s'e the coristrdction -of" said - system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: Owner of Property c�0 r- t r Address �P 'ANC °lg �p'P,p Address H ti; >>- Town -2- 7 AR : "' . Telephone �� FEcS O Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 �, �- APPLICATrON Ty "CONSTRUCT A WATER W- .ELL PCHD PERMIT #/_ WELL LOCATION Street `Address Town Vi lage City Tax GridWumber WELL OWNER Name Maili Address I Private O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O.OTHER (specify O AMOUNT OF USE YIELD SOUGHT— �3'_gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE 4;�G gal REASON FOR DRILLING 7CREW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE j4DRILLED 0DRIVEN DDUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES J,--' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No.' /j WATER WELL CONTRACTOR: Name Address: 00a/,V o y IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: .--► TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARATE SHEET 217-0101 (date) /j 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. Date of Issue: g19 �= �'""'�� Date of Expiration: 1923 � rmit Issuing bff�ia J Permit is Non - Transferrable White copy: H.D. File Yellow Dopy: Building Inspector . Pink Copy: Owner 287 Orange copy: Well Driller 'John -M-4-,'jE �'D NAME si� MAILING E1 ` TE12PHONE PERSON.-IN OR INTERV DATE TIME: ARRIP INSPEct6k, , . 'C Field A' T.M. 119 - 4 -11 ib; FAZIANt) PUTNAM COUNTY HEALTH DEPARTMENT I hp� DIVISION OF ENVIRONMENTAL HEALTH SERVICES § Y. ins', M.D. loner of Health FIELD ACTIVITY.REPORT Sheet of INSPECTION Orig. Routine Orig., Co'Mplain LAN rz NNAW, VAUey Orig. Request Street Municipality (T)(V)(C) Compliance Complaint Comp SS Final ".0. Box Post Office. Zip Code Group Illness Constructi6n Reinspection RGE Field Sampling Only D:- Field Conference Name Title Other. TYPE FACILITY. 021 TIME LEFT W• Signature and Title SE OR INTERVIEWED: receipt eipt of a copy of this SIGNATURE: Report ... 6 .............. TITLE: TELEPHONE: Explain PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES N" TO 12: UNTf :'OFFICE LVINg -`OAI�Mtt, .- iv 5 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owne 't7 // e Addre s s 4,11 C. Sec. Block Lot Located at (Strel -�, C) Tn7icate nearest cross street) Municipality- ,,ru,A OPPV Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth.to Water _T Water Leve No. Time From Ground Surface,in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches 12,00 33 33 2 -3S 5.3 � ..4 33 J/ 3 4 5 0.1 4 Nov 4 lot) n 5 `II AJ4 UF MFgL Y Pi Notes: 1) Tests to be repeated at same depth until approximatel� equal soil rates are obtained at each percolation test hole. 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 SOIL.` ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.' /* HOLE NO. HOLE NO.- G.L. "57 Jz.4, 6 1211 1811 2411 3011 3611 4211 48" 5411 60" 6611 7211 78 Ph INDICATE IJ,,1VEL AT WHICH GROUND WATER IS ENCOUNTERED WHI.CHAIATER FTER—BEING .1 .710, T--Plr RISES Z Soil Rate Used _PUn/l 11 Drop: S.D. Usable Area Provided No. of Bedrooms septic Tank Capacity Gals; - Type Absorption Area Provided By.,-r./ L.F.x2411 -, ,& 0F h trench. I fv V0, ,0130. :, 'her APP, tMal P Address�Y)i N 410 \ip'' see THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved . Sq. - Ft/Gal. Checked by Date 1 a �1 11 r. _ ieciwiWro•• ___ {'4 1 Ai fff f f'. 1 jry J .•, 2 7 t , � ' S '15 T G t 11 _gip 1 .'1� —SL