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HomeMy WebLinkAbout4509DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -43 BOX 34 " 4M 0 ,r i Ir jr kv I' � - 04509 .11 ..1 11. . .. ti PUTNAM COUNTY DEPARTMENT OF HEALTH } Rer . 3/86 Division of Environmental Health Servicex, Carmel, N.Y. 10512 Engineer Must Provide Py' ��_ �r'G P.C.H.D. Permit N= 'a CE ATE OF CONSTRUCTION COMPLIANCE FOR 2"GE DISPOSAL SYSTEM Owner /applicant Name Mailing Address I Zip Town or Village Tax Map- - — Block - ..Lot Subdivision Name Subdv. Lot H Date Permit issued ��C_ 1�97-G Separate Sewerage System built by a d',-n Ae '— Address Consisting of / Gallon Septic Tamk and f ZC� $ t y o ✓ _ °� Water Su 1 1 .�' �i fv PP Y• -Public Supply From � Address or: Private Supply Drilled by Address Building Type Has Erosion Control Beem Completed? Number of Bedrooms _Has Garbage Grinder Been InstalledY Other Requirements I certify that the systems) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department of Health. ins of the completed work ( copies plan,:and the.permit issued by the Date _41— Z/_ Eel—, Certified by t P.E. 61-1 A.A. Address ©i/ `i7 ~ d Licsnae No. &J99.9- Any person occupying premises served by the abovili system s) shall promptly lake such action aad� a•' ( ye to recurs the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become „tlim% soon as a pub;'. sanitary sower becomes available and the approval of the private water supply shall become n %sold when a public water supply becomes available. Such approvals are sub)ect to" modification or change when, In the Judgment c the mmf nor of H Ith, such revocation, modification or change Is necessary. Date r By v ° �£�!- �^' Title Rev. 3/86 CONST#UCEI -N I:ErdbHT Ft3i�t S Located at PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # SAGE VIyVOSAY,'SYSTEM ' - on CERTIFICATE OF COMPLIANCE ....:...,........ 1111..: - -- .�..�.. ." ..; Town or V(Dag / Subdivision Name '/ / /45� �� %� ��rl S`abd. Lot N /1D Tax Map f Z' Block— 3 rot Owner /Applicant Namo z jJ/,4 7� �j /GC �OfT /. Renewal— ❑ Revision r i Date of Previous Approval Melling Address GB 1/4p S Town Zip Building Type J Lot Area �v�, 23-30i FBI Section Only Depth Volume Number of Bedrooms Design Flow G /P/D S10 O PCHD Notification Is Required When FIB Is completed Separate Sews 2 O � C> L Ji' r✓ % i `. p rage System to consist of �s_GaBon Septic Tack and To be constructed by 1017 a° t— Address Water SuPPb': i' Pdblic Supply From � l` 0!1ddress or: -02" Private Supply Drilled by address Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of the stem(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and i cQ� arg�i a standards, rules an regulations O e Putnam County Department of Health, and that on completion thereof a "Certificate of 41ttfOar=Ponfpli 'satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the r,oht3 fJ►� �► r assigns by the-builder, that said builder will place in good operating condition any part of said sewage disposal system d ng'tb8 ( � ) y s immediately following thedats of the isw- ance of the approval of the Certificate of Construction Compliance of the ot Ina (p °tam or any th to; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed c an t( he XJ4 rule s anti regu aa�T'f'ons of the Putnam County Department of Health. ir Date /'� % I 1 y _ P.E. — R.A. Address ZU! L �j�//�Ci// y ,� . c ens- No z y _R APPROVED FOR CONSTRUCTION: This approval expires one year from the dat#`gss6 %pies IAtad, � the ilding has been undertaken and is revocable for cause or may be amended or modified when considered necessary' Dy tie= 'iCo'rt.ss�onp{,7b "f h. Any change or alteration of construction requires n-W A.. xywa i _ permit. Approved for disposal of domestic sanitary sewage, a+e ,W.;rt,e._6�iy. .� e. q PUTNAM COUNTY DEPARTMENT, OF HEALTH { REV 3/86 Division of Ibvlroameaitel Healtti' Services.. Carme[ N Y 1051? Engineer to Provide +Permit # on CERTIFICATE OF COMPUTAIQCE� s Permit' # s, CONSTRUCTION PE FOR'SEWAGE DLSPOSAL SYSTEM 1 /.% v or as, . -:Town Subdivision Name / �� �"%' Sabd Lot # Tn:lVfap Block -�' 7t ❑ Revision ❑ i Owner /Applicant r Date :of Prevtod Approval ,_. McWng Address / /Y` rJ j F10 _ Hbildtag Ty$e x. Lot Area ,. Sectlon Only De 'th :_ Volume: + r Y Number 6i: Deslgo;Flow G /P%D Notlficatlon is Regalred When FIH is completed P -, t�eo pCgD Separate Seweritge System to consist of ��fiallon Septic Tank ^� To be oonsiracted by � �� Address Woter SaPP,h'PdbllC Sa 1 From��(�e� �, Address 1 PP Y. or: Private Supply Drllled by address Other Requirements "�" 'd :represent' that t am wholly anG completely retDOnsible,fOrahe design andliocaUOn of :the,. M ,a�s�e �j�„ hat the% separate_. sewege..d isposal system - 1 atio4e tlescripied wilt be constructed ss shown on the apD,rovetl amenomenf,there to and in /{ std ' rulas,an •regu ionso e Putnam County Department� -of Health and that on compleUOnbthereof a,.,,Certdwate of Cons ctic�p�'C$�iar68siac ry -fo the Coinm�SSfone► Of Health will be`.'suDm�tted to the'- Departm8nt and Za wnEten.guarantee, will. befurn� shed the own i his?cessors, heir t'tsyn by;the builder abet said builder will place �n good operating condition any part of said sewage tlisposal systertl during a peia�ll of't j2) yewtop a lately foljowmg thetlats of the isw- once of ,the;approvaf'of the:CerhLCate of Construction .COmpNbnce of 'the origins yst�5wr a �✓ aga4F zneWxe ;j, hat the drilled well,described above - will -De located as Shawn on the approved: plan and thatsa�tl well will be Install cc da a wits "t QC, ul d regu a ons -o} the Putnam Courtly OeP rt nt'of ealth'a ` ► rF • �/ a f -• r Date S�gneC P,E.� R.A. Address 6' License No APPROVED: FOR CONSTRUCTION This pproval expires one year from the date 'issued ` .r ® `the building has been undertaken and is _• revocable- fOr,CaUfB••Or may- rnentletl: mods }iedwhen' considered necessary by•Ihe:COmml _ = Any - change or : alteration -of construction _ reQUVes a view aerrrit. Rppro�ad f ti dlspasal Of CrOilie3Cfc sacit 'ry ses:zge, Q%O pr vale water y only.. j} ' Date. BY TitieT i - .., -, PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIR01NME TAL HEALTH SERVICES .. _. ....._.. ., .... _. ..0 1. \. .:r��T �.V15- ��:'.. -_+. r•n .. - _.. p, =.. . -.. �. . -s, t u�.� ". •.... �i. ... Own& or Purchaser of Building Section Block Lot Building Constructed by Location - Street /// Municipality Building Type , 0 �s Subdivision Name 1� Subdivision Lot # GUARANPTEE 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 mkade...bv,.,w_ to. .. -. to .such; system,- .e_xce pt... _w.. h.ex.q the failure to.- opexate...properly .,is_.: -.- .._:.: 4' .mac .4.. -. R. ���W' ^..V'•...__y.�. ` - cause t u� h� irlfvZ"or "negl�g ac t° df"ttTe' oc.�iipant of"the -iii ld rig " utilYzing 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 ;7- day of v/ 19 77 Signature :Z";. i General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Title rporation Name (if Corp.) - Address :I. T. k APPENDIX c ' !' FINAL SITE INSPJCTION Date " In t by ;.CATION J TM # OR SUBDIVISION LOOT Q _ j . � �. _ �� ". �, �'.._ -. ....._ OWA 10 ;DISPOSAL = NCB`.. - SF<hAGE AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. I= WIDTH AVG.DPTH c. Natural soil not stTinned d. Stone, brush, etc:, greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. SEWAGE DISPOSAL SYSTEv! a. Se tic tank size - 1,000 1,250 b. Septic tar_k insta led level c. 10' minim= fran fcurdation d. No 90° be.*ads, clear-cut within 10 ft. of 450 be_: e. DISTRIBUTION BOX 1. All outlets at sa1;�- elevati -water test . 2. Protected below frost i r^ Q 3. Minimum 2 ft. original soi twee..n bo trFmches f. JUNCTION BOX -` rooe_ l set . g. TRENCHES 1. Length required installed ,Z 2. Distance to watercourse measured _ ft. �- f r _ d 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran rcr�Tty line - 20 feet - foundations v, a 7. Depth cf trench < 30 inches fran surface . 8. Room allcwed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel- in trench 12" minimum , 11. Pipe ends caner h. Pump OR DOSE.SYSTEMS 1. Size of pumm chamber --'� - 3. Alarm, visual/audio f 4. Pump easily accessible manhole to grade 5. First box baffled 6-. Cycle witnessed by Health Denartment esthrated flow per cycle MUSE a. House located per amroverl plans. b. Number of bedrecros WELL a. Well located as per anDroved plans b. Distance from SDS area measured ft. c. Ca sin 18" above crrade. d. Surface drainage around well acceptable. - OVERALL WORKM.ASIP a. Boxes properly grouted b. All pipes partially backfilled C. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Cur ��. ' Curtain drain insalled according to plan f. Curtain drain outfall p rotected & dir. to exist.watercours -- g. Foots.n drains discharge away from SDS area h. Surface water rotertion adequate i. rosion control provided on slOPes greater than 15 %. OWA 10 DAVID D: 'BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: July 21, 1986, JOHN 'SIMMONS, M.D. Deputy Commissioner Re: Aphrodite Const. Co..SDS Constr. Permit Appl. Knob Hill, PV, Tax Map 120 -5 -18 Mill Pond Lot 18 Review of plans and 'other supporting documents submitted at this time relative to the:,above- captioned project has been-.completed.. Comments are offered as follows: House plans indicate design flow should be based on four bedrooms. JT-t- C-ROU-). top 0/0, eye, _. 4=-. ,/2. Subdivision approval was based on soil percolation rate of 8 -10 minutes/inch. 3. Subdivision approval specifies a curtain drain is required unless =:,,deep holes dug during the wet season of the year.give no indication of shallow ground water. to- -the - tightness of this Tot;"ldyoUt "of enure Psewage disposal system including expansion must be demonstrated on plan to scale. In the future, plan must show trench layout at a readable scale and include the.information shown on the 111=50' scale plan.. 5. Water lines within ten.feet of property line must be shown. -/ 6...:Size of water main serving site is "lacking from plan. 7. New detail.sheets will be required for.four bedroom design to show septic tank details. Upon _:receipt of a submission, revised to reflect the above comments, this application will.be considered further. Very truly yours, JSH:amm cc: File` fc ..James S. Hodgens Assistant Public Health Engineer. I. :ENTER CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request `-'REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area: shown; gravity; flow, suf f_. ,size - If` "P'cuaped "Pit: 1& D- Box- Si owr '' - be-- Lai.1�C1 House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains-Curtain ,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL ORAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REVIEW SHEET - CONSTRUCTION PERMIT _ :.— —. ....,.. _, C\ .� �. I.11 .x.• �. T= .—a �� — - -- �_ ,.. Cl e. �t DATEJin'iilEW10. _ e T I� �: • r — ( of Owner) (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request `-'REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area: shown; gravity; flow, suf f_. ,size - If` "P'cuaped "Pit: 1& D- Box- Si owr '' - be-- Lai.1�C1 House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains-Curtain ,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL ORAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same a� rA �s UMM T DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request `-'REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area: shown; gravity; flow, suf f_. ,size - If` "P'cuaped "Pit: 1& D- Box- Si owr '' - be-- Lai.1�C1 House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains-Curtain ,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL ORAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same PUIMM COUNTY DEPARDUM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL MTER SUPPLY SUBSURFACE SEDAiGE DISPOSAL SYSTEMS i r� r r •a • X510) y v INSP. BY: ( of Owner) (Street Lora ion) INITIAL SITE INSPECTION .Z Tit YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ Willdriveway need cut ............................. Must trees be removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed..... .......... 4,04 g, r�-P Sufficient SDS area available considering driveway Put, house location, separation distances,etc... ✓ �.��� Adjacent wells/ septics ............................ D. H. 1 Lot Depth to G. W. Depth to rock Soil Descri 0 ft. 3 ft. 5 �- 6 ft. �J / 9 t" 12 ft. �� D. H. -Deep Hole G.W.- Groundwater D. H. 2 Lot D. H. 3 Lot Depth to G. W. Depth to G. W. Depth to rock Depth to rock soil Descr 0 ft. 3 ft. 6 ft. 9 ft. 12 ft.­- . soil uescri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. _ - - - DATE: FINAL SITE INSPECTION INSP.BY: YES NO CAS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse ................ . .. Natural soil not stripped or SDS area , unnecessarly graded ............................ 10 ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set .... ...... ................... ^.ould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... �( Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services -r7 7 AF F.-1j)A-V:-1--T:, C 0 RPO RATE OWNER APPLICATION A FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT 0 R".1 V� TO: Commissioner of Health � In the matter of application for': I I represent thatJ am an officer or employee of the corporation and am authorized to act for (Name of Corporation) having offices at A- r_'� e, 4- -PW UA Whose officers are: President: 4 Vice—President: Secretary: Treasurer: Name and Address) (Name and Address) U and that I am and will be individually responsible for any. and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn' to before me this 22 day of l91s 7- Notary Public Felicia G. Winograd6ff Notary Public State of New York I # 4SQ2r-d'7 Qualified lri fcAwe­ ootl_� Term Expil, r " & tv a "'-. 3 ", I 1 (9 8/84 Signed: A_ Title: Cort)o'rate Sea] MILL PONDS WATER CO. d _ R _ _.. Rd.. #3 Mill Pon s. o 'utn V w., . •. am, alley, NY 105 9 June, 24, 1986 Mr. John Kare11 Jr., P.E. Director Environmental Health Service Putnam 'County Health Dept. 2 County Center Carmel, NY 10512 Re: Aphrodite Construction Co. Mill Ponds 120 -5 -18 Lot # 18 - Knob Hill Putnam Valley, NY Dear Mr Karell: In regard to the above subject property located on Knob Hill in the town of Putnam Valley, we.see no.difficulty in supply - ing.sufficient water for normal residential use. Very truly yours, Joseph Marinelli JM: f v •• • � �- • is v °i �• •+ati DESIGN DATA SHEET- SUBSUFACE SEWAGE. DISPOSAL SYSTEM FILE NO. Owner r '`r �l`" L �° Address Located at,(Street) Sec. Block - Lot /�✓ #- (indicate nearest cross street) Municipality /`G Watershed SOIL PERCOLATION. TEST DATA REQUIRED TO BE SUBMI= WITH, APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME. PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No.. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 012-10 .,22 12 4 5 5 3 4 R 5 r NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are.obtained at each.percolation. test hole. All data.to*be suYmitttd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED.WITH,APPLICATION DEPTH HOLE NO. _ 1° • 2'�� 3' ' SOIIS`IIQCOUNTEEtED 'IN TEST."AOLES HOLE NO.' x, "W,/ 13' 14' iEi, AT Tnhii"�ri =: GROC1iv'Eit :,IS FIJOOU�1'iEk�ED" ' "+� INDICATE LEVEL TO WHICH WATER LEVEL `RISES AFTER BEING ENCOUNTERED" DEEP ROLE OBSERVATIONS MADE BY: i �� DATE: DESIGN Soil Rate used Min /1" Drop: S.D. Usable Area Provided L57e9a No. of Bedroans Septic Tank Capacity Zo0e' gals. Absorption Area Provided By �0 L.P. x width trench Other Name Address Soil Rate Approved sq.ft /gal. Checked by-- Date e • • �+ �• • i� v •� �• tea•. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner,�%fJI•'t �'�F Address Located at (Street)�?�� /. Sec. Block .4 Lot (indicate nearest /cross street) Municipality Watershed SOIL PERMLATION TEST DATA RDQiTnm TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE N[ 4EM . CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop in Min/In Drop Inches Inches Inches 57,1 a 6 4 5 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until appracimately equal soil rates are -obtained.at. each.:percolation test hole. All data.to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 `s DATA !REQUIRED' TO BE SUBMITTED, WITH APPL MIPTION OF SOILS` ENCOUNTERED IN TEST Ed 10'. 12' 13' 14' 1 IIVDfCATE LEVF.'I 'AT Rfc- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:, 1 0 , ��/ ,,. ,nr% DATE: Soil Rate Used Min /1" Dro S.D. Usable Area Provided of Bedrooms Sep is Tank Capacity gals. Type sao Absorption Area Provided By L. F. x,d4ef�Yr; Other Name Signature v • Address i . SEAL USE BY ONLY: Soil Rate Approved sq.ft/gal. Checked by Date sca c i 2-'t. sjp 5 • :,,ttx `'Sau:t`.'.. �1'>.r.::s lk�a.`','�,�.'Ls.^2h�z ,;.e... .. ._ � ��'`' «°'' - T F �� / �' ✓cr.�a ,+f'.� . ,��:�r�, 4G 1�W %7 .C._ -7:— 7 _ s T i �3� .. z 37 15- - 3 _ 13 2 7' i�iGT 2-'t. sjp 5 • :,,ttx `'Sau:t`.'.. �1'>.r.::s lk�a.`','�,�.'Ls.^2h�z ,;.e... .. ._ � ��'`' «°'' - T F �� / �' ✓cr.�a ,+f'.� . ,��:�r�, 4G 1�W %7 .C._ -7:— 7 _ s T -' 4 h ` ;� o•6rb�c. / A , r w i 4,,c 4 A7 E 46 e c ;SGG+hG P�� - rurnm County Department ar neucw rieision of Ehvironmental Health Servi4 pproved as noted for oonformeaoe with yplioable Hales and Hegnlations Of the ut b �unty Health Department. K