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00114
Rev : 3/x.6 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Envhronmental Health Services, Camel, N.Y:10512
(�.,` Engineer Mast Provide
P,Xx D Permit N y�
CER OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM - — A cn -tn
.Located at
Owner /applicant
Mailing Address
Town at -V ge
Tax Map I Block I Lot • v
Sabdlvlslou'Nam Subdv. Lot #
Zlp_ 16)S,9 Date Permit Issued
Separate Sewerage System built by
/ ®�T Allylin," &'> Jat.0 Address
Consisting of t L150 Gallon Septic Tank and 7
Water Supply: Public Supply From Address �,� y� r J
or: %C Private Supply Drilled by AddresspU ! PL'JiM "ZI fi ..7 .
Building Type
Has Erosion Control Been Completed? �o
Number of Bedrooms 4— Has Garbage Grinder Been Installed? Nil
Other Requirements
I certify that the system(s) as listed serving the above premises were
of which are attached), and in accordance with the standards; rules an,
Putnam County Department Of Health. 1!/
Data certified qY
Address
tially as shorn on.th plans of the completed work ( copies
Ic,co �rd h th f ed plan, and he permit issued by the
P.E. R. A.
1
{,�-�
�'1L_I ` License No.A1574>
e
Any person occupying promises' Served by the above systems) shall.promptly take such action as may be necesury to secure the corrWIon of any unsanitary
conditions resulting from such, usage. Approval of, the separate sewerage system shell become null and void as soon as a pub!': unitary.sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification of change �wwhen, . in the Judgment of the Commisslo' dw �of Maul h, such revocation, modification or change Is necessary.
M1
Date � � C_ �l �� By T we
in
II.
IV.
V.
VI.
APPENDIX C
FINAL SITE INSPECTION
2 ce� OWNER
M1 # OR. SUBDIVISION LOT #
Date
Inspe ted by - L
COMMENM
SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier. LGTH WIDTH AVG.DPTH
c. Natural soil not stri
d. Stone, brush, etc., greater,than 15' fran SDS area.
X
e. 100 ft. from water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size - T,000---
b. Se tic tank installed level
'All
c. 10' minimum fran foundation
d. No 90° bends, cleanout within 10 ft. of 45° bend
X
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX - properly set
g. TRII�ICEiFS
1. Len r ired - C� !� Len installed
/k"
Distance to watercourse measured: -- -ft.
3. Installed accordipq to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
q'
6. 10 feet from proiperty line - 20 feet - foundations
7. Depth of trench < 30 inches frcm surface
8. Room allowed for expansion, 50%
9. Size of. ravel 3/4 - Jill diameter
-YL
10. Depth of gravel in trench 12" minimum
11. Pi' ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of pwip chamber
2. Overflow tank
3. Alarm, visual /audio
4. Pum p easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrooms
WELL
a. Well located as per approved plans
b. Distance from SDS area measured ft.
c. Casing 18" above grade.
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
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. Curtain drain installed according to lan
f. Curtain drain outfall protected & dir.to exist.watercours
.
g. Footing drains discharge away from SDS area
h. Surface water rotection adequate
i. Errosion contr o rovided on slopes greater than 15 %.
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -3203
Director: Albert H. Padovani M. T. (ASCP) .
r
A. D. A. HOME BLDRS.
6 MCKINLEY PLACE
ARDSLEY,, NY. 10502
L :J
LABORATORY REPORT ON THE QUALITY OF WATER
LAB #
Date Taken• • 8 /29 /88Time• 11:45am
Date Rc'd:- Time: m
PPR 'Date Reported: 1988
Collected By:
Referred By:,
Sample Location: Outside hise
Cushman Rd.
Patterson Y .
Phone # b97,.b4O9
Phone # Sample Type:
Repeat Test? _ I (check one)
INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL)
Acidity
Alkalinity
Chloride
Detergents, MBAS
Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
Sulfate
_ Sulfide
Sulfite
GENERAL BACTERIA
Standard Plate Count
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
Total Coliform
Fecal Coliform
_ Fecal Streptococcus
METALS (mg /L)
MOST PROBABLE NUMBER TECHNIQUE
Copper
_ Iron
_ Lead
Manganese
Mercury
Sodium
Zinc
MISCELLANEOUS
pH (units)
Color (units)
Odor (TON)
Turbidity (NTU)
Total Coliform Index
Fecal Coliform Index
KEY FOR TERMINOLOGY
CFU =
Colony Forming Units
N/A =
Not Applicable
LT =
Less Than ( <)
GT =
Greater Than (>)
TNTC=
Too Numerous To Count
CON =
Confluent ( =TNTC)
NR =
Non - reactive
�( Potable
Non- potable
STP INF
STP EFF
Other:
Sample Status:
(check each)
Outgoing
HNO3
_ HC1
H2SO4
NaOH
ZnOAc
Na2S203
Other:
Incoming
LE
4 °C
GT
4°C
_
pH
LE 2
pH
GE 9
pH
GE 12
_
Other:
REMARKS /COMMENTS (For Lab Use) NLAP #10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO T E NE YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE E OF COLLECT
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA DRINKING WATER
CODES, FOR,, ii_E f1 � ARA ERS TESTED, AT THE TIME OF COLLECTION.
Bl
2 /86(Rvsd7 /87)RWE
�M COQ.
-j O
WbLL L;Ur'1rLL11UD1 r%Lrvml
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOORESS: TOWNIVILL7117ciff- TAX GRID NUMSE8:
Cws,ymA.�/v- PA7TERSDn/
.WELL OWNER
NAME: A d A C�/.pyj� ,QGc cQci ADDRESS: pgIVATE .
c o 0 PUBLIC
ZRESIOENTIAL O PURL C SUPPLY AIR /COND. /HER PUMP ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION 0 OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL 0 STAND -BY 0
USE OF WELL
1 - primary
2.- secondary
MOUNT OF USE
YIELD SOUGHT _ L.. gpm. /N0. PEOPLE SERVED :L/ EST. OF DAILY USAGE _T gal.
REASON FOR
DRILLING
'I,TNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 0?0 S ft.
STATIC WATER LEVEL 17 ft.
DATE MEASURED aa2
DRILLING
EQUIPMENT
O ROTARY ($'COMPRESSED AIR PERCUSSION 0 DUG
0 WELL POINT O CABLE PERCUSSION. O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING.. ,;OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH E fL
MATERIALS: STEEL O PLASTIC ❑OTHER
LENGTH.BELOW GRADE / ft.
JOINTS: 0 WELDED THREADED ❑ OTHER
DIAMETER in.
SEAL: VICEMENT GROUT 0 BENTONITE OOTHER
WEIGHT
PER FOOT lb./ft.
I DRIVESHOE:PYES ONO
UNER:0YES 0
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ❑ NO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE; .
DIAMETER
OF PACK in.
TOP
DEPTH ........ft.
BOTTOM
DEPTH _ H.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED a tests were done is in-
COMPRESSED AIR formation attached?
O SAILeD 0 OTHER I O YES 0 NO
'WELL LOG
It more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE
Water
ear.
ing
Well
Di".
peter
FORMATION DESCRIPTION
coot,
It.
IL
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
ft,
YIELD
gpm.
5 rlace
4,11- 67S of S,4�i/
02o S
/-SS s
/as
ias-
gAC- 7V,e.F
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL. --
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME Id t��� DATE
-T
AO RESS SIGs . .
02
V
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- �j,�, 1,Lwk e--4 i . -tal-c� S#A cL./ L r
Owner or Purchaser of Building
e. D A 4,04AL 'Qul -b tw-S �� t-
Building Constructed by
-cis � m n
. jw4Q
Location - Street
�r't��sb,✓
#-),,,4, 1 2
Municipality
Building Type
11 1 7.2.
Section Block Lot
buLV!A Sr,RZWi.SrT.,)
SS b ivision Name
2- Z
Subdivision Lot #
GUARANTEE 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
o pirating 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
repairs made by me to such system, except where the failure to operate properly is
caised 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 Environinental Health Services of the Putnam County
Deaartment of Health as to whether or not the failure of the system to operate was
eatsed by the willful or negligent act of the occupant of the building utilizing
the system. t1
Datai3 this -1 day of k)6%-1 19 9 b Signature
Title .$£1,7-
J2 /�,X-
Contr ctor (Owner) - Signature�,(� J9ory�20�JS
1) q / Corporation Name (if Corp.)
?1'!� . if0�'1£, Du /LDr-j �NC--
45 oration Name*(if Corp.)
Address
i
- 1 es /f,� Y f0SZ
z
rer. 9/85
1
PUTNAM COUNTY= DEPA�tTMEP
> - `� DlvlBlon of Envlronmeata! HedtlP rvl CaIrmel N Y 10511 g� r Provide
En ee to Permk A
CERTIFICATE OF COMP _
:1 peimit r V ��k,�f ..'.. 11
y CONSTRUCTION PERMFf EWAGE DISPOSAL SYSTEM• \
l r }
Town erg
`ILi S(I else Z Z 1 l 1 Lot . Z
Sabdlvlslon Name Sabel "Lot N Ted Map Block
�. O .• �,O� -t ZLl t \- Renewal_ ❑ Revision p
,.Owner /AppllcanfName. ��Ot�%lfl�(IC.lC,' tilQr<7
Date of Previoae Approval
MaWng.AddreaeSQ MG 1/_11.(lYZ -?aC Town P'nS rr Z1p `lO.JSo�.
w tLE.S\tDECL"Il>c 81 'ocv 5 F
Building Type Lot Area FIII Sectloa Only ,Depth '� Volame .
Number of Bedrooms Design Flow G P D -� PCHD Notlflcitldn Is Regahed When FN Is completed
Sepvate Sewerage Syetens to coutilet o['Gallon Sepik T.ank and (o�Z
Te be coneteuetea bye �E ` mil- ti.l�t i
_ 'Address ,
WalterSuPPIJ' Public Supply From B Address
or: 'Private Supply Drilled by2'l (� t�- Address
•, Other Renalrements .- t: ,. " . , ` - ;:. ` . ; ,.; • ::. 'r ,;
1 represent that -t am wft011y anC completely responsible for tho design a'nd locat�oh of the proposed •system(s) 1) that the separate `sewage disposal system
above described will be constructed as shown on the. approved amendment there to and-in accordance with the standards' rules an "regula,ions o.'. a ,._.0 nam
.
•- - actory.to the Commissional of Healthw�ll
County Ospertment ot'- HMlth,.: and ths. Completion thereof a ,, . 1. },caI a t- f ConstrueLOn ComDlunce' saGsf
ba_wbmitted to the Department; 'and s written - ,guarantee will :be furnished',he,owner, his wccessors,.haiisor sssigns:bythe builder,
Yhat- siid,builder'vG�ll `I
place - in good, operating: "condition any part of. -saiC sewage - disposal; system uring the' period of two (2) yea rs.imniediately follow! the datq of tha,istu -
once •of the approval of the Certificate •;of Construction_, Compliance of the rigmal syitern or any repbi s there ; 2) th Me.drilled' well descr�DeG.sbove
will be . _ -, -3 .11 ,
iocated.as shown on the approved plan and that` said well'wlll De °ins al eel in accordance th - standards ules d r a Toni of -.the _ Putnam
County Department
off kealth -- ✓/
S-77 -.� Cam; -I' a `:S�gned R A _.
L. ense No
APPROVED FOR CONSTR.UCTIO,N Thlsapproval expuestwoyear lromthe aM'iss ed unlessconstruetion of he building bas been undertaken and Is
revocable` for -cause oi;' y be ain d C- ormoditied when co'ns�dere cesser by
a ommission FI 1 .. Any change or alteration of. construction -
requires a new permit p ro or d' posal of tlomestic sane re e, sn r p ' sto p nty:
1�/W Date ev
E
Title ,7
}
�s.
APPENDIX B
PU111AM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL 9UNTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
A0/f �f
(Name of Owner)
lcmm IVTS
LF trench provided
required
60 ft. max.
Parellel to
10
new
DATE
BY:
(Street Location)
YES LNO DOCLZ1EN TS
Permit Application'
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
100 yr. flood elev. I 1 I I
s/s
SUBDIVISION
Perc -2-1-30
(3) Fill
cd —
House Plops - Two sets
Well './ permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
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 (grinder notes)
Design Data: perc and deep results
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shawn;gravity flow,suff. size
If PmVed Pit & D Box Shown & Detailed .4
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed Systems
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 110; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512. (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT # /
WELL LOCATION
may, Street Address
D Town illage City Tax
Grid Nu ber
WELL OWNER
Name
kQ�
Mailing Address- 1050Z_
1 - "C r PL,
OTrivate
0Public
USE OF WELL
1 - primary
2- secondary
—�. /�.
UYRESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
OPUBLIC SUPPLY OAIR /COND /HEAT PUMP
O FARM 0 TEST /OBSERVATION
U INSTITUTIONAL 0 STAND -BY
13ABANDONED
0 OTHER (specify,
0
AMOUNT OF USE
YIELD SOUGHT
%j gpm /# PEOPLE SERVEDZr /EST. OF DAILY USAGE al
REASON FOR
DRILLING
ITNEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
.REASON FOR
DRILLING
WELL TYPE
1315RILLED
DRIVEN E]DUG
®GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 'iii .L L j6;Z: ,jyi.5l�ltl` !
Lot No.
WATER WELL CONTRACTOR: Name —�b_ -ze: ..(1NjEin Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No
NAME OF PUBLIC WATER SUPPLY: kA14 TOWN /VIL /CIT'Y
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED'
ON REAR OF THIS APPLICATION ZI EPA E S
�= 7-6-7
(date) (sin ture
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 s.hall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Rutnam
County Health Department attached to this permit.
3. Submit a Well C mpletion Report on a form provided by th Putnam Cou ty
Health Depart t.
Date of Issue: J 19 1 Id", A
Date of Expiration: _ 19 , it Isstrfn§ Official
Permit is Non - Transferrable
2/87
White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Oranae cove: Well Driller
4
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT. APPLICATION SUBMITTED TO -
PUTNAM COUNTY }[EALTH DEPARTMENT.
Tb: Commissioner of Health - In the matter of application for `
ev
I► _ _ �/'QiL _ - - - - - _ .. , represent
that'I am an officer or employee of the corporation( and arts authorized
to act for
(n
-- nw'ame of corporation) _
having offices at -i -t
e-,JLr d__-, - �__
(1�b' ✓ Whose• officers a e
President _ --
ame an Addr' ss) '-
• Vice - President C�2_vt Q-
�1 (Na me a ddress){ '
Secretary � - - - - -
(Name and Address) .
Treasurer -� ---------------------------
. (Name• and Address)
and that I am ano will be individually responsible for.any or all, actp
of the corporation with•respect to the approval requested and all•sub- -
sequeA. aeta relating • thereto.'
Sworn to before me this t �i. day Signed _ aLclfl ,? -
_ _ pp ,,_A�
of d 198' Title _V_u e-.P�:1_
Notary Public
Lit-; `
Corporate. Seal
{ _ pUTNM COUNTY DEPAR'.INiW OF HEALTH
DIVISION OF. HEALTH SERVICES 4a
:.;DESIGN DATA SHEET- SUSSUFACE SEWAGE DISPOSAL SYSTE4 FILE NO.
Owner % Sir t tic �c�f/ t� -IA�e� Address
C:
Located at (Street) QC-C-) Sec. i Block Lot Z.z
(indicate nearest cross street)
Municipality `�d'i''(C(L- Sc�i�! Watershed Cr-c�r-rp I
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of pre- Soaking q
gCo Date of Percolation Test
q —Z�—f — &(o
HOLE
=�
NUMBER CfACR TIME
PERCOLATION
PERCOLATION
_ Run Elapse
Depth to Water Fran
Water.I I
_
�- No. Time
Ground Surface
In Inches
Soil Rate :-
Start -Stop Min.
Start Stop
Drop In
Min /In Drop
Inches inches
Inches
-
/1 150 — 3 : c? } :1 C� 24 Z7 ZQ
2 3:01 - A: 1(c :
311:1`1- 5'.3-7 1
4
9
5
/i Z`7 I
27:46, -3'50 1 •call
3
- 4.50 1;06 .zQ
3
ZZ
4
5
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 submitted
for review.
2. Depth measurements to be made from top of hole.
=�
5
f�
2
4
5
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 submitted
for review.
2. Depth measurements to be made from top of hole.
�-s.a
i .� Ywf��`t�.TEST -' PIT. ~DATA . i2DQUIRED, .T0 •BE ,'.SUBMITTID - 'WI'I'fi�APPISCFITION
,,•
a }L i� �,. � t4 f ,. , Y�,� � 2 a" ["j ' }�5,�* 71, ., :.:,.- .+,•
DESCRIPTION OF
n#` wASy.'N+O. !- I LS ENCOUNTERED IN T, E f ST A �SfSOLi L ES
<.
HOLE N0. HOLE . N0: '
Y,E,y
r: .GL
21
31
6'
71
81
91, -
10,
11' .. ....
.12' .,
131
14' .......:.-
INDICATE LEVEL AT WHICH GROUNIXRATER . IS .ENCOUNTERED V�-i o t�-lC
INDICATE LEVEL TO WHICH WATER .LEVEL RISES AFTER BEING ENCOUNTERED�_�
DEEP HOLE OBSERVATIONS MADE BY: .tit/ l- Autz�T DATE:
DESIGN
Soil Rate Used Z( -32b Min /lit Drop: S.D. Usable Area Provided SpOO
No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type Cc'>jcze-j�-,-
Absorption Area Provided By &-7Z- L.F. x 24" width trench
Other
Nate L,UZ0.L - i►. i NC. ,&SSOOJ. j �s. ?C Signature
Address F�,,tzneLn zjVE SEAL r� W
kly
cz -s� No. 56124
F
THIS SPACE FOR USE BY HEALTH DEPARTMENr ONLY: OFESSION
Soil Rate Approved sq.ft /gal. Checked by Date
PIPE
sa ° /FT.
> STONE
N>;L
II.ET
� Tw0 sipE
6E KK06KED
2WN .
G,RAPe
77,
ALA, OuT1.ET5
AT SAME ELEV
Tp
A5- OUil. -T DIM6N510N CHART
6
N-
A
P�
I
C, +0
5.1.O'
t
9-t.0
11(.0
2
70.0'
5 5.0
15
°98.0'
I ( I .0'
3
la. 5'
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102.5'
111.5'
4
83.0'
5.8.5'
17
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112.5
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89.5'
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113.5
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95.5'
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15
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115.0
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93.0
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8
57.0'
110.0
21
144.0'
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9
10 1.5'
110.5'
22
146-5,
1 &7.0'
10
105.5'
1 I 1 . 5'
23
151-0,
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11
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112.5
24
153.0
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114.0'
25
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112.0
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