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BOX 4
00142
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00142
OWNER'S NAME i O S�
SITE LOCATION
MAILING ADDRESS
PUI'NAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
/1? G -191';;7-
u CC 0,. r L4 I. L PHONE 0/6"
oss Re/ 4 To
G ro.
PERSON INTERVIEWED - -- -Ow 14e-t- - -- - -- - Pam Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER Fred 4 0hm-S PHONE c? SS - 37 3.3
REGISTRATION #
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
Proposal approved
Inspector's Signature &
Proposal Disapproved
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
/3
to
(e.g.,house corners).
three precast 6' diem. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or ported agent of owner agree to the above conditions.
SIGNATURE TITLE %��" DATE l 1 7
PIN'S: Rdbe (PAD): YeUc w Mkin HI); Pink (AFpliaBrit.)
F.L ADAMS, INC.
0l'
4 855 -3733 Invoice Number:
Invoice Date:
CUSTOMER:
�OSc� Z �lCcorLk
s.r' --rax -�
^^..,�""°.: - ,-,sry- Jc-
Rev.: 3/86' CJ� PUTNAM COUNTY DEPARTMENT OF HEALTH
e Divielon of Environmental Health Seivices, Carmel, N.Y 10512
t " Enptneer Mus t Pirovlde D . �� 8
CER ATE'OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM J1 � yU_
Town or;V_ l0age.
Located at Q� Ta= MaP— _Black 3 Lot
Owner /applicant Name F erly Subdivision Name �r= Satidv Lot N_
i
MaiWng AddressT i ( �X . Zj Zip 1 5lO Date permit Issaed9
Sep -ate Sewerage System bafft' by l 1� .4 - . —Address -
-ate I O v c C Z�j: •Z
Conaietiag .1 f O O Gallon. Septic Tank and -i �T(4p t4
Water 'supply: Public Supply From Address �r^�
or t✓ Private Supply DrUled by T AddreBe
Building Type Has Erosion Control Been Completed?
Namber of Bedrooms - "_ Has Garbage:Grtnder Been -Installed?
Other Requirements
I certify that the system(s)_as listed serving the above.-premises wake constructed essentially as shown on the p s,of the completed work ( copies
of which are attached), and in accordance with the. standards, .rules and regulations, in ac rdance with the i d plan, and the permit issued by the
Putnam County De ent t16f Health.
Certified bp P.E. R.A.
Address License No
Any person •occup0iii promises 'served by the, above system($) � shall prornptiy take such action as may be necessary to cure the correction .of any unsanitary
conditions rewtting; from such usayd. .:Approval 'of the separate sewa►a , system shall become null and voidas soon as a pubt'p sanitary sawn► 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 or change when; An: the' judgment of.the Commoner !!,t4eiilth, such revocation, modification Or change is necessary.
Date �I '. By Title
m
i
�. .jam
►e
s �
f; W O4
w�LL �vriri,r.liviv �rvc�i
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
�10
tr
''TELL LOCATION
STREET AOURESS: 7UWNIVIELACEICIN TAX GRIO NUMBER: o - pt
WELL OWNER
NAME: ADDRESS:
P8IVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND:/HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT �gpm. /N0. PEOPLE SERVED % EST. OF DAILY USAGE Q� gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ 0BScRVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH % vim ft.
STATIC WATER LEVEL ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY WCOMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. VOPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft_
MATERIALS: irSTEEL ❑ PLASTIC ❑ OTHER
CASING
LENGTH.BELOW GRADE 0 ft.
JOINTS: ❑ WELDED IdTHREADED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: ❑ CEMENT GROUT f(BENTONITE ❑OTHER
WEIGHT
PER FOOT L< Ib. /ft.
DRIVE SHOE YES ONO
LINER: OYES ONO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH
(1t)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
❑ YES ONO
SECOND
OURS
RA ACK
GRAV
SIZE:
D1A
PACK tn.
P
DEPTH ft.
OTTOM
DEPTH It.
❑ YES
O NO
WELL YIELD TEST If detailed pumping
M HOD: ❑ PUMPED tests were done is in-
t
EF COMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ❑ YES O NO
WELL LGG it more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear.
in
Well
Dia-
peter
FORMATION DESCRIPTION
CODE.
ft
fL
WELL DEPTH
It.
DURATION
hr, min.
DRAWOOWN
ft.
YIELD
9Cm
Land
Surface
/
O
E �,/) d 6.011/
o
/mac -�G°U //t E. f' �, " c:) CX
s
L
*� Q
ell
WATER ffCLEAR " TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ❑ NO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
X t 1 %fM 4YATT & SONS, INC. . DatE` 9
ADDRESS Well Drilling SIGiMTURE o
Rte. 311 R. R. 2 Box 171A �jr 2/
PI�TTERSON; NEW YORK 12563 /
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -2800
Director: Albert H. Padovani.M. T. (ASCP)
T_ OrHARA, PERCY
BOX 282
PATTERSON,NY. 12563.:.
�51c21 —_2
LAB #
Date Taken: 6/6/89 Time: 2pm
Date Rc' d: 51,61's - — Time : �—
Date Reported: JUN. 091989
Collected By: 11. U I dara
Referred By:
Samopl ;2Location: c en ap
a o ,
Phone # -
Phone #, Sample Type:
L J Repeat Test? _ (check each)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS mg /L MICROBIOLOGICAL CFU /100mL
Acidity
Alkalinity
Chloride
Detergents, MBAS_
Hardness,.Total
_ Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
Sulfate
_ Sulfide
Sulfite
METALS (mg /L)
Copper
_ Iron
_
Lead.
Manganese
Mercury
Sodium
Zinc
MISCELLANEOUS
pH (units)
_ Color (units)
_ Odor (TON)
Turbidity (NTU)
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
Total Coliform
Fecal Coliform
__.. Fecal Streptococcus
MOST PROBABLE NUMBER .TECHNIQUE
Total Coliform Index
Fecal Coliform Index
KEY FOR.TERMINOLOGY
4 °C
CFU =
Colony Forming Units
CON =
Confluent (q.v. TNTC).
LT =
C =.Less Than
GT =
> = Greater Than
N/A =
Not Applicable
S/A =
See Attached
TNTC=
Too Numerous To Count
REMARKS
/COMMENTS (For Lab Use)
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:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE Was)' (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) .(Didn't) N /A), MEET THE
SATISFACTORY CHEMICAL QUALITY. STANDARDS OF THE NEW YORK PUBLIC RIN ING WATER
CODES, FOR THE /RRPMETE kS TESTED, AT THE TIME OF SAMPLE COLLECT
Lx/ t , 2 /86(Rvsd7 /87)RWE
Albert H. Padovan , M.T. (ASCP), Director
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMAL HEALTH SERVICES
Owner or Purchaser of Building
Building Constructed by
Location - Street
Municipality
Building Type
Section-- Block Lot
j vL�
��� N
Subdivision Name
Subdivision Lot #
GUARA= OF SUBSURFACE SEVMGE 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
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 IZi day `of .�VL19Tq Signature ,
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address FZ- iG 5
rev. 9/85
rmk
Corporation Name (if Corp.)
Address
~ F1 PL SITE INSPECTICN Date
i
Ins_°=-ted b .
STR= LOCATION
PERMIT s %G � m a OR SUBDIVISION LOT a
s
I
ff
m
w
1*1�9 - CON±y
SLr &GE DISPOSAL AREA
a. SDS area locatedd as r anoroved laps
4 4-
b.
Fill section - Date of placement
2:1 barrier. L �i GTH lw-m AVG_D �°
~c.
c.
Natural soil not striumed
j I
d_
Stone, brush, etc_, create_- than 15' fran SDS are?.
I ,--
e.
100 ft. from water course /wetlands.
I. SaUlIG.c DISPOSAL SYS EM
a. Septic tank size- 1 0. 1,250
b.
Ser)tic tank ins+z -11 evel
I I
c.
10' minim n frog foundation
d.
No 900 bends, c-le=nout within 10 ft. of 45 ° bend
e.
DISTRIBUTION BOX
1. All outlets at same elevation - waterr tested
( I 1
2. Protected below frosU
I
3. Pinjzn= 2 ft. orici ral soil between box and trenches
f.
JUNCTION BOX - nrotx---ly set
I �I
g.
TR_F'NCE S
1. Length regui red - Iamc 2h ins wed
2. Distance to wate_tcourse _ft.
3. Installed accordinq to plan
I Di I
4. Distance cente_T to cente_T
5. Slone of trench acceptable 1/16 - 1/32 "/foot.
Imo" I
6. 10 feet from DroDe_Tv line - 20 feet - fourdati ors
7. Denth of t_mch < 30 inches fran surface
I I
8. Room a -1 c v-ei for em-- arsion, 50%
9. Size of .gravel 3/4 - 1 -i" diameter
10. Depth of crave) in trench 12" minim=
L.-Pipe ends carced
h.
Fl--,MP Fl--,MP OR DOSE SYSTEMS I
1. Size of mmm chamber
I I
2. Overflow tank
3. Ala=, visual /audio I
I I
4. Pump eas ??v accessible manhole to Grade l
I
5. First box baffled
6. Cvcle witnessed by Hest th Dew anent (
I
estimated flora r cvcle
a. House looted pear a =roved plans.
b.
Number of bedrooms
a. Well located as re- a=roved plaPS I
�,
b.
Distance fran SDS area mea=sured 1 r' ft. i
®i--
c.
Casing 18" above grade.
d.
Surface drainace around well acceptable.
OVERAI L WORKMASHIP I
a. Boxes prowl crcuted
4d,
b.
AU ipes p raa11v back--Filled
c.
AU - roes flush with inside of box
I
d.
Bac-kfi11 material contains stones < 4" in diameter
e.
Curtain drain installed according to plan
f.
Csrt,.ain drain outfall protected & dir. to exist.watercours�
(/(
g.
Footing drains discharge away from SDS area
�-
h.
Surface water rote-c-tion adequate
i.
.r-rosi.on c--nz--oi provided on slopes create-r than 15$_
YA , 00P
Ile
'4 I
Alp
o0o, *4
tc)ao P&L' MAhcrltz
h /PT1�G TASK
THIS 1:; 1*0 (11"Ch Y 'lil' . -11 " !'J' 1. ';Y"'; 1-:.X! "" -_;
CONTRUC,-1113 AS INDICATED ON THIS PLAN AND THAT THL
SYSTI'M WAS WSPECITAD BY Nn' fir;-oru IT WAS (-O'NTRE-D OVER.
THE SYYffAl WAS CONYIRLK-1-11) IN AU-MI)ANICA' %VJTfl AIJ.
111L, RULES AND RFGUI�1l'101'JS OF THE PUTNAM C01,111\11-Y
DEPARTMENT Of! IffALT14.
A lcr6wryg;�,,�5�
"FUZ
V-0T 1-; :::f A AV.A V I 1�v 0
FtA
0 0
F
j
2- —A-
"X,4 v 6y 198S
•1c
tiles
OC) a 4Al1. IAA O#Arz-C -M'jK
1-1113 tAKI FTC Z4'` TQ=uGK
Ta'57&'-;
7 A o L% ki FT W 24
k0c;
'.'LL
Putusm County Department of xesm
Jlvl@l*n at EnvOoymental Realtb Service,
�S ' " - '/' S /-,0— '- , - S—g-
ypproved as not.ed.for conYormgnoe with
-kyplicable Rules and Regulations of the
..Itna:m County H
G�unz �119 ltih Department-
rb
7'kqk(
14'
54'-5"
Putusm County Department of xesm
Jlvl@l*n at EnvOoymental Realtb Service,
�S ' " - '/' S /-,0— '- , - S—g-
ypproved as not.ed.for conYormgnoe with
-kyplicable Rules and Regulations of the
..Itna:m County H
G�unz �119 ltih Department-
w. aavvo ♦q uow " a wa a vua -,w. n u aoo wa.a.oaw. i ..e . « � _...o o. a . .�..... �., ..... .
pleca in good ,operatinq'•contlition any, part of fain' fewage disposal 'System dunry the.perksO.of two (2) ysar$immadiately folbwinp -this date Of thi ifsu-
h - 4
ance .of the approval of the 'd Aifi"te, of Conftruction Cor'npliance_ of the original system or any: repair$ then ; 2). hot the drNl ' well described apove
Will-be located as shown on the app►oved' plan and ,44t said well will be installed accords wit the a Yu and repu a, ons of : the Putnam
County. De rtment of Mealth '
Date �° �I 5loned P E
Addieu Y" `' License NO_j
APPROVED FOR CONSTRUCTION Thii approval'expires'two Years from the' date issued unless_ construction of t e building.ha$ been ,undertaken. and is
.'revocable for cause 6r:may be amended brmotliRed; when consi"4i neeessar,i by the Commissioner. of ,Health. Any change or alteration of construction
requires�a/'new ;permt �'yApprovedCyfo /r�d�sposal of domestic,,famt/ar'y sgway rrvate water wpply only.
I81 Oate N 1� ry _ �'� —��` Title
17
-s.
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 # P-2�5da",
WELL LOCATION
Street Address
G
Town/Village/City Tax
atSo�U
Grid Number.
—3— Z
WELL .OWNER
Name
Mailing Address Private
*Private
Ptok -2,g Z ( b�,Vk% OPublic
-USE OF WELL
1 - primary
2- secondary
G- RESIDENTIAL
O BUSINESS
0 INDUSTRIAL
0PUBLIC SUPPLY QAIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE SERVED & /EST. OF DAILY USAGE 24,50 gal
REASON FOR
DRILLING
EW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE XISTIN SUPPLY ODEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
MRILLED
DRIVEN ODUG
GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 75'
Lot No. +Z�
WATER WELL CONTRACTOR:
Name
7_1 �j, -�
Address:
IS PUBLIC WATER SUPPLY
AVAILABLE
TO SITE:
YES L_-''O
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
II ❑ ON REAR OF THIS APPLICATION RAT S
I c,
(date) signature
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 Z 19 �� -�
Date of Expiration: 19 9'0 ermit Issuing fi
Permit is Non - Transferrable Wldte copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
PUTNAM 00UNTY DEPARnd= OF
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM i FILE NO.
Owner Qe'it-L (7� E7 A� Address
Located at (Street) Seet. 1io . Block_ Lot `Z-
(indicate nearest cross street)
Municipaiity �/� ,y Watershed
SOIL PERCOLATION TEST //DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking i 1 117 6P) Date of Percolation Test it l l ej 1 b$
099N
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 -
1 3
n
5.
i t 71
2 3 19
4
5
1.
2
3
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 fran top of hole.
rev. 9/85
DEPTH
G.L.
1'
2'
3'
4'
TEST PIT DATA REQUIRED TO -BE SUBMITTED. WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. HOLE NO.
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE: It l g l
DESIGN
Soil Rate Used —JO Min /1" Drop: S.D. Usable Area Provided �—&p6j5>gj
No. of Bedrooms 3 Septic Tank Capacity Off gals. Type
Absorption Area Provided By 3_ L.F. x 24" width trench
Other
(E Siqnature
Name
' • • - f - I SEAL
THIS SPACE FOR USE BY HEALTH DEPAR24MT ONLY:
OF NV�
Soil Rate Approved sq.ft /gal. Checked by Date
t
CCLR\M_f DEP R_211 F OF HEUT ? - DIMSIO OF E`V4=C-R� .L H A=,.H S-_--IV - =S
D017MIRL WA=:- SUPPLY & SUESbRF = Sgv-t= DISFrti3I. S'i5=15
('Name of Cumar
0
re- --, w
RE'\T ,- S= - CGNSME=ICN PE1nrT
(Street L catic -_) .
�`I9M��
T
D. a __.� E
BY:
Permit Amol.Lc? ticn
Cor::crate Resolut_cn
Plans - Three sai
E::cir_eers Autzcrizatica
Design Data Ci ?E-t ('C;S )
Pec.r� Hole Lcc
Ccrsist =nt Perc RE :_
Parc Hole Decc-i
Ecuse Plans - T� o =_
�_ F= ; _; P'
c=iaz-C°_ RE_L:eSt
ee,, %` .a,
s/s
5�1��1�%IC1CiJ
c�
L l SL'bL ' v i5 icII
Wet-2, and & D)
Data Ca DDS Plans &
RE; =H=j DEI]I i T C CV — 'E
S =.voce Sv s-_F_m plan
Sc.vcca Svstan iii %l Y _' r t'r :ri_I!
1' 1 I I: le & DL is ens-c. -,s - Yom.:_ .
D or .1 ;,T a_nc :/ Ct t l c v; r ci - t d e =il5
SeTtic Tani - S_z-, G`�11
Well Der„ri 1 , ._.=:"JiCS Li -e 1= cve_
Crnst_ucticn Notes (crinder ratS)
Ces:gn Da--_: per_- and daec ras-'• _`.
TWO -Foct C^ontcurs Exist_nc & P_c_ccsw
Drivacv & Slcces Cat
Fcotinc/Cstter,Cartai : Dra? ns (C:- Stiharae C'K)
Perc & Deeo Holes I,cC tw
Represz ^_trtive of pr'Tar% and exnamnsicn
P{_ansion AS=;shccvn;:ravit_i fllc— ,sui -. size
If-P..� Pit & D Ecx Shcw-n & De tailed
Hcuse - No. of Eed_roa:Lc
Wells & SEDS' s Win 200 ft. cf r opcse^
Protie_* Y Met-as & Ecunds
ECUs` Set - ack Necsssar"i (`Fight lot)
Heusi Sewer - 1 /4" /ft. 4 "0; rT_,Te pi7ge
No Bends; Ma.Y. EE ^.ds 45° W /c_earcut
S °�RATIC�1 DIST ; \� S? =CL� CV PT_lN
P.L., Drive av, Lee T_ fs,TC_ or
i Foundatics walls
.o Well; 200' in D.L.O.D, 150' Pits
c St_._:n rak= (inC. Er.
Drains =Curt; in, L ^ceY, F'xtinc
catch L--=si:l,5LcrTiGra4!1,C12,r,--a3 Watsr'=L,u
10' to 'water Line
50' inte*�tt`nt ara?^rce cc's =e
Sect' c `I``nkc
10 ' 50' to aLl
F�L SITE ENSPECT- Date � Inspe✓ted by
TrfP a
I.
ITT .
V.
V!
1 .
YEE
NQ C—
DISrP0,' -AIr, PAE3
_ SDS are-- as r acnreved plans
b- F 11 s- . icn - Date of plac---D--"t
2:1 barrier . I - w=ri - AVG_DPTFi
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C- b7atur-'l Soil nct
3_ Stcne, bras , e c_ , areate-r t`i.an 15' f--an SDS area_
e. 100 f t_ fZC. '.voter ccur e/T etiands:
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Sec�c t±n� size - 1700 IJ2`G
b . Sentic tank ice_ = =: _ � � ed level
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c. 1G' mini_m -mri -= fcund�ticn
goo ben_c=_, c1e-recut wiLrnin 10 f=. of 45° bcrc
e. D SL-TR-T--,UT:[c.i
1. tt ' cu lGt:--= at sCIrG ell eval..I cn - wGLar test_ "
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L. Prctec .t - be1cti fres �
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- -I Soil LCX arQ 1 e. C ES
3. IA1 r— ra--t 2 ft. cricIn
f_ j-UNCTICN ECX -- orcc`rt y s==
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L. Di t-a�nce wc-e- �Serr.5-,-- Su- -=
d Di —.—rice _r tc cz' te-r
Slcce c t—_ch acc= _ctY^le 1/15 1/32 " /-cct
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6 . 10 _ 20 ^- SCU: ^tee_ ? cns
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%. E�eT_ti n cf t=--- Ch < 30 L ^.G1es --GR sl= =Ce
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8. Rc,=,n a?Ir -cam =cr e--Y-.ansicr_, 50%
1. Size c= c '7el 3/a - 1-t" Qi G:1lET
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10. r.,-- 'T cf c a e.? in t_ercz 12" mzniTrinn
L. Fire ends
h. F -DT CR DOSE S YST-7- �-S
1 Size of c_= c G-icer
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3. Pla—n, v =sue /aTcdic
4. P=r) accessible, e, manhole to crade
5 First. L-x
6. Cvcie by E�..=i tL-i De=a tnEnt
-=
es t zmat �H r_� crcie
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HCIIc �:
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C.. Luce lC rer an crcvcd r+1GT�iJ .
a_ W, =Il lcca�_= ��' aTcrav Man_=
b. Di _= tz-:r�ce f_ SDS area mea- scared
C- C=sina 18" a:^cvc crrade-
Q_ s.—�aC° dta_ ice around wz1 cCC` L= ! °_
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a_ ^Ye5 prcc CrCUt='
b_ A -' ices -�ia! lv �ck.=c_
$11
P- pices f=»=h. wit�n inside of bcY
d_ ill sa t_i� ccn�i ns stones < a" in dia.Tract
e_ CT7-,a.in d= in in_ =till accordinc to plan
f. c:.:.,-tai n drain cut=:-all cr ^ter r & eT T to eve =t S4a -rC L_rse
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a. r•rotinq d'_=c-iarce at-av t:cm SDS area
h_ S._rfac=_ watar rrct c`icn adequate
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