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BOX 4
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00156
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Richard_ Louise Baird Patterson
Owner or Purchaser OT Building Municipality
Wi1.11am L. Schaub (Kent,
Map.On'e Mooney Hill Heights,Subdivisi.or
Building Constructed by ..Section
Bald w i,n Road P i 1 ed.: Map :N.o 908
Location Street Block
Frame i.4
Building Type Lot
GUARANTY OF SEPARATE..SETIAGE SYSTEM
I represent that I am wholly and completely responsible fo r '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 guaranty to -the owner, his.succes-
sors, heirs or.assigns; to place in good opera4ting condition any part of
said system constructed by me which fails to operate for a. period of two
years immediately. following the date of initial us--,.of 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 occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de
termination . of the Director. of the Division of vironmental Health Ser-
vices 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 15th.. day of January 1970 Signatur ;
Title
I corporation, give.name
and address)
.THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
•CERTIFICATE OF COMPLETION WILL BE.ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
.Division of Environmental Health Services, Putnam. County, Department. of Health.
• -.
I
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Notes:'
1) rests to be repeated at same depth.until approximately equal soil rates are ob-
twined at each percolation test hole..All data 'to be submitted for review.
2) Depth measurements to be made from 'top of hole.
NA
. PUT NAM
A'
COUNTY DEPARTMENT OF HEALTH.
DIVISION OF
ENVIRONMENTAL HEALTHSERVICES.
DESIGN . -`DATA SHEET —SEPARATE
SEWAGE DISPOSAL SYSTEM FILE NO.
Owner gj der
Address i-
Located at
�u16q%ie��3ra,
�9y
:'{Lot.
.(Street)
. ®.'
.(Indicate/. nearest
cross. s'treet)''
Municipalitya. sod
Watershed . L�'tjZ"�'h .
SOIL PERCOLATION TEST DATA' REQUIRED.: TO BE 'SUBMITTED WITH APPLICATION
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
2: O137
3 /OY,i 111�
Ile
4
:
- 5
Z/
2 /60/ ' YD
4 �.
Notes:'
1) rests to be repeated at same depth.until approximately equal soil rates are ob-
twined at each percolation test hole..All data 'to be submitted for review.
2) Depth measurements to be made from 'top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH; APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN.TEST.HOLES
DEPTH
HOLE. N0. / ,HOLE: N0. HOLE.,NO.
G.L.
%.
611
Qrov'4s
1211
1811
2411
30rf
.3611
C14
4211
48 It
w5 e _
5 411
6 0"
6611
72"
78it
8 4i1
INDICATE
LEVEL & 'tR ND (CATER IS ENCOUNTERED, Noh"e
INDICATE
LEVEL. TO WHICH WATER LEVEL .RISES AFTER BEING ,ENCOUNTERED /Vow P
TESTS MADE BY /,� (.'2f,1� — �� (h��T� Date J %ZYi70
Soil Rate.
��FESSIONq�
Used Min/1" Drop.: rea Provided Alerj/ e
No. of Bedrooms
Septic Tank Capac o . ? Type
.Absorption
Area Provided By L..F.x24T
- i
trench. Other
33oo s
Name
Pte. Signa ^P
Address
/i X33 �Ty� �Pj °F
PUTNAM COUNTY DEPARTMENT -OF HEALTH
Soil Rate.
Approved Sq..Ft.. /Gal. Checked by _ Date
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