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Home My WebLink About0359DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -72.3 BOX 5 i y,. ' i 11 11 , 't ', - i - - rr '�1,■ ?, I 16 1 LL Ems OR NO Jr 11 .: n PUTNAM COUNTY DEPARTMEN T OF HEALTH 7/� , ': Dbbbn'.of P:nvh+oomenW_Hedtb Servk+er, Carmel, NY 1OS11 � ., f > N t Ibgleee� Mart Provide P- 2 7 89 • P C H D Peimit ' t CATE,OF CONSTBUCPION :COMPLIANCE FOR SEWAGE- DISPOSAL SYSTEM T. Pafters.on ,. VNage Cross Road Ta:`Map 10 Bb�ck { • 1 1 Owoe /appilcaot Nrme John -;C Weizeneeker . Foemedy Subdivirlon N.me£Jolin & 'Elizabetai Werzeneck� v-n�w : Address Croaa Road a raon,. N V_ 7.Ip .1�5ti3 :- ; _ _ suba `Lot 1 v 41 Fee 'Enclosed' ,, :Amount, .$T0o :00 Date Permit Issued - 7/25/89 Separate Seweeeoe System bo oy Burdick. Contracting ' LTD A eSaaer Rd Brewster N Y 10509 ,. - :1000. : a .:• .,• �. Conlsdng oi,' ti. Gafon Septle TaA nd X00''• x .24" W X- 18" deep. laterals • Waber:Sopply; Pablk Supply From Addresii or: X' Private Supply Drl�ed`byP F.: Beal & Sons ASP 0 Box B; $rewster; N Y,. 10509. BaQdidg Type. Frame; Lot 'Size 1•:637 Acreas Erosion - ('nntrnl Roan ('gym= 1 pf pd BAs;` required Number of Bedrooms Three Hue'Gaebage`Gelnder Been IaetailedT No Otter Begtdiementa ` R 0`B,FillP Section_ "L."3 , 500 `sq, ft I certify thst :the syetem(s)l ae listedatiervinq he above pzemiaes were constructed eaeentiall as chow on the leas of the c w Depleted work -`( copies Y P P oP vliich are :'attached)< ` --," Ain ,accordance with the 'standazda, ' zules and regulations, in dccordance witfi'.tlie la led''plan;'-and the permit ,issued' by the put%" d ?"uaty'Depsrtment 0!'8ealth X. 18 `July :1990 f Data art lad by P E AA IRdCrett RD9 Fair Street; armel, N Y 10512 LfanM Ivo.' 29206 Any "pe►wn oteupyinq p►omtsaf Bawd by the above systerr(s) shall ,promptly; tako wch actbn:as may,ee naoawry to selun tM eonaetbn` of any unsinitary eonditbns r*ginq yf►om such .usage. ADproval'4of tM siparaM raworagr'sy om fMll Meona nuil and vold as eat as a pubt;_ .reltpry Nvih►- boo0mp avalltble and the approval of itho p►ivate water supply shalt. become null ay whin a puelk watw. suPPly"b�taoma avillabM.` Sueh fowls a►tl WOJfaet to nlodifkat n ,or ih9e when, in "the °Judgment, of the.•COMm of weh rivoeatbn. niodHkation of Chan4a 3/89 `•. ; - eY�, .Tltl. • 1 CR fit. WLljL UUr1rLZ11UM AZrUD.1 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WE' LL LOCATION' STREET ADDRESS: W* GRID NUN18ER: Cross Road Patterson, NY WELL OWNER NAME. , ADDRESS: -john'Weizeneckeri.Cross Rd., Patterson, NY ❑ PRIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary IS RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS 0, FARM . ❑ TEST /OBSERVATION - ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ MOUNT OF USE YIELD SOUGHT gpm'./NO. PEOPLE SERVED EST.. OF DAILY USAGE gal. REASON FOR DRILLING 5 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 225 ft. STATIC WATER LEVEL 470=1t.FDATE MEASURED 4/3/89 DRILLING EQUIPMENT (3 ROTARY a COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ZMPEN HOLE IN BEDROCK 0 'OTHER CASING DETAILS TOTAL LENGTH 21 k . MATERIALS: 13 STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 20 ft. JOINTS: ❑ WELDED 0 THREADED ❑ OTHER —DIAMETER 6 in. SEAL: 0 CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT' 19 . Ib./ ft I DRIVE SHOE: WYES ONO LINER: 0YES 91NO SCREEN DETAILS DIAMETER (in) SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO HOURS SECOND GRAVEL. PACK 11 YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. I TOP DEPTH —tt. BOTTOM DEPTH — it. WELL YIELD TEST It If detailed pumping, METHOD: ❑ PUMPED tests were done is in- AkCOMPRESSED AIR formation attached? 0 BAILED 0 OTHER 0 YES 0, NO It more detailed formation descriptions or sieve analyses VELL LOG are available, please attach. DEPTH FROM SURFACE Water sear- Rg Welt Dia- mete in FORMATION DESCRIPTION cooe ft. ft. WELL DEPTH it. DURATION hr. min. DRAWDOWN A. YIELD gpm. d Sur Lani2ce ing in overburde3a clay H --I' nock at 3 feet. . 225 6 20 5 30 3 21 zjL g in - in rock set casing,g route d. I 21 225 D -il -ing in rock granite. WATER ❑ CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? OIES 0 NO STORAGE TANK: TYPE CAPACITY GAL. 1 - PUMP INFORMATION TYPE MAKER — MODEL — CAPACITY DEPTH VOLTAGE — HP WELL DRILLER NAME P . F . Beal & sons �,I/rte). DA 8/16/89 ADDRESS PO Box B SIGU-TURE Brewster , NY 10509 Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovani M..T. (ASCP) F JOHN H. PRENTISS,P.E. RD9,FAIR STREET CARMEL, NY. 10512 L 1 J LAB N _j .:..,� ._.._ .. — Date Taken: 7/18/90 Time: 12.15 m Date Rc'd: 0 Time: lnl Date Reported: 21990, Collected By: J.Weizenecker Referred By: Sample Location: Pressure Tank Cross Rd. Pe,tterson.NY. 12561 Phone # b78-6417 Phone # ( Sample Type: Repeat Test? — (check each) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC'NON- METALS mg /L MICROBIOLOGICAL CFU /lOOmL _ Acidity GENERAL BACTERIA Alkalinity C = Less Than Chloride Standard Plate Count _ Detergents, MBAS _ (CFU /1..OmL) _ Hardness, Total See Attached ` Nitrogen, Ammonia MEMBRANE rFILTRATION TECHNIQUE Nitrogen, Nitrate /COMMENTS (For Lab Use Phosphate, Total X. Total Coliform Sulfate Sulfide Fecal Coliform Sulfite. _ r Fecal Streptococcus METALS (mg /L) MOST PROBABLE NUMBER TECHNIQUE Copper _ Iron _ Lead Manganese Mercury Sodium Zinc luSCELLANEOUS pH (units) _ Color (units) Odor (TON) Turbidity (NTU) Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY 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 i LE 40c _ GT ,4OC _ pH LE 2 pH GE 9 pH GE 12 _ Other: ELAP No . 10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE U(Wat) (Wa sn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH 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) U/A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC NG WAT ER CODES, FOR THE PARAMETE�TES/Iu,D, AT THE TIME OF SAMPLE COLLECTION. Albert H. Padovani, M.T. ASCP Director 2 /86(Rvsd7 /87)RWE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES John C. Weizenecker 10 1 1 Owner or Purchaser of Building Section Block Lot Owner Building Constructed by Cross Road Location - Street T. Patterson Municipality Frame Building Type John & Elizabeth Weizenecker Subdivision Name 1 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 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 '18 day of July 19 90 Signature ' &2,1, C . , 1 Title Gen al Contractor ( er) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if .�)) ,( % ess SZR�.- r=TION C.. Inspected by e P MTT a 7 -7,v C:9 TM A S-•-�rJISION a a a OR. ut LC7P a I- SEWAGE DISPCLAM AREA a_ 95 area loud as per a =rove3 lays b_ Fill se='s G It 2.1 barrier �T3 AVG_DPTH C. Natural soil not stri=O d. Stone, brush, etc., greater than 15' from SDS area_ e- 100 ft_ from water course /wetlands. II. � DISPOSPl, SYSTEM M a_ Seotic tank size 6 1,00 1,250 b. Seotic tar_k insta 1eve� c. 10' m? n n=. fran four. on d. No 900 ben :s, c-1 e=ncut within 10 ft_ of 45° bend e. DIS=Tj=CGti BOX 1. All outlets at sane elevation - water t-asted 2. Protected belcw f-cst 3. bl- inim,-, 2 ft:- oric i-al soil between box and trenches f. JUNCTION BOX - Drooe_r'v set rang-Cm ins -a, , 2. Distance to waterc -= Sa 3. Iris t _ l -1 - a=,rd i na to plan 4. Distance cent,---- to center 5. Slone of tench ac_er able 1/16 - 1/32 " /foot 6. 10 fit frcn nrcDe_ ty line - 20 f t - fomr -t a 7. D=Jth of tranc'1 < 30 inches fran Sclface S. Roan a-1 ? cx-ed for EY=E —s? on, 50% 9. Size of cr_vel 3/4 - 12" diama__r 10. D -mth of gravel i_ri tech 12" minim. L. - Pipe ends c—.,-.ad h. _gip OR DOS sys= 1. Size of == Chamber 2. Ove_r-low tank 3. Alarm, V sum -a /aL'a o 4 Ptyrm F =S7 V .access l manhole to a--, -d 5. Fir t- b=< bsf =lam 6. Cycle w�_ E_ ' to Denar -ment tiers IV. fiOC-S a. E^Le Ioc-mted- per a:=roced plans. b. N m- h—er of boars V. w-r.r, a_ Well as a=m rove..^ vlars b. Distance from S--.,S area ft. c- Casing 18" a eve cr_rzde. d. Surface &_-`race a_rou_n. ^ we? 1 acceotaHe. VI. 04?,UL WORKKm-SEEP a_ B xes Drcre—ly crcut= b. A -1 pioPS ppurtiz? 1y ba6cLe3 C. An pipes f ush with inside of hex d. Bar-krill material contains stones < 4" in diameter - e. C --tain drain installed Zccordinq to plan f. C_r'`ain dr=i n cut=a?1 yrotet--ted & cir. to exist- water g. Fcatinq e_rzi*is a' scnarce awav fran SDS area h. Surface water Drote -_tion adequate i. F csion ccr,z--o provide' cn slooes cr =t_*' than 15-5_ I I ,4-1 I I �I I - il • w A; PUTNAM COUNTY HEALTH DEPARIMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES• John M. Simmons, M.D. Deputy Carnnissioner,of Health - FIELD ACTIVITY REPORT - ADDRESS 'Cleo 5 s 1! 8 A P No. Street Town TM No. MAILING ADDRESS P.O. Box Post Office Zip Code 01D1• •i 0 • �• a • Name and Title DATE TYPE FACILITY TIME ARRIVED TIME LEFT 12: a Sheet of INSPECTION -- - - - Orig. Routine Orig. Canplain Orig. Request Compliance . Canplaint Carp _ Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain FINDINGS: - - - - -- 4X> P%i 1=6 u— 6 Al {7L.X4,&: INSPECTOR: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: . :: TITLE: } ,� � � { •t0•tAtta�al�l BwYr S•evlaa. � N V 4"lYr i rt S. F01®P F00 �6 PAW,0�?OSAL I -T PF L•eaMi.ati Cross, Roap lt16�liMi'!Ir•r John &'i -E 1, i'abeth .'Weber Otf�A��■ art tlns John i zene cker t ' ,:, lit• at- FttevMtn < 1WIyAeWtiN• f, S Road Yowe Patter Date -• Subdivision9gnroved :Ausust 25 1977 Fee ,Enclos 2 S L Frame + Ass 1 6;37 Acres N•e ei Baas Three l Flow G P D 6 0 Q. .106 _ } 1000 30:0'' x:.24" w. x '.18' Seuaa Sj•h� `•es8abt d S•peta � � T�'bs e•e1ai -j Adis+ 9 r - Waihr $1�4s r { ' F Addis• yi x 'ti jiet•IOY� -. r t �Y� r g.� >R 0 B 3Fi11 section :3500 `sq f't, 1 r pFaMt ,tMt 1 •m wlally a AtcompNttaly i•tponsiblo fw EM Wtign •ntl location of tM propOspi tyst� abai detcii0�d will W'oonstructed a shown on th• approved amendment then. to and in accwGnp with t Oouiity f�•ppntlhint W MNeRA, 'ane tMt on eompNtion threof a Certifkates of Cogstrudton Yomp14 N wbrnitt•d ae tM� Osgatmplt, arrd a written,,,OlNnnt• will be furnished.�tM ownor his aucatyo►s,n• pl•q MI tiooArsiperatNipxoorwitwn any "o•►t�aofy fetid saarpg• dispoYl system during tM pertoa of two,(!) •ll•f;of tM ippeval Ofthi CaitHkat•,' of <Const�udion COmpliaepof 1M orllfinalisystem oi. any r•p�ir ww M beat•tq •a shown on tM approved plan and !lest said swill will M installed in atcoroenoe wNh tM sta C•utitY Opartniillt ofr Mplth ou•;: 15 June 1989; , sionar: � i� �� ;�jtei x RD9 Fair St , Carmel` Nk Y 10512 APPROVED FOR CONSTRIJCYIOId Thi9 ipp►oval aecpi►•t two °yea►s' from tM Mti issued unN�s eonstru retroubM for M M miy Oetenande0 0► moditiati when eonsidaed necas�ry by tM Commissionw of; r quM•s a it APpfobed for disposal of domestk gnkiry sewaN a to witer su RevV. 10/88 < .y i son N Y � 1256,31 F ed ®_ tnii;nt ,$1'50 00, x 36" y }3902 cu yds N•I�eatiii'b �egabr•� FM l: a•aple/ed ` ' deep laterals: v S t ` � Y m(s) 1) that th• s• a►ate�sawa'e.;Ais oal,s'stenl M ftanelord; rule3 an rpu a ons o : Y • n r�i nce' satit<ractory to tM ;Commiplon•i of NMKhwtll Ns or inns bytM,bu1NN► that YW builslr will _� years NnmediaNly follow%ilp tMdeN Of tM IteY , s th•►!to 2) th4 tM.OrNNO wu1l:AapiOnl;a6otr� neaitis,, rubs and reEtu a�O s Hof' n tM PutMm PE x RA - license No 29206 etion of tM Ouiidiny Mi; boon un"ksI W and is Mtalth Any diinOe or' olpwat" of constructbn .. only.. A ) A� Ila LA to o o Z0 K � 'd 1 j ti {�. F ` ri tJ'' 1A `FS� •r: as'.. ✓' N+'�t"''�.•'+.v ` '"� +� +.+,� y'.-� '.r'7iaf i� x dR r t F;;. -:. •hF .. 1 Ktiw+ww.ar .. I'"`.� °+ _ k1,i�w h' :. .�a"'gy!.... r � ee Al h K �i c� �\ Z ;I ha Z,o� Aw o_ z 0 t. ! i. ••i: ,(. .5.1., ..4 e a NC)TES: 1. Tests to t, epth until approximately equal soil rates are, obtainer "'� l on • test hole. All data to' be submitted A.7 ; ':; fore review. L . z - 2. Depth measur t _� a' 1 � made fran top of hole. , rev. 9/85 1 DESIGN DATA SHEET- SUBSUFACE..SEWAGE DISPOSAL;SYSTFM FILE NO. Owner� �jrn ''.�' WQ /2Qy1E�CIE'I Address `�/oSt . Pt�• Located at (Street) 't 1GI:60.USC ..hid•. Sec.j? /ri Block �_ Lot (indicate nearest cross street) municipality Pal-0-my So!23 Watershed Cfo'6022 SOIL PERCOLATION TEST DATA RDQUIM TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE NUCER CLOCZ TIME PERCOLATION PERCOLATION ' Run Elapse Depth to Water From Water Level No._ Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 1 2 to19 -.toz� 7 Zt Z� 3 3 1oz(- %33.5 4 to')X- /�Py f -1 YL 2 24 3 -5 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y...10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PC'Hn PRRMTT AP, 1 -ICZY WELL LOCATION Street Address .Cross Road Town/Village/City Tax Grid Number T. Patterson 10-1 -1 WELL OWNER Name Mailing Address John C. Weizenecker Cross Rd., Patterson, N.Y. 12563 [Private O Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL' O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED Six /EST. OF DAILY USAGE 450 gal REASON FOR DRILLING EINEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING Residential WELL TYPE ODRILLED DRIVEN ODUG GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES x NO' IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: John & Elizabeth Weizenecker Subd. Lot No. 1 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over one mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See dwg. #1,job #5.0.2504, By John H. []ON REAR OF THIS APPLICATION 9WP4ATHEE , Prentiss, P.E.) 15 June .1989 (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 72 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 Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the utnam County Health De artment. Date of Issue': 19 i Permit Issui g Official Date of Ex "ration v . 19� Permit is Non- Transferrable 2/87 White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well. Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF HEALTH SERVICES. DESIGN DATA SHEET- SUBSUFACE.SEKAGE DISPOSAL SYSTEM FILE NO. Owner .10 ft i�• �� IC9� GCKeX' Address d yVAS Located at (Street) %�Yi cikl, oySG it d • sec: rA /a Block �_ rot / jindicate nearest cross street) Municipality Pw.f4e,rs01, watershed ero�o -r► SOIL PERCOLATION TEST DATA REWIRED TO BE SUBbW= WITH APPLICATIONS Date of ' ;Pre- Soaking ��Z 6 $ Date of Percolation Test HOLE NUMBER CIACR TIME PERCOLATION PEROOLATION Run Elapse Depth to Water EYom Water ;Level No. Time. Ground Surface In `Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 r21g IZZ6 .8.� 3 122.7 /23C. q r 4 41236 1245' 9 5. -, . Ql. l t ff 1:u; 4 21 2 U15 1s19 2 3 4 '} A VD. 1:3t 5 .. ,1 2 3 4. x 5 t;. A fit. • .t..: v NOTES: 1. Tests to be repeated'at same depth until approximately ,enual soil rates are obtained at: each..percolation .test hole. ".,.A11:data " to %be submitted for review. 2. Depth measurements to be made from top of hole. rev: 9/85 TEST PIT DATA DEPTH HOLE NO. I HOLE NO. Z HOLE NO. 3 G.L. rep soil 1' 8' 0"a-ft.' I 2' 3' 4' 5' 6' 8' 9!. 10' 11' 12' 13' 5awc�y t.. Q( • ��«► a �r�a.q . 'Ro ek m►o cK Top S'oi/ Top soil 4 oL�i t 9 T--- Sc��►a 1.ad.gQ^iock L.e c(9�e �l o ck • 14' INDICATE LEVEL AT WHICH GROUNDWATER .IS ENCOUNTERED 9047 p INDICATE LEVEL, TO WHICH WATER LEVEL:RISES AFTER BEING ENCOUNTERED j1/oyJe' DEEP HOLE OBSERVATIONS 'MADE BY: M.F.T. DATE: S z G/8 9 . R DESIGN Soil Rate Used Drop: S.D. Usable Area Provided R00c No. of Bedrecros ` h .,r e e Septic Tank Capacity 1 O #,2 o gals. Type M u s tnj ry Absorption Area Provided By app L.F. x 24" width trench Other ' RV c.OFESSIUNqz F s 3 61i Sid s D et13 Name Address 2� F9J: THIS SPACE FOR Nc. • 292t/. � Soil Rate Approved Signature JOHN H. PRENTISS. b R09 FAIR cs 914 -87 3! CARMEL, NEW YORK 10512 TH DEPARZMENP ONLY: sq.ft /gal. Checked by Date I® 1 -1 r.) 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HOLE NO. 011-1- HOLE NO. G.L. 1' S 2' 3' 1 4' 71 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROURMTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: l�'�' /Z- DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrocros Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date