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BOX 5
00200
1
1�
J
1.
00200
-Rev: 3/86
P,UTNAM COUNTY DEPARTMENT OF HEALTH.
Division of Environmental Health Services, Carmel, N:Y,'10512',,
'
Engineer Must Provide 9 97
P C.H D Permit #
CERTIFIC OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL 'SYSTEM �/ 2�SaJJ
t_t. H ILL � O iZ r-G . 16 Ta: Map Z . d
Town
11.7
Located at eo R1�wA Block Lot
Cbw�wl4ll_ ►;its: At_ �►;uE� 9
Owner /applicant Name 63- A'�o 5 f 1 i'i C. Formerly Subdivision Name �ie7AT iii 5 Stibdv. Lot #
McWng Address z 2 3 K A 'jb>J A H AVC , Z1p Date'Permit Issued
K /�XoJ0 -A— NY
Separate Sewerage System built by S, A, F, :-SgpTIT G VS MST i NC. • Address ?�62 BpX ' 1410.- 5—PASS—RIV6i� .Ai V l id
Consisting of l 't � 0 Gallon Septic Tanis and 3 ?A i t' >TISI rsR . B� •1 O N 12 6 N ��
Water Supply. PubpQ Supply From C.o Address
or: X Pilvate Supply Drilled by :61 . S � M 1 NI C Address 9.i . B V GK F3j� R6 IZp . To ro k j �S
t ;5 I- bM OZ i A L '' Has Erosion Control Been_Completed? 1 N }� Ro GAS S
BulldlnB Typo •
Number of Bedrooms Has Garbage Grinder Been InstA d?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in.4ccordance with thi .standards, rules and reg ations, in ,accordance with he iled lan, and the perinit.issued by the
Putnam County Department Of Iieaith.'
Date 3� 8� certlflid by
Addie4f' i W'i' - "�"•� License No.,_r�•""
Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to aacure the correction of any'unwnitary
conditions resulting from such usage. Approval of the' separate sewerage system shall become null and void as soon as a pub(': unitary sower becomes
avaliable and the appiovah 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.whhe/n�,' In the Judgment of,the dommisfioner'of Meal h,.'such revocatlon;.modification or change Is Mceaury.
. / i �f 4� g ,�/Lia� Title ��
Oat
t
COUNTY OF WESTCHESTER
DEPARTMENT OF LABORATORIES AND RESEARCH
Ettev,BH VALHAILA-NEWYORK10595- ;
4 BACTERIAUEXAMINATION OF DRINKING AND TREATED WATERS ;
1 �
3
Time Set ' jime Submitted* > f
Tests (Circle) SPC*"ConfoYrt+ MPN Coldorm MembrAnei fFecal Other �
� i� - s „�Y,. 3. """'2t .t a-� ✓ � r^ d
Coll °d by es *� #
CoNdfrom Namerr���
Add►esa �'t�- `7:�`3
-� - `(St RO 1 ICiry Tern vdlp�j - IZip CoOd
(Coon
ff !
Identlficatlon of Source ! kAN
i" C ia2^3n �" y x �3' �; K� { �Y /�?-` j R 'W'"C..'.'t..`L!S
Samphnq Point wlthiri'Premises;, Refngerated�
w x ti
mg /I -3Tofal mg /I p
C Chlonnat Yes �No: ❑Free M
> s a
``RESU6TSO_F -.EXAMIN%1TION`OF WATER "~
1
5
MPN /100 nil Standard Plate Count' S
3 4 �:, } �� r Rt'• s ,;138CfenA, er inIgIAA hr �- � �"��� • "-'�
ti
P )
Number Pos�nve Tubes r t Total Conform r '
Fecal Conform 6
� Other -
s,
These results, indicate sample ( was not) ofl Reported by ` ,Oale
satisfactory +sanitary quality :when the sample was
Collected
ae �'�.�` a�`a.
,,!? N f tt''+a J F t•. m y^ . 3'",, 4„ `Yy .1✓ .19 i •7. 7 .t' ^" k;.
a :.. �' ..... ,:' :. .:..,., ::'�. .. ..:�:���/ ./y�}�y/�(� �W�'1w.���M��M��•♦ Y.. �•y .�, t.n!wl.r::.. ,:t �:: ,_
' .. .. 'rlJit`I[Y7 M1trtilUL�1.L� 'iJF+C {JS .f�' TH
DIVISION OF ENVIRONMENTAL 'HEALTH 'SERVICES
atnnah dose Cnnstrti tinn rn- Tn
Owner or Purchaser of Building.
Katonah .lose- constrti tion Co. Inc.
Bu�ilding Constructed by
(
47 VOin Rva e of f Corn_w -all- Hill -Rd
Location - Stree
Cornwall Ridge
Subdivision Name
Patterson9
Municipality . Subdivision Lot #
Residence
Building Type
G114RANM OF SUBSURFACE SEOM 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 Deparbient 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 systen, or any
repairs made by we 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 detemraination of
the Director of the Division of Environinental 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 u ice'
'the system. -
ted this 30 day of 1932 Signature
j - Title -
er 1 Vo ctor (Own ) - Signature F. /
Corporation (if Cor0j.
Corporation Name (if Corp.) (.�?_ 0 . 4 -
!Miess Ion
Z.Z 3 t? � r - C�t.e
Address
rev. 9/85
mk
4c it
_; r/r •p 4
W
WL'LL UUr1rLL11UJN AzrvA.L
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATIONS
STREET ADDRESS: wNwtl / I Y Tax GRID NUMBER:
WELL OWNER
NAME: ADDRESS:
G'0£0 c��. LC. �.S 7i�7 — Cv�. . �y�� �,9 _ 7 i40�.��
E
O PUBLIC
0
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
' DRILLING
INEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY 0 DEEPEN.EXISTING WELL
DEPTH DATA
WELL DEPTH 202 ft.
STATIC WATER LEVEL ft.
DATE MEASURED
DRILLING
EQUIPMENT
9KOTARY OMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION -❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. ErOPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH 0 ft-
MATERIALS: TEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE ft-
JOINTS: C1 WELDED CA'f AEADED 0 OTHER
DETAILS
DIAMETER in.
SEAL: 9KIMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT
PER FOOT Ib. /ft.
DRIVE SHOE: O NO
I LINER: ❑ YES 15-W
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST.
❑ YES ❑ NO
HOURS
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL /y
SIZE �U /!�
DIAMETER
OF PACK in.
TOP
DEPTH fl
BOTTOM
DEPTH It.
WELL YIELD TEST pumping
If detailed
METHOD: O PUMPED a tests were done is in-
PRESSED AIR , formation attached?
O BAILED ❑ OTHER ❑ YES 0 NO
W�LL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE.
water
Bear-
ing
well
Dia-
Deter
FORMATION DESCRIPTION
CODE.
ft,
ft.
WELL DEPTH
ft.
DURATION
hr- min.
DRAWOOWN
It.
YIELD
gpm.
Land
2aT
WATER LEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK : TYPE L - Q 2-
CAPACITY GAL.
PUMP INFORMATION
TYPE CAPACITY
MAKER 6001-602 DEPTH S—.
MODEL %f//D.FS/ VOLTAGE�C% HP
WELL DRILLER NAME DAT6, p/
ADDRESS J SIGTiATURE •!"
�PI�
f,
.J
APPENDIX C
FINAL SITE INSPECTION Date 'i./'
Inspected-by
CATION vR..� vim-. !'�� �:. OWNER
T # ' % TM # , OR . SUBDIVISION LOT # fir'` b —Z �. o ? 41
YES NCJ Ci`I'S
SWAGE DISPOSAL AREA
a.. SDS area located as per approved plans
a.
Well located as per app
b.
b. Fill section - Date of placement
2':1 barrier. LGTH WIDTH AVG.DPTH
c.
Casing 18" above grade.
C'//
c. Natural soil not stripped
VI. OVERATE, WORKMASHIP
a.
S
d. Stone, brush, etc., greater than 15'' from SDS area.
X
c.
All 2ipes flush with in
e. 100 ft. from water course /wetlands.
Backfill material conta
e.
LcrO�,
II. SERAGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,250
Curtain drain outfall p
g.
Footing drains discharg
b. Septic tank installed level
Surface water protectic
i.
Errosion control. p ivor d
c. 10' minimum fran foundation
d. No 90° .be_nds, cleanout within 10 ft. of 450 bend
�-
e. DISTRIBUTION DISTRIBUTION BOX I
1. All outlets at same elevation - water tested
1 vCUT Gu o T
2. Protected belcw frost
z4j V7'1L6(-
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX - properly set
g. TRENCHES
1. Length required - 3 2 Len ' installed 3 "l U-
ZY
�Le1�r
2. Distance to watercourse measures.. ft.
.06-)I ,;-- ut
3.,.Installed according to plan
X-_
A p
4. Distance center to center /
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
x
6. 10 feet fran property line - 20 feet - foundations
)C
7. Depth of trench < 30 inches from surface
'X
8. Roam allowed for expansion, 50%
�C
9. Size of gravel 3/4 - 1 " diameter
10. Depth of gravel in trench 12" minimum
X
11. Pi' ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of ump chamber
2. Overflow tank
3. Alarm, visual /audio
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Departnent
estimated flow cycle
IV. HOUSE '
a. House located per approved plans.
b. Number of bedrooms
v. WELL,
a.
Well located as per app
b.
Distance from SDS area i
c.
Casing 18" above grade.
d.
Surface drainage around
VI. OVERATE, WORKMASHIP
a.
Boxes properly grouted
b.
All pipes partially bac
c.
All 2ipes flush with in
d.
Backfill material conta
e.
Curtain drain installed
f.
Curtain drain outfall p
g.
Footing drains discharg
h.
Surface water protectic
i.
Errosion control. p ivor d
e of box
stones < 4" in diameter
cording to .plan
ected & dir.to exist.waterc
way from SDS area
deq'uate
on slopes greater than 15 %.
vv:) No 1
LUCn-L'
jw 1?UTNAM COUNTY DEPARTMENT OF HEALTH
?�1 \ nlaeer tPolda of Enmea'ealtb SMcsCmeN Y 1051? Permit Dlytelon
on CERTIFICATE OF C
`Permit .'N
CON ON PERMIT FOR SEWAGE DISPOSAL SYSTEM
I4cated at ��_C Town
Sabdivblan 'Ns mel•L' )d•`i et q
Tax; Map. i Block v Lot /
�Qj�t Renewal_ O
Re al ❑
Owner %Appllcat Name - • •
Provlo •
�� Jim% �10� Town P'.
MaWng Address -
Building.. Type °�- J-G • Lot ,Urea � • �•
[]Fill Section Only Depth Volume
Namber of.Bedrooms ;Design. Flow G P D �o C7 P.CHDNotiflcation is Regtilred When FN ie cotuplated "'.
Sep�rste Sewerage System to conelst of Gallon Septic Tank and �Zli� ' L QAL•Len CS
To be constructed bye
Address
WafsrSapplj:• Pabllr,:Sapply °:From.
Address`
or: Prlyate Supply Drllled by I Address
Other: Rrxittlrements .;
I represent that 1 am wholly and' completely responsible for the design and local On of the proposed systein(s) that the separate sewage djsposal system.
above describetl will 6e cons'tructed as shown on ^the;apD�oveCamendment there do and in`'accordance w th,;the standards; rules an regu a ions O e , .0 nom
County, Department of�.Health, and that On completion thereof a Confiscate, of Construction d6mphsnte.' satisfactory to the Comm�ssioner;of Healtn.will
be submitted 4o' "t lie Oepartmerit and a written quarantee:w�ll be furnisheC: the owner his successors;: heiis Or-_assigni'dy the builder; that said budder, will
z.
pkca m gootl,.oparating- congition, any -part Of-said sewage disposal system dur�nq, the perioq,of two?(2) years immediately following:the0ats of the. issu
an ce of the 'approval of the Certificate' -'of., Construction :Compliance of.,tha riginal. system or any rep$_irs t reto, 21 that the''drilled wall described`
:above
will be located -as shown on the approved plan and that,. sutl well will De install m accordance with the stand ds, les :and regula ions "Of� Putnam
County Department Of ;Health. .
Date U yCi 1' � S ignetl - —
vm=
Address
\C.� -t� License No.P
A
APPROVED, FOR CONSTRUCTION; -This approval' expires ,two years, fromthe'date �siued unlesf construction of the uilding has bben undertaken and is
revocable for causebr maybe,amended:or ' moditietlwhe mconsidered ^nseessaryt Dy the;COmmissioner Of .6alth: Any change.or alteration Of construction
require s s new pe mit. Approved for...disposal:`.of domestic sanitary' aewage,'•�snd w%. a water, :supply 'only.
_ -c� g,
Rev: ', / // �a�
1/87 Date, C� BY e
i
DESIGN DATA SHEET — SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE M.
Owner (fx->MJW,%t_ , HILL CS;MIEs WC Address "Zz-3 l(=t� tm
Located at ,(Street)(yemyALL grt -PZp, 4 Z-g�..1(-,4 Sec. )1�5 Block Lot ZI (q�
(indicate nearest cross streetY
Municipality �ow�l cam
r�-� ?��CS�,►�
Watershed
SOIL PERGOLA CN. TEST DATA. RDQ(MM TO BE : SUBMI= WITfi APPLICATIONS
Date of Pre - Soaking. �! Z3 � i .
Date of Percolation Test 5/Z3/8-7
'BOLE
NCZ,,M R CU)CK TDO
PERCOLATION
PERCOLATION
Run Elapse
Depth tojWater From
Water Level
i
No. Time
Ground Surface
In Inches
.Soa Rate;.
Start -Stop Min.
Start
Stop
Drop In
Mir4AI Drop
Inches
Inches
Inches
:13 q -43 4
Z4.
/ u
-715 i i
36,
�2q,44 -10j -I So.
V
Z4
-114
Qa
3 IQ15 -1045 3o
Z.4
-M Y
314
4o
4.-
5
1 : 1.(,o - q, 4 fo 3-o
Z4
Z6 1 Z,
I %Z
ZZ
Z 2q'4-7- io:i 3D
Z6%'
1/4�
Z4
T-3 .IO:lo�tJq� 3 J
21a
Z,5
t�����
ZQ
.5
2 St t� i �T `(� tZ_ tZ �c ` l S i FI-D& S-3 1 L2AZc
3 CA`Tt , ,-1
NOTES::... is TestsAo be repeated• at same depth until apprcncimately equal soil rates
-.. are `obtained at each percolation test hole. All data to' be submittmd
`for reviewi.
2. Depth measurements to be made` -from top of hole.
>' rev. 4/85 _.
DEPTH HOLE NO.
G.L.
1'.
Z'
3'
4'
5'.
HOLE NO.
HOLE NO. '
6'
7' ± i
8' :... C
9'
10'
12'..
13'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN7UUNTERID
DEEP HOLE OBSERVATIONS MADE BY: Dom;
- - DESIGN
soil Rate Usecl Min/1" Drop: S.D. Usable Area Provided �! 0C-)o
No.....of Bedrooms Septic Tank Capacity 12,50 gals. Type .
Absorption Area Provided By L.F. x 24" width trench
Other rZo
Name C►A�I1�fE�(tlt�[� ,��soc.,QC. signature
Address �n 0 1IEl� SEAL
au
W
j ZA3 ,+ r
�. "a 24
THIS SPACE FOR USE BY HEALTH DEPAR24EM; ONLY: pit gip
Soil Rate Approved: sq.ft % gal. Checked by Date
}
i .
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 PFRMTT -A V q l
WELL LOCATION,-._'
Street Address
own illage City Tax Grid Number
WELL OWNER
Name
111 l�L. 41(-L
Mailing
Ad ress
W Lt, EJ
afffivate
O Public
USE OF WELL
1 - primary
2 - secondary
06SIDENTIAL
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
p
AMOUNT OF USE
YIELD SOUGHT
gpm /#
. PEOPLE SERVED-4-(o /EST. OF DAILY USAGErX)00 gal
REASON FOR
DRILLING
aMEW SUPPLY
O REPLACE EXISTING SUPPLY
OPROVIDE ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
'
aDUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING?
YES '✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:` 'jZi p m s
Lot No. Cr
WATER WELL CONTRACTOR: Name--C6 :BG ,ps -rMH liJEj Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L, ENO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: vj,
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION SEP TE. T
XU GK . ZsJ, i qt3-7
(date)
Y.Ar
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 Py the Putnam County
Health Department.
Date of Issue: -VA�01 19 !V7,
Date of Expiration:
Permit is Non - Transferrable
2/87
ermit Issuing ffici
White copy:
Yellow copy:
Pink Copy:
Orange copy:
H. D. File
Building Inspector
Owner
Well Driller
APPEND--KR-
PUTNAM COUNTY DEPARTMENT OF :I k: DIVISION OF /' • M E Y• HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE S39M DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
DATE
BY:
(Name of Owner) (Street Location)
YES M DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
ouse! s - Two
ell / permit;
ariance Request
I
I
SUBDIVISION
Perc
Fill
cd
ENERAL
egal Subdivision
ubdivision Approval Checked
x- approval SSDS Adj. Lots Checked
etland (Town /DEC Permit R & D)
ata On DDS Plans & Permit Same
SQUIRED DETAILS ON PLAN
ewage System Plan - (rKqh. ar
ewage System Hydraulic Profile - Gravity Flow
ill Profile & Dimensions - Volume
or J Box;Trench /Gallery; Pump pit details
eptic Tank - Size, Detail
ell Detail, Service Line if over
onstruction Notes (grinder notes)
esign Data: perc and deep results
wo -Foot Contours Existing & Proposed
riveway & Slopes Cut
ooting/Gutter,Curtain Drains (discharge OK)
erc & Deep Holes Located
Representative of primary and expansion
xpansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown &Detailed
ouse - No. of Bedrooms
ells & SSDS's w /in 200 ft. of Proposed Systems
roperty Metes & Bounds .
Ouse Setback Necessary (Tight lot)
ouse Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
E ARATION DISTANCES SPECIFIED ON PLAN
'ields
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
PUTNAM COUNTY DEPARTMENT OF HEALTH
�~ DIVISION OF ENVIRONMENTAL HEALTH SERVICES
A, Yf COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
r
DESIGN DATA SHEEYI'- SEPARATE SEWAGE DISPOSAL SYSTEM FILE ]NO..
(lwtteiaiW MILL ES 1QC, Address 1-� �v�.rlLj�;t�i1,1�1��[ 1053(0
Located of ( Street s ZZ S. t G4 sec. 15- Mock _Lot _Z
pia cate neares • cross itreety
Mwiicipality -Tov 'i 6-- 94'knc—Eg;zti1 Watershed Ctt_0 .
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
I flo
►
Nwnl (-r CLOCK TIM'
PERCOLATION
PERCOLATION I
Elapse
Depth to lVater
Water avel
`
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop
Inches Inches
Inches
17-0
0?5
3'.'
40
5
2 :35- la: 50 6
;x
NuLwl : 1) Tests to be repeated at same depth until apf )roximatelyy equal soil
rates are obtained at each percolation test hole. All data to -be submitted
for rovit -w.
•i►th measurements to he merle from top of hole.
s
.
4
5
2 :35- la: 50 6
;x
NuLwl : 1) Tests to be repeated at same depth until apf )roximatelyy equal soil
rates are obtained at each percolation test hole. All data to -be submitted
for rovit -w.
•i►th measurements to he merle from top of hole.
TEST PIT DATA R EQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOIL: ENCOUNTERED IN TEST HOLES
DEPTH - - HOLE NO.--- ROLE NO.
HOLE NO.
6 "
.12"
1811
.24"
30
36 "
4211
4811
5.4
6001
66"
6
3411
I NDI CATh: UXEL AT WHICH GROUND WATER IS ENCOUNTERED
I N 1) 1 GATE LEVI-:L TO WHICH WATER LEVEL RISES AFTM3 MING EUCOUNTEREP
'1' Y113 bAD& BY It. VQ . L. Date to
Dh6lull
Soil Rate Ubed:n,Miq/l"DrOP: S. D. Usable Area Provided SHOO S
No. of U,,-drooms Septic Tank Capacity -jt50 Gals. Type i
By 36"- :1M ----c-
Absorption Area rov F. X24 Yren Y.
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THIS SPACE FOR USE 13Y READPH DEPARTMT ONLY:
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Checked by___.:_� �Date
.LIONEL WEINSTEIN
Notary Publlc, Sato of Now YZM
No. ,k-4199160
QaaNflod In Wostclmlter CdOn
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8/84
Corporate' Seal
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