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HomeMy WebLinkAbout0391DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -28 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. -77- Z40 L.F. TRI-C-ALLGAMS Bull" 6AUma-L-c olgrldLu J - A- AddresB �jC51GLO VZWC: Y:0 04 51 04 THIS SPACE FOR USE 13Y READPH DEPARTMT ONLY: 3611 Rate Approved Sq. Ft/W1. K EQj w SEP 2 v85 Pum DEPT.t NE AL Checked by___.:_� �Date .LIONEL WEINSTEIN Notary Publlc, Sato of Now YZM No. ,k-4199160 QaaNflod In Wostclmlter CdOn 1'�wnL%s:oir Expir ®s i -larch 30, 8/84 Corporate' Seal A5 tN tG , TN ST M Wk I:N�PGG'(E:b S �T7%.M.: vVAS GDNS (ti2OC -f Eta= tN /�GCip2D ANGE NVt`fN A� STAtt.�A�2c tZUvEs AtiD szr,GiUI- A'fIONy. OF THE pUTNA:M GOUN'fY . dEPAgI -MAN`( Oi% EaLTN AN17 -iHE :IVt%W (oR K s'CA PArzTM EN-f NO'CE: NOU. 6', A GN. F42OM t,0' Pt2E.I -Af7e t%Ot2 KA'CONAFN GI�OSE" I�A'«tD �2 - t.5- a7,: P�2E.pA.rz�1�: t3Y p�_UNttEY - AS�OG IA'C�'s:, LAcN:O SUtZV��YD�S. J'5,UII.T S�a��: r vz- v Lla�-fl CIA, , 9f- l TANk 3.� 77. - SEWAG !�w�w ..� a e q�(Ed ON 'fW ► a i��AN AN1� TtiA'( A5 tN tG , TN ST M Wk I:N�PGG'(E:b S �T7%.M.: vVAS GDNS (ti2OC -f Eta= tN /�GCip2D ANGE NVt`fN A� STAtt.�A�2c tZUvEs AtiD szr,GiUI- A'fIONy. OF THE pUTNA:M GOUN'fY . dEPAgI -MAN`( Oi% EaLTN AN17 -iHE :IVt%W (oR K s'CA PArzTM EN-f NO'CE: NOU. 6', A GN. F42OM t,0' Pt2E.I -Af7e t%Ot2 KA'CONAFN GI�OSE" I�A'«tD �2 - t.5- a7,: P�2E.pA.rz�1�: t3Y p�_UNttEY - AS�OG IA'C�'s:, LAcN:O SUtZV��YD�S. J'5,UII.T S�a��: r vz- v Lla�-fl I