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HomeMy WebLinkAbout0445DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -10 BOX 6 ,. as IL a - 41, � I. , �6 E ;� E 6: r .♦a r ` ILL a 00254 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES f DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner GjATTo Address -P,q "/ -P_'X Located at ( Street) go T ` Lel ME...... Tax Map t3to7 Block j Lot _ (indicate nearest cross street) Municipality P,,¢7-rog!�osi' Watershed . Epp-j 77 37,14NcH SOIL PERCOLATION TEST DATA Date of Pre - soaking �� % �9 Date of Percolation Test / 2,/9 Ale �✓ 7'r'iMAry 4 Grw Ve /. Time n:) ZZ 3 3 0137- 7- )-- Q 9 -;L7 3� 4 5 1 2 3 4 5- 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to N submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Sheet PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL IIEATLH SERVICES 'FIELD ACTIVITY. REPORT:,- _ 91?I?BFCC• � / l�r9'TT�"T�'S✓ l: lS Rf� AZ, Street Town J State Zip.` PERSON IN CHARGE - ^ _nR Tt�TTFTZ VT WRT)_- g 4Z91 Name an&Title �T:Y.PE -OF FACTLIT`fY ..:5�itrGGE i,q�y /, `SUS S uYZ FINDINGS?IcZ fa L�/�irtf -EMeS� Trc ®ctk clv� 7�-0 �.. . may r t.. 4 - '. .'. T: • '��V 'Signature acid Title RFPnR RF('FT -VF- RV• .I acknowledge: receipt ' this report SIGNATURE: ., r j 02/9.6. . rtle• . a Rav:__ f I TAa Y7 31 5- 4 '/ o .'ar-cl ' I"l 1, V "e4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 1A 1::rj2 Address 'PAR/ AZ Located at ($tiedt) Tax Map P5,o Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test .. ....... ... ......... . ...... ...... .. .......... ... ........ ........... . .............. . .. ....................... ...... . ... ......... ............... ........ . .... . .. ... .... . . . .... .. .......... ........... ... . ...... . . .. ... ... ep . ... . e . Water iZun No .... .... ........ e Start ...... Efa se Time . ..... From Ground ace: 0 . Start .Level Rate . Hole l�io to ................ Staff ... .... ..... Inches ... .. .. .... ... fiA1...0 Y' ? 2 01 J10/ -91004, 7 3 5 ;Z7 4 a'Z 7 -7 2 AIP I 4'6_0 /0 ;La - 26- 3 3,3 2 X 0 0 -.V, 1_3 13 � 2 0Z Af 3 ;-Z "(7 4 7- ;2, q6 3> 5 2 7 -3 3 7/a 1 Ai 4 X1 A7 3 AND 5 -'3,00 6 Iq L-7 3 Tests to be reneated at same denth until anoroximatelv eaual percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0'_ TEST PIT DATA 2- DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES .n/e fuv pP r Mav y i��lyya vy HOLE NO. HOLE NO. 02 HOLE NO. D Jj6 j -W e SJ' 1, dicate level at which groundwater is encountered 4-% Pf G vdicate level at which mottling is observed hdicate level to which water level rises_ after being encountered &0 we Jeep hole observations made by: '2�e,2 � or�d� KovK2 Date *2- y m Ewa. Tesign Professional Name: Iddress: signature: Design Professional's Seal ;a I acknowledge receipt of this report:. � SIGNATURE; ayt 44. ¢�r.0�,2.,/96 Title :�. t� - GeU-: I -, Ile d 1 RECORD OF PHONE CONVERSATION DATE: TIME: Ci 5�CD PERSON CALLING: &ell / PHONE REASON ( ) Inspection• ee and /o eres• SCHEDULED FIELD MEETING DATE: TIME: -J 1 3 C50 '©o ROAD /STREET: Ut yj 72Z TOWN: CL' TAX MAP#: SUBDIVISION: LOT #: / Q OWNER: e" jAI' ro COMMENTS: a.. 6 RECORD OF PHONE CONVERSATION DATE: TIME: C PERSON CALLING: K 2 4 PHONE #: '4 REASON ( ) Inspection: RDeeps and /or Peres: SCHEDULED FIELD MEETING DATE: TIME: `3© ROAD /STREET: f G1 (C �X 1 TOWN: %�� "'. TAXMAP #: /3,07— I— AD SUBDIVISION: Grd 55 �� �Jc/ %�r LOT #: / Q OWNER: �' .. C /A=Z) COMMENTS: