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00571
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00571
Other Regolrementa
I certify that the system(s) as.listed serving the.aboge premises were con
of which are attached),', and in accordancewith. the standards, rules and re
'Putnam� county- bepartment.PC Health.,
Date 3 i� $ ` Certified by
Address
essentially as shown on th pla s of the completed work ( copies
in accordance with the ladhan, 'Ind the permit issued by the
n ffffff / / / /// ,
P.E. ^ R.A.
VZ "i Ll License 'No, ,5fcl �4
Any person occupyiriy premises served by-the above system(s).sha11, promptly, take, such action as Maybe nocesury to secure the_co►rsction of any unsanitary
conditions resuliing' from such usage' ,Approval of 'the separate sewerage system shallbecome, null "and vole as Soon as a pubs': sanitary sewer becomes
avalleble and. the. approval of the private water supply shall become null and void• when a public water supply becomes available. Such ..approvals are
subject to modificatiotl or hange when, in the Wdgment Of the Commissioner of Healtt,+, such revocation, modification or ,change Is necesury
-Title
Date,
�'UTNAM COUNTY DE OF HEALTH
Rev X3%86
u . Division of- Environmental Health Services, Carmel, N Y10512 .;
kigineer Mast Provide_
P.C.H D Peimit q P
CERTIFI OF CONSTRUCTION COMPLLdiNCE FOR SEWAGE DISPOSAL SYSTEM
Town
Located -at it..L Q ;RL T E 1 c- 4. Tas Map 1 Block
-Lot Z! I
OOMA44iAV —L )*U." COtZ`JV4i l:L �1�G
, . Z
a� 'Lot
CST ^, h �" Sabdv.
Owner /applicant Name i �. Formerly Sabdlvislon -Name i**T
a
Mailing Address Z 2 3 K A To N A H AVE Zip I O 5 a (c Date permit Issued
k Ara 1' 'AN
f_
Separate Sewerage System built by S, A , F, BLS 1' + G y.S'fie,- tv+�t i N G , - Address 165 > BBX ) 4 i, G iZo4� R1y r2
.'N� I o i a
Consisting of I Z S O Gallon Septic Tank and
Water. Supply: Public Supply From Address
y
or: . x Private Supply Drilled by I W C6 Address 911 laot-ic BE1i S iZ -�
• Cov�j fJ
Building Type lZ15i i Corg is i F.l Has Erosion Control Been Com pleted?—/ Qis.o C X55
Number of Bedrooms Has Garbage Grinder Been InstalledY J10 0
Other Regolrementa
I certify that the system(s) as.listed serving the.aboge premises were con
of which are attached),', and in accordancewith. the standards, rules and re
'Putnam� county- bepartment.PC Health.,
Date 3 i� $ ` Certified by
Address
essentially as shown on th pla s of the completed work ( copies
in accordance with the ladhan, 'Ind the permit issued by the
n ffffff / / / /// ,
P.E. ^ R.A.
VZ "i Ll License 'No, ,5fcl �4
Any person occupyiriy premises served by-the above system(s).sha11, promptly, take, such action as Maybe nocesury to secure the_co►rsction of any unsanitary
conditions resuliing' from such usage' ,Approval of 'the separate sewerage system shallbecome, null "and vole as Soon as a pubs': sanitary sewer becomes
avalleble and. the. approval of the private water supply shall become null and void• when a public water supply becomes available. Such ..approvals are
subject to modificatiotl or hange when, in the Wdgment Of the Commissioner of Healtt,+, such revocation, modification or ,change Is necesury
-Title
Date,
I A�OIl. A %� T TM r%XT T1TT)r%nT
Yy laL IJVl'LL LliLLVLY LWL %iL \L
�e� a
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
w tij �4�7Z/ PUTNAM COUNTY DEPARTMENT OF HEALTH.
Off ice Use Only
i WELL LOCATION
STREET AOORESS: wNlvll ! i. Y TAX GRID NUMBER
;Wa),
j
WELL OWNER
NAME: ADDRESS:
D &es!2 4*ws-7, - 3 7 lz�o . Vwf*- %ids -W -L
O PU8LICE
USE OF WELL
1 - primary
2 - secondary
liKESIDENTIAL ❑ PUBLIC SUPPLY. ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM O TEST / OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL'. : ..❑. STAND -BY p
MOUNT OF USE
YIELD SOUGHT �L gpm. /NO. PEOPLE SERVED j EST. OF DAILY USAGE � gal.
REASON FOR
DRILLING
2<EW SUPPLY O PROVIDE ADDITIONAL SUPPLY . ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL ft.
DATE MEASURED Z P7
DRILLING
EQUIPMENT
616TARY LET t,OMPRESSED AIR PERCUSSION 11 DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. 2--0,PEN HOLE IN BEDROCK OTHER
CASING
DETAILS
TOTAL LENGTH_ ft
MATERIALS: ffSTEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE 8 fL
JOINTS: O WELDED HREADED '❑ OTHER
DIAMETER in:
SEAL: iFEMENT GROUT O BENTONITE ❑ OTHER
WEIGHT
PER FOOT Z (b./tt
DRIVE SHOE: ES O NO
UNER: ❑YES UhrO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(it)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL ,t /
SIZE:
DIAMETER
OF PACK 1n. I
TOP
DEPTH tL
BOTTOM
DEPTH It,
If detailed um in
WELL YIELD TEST p p 9
M O PUMPED tests were done is in-
COMPRESSED AIR formation attached?
D BAILED ❑ OTHER ; ❑ YES ❑ NO
1ELL LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEaTN FROM
suaFACE
water
Bear-
ing
wdt
Dia-
me er
In
FORMATION DESCRIPTION
pnE,
tt.
ft.
WELL DEPTH
It.
DURATION
hr. min.
ORAWOOWN
It.
YIELD
9Pm-
Land
Surface
/_
10
~lVtJ
WATER ieCLiAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES �TNO
ANALYSIS ATTACHED? O YES [! NO
STORAGE TANK; TYPE
CAPACITY A96oORZ_ GAL.
PUMP INFORMATION
TYPE S`�3 CAPACITY :Z6?91
,c.r�
MAKERS DEPTH 1. � 0 _
MODEL D-z//Z- VOLTAGE-710 HP 1___,
WELL DRILLER NAME CP050W- DAT E
ADDRESS AV 510ATURE
DNS , AA1
V// // 400-
.,
32.01245 1�
Yorktown Medical Laboratory, Inc.
LAB hF - - -- --
32. 1 Kear Street
i:
Date Taken. T me
Yorktown Heights, N. Y. 1059$ -_
Date Rc' d: —.
Time • //✓-1
(914) 245.3203
Date Reported:
. 1 7 1888
Director: Albert H. PadovaniM. T (ASCP)
Collected. By:; . G. ~BELL
....Referred By
Sample ,Location: TAP:: %o;y - Alhe�?ii
GIL BELL
`2% �Samm�f-7
li/� �137?G�zSa.r.
WATER TREATMENT S.ERVICES-, INC..
223 KATONAH AVENUE
Phone N 232 -3402
KATONAH, NEW -YORK, J
Phone # 232=37.30
Sample Type:
L
- ..
Repeat Re P e._
sU ?
. . _
Te
(check one).
✓Pot able
LABORATORY REPORT ON THE BACTERIOLOGICAL
QUALITY OF WATER
_
Pion - potable
STP I..
STP E
GENERAL BAC ^ERIA
_ Other:.
1XStandard Plate Count (CFU /1.OmL)
(Agar Plate @ 35 °C)
Sample S -atus:
(check each)
MEMBRANE FILTRATION TECHNIQUE (MFT)
�
v Total Coliform (CFU /lOOmL)
_
Outgoing
— Na2S2.,3
Fecal Coliform (CFU /100mL)
Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Tctal Coliform: MPN Index (per 100mL)
Fecal Coliform: MPN Index (per lOOmL)
OTHER ANALYSES
REMARKS.(For Laboratory Use)
Incominc
LE 4 °C
GT 4 °C
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec
tion of Source
TNTC= Too Numerous To Couni
CON = Confluent (= TNTC)
LE = Less Than or Equal tc
GT = Greater Than
N/A = Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE UNYORK (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, ATIME OF'COLLECTION.
For Lab Use Only:
H/C to
/ X / 4 �- e�x z e, r /L /�e_4� = ��/�i
Albert H. Padovani, M.T. (ASCP), Director
• II.
=s
IV.
V.
VI.
•J
,a
APPENDIX C
FINAL SITE INSPECTION
�- r, 0 OWNER
Date l � - j ^ �1
Inspect by C
IFT # V V `M # OR. SUBDIVISION LOT #
6 _.. Z.. l L
SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
.>(
b. Fill section - Date of placement
2:1 barrier. LGTH WIDTH AVG.DPTH
c. Natural soil not stri
d. Stone, brush, etc., greater than 15' from SDS area.
X
e. 100 ft. from water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,25,0
X
b. Septic tank installed level
c. 10' minimum from foundation
x
d. No 900 bends, cleanout within 10 ft. of 45° bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX - properly set
g. TRENCHES
1. Length required - 0 L--,igth installed C J
2. Distance to watercourse measured: ft.
3. Installed according to plan
4. Distance center to center -
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet fran property line - 20 feet - foundations
-�
7. Depth of trench < 30 inches from surface
fi
8. Roan allcwed for Sion, 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11. Pi "-)e ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber
2. Overflow tank
3. Alarm, visual /audio
4. Pum p easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
E
estimated floc per cycle
HOUSE
a. House located per approved plans.
b. Nin— of bedrooms
J uJ ,
WELL
a. Well located as per approved plans
b. Distance from SDS area measured ft.
L;
c. Casing 18" above grade.
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
a. Boxes properly grouted
k
b. All pipes partially backfilled
c. All pipes flush with inside of box
X
d. Backfill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to exist-watercourse
g. Footing drains discharge away from SDS area
/Vor'
h. Surface water 2rotection adequate
i. Errosion control Provided on slopes.grea ter than 15 %.
PUTNAM CQUNTXsDEPARTMENT OF HEALTH rt
Rev 3/86 (�� Dlvislon 4 Envlrorimental Heelffi Seevlcee Carmel; N.Yc 1051? Engineer to Provide Permit #'
on CERT�ICATE OF COMPLIANCE
CONSTRUCTION PEItMiT FOR SE GE DISPOSAL SYSTEM" •"'
Permit N ";
%A ;
s ti "•
Yocatedat ��U1i�a� ..h►�ll.�.. ff �I�. ��1 Town
Subdivision 15� bd. Lot a 1�✓
u To Map.
/! � �11 ,, .�� ^ Renewal ❑ Revtelon p
Owner /Appilleanf Name C:OLL LL , x'4'((1..
Date of Prevloas Approval
Melling Address Towni�r 7 Zip
:: ff 1P 2 �C . y DeptL Vohtme
Ballding Type SLf AL'f'lAl.. Lot Area FDI Secdon Onl
Number of Bedrooms Design Flow G /P /D g� FCHD Nofl$catlon is Required When Flh ie osmpleted ;
Separate Sewe age System to consis "t of I e on Septic Teak and
To be Constructed Address
Water SaPPb: Pdbllc'Supply From Address
art. Private Supply bellies by
" (k-�% Address
Other ReguiremQnts
I represent that I.am wholly and • completely responsible for the design and location. of the proposed system(s);- 1) that the separate sewage ,disposal system "
above described•will' be constructed as"shown on the approved "amendment there• to,and in accordance with the standards,, rules and regulations o : e .0 nam
County Department of Health, and that on- completion thereof a "Certificate of Construction ,Compiiarice". satisfactory to the Commissioner of Healthwill
be- submitted; to the Department, and a" written guarantee, wJt,be: furnished the owner, his successors, heirs`o► assigns by the builder, that Sa�d;builtler "will
place "in good operating condition any part •of said sewage disposal system eurinq`.the� period of two (2) years Immediately following'thedate of�the issu -..
ante of the approval. of the-Certificate of Construction ";Compliance of ,the original system or any re irs th to; 2)-that the drilled well described above
will be located as shown on the approved plan and that said well will be lost I -ih accordance with the land s; Is and., regu_a i�'ons of the Putnam
—
'County Department of Health. �—y - "
Date Signed_ i(o 14i ! Signed
Address 'F � —license
APPROVED FOR CONSTRUCTION: This approv oxpires y r.from the Oate is ued unless construction of the building has been undertaken and is
revocable for cause or,may be .amended or, mod�fieen'eonsider neces y' Dy th Commissioner o Ith. Any change o► alteration of construction
requires 'a nnee11w/p emit, A roved" foi disposal of domestic sin; ry $e ge, and %o r` -t w e nly.
Date v - By Title �����
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
Cornwall Hill Estates. Ine.
I, Kenneth Emerson
represent that.I am an officer or .employee of _the corporation and am .authorized
to act for. Cornwall Hill Estates . Inc.
(Name of Corporation)
having offices at 223 Katonah Avenue
Katonah, N.Y. 10536
Whose officers are:
President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
Vice - President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah, N . Y .
(Name and Address)
Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536
,(Name and Address)
Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
and that I am -and will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subsequent acts relating
thereto. /
Sworn to before me this : % day Signed:
of . 19
Notary Public
J.IONEL WEINSTEIN
Notary Public-, Statb of NeW YbM
No.
In ostch9160
Qaaa "find in WastcNa:lor Co�sc�
&*mmfss:otr Ex0res March 30.'Z9
8/84
Title: Vice President
Corvorate Seal
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 PERMIT #
WELL LOCATION
Street Address
LU Ili
Village City Tax
r=. (o
Grid Numb r
— — Z.
WELL OWNER
Name
r1nQC.C. IVC.
B RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
Mailing Address
G -[
0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP
0 FARM 0 TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
rivate
t4k O Public
13 ABANDONED
0 OTHER (specify
USE OF WELL
1 - primary
2 - secondary
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED-/EST. OF DAILY USAGE )gal
REASON FOR
DRILLING
UNOW SUPPLY O PROVIDE ADDITIONAL SUPPLY
❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
❑ TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
ODRIVEN
QDUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 1l NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Ymt�(Ci-�z',
Lot No.
WATER WELL CONTRACTOR: Name g6 --r( iE"IK(F= Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES w---" NO
NAME OF PUBLIC WATER SUPPLY: I� TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:14N
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION ON SEP T TEET
(date) ignature
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 provi ed b th Putnam County
Health De pa ent.
� �---
Date of Issue: 19 � •
Date of Expiration: 19 a mit Issuing Official
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
APPENDIX
PUrMM COUNTY DEPAFM4ENT OF HEALTH DIVISION OF ENVIRONENTAL HEALTH SEPVj(
qli � it P h �1• • • • M � P !S i • •. • y
_o J
i;
(Name of Owner)
'i � 11 � .lyf •• • • 01•
DA TE
BY:
( Street Location)
DOCCMPS lam+
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
{ 2�
s/s
Design Data Sheet (DDS)
V
Deep HoleLag
Consistent Perc
� 'i M
(3)
Perc a Depth
Wnm
House - Two
;Pans
WSM
Well permit;
ems
letter
`VJ
®
mum
• _ - -
Emm
mmm
mum
mum
Im
■AIM
�m
Emlm
- .-
mm
mmm
DOCCMPS lam+
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
{ 2�
s/s
Design Data Sheet (DDS)
�VariAnce Request
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tawn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity'.
Fill Profile &'Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit detail.
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design Data: perc and deep results
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK;
Perc & Deep Holes Located
Representative of primary and expansion .
Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedroans
Walls & SSDS's w /in 200 ft, of Proposed Sys{
Property Metes & Bounds .
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, large Trees,Top of
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. e
15' to Drains -C- rta.in, Leader, Footing
35'to catch basin,stormdrain,piped watercy
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
V
Deep HoleLag
Consistent Perc
Results
(3)
Perc a Depth
House - Two
;Pans
sets
Well permit;
PWS
letter
�VariAnce Request
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tawn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity'.
Fill Profile &'Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit detail.
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design Data: perc and deep results
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK;
Perc & Deep Holes Located
Representative of primary and expansion .
Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedroans
Walls & SSDS's w /in 200 ft, of Proposed Sys{
Property Metes & Bounds .
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, large Trees,Top of
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. e
15' to Drains -C- rta.in, Leader, Footing
35'to catch basin,stormdrain,piped watercy
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
° PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0:
UwrierC o �� R(LL
Located nt (Street 2 -zr,I& Sec. � Block Q2 Lot,
�ca a nearest cross s ree
Mwiiciplailty Watershed Ceo -tr- '1►
301L PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Tr T6
Numbor CLOCK TIME
PERCOLATION
PERCOLATION
^WWI 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
33
-Ts
2 355 -3:�� Z 219 3`j
4
3''
Is
E
4
5
3:37 a a as 3'
z �2- 3:.40 -Y6;t
4
NoLwl 1) 'mats to be repeated at same depth until a proxiirately equal soil
rates tire, obtained at each percolation te�t hole. All data to be submitted
for rovfe-w.
• • 1►t h measurementn to he made from top of. hole.
TEST PIT DATA REQUIRED TO BE SU11MITTED WITH APPLICATION
DESCRIPtTION OF . SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. \ HOLE NO. HOLE N0.
G.L.
6" - Too O'%
12'0 v
18" •
�4 °o
30'° _
36"
42"
48" .
,.A
W11
I N1)I CA`1'E; UVEL AT WHICH GROUND WATER IS ENCWNTEMM
I NI )1 GATE, LEVEL TO WHICH WATER IAVEL RISES AFTLR BEING ENCOUNTERED
'i'1i:3T3 MAIM: 13Y JZ.tuaLg Date
DMIGN
Suit Rate] Uaed 6 -`7 MirVl "Drop: S.D. Usable Area Provided —,Go**
No. of Dedrooms Septic Tank Capacity JZ50 Gals. Type
Absorption Area rov deter By qp0 L. F.x24" - - � trench.
ut
Addrsa 7 sI:A16 ' Iti..•::.....
THIS SPACE FOR USE BY HEAL'T'H DEPARTMENT ONLY: N�., ro° 0,40'���
Soil Rate Approved Sq. Ft/Gal. Checked by., , Date
SEP 2 0 i985.
PurNAM COUNTY
DEPT, OF HEALTH
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