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HomeMy WebLinkAbout0608DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -15 BOX 7 lirm ' J iy 1 oil 7 I �I � � I 'V 'ti r . 16 9 j .; ` , �, F �: 11.1: n j PUTNAM COUNTY DEPARTMENT OF HEALTH ii i Rev 3/86. b Divlslon of Environmental Health Services, Carmel, N Y:10512 Engineer Mi CERTIFICA F'GONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM, F J Provide It li .� 1 WE LL COMPLETION REPORT PUTNAM COUNTY DEPARTMEN COF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME WilliamVogeler 1124 ADDRESS Buckingham Ct. Pomona., NY 10970 LOCATION OF WELL (No. & Street) (Town) (Lot Number) McManus Rd., Patterson #8 PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL HER) ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (SP DRILLING EQUIPMENT JN � COMPRESSED ❑ PERCUSSION ❑ OTHER ROTARY AIR PERCUSSION P R (specify) CASING DETAILS LENGTH (feet) 30 DIAMETER (inches) 6 n WEIGHT PER FOOT 9 lb.s . 7-VOE THREADED El WELDED SHOE I YES ❑ NO G YES D NO YIELD TEST HOURS G.P.M. ❑ BAILED @ PUMPED ❑ COMPRESSED AIR 6 5 —+..a YIELD (01 P.M.) 5 WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Speclfyfeet) 251 DURING YIELD TEST (feet). pth of Completed Well 285 1 feet below Land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): ' " GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION . Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET O 5 Drilling in overburden clay and boulders Hit rock at 5 feet 5 3o Icasing,grouted Drilling in rock,set �0 285 Drilling in rock granite. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 11 zz 8 DATE OF REPORT 4 zl 86 WELL DRILLER (Signature) / — d ?r -or Pu PUTNAM COUNTY DEPAFaMENT OF HEALTH of Building 04 by Location - Street A",4 S 0 Municipalit94- 6A l,/�N� Building Type ENVIRONMENTAL HEALTH SERVICES -73 .3 1 Section Block Lot A #�lo Subdivision Name� / d Subdivision Lot # GUARAN= 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 �. day of 19 Signature Title ) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Z-- Gx Address rev. 9/85 mk BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (994) 225 -2072 SAMPLE NO. 6083 SOURCE: William Vogeler McManns Rd. Patterson, NY COLLECTED: February 28, 1986 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Hose Bibb - Well 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. march 4, 1986 4, F x PUTN'AM GO.UNTY.'DEPARTMENT OF HEALTH, ENGINEEBFIOVP'EOOFDCOMPLIIT # 1\ ON CERTI. ANCE�' }; Division - bf >Environmental Healih.Services, .Carmel ':N..-'-Y. f0 P,ERMIT` > CONSTRUCTION PERMIT FOR SEWAGE: I ', 009A ' L SYSTEM' O'! Town 0.! .Ilage at �' ✓ > Tax MaP Block lo Located t C� '._LOt Renewal Revision Subtlwis�on _ ❑ ag Owner/Address A4 - Date of Previous Approval v K/>r'lRy iiG' Lot Area only ❑ = Builtling TYPe , Fill Section Number of Bedrooms Jr f Design Flow G /P /D —� - ® P.C. H. D. Notification Required `B© Separate,Sewera9e System to consist of Gal. ,Septic Tank and -, - Address {{ To be const►utted by , -.'Water- SuPPIy Public Supply From Private Supply to be drilled. by Address ` + Other Etequirements f{ r.•'. I represent .that I a n wholly and completely responsible for the desigivand location 'of 'the `. proposed system(s); l) that the separate sewage:,diiposal system above described =will be'constructed bs -shown on the approved amendment, hereto. and in accordance with the standards, rules an regu a ion ;o e Putnam County .Department of � Health; and thaYon completion tAereof a "Certificate of Construction Compliance ". satisfactory to the Commissioner of Healthwill p Abe submitted to ;,the Department. and*'a written guarintee,.will -be Yuinished the owner, his successors, heirs or.assigns b y the builder, that said builder -will place m ,good operating condition, any ..par part of said sewage:d�sposal;,•syitem during, the period of two (2)•years immediately following the of the'issu- ence of •th -e approval of the Certif.icate,of Construction- Compliance of th's original system or any repairs theret ;2) that the drilled well tlescribed: above will. belocated as; shown on;the.approved plan a' nd that said well wilYbe.installed accordance with the standard rule and .regu a ions of 'the •Putnam r County Oep ent of Health, i y tom-- a/ Date Signed P.E. '7 RQ.A/.� f Address t/ / ZC� V �' } APPROVED FOR CONSTRUCTION: This approval ex one year from the ,da a issued un nstruction -of the building has:been undertaken and is revocable for cause or may be amended 0 (modified when consi d ne essay the Co issioner of. Hesith. Any change or alterat ion .of con st►uctior,;` a new pe mif. APP . etl tlisposal 01 dome ic- san�tar age,. an or pr'• a ly on y - requues a - r Date_ By ills _ T r Rev X6/85.. tf s. y,� iv" x sJ,+aa P S"+t aC a > { s .,. e" r ; �'_ r ,p� Y r r ; PUTNAM COUNTY ;,DEPA MENT OF HEALTH ;: Y y T" Permit N / + Divaion of Environmental Health :Services Carmel N Y 105,12 CONSTRUCTION PERMIT IFOR SEWAGE DISPOSAL SYSTEflA <� /f �. . r o own' or illage t { 73 - L•ocatetl at Tax Map Block Lot 4- 4b w � h Subd � Lot M < f t Renewal. s i❑ Revisionrs ❑" 3 e 1 SYDdiVlsioti // a b r a i pFai a 3 xt r' ••,1V Of= Previous Approval �' { •f Owner /Address r 4 L ;ot Area Fill Se on One ❑ `'t BUIIdln9 T -YPe Required o Desi n Flow G P �°'� L@ �' P C •� of aLion Number f Bedrooms g /D r s r Separate SewerageRSysteM _to sconsist of �0iic7 ,Gal Septic T and _3 To be constructed by y M Addre yzz 11 � F t h k t a..a •,r r c ,.^a. ° t :"A' t Water Supply Public Suppply From Pnvate Supply t -be drilled b x ".µ C- e• ' 4C }:= S '`' ) o-y n.. x z. 1 i y >V A.;V. 4.Other Requirements I:yiepresent; that I am wholly antl completely `r ponslb or to . desl no location of the proposed systems) s 1) that tthe separate sewage dlsposdl system:r r: 5bove "described; °.will be COrstructed'as shown o the appro . a dment ere ao and In accordance�witnthe standards pules an regu a ions• -o County ijepartm'ent of HeaRh, and that on completion th_ f a Certificate of Constryigtlo ce satisfactory "; ;o the Commissione► of HealthwTll be submit "ted to fhe DepsFtment .and a wiitten.'guarantee wl be furnished the owje4 isw rs:or assigns.by the builder that said builder will' ax .� r ere:so place in goo operating `conddion any part of -saHi' sewage aisposaf• system during L�rt4 � �earB Immediately tollowing•the`date : of;the issu;. ;ante of ythe sapproval of ;the Certrficate of Constriction. Compliance of the or,igkn�il(�yj�> YgFi its t}eieto 2) that the - drilled` well described above' will be lo%ated assh�own on the approved plan.and that said well wlll�ba Installetl`.in, c��pj See�e ?_; {p u es- d regu a Ions 'of the :Putnam , r County Departmentaol "ear Date /,� _ S19ned RA �. ;Address s n ' i bu 1 11 5 b and iS �� APPRO�GED FOR'CONST.RUCTIOIV This- b'pproyal. expires ,one yearirom theitlate iss rii{��zs ri4l gf the i ding .,a een .undertaken 1 [evocable for cause or may be amended or modified.when consitleretl riecessarX by the, ` ill. .. Any change oration of constructlori requites anew permd Approvetlrforltlisposal of Gome i ntart' S". g •`an o pPiv t ptq'61SIy Y q r , i -a. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN //D /ATA SHEET- SEPARAATTE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ItIO eo� Address Located at ( Street Ydicate Gla4vr f� /�, Sec. Block ,� Lot h nearest cross street) Municipality. AV76-MS-e-VA-) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water It--v-el No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 3 I! i7 12.30 jP.l� t3" 13 z tc t2�1 11ay t+ 2 3 5 1 _ 2 3 Notes: 1) T6skts to be repeated at same depth until approximately equal 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. DEPTH G.L. 6" 12" 18" 2411 30" 36" 42" 48" 5411 60" .. 7211 78" 8411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. �_ HOLE NO. HOLE NO. Ja 73 4 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER .FEVIS S AFTER BEING ENCOUNTERED TESTS MADE BY AdvB IR L iy G t�F Date DESIGN Soil Rate Used 16 Min4/1 "Drop: S.D. Usable Area Provided Z No. of Bedrooms = Septic Tank Capacity t000 Gals. Type c08UG Absorption Area Provided By 6© L. F. x2�+" �/- jT`� a�trenc ,_ Address - -IA I v :_ THIS SPACE FOR USE.BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by No. 1728 'f THE Date 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 NO. Owner Address Located at (Street L &4AI Sec. Block Lot 6dicate neares cross stre-eTT Municipality, �i4-P8 S_CK) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Xs, lo eo -- /030 3o Wov �! /y " /! K 7 © m;'V h'i 'c" l 2 /o tsv. -- /O3o �c� .0 %v ". 3 /o oo — /030 -?49 .Viw W/ f4 . !z'' 20 M/�`i,�,�,�, 4 5 e z 1 c/ l Z psi %v� /2r�j i dv 2 200 .—Sao ly� �j &1A) 3 2= oo 2 � 3c7 3rd AV IN ro �� �'`r / `� '60 ar 4 5 RECEIVED PUTNAM ;AUNTY Notes: 1) Tests to be repeated at same depth unto 11 1�, equal soil rates are obtained at each percolation test hole. A datalo be submitted for review. 2) Depth measurements to be made from top of hole. L .. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop Elapse Time Min. Depth to Water From Ground Surface Start Stop Inches Inches Water ve in Inches Drop in Inches Soil Rate Min. /in.drop �zBS 1 1.3o -3�s 2�2S�N 6`` o" (" 2�{rwZ/a�c� ®4 y AMW_ 2 �/8 j- //o f � : quo m;- ./7 iro ,.v /sic Gi k,-, VoAA:�. . 3 /(� oe i- IZS 2; 2! �scrw 6 ,� lv Q, 23 Ml v Xs, lo eo -- /030 3o Wov �! /y " /! K 7 © m;'V h'i 'c" l 2 /o tsv. -- /O3o �c� .0 %v ". 3 /o oo — /030 -?49 .Viw W/ f4 . !z'' 20 M/�`i,�,�,�, 4 5 e z 1 c/ l Z psi %v� /2r�j i dv 2 200 .—Sao ly� �j &1A) 3 2= oo 2 � 3c7 3rd AV IN ro �� �'`r / `� '60 ar 4 5 RECEIVED PUTNAM ;AUNTY Notes: 1) Tests to be repeated at same depth unto 11 1�, equal soil rates are obtained at each percolation test hole. A datalo be submitted for review. 2) Depth measurements to be made from top of hole. L .. DEPTH G.L. 6" 12" 18" 24" 30" 36" 42" 48" 54" 60" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. 4 HOLE N0. 5 HOLE N0. C� Goa -vim G��a vas z-A a ,-5 ,���osa?�yd5e� G�t� �E'Z�a�r,pO�e70 (..�''�i�5 %��l�etti>oS�✓ �J�6S La,:Z-94 2-o A vet 66" j i Lo mm .. . O 7211 _ tG7r� 78ft A10 �i1cv�,�a6l1, Low 84" rQvc/C /J° INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WH,Ig H WATER EL RISES AFTER BEING ENCOUNTE TESTS MADE BY 14J41 �v Date dZ -IS-- Z17 0,C DESIGN Soil Rate Used SO Min/1 "Drop: S.D. Usable Area Provided �.rc o s9 No. of Bedrooms %_3 Septic Tank Capacity Absorption Area Provided By ' o L.F.x24" Address a SEAL THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY:. Soil Rate Approved Sq. Ft /Gal. Checked by Date t F a /' A • of V, ' IDI • i • N 4AW ( Name of. Owner) INITIP. SITE INSPECTION M a 01 Ail u5 P-D CP (Street Location) YES { NO Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willc1riveway need cut ............................ must trees be removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed...................... Sufficient SDS area available considering driveway mot, house location, separation distances,etc... Adjacent wells/ septics ............................ DATE: ) 6 INSP. BY: D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G.W. Depth to G.W. Depth to G.W. Depth to rock Depth to rock Depth to rock Soil Description Soil Description Soil Descri tion 0 ft. 0 ft. 0 ft. 3 ft. 3 'ft. 3 ft. 6 ft. 6 ft. 6 ft. 9 ft. 9 ft. 9 ft. 12 ft. 12 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO C�R+��S House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........ .................... 10 ft. maintained fran property line and 20 ft. fram. house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ......................... Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRAD% OF SITE ACCEPTABLE .................. V/ I/ i1 RLVIII.1 CIII,.CK SIMET ' -,k IMcets Std. DOOM11 idTS MP,P LGtA none - ) Z �L L -rouse plans 0. K. Dysign data sheet Peres presoaked? 30" perc test depth Const. results for 3 runs 1 D. Hole log O.K. Corporate Affidavit for other than individual N Authorization for engineer Letter from Water Supply if applicable nr If variance requested -such noted on plans & apps. ;r; TM WA 1.cw,( r{.1 Re'nI i1 &APAyS" FARER v3C �IGtiSRTIiRE E sea!- orJ V, a D -TAILS 1� . Vlil. DcP1 N i RREA• SR0k,1&%( c i) NDTE • PLAN To aw rpov, ED Existjng contours shown (show new contours) Slopes for driveway cuts, etc. shown iLter service line location Footing drain, etc. location 1- Top slope, bottom slope of Pill DRTF 1047 , �Z Remarks' . l+wJ" Cbtt�f� bfc'r - � ro recex � Percolation tests and deep test pit location ✓ j i Septic tank size and conformance to std._ r 3 B.R. house minimum ; I House setback shown ,i I I vNt>C�: crams- Distribution box £t�_ below frost All water within 5Q`Tt. of. PL shown Plan and -- - -- profile SDS .. �. ...�....�� Se•i0w i ='t.c t� -1�`Z All other wells and SAD, closer 200' shown or reference made ' Property boundaries (metes and bounds- clearly s -ZSDIV S lo�N 3,( xM -ilk ttp ecuAL .SEFARATION DISTANCES SPECIFIED ON PLkN 10' to P. L. fR Al 20' '/ to Foundation i;alls l00 to Nearest well 100' to stream, march, lake, etc. incl: W to Curtain drain � 0' to water line (pits 720 5' to storm drain 110' 'to lari;a trees 10' from !, oundation to septic tank 5' to pipe from leader drain &.foolne. 25 To CAIM4 eAS11J I5 WEIL TO ' . f ERRC- TRNK TO • 1Je.Il i on 1 1 J'1JS1 .IJ V1llil�l� 11 L.J 1. 1 Date: Insp.by: INITIAL SITE IIISYECTIOi1 _ Yes No Con>nlcnts Property lines or corners found . . . . . . . Can estimate house.location . . . . . . . . . Will driveway need cut -. . . . . . . . . Must trees be removed -hote these . Is deep hole representative of entire SDS area Additional deep holes needed. . . Sufficient SUS area available considering driveway cut,house location, separation . distances, etc. qrl. wE�� >�SEPTCS .. DEEP HOLE DATA D°pth: Water elevation:. __ Rock elevation: 6 _ Soils descr_i.vt on: -- - _ �- O -` Date: _ FINAL SIT., II•ISPECIIGTi jIns • by: , -- House located where shown on approved plan SUS located inhere approved . . . . . . . . I�engSth of trench measured Width of trench avei -age S) -ope of tile line and trench.acceptable . . Room allowed for expansion trenches . . . . .. Over�'Tt. from swamp ,ilatercourse Natural soil not-stripped or SUS area iuuiecessar:ily graded 10 ht. maintained from. prop. line and 20 ft. from house . . . . . . . Separation of trench from house, well - etc.- follows plan . .. -__.: -_. - __ - -- ..- . - - - Number of bedrooms chec]cs . . . . . . . . Stones, brush, -stu>"ps, rabble, etc'. greater than 15 ft. from nearest trench . . . 15 FL-. of peripheral soil horizontally from trench Jiuict.ion boxes properly set Could surface run off from driveway, roads, •ground surface, etc. channel near SDS ... . area . . . . . Does lot drama ,e '>x11 O.K. in area of SDS _ _ _ FINAL GRADING OF SITE ACCEPT11=- ' 1 ' t'J ENGINEER TO PROVIDE PERMIT # JAM COUNTY- :DEPARTMENT OF HEALTH:+ ON cERr FlcarE oF:coMPLIaNCE. Div, ` Environmental - Health: Services,. Carmel N:: Y. ,10512 .' -PERMIT CONSTR.0 ON.. PERMIT . FOR SEW, .__ .,- SPOSAL. SYSTEM' f Town or Jlage Located at &41:100 A,,j �S PG O��' Tax Map ock Lot Subdivision, Q' L Stibd. Lot . Renew Red on i- pc . Owner /Address - �� Date Of ire, oys Approy Building type,-- '` Lot Area 4 0; Section° y ❑ Number of :Bedrooms %_ Design Flow: G /P /D, P. H No ficat n Required Separate Sewerage System to consist of 620 �- Gal Sep is nd DLO To be constructed by • Ad res / Water Supply: Public Supply From = . Private'$upp1Y to be drilletl by,' Address Other Requirements I represent that 1 am wholly and co letely spon able for t e design' d location ion of the. proposed sy 'em(s) 1) that the separate sewage disposal system above described will be constructed as shown on h approved, end nt here to and 'in accordance ith the standards, rules an regulations o e u nam County Department of Heath, and thaf:o6 "co letion ther' C tiii- te: of constructlori mpliance 'satisfactory to-the Commissioner of Healthwill be submitted. to the Department, -antl a ,wntte ara e. will 'be urnished - the owner, his .ccessors, heirs or assign's by the builder. :that said.builder will place in,gopo operating 'eondition any, part of'sa sewa 'd Is sal system :d g the rind of two t2) years i mediately following'; the, dais of the issu- ance of- the approval of the Certificate of Constru ion ".0 Iiance of f ng r;al' stem:'or any re irs Hier ; 2) that the drilled well described above will be to s: shown on the approved.,plan antl that id we will,beanst rdance wit a ;; antJar ru sand regula— off' ns': of the Putnam County ( epa ment of Health +• (® / P.E. R.A. Date v Signed Address . a1 ense No. ZZ ��jj 110 APPROVED FOR CONSTRUCTION This app' val expires one -rirom the= date issued unless construction h'e.building has been undertaken and is revocable for cause or may be amended or: mo rfied' when cons eyed neces3ary `by the Commissioner of Health: Any change Or alteration of construction requires a new permit. Approved for disp sal of domest' . sanitary ':sewage,:,ano /or, private water 'supply only. v_ - Title Date .. Rev. 6/85 - - - — -- i RG'VII;ti1 CIiI:CK SIIi�i;T IMO, cts DOCUf,711TS MP,p LUc_ - A ions House plans 0. K. Design data sheet Peres presoaked? !-in. 30" pert test depth Const. results for 3 runs_ D. Hole log 0. K. Corporate Affidavit for of Authorization for engineer Letter from plater Supplyi If variance requested -such M DATE Std . [ Roma r1(3 * . r tnan lnctivlctua.l ; ro 4 applicable (v oted on plans & apps.: /OA 4 z' t r-- D TAILS DD• -- . Ftl-L DEPTH RtQEA- St{owWC oi) Ca T. Existing contours shown (show new contours) Slopes for driveway cuts, etc. shown hater service line location i f Footing drain, etc. location 3 i Top slope, bottom slope of fill i Percolation. tests and deep test pit location Seotic tank size and conformance to std. i 3 B.R. house minir -um . House setback shown Distribution box ftg. below frost All water within 59 f�. of..PL shown - - UJ EU_ - CRS I NG 12 -" t� E G Rt4D C - t Plan and profile SDS I All other wells and SDS closer 200' shown or reference made ! �, Property boundaries (metes and bounds - clearly how LECzCFL s�aoly is ID,�'� i l REALTY SvQDtvlSle 1U1�}�(�ft� 'SEP I ATION DISTANCES SPECIFIED ON PLkN '10' to P. L. ' ne ��►i� ��/ X20'/ to Foundation z:alls .io0 to Dearest well ;CO' to stream, march, lake, etc . incl 15' to Curtain drain 10' to water lire (pits -20 15' to storm drain to lar`,c trees 1 0' from foundation to septic tanl; 5' to pipe fi,o tt lOtidor Chain &.1,00r,111, 15 To ciTc4v gRSih3 15 WELL TIO �E4�IC. TRtitt Tp I I e:;nanslon fain 4) }703T.,D CI-U-,CK L'CST. . Date: - I� • g� Insp . by: INITIAL SITE 111SP1;CTI0i1 Ul✓���� Yes No Comments Property liner or corners found . . . . . . . . .-,�- Ca.n cstimate house. location . . . . . . . . : . U Will driveway need cut . . . . . . ... . . . . , hnust trees be removed -hote these Is deep hole representative of entire SDS Brea .. Additional deep holes needed. . . . . . Sufficient SD3 area available considering driveway cut,house location, separation . distances, etc. A-ri. iJ�LLS SEP CGS DEEP HOLE DATA MOAB f-C - -AID' Depth: eva.tion :. --- - Water elevation-. Rock elevation: Soils descri. pt i on: iDate . t FINAL SITE IN? ,HJC`t'IGY !Insp. by: House located where "shot;n on approved plan SDS located where approved .. _:_._..._ Length of trench measured Width of trench average Slope of the line and trench. acceptable . . . Room allowbd for expansion trenches . O Over �' .ft. from swarip,watercour•se - _ Natural soil not- stripped or SDS area uruaecessarily graded .. . 10 li't . maintained • from prop. line and 20 ft . from house ." . . . . Senl1ra.tion of trench from house, well -plan nwnber of bedrooms checks . . . Stones, brush.,. stumps, rubble, etc'. greater than 15 ft . from nearest. trench . . . . . . 15 I't . of peripheral, soil horizontally from trench . . . . . . . . . . . . . . . . . . . Jiniction boxes properly set Could surface run. off from driveway, roads, ground surface, etc. chaa-nzel near SDS area. . . . . . . . . Does _l.ot drainage appear 0.1 {. in area of SDS FINAL Gr&DING OF SITE ACCEPT-ABLE, , b � x t �Q l` t, j slog.• -�_ t. t. J G r-