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HomeMy WebLinkAbout0706DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -131 00706 -7, • _ PUTNAM COUNTY DEPARTMENT OF HEALTH "3/86 Division of Environmental Heolth.SerVlces, Carmel, N.Y. 10512 Engineer Moist Prevlae /� 9 �' •.;��„ P CtH D Pena_ tt N L ' CERTIFICATE C TRU.CTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEMlil • i!-?U Located at /;- D �J7 `iQ c _ Tax Tg r:V_ _Lo; Owner /applicant Name / ` Formerly Spbdlvlsion Name ` J Sdbdv. iot N l G' d � / _ Zip /f VJ � Date Permit issued Mailing Adores, . .9 Separate Sewerage System built by %[dY�(fi' . ; Address cU _ /G'S G ,. VLv... Consisting of. - 1 Gallon Septic add . Water Supply: Public Supply Rem Address " or: l✓ private Supply Drilled by " `i' df44 ' Address Building Type %fir°_ -S / C Has Erosion Control Been Completed? Nuntber�of Bedrooms " Has ,Garbage ".Grinder`Been InstalledY G Other Roqufrements . I certify that the syitem(e) as listed serving the above premises were construct �'s oa the plena "of the completed work f copies of which are.attached), and in accordance with the standards, -rules and regulat er- a filed plan, 'and the permit' issued by the Putnam. County DeparLd nt Of Health. , Date.� Cert)fledby P.E. R.A. _ Address G,, License No. 9r Any person occupying prom ises served, by the boob syaem(s), shall, promptly take su usury to secure the correction of any unsanitary conditions resulting ;from 'Such 'usage., Approval'of the separate sewerage sifftem shin., - oid is soon as a pubt;c "unitary_Nwer becomes available and the approval :of the private water supply shall, become null ins! void when-V. supply becomes avaliable. Such approwls are wblset to modifltatfon or change when, in' the judgment of the "COntmissiof Miialth, ..� revocitlon, modification or change Is necessary. Date Title �_5�7 0 PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONME =AL HEALTH SERVICES Owner or Purchaser of Building tJ Building Constructed by Pa \rVAe- � Location - Street . Fln- Municipality Building Type Section ,QBlock. Lot / J I ' %-7 Subdivision Name lU Subdivision Lot # GUARARM 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 y19 2s Signature Corpora Address rev. 9/85 irk Title Corporation Name (if Corp.) 10 � 10 Address BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914). 855 -1930 - WATER ANALYSIS REPORT - SAMPLE NO. 8431 TEST WELL SOURCE: Greenspan Blds. Lot 10 Flintrock Ridge Patterson, N.Y.' COLLECTED: 10/20/92 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 10/22/92 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 0 per 100 ml. CO�� WELL COMPLETION REPORT Office Use Only y DEPARTMENT OF HEALTH Division Of Environmental Health Services [� 10 PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WN/ IL I TAx GRID NUMSER: WELL LOCATION Flintlock Ridge Patterson, NY Lot #10 NAME: ADDRESS: �s— �j ❑ PBIVATE WELL OWNER Greenspan Builders PO Box 0 Briarcliff Manor ,N7 ❑ PUBLIC USE OF WELL ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR .[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY DRILLING ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 445 ft. I STATIC WATER LEVEL 60 ft. DATE MEASURED 8/13/92 DRILLING EI ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 51 ft. MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH BELOW GRADE 50 ft. JOINTS: ❑ WELDED. ® THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: 9CEMENT GROUT O BENTONITE p OTHER WEIGHT PER FOOT 19 1b./ft. I DRIVE SHOE: ® YES ❑ NO I LINER: O YES C00 DIAMETER (in) 'SLOT SIZE LENGTH (II) DEPTH TO SCREEN (It) DEVELOPED? SCREEN DETAILS FIRST O YES ONO SECOND HOURS GRAVEL PACK ❑ YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE: OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST It detailed pumping WELL LOG V more detailed formation descriptions or sieve analyses are available, please attach. METHOD: ❑ PUMPED 1 tests were done is in- formation DEPTH FROM Water We1l (3 COMPRESSED AIR , attached? SURFACE Bear- Oia- FORMATION DESCRIPTION COGS ❑ BAILED ❑ OTHER i ❑ YES ❑ NO ft. ft. ing meter WELL DEPTH DURATION DRAWDOWN YIELD Surface 35 Drill ng in overburden clay & boul er ft. hr. min. It. gpm. Bit ' ock at ' 35 445, 6 220 100 35 51 D 11 ng in rock, set casing, grouted. ling-in rook granite. WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? ❑ YES ❑ NO WellXtrol 250 ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE PUMP INFORMATION CAPACITY 44 GAI.. TYPE submersible CAPACITY 2 h WELLORILLERNAME P.F. Beal & Sons,r• c DA 0l I92 MAKER Gould DEPTH 40 ADDRESS 4 Putnam Ave. SIGfiMRE MODEL7EH0_ 5 412 VOLTAGE?.�aHP _ Brewster,NY 10509 �' \' �4' - !Q!!IY[�IfRDQ�l1l�lR��ACI� �•� ��''� � :�� , , T � v 12014 )bseLale tw lrwYa lrslt / 1 reprNNnt tnat 1 am whelly pen comOMtMy responsiele for the d"n and, locatlori:,of tho. piopowd aydem(s11. i) that thi M atr saw di sal stem • ' above dwvlbea will be Constructed as shown on then approved in+irWmantthere to ;ana in fccordanoa with the stahmrds. rum a regulations o VVIMOM prhty; Depwr rnelrt .of HwKl% and that on commoetion.the►eof a; --.4r, fkate o1.6nttrudwn,Ce!mpliance'• satisfactory to the.Commiaabngr of H"Nhwlll be Mme w to the'vePiremsant. x110. a. written w"rodie will- Oe' furmidied the o sao►i. heln.or aaalgni by the builds, that aid. builder wi11 weed in oo",.dpdatl" common •any +part of 1. >iswae' aii posal system l � (!) years bmmedlatefy following thadate of the Issu -. auoa of the ajpioual of the'Nrtllketo of'Comlr40 4i- Gom0lianea ;,of 'flit irf tI wdb: 2) that YIN dr4Md wNl eesvlbw above ' 11NN be Mooted as O Mw:M tha'appie pen and that Yid wait wit M.Instalkid amAards; 'rule- and. reg s of ten Putnam . ce v oepnbmmt of atOtth © � 0 / Slghed !n y.E. APP"4EO F011 CONSTRUCTION: Tit .appovaI oapiras two yeast fro the uetkln of the "building has boon ue0artaken and is �►MOCeble for, Cause, or 7haY w,ahramiad r rnwMkid wham toigida►ad-necesta►y - Fleelik Any tharps or aKwation of construction 1edyNU a w.perrna.: Aspreved fa d"Powl of dow"k sanitary:sol►Me. ,nlupply only. . 0/88 o.b tlir"� Tale`,' ' an - r...,._. -�-�� _.... _ DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # l WELL LOCATION Street Addres d✓Cl r� Town Villag City Tax Grid Number c. c t..a Z' BLS = --I-- � X�, WELL OWNER Name M ili g Address Private �� d_J� �C� �^ ✓a�s4•�fi 0Public USE OF WELL 1 - primary 2 - secondary ARESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify []INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT :j^ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE_�gal E3 REPLACE EXISTING SUPPLY O. TEST/ OBSERVATION 13. ADDITIONAL SUPPLY VNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE GRILLED DRIVEN ODUG O GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES t•' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 1*9 tz/ Lot No. %fi ' WATER WELL CONTRACTOR: Name 13z�11 . "f > Address :,5/�ll::�5 r%/, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1 NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED , ON SEPARATE SHEET (da e) (signature) 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 by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration 19,!2 K Permit Issuing ficia Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller i p `:v_C =^=_ i I / I � I I I I I Etc. L i I rive. -'rC.� l..C.: - -`?•_ - ' - = —r._ � -- =C: t �� --- - - -- -rte- - --- CN � � c 20 _- _ 100' to _' 10' LO I --_-- i _ -- -- -- — �- Szam tic T i I / I � I I I I I Etc. L i I rive. -'rC.� l..C.: - -`?•_ - ' - = —r._ � -- =C: t �� --- - - -- -rte- - --- CN � � c 20 _- _ 100' to _' 10' LO � •' • � 8' 0: I� Y• 'I x' MS. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0. Owner 6 G Address po'G 33y �.-: woo % moo / lV Located at (Street) Sec. ,i/�_ Block r� Lot (indicate nearest cross 'street) Municipality ./ Watershed e .• • • 71'stf!� _: •' 4�'.y �: Y: : ���� /� �� ►'•�'j l: u• YY�• JY�. : • • s Y •,. Date of Pre- Soaking Date of Percolation Test v g- �— HOLE N(bMM CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water FYom Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/in Drop 2 /c-., . �0 3 v 3 a Z Z Z s'- 3 /a 3U 4 5 1 y yo. /o /0 3 v io 3/o 4 5 01 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 DEPTH G.L. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' TEST PIT DATA REQUIRED TO BE wwiliw�ww7 l - AATT A -11 HOLE NO. r HQLE.NO. 74 � �� 1 i WITH APPLICATION !N TEST HOLES HOLE NO. INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED /✓D y e INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: l! i ✓ DATE: DESIGN Soil Rate Used Min/Ill Drop: S. D. Usable Area Provided No. of Bedroams Septic Tank Capacity gals. Type ��V Absorption Area Provided By L.F. x 24" width trench Other �r UE NEW Y Name i ✓ Signa* °q G� Address THIS SPACE FOR USE BY HEALTH DEPAR24EN'P ONLY: t �JF�z4r %*171 � PROF..: Soil Rate Approved sq.ft/gal. Checked by Date �. J�tl..�f•�esrF:.�'p./f,�eS_�y :11 S��'a..?. Divlslon of Envhvnmenti4 Health Servloeri: Carmel.: N:T 1051? 14v PUTNAM COUNTY DEPARTMENT OF HEALTH 3 'q Enghtee; to Peovide Pamlt M - II on CERTIFICATE OF CO CE CO 70N FOR'SEWAGE;DISPOSAL SYSTEM p Located at T y 1 ✓K/ . /,� //7 %3A �. (i own or -'. Vlllige q Tt MaSubdivision Name Sabd. Lot / Bloeh - t••t io ¢ ' Renewal ❑ Revlslon - ' p Owner /Appil,"t Name . Date 'of Pre Apps Approval Mailing Address Qx 3 Town Z1. Alf Bum ape: ��°�'/ �Lyi C C Lot Area 3.. FIII Section Ottly Depth volume Number of Bedrooms Design. Flow G : P D ° PCHD Notification le Required When Fill is completed Sepeiate Sa�verMe.System to consist of i 2 Sldcwon Septic Tank end S'�O'd 1 F 2's' " v✓� � pn � To be copetracted by Address Water S4PP4's Pdbile Supp y -From Address or:XPrivate Stiipply Dewed by' —Address Other It I represent that 1 am wholly and completely responsible for the design a above described will be constructed as shown pn the.approved amendmel County Department o1 „Health,' m and that on coplation,thereof a _'Cel be subnritted to.. We ; Department, ,and' a written guarantee' will'be fu place, in good operating condition4ny part of,said. sewage disposal once of the approval of the Certificate of-Construction Compliance will be located as'shorvn on the approved plan and that aid well will be I, County gOepartrtment'oo'P H Ith; , Date' 'r/ O �% SWned- / / "Address eA*,7r APPROVED FOR CONSTRUCT,ION:Th' approval expirestwoyea";fi •revoubto” for cause or may be amends or'modified when considered nt requires a, new per roved or ispo *6, domestic amtary' Rev. / 1/87' Date C ` d location. of the pr poPsd there to and in ac n ifieats of Corirtr ti n r 7kkid the owner his t ystem. during •t per oft1 N the original _ > m'aet Italied m a r a it Itemfs)( eP);,that the separate sewage dis 9 oral system —ate d"i; rules and regu a ions o . e u nom once —Y. actory to'the Comrniai4oner of.Healthwill Ira o !b igns`by the builder, that said builder will ears egiately following thedate of the Issu- eretb that the drilled well described .above ysln t, r lea and regu aZ oiT ns of . the Putnam J r i P.E. R.A. 2489 License NO zf�the building, has been undertaken• and is '$Any, change or alteration of Construction G ITC, 17 JOSEPH F. SULLIVAN, P.E. �fp eonse�. ung Eft9buec 7;I s-07 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N. Y. 10598 (914) 962 -4248 1 I 1 f � 6 � /°o wG11s W;,Ov," I oo' Rim � 6 � 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 Town/Village/City- Tax Grid Number WELL OWNER Name ' lin Off yi�v�- Address rivate �v s 33U Uii oi��. e�i/ D Public USE OF WELL 1 - primary 2- secondary ®'RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION []OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED « /EST. OF DAILY USAGE .Fov gal REASON FOR DRILLING NEW SUPPLY OREPLACE EXISTING SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST OBSERVATION 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL El OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �s6 Lot No. U WATER WELL CONTRACTOR: Name �Pvl Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: I YES ✓ NO NAME OF PUBLIC WATER SUPPLY: '" TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION []ON SEPARATE SHEET W,4� date) 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 by the Putnam County Health Departme t. Date of Issue: 19 0 Date of Expiration: 19� ermit Issuing icia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pirk Copy: Owner Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at /sr✓441y / ��, 6?j. (T) ,/74 _Section I J Block Lot po Subdivision of /'� �d aAr /'Y; �9 dry Subdv. Lot # ®0 Filed Map # Date Gentlemen: �j This letter is . to authorize a duly licensed professional engineer or registered architect (I,ndi.cate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagat.ed by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code: Co ters Arfe� P.E. , R.A. ,r7# _7yZ�Z Address Very i r Signec roQ� 9iy_��z Telephone If v lei 7 Town �v Tel pho e APPENDIX B PUT73.00 COUNTY DEP.AKIl+= OF HEALTH - DIVISICN OF ENVIRCNMENTAL HEALTE SERVICES EMM -IDUAL WATER SUPPLY & SUBSURFAM SEWAGE DISPC SAL SYSTEMS REVIEW SHEET - CONSTRUCTION P- T;2MIT DATE Rl:,V7 -M: BY: ✓' cta ter., (Name of Cwner) (Street Location) CctA- %.\ITS YES I NO GI� I � IC Z-1-- I. L' _ .L ench provided !�:�60 ft. ma:,-. Parallel to contours ( �- at T-L SYS= �--° �aVbarrler 1 ft. fi notes rea. - ceotn u es 100 vr. fl elev. 200 ft. reservoir, etc. 130 ft. trigall /gall. L DCCU AaM Peruit Application Corporate Res .pluticn Plans - Three sats s/s Engin s P_uthorizaticn Design Data Sheet (ACS) SJBDIVISICN Deep Hole Log Parc Consistent Perc Resits (3) Fill Perc Hole Depth c3 House Plans - T'wo sett -- Hie? pe. mi t; P-'—is Variance Rec_uest Gr�RPL Legal Subdi.visicn Subdivision Aoorcval C'ieck Ezc- acaroval SS0S Ad . Lots Checked Wetland (Town /DEC Permit R & D) Data Cn DDS Plans & Per -mit S, e REQTj- D DETA TT S CN PL2NS Swage Sys, em Pl an - (north a-r_."W ) Sewage System Hydraulic Prof-'le - Gravity Flcw Fill Profile & Dimensions - Vo17�-t'e D oC:T�;Trench /Gallery; Purp, pit details Septic Tank -Size, Derail Well Detail, Service tine if over Construction Notes (grinder rate) Design Data: per.- and deep re=sl_s Two -Foot Contours Existing & P_- -oosed Driveway & Slopes Cut Footin /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Represeritative or primary and Ex-pansion Expansion Area; shcwn; gravity flca,suff. size If Pmgxd Pit & D Box Shoran & Detailed House - No. of Bedrooms -Wells & SSDS's w /in 200 ft. of Proposed Systan. ProDe.*ty Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Z_Ce pipe No Bends; Max. Bends 450 w /clernout SEPARATION DISMILNCES SPECIFIED CN PLAN Fields 10' to P.L., Driveway, large Trees,Top of fi. 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. 15' to Drains - Curtain, Leader, Footing 351to catch basin,storm3rain,oiced watercour: 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 I• k-SUROWSROV.1 •' • I 15CK la U V• 1 2 to' a•. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. j v /v -/v Owner G %f�i Address Located at (Street) / 6, d,e, , �a /�7 � Sec. lr Block _� Lot a -0�- (indicate nearest cross street) Municipality Watershed Date of Pre- Soaking &3v SJ Date of Percolation Test HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 3 n zz 2s 3 40 2 /v 3 v -3 4 ' yenv le /4,C/ 3y zz z� 3 is 314P fU ///0 U 4 5 1 2 3 4 5 NOrI'ES• 1. Tests to be repeated are obtained.at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. DEPTH HOLE NO. HOLE NO. HOLE NO. G. L. a 21 31 41 51 61 71 81 91 10, 121 13' 14' INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: &dz DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided dae2 No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other NEW '311101-h Name GL f <f Sign��,, Address S % THIS SPACE FOR USE BY HEALTH DEPARTMENr ONLY: O. 241"J' Soil Rate Approved sq.ft/gal. Checked by Date