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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -95 BOX 9 J : ' 19 i ; IN 1. 1. IN I I IN '� ■ '.i A 6.21 L i P / PUTNAM COUNTY DE] Re *X34 8E Dlvielon of Environmental Hea J NT OF HEALTH ep,:Carmel,'N Y 10 >CER C OF CONSTRUMOIN.COMPLIANCE FOR SEWAGE DISPOSAL SY last J ;1 :r= h Owner /ap t Name ON "' Form rly J Ma ling Address ,J ' ..: ; "Lale A4 zip--O �G Separate Sewerage System bnpt by v r ✓�+ • L c. Lf - Jt Consisting of ` Gallon Septic TL and _ Z �vltieer.MvatPmvlelw � 7- / �% •Q' Aafj i;4 iCr't1 Town or Vill Tax Map _ LotC_ Block Subdivision p Name T Date' Permit Issued 2-7 '7 f ss Water Supply: Pnbllc SnPP1Y{ From Address ,Private Sripply Drilled by r �h 4 n -�a�LL Address =-- 14 v o} Building Type Has Erosion Control Been Completed?-�G f Number of Bedrooms Has Garbage Grinder Been Installed? Other;Requlremente I certify that the system(s). as listed serving the above premises were constructed essentially as,sh wn'on the plans of the completed work ( copies of which are . attached), and•in accordance with the standards, rules and r at ions, in accordance th a filed plan, and the permit issued by the Putnam County'Department Of Health. 1 Date �'� I- C art iff e�Mpy ' ^ 1 a P.E. R.A. Address ✓ 't.4� V77 G 1 Aerc-fivik License No. Any person occupying premiss served by'the: above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of. the separate sewerage system shall become.null and void as soon as a publi- sanitary sewer becomes available and the appio'val of'-the` private watei' supply 'ihill become n6if and void When a public wrier supply becomes systlable. Such approvals are subject to odill Rio(' or, change when, in the Judgment of the Coinmisfione ,; �h— uch ►evOCitlon, motllflutlon 0► change Is na spry, Oats - r // � � By �i TitW5 zi ti C CO 0.' 14lrLl.. I.VI'1tLC.ilVly c�r..rvc�t Office Use Only IJEPAWD ENT OF HEALTH Di .vision Of Environmental Health Services PUTNAM COUNTY DEPARTMENT (IF HFALTH / -� /` WELL LOCATION SrREU AOuRESS: wNr I tA% GRIO NUMAE;t: cnu WELL OWNER NAME: Annnss: PRIVATE O PUBLIC USE OF WELL m RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED I - primary © BUSINESS O FARM Q TEST /08SERVATION O OTHER (specify) 2 secondary ❑INDUSTRIAL O INSTITUTIONAL M-STANO -BY ❑ A MOUNT OF USE YIELD SOUGHT _ gpm, /NO. PEOPLE SERVED _/ EST. OF DAILY USAGE -t!!L4 .11, gal. REASON FOR ❑REPLACE EXISTING SUPPLY IJTEST /OBSERVATION [ADDITIONAL SUPPLY DRILLING ffftW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH A9 () ft. I STATIC WATER LEVEL 1t, DATE MEASURED � 9 DRILLING C] ROTARY WCOMPRESSED AIR PERCUSSION IJ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK a OTHER TOTAL LENGTH..._ fL MATERIALS_: STEEL O PLASTIC O OTHER CASING LENGTH BELOW GRADE _ ft. JOINTS: ❑ WELDED HREADED 13 OTHER DETAILS DIAMETER ._ in, SEAL: CEMENT GROUT O BENTONITE 00THER WEIGHT PER FOOT ib.l lt. DRIVE SHOE ES- ❑ N0 irINER: Cf YES NO SCREEN DIAMETER (In) - 'SLOT SIZE LENGTH (IQ DEPTH TO SCREEN (IQ DEVELOM7 FIRST o rt;s aNO DETAILS SECOND _ _ "QURS .,_._... GRAVEL PACK O YES GRAVEL. DIAMETER TOP BOTTOM O NO SIZE: OF PACK In, DEPTH .._._._.,..,It. OEM 1L WELL YIELD TEST 1 II detailed pumping Y E�� LQU II mdrtt Qela +led formation descriptions Or sieve analyses are available, please attach. µFJN00: O PUMPt D tes►g were done is inDEPTH FROM W3jjr well COMPRESSED AIR , formation attached? SURFACE Bear- az I Q BAILED Q OTHER i ❑ YES ❑ NO tt fl 109 metes FORMATION OESCRIPTIOM COO[ In WELL DEFM DURATION ORAWOOWN YIELD �rtace It. hr, min. It. 0M. i WATER 9CLIiAR TEMP, QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES Q NO STORAGE TANK : .TYPE CAPACITY GAS. PUMP INFORMATION II��ORILLER NAM DAiE �r �� T � SONS, INC. I ERT M, 'HYA T TYPE CAPACITf MAKER .. - - - -- _ _ DEPTH ADDRESS Drilling StWrATURe MODEL VOLTAGE HP Rte. i1'. '"' 2 Box 171A STT''' ":•,•.jtv, YORK 12663 PUTNAM COLTN•IY DEPA OF HEALTH DIVISION OF ENVIRONMEr1TAL $EALTH SERVICES A ��,q OFm or Purchaser of Building o 5-( Ala, Buildinng Constructed by L,. G v k �►� Q c, Location Municipality + / `•'tai 1 Gt G h �� �' . Building Type 24, -- ! 96,_ Section Block Lot 1 Subdivi ion la. e Subdivision Lot ff GUARANTEE OF SUBSURFACE S.GE DISPOSAL SYSTal I represent that I am wholly and completely responsible for the location, workmanship, material,. construction and drainage of the sewage disposal syst�-_rn serving the above described property; and that it has been constructed as— °fin on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County DeparbTent 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 inmediately following the .date .of approval of the "Certificate of Construction. Compliance" for the sewage disposal system, or any repairs made by. re 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 detexmination of the Director of the Division of Environirental 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 10 day . of-41r) 19 °i = Signature 055 Alan. o-G Title Gen Con actor (Owner) - Signature Corporation Name (if Corp.) Address N_ \1! rev. 9/85 mk �. &C,11 t4.4 2,,L�Lj, &nktta� I- i-I Corporation Name OX Corp.) P ess LAURENT ENGINEERING ASSOCIATES, P.C. - MILLBROOKE OFFICE CENTRE - Route.22 &Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS April 21, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: As -Built SSDS Lot #14 Courtney Lane. Patterson, N.Y. Dear Bill: Enclosed are the following:. 1. Four (4) prints of Drawing S -10 "As -Built Plan "., dated 4- 20 -95. 2. "Certificate of Construction Compliance for Sewage.Disposal - __...System ".►. _dated .4.- 20-- 95...._ ... 3. Three (3) copies of "Guarantee 'of Subsurface Sewage Disposal System ", dated 4718 -95. 4. Well Completion and Well Log Report. 5. Water Analysis Report. 6. Money order in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr.., P.E. HWN:bd 88044 -14 encs. cc: Mr. R. Alan w/1 copy each NORTH AMERICAN LABORATQRIES, INCM- TYPE: LAB ID NUMBER: LABORATORY REPORT PW 95 -1395 CLIENT: Ross Alan 25 Byram Lake Rd Armonk NY 10504 SAMPLING LOCATION: DATE COLLECTED: COLLECTED BY: Well: Lot 14, Courtney Lane, Patterson NY 03/24/95 TIME: 11 :30 AM R.- Alan DAVE OF R1PORT: 03/27/95 ANALYTE RESULT UNITS METHOD ANALYZED Total Coliform Absent. Colilert 03/24/95 E. Coli Absent This sample, as collected and submitted to the laboratory, did meet the requirements of the New York State Sanitary Code Part 5 -1 for bacteriological (sanitary) quality. r-� Y� Laboratory Director NYSDOH ELAP #11218 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914.278 -7600 / Fax 914- 197.0536 G 7 3, x;T 7�L- %OKA= IMMErARnam.101T 4,� '777".7 TK Yi -A, .,i- er< mar— f rl AAAA_._. 1 "a. Sys' Q, Sb dIV qti t, ! Dtit� 1jT! r 11 t7%� Tc �( M .00b vdae CI N Wbeii FM litmm�b� iil 47) ism" sl t 4, "Te"bi- OWN by", ........... 941W 1140" proposal ikignand: locstlon;,�-of.,.the, IV,0n.thfitpp_r_&W &_m6ndn'4644T'" ' to itpiiiilV nce witS46 stii1dird , 1, 1 .. _!6ruw".anp.re f - Iumi�onsov,xm inen of j-4 ih—, @tL0!!.0qrn00GtiQn th*rr Will 'Consti6c ...... jiapoidory.. o &UlliliWj 'isid,64MV will i 'ihat tiis of 4olkiwI044111i4liti 6f,the IMM- t "i diuik� will 410crilmi above was 46 ~IL 71 'n -A UPW No kpoicnisl4kipir-es,two yurs - for" thiv cclate-, �u be" und"kGn and it 4�4*OVEO FOR COO TMs nt!t*. 4v�li for !U�tlO".Of builcling J�ss cause ora"Y' !'�mq or_nWdi,i4d C66%niiiii6iiii., of kwth.`-` Any chaqp or alteration of construction Muhea a n9w PWM t 'Aporovecl., 'dornedlc un`ft sie a Mupply on Y: -y Rev.' ;ritiii n. JIM DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PIVI* PCHD PERMIT # WELL LOCATION Street Address ('TowWVilla ge City Tax Grid Number WELL OWNER Nam Mailing Address o g rivate O Public USE OF WELL 0- primary 2 - secondary RESIDENTIAL PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 13 INDUSTRIAL t] INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY E( NEW SUPPLY NEW DWELLING PEOPLE SERVED4,Gj /EST. OF DAILY USAGE_440 gal O TEST /OBSERVATION Q ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE-TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (3ON SEPARATE SHEET (date) (signature) 77 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 mann r as not to degrade or otherwise c mina su ce or groundwater. Date of Issue: ' 9 Date of Expiration 1 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller � r• � • r . +a �* t �• °M7ao..� � .s aA;e.�$"a,� �a,,�?6,� A�.a. y.- .,C �Y �,.•'�, Sqr;�- ,�� z w r^s � � .., S z \ �J ^,,. n U `.'� Y �' yyj,Fb. � ✓ ` tbcy yP,�r�N+ 6>r� r AS � y < e ..... Bedroom 12'x11'2" Bedroom 18'2" x 12'4" Bedroom 12' x 11'6" Bedroom 12'x 11'6" � �X "1�I0 u,�'lOG s�' ^G?aCi3g tTtI'IV:iH -TO F'{ - 2T-id,-R i; XTi�i?GG �i�flLtld Wood Deck,.j 8' x 12' i Breakfast Area Living F-I 12'4" x 11'4" Family Room Room 13'2" x 21'4" 13'x 23'4" Kitchen 1002" x 7'8" i DiningRoom 12'4" x 12' Foyer APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS EVIE V $HEET for CONSTRUCTION PE3#1 STREET LOCH ON NAME OF OWNER BY B. HEDGE R.MORRIS O R DATEe� MAP # DOCUMENTS. 171 APPLICATION E01VELL PERMIT w PW S LETTER ® F A16INEERS AUTHORIZATION �J D GN DATA SHEET(DDS) CO TE RESOLUTION S THREE SETS PLANS - TWO SETS VARIANCE 1 EQUEST DIVISION G UBDIVISION SIGN APPROVAL•CHECI RC RATE M FILL REQUIRED D M CURTAIN DRAIN REQUIRED m STANDPIPES AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE ED PIT & D BOX SHOWN & DETAILED_ I I - NO. OF BEDROOMS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS USE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 75T. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS CLAYB R m 10 FT HO ONTAL: SLOPE 3 :1 TO GRADE FILL SP S m FILL NOTES m FILL RTIFICATION NOTE m D GAUGES m FI PROFILE & DIMENSIONS OLUME_ GENERAL m FI ... E ROVAL SSDS ADJ. LOTS WRIXND ( TOWN/DEC PERMIT REQ ?) TRENCH DAT ON DDS PLANS & PERMIT SAME w . TRENCH PROVIDE - NEIGHBOR NOTIFIFICATION �LEL TO CONTO L 'BI/ZBA . I- -� 00 %EXPANSION PROVIDED r - 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED LAN -�/ OUIRED DETAILS ON PLANS FIELD HY�J S E SYSTEM PLAN - (NORTH ARROW) 1 , DRIVEWAY, LARGE TREES TOP OF FILL �DRAULIC PROFILE m GRAVITY FLOW 20' OUNDATION WALLS 15' WELL TO P.I 2TRUCTION NOTES (GRINDER NOTE) m 0 TO WELL, 200' IN D.L.O.D., 150' PITS GN DATA: PERC AND DEEP RESULTS 10 O STREAM WATERCOURSE LAKE (INC.EXPAN) .0-FOOT CONTOURS EXISTING & PROPOSED 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER IlaVEWAY & SLOPES CUT 1 O WATER LINE (PITS -20') T7TING /GUTTER/CURTAIN DRAINS 50' INTERMITTENT DRAINAGE COURSE SPSION CONTROL; HOUSE,WELL, SSDS 200 SERVOIR, EtC.m 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE m MIN TO C.D. S=>5%,20'-4%,25'-3%,30'-2%,351-1%,1001<1% PERC & DEEP HOLES LOCATED 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK L,Lh' FROM FOUNDATION; 50' TO WELL COMMENTS: /) LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278-6108 - (FAX) 278-2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS October 11, 1994 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm Subdivision - Lot #14 Courtney Lane Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -10 "Proposed SSDS - Lot #14 ", dated 10- 11 -94. 2. "Application For Approval of Plans Fora Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 10- 11 -94. 4. "Application to Construct a Water Well ", dated 10- 11 -94. 5. "Design -Data Sheet".*Y 6. "Letter of Authorization ", dated 10- 11 -94. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Check in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. ichols, Jr., P.E. HWN:bd 88044 -14 encs. cc: Mr. R. Alan w /enc. P�C7'x'I�7AT:N COiCJN')C'Se DEPA.R.TM)EW'T (D)E" APPLICATION• `FOR ;APPROVAL` OF PLANS FOR A WASTEWATER •_DISPOSAL• SYSTEM +1: Namd and Address of Applicant: f� ALA 1 ' 2, Name of Project: rr- lyPD9I%9 3... Location mm�o 4. Project Engineer: IJI GNDlTt2 5. Address: M1jA, J!00� 01'�t SZ?� .44 4 roWIJ �o License Number_ � �•12a .. :... •- _ •t =... .! i ��1�7T�� � Y 1050 : Phone: 6. Tyoe of Pro ect: :•.,•. :: t: Private /Residential Food .Service . • .:Commercial Apartments Institutional Mobile Home Park Office Buil_ding't , i Realty Subdivision Other (specify) 7..Is this project subject•to State Environmental-Quality Review'(SEQR)? Tyke Status '(Check One) Type I... Exempt ✓ Type II. Unlisted. ,..8,. Is. ,a Draft . Environmental• . In, pact..:-Statement (DEIS) - required? 9: .Ras. DE, IS been completed and found acceptable by Lead Agency? ....... tJ /A 10—Name of Lead Agency Ill. -Is. t.hi.s._pr_oject.. in an area _under. the control of -local planning; zoning, ..or .other officials, ordinances? �)d f2. If 9.0, have plans- been- submitted to such, author .ities ? ........... .......... _ ►J�Q ` 13.-Has preliminary approval been granted by such authorities? —N-/A�.' Date•Granted: ' 14. Type of Sewage Disposa-T. System .Discharge. -- a. ^ Surface-Water v Ground Waters 15. If surface water discharge, what is the stream class designation ?........ :6.1 Waters index number (surface) .... ... :7. Is project located near a public water supply system? .,..,,., N U S. If yes, name of water supply _ 4.1 /A Distance' to"- water supply , 9.-1 Is project site near a public sewage collection or disposal system ?...,. IJo .0. Name of sewage system Distance to sewage system t. Date observed: 1_ Z-4 A`► 23. Name of Health Inspector: M , t�iUdZINSK -I I*- Project design flow (gallons per day) ,,,,,;,,,,,,,,,,,•,,, ....................................... �j�p 25.- Is State Pollutant Discharge..Elimination System ( SPOES) Permit required ?.._ ►Jo 26. Has SPDES Application been submitted to local DEC Office ?. ............... 27. Is any portion of this project located within a designated town or State wetland?-..,'..., ............. . :............................................. �) 28. Wetland ID Number ........ . ................. ........................ /d 29: -Is Wetland Permit required? ................. :...... .... Has .appl.ication. been made'to Town or Local DEC Office? ...:..::.......... .30.-Does project require a DEG Stream Disturbance Permit? .... ................ tJ0 3.1. Is or was project site used for agricultural activity involving application of pesticide$ to orchards or other - crops, solid or hazardous waste disposal; landfilling, sludge app lication :or industrial activity? ..... .. YES or N0 �)y 32. Is.project located.-within 1-000-feet of existence of abandoned landfill, hazardous waste site, salt stockpile,-landfill, sludge disposal site or any other potential known-source of contamination? ..... • ...... 1..YES or NO_ k10 DESCRIBE: 33. Is .there a local master; plan or file-with the Town or Village? ...:.:..... h_ 34. Are community water, sewer facilities planned to be developed within 15 years? MINA00 35.- Are any sewage disposal .areas in` excess of- 1.5% slope? .................... 'x.10 36. Tax MapOID Number .............. ,.. ....................... .... ..... 37. Approved Plans are to-•be' returned to: ................. • App-1 icant �� Engineer If the application is signed.by a person other than the applicant shown In Item.1, the. application.must be-accompanied by y-a Letter of Authorization: Failure to comply with this provision maybe grounds for the rejection of any submission. f I. hereby affirm, under penalty of perjury,• that information provided on this form is true to the best of my know7edse and be ief. Fa lse statesents made herein are punishable as a Class A Xisde,reanor pursuant to Section 210.45 of the Penal Lair. / A 31GNATURES & OFFICIAL TITLES: ?,AILING ADDRESS: UJs7iiYL , JJ ,`�. j a50-ei DIVI-1 I OF -ENV1MZmNrAT, Hiukra-H SEjtVr, 2 DESIGN DATA SHEET-rSUBSUFACE SEWAGE DISPOSAL SYSTEM RTT, Owner Address 2- 5',8YR4)vf 14?,EQFV. Tomi---A at (Street). Sec. '.'14,4 tl&-k Ict (indicate.nearest cross street) Municipality. , TTY 'R-5 Watershed C)? 0., T6 SOIL PERCOLATION TEST DATA REQUIRM. M BE sUBmr= WITH APPILICATIONS Date, of Pre-Soaking Date.-of Percolation Test. E-101189 --ff0—l;E Ndmm CI= TIME PERCOLATION. PERCOLATION Run Elapse Depth to Wate-,,Frcm Water Level No. Time ti Ground Surface In Inches Soil Rate Start-Stop Min. :Start ..Stop Drop- In. 'Min/In Drop. - Inches Inches Inches 2 C- 3 4 5 7 24' 4' t 2 .3 4 5 NoTFS: 1. 2. rev. 9/85 Tests to be repeated at same depth until. appradmately equal 'soil rates are obtained at each percolation test hole. - 'All data to* be submittlad:- for review. Depth reasurements' to be made fran top df hole. L, 9 12' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOMMERID INDICATE ISM-TO WHICH ,WATER IEVEL R.IStSAFTER BEING M=L k4TE RM DEEP HOLE OBSERVATIONS MADE BY: A/c t r;5 l 0 DATE: DESIGN Soil Rate Used ^ 7 Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms ¢ Septic Tank Capacity 12 S, o gals. Type Absorption Area: Provided By L.F. x 24" width trench Other Name A -5 C. C _ Signatur& Address SEAL ma. 5E124J.. to THIS SPACE FOR USE BY HEALTH DEPA:ONLY: : Soil Rate Approved sq:ft/gal: Checked by Date PU4k4 COUNTY. DEPARTMENT OF HEOH • DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of �ZV55Ll�l Located at . . TTGD�II- -TN►S 1/A1J;�_ Section Block Lot Subdivision of Subdv. Lot # �� Filed Map # Zzl'6 A Date - Gentlemen: This letter is to authorize A}Z `i W. M16HOI G ,riz- •• a duly licensed professional engineer or registered architect (Indicate) to apply for a,Construction Permit for a separate sewageo8ystem, to serve the above noted property in accordance with the standards, rules or, regulations, as promulaga.ted, 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 sy.s.tem...or systems - in_. con�fprmity with the _provisions of Article. 145-or .., 147, EdurAtion Law, the Public Health Law, and the Putnam County Sani- tary Code: -r,ly .. Very truly yours, ; Signed Counters��e d W. Owner of Property Address�i�o>�� Address jZ 2'L II- l -YpvUN f2r.� Town 2�1.+JS'jY fz , �J Y. I d ,5oI - Telephone ��11�� 21� r, -, 10� ' Telephone . 45 - SUI L T ClMfNS /ON CHAR7,11Wr.) N° A B 1 /700 39.00 2 65.00 68.50 3 6650 9 ?.50 4 70.00 98.00 5 73.00 102.50 6 7700 /0750 7 8150 113 SO 8 6500 /18.00 9 ; 68-00 /2300 /O _._..55.00 /Z 2/.00 53-00 /3 2500 6,.5.00 14 2700 69.00 l5 3300 76.50 16 44.00 8,6. 5.,0 /7 50.50 93.00 i' TH15 (s TO G�12T(FY THAT THE SEWAGE DISPDSAL. SY5T�M WA5 A5 INPIGATF-:-D ON THIS 11% %�� .q .j 11% %�� .q