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BOX 9
11191 11 1 1
-7; .. .I
J
UL
ri ' PUTNAM COUNTY DEPARTMENT OF HEALTH .y
Rev . 73/86
DlAsion of Environmental Health Services, Carmel, N 'y 10512
' Engineer Maet Provide
b r.c:H D Permit a P 8 5 8 6
CERTIFICA OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P.A T TE R S O N
E S t .. Town or Y e
Branch . Road
Located at _ Ta:.Map 1 E $lock 3 Lot -- . 1
Owgedeppllcant:Name R i c h a r d Ra p p ., S r. Formerly Subdivision Name - � Sa' b
dv: Let a
c/o Scout `Realty zip 10509 10/7/86
Mailing Addres Dte Permlt issued d'� 1
Route,22.,: Brewster, NY.
separateSewerage , systembpiltby' Mike Rapp Addreesc /o Scout Rea,Tty;. Route22, ;Brewster,NY
Consisting of 1000 Gauonaeptte Tanis and 504 L.F. :perforated' PVC . pipe.
Water Supply: Public Supply From Address
ors' X P.F. Beal Addess '-BF-r- 12 , ,J •4
Private Supply Drilled by—
Building
Type Residential Has Erosion Control Been Completed?
N/A
Nuniber,of Bedrooms 3 Has Garbage Grinder Been Installed? 'No
Other Requirements
I certify that the system(s)'as listed serving the above premises were construqtA essentially .5 o e pl f the completed work ( copies
of which are attached), and in accordance with the standards;' rules and regul s, in a r i'th and the permit issued by the
Putnam Coun�yry Department Of Health.
Date
(/ v Certified by. e P.E.X R.A.
- pldniiri & Cornelius � ' P X. Route 22 Buster .. NY -10 ✓
` Addre License No.
Any person occupying premises 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, (hall become, null and 'vold is. soon as a pubt% sanitary paler becomes
+available and the approval of the' private water. supply shall become null.anb v' old when a public water supply becomes available. Such approvals are
subJect to modification or Change!: when. in the judgment of the m ssionDer {(iff /Health, suchh,r/eevvocatlon, modification or change is necessary.
Date /0 Z By rR sJ vvr `% �?� , _ Title _LL_` ' L
..,J.. _ Y . „,r w " �: Fa'' s ° �,..� :.9 � K „. -a - c�a.'.e�.i,�r_ Ya:ti»"kC��;nC+i�+- xsuxr�:::ry i1`� ",= �;•2?:iS7�i�..?Y+iG'�Fe' �.'K„- '�".w`�;f �nx
W �4
WL'.LL 1rV11rLr,llvly N�rV�1_
DEPARTMENT OF HEALTH •
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADDRESS: wNlYll I Y TAX GRID NUMBER:
Last Branch Rd., Patterson, NY Lot #1 '
WELL OWNER
NAME: ADDRESS:
$f&1� Develop r/ it a „ ewville Rd. ,Brews *er N''❑
p PRIVATE
PUBLIC
USE OF WELL
1 - primary
2, secondary
®. RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL Q INSTITUTIONAL ❑ STANO -BY— ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
m NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING' SUPPLY.; .....0 DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 455' 7ftSTATIC
WATER LEVEL 15 ft.
DATE MEASURED 3/15/89
DRILLING
EQUIPMENT
®ROTARY .91 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING Q OPEN HOLE IN BEDROCK ❑ OTHER-2
CASING
DETAILS
TOTAL LENGTH 41 ft.
MATERIALS: 11 STEEL 0 PLASTIC O OTHER
LENGTH .BELOW GRADE 40 ft.
JOINTS: ❑ WELDED ® THREADED O OTHER
DIAMETER' in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT.
PER FOOT 19 Ib. /ft.
DRIVE SHOE.. ❑ YES ❑ NO
LINER: O YES ONO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
OYES ONO
HOURS
SECOND
_ _..
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE
DIAMETER
OF PACK in:
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST tt detailed pumping
t
METHOD: O PUMPED I tests were done is in-
CkCOMPRESSED AIR , formation - attached?
O BAILED 0 OTHER r ❑ YES O NO .
WELL LOG 11 more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE
waver
Pear-
ing
WeII
Dla-
meter
FORMATION DESCRIPTION
CIOE
it.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Lurface
T,v
,
i r3vr� i .� av 'A-'
Hi
t rc
ck at 201
4651
6
4459
5
20
4
; rock.-set casixn ra to
t
41
,465
D
it
in g -in rock granite.
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE Well Xtrol 250
CAPACITY 44 GAL.
WELL DRILLER NAME P.F. Beal & Sons,Zng,. `; P4TE9/1 89
ADDRESS PO BoX B SIGFl3MRE ` /.'
Br`T'cast:c�r,Il'1 i050�
PUMP INFORMATION
TYPE submersible CAPACITY 59
MAKER r**i9T r DEPTH hLn I
MODEL 5ES07412 VOLTAGe -3 HP3L/
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 279 -4945
- WATER ANALYSIS REPORT -
SAMPLE NO. 7479 HOSE BIBB WELL
SOURCE: R &R Developers
LOT.8 .1, East Branch Rd.
Patterson,' N.Y. 12563
COLLECTED: 8-30-789
BY: P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
8- 31 -89]
21000112 � f /L--11
Thomas Meyer
Director
PUMAM COUNTY DEPARTKERr OF HEALITI
DIVISION OF FNVIROiN1TAL HEALTH SERyICES
owner or Purchaser of Building-. Sectiinn Block Lot
Building Constru ted by Tax Map Number
Location — Street
Municipality
Building Type
A4,,7- 15 /1�
Subdivisi on Name
Subdivision Lot #
GUARANI 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 selvage 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 donclusive 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 5
� r
General Contractor ( ) - Signature
Corporation Name (if Corp.)
pr� •�. y�rl• �� -- �7 y cam,, s'T��, ti�
Address
rev. 9/85
mk
c
Signature
Title T < 14 S � .1 Ov
f /Z L"- /a
Corporation Name (if Cofp.)
Address -' �s -� F
'II.
W.
V.
Vi'
f0 FEPL SI`T'E' DJSPECTICI�l Date 3v ��
( �) _ - 'Q CRIER �T_ Ins�'E='�sd v/
.CN �LLQ `1;1l'� L
} r
)� r"A 8 OR SU-EDIVELSICN; LCIT
- - --
SL: L DISr-'OSAL A RED
a_ E-jS are_ lc a t-d as per d✓Drovea Dlans
I YES
NICL. CGM F7rc
b. Fill s i cn - Date of placenent
2: 1 barrier LGIH WZD H AVC . DPTR
144
c. r7atu=al sci i nct stricced
I -�—
d. S tcne , bras= etc . ', ere te-r tian 15' frart SDS area-
e. 100 ft_ f_=. water ccur= e / *Hetiands.
I
mil-..
SL v�r� DISrGSA.L Sjcl`n
G. ,.eo�c t: n.: s_z - 1, 1 / 2�0
1 -
I
I
b'. c=mtiC ea leve
c . 10' min i mrn -_ =m fcundaticn
4' a0� c? =^.cut witriin 10 ft. of 450 herd
. �- 1� �
e. D i S==N. MK
1 All cutlets ets at sae e-l-`va } Cn - �hlGt =T tes`r- :
hoIl
Protec -:1- h�elcrV fres_'
[vii n_mi= 2 _' Cr1ci nal sci between bcx ar-d t rc.c:?es<
I--��_
f. j e,-CC'I'ICN ECX -- nrc=e rlv Set
1 L =nc=`� r� ' _ - qTq Len&,lh , ins tell c�= ✓V
2. Dis anca L'.7 waterC'ur m—s'y u fi..
�••-
1 `4T
1
- Install = Ec -rdinc tc�plan
Di =tancsyc__t`r to Canter
I —�
" S_c� c= .ch accect=�le 1/ L'o - 1/32 " /fcot.
E. 10 f = =uu Drcre_= 1-ire - 20 f�
! Den-E1 c= %an_C_^ < 30 L''.G'les f "'an c'i r=cCz_
8. Rcan all r-ce::E fcr es- ans i cn, 50S.5
I
9. Size c= c a -vet 3/4 - 1=" diamet_r
'10. Deot n cf a �vz1 in t_ E-.ch 12" mini'm
h. F -DT . GR DOSE Si57_r,-,4S
1 Size of c=,,,;' c:a-nher '
_
2. Gve-rflc- . taomic
I
4. p=r) e=s' 1v ac_essible mar-hole to crade
5 First hcx caf "_
6. Circle wit._e-csed. by Esail th De_.G_ me
- =aw p-ar c7 cle (
I
a_ Ecuse lcca== c_r acorcve -i p1G*�s.
b_ -
\�zicer cr he�CC:<•= c�
a. w-zLi lcc=_t_- as cer acnrcver plans
b_ %ist __,ce f_= SLS area te_-sured ft.
c. C_sinc 18" al:cvc cr ade.
d_ c T=aC° dry ace arcund wel acre- c.,iah e 1
CVO ; .� . Snti7Rh�.i =RE_� 1
a_ E~Y2S prccer_v crcut
✓�
1
b. Ai_', PiZES
-
C. A_--, piCes f_umh with in=side of hes
d. i 1 Bret = -i a1 ccnt ins s tcnes < 4" in di�Tet�
_E=�kf
e. C., -tom; n dr = n in_ Willed accordinc to plan
�^^ i 1 1 r-�-= i t v' �� i^
f_ C- �.. n d.r= cut =a._ prcte_�.^ & d_ _to e__�_`.��a_.=ccur�-"`- "I"'I-""'
c_ r-ocr..una cra_r_ c__=czarce awav z_czn
h_ S =ace wat =� crct=c-t, ±cn adequate
1_ iY_csicil Cc =_! crcvidad cn sioCes cr; :--ter t^lur 153.
�� "L 7` "!S'v+^ +'f✓' " "T 7 i'-t`^ 5 T?'S' S ry° xP^ `Y .r- x•+f'y ;} „� z 'k y�rx, r1. ��
PUTNAM COUNTY, DEPARTMENT OFHEALTH
g ? eer'to Provide Permit a .
Rev. f 86 Dlvielon of Environmental Health Services "Carmel N:Y 1051?
' J� on RTIFICATE OF C MPI.IANCE
�..D
CONSTRUCTION P_ - FOIL SEWAGE >DISPOSAL SYSTEM
P
Locked at E a s t $ r S n, C h R o a d Yawn or : wmage '-
Sabdlyision Nsme E . ' B r;a n c h .'Woods_ Sabd. Lot a 1 Tax Map =' Block --�-3 Lot
a
Renewal_ Revieton ❑
Ownet /AppUcant Neme R 1 "Chard Rapp ,
Date of Previous Approval
Mailing Address CIO S:C O U t :Rea 1 t Y Town
Brews °te'r, N'Y 1Q5'09 p
Building Type ' S i n g l e F,a rh D w e l Lot Area 1,: , 6 2 4 /A a FtHD tlon only. Dopt6 > Volume
Number of Bedrooms '` 3 Design Flow G /1?/D . 6 0 0 • Notlfleatlon is Required When Fill is completed '
Separate Sewerage System to consist of Gallon Septic Took and
To be de_term`ined .
To be constructed by Addree@
Wake :SnPP1J Pab1lc,Sapply Flom Address
or X X Privpte` Supply DrIDed by T O d et a r m
Other Regatrements
represent at'1 am wholly and completely responsible for the design and location of the proposed systems) 1) ,that the separate,,sewage 'Gisposalos stem `.,
above; tlesuibed w�II be.construcYetl as shown on tFie;approved' amendment there to antl maccorGance with the standards; ruler an regu,a ions o <, a u.nam
County Oepaitment of Health .and thbt,on completion thereof a Certificate `'of Const►uetlon. Compliance satisf9ctory to'the Commissioner,ot Healthwill
be• submitted Ito the Department, and i '%w'4 tten -guarantie `- be•fwnuhed; the owner his wc2essors,.iieirs or, assigns by tho bwlder' that'
said builder,.will ,
place..m good 'operating condition any :part of seitl sewage disposal} system pur g she period of two (2,) y rs; immediately following the date of thoissu _
an�e .pf, the approval ;of thB Ceit�f�wte Af Con'stiucUon-COmplfance of the o nalaystem oi, y, a ereto 2) that the armed well'desuitied'.above'' :,
will be located 6s shown on the approved plan and Mat said'well w�lhbe'install accordance h e' ; rules and, regu a „i —ri ons of.:.the :Putnam
County Department of ,Health p A r
Date. 9 4 8 6 Signed
Address For B &C. .RD6 Rt 22 Brewster, 10509 L'ic'ense- No
4
APPROVED FOR C NSTRUCiION This approval�exp�rei'one year from the, date ued unless construction of,'the' building has'been °undertaken
flf
revocable' ?or cause, m e amended 6n 0 n notes :;by e^Commis `on r,', f. ealth; Any charge -or slteratlon.of construction
ll J
requires a newer 't.' PCOproved for disposal ofaomest;ic sang r ae a and rva of r u ly only.
Date By;
Title'
"6
EP RTMEN f OF-HEALTH
HEALTH - - -- -
Division Of Environmental HgAIth Services
TWO COUNTY CENTER — CARMEL, N.Y.. 10512 (914) 225-3641 .
APPLICATION TO CONSTRUCT A WATER WELL
WELL SITE SUBJECT TO FLOODING? YES NO .
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:E. Branch Woods
LOT NO.:
I rER WELL CONTRACTOR: Name
- Address:
PUBLIC WATER SUPPLY AVAILABLE TO SITE: ___ YES .x NO
LE OF PUBLIC -WATER SUPPLY: TOWN /V /C
I;TANCE TO PROPERTY FROM NEAREST_ WATER MAIN
:ADION SKETCH & SOURCES OF CONTAMINATION
(date)
(signat�pre)
PERMIT '
TO CONSTRUCT A'WATER WELL
This permit to construct one water well asset forth above is
granted under the provisions of Subpart 5 -2 of Part 5 of the Neva
York State Sanitary Coder 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 orm prov' b
the Putnam unty Heal Department. /'
Date of Issue: 9
Perm , Issuing Official
Permit is Non - Transferrable
1AFfT L A S
1OViNIVILLAGE101Y lax UMU HOMER.
_L LOCATION
East Branch
Road Patterson 18
- 1 - 18 L6�- /
ELL OV'JNEfl
NAME.
ADORES IS:'
NJ- P;9iVAT(
PUBLIC
E OF WELL
Q RESIDENTIAL
❑ PUBLIC SUPPLY ❑ AIR /COND. /IIEAT PUMP
❑ ABAtIO'NED
primary
❑ BUSINESS
❑ FARM 11 TEST /OBSERVATION
❑ OTI-IER (specify)
secondary
❑ INDUSTRIAL
❑ INSTITUTIONAL ❑ STAND -BY
❑
IUt1T. OF USE
YIELD SOUGHT
5+ gpm. /N0. PEOPLE SERVED 3 -5 / EST. OF DAILY USAGE ' 450 gal.
:ASUN FUR
® NEW SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY
❑ TEST /OBSERVATIDII
1RILL1I�G
❑ REPLACE EXISTING
SUPPLY ❑ DEEPEN EXISTING WELL
ELL TYPE
Q DRILLED
DRIVEN- DUG E] GRAVEL OTIIER
WELL SITE SUBJECT TO FLOODING? YES NO .
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:E. Branch Woods
LOT NO.:
I rER WELL CONTRACTOR: Name
- Address:
PUBLIC WATER SUPPLY AVAILABLE TO SITE: ___ YES .x NO
LE OF PUBLIC -WATER SUPPLY: TOWN /V /C
I;TANCE TO PROPERTY FROM NEAREST_ WATER MAIN
:ADION SKETCH & SOURCES OF CONTAMINATION
(date)
(signat�pre)
PERMIT '
TO CONSTRUCT A'WATER WELL
This permit to construct one water well asset forth above is
granted under the provisions of Subpart 5 -2 of Part 5 of the Neva
York State Sanitary Coder 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 orm prov' b
the Putnam unty Heal Department. /'
Date of Issue: 9
Perm , Issuing Official
Permit is Non - Transferrable
DIVISION OF EIS ��IRONIENTAL HEALTH SERVICES
COTUff OFFICE BUILDING, CARMEL, X. -Y. 10512 -''
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
O'rtne]lRichard L. Rapp Address Drewville Rd. Brewster, ,N.Y. 10509
Located at (Street D Sec. Block •3 Lot 4
OndInate neares cross s ree
tun.icipality. _Patterson Watershed Croton
SOIL PERCOIATION TEST DATA R - 0JURE6 TO BE SUBMITTED WITH APPLICATIONS
.Subdivision Lot #1
bole
Number
CLOCK
TIME
PERCOLATION
PERCOL;ATIOA'
'Hun
No.
SStart =Stop
Lot 1
Elapse
Time
Min.
Depth to Water Water Level
From Ground Surface- in Inches
Start -Stop 'Drop in
Inches. Inches . Inches. ..
Soil Rate
Min. /in drop
.
A 1+15
- +45
= '30
min
25
27 =240
'' =1.5.00
2• +45
- . +75
30
min
25
26.38 ',=1.38
=21.74
3 +17
- 48
= 31
min
25..
26.63 =1.63
=19.01 '
4+48,--
94
= 46
min
25-25
27 -.5n =9-';O
i R _ n4
5 +34
-- +6'5
=; 31
min
25
27.25 .= 2..25... .
=22.66
B 1+3.6
- +70
_ .34.
min
26
28.25 =2.25'' `
=15.11
2 +13
- 43
= 30
min
26
27:50 • =1. 50"
-gin nn
3 +44
- 95
= 5.1
min
26
28.'25!.=2.2514_ -
=22.66 .
4 +35
- +70
_ 35
min
26
27.75 = 1.75"
=20.00 '
Notesai 1J Tests to be.lre.peated 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.
\I
DEPTH
G.L.
3'
41
HOLE NO.
Topso!'
VJ/ c-'LA Y
51
0
61.
71
81
Dot NVOR i voi 05 970 ONW—=
HOLE NO.
HOLE'NO.
J-4
'7*
INDICATE, LEVEL. AT WHICH- GROUNDNATER- IS ENX)OUNTERED. NON
INDICATE LEVEL.T0 WHICH WATER 1=..RISES AFTER BEING =UMTERED
DEEP HOLE. OBSERVATIONS MADE BY: go.ci+Aem)-T,. 2-A pp :JP- DATE:
DESIGN
soil Rate used 3.6 min/191 Drop: S.D. Usable Area Provided SZ.700 sf
No. of Bedroams 3 Septic Tank Capacity 0 _gals'. Sype coc
Absorption Area -provided By. 5-0+ L.F. x 24 width trench
)F Nek,
Other
BALDWIN & CORNELIUS, P.C.
Narre
6, R 17 22
Address BREWSTER, N.Y. 10509
re
49% 1980 f
83
SS1014
THIS SPACE FOR USE BY f1EMTH DEPARMM ONLY: .........
Soil Rate Approved sq.ft/gal. Checked by Date
V
j
r
J-4
'7*
INDICATE, LEVEL. AT WHICH- GROUNDNATER- IS ENX)OUNTERED. NON
INDICATE LEVEL.T0 WHICH WATER 1=..RISES AFTER BEING =UMTERED
DEEP HOLE. OBSERVATIONS MADE BY: go.ci+Aem)-T,. 2-A pp :JP- DATE:
DESIGN
soil Rate used 3.6 min/191 Drop: S.D. Usable Area Provided SZ.700 sf
No. of Bedroams 3 Septic Tank Capacity 0 _gals'. Sype coc
Absorption Area -provided By. 5-0+ L.F. x 24 width trench
)F Nek,
Other
BALDWIN & CORNELIUS, P.C.
Narre
6, R 17 22
Address BREWSTER, N.Y. 10509
re
49% 1980 f
83
SS1014
THIS SPACE FOR USE BY f1EMTH DEPARMM ONLY: .........
Soil Rate Approved sq.ft/gal. Checked by Date
NJ
PdTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONKENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
(Name Pf er)
COMMENTS
I/
REVIEW SHEET — CONSTRUCTION PERMIT
DATE
BY:
(Street Location)
YES NO, DOCUMMUS
Permit Application
Corporate Resolution
Plans Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Var$ance Request
REQUIRED DETAILS ON PLANS
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions.- Volume
or J Box;Trench /Gallery; Pump pit details
-Septic Tank - Size, Detail
:Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area; shown; gravity - f.low, suff : - -size . -
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Stoxm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
DIVISIOR OF rPATTRONfENTAL HEALTH SERVICES
COUNTY OFFICE BUILDiTIG, CARME -L, X. Y. 10512
DESIGN DATA SHAT- SEPARATE S31AGE DISPOSAL SYSTEM FILE NO
0-itnerRichard L.`'Rapp Address. Drewville Rd. Brewster, N.Y. 10509
Located at ( StreetOndicate D ' : Sec. 1-r Block 3 Lot4 , 4
neares cross ss ree j
Municipality Patterson Watershed Croton
SOIL PERCOLATION TEST DATA RnUIRE'D TO BE SUBMITTED WITH APPLICATIONS
Subdivision
Lot #1
= `30
min
77016
'27
= 2..00..
`-1.5.00
Number CLOCK
TIME
PERCOLATIONI
PERCOLATION
Run
Elapse
Depth to Water WaEer Uavel
=21.74
IVo.
Time
From Ground, Surface in Inches
Soil Rate
Sitart -Stop
Min.
Start Stop .. , -Drop.: in
Min. /in drop
Lot
94
Inches...... Inches .. '.inches . _.._.....
.
A 1+15 +45
+45
= `30
min
25
'27
= 2..00..
`-1.5.00
2* +4.5 -
+75
= 30
min
25
26.38
r-1:38
=21.74
3 *17,=
48
= 31
min
25.,-.
26.63
=1.63
=19.01' ✓
- 4 +48 -
94
= 46
min
95.95
97_.50
_7_Sn
1R�n�
5 +34 -
+65'
, 31.min•
25.....
27.25....--2.25..
,.,
=22.66
B 1 +36 -
+70
34
min
26
28,25
=2:'25
=15.11
2 +13 -.43
= 30
min
'2.6
27:50'.
=1•.50"
an nn
3 +44 -
95
= 51
.min
26
28.25. !. =2.25 " .
=2,2.66.
4 +35 -
+70 35
m1n
Notes.: 1) Tests to be repeated at same depth until approximatelyy equal; soil
rates are obtained at each percolation test hole. All data to. be subiaitted
for review.
2) Depth measurements to be made from top•of hole.
TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION
OF • • LS ENCOUNTERED IN TEST HOLES
DEP'T'H HOLE NO._ HOLE NO. HOLE NO.
G.L.
11 Topso i L
2' I I
.31 LoAi
4' c- LA
5'
6'
w � CA_, A y
7'
8'
9'
10'
13'
14 k- '`' '4
i ark
V1
` � NoNC p-
-
INDICATE.
LEVEL -. AT WEiICH GRO�. -
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
.DEEP HOLE OBSERVATIONS MADE BY: g, c l+Ae p _T. ZA p P ? R DATE: 10 / 14 /84.
DESIGN
Soil Rate Used 30 Min/1" Drop: S.D. Usable Area Provided .SZ'°0 S�
No. of Bedroans Septic Tank Capacity / O o U -gals. Type C-0, c
Absorption Area Provided By 56+ L.F. x 24" width trench
Other
Name sjjia& re
BALDWIN & CORNELIUS, P.C. a SEAL
c� r
Address R9- th, RTF 99 p� AL 1980 'm2
BREWSTER,: N. Y 10509. ;� `"� ti
THIS SPACE FOR USE BY HEALTH DEPARENir ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
yiy.LoiU1V. U!'' E'RV1NUlVMLENTAL HEALTH SERVICES
COUNTY OFFICE BUILDiTIG, CARMEL,' X..Y. 10512
DESIGN DATA SHEET-SEPARATE SEVIAGE DISPOSAL SYSTEM FILE 110.
-Oc�nerRichard L.- Rapp Address Drewvi'lle Rd. Brewster, N.Y. 10509
Located at (StreetNndlcate D Sec., Block •3 -Lots 4
neares cross. s rep,
Municipality Patterson
SOIL PERCOIATION TEST DATA
.Subdivision Lot #1
Watershed Croton
RE'Jt1IRE'D TO BE SUBMITTED WITH APPLICATIONS,
oe
Dumber
CLOCK
TINE
.
PERC6LATIO14'
PERCOLATION
IVo.
!tart -Stop
Lot 1
Elapse.
,Time
Min.
p o Water Water Level
From Ground Surface in Inches'
Start Stop ... -Drop in
Inches- Inches Inches..:..._...
Soil Rate
Min. /in drop
-. .
A 1 +15
- +45
= `30 min
25
27.
= 2..00.
'' =15.00
2445
- +75
30 min
25
.126. 38
T1.38
=21.74
3+17.
= 48
= `31 'min '
25..
'26.63
=1.63
=19.01 '
4 +40
_ ..94
= 46 min
25. 25
77 . g;n
=9 g;n
1 FA nd
5 ±.34
+65
=, 31..min .
25
.27.25
. =2...25 , .
=22.66
•B, -1. +36
- +70
34 min
26
28.25
=2.25
=15.11
2 +13
- 43
30 min
-26
270'50'=11.50"
_gin nn
3 +44
- 95.
' = 51 min
26
28.*2:5 •. =2.25" - ..=22.66
;
4 +35
- +70
35.min
26
27.._75:.- 1..- 75° - --
- =20:00 _
5. +11
- +43
a_32 min
26
2A_00
=9 _00
_16.00 .
2 _
4
5
Notes:: l-) Tests to be. repeated at same depth until s roximately 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
'a
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
�• To PSo
2`
3'
4. W /C-LAy.
5'
Sfi-N � ",y LpF}N�
6'
(N/ GLAy
7'
9 Of
Ll
1 v
131
14'
WHICH-GROUNDG� 'S. E[vU0(iNTEEZED _ - ._._ -_. -- - -.. -N -ONE
INDICATE LEVEL TO WHICH " WATER LEVEL RISES AFTER BEING ENOOUNTERED No N [-
DEEP HOLE OBSERVATIONS MADE BY: c I+Ae-D -T. ZA P P ? iZ • DATE:
DESIGN
Soil Rate Used 3 Min/1" Drop: S.D. Usable Area Provided SZ�°Q s�
go. of Bedroans 3 Septic Tank capacity gals . Type coN c
Absorption Area'Provided By 50 4- L. F. x 24" width trench
Other unui�y�_,
. Q. RA n. g(P
e V4
�r-
a
Address ,. . ._.. � SEAL
a.:
it
THIS SPACE FOR USE BY HEALTH DEPARDENr ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
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