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Home My WebLink About0906DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -22 BOX 10 NJ �� ~, : IX. din . I oil IN r ` L �i. ti � ti7 16 1 ` r� IN I IN �ll Rev. .3 /r �^ OF Located PUTNAM COUNTY DEPARTMENT OF HEALTH �Z Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P, !�' 1-0-7 P.C.H.D. Permit N FOR SEWAGE SYSTEM _ I �Tl1fz' -!a _.. Town or YRlage 46113 p Tax Map Block�_Tot�� Owner /applicant Nome�l%l-Ij wy- f��s AI. t l Formerly Mailing Address ml e, I= r. i NCI l>0W' -:5T zip 10*10 Subdivision Name Subdv. Lot # Date Permit Issued Separate Sewerage System built by NalL 6g v /'<Jg Address 9 Y t �, PfiTy4esQN N y Consisting of 1 ooa Gallon Septic Tank and i Gft Q ES Water Supply% Public Supply From Address qq�� /� `' IE or: Private Supply Drilled by MILL DRILLIN% , I ML Address t�tTl�J4H AVE. J$2L✓w15-ft� NY Building Type AL Has Erosion Control Been Completed? y ES Number of Bedrooms Has Garbage Grinder Been Installed? OtherRequiements l'�tC2yAl/t! D2��tiJ I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and r u • � ationa, in accordance with the fil lan, d the permit issued by the Putnam County Departmept Of Health. l Date / % % �� Certified by- r P.E. R.A. Address V� • N J�� np 1 �� Any person occupying premises served by the above system($) shall promptly take such action as maybe 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 publ;: sanitary sewer becomes available 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 modification or change when, In the judgment of the - Commissioner of Health, such revocation, modification or change is necessary. Date 31 By✓Ti �I.s �- -^ _-- J Title El IS A. TARLTON LABORATf''�Y DIV1510N OF ELLIS A. TARLTON, ENGINEERS, INC. H L 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 MATER -WASTEWATER PHYSICAL METHODOLOGY BIOLOGICAL. P.O. BOX 2328 203 - 748 -7903 APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER NAME AND ADDRESS OF PERSON TO RECEIVE REPORT F Mill Drilling, Inc. Putnam Ave Brewster, N.Y. 10509 1 DATA —J SOURCE OF SAMPLE Water Supply, Alicci Res. Quincy Road Putnam Lake Patterson, N.Y. DATE OF COLLECTION May 18, 1988 COLLECTED BY Mill Drilling .Hydrogen ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (PH) RYZNAR NTLI Mg /t Alkalinity as CaCO3 Fluoride (F) Bicarbonate -Nitrite MOIL MOIL MOIL Alkalinity as CaCO3 Chlorine Residual NITROGEN CONSTITUENTS Nitrate MOIL Carbonate MOIL Mg /l AS NITROGEN (N) Total Hardness as CaCO 3 Conductivity Ammonia MOIL MOIL Micromohos/crr MOIL Iron as Fe MOIL MOIL Chlorides as CL MOIL Manganese as Mn MOIL MOA Dehirgent as MBAS MOIL Sulfate as SO4 MOIL MOIL The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST - - Co llform-Colonies /100ML one colony per t00m1. Co111orm colonies paY standard sample shall hot_e><eeed 3/ SOmI,_ 4/ 1QOfnl.._71200ml— or.._13 /SOOrnI in: (al Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month: or (c) 0 More than five per cent of the samples when 20 or more are examined per month. AT THE TIME THE SAMPLE WAS SUBMITTED: 'I. The results of the analysis of this sample were satisfactory and met requirements for a potable water. Qa 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: EJ:1. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group In a sample of potable water is undersirabie and, while not necessarily Indicating the presence of any disease - producing organisms, does Indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also Indicate that the treatment was not adequate at the time the sample was collected. D4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicates the water potable. - Certified...... ........................ ...........................p... !n• WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Iff STREET A00RESS: wNivl I Y TAX GRID NUMBER: WELL LOCATION Quincy Road Putnam NAME: ADDRESS: ( PBIVATE WELL OWNER Dominic & Gladys Alacci Q PUBLIC USE OF WELL )G 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 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR 0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 425 fj STATIC WATER LEVEL 10 ft. DATE MEASURED 5/ 10/88 DRILLING ❑ ROTARY kkCOMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING, EkOPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS SCREEN DETAILS. TOTAL LENGTH 50 ft. MATERIALS: PxSTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 48 2 ft. JOINTS: ❑ WELDED UTHREADED ❑ OTHER DIAMETER 6 in. SEAL: )G CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 191b. /ft. DRIVE SHOE MES ❑ NO I LINER: ❑ YES ❑ NO DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST GRAVEL PACK O YES ❑ NO I GRAVEL SIZE WELL YIELD TEST ; If detailed pumping METHOD: O PUMPED tests were done is in- ®)CAMPRESSED AIR ; formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL DEPTH DURATION I DRAWOOWN YIELD I it. hr. min. DEPTH It. ft, 9pm. WATER Lg CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? 4PES ❑ NO ANALYSIS ATTACHED? 19 YES ONO PUMP INFORMATION TYPE CAPACITY 7 MA ER Goulds DEPTH 260 MODEL 7 E H 0 7 VOLTAGE 2 3 0 HP 3/ 4 15 281nol ❑ YES ONO ISoft, crusty, brown ledge. - — - 38 HOURS z6 Med /hard fractured ledge. DIAMETER TOP BOTTOM ve- 6 OF PACK in. DEPTH ft. DEPTH It. It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach: DEPTH FROM Water Well STORAGE.TANK: TYPE Diaphram. CAPACITY 42 GAL. 14 WELL DRILLER NAME Mill Drilling, C. 'A?/ 10 / 8 8 AOORESS Putnam Avenue SIGs Brewster, NY 10509 SURFACE ear. Oia- 1 FORMATION DESCRIPTION paE. It. it. Ing meter 15 281nol 6 ISoft, crusty, brown ledge. 28 38 no z6 Med /hard fractured ledge. 3R 1I95 ve- 6 Nled /hard oink & orav aranite. STORAGE.TANK: TYPE Diaphram. CAPACITY 42 GAL. 14 WELL DRILLER NAME Mill Drilling, C. 'A?/ 10 / 8 8 AOORESS Putnam Avenue SIGs Brewster, NY 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.._. �QM N r�K J L0>7 s 14141-x1 Owner or Purchaser of Building &O2M 4E7ZIcHN Building Constructed by Location - Street FR, 77,- 7Zso,u Municipality ,ee5 I i�>e5A/Tl RIL' Building Type 19 a 46 / r - -fag s Section Block Lot Subdivision Name Subdivision Lot # GUARANTEE 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 Environinental 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 C % 19 E0 G Signature Title Gener Contr or (Owner) - Signature Corporation Name (if Corp.) ? i 5 rT, I NPOOU -Perko s I .. Address �, N-/ rev. 9/85 mk Corporation Name (if Corp.) Ells 1 �UWLO Qty Address ^ WON r7. V. V-1. . FTVAr, SITE LISr`C'-'ICN Cate �zw In=Zected v Am �? ;r OR SuMDItT_SIC-;q T :/r _ - -- - - - fs tic C lwMEIL^ DISr•CSr1• r, Pow-_ b. F=l s icr. - Date of glace-re-rit 2: 1 bar'"i e_> L M-79. Wi1T11 -1 C- =cii rct s `i rr d I I d_ S` .e, brussin, etc. , crEate_- than 13' f_aan SDS arm I �I I e- ft- f_a.: water ccur==_ /•.Y2- ands- I I a. SEC �C tank lrGCU b. c= - -;c tar-ti C. l ri t-, i rI� : t -"..- --- .err'• -=%� Cit I I I� �/IDJr ri / /� _,013 Ir�rc_ C_- �ncT�� w� _�� -- ltd t of 450 b�.0 G_�, t 1 GEC � Gs`. a l evert- T., 2 Prct =r- -cr- '-e-Lc f -c= t I I i t.1in_:nL•t 2 Cr = SC1! :c =vc ° ^_ ccx and L'.c_CnES • Di5 ^.Ca L' . G . 'L' ='- IT. =... =5'.:Y L L . I 1 L lY 4. S_Crc C.' `—C;, acc =7- =^le 1/ ! O - ! I32 =CCr. E. 10 ^_ r- _.. �,-`T ! ' n= - 20 e c- t_` < 30 I I E. Rc= a l 1CWF-� Cr Er. __n_SiCi_r cU� C Size ze of (. r .7a 3/4 -cDt -1 C- C avali in t =-nc ? 12" a .- *Tan I I • S-ize of L_ 2. Cva= -- c lw r _a : < = 1�*i1D eta -cl.= i ac=esc; b e Ira_ -hcl - to Ciade I 6. cl e w_ i. - =_ CV Gs-.2 t Dcr_c: �ttEnt I e5t i maL = flaw Car C JC! e I I I HCuSE a. Ec'_s=_ lcct=—, t ='' accrccea plans. b. cf JL.u: a l'1i -:_ 1cCat =� as Ca_r ar =rC -, e= b. Di - -= 1C= f'-•- cL.0 aT == It' = =Cur=^ ft. C. C==-nc- 18" a•-'"cva C ere --= - b_ oi.r;es C•— ; T �.�; l i ( . C_ ALI ci Les with inside of ]--c: I I/ I -- d_ c^nt =i n= stcne_= < 4" in ci `-rat_ e_ C_— = in c_ __ accordi nc Ll� ^tan I I I f _ _ i *1 Ctr C" i- l 1 ZTr�C =�1* & C' T' t0 E"' ` 'vc - =T •-�•L - /I�' -_�- -_ (:jr--zins c arse away Fran EDS ar -= I I L — h _ �, = =c= w -mot =r c-ct1-= : cn i . - -c- nn (' n siG`cs Cr' =L- than 1 5:.� _ I — "� PUTNAM COUNTY DEPARTMENT OF HEALTH U Rev;: 3/86N\ Division of Environmental Health Services. Carmel, N.Y. 10511 Engineer to Provide Permit q on CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT FORS GE DISPOSAL SYSTEM Permit N Located at_iXit -t —� 3K Tgxn- or village Subdivision Name Subd. Lot A Tax Map Block Z Lot lom- z3 YS ,j _ Renewal_ ❑ Revision ❑ Owner/Applicant Name ((� f y� Date of-PPrrevvlou_s Approval �� Mailing Address 341 f:Cfl _i I N 1�1 N I// m b i_ Town �1 N x. - �� Y Zip i D 'e3 Building Type aEs { � Lot Area Fig Section Only Depth volume Number of Bedrooms 7 Design Flow G /P /D �D '� C7 PCHD Notification is Required When FIB Is completed Separate Sewerage System to consist of IQO-(2 Gallon Septic Tank and L �' o 4'N4'. G141,I.t�Zl. To be constructed by _171 G. Address 4vater Supply: / Public Supply From Address or. ✓ Private Supply Drilled by Q Address Other Requirements i represent that 1 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 an regu a wns o e u nom County Department of Health, and that on completion thereof a'•Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill ,)a submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Complia f the original system or any ►ape' thereto; 2 at the drilled well described above will be located as shown on the approved plan and that said well will ins a in accor ce with the stun rd s, as and regu ns of the Putnam County Department of Health. p,E,� R.A. Date •a .-�� Signed Address' F t%' License No APPROVED FOR CONSTRUCTION: This approval expiresr year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered nllcessary by the missioner of Health. Any change or alteration of construction requires a naw�rrmit. Apprgovedd for disposal of domestic sanitary sewage rivste water only. Date '� % �{ / S� g Title 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 Addres T Village C ty Tax Grid Number v - 40/0- 40Z WELL OWNER Name �n S Mailing Address m7e ?ao 'Private O Public USE OF WELL primary 2- secondary EI RESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION M INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED _5::: /EST. OF DAILY USAGE,4�;Q gal REASON FOR DRILLING ONEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE 19DRILLED DRIVEN ODUG GRAVEL E] OTHER IS WELL SITE SUBJECT TO FLOODING? YES V'-' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name * -S. �). Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,-' NO NAME OF PUBLIC WATER SUPPLY: /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /A LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED e-&-0-7 O ON REAR OF THIS APPLICATION ffON EP TE S T (date) (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 s.hall: 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 P am County Health Department. Date of Issue: / 19� /�f Date of Expiration: 19 ermit Issuing ff Permit is Non - Transferrable Mite copy: H. D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copV : Well Driller _.... - : pCTMM ' COMM DEPARTKMT of xEAL2 DIVISION OF MMMUML iiFA= SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSM -- FILE NO. owner Address iI5 �7-00-r INDO-ADJDAN , 3rt;��.vc;IJ -� Located at (Street) j (x i y Sec, l q Block ? Z. Lot 4bm on (indicate nearest cross street) Municipality PX-( (0ZSohl - Watershed CnonOAJ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WMIH APPISCATIONS Date of-Pre- Soaking Date of Percolation Test Z3 HOLE W3-(o 12'- i 3 � t7 24 Z? ' NUMBER C= ME j PERCD=CN PERCOLATION Run Elapse Depth t) Water Fraa Water Level No. Time - Ground - Surface In Inches Soil Rate ' Start-Stop Min. �_ Start Stop Drop In Mi.n/In Drop Inches Inches Inches ' 1'I''�' -' 11, �� v 1 -7 � ��1 C 2 W3-(o 12'- i 3 � t7 24 Z? 0 3 :n — 2:-32 s2 ' Z7 q, - 4 5 Z 2 11:2b- 11.� 5(o - ? .-7,4 7-7 3 el 3; l 74 2-7 9.3 5 . 2 3 4 `NOTES: _ ... l... Tests to be 'repeated at same depth until apprcaimately equal soft rates are obtained at each percolation test hole. All data to' be. suimitttd . for review.:. • , :.;:: -. " 2: Depth reasurem hts'to be made from top of hole. r a+• . G.L. 1' 2' 3' 4' 5' .61 7!- ton y. RE• •• air TO BE SUBMITTED Wr"q APPILTCATION DESaUPTION OF • r S ENCOUNIERED IN MHOLES HOLE NO. I 8' 9' 10' ' 12' 13' HOLE NO. POLE NO.. ��iL 14' INDIC= LEVEL AT WHICH GROUNDWATER IS ENCOUNZ= �o D INDICATE LEVEL TO WHICH WATER IMEEL RISES AFTER BEING ENCOUNTERED Cn f • O ,I DEEP HOLE; OBSERVATIONS MADE BY:1WI.YLY t�itgpt .S % &Lt- IAEV&� DATE: - 23-x7 DESIGN Soil Rate Used $ -lo Min/1" Drop: S.D. Usable Area Provided OC3 No. of Bedrooms 3 Septic Tank Capacity (Doc> gals. Type UWMT6 Absorption Area Provided By fA L.F. x 41 x4 I &J<l,lFd2 E-S Other Name LAU 'iSSCC.• signature Address '73At Y�� IQaT� • �(L1�1� SEAL �► r- o „<'� -� THIS SPACE FOR USE BY HEALTH DEPARUlEW ONLY: or \ - 0 V Soil Rate Approved sq.ft O_ F t�- �t -.4ate /gal. Checked by DEPTH G.L. 1' 2' 3! 4' 5' (p TEST PM V • D• /• E• TO BE SMUTTED DESCMMION OF • .'!I •1 MM Ih HOLE NO. 7 ! to" �c�Gr✓ 81 10' ' 11' 12' 13' HOLE NO. Z HC)LE NO.. 14' ___...- ..--_TN_nTfrm2- T EL --Am. WEICHa M=,,'iJYrfiii�' IS -x+iXURTIMSF , _ �DI�O.If • INDICATE LEVEL TD WHICH WAS LEVEL RISES AFTER BEING M=UNTEPM (o f, O a DEEP HOLE OBSERVATIONS MADE BY: ggmY f /is I L�._ oe9o� DATE: ¢,23 -e7 DESIGN Soil Rate Used t-10 Min/l" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity I ooc> _ gals. Type an/CKC�7'C� Absorption Area Provided By b4 L.F. x 4 X41 CoMJ eu Other Name LAU Y1exf"C f NQ & mt a kC& % tSSG1G. ► pc. Signature — Address C� <,, t 6- rn = THIS SPACE FOR USE BY HEALTH DEPAR'IlMIl`1T ONLY: Soil Rate Approved sq. f ,/gal. Checked by PUIMM COUNTY DEPAiM4Wr OF REPX1 1 ! DIVISION OF ENVIROR4MM HEALTH SERVICES DESIGN DATA SEMT- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. X15 Owner �✓I.A�`�s / J`�. Ca Cpl Address _ v fL� N D Qk'i.(�7Anl 1320 RUC. l� Located at (Street) ajfkla 4)AO Sec:. �� _ Block L Lot lm on (indicate nearest cross street) Municipality �� ltaZS,oI.� Watershed CPo -rOAJ SOIL PII20o=cN TEST DATA RBQITmED TO BE Sum= WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test _j113& -7 HOLE . RNBER C= TIME I PEROOLAMON .PERCOLATION Run Elapse Depth tq Water Fran Water Level No. Time Groma _Surface In Inches Soil Rate Start Stop Min. '_ Start Stop Drop In Min/In Drop Inches Inches Inches 2 W-3(- 11' Ur_ "� Z7 24 z� 3 �1. 3 j- 7-:o 7-4 Z7 3. q, -3 4 2 2b - 1z rot. - zg _Z4 22 3 l ti' 5 -7 3 9.3 4 5 2 3 4 5 `NOTES: 1, Tests to be repeated at same depth until, apprmimately equal soil rates are ebtained,at each percolation test hole. All data to ' be.sutmittbd• for review.... '2 Depth measurts ` to be made fran top of hole. �TiAM COUN'T'Y DEPARTMEMU OF HEALTH - DIVISION OF UNIROUVIENM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT - 0 DATE REVIEWED: Z% - IJ BY: oe - '(Nwne of G-W per) - (street Location) _ /COMMENZS YES I NO DOCUMEN'T'S Permit Application Corporate Resolution - Plans - Three sets s /s• { Engineers Authorization - 1/710, Design Data Sheet (DDS) SUDDIVISION Deep Hole Log Pe Consistent Perc Results (3) Fil - Perc Hole Depth cd v v Ho Plans - Two sets 260 el permit; PWS letter - Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked 's LF trench provided Y y yam' required �3 yX 60 ft. max. Parellel to contours Wetland (Town/DEC Permit R & D) Data On'DDS Plans & Permit Same REQUIRED DETAIIS ON PLANS Sewage System Plan - (north arrow) Sewaae_System Hydraulic Gravity Flow r J ac; rem ery°-; Pump'.pit details eptic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut MinnIGA-tcr Curtain Drains�-(C�'ischazrge M 7I Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pmped Pit & D Box Shown & Detailed House - No. of Bedroans Wells &-SSDS's Win 200 ft. of Proposed Systems 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 I Fields 10' to P.L., Driveway, large Trees,Top of fil: 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan: f 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercoursY 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 10 'ACE SrwHCr J1�Y L SYSJ�'5 INDIVIDUAL:V�ER SUPPLY & SUIZURr REVIEW SHEET - CONSTRUCTION PERMIT - 44 / • . I DATE REVIEWED: a-6c I C4 / 04 G y / 'd BY: �l (Name of Owner) - - (Street Location) C5 YESJ NO DOCUMENTS Permit Application Corporate Resolution - Plans - Three sets s/s Engineers Authorization - Design Data Sheet (DDS)_ SWDIVISION - ,� Deep Hole Log Perms - " Consistent Perc Results (3) Fil - -- Perc Hole Depth cd X,p Housp,,Plans - Two sets ell permit; PWS letter Variance Request = cENEunr• Legal Subdivision Subdivision Approval CheckOd Eft- approval SSDS Adj . Lots `Checked Eli required 9 01'e 60 ft. max. Parellel to contours w � I• 1 O 44 ,: Ze 1.111' Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DEMIIS ON PLANS Sewage System Plan - (north arrow) Sewage S stem H draul'c Pro - Gravity Flow i Pro i e & Dimensions - Vol uZ r J ren ery; Pump ".pit details eptic Tank - Size, Detail /,0' Well Detail, Service Line if over i•C'onstructicn Notes '--'.Design Data: perc and deep results f Two-Foot Contours Existing & Proposed Driveway & Slopes -.Cut. rLain-Era�is�- ic5charye- Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shcwn;gravity flow,suff. size If PmTed Pit.& D Box Shown & Detailed House - No. of Bedrooms Wells &.SSDS's w /in 200 ft. of Proposed Systems 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 fil. 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan'" 151. to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,pived watercourse. 10' to Water Line (pits -201) l 50' intermittent drainage course 1 Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 s 10 l 7 Ys , AuG 2 6 19� PuTNAm axnm DERARniWr OF HEALTH DIVISION OF ENVIRCtMZML HE= SERVICES' DESIGN DATA SEMT-SUBSUFACE SEWAGE DISPOSAL SYSTEM Firz NO. . ........... Owner Address Located at (Street)-' Q I m Sec. Block Z_ Lot 4063- 4OZ3 (indicate nearest cross street) Municipality PXT-(OZ-&0� Watershed CgCr(OAJ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking 4 1 24- LU Date of Percolation Test 23 -7 HOLE NUMBER C= TIME PERCO=ON PERCOLATION Ran 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 j Inches Indies Inches 1 WAL- 2 "W.-3(o - kTV3 '� 2--7 ?Z4 3 1 77.04 — 12.32 ul 4 3 2 k z: 122.5c, 7P, 7-7 el 3 4 5 4 . 2 3 4 _z:1 -74 :7- rn Tests to be repeated at same depth untMapprqdmately eqml soil rates are obtained at each percolation test hole. All data to* be. submitttd for review.,,... f. 2. Depth measurements 'to be made fran top of hole. TEST PIT DATA RREQI DESCRIPTION I DEPTH HOLE NO. I G.L� 1' 2' 3' 4' 5' .61 7'.— [orsG� bc7 �r-(�1t s' 9' 10' ' 11' 12' 13' 14' HOLE NO. HOLE N0. �r � _. INDICATE LEVEL AT WHICH GROONUOTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Cc f, O ri DEEP HOLE OBSERVATIONS MADE BY: 4(LYL4 4Cl�cjL -S ! 19 1LA- DATE: 4- Z3-e% DESIGN Soil Rate Used ?� -I0 Min/1" Drop: S.D. Usable Area Provided 2GC: No. of Bedroans 3 Septic Tank Capacity ► oocc) gals. Type XIeETC Absorption Area Provided By eA L.F. x 24" m dt— ,. "ni+A 4x9 CAl.l� GS Other Name I�M &!7W& SS- Signature Address 7S 1FAd 12w 1 E —T7) Du\1E�7 SEAL `:) d e- ��'��/� 1�•�: 12n� (M Q ti`s d THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: VO Soil Rate Approved sq . f t/gal . Checked by ®R�F� J J J iJGlte _AYEe - EX \•jT1tJC �1TL= PLAN A9- C3L11 LT PIMeN51pN GHAKT N0. A I It, ! 23.0 3!•5 2 370 �t•q.5 3 4p.0 !i0 0 Y 415 740 5 411-17 11.0 t�OJ FD izOUf PJ�A1Nf fdUNVgT10u 80. D 66-g S +-t 3 83.1 w TO GPaCTIPY THAT THC hEWAGE phYSTEM WAh fONOYM4cTCP A5 IN- l THIS MAW AND THAT THL hT`5- IN01;lrP.GTeP 0Y MC P�CFGRe IT /EReD OVER THt yY5TEM WA--�- fCP IN AWMDANGC W1TN ALL 11- ,Th"- 9 Aviv KCGIALATIONh OP THE eWNAM irPAKTt 1R�IT OF HCAI -TVA /WD THE NI;W ifE PCPAKTMeNT OP HEALTH. LIME, ANn TOP WIMIM(SAI, i I7OMINIC K 9 &L ADl(5 ALA-L1 r FF. 5r_W E 4Vb?.FF 17MV Lir-Li- LOGATIRN-t, TAKEN FROM OMK ME FOR POMIWVK- 4 MADYS ALALGI E 10, 110-7 4 M05T (ZEGP_tTI,`( VAT(-'P 1980, MCPAKCD &( KOI�IEKT H- KFr , L. h. 505 460 I } Q'IVE •A �'��EGTI /N5 OP GWU.CRIChCTYR� i t4( SoLly PvclT l I _% RTA lrt N -- _PrtAln! i s i• i. r' vv 1 .,\ I I..►,.EL.�2.pd\ i\ \ inlV. aB�.O IT 1 h QI { v i a k I t' I "I notes I ,1Al WIL. TANK 4'glGLP. ' ll/•0 A S 3 e vK. rtegl ve.Nce _ A5-P�IiIiLT °✓GAL.E: �'• � 219' 3� r r 0 rNr (19 -Mzave - Mf,E'( 1;X157. �oi`AnC exlhT. WMA_• 505 5190 . 401* . 460. 400- rILL �t;6tvlr<�v 2va oY 61 ae Ia' L�G�.1JD -- rrOflefq f f 1-We / (t-o_ w r(xOr.� *j.A� 49 'O mar. ' hpU1 & IcAr- t�OJ FD izOUf PJ�A1Nf fdUNVgT10u PROJECT: morosop SSDS QUINGY � RDAD PAn6ICSON , i Now YO CLIENT XMIMIGK jGLA[)-fS AIA( 1z7 INOF�PEI.baNGE �tOr3X , NEW �cc RAN DOLPH W. LAU ,ASSOCIATES, P. e \ PATTERSON NEW YOORK 914-270-610B CONSULTING SITE ENG DRAWING TITLE A5 - DO LT PLAN i I i