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Home My WebLink About1008DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -1 -35 BOX 10 I I r� 41' 531 t9-7-1 IN: "'Im-1 r-r No IN 1 114, 6; N � .oral IN tk.f ` ,R .,, f �' IN or IN IN IN p - 0,91014:011 bit Or field j110110414411 1100111/ wolvotr e A COU11TY INFICC DUILDI14C ° CARMCL. NEV, Thit,re'ort "is to bc'completed by well driller and submitted to County -Health ®cpartmcnt together with laboratory reoor• �tu,ly ;i; of water ;ample ondicalinq water t; of sati ;fatiory bacterial ouillty before cerlific:,tc Of construction Compliance it ISIL _...._ n[PORT MUST RE CUPI- 111TTED WITHIN- 30' DAYS OF t °:LLL CO*.1P-LETIO:1° 1t : tGr te• ;a :7t:a „+ St91ch foract locoman Cl well earn Ogllnces. to at loost °1tT n PUt ; FORMATION D:SCR17T1ON two pvnranenl lsnzmares. 18� e ° r7CQ 11 yield Trot 9eurd at o.no.oal doelwa during d.;ll:n0, Lot bviaa HIT • CAItot4S Ptt PA104VIE NA *11 A=atSs 'D9'(ltEit CIASSIC T (n . 6 .over/ . (7o ®n1 (tot Povaysoq T&VON WILL 8US7NESS ® ® `Y9POSLD DOMESTIC LSTALLISMMENT FABAI TEST G1M f ust OP v ®SUPPLY 11 INDUSTRIAL 0 CONDMONING.° flu - -617l Dtfulm: 1 (j COMPRESSED CASLE PERCUSSION T� OTHER Grou -Lc!" bottom u GUIPM.0(T ROTA$Y 1}I l AIR I'MUSSION (S•,.e:rr)• d1Nv (ro011 E;1sr%tdlrncneal lwglkonl Fit 1001 ❑ +IVE SO ^a.+ CA CNO' Li 28 ft.—S"_ I)a TMREADED WELDED i P TES YES NO —_ _�rj 1tE10 ° RAILED ED PUMPED MOut$ COMPRESSED Alit G.P.0d. — TILLD (CJ ,) - IEST WAILI rnLA.SUC! Pips LAND SUtPACL- 17A1JC(Svourrlevtl DURING TILLD TLS711coll Depth of Co-pieled Well UYLL 211 40Q a In feel below land aureate: 440 bJ�Lt �L:�lGlli GPLN TV a6J1P: S:ttt►( lya'T1J:S SlG1 S:� I O1A -ALILA (lncnesl I If GRAVEL Diornelor of "Il ;ncluding GLAVJL S ;:L (rnuresl�la0s 110011 1100 ;1_ PACKED: pro-vt pock fen:. -, : ITO 1t : tGr te• ;a :7t:a „+ St91ch foract locoman Cl well earn Ogllnces. to at loost °1tT n PUt ; FORMATION D:SCR17T1ON two pvnranenl lsnzmares. 18� e ° r7CQ 11 yield Trot 9eurd at o.no.oal doelwa during d.;ll:n0, Lot bviaa HIT • CAItot4S Ptt PA104VIE __._ .. _.._ ._. _....._...._._.._... -. _...... DIVISION- OF— MW.1R0>KEL�IT -AL - HEALTH SERVICES ANN CATALDO 50/8/9 Owner or Purchaser of Building Section Block Lot CLASSIC HOMES, INC. Building Constructed by PERRY ROAD Location - Street PUTNAM LAKE Municipality ONE STORY FRAME RANCH- MODULAR Building Type Subdivision Name 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 Certifidate- 'of"'-Coiis ruction 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 10 day of Oct 19 86 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk g Si nature Title 104a, -' Corporation Name (if Corp.) Route 22 Brewster, NY 10509 Address a BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 SAMPLE NO. 6118 SOURCE: Classic Homes Inc. e11 Perry Road Futnam Lake Cwner - Cataldo Patterson COLLECTED: April E. 1986 BY. ill Drilling, Inca BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality -when the sample was collected. April 12, 1986 0 per 100 ml. 7 Y. l .. �_ � ._��._ ;_.. .. ..-.. _.._. __ ..�.�_�..� - -...� - ,.. ..... �� .__.u-- �_- _�- .._- .�.�_.�.___.� .�._�.... .. • .... ..... ..�_ -..� -..-nom ��.� .. BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 — WATER ANALYSIS REPORT — s SAMPLE NO. 6"118 - SOURCE: Classic Homes Inc. :fell Perry Road Putnam Lake Owner - Cataldo Patterson COLLECTED: April 8, 1986 BY: ;,-ill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality .when the sample was collected. April 12, 1986 0 per 100 mi. vita it T;ald -as looted of o.ne.onl denno dre:r.a d.:IGwo, Let bo;ow fEfi I • GAU01IS 1'ER MINUTE U191flllfli dl ¢ hbUiNUlatHal 1foolits LODI n.l r e a' °° COUNT%' OrFICC DuILOItjC • CAnmC -L. Pdt ►r INs tc on is to bc'eomaleted by well driller and submitted to County+icalth Dc=tmcnt together with laboratory rcaor- �raaly ;i: at water :ample Indicating water n of sati;taciory bacterial Quality before eerttlicatc of eon:truetion eomobance is ML _ F - PO-RT'�tiST HE "WIMITTED Wffi IN: 30 DAYS OF t•:GLL COtitPLET10 7 • dear! a.tJOat11 CrWP(tt: � T h ICATION �f Suse/J.. 41 avaj (lof A1r1o°oo•/ tutu - QI BUSINESS EStALLISHMENT ® Al ® vim f?BOPOSL>f DOMESTIC ZAR TEST VSE Of ° w" ®S Alt D IM0USMAL 0 CONOMORING "* � OTHER L i1 ►PL 1 - DYING i ("1 COMPRESSED CABLE i'i OTHER Groutt:-u bottom u DeutPKit(t u ROTARY AIR ►:ACL:SIOa U PERCUSSION ts�•:trl. CASINV LLI.Gtn (1961; 12E "s &%1ILtllnctl6lt jW91Wr1I PL® toot ❑WELDED ` t s++p! E. ft.-8 1-9 lb THREADED TES NC) YES (J HO Si1ELD ° MOuts GJ.M- TILLD (G-P J - • TEST 13 LAI= LJ PUMPED � COMPRESSED Alit ®h'AIEY r,LA4Ue; liCkm LAND $U&lA:.L— SIAIJC(SveellrJoel� /leaf) OUalhiCe TILLS) 7LS7 leaf) of Colnpipled Well tM1 o In (cat below Lend svria:e: 44 0 �L l:�tGTM OoLr JCr A.^.;;Ii: 3LtEEN DITL,1:S sic, 5:.: j OIAxFJit (Incn¢a! IF GRAVEL Worneter of well indwding GiAVLL S::E (1nr.+ea! t 80M /1061J 1i 1100: PACCED: are-91 peck /1n::+et/: ! Jlt'SD" -- - ..,.,.....,,....ear•.......... St¢fen aroer facerletl it wall atrn 0/suncts. to at least vita it T;ald -as looted of o.ne.onl denno dre:r.a d.:IGwo, Let bo;ow fEfi I • GAU01IS 1'ER MINUTE -- - ---r_ _- -_...- a--- -7 7-- � -777777777- PUTNAM COUNTY. DEPARTMENT OF HEALTH ENGINEER To PROVIDE PERMIT # ON CERTj,IlIffE'OF COMPLIA CE. Division of Environmental Health Services, Carmel, N. Y -10512 PERM I T # 1 6.� 62 -8s n� _ CONSTRUCTION .PER IT FOR SEWAGE D.LSPOSAL. SYSTEM.,_. T own or, Villag e Tax MaP Located at PA4• " /DD / is T ock Lot 7L� Subdivisi011 - '' �Q�1 //ray - Subd. Lot H _i:' Renewal _� Revissiionn Q. Owner /Address_, T, / /�ZOUr �i —I� /. 1041/%IkO/107 Date Of Previous Approval Building Type / LOt Area ' '^a/ Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D 40® P.C. H. D. Notification 3eQu�rea' /D�' .. , Separate Sewerage System /ttoo7 consist of Gal..Septic Tank and r To be constructed by R64'/ =2 Address y�ovCy�'4uR' Water Supply: Public Supply From 9 __L�Private Supply to be drilled by C�D/S!ilJL/�7J M / Le {!1/LZ/1.'a, Address Other Requirements /7 T.�C:' / — �i/LaQ !'' D v�zF�a TAN /C' 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 regulations o e u nam County Department of Health, and that on 'completion thereof a "Certificate .of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department,, and -6 writteri'guarantee.will : be furnished the owner, his successors, heirs of assigns by the builder,-that said builder will place in good operating condition' any part of said sewage disposal ay`stem during the period of two (2) years immediately following thedate'of the issu- ance of the approval of. the 'Certificate of zConstruction...Compliance %of the original system or any repairs thei sto; 2j that the drilled well described above will be located as shown on'the, approved plan and that said'well will be'insialled An accordance with the standards, .rules and regulations Of. the Putnam County' D`epa /rtment Of Health Date �/ ff/yf LJ Signed P. E.R.A. ess %.e r License No:�rn 2 ¢f0 APPROVED FOR CONSTRUCTION: This approval expires on ear fr m the'date •i ed unless construction o the building has been and is y revocable for use rn ':be amended or modified when'co ed n essary ' t onlmissioner of , ealth. Any change or alteration of construction requires n per i proved for disposal of domesti Wary swage' d r p vats ter sup y only. Date 0 By Title PUT AM COUNTY ®EPARTMENT OF HEALTH Div /soon of Environmerital: Health Services Carmel N: y 10512 tUCYO Y FOR SEAAGDISPOSAL SYSYEA CONSY RA u7, �R,>✓/, _,.,. v �l fage i own .79r Loiated at `%� �c 'Tax Map® Block �x i 'Subdivision Lot Jot Address i r � a , j Building Type Number, of Bedrooms Design sFlow ' TotaF•:Habitable Space �DI, 6 Square Feet ..3 Separate Sewerage 'System o consist of ®� Gal rSeptic Tank antl ,1{ /�c -�+J To be constructed "by7�Tyn �U2 Address— �TIL�:7 4 Water Supply Public Supply From oP�rvate Supply to Ybe drilled by,– C / .Address �/� �pf •7 /— '�� =�''Y o � `, 1 Other :Requirements 1- represent'that I am wholly and'corripleteiy 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 ions o . e 'Putnam } County .Departmerit of .Health, ahtl that ontompletion thereof a'- Certificate`. of Gonstriictioh Compliance "'satisfactory to the'Corrimissioner of:Healthwill be submitted ,to the Department,; anC a..written guarantee .will be turnishedYhe o_wrier his'successors, heirs or assignsYby the ; builder,3hat -said builder, will place in d' operating ?condition any part of, -said sewage_ disposal: system ;during 't he period of two-(2)'.years immediately following hedate`of the issu once of °the approval of ;the Certificate o'f ,:Construction: Compliance of �the5.originaysystem or any,repairs thereto 2)'3that ihe'- d'eilliid well described above will be located,as'shoavn on the approved plari and that said well will be- installed in acco►dance� with the. standards rules and regu a ions .:- of the- Putnam County D partment of Health n ` e + r Date d« isti6.O P E. pR A i k Address c /'"+ ` License No APPROVED Ill CONSTRUCTION This ,approval- expires'.one r from tt date'" , ued I ss c '`st►uction'o the bwlding`.fias be" en. undertaken and is j revocable•for• cause or may.,be amended or, modified when cohsi I, neces by' C fission of- Health. Any change =,or alteration of construction `•._,� regwres 'a• ew %per d Approved ;for disposal of do st n y sew e ; a r iva at Supply. won bate " -6 'w',ri ....nc s,., �•,-°i�rA,' -'< ,.. ictl,x assts sx�`..'r'� 3'.a b,'a,5f.a'j+'.,,?`r«,W�'" aTU'h'S" -°`�^'R'e.�''b6--'''ar`' k- "- ,x*,'v,N'. A,..✓t', �!tac- :'�r.•w. -,-,- 4+v.;; ; '.. +.._ ». ^ -r %!asr .. .. �✓- Vii.:..., * - �r - '!S• -�.. �a•°'+ �."u.i.'•. '.Yi°_'.M�_ �?'vw +s: 1rw.at a°'�'.°?„. ..} =+Vi_µ sv:�'d'T�= e.�:.�',M +t;..yY _ :_r t ..Y=:S .�i. .f _ = �.�__�'. '.F..__ '�".'.e�°'�.e. �.r�:. ia' c.v.:••. .i. :..F.'•:�?G afSy,_ J _ .- a- ,i -`�' PUrMm COUNTY DEPAR'MIM OF HEALTH - DIVISION OF ENVIRONmEarAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIMD INSPECTION REPORT {VO DATE: / �'+ ,��✓�' %' " t�4N INSP. BY: Name of Owner) (Street Location) INITIAL SITE INSPECTION I YES I NO CCMMERI<S Wetlands on /or proximate to property .. ........ Property lines or corners found .................:. Can estimate house location —s ..................:. Willdriveway 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 cut, house location, separation distances,etc... Adjacentwells/ septics ............................ D. H. 1 Lot Depth to G.W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 `ft., 12 ft. D. H. 2 Lot Depth to G.W. Depth to rock Soil De 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Descrir)tion 0 ft. 3 ft. 6 ft: 9. ft.... 12 ft. DATE: —/: / ./ FINAL SITE INSPECTION INSP.BY: YES NO - . COMMENTS House SSDS located per approved plan............. Length of trench measured Width of trench average Slope of tile line and trench acceptable ......... T Rocm allowed for expansion trenches .............. Over 100 ft. fran watercourse ................... Natural soil not stripped or SDS area unnecessarlygraded............................. 10 ft. maintained from property line arid. 20 ft. from house.............................. Distance well to SSDS (ft.) .............. .�!� „vv cy� Number of bedrooms checks .................. ._!%' ) . Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally fromtrench....... ........................ V Boxesproperly set ............................... ( �.�� ra ✓ - �? Could surface runoff from driveway, roads,. ground surface, etc., channel near SDS area.... TM1GC I n+- Ara innm4n anriaar rV in arp;; t)f Rn.�' _rte _ PC yZ�4 ^� ^^ 72 -, � 'd DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M.,.Si Or1 g.. Orig. Complain ADDRESS Orig. Request No. StreeU Municipality (T)(V-)—(C) Compliance MAILING ADDRESS— Complaint Comp Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE Reinspection PERSON IN CHARGE Field,- Sampling -Only ..---OR. INTERVIEWED Field.Conference.. Name and -Title Other DATE TYPE FACILITY TIME ARRIVED TIME LEFT Explain FINDINGS: —Te INSPECTOR: TELEPHONE: Sig44ture and Tit-16 PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: 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 I'VI-11-1 Address ps_j" Z/ Located at (Street Sec. Block Lot 6dicate nearest cross street) W77P- -6-0 Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS -Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse p o Water Water Level No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches Z_e) 0 q. 2 A0• o 7 /0 3 A 09 - 2 3 4 1 . -2 5 Notes: I Tests to be repeated at same depth until a roximately equal soil ra , tes.are obtained at each percolation test hole. Affdata to be submitted for..review. , t6pt'h.7,measurements to 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. 611 1211 it A 1811 A, 2411 3011 36.11 4211 4811 f, 5411 6011 66" 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED- DESIGN Soil Rate Used MirV!"Drop: S.D. Usable Area Provided A66V No. of Bedrooms Septic Tank Capacity A 6d Gals. Type M/Yolylc� Absorption Area Provided By_.,. L.F.x2411 F width -french. Other .2 /w A' 7' Name Sip-nature Address h,- SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq. Ft/Gal. Checked by Date 4:1 OF co 6 A 01 ris \j� ( PUTNAM COUNTY DEPARTMENT OF HEALTH - Division of . Environmental Health .Services Ca'rme% N. Y ..10512 ` , CONSTRUCTION P RMIT °FOR SLWAGE.:DISPOSAL SYSTEM, .Town or Village Located at /� e� s �Q� r�s? (hF �G�h!/�i3oyl�1,�' :Map � Block Subdivision / r - • Lot s Job Owner `� a Address.1LL�c(c .4.Cf Buildih9.TYPe, ,. ° Lot Are�a'J� f Number of Bedrooms . Design;:F,low� +� Total Habitable Space ��"`' Square Feet .A Separate Sewerage - System to consist of 'Gal Sept is -Tank and To :be constructed by s ?��%�� Address 7 ��%�� Z1��r,/J Water .Supply Public. Supply'Fiom __Private Supply, to be drilled -by LL LGi Address Other Requiremerits = IV represent that -I am wholly and comptetely responsible foNthe 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 twand in accordance with the standards, 4u lei an regulations.o t e; u nam County Department of Health; and that'on completion thereof -a "Certificate of Construction Corirpliance" satisfactory toahe Comm issioner.of Health will be submitted to the '.Department,'and a written guarantee will .be furnished:.fhe owner,. his.wccessors, heiisor assigns by,the builder, -that said builder will P lace in ,good operating condition „any part of, said sewage dis.posal system during:the.period of two (2) years immediately following the date of.the issu- ance, of the approval of the Certificate of "Construction` Compliarice of the ^orig Ina l system or any repairs thereto; 2) .,that the drilled well- described above will be located as shown on the approved plan,and that said well will be installed 'in accordance with the .standards, rules and regulations of, 'fhe Putnam County Department of Health. _ ==== f Date — 7.r ,(T - Signed �. P.E. R.A. Address License No:- APPROVED FOR. CONSTRUCTION; This approval'ezpires one'year from the date: issued un ess nstruction of the building -has basil undertaken ;and is revocable for cause 'or may be amended or modified when con i erect essary'by fhe'COmmis r'of Health. Any ,change or.5lteration .of construction' requires .a raw permit.. Approved for disposal of domesti itar , ewage, and or privet t r su my Date �� BY. Title` I• VA I• I r• A a"My YD4 ' I• • M `I5 h L4 9_5 M U,73 Y� I I , %J iV1 n Notes -Two-Foot Contours Existing & Proposed Driveway & Slopes Cut ;rFoot�ng /Gutter} Carta Am, _ � 1_ Perc & Deep Holes Located �� P 7Representat," f Sewd Expansion Area i.i +'s„ .rci..;...... b.:o. .ru.,.ur... c.s..*s.5+..s: an Expansion Area; shown; gravity flow,suff. size If'Pmped Pit & D Box Shown & Detailed House - No.-of Bedroams, _.. Wells & SSDS's ,4/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 45° 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 -C rtain,Storm,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 REVIEW SHEET - CONSTRUCTION PERMIT (25, ele DATE (Nwt "of -Owner) -( Street Location) COMMENTS YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization" .- Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other,.. u . Ho�usePlans If PWS - Letter .- Variance Request y; ; o q * , 'via-r1 ,. f 1,4 f _0 REQUIRED DETAILS ON PLANS j Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow I I , %J iV1 n Notes -Two-Foot Contours Existing & Proposed Driveway & Slopes Cut ;rFoot�ng /Gutter} Carta Am, _ � 1_ Perc & Deep Holes Located �� P 7Representat," f Sewd Expansion Area i.i +'s„ .rci..;...... b.:o. .ru.,.ur... c.s..*s.5+..s: an Expansion Area; shown; gravity flow,suff. size If'Pmped Pit & D Box Shown & Detailed House - No.-of Bedroams, _.. Wells & SSDS's ,4/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 45° 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 -C rtain,Storm,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 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT D -uM,d �V CGi Ol ( �. _.. _ - --- - DATE REVIEWED s -BY: _ _. �� .._ (Name of Owner) f (Street Location) COMMENTS YES NO DOCLMUS 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 Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan 12r Sewage System Hydraulic Profile Gravity Flow Fill Profile & Dimensions - Volume (Dor J Box;Trench e Pump pit details Septic Tank - Size, ail Well Detail, Service Line if over v 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 flow;suff. size If Pumped Pit & D Box Shown & Detailed __....._... ........_._._.. _.... House No: - of - Bedrooms - -. - - -- Wells & SSDS's Win 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 r/ 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,Stom,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation �1 50' to Well 15' Well to PL Legal Subdivision `+ _ .. �' F(,✓ },� Subdivision Approval Checked r Ex- approval SSDS Adj . Lots Checked Wetland ( Town /DEC Permit R & D) Data On DDS Plans & Permit Same +DAVID D. BRUEN County Executive 4 __..__.. DEPARTMENT. OF HEALTH Division Of Environmental Health Services DATE: RE: JOHN SIMMONS, M.D. Deputy Commissioner Dear Sir: Review of the materials submitted at this time relative to the above - captioned project has been completed. Comments appear on the reverse side of this correspondence. If you have any questions please call me at ext. 242. Very truly yours, James Hodgens Assist. Public Health Engineer JH:mk TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 f k � >°� r ; + ,�' � ��5 � ' � .' ./'� � '� 3�`.` • `fix � � � j�o � 4'4'i s6 1 Nl �, �� ` t • +� jay,. yTM. �'b At,�� . J1 � � K� t \ \\ .. ._... ...._ _.__.. +_ _ _- _. :� .. � fin, �rt �;S�i �• + � ra � � • n t AV IN /• t ��4vr c ': t'. Tbl. Arl ct �� m b� .[