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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
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A=atSs
'D9'(ltEit
CIASSIC T
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.
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(tot Povaysoq
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8US7NESS
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`Y9POSLD
DOMESTIC
LSTALLISMMENT
FABAI
TEST G1M f
ust OP
v
®SUPPLY
11 INDUSTRIAL
0 CONDMONING.°
flu -
-617l
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1
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COMPRESSED
CASLE
PERCUSSION
T� OTHER Grou -Lc!" bottom
u
GUIPM.0(T
ROTA$Y
1}I
l AIR I'MUSSION
(S•,.e:rr)•
d1Nv
(ro011
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lwglkonl Fit 1001
❑
+IVE SO ^a.+
CA
CNO' Li
28 ft.—S"_
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TMREADED WELDED
i P
TES YES NO
—_ _�rj
1tE10
°
RAILED
ED PUMPED
MOut$
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•/
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-
QI
BUSINESS
EStALLISHMENT ® Al ® vim
f?BOPOSL>f
DOMESTIC
ZAR TEST
VSE Of
° w"
®S
Alt
D IM0USMAL 0 CONOMORING "* � OTHER
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u
DeutPKit(t
u ROTARY
AIR ►:ACL:SIOa U PERCUSSION ts�•:trl.
CASINV
LLI.Gtn (1961;
12E
"s &%1ILtllnctl6lt jW91Wr1I
PL® toot
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` t s++p!
E.
ft.-8
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TES NC)
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• 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
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