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HomeMy WebLinkAbout1077DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -1 -27 BOX 11 lQr ;6� I Re ` 1 r - r. I 01077 PUTNAM . COUNTY DEPARTMEN'Y' : OF �IEAI,TH t N i NE E K' MU S'I" 0��-- ►:� PROVIDE .. Diwsitin of Envit-onmenta/ Health Services, Carmel, 'N. Y 1051? ..: PERMIT # O' -•Seo- 8"1 CERTIFICAT CONSTRUCTION COMPLIANCE •FOR 'SEWAGE AISPOSAL:.SYSTEM Town'. or, Village LOCated at �gW Bt.112G� t-i rabr> Tax Map__..! 9 Block ) y Owner-r*!OHA1 Formerly - Tax Map Lot N 8 0',q Subd. Lot # Separate Sewerage System built Irby = r'(t> 0th l.ttiS 1711 C Address (JY Consisting of LDO o Gal. 'Septic Tank 'and 40 9 t-- :Prxt3c.�sT �on/C e&TE 'Al Other.. requirements L�ISTRIP.�uTlChi Water .Supply: Public .Supply From P►ivate'.SuPoly Drilled By.. Mll.� L iP�L�- I!1�1Cg. It.AC. Address Building Type RC3S I1>WjC•a Has Erosion Control Been Completed? No. of Bedroom$ Z Date Permit Issued Has ;garbage grinder been installed? (V O 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, rdles.and regulations; in• accordance with the fi d plan, and,the permit issued by the Putnam County Department Of ,Health. Date ' Certified by' �- P.E. X R•A. Address . a License No. "L40049 Any person occupying premises 'served by the above'system(s),shall promptly take such action of may be necessary to secure the correction of any unsanitary conditions resulting 'from such -usage. Approval of the .separate sewerage systeYm shall become null and vold,as soon as. a public.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.`Judgmerit of the Commissioner of V."'Ith, such revocation, modification or .change Is necessary. Oate� Title Rev. 6/85 ^4 . Owner or Furchaset of.Building E �Cc:E 46 me-,Q Building Constructed by o �Ue w b cc ,e e Location Stgeet. lee- 9I C xl_�li9- G Building Type uncpaity erect on Bloc Lot GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing. the system... The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices 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 __ 19ZE Signature Title corporation, give name- and address) THREE (3) COPIES ARE REQUIRED WITH THREE. (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health Yorktown Medical Laboratory, Inc. 321 Kear Street _...__ ..... _ Yorktow.n- .Heigh.ts, N., Y.- 10598- - (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) �- FITZGERALD, THOMAS 60 NEWBURG RD. PATTERSON, NY. 12563 LAB M ' Date Taken: 6/7/88 Time: 8am Da_te.._RcId.:.. _.. 7.. Time -:. 10•.�.O.am. Date Reported: JUR U9194 Collected By: Fitzgerald R P , red B e er y. 1 Sample Location: Kitchen Tap Phone d 279-8792 Phone d I Sample Type: L J Repeat Test? _ (check one) LA3CRA:'ORY R_vDORT ON THE QUALITY OF WATER' I`IOR,A'i?C 'SON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL) Acidity GENERAL BACTERIA _ Alkalinity Chloride X Standard Plate Count_ _ Detergents, MBAS (CFU /1.OmL) F:ardne.ss, Total _ Nitrogen, Ammonia MEMBRANE FILTRATIOii TECHNIQUE " nitrogen, Nitrate jj 0 — Phosphate, Total Z .Total Coliform Sulfate _ Sulfide Fecal Coliform _ Sulfite _ _ Fecal Streptococcus METALS (ma /L) _ MOST PROBABLE HUMBER TECFNIQUE _ Co.t)er Iroll _ Total Coliform Index _ Lead �. ....... ... :.....,......,. :: :_ Manganese _ Fecal Coliform Index _ .Mercury Sodium KEY FOR TERMINOLOGY Zinc MISCELLANEOUS pF (units) Color (units) Odor (TON) Turbiditv'(NTU) N /A'= Not Applicable LT = Less Than (< ) GT Greater Than (>) TNTC= Too Numerous To Count CON = Confluent'( =TNTC) NR = Non- reactive. REMARKS /COMMENTS (For Lab Use) Potable :ron- notable STP INF _ ST? EFF Other: Sample Status: (check each) Outaoina. . 3. H2SO4 NaOH ZnOAc "a2S203 Other: Incoming. LE 4 °C _ GT 4 °C DH LE 2 DH GE 9 _ DH GE 12 Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE((WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER, STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) N /A) MEET THE 'SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA DRI KING WATER CODES, FOR THE PARAMETER;,,TESTZD, AT THE TIME OF COLLECTION. X 2 /86(Rvsd7 /87)RWE WELL GUMYLL:'11U1V KPrUnt Office Use Only .0 DEPARTMENT OF HEALTH .Division -O - Environmental Health Services OF HEALTH PUTNAM COUNTY DEPARTMENT STREET ADDRESS: 701 I T I I Y TAX GRID NUMBER: WELL LOCATION 60 Newburg Road Patterson, New York NAME: ADDRESS: MPBIVATE WELL OWNER Grace Sarro Rte. 311, Patterson, NY O PUBLIC USE OF WELL X RESIDENTIAL ❑ PUBLIC SUPPLY. ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS O FARM O TEST/OBSERVATION' ❑ OTHER (specify) 2 - secondary O INDUSTRIAL ❑ INSTITUTIONAL O STAND -8Y ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR 4 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 360 ft. STATIC WATER LEVEL 40 ft. DATE MEASURED 4/20/88 DRILLING ❑ ROTARY NO COMPRESSED AIR PERCUSSION O DUG EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING. xfR OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 40 ft MATERIALS: xEkSTEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 39 ft JOINTS: ❑ WELDED xi&THREADED O OTHER CASING DETAILS DIAMETER 6 in. SEAL: %XCEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE:)MYES ONO LINER: O YES ❑ NO DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN DETAILS FIRST . O YES ONO SECOND .. _ __ - HOURS' " GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE:. OF PACK in. DEPTH ft OEM It. WELL YIELD TEST If detailed pumping WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. METHOD: ❑ PUMPED i tests were done is in- DEPTH FROM Water wen 19 COMPRESSED AIR formation attached? SURFACE . Bear- Dia- FORMATION DESCRIPTION CODE. O BAILED ❑ OTHER O YES 13 NO tt. ft: ln9 neter WELL DEPTH DURATION DRAWOOWN YIELD Lana SuAace 18 . no 6 .Hard & clay It. hr. min. ft. 9Gm 18 28 no 6 Fractured bedrock 320 2 30 300 4 28 .360 6 Med:Lun to hard 9r Y e granite. 340 2 30 300 4 360 6 - 300 12 WATER MCCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? )UYES ONO ANALYSIS ATTACHED ?AkYES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION WELL DRILLER NAME . MILL DRILLING, 6/88 TYPE CAPACITY MAKER DEPTH ADDRESS Putnam Ave. 5 R j hl MODEL VOLTAGE HP Brewster, NY M. Mill id t FINAL SITE INSPECTION Date Inspected b ;CATION OWNER - # TM # OR SUBDIVISION LOT # L - YES NO SE DISPOSAL AREA AGE a. SDS area located as per ao roved plans A I b. Fill section - Date of placement 2:1 barrier. LGM WIDTH AVG.DPTH �✓ c. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. II. SFW�GE DISPOSAL SYSTEM �._ a. Septic tank size - 1,00 ` 1,250 b. Septic tank ins level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water. tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f . JLTKTION EOX -- prot�ly set g. MRENCHES 1. Length reau.ired - /Q y Le 2. Distance to watercourse measured_ 3. Installed according to plan 4. Distance center to center 5. Slone of trench acceptable 1/16 - 6. 10 feet fran property line - 20 fE 7. Depth of trench . < 30 inches fran 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" min. installed ft. 2 "/foot. foundations zs ft. aptable. c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to' plan f. C=tain drain outfall protected & dir.to exist.watercour g. Footing drains discharge away from SDS area h. Surface water protection adea_uate i. Erosion control provided on slopes qreater than 15$ 1 11: Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size- of -pump chamber 2. Overflow tank 3. Alamn, visual/-audio 4. Pump easily accessible 5. First box baffled 6. Cycle witnessed by H th estimated flow cle IV. HOUSE a. House located per approved p] b. Number of bedroans V. WELL a. Well located as per approved b. Distance fran SDS area measuz c. Casing 18" above grade. d. Surface drainage around well VI. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfille installed ft. 2 "/foot. foundations zs ft. aptable. c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to' plan f. C=tain drain outfall protected & dir.to exist.watercour g. Footing drains discharge away from SDS area h. Surface water protection adea_uate i. Erosion control provided on slopes qreater than 15$ 1 1-homo6 aVa cant Newbury Road N H/ Its or sPtics -� pafterso n . - - - -- - %0 0 o�• N5' 5'10 w 0. min 4-0 OPSO, N/ , DI5TRi13UTI0I.r_ Box dl EXPAP t " pPR`4 o` 5� ln eggr T A. / - • ' ° -t� ` • ,,�-i- gad Op 0.00 tI. ' . ! C.)N 55 10" °l4 °9\ Ug too' A� * PUrNAM COUNTY HEALTH DEPARTmENT DIVISION OF ENVIRONMENtAI;.HEALTH`SERVICES John M:: Simmons,` M.D. Deputy Caminissioner of Health . L - FIELD' ACTIVITY REPORT'. --, ` Sheet of —INSPECTION. NAME' r,a•s 5;.° ,. .. Orig. _ Routine Orig: Canplain Orig. Request'. No. .Street : " Tcxnm . No.: Canpliance MAILING ADDRESS & ;,�° g Gf=- / :''�S' Complaint Camp Fina l = P.O: Bcx Post Office:-' Zip,, Code — ' Group Illness Construction T ELEPFiOI� .. - Reinspection . PERSON IN CHARGE `Field,. Sampling Only OR INTERVIEWED Field Conference ;Name, and :Title x: DATE_. ' .:. TYPE .FACILITY Other TIME ARRIVED': f , TIMH LEFT, Explain. �N � � 9. _- .i ` $ ` C `f4 (J� PUTNAM COUNTY,DEPARTMENT OF HEALTH r i Division o nmentel Health Services Carmel N Y 10512 ' Engineerto Provide Permit N on;CERTIFICATE OF COMPLIANCE NSTRUCTION PERMIT FOR,SEWAGE DISPOSAL SYSTEMa Located at guAH �p,rsp Town er -Vltt� Sabdlvision Natise ►-� ` f abd °Sei? �� ' S t of k i ti_ j iet a : e az Map -B } RenesJid 'O� x 1 Revision i I Owner/ Ocant Name,, t ►o a -lrs.S �ZZG G -Rl APP f ` Date of;Previoati A at ' 2 , PProv � � `l "1 88 � Address p 0.' Bolc X53 '.' ' Pw.T'T£pSo tJ ` , .. .. , .. . -Town Zip 1t.S -6 Bail �t3stD8 - 0 3 �aGR.S FW :Sectlon Onl y. B , Lot, Area y Depth, Volume Nam!►errof`Bedroome 2 Design Flow .G P, D �9cc PCHD Not 14tiooi ' Regdired When FW is completed Separite Sewerige System to consist of boo Gallon Septic Tank�a�, l O s1 + t L"' C x 2j ;dAdjd' '%Rl �.d t_l.t E S a . To be coneteacted by yT?7 l6 "ey ,7 eiir; 7M P-ithlC SLj`' �" � Address h water Pablk Sapply From Addrerae or'= Prlvnte Sapply DrWed by �� ���IA ddrese' ` Other Renairements -+ - ' - - 'y I .ieDresent 4 iat I ,anir,.wholly anA -'cam slate'Iv rwteent hlw lnr;thw AwEien�a d.ieion bf"tne proposed systems) •�• *% that the separate sewa a dif osal's -stem' �. above described will be'constructad as shown ,;W6a:aDproved an 'County Department of, HoWth,,and that'on completronitherec be: submitted to the Department and a :wntten'guarante"e wi Dlace` -rn good` operating condition any part of as d sewage,'< ance;of the'.tiapproval of the,Certrficate of ConstucUOn Com Will be IOGated as shown On the aptDroved Dian and tAat card well; COUr,ty Depdrtme t of;He Ith �:;, ,.• t . Atldress C:.�46N/.j %435 ,.. APPROVED'FOR CONSTRUCTION Thrsapprovel',exprresiwo; revoeable' for cause or' may tie. amended ;or_modified' when ..co'nsil re0uires a new )permit. Approved for' - disposal. of,domestic,u Rev. i, 1/87': , Date n. 9 . P Y ; , . `1 to and in accordance wit A,,fhe standards, :rules7an regulations a ions of ., the, u nam of Construction Compliance satisfactory to t_he Commissioner of Health'wili` Qhe owner his successors is or assigni by the builder, that sa id.'bullaei will Burin .the rio0 of two 2 ` { g pe ( ) years - immediately following the:date of the,!,sU original system or any repairs t rate 2) that the drilled well descelbed,.above �I aecordanee W' the sEa ids` s:rules anti' regu aTFZoni of '•the Putnam f k'P.E .)C^ R.A. License No MOREL .date issued ;unless construction, Of the building has been undertaken and is -by the- Commissioner ot:Health. Any change or alieration of construction and/ .'iry water suPDIY only. : -- - tie 'submitted to the _Departmer place on-good operating cord U once, of the; approwl of the C� will"be located.as shawnon the _ii County Depart t, °.of YM li Date C s A APP .,R CONSTRUCT revocable for .cause or-.inay be sr '. requires a w per d.. Approi Rev. 1/87 Date ? 0 rtdicate�ofs Constructwh rCompliahce of the;;originel'system or any repair to 2) that the drilled ,wel .describ" 466ve i , .,., proved' plan'an0 that said well willbe,installe0 m accoitlance with stand ;rubs and regu a� oiT ns .,of the 'Putnam Syned'`/ P.E. R A. r ldress „R 63 j License No 2 v ON This, approval expues „two Years';from the; date issued unless cohstruction of. the building has been undertaken and is ended or mod�f�ed when considered ri4cessary by the, Commissioner of Health.' Any, change or alteration of- construction ed for disposal of: domestic sanitary sewage an rvate water sup ly only.' �� B Tale c ' PUTNAM COUNTY DEP 1RTMENT OF HEALTH V 1. Divletoa of Eovl;onmentel Heaitb Services Csrmel N Y 10512 En eerto Provide Permit M; y t ` on CERTIFICATE OF COMPLIANCE CONSTRUCTION FOB SEWAGE DISPOSAL SYSTEM Permltr q i Los .t ur 'h r, Wage pul7iam I a ke 4- Sabdlvlalon Nerve Sabd. Lot H Ta= Map Block Lot OC • Renewal Revision' o Owner /Applicant Name 1 I1 �lmQS. i'LZOe:� l Date of Previous Apptovah• MiWng Address Po . QOX 5 z Town Asti e ^SO Zip Bollding Type i �Yi/ ii�V - 'Resid IC.Q Iot Area., ©� } �G Fill Sectlon`Only Depth Volume' �0� Number of Bedrooms Deaigri Flow G,P D � PCHD Notlflcation'is Required When'FW Is completed Separate Sewerage System to conslst of .lobo GaHon Septic Teak 'and 1 O4 = T s` To be rnnetrncted by _��► (� �fszt� M /a Address c. Water $ 1 aPP) Public Sappiy From /�,, Address or: _Pdvote Sapply Drilled by • +� ��: Address Other ROArements i S r` Q� X ..< I represent that I am ;whoily and ,completely responsible for th�e, design and location of, .the proposed. syitem(s) 1')' ,that Cho separate. sewage _tliiposaf;.systom _ above ,tlescribetl will be constructed as showmon the approvedcamendment there to.and in accordance with ttie standards; rules an 'regu a ions o e .0 nam. ` trvient.••of. HealtN' antl that on completion thereof a 'l:ertif" of' Constructions Compliance saiiiiactory.to the Commissioner of Health will be' u utbmOtetlrto the Department an0 a wntten';guaranteeswill be. furnished `the owner his wceessori, heirs or assignrby the builder that.said'builder v Ill place in; good operating Condition any part of ,said sewage disposal aystein,,4&inq. the period of two (2) years Immediately following thedate of the •iiiu -' ante' of -the approval of the Certificate 'of Construction Compliance of `the oiigirial .system or'any repairs thereto; 2) that the drilled well described above will be locatetl as shown omthe'approved plan and thatsaidwell will De installed in accordance with the sta dsrtls,, rules antl regu a� on�f the Putnam . County Department of_ Health. 1 r� /•� Date 2 . 5l9ned''. P.E. _f�L_ 4.A. ns t rl r i1 to 5.2, &L 2 6 0 ®g Address License No 'APPROVED FOR CONSTRUCTION This approval expires two years frOT the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended. or modified when considered necessary 6y the Commissioner of Health. Any change or alteration of construction I reQuies a `new permit. Approved' for ,disposalofldomeslic sanitary. sewage,�antl /or "''ate' water su ly `oly, - i, : 1/87 Date +S,l % ���3 �'"'"�!� '� s ��• E 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 0 �cr��J:�® WELL LOCATION Street Address Newburgh Road Town/Village/City Tax Grid Number Patterson 54 -1 -8 8x9 WELL OWNER Name Thomas Fitzgerald Address JUPrivate PO Box 353 Patterson NY 12563 0 Public USE OF WELL 1 - primary 2- secondary @( RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED ® BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHIMin 5 gpm /# PEOPLE SERVEDI Fam. /EST. OF DAILY USAGE600 gal REASON FOR DRILLING NEW SUPPLY 0 REPLACE EXISTING OPROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING Public S WELL TYPE ®DRILLED DRIVEN ®DUG ® GRAVEL OTHER IS WELL SITE SUBJECT.TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Putnam Lake Lot No. 7,5'42_ `75- +6 WATER WELL CONTRACTOR: Name to be determined IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: Address: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY. _. DISTANCE ' T6 PROPE9TY FROM NEAREST WATER MAIN: Greater th 1J 'A' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED / []ON REAR OF THIS APPLICATION 13 A �! (date) ?�'\ ' _1401Va TO CONSTRUCT A WATER WELL See plans This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue:. .20 19 % w Date of Expiration: 19 75f ermit Issuing f ' a Permit is Non - Transferrable COUNTY DEPARTMENT OF HEALTH -DIVISION OF. ENVIRUNK iAi. hbAU11i INDIVIDUAL WATER SUPPLY & SUBSURFACE SWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DAT] BY: (Name of • - -- •. COMMENTS. NO ®r�r� LF trench provided ,required 60 ft. max. Parellel to contours mom, ®� ®I= IMWA ®rl m MIM MIM MMI =NI WPM mom ®IM cation) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth REVIEWED: s/s . SUBDIVISION Perc (3) Fill - cd House Plans - Two sets Well t; PWS letter VarG�euest Legal Subdivision Subdivision Approval Checked Ex- approval -SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage..System Hydraulic Profile — Gravity Flow Fill Profile & Dimensions - Volume D orox;Trench /Gallery; Pump'.pit details Septic 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 rooting /Gutter,Curtain Drains'(discharge OK) Perc & Deep Holes Located Representative of primary and expansion 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 Proposed Systems ;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 SPDCIFIED ON PLAN Fields 10'.to P.L., Driveway, large Trees,Top of fil: 20' .,to Foundation Walls 1001. to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan' 151"to Drains - Curtain, leader, Footing 351to catch basin ,stormdrain,piped.watercours, 10' to Water Line (pits -201). 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 10 NOTES: M 1. Tests to' be repeated;, at same depth until app�'rootimately eciva].: gpil rates are obtained .at each percolation- for review. 2. Depth measurements to be made fram top.o,'Jiiale. ; rev. 9/85, . PLnNAM COUNTY DEPARTMENr, Jam _m DIVISION OF,. ;FEAI1l 1'5FE MCE91 SYSTF .. DESIGN DATA SI EEr- SUBSUFACE SEWAGE DISPOSAL NO. FILE Owner in s _ . Ft tz ae r a I c( Address:. x : ,�53 {�a 1, �C'I SO'2 IOS6 ; Located at (Street)_ ; New burs h Rid ". ` ,Sec: ,':5 : Block Lot s„ ( indicate �.. ftarest cross street) municipality, Pa rsoi� ,Watershed o Fort , SOM. PEROQLATION TEST DATA REOU RED TO HE Sil&QTTFD Wm APPWCZTIM .. Date of Pre - Soaking _ %io u (2 86 Date of PerQO�] at�cn Test _ Iai i 3 g6 HOLE NLAMER CIACR TIME PEROQIIa MCN PaxUrAm N Run Elapse Depth to Water Frcm _.° Water, level, No. Time Ground Surface In.L�dies' Soil`Rate Start -Stop Min. Start- SipaP Inches Inches Iruhes 1-94 '4 2 g: 5e- 9. i 6 22 24 3 3 4 43 -11) 13 3o. 5 ro; IS- 10. yS 30 - 2l -'-2- ? 3 10 2 r,. 22. -lo:g9 2`? ZZ 2S q 3 ro:SJ -n 20_ 30. zz zsiz 3 Io 4 (t 2t - 11.5 ,0 22 5 r( S 2 (I '2 z 3 o 2 2 :,. 3 NOTES: M 1. Tests to' be repeated;, at same depth until app�'rootimately eciva].: gpil rates are obtained .at each percolation- for review. 2. Depth measurements to be made fram top.o,'Jiiale. ; rev. 9/85, . 2 it • , SPACE FOR USE BY HEALTH DEPART CM ONLY Sail Rate Approved sq _ gt/9al • y� Mo 26 by \ �� nt 51 AjF. �'•� Checked ...Date mmmm. aXNN DEPARMW OF HEALTH DESIGN D= ti. mr-smunm sa n DisposAL Owner 1110AceS Fr fa- k I I Address PO. Qox 3.53 P fte✓sw ow Located at (Street) New bLL r c k koa_cf Sec. 5 / Block I Lot g. y (indicate' est cross street) munici.pality . ' Pa H e.'son Watershed Cra-fo,-? SOIL PERGOLA m TEST DATA RDwmm TO BE S[mmrTTID ME APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE . NUMBER CLOCK TIME PERMLATION PERCOLATION Run 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 Inches Inches Inches 1 ' 3 9 5 2 3 4 5 NOTES: 1. Tests to be repeated 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 fran top of hole. rev. 9/85 G. L. 1' 2' 3' 4' 5' 6' 's TEST PIT DATA REQUIRE TO BE DESCRMION OF SOILS EN HOLE -NO. HOLE NO. 3 APPLICATION HOLE NO. INDICATE LEVEL, AT WHICH GROUNDKATER IS ENCOUNTERED N INDICATE LEVEL TO WHICH. WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: !0 07 DESIGN Soil.Rate Used (I-IS- Min/1 ". Drop: S.D..Usable Area Provided No. of Bedrooms Septic Tank Capacity / 06 o gals. Type Absorption Area Provided By /_04 L.F. x 24" width trench Other q- f 0 /e fir Name ass o Signatur - 4 Address 5 Z SEAL , THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date + PurNAM COUNTY DEPARTMENT OF HEALTH 3186 Division of Environmental Heattb Services. Carmel. N.Y. 10512 Engineer to Provide Permit # I 66 on CERTIFICATE OF COMPLIANCE Permit # ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM tNewburgh Road Subdivision Name Putnam Lake a Owner /Applicant Malting Address Thomas. Fitzgerald PO Box 353 Patterson Town or Village Tax Map 54 Block 1 Lot 8x9 Renewal_ ❑ Revision ❑ Date of Previous Approval Town Patterson ZIP NY 12563 Building Type 1 Family Res 0.3 c. Fnl Number of Bedrooms 3 Design Flow G /P/ 600 Separate Sewerage System to consist of 1000 Gallon Septic Tank and LF Of pi To be constructed by to be determined Address Water Supply: Pabllc Supply from Address or: X Private Supply Drilled by to be det. sddr.�a t 'f ' 1 Depth 4 t Volume465 cy is Be d When Fill is i r a oalli Other Requirements 4 ROB ill D1str1 utlo represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate s ge disposal syst above described will be constructed las shown on the approved amendment there to and in accordance with the standards, rules an regu a j s o e u na County Department of Health, acid that on completion thereof a "C art ificate of Construction Compliance" satisfactory to the Commissi er of Healthwil be submitted to the Department, •and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that s builder wit place in good operating condittory any part of said sewage disposal 'system during the period of two (2) years immediately following thedate the issu ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that. the drilled well descri will be located as shown on the approved plan and that said well will be installed in accordance with the standard , rules and regulations. of the. Putnam County Department�Nealth. a, - X Date 9 Signed k-� P.E.- R.A. - Add Cashin Associates, P.C. Rt 5 armel NY 10514 i�ense No 26008 APPROVED FOR CONSTRUCTION: This approval expireS�' year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amerided or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction reVuires a new permit. Approved, for disposal of domestic sanitary sewage, and /or private water supply only. ' Date ' By Title r 1 t) ' ' ` � ' � ' ' ' Fo ' 'PSG"•: >, � T :., �,. ,. -s• ';"'..rt,a •' -`�,'. •... . _ .; ; :c� -� .t, ��,,. r ;., _ -��., fi' s r'�G �' .� •Ft. ?�;, 'it,�.'�".:;�+i',e �. ' .at5�. • ri k�i d r tS yry .x i A u : 4 :sa K 2•" i,tG : 3 • #t r�Y• t :c l x �i14{_ X - bt.�,d ,�„ � :., _• . -: .< _ Y � .c _ -"i :i�. "'� r i tnn � �- ('�y,L�•^h{'p, �.,Y n.��'i�,i'} �x�;,(''{e�s�:�,-. �� �•.�: ... u(y.. � :' .'. 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