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Home My WebLink About1112DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.55 -1 -17 BOX 11 01112 IN I. L by J I a it I% 17 T ON 16 Em ' -.`,� 01112 OUNTY�DEPARTMENT Diwsion of En wronmehof-Ifea /th Services, Caren% Nk i�fOb12 " permit,.#" P 41..87. CERTIFICATE :OFCON UCTION. COMPLIANCE FOR ,SEWAGE. DISPOSAL!`.SY,STEM • T. • Pattel eon., :' ` or •_ � Town Vllliga Located at Garfield Slayer & "Java' Rds. Tax Nap 56 t {.Block' 3- :owner Altars Development Gar�rmeriy ` Tia Ndp Lot 13 subs yot b677 -92 :Incl. j& 672`2 8 3nc1. Separate Sewerage System Tbuilt by Addresi consisting of 0", paj Septic Tank and 152' Trigalleries other requirements _•One ft R =0 B ,F -i11 Section i85 Cu Yda + 0 in rt�n & haff1Pd T''�i Water Supply Public Supply From • X Private Supply Drilled By, Address Modular' . Building .Type of Bedrooms -• Three. bate permit. Iswed 2 5 88 ;'Has Erosion Control Been Completed) AS .reQUired ;I certify that the eyetemIs) as listed sei'inq,•the above•preiis®e-,were constructed'.esaentially ae _ehorm oh the plane of the completed work "l copies of which are attached) and in accordance,with'•the standards, rules and regulations, in accordance "'witti'the filed •plan, .and the.'pexmit issued by the Putnam.County Department:?Of,Health "' n a bate 25 May 1988 Cart if ied,b • P E.• X R:A: RD - r6 9 Fair, St a el NY 10512 206.'.• u uprise No 29 Any person occupying promises served by -the abovesystem(3) shall promptly eke such action as, may be neassa►y to acure,tM.eorreetlon of any unsanitary conditioels: resulting from' sucli 'usage Approval, of the•separate sewerage system shall become. null and void soon as,: a publk ynlUry,pwh becomes avallatile snd the •approval'of,,'fhe prt`vate water supply shall become null and void whorl a .putilic wits► suppl , 64b times available. Such ipprowla are subJect_to rriodifiration ;or ,change when, in the' - judgment' of.the Commissioner of'Heslth.'Wch revocation ;.moalileation or,sihange Is neasN►y. . oat py, .T.Itle _Re'v. 9 -81 j32.O14552 Yorktown Medical Laboratory, Inc. LAB 321 Kear Street Date Taken: Time: 1.23 Yorktown Heights, N. Y. 10598 - - - Date - Rc' d-: Time: _. (914) 245 -3203 Date Reported: "MAY-'20'1988 Director: Albert H. Padovani M. T. (ASCP) Collected By: /#�k Referred By: F Sample Location: Phone " Fa L / J Phone " I Sample Type Repeat Test? _ (check one) LABCRM^ORY REPORT ON THE QUALITY OF WATER I`iO3:,AaC 'SON- METALS (mR /L) MICROBIOLOGICAL (CFU /lOOmL) Ac:d:ty _ Alk- _- Iinity Ch !or ide Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen,' Nitrate Phosphate, Total Sulfate _ Sulfide Sulfite METALS (mkt /L) CoDr�er Iron Lead _ Manganese. Mercury Sodium Zinc MISCELLANEOUS PH (units) Color (units) _ Odor (TON) Turbidity (NTU) GENERAL BACTERIA L.�Standard Plate Count (CFU /1.OmL) ME."4BRANE FILTRATION TECHNIQUE Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index a _ -Fecal Coliform Index KEY FOR TERMINOLOGY N /A* = Not Aoo7..icable' LT = Less Than ( <) GT = Greater Than ( >) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non - reactive REMARKS /COMMENTS (For Lab Use) i,, otable _ iton - notable _ STP INF _ ST? EF F Other. Sample Status: (check each) Out¢oin:. Hif03 _ HC1 _ H2SO4 _ NaO:. ZnOAc Na2S203 Other: Inc OminC,. : :.... _ ° C _ GT 4 °C pH LE 2 PH GE 9 _ off GE 12 Other . THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WASN'T) (N /A) OF A. SATISFACTORY SANITARY QUALITY ACCORDING TO TV E N YORK STATE DRINKING WATEP, STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A) EET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA DR KING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert-H. Padovani, M.T. ASCP), Director 2 /86(Rvsd7 /87)RWE A� CSI. Fi� WLLL UVrLrLLiiVn rlzrviti DEPARTMENT OF HEALTH Division Of Environmental Health Services - PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only -- WELL LOCATION�� STREET ADDRESS: t r wl I TAX GRIO NUMBER:' /�� ,� AC1Tr/•�� I WELL OWNER NAME: ADDRESS: , /0/�fL /e`�G) LTf�.2/� 1% FLOP/)? D6 - /��j sT': /1f /.q 5-& P8IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary !RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS 0 FARM 0 TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE�QQgal. REASON FOR DRILLING KNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH. _ ft: STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT ❑ 'ROTARY WCOMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ .OPEN END CASING. ,X OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH _ fL MATERIALS: OSTEEL ❑ PLASTIC ❑ OTHER LENGTH- .BELOW GRADE - . — -fL - JOINTS:- " . ❑ WELDED _ (THREADED _O- OTHER DIAMETER in. SEAL: CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT. PER FOOT lb./ft. I DRIVE SHOE:POES 0 NO LINER: ❑YES >00 SCREEN - - HTAILS- - _ DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (1t) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping t METHOD: O PUMPED 1 tests were done is in- ,COMPRESSED AIR , formation attached? O BAILED O OTHER ; O, YES O NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM' SURFACE water Bear- ing we►I via' meter FORMATION DESCRIPTION COOE. ft fl WELL DEPTH ft. DURATION hr: min. DRAWDOWN ft. YIELD gpm. Surface ow �OOG' -JfC� A30 60 WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP.LUl�L WELL DRILLER NAMEu� � AooRESSQ (JT�77� SIGf77�TT1— <6` A r 1dr- V PU NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO►�JrAL HEALTH SERVICES Altera Development Corp. 56 3 4 & 13 Owner or Purchaser of Building Section Block Lot Owner Building Constructed by Garfield Dr., Slater & Java Rds. Location - Street Patterson Municipality Modular Building Type Putnam Lake Subdivision Name 667 -92 Incl. & 6722 -8 Incl. Subdivision Lot # GUARANPM 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 23 day of May 19 88 11 Holiday St., Pawling, NY 12564 Address rev. 9/85 mk P1. IRI Corporation Name (if Corp.) ess AIJIJENDIX C FINAL SITE INSPECTION Date y In ed a •;CATION �v� # �" e-/ / TM # OR SUBDIVISION LOT # S !!;�7 II. IV. 0 VI. 1; YFr- NO COfl'S SEWAGE DISPOSAL AREA a. SDS area located as approved plans b. Fill section - e of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil kn66 stri d. Stone, brush, etc., greater than 15' from SDS.area. ,X e. 100 ft. fran water course /wetlands. Sag,GE DISPOSAL SYSTEM a. Septic tank siz - 1,0 1,250 b.. Septic tank instarldd level c. 10' minimum fran foundation d. No 90° bends, cleanout within 10 ft. of 450 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. JUNCTION BOX -° ro 1 set g • MKS 1. Len recui.red - 2 Len installed (S - 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5- Sloce of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran prcperty line - 20 feet - foundations .7..De th of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12" minimum vi I 11. Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size . of -pmp chamber- 2. Overflcw tank 3. Alarm, visual /audio 4, Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedroans WELL a. . Well located as per approved plans b. Distance fran SDS area measured 4g2V f c. Casin 18" above grade. d. Surface drainage around well acceptable. OVERALL WOR QWHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain cutfall protected & dir.to exist.watercours g. Footing drains discharge away fran SDS area h. Surface water p rotection ad to i. Errosion_control provided on slopes greater than 15 %. 1; ' PUTNAM COUNTY DEPARTMENT OFEW , ALTH,:,,,. Ji 6W 6" NX. e� ;P SYSTEM `41- P 8 Provide peewlRM on CERTIFICATE OF COMPLIANCL CTION PERM FOR SEWAGE DLWSAV 7 , Patterson _ers.on'. Imtedat Garfield Dr. -Lit J er., ava: -V SubdI,Id=,N=6 92 -Mp5 :Saw. 3, , 13 -",Ptitfiain Lake -1-lito,"6677; no 3�10 rat 6722 '8 4-rfc, ii3iiial—b Revhdon iCl- SIO, Al t4ra.':,, Development ,-'.,��CprpL..,,.I CN�. 7 :Date _61F, 5/19 8 7 -NY -6 tip 4' H6 1 4, i25 Ad&iise ii , g, J. 7-7, - NO �V_ 61. Us. Modular hot One :,71, Oidy Depth c : fe SeCtIO67 IT voluttle "85. SW '43, onli Re�. on Fin to completed Nviii�ef Be&— 1 2 _L Lzf dries 6 seweisi S "W-M YINILS02,110.60AW" of' Twbe &-tirketw- g2" Water SuPPh PtmllctSapply From Adiiiiis Ory ply] Tij,j-. Section. 85 Cu o.�.`, ds-.,". OtherRegalremento '0, i, -, - - I :.'C', Y ,-,�iystemwi that the separate. sewage diipoial s�item- 4,c for the dejfgh i6d,;Io on of the '�propoi Ibovp described will be Wrud `ai and �'. 666id�hci with rulei ano-regulation Vthere.Wa !n a,, 517169 Fultnarn �CO6 Ity epfr!m"t,-q� oWc6Apiefi6n`thi46i i` tiriii'64'.'tf 4Wfictori' to-ihe Commissioner of,H"Ithwill 'o W submitted to, tlie D,ip�rtrivani, and 'a written ihi, his 'succisior It4irsbiai;s4n' I buflderj thit'laid ..builder will assigns place v. condition �,Sny part, C!". rn,durt me a in good, f, said '6i of -two (2)� yii�i I diatel� foilowir4 the clatto of the Issu- a -,approval-oif 'i,-Of.' hiwtkiio iridihil�'Systim.di any repsiis�6 lancel:ID the the � dait ifiat C6 0 7CP!"p! f the to. that,thi dilillid will discrjiied'a'bov* 1 1. .- si will be located is sho�wn,oK the lioi k�ila'n irid;,that .'said well will t accordance �,Yvo and rubs and rev—UT&TIFni, of �.�th Putn ard 'am Y DepartmeI' 0 �H ""Ith P.E. �'' R.A P�lC,, -26 S Town P 10 11D9 e it l.:i-_ f• jt2 29206 .�'License No Add APPROVE,D.FORX CONSTRUCTION ThiS ap,.O*v's - . . . . . . . "r T. s constructio n ..o f the building :his. ,been u nde r'taken and is revocable cause- 3r.mfy e,amen ere n es r iiii nai of Health. change or a lieratj 0 n of c6nitruitlon requires a p iA00vid7 for j3i osa - V 0 a kC n a la kei 1/87 Till i-ounxy uepariment:,oT,,,me4sLP�.,i,,.',, Date :-Ad4 AOPROVEO FOR CONSTRUCTIC revocabril;ford cause ,or.rnay., oa-,amc A:q ffia t-said Wilder will v g 'the .diti;o"fthe Issu- wed ptah and that said well :wil i"66,16stilled;, in -accordance wit h' th " e standard; , ' r- u i' "and -.regu&—TIon--f the''. outnam P.E. R.A. Date v Y. Rev .'5 ,_(V8 A 'b"I NY IG512 License i4o.- —29206 ,one yearf►om the date I less construction issued 04 166'b6iidinq� hii been undertak'an and is -a 0 A a t is nier o . w,ch change or terati6n of construction c'samtary sew pfi ter supply, pp -�-j DEPARTMENT.bF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL �7 PCHD PERMIT # / 7 WELL LOCATION Street Address S( o o Town/Village/City Tax Grid Number do '56-3-4 WELL OWNER Name Al r'4 e Mailing . Address I jU QPrivate 0Public USE OF WELL it - primary 2 r .secondary RESIDENTIAL 0 BUSINESS 13, INDUSTRIAL ❑ PUBL C SUPPLY ❑ AIR /COND /HEAT PUMP 0 FARM ❑ TEST /OBSERVATION OINSTITUTIONAL ❑.STAND -BY O ABANDONED 0 OTHER. (specify' 0. AMOUNT OF USE YIELD SOUGHT VP gpm /# PEOPLE SERVED F /EST. OF DAILY USAGE�dd gal REASON FOR ' DRILLING 01NEW SUPPLY ❑REPLACE EXISTING SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING s• WELL TYPE DRILLED DDRIVEN ❑DUG []GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ —NO IF WELL IS LOCATED IN'A REALTY SUBDIVISION, NAME OF SUBDIVISION: p d rvi �-a Lot No. G 722 8 V c WATER WELL CONTRACTOR: Name ? Address: IS PUBLIC WATER SUPPLY AVAILABLE TO .SITE: YES NO NAME OF PUBLIC WATER SUPPLY:. TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Q dw le LOCATION SKETCH & SOURCES OF CONTAMINATION 'PROVIDED See 01Vj Al Jab *Sla 2330 yJ044 j-� P►�(,�s,P,E,1 []ON REAR OF THIS APPLICATION '®ON 5EPARATE SHE (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 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: f7 r �� 19 �� Date of Expiration : i*osr /,,,7 19� e�rmi ssuingicia Permit is Non - Transferrable.. White copy:, H. D. File 7'� ,S A�ja+rccrr! 5 sr� �o �` Yellow copy: Building Inspector 2/87 -t-0 /. Pink Copy: Owner. t a .4 Orange cove: Well Driller PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT _.. DATE: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location... ............ o ........ Will driveway need cut ............................ Must trees be removed - note-these................. Deep holes representative of entire SDS area...... Additional deep holes needed... o . .......... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics. ................... ........ D. H. 1 Lot Depth to G. W. Depth to rock 0f 3f X 6f 9f 12 D. H. 2 Lot Depth to G. W. —�- Depth to rock Soil Descri tia 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 (,p - Soil Descr 0 ft. 3 ft. 6 ft. YES 9 ft. CATS 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO CATS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ......... 10 ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... ( __ Does lot drainage appear OK in area of SDS....... �� -1 FINAL GRADNG OF SITE ACCEPTABLE.. PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEZTrAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SE kGE DISPOSAL SYSTEMS (Name of Owner) REVIEW SHEET - CONSTRUCTION PERMIT n DATE REVIEWED: BY /9ilt� (Street Location) YES NO DOCLMWS 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 Sewage System Hydraulic Profile - Gravity Flow Fill Profile& Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut ooting /Gutter Curtain Drains _ Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shawn & Detailed House - No. of Bedrocros' Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 1001.to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,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 ENVIRONMEU.AL HEALTH SERVICES INDIVIDUAL %�= SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) COMMENTS REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED: BY: - (Street-Location) YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Resul 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit_ & D Box 'Shown & Detailed ,House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "t; Type pike 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 - =tain,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 7 DIVISION 'OF,. ENVIRONMENTAL HEALTH SIMMCES.,. - DESIGN ,DATA .SHEET:!- _SUBSMCE SEWAGE. DISPOSAL.. SYSTEM Owner Address s�tl C6e1 Dated -at (Street) (IVYrreh Dr;✓ip :. Sec :TM S--L Block._ Loth_ . ( indicate nearest cross street) 191t("�asm LQke Lo&4 4 Z4,G [Municipality Soa Watershed t• SOIL. PERCOLATION TEST DATA:RB _IRED TO BE SUBMITIM WITH,APPLICATIONS Date of Pre- Soaking L 6 Date of Peroolation Test &X HOLE NUMBER CLOCR TIME PERCCZLATION PERCOLATION Run Elapse Depth'to'Water Fran Water Level -No... �;;,;;� ,,� : Time Ground Surface -;In Inches., _ •Soil Rate Start =Stop Mina Start Stop Drop 1d Min /In Drop Inches Inches Inches 4 -— 1 3 7 �4- 7 L (10f Ilia s I f3`I "1 3 Z 4N 1317 O= P Z,, 71 0 i5 r s Tests be repeated•at same depth•until approximately equal soil rates 'are .obtained at each percolation test, :hole." All data to' be sukmitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. 2 HOLE NO. 3 G.L. T�psoi (;g 1 _ .31 4' Lo 4 W 5' 6' 7' .. M �Q gemcr 9' 12' °�z 13' 14' . INDICATE LEVEL AT WHICH GROUNDWATER-, IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEM DEEP HOLE; OBSERVATIONS _ MADE BY: p ( AM n a -n 2 i A Dom: ) g • �'�_ DESIGN Soil Rate Used ((—(C—Min/1" Drop: S..D. Usable Area Provided .0 o0'j_ _ Septic Tank Capacity 1066 gals. Type Ouly No. of Bedrooms Three— Absorption Area Provided By L.F. x 24" width trench Other k -0 -B FM Se4 i on - (-)," D e em x 29 5-4-' N JOHN H. PRENiISS. P.E. Signature 87a -Fi7o GpRNEIa NEW YORK 10512 / Address SEAL SPACE FOR USE BY HEALTH DEPARDIRNr ONLY: Soil Rate Approved sq.ft /gal. Checked by Date - .. -as � Structure located trod survey by surveyor notod bolOb� Wolf locatod by: Survoyors survey., r� _ 122.7/ Wolf drillora roport co Englnooro moauromonto.0_ _ 0 312 UI.L Tf %� O M Ton U, Boxes, pits, gollonos 61 laterals located by: ControctOr RIO DA (a tG1 Engtadrtti y �� ZJN48° ��✓ 76. He0'ifhdvDS`: x n Mold Inspoction by: Hoalth dept® dat.o:� J $. 4 t7 Pl�� -^3� Engenoor q�u �F .a � „ �� —;' p 1Q• %l "'This is to disposal SySLern was ,X certify kI hat tthrUe C`tpR 0.5/00 /J Cgna t �� l NOT1£S: indicated on this an J P ap0` Ch44 Ljur. TU11Cilo� P('(1�PIr.M.) i� system was inspected by ��eis" 11 4u� Q was covered over. Th6 sys %iM tlitg constructed in accordance *,,I& standard rules and regulat -loho of i TO ibL' tl u ` the P.C..H.D. 6 the N Y 3 D -& 5 Go C) h &1_ I i7ac, b I ME N S I O N` .S/ nA1 (\ _ E A - H °1alZ-� a _` 19 - H T �L� { ' _I {! � �// � _ 1( a B _ {( Pl7taaID •@� Uyy:ttLmeIIt aY $8a.1"�1 r�.k '. _ _ - - - - L:.1�l��. // •\ - ��_ — _ _ - 71V1810A O�o➢Vii'ellm ^II'tB.I FSHISZEil �6Y`�oa� ! J►yproved as notod for Conforaanoe WLth ; n � e 1 1 r 3i tl + � Putraa County De rtment =2t0 �• a � — a'G -- - - - - - -- - Z 0(9 16 PP- IZA F O OR: — — - -�- =-- t�ir LOCATION 9 treat: G�ptL1 =16UD p.21�s>w �l� �/yD �, x'9205' Tow n:pA'i1� ✓��0� County: eQ1?A�1 _ toto : ,� -— toe, \ 0 12 SUBDIVI ION:: rT�� -1 La K6, (Lo Th ha77 -6694 �67Z g�{ GL i'_lJ_Lila Map. L'(�1cC15� — - - ---- -- -- -� L� -_ -. .. ' ioJQ ¢� BlooX•. — — _ LOT NQ --- _— -- — - - - -- -..__- ,Iqz ,Budder: Drawn : Date: JOHIN H, PR ENTISS P.E. - 182 I