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HomeMy WebLinkAbout1184DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 f- 25.62 -1 -36 BOX 12 01184 PUTNAM COUNTY DEPARTMENT OF HEALTH R v. 3/,86 Division of Enviionmental Health Services; Carmel; N.Y. 10512 Engineer Meet Pro-;M6 P -63 86 _ . P.C.Ii D Permit H " .-CER ATE OF•CONSTRUCHON"COMPLUNCE FOR SEWAGE DISPOSAL SYSTE113•... -.. _P_att$rSQn Town or V e r l d Drive ' Tax ap 56 Block tot 10 M Owner /appllcmt Name STIR 'BUILDERS Formerly Sabdivlslon Name '8th .Ma Sabdv. iot N6-780 of ", Putnam ,L' &e . 9/5/86 Mewng Aaaraee R D..- #6, Ballyhack Road z1p.10509 Data Permit Is' sued Brewster NY Separate Sewerage System built "by BT111 EXCawatOrS Address 'M11'ler St., Pawling, NY" 12564 Coneistlng of Gal. Pr'ecast Gallon Septic Tank and 12 EA 4' X 4' X a " Box Galleries Water Supply: Public Supply From Address or: X 'PrtVate.'sapplyn ruled by.Mill Drilling Inc. Address Putnam Ave., Brewster, NY BaUding Type Raised Ranch g Eroelou Control Been Completed? Y.ES, Number of Bedrooms 3. Has Garbage Grinder Been Installed? I No Other Requirements - - - - - -- I certify that the system(s)as iisted serving the above premises were constructed essen lly s shown on a plans of the completed work ( copies of which are attached), and iri.accordance'with the standards, rules and r ulations, i!Lr n e with the 'led plan', and the permit issued by the Putnam County Department Of Health.' Date 9/ 16/87 j ; certified by P.E. X ft.A. '.Address 3 East. Main. Street w11 NY 2564 license No. i Any person occupying premises served by the above tystem(s), shall promptly take 'A hl on a ay be n4 spry to secure the correction of any unsanitary conditions }resulting from such usage•. Approval of the separate sewerage, systsm shall scums null and v Id aasoon as a pubG: sanitary awar becomes available and the approval of the private water supply shall become null and void' when p public water supply becomes available. Such approvals are subject to modification or change when, in, the judgment of the Commissioner o`f Health, su revocation, modification or change Is necessary, Date "� // 'Dr� - —:tie PLJTNAK COUNTY DEPAIt'l OF HfEALIH IVIS%ON OF ENVIROMMUAL HEUZH SERVICES Lila- or Purchaser of Building lion Bloom Zat 0. lding ConstruCtGa by Map Number .. URtion - Street Subdivision wam Amicipality Subdivisicn Lot welding Type GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and ;completely responsible for the lomtirn, workmanship, material, construction and' drainage of the sewage disposal system aGrving the above de=ribsd property, and that it has been constructed as shcm cn the approved plan or approved amendment thereto, and in accordance with the standards, males 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 wCertificate of Construction Compliance0° for the se;aage disposal system, or pay repairs made by me to such system, except where th(p failure to operate properly -is caused by the• w, ill ful - or..negligent act-.of -the occupant of the Branding utilizing l +6'ha unders,ignid gugtheg agrees to accept as conclusive the determination of• the Director of the Division of Enviroaurental 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. Nted thiP' ,� day of 194�1 Signature Title CIA Contractor Krdner�Signature rev. 9/65 Ift I. << 1 0 i; ,ENGINEER TO PROVIDE PERMIT PUTN AM COUNTY DEPARTMENT OF HEALTH . r ` " A ON CERT F I CAT 0 COMP •I NCE D.ivisfon ofi - I'll r menial Healih Services ,Carmel, N -•Y 10512 .�ERMIT.ti A ' Address ��ur ?00 Other ' Requirements 1. represent that l am' wholly and completely, responsible for'the design >and location of, ;tl above - described; will be constructed as shown on'the approved a mendMjht, there to and „ir County. Department of Health bnd,thaYon completion thereof a 'CerLiicate of Cons be submitted `to the'D,epartmenY and a, written” guarantee; will De :furn�shed'the owm place in.,,good4 opeiating condttion'4any ,part '.'of.,said sewage, d!spo',ri system" during tl ance of 'the approval of the. CertiiI-cate,'of Constiuct�o� 'Complianye 'of the ongmal`:I will be'iocated as-shown on the approved plan and that said well;wilibe?InstaI fed i- :accor County Oepa��rtyyment'of ,Htealth 'Date • APPROVED FOR CONSTRUCTION This approval "expires one year from the date issi revocable "for,;cause Z. ma'y'be,-.-a mended or mod IfFed wheri considered'neCessa'ry by the requires a new permit Approved'.,to► disposal of domestic. sanitary�ewage f Date 7 �� t Rev.- 6/85:..: 'proposed _System(s); -1). that the separate sewage disposal system mordance'with the standards, rulesan regu a ons of e,' u nam ictlon Compliance sat Wait Itoiy'to. the Comrnissioner,of Healthwill . his succeisors, heirs.or' assigns by'tha builder,'•that said builder will period of twd'(2)'yesis immediately,following'.thedate' of the issu- terri or any"repairs.theretol= 2)'that the drilled well described above C' with _the st�and�aarrds,' rules, and regu.a ons of the Putnam License No.' i u nie"ss construction- of the building has been undertaken and .Is. mmissionee' of Health. Any. change or alteration of 'constiuction ,dte',water supD1Y only. /• ' Title e� I I � i CIO 111� WLLJL UVr1r1jziiV" 1%r1r V A I DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ORESS: TAX GRIO NUMBER: Patterson, New York WELL OWNER NAME: ADDRESS:. StiX BuAders, Inc., RD #6, Ballyhakck Rd., Brewster,.�.qy PBIVATE 10 PUBLIC USE OF WELL 1 - primary 2 - secondary .. 13 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT 5 3 300 gpm./NO. PEOPLE SERVED / EST. OF DAILY USAGE — gal. REASON FOR DRILLING 3 NEW SUPPLY, ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA 200 WELL DEPTH f 25 IC WATER LEVEL _ft- F .6/12/87 DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY Q- COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING, 91 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 3 4 ft MATERIALS: -STEEL ❑ PLASTIC 0 OTHER LtNGTH,BELOW GRADE ft. JOINTS:. EAWELDED ❑ THREADED 0 OTHER DIAMETER 6 —in. SEAL: CREMENT GROUT 0 BENTONITE 0 OTHER WEIGHT PER FOOT 19 1b./ft. [DRIVE SHOE qYES ONO I LINER: OYES ONO SCREEN. DETAILS DIAMETER (in) SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0* YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE. - -FW-ELL DIAMETER TOP OF PACK in. I DEPTH —ft. BOTTOM OEM — It. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- (R COMPRESSED AIR formation attached? 0 BAILED ❑ OTHER 0 YES 0 NO It more detailed formation descriptions or sieve analyses LOG are available, please attach. 'PT' F" DEPTH water Bear- ing Well ia meter In FORMATION OfESCRIFTION COOS, L It. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD 9prn. d S la�urface _10 .1no 10 , ay & silt. Q1 10 200 1 - 6 Hard grey & black granite 200 6 .150 20 WATER 10 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? INYES ❑ NO ANALYSIS ATTACHED? 11YES 0 NO STORAGE TANK: TYPE Diaphragm CAPACITY 62 GAL. is PUMP INFORMATION TYPE Gnhmarsi ble CAPACITY - 7 MAKER —Goulds DEPTH 160 MODEL 7FHO5412 VOLTAGE M HP Ja WELL DRILLER NAME MY DRn& 18/87 ADDRESS Putnam Ave. SIG' Brewster, NY P 0 C4F�id3:.�4r'•t�14'r; ":,=5 - �a1'.� S7. .. . . Or n Medical Laboratory, Inc. 321 Kear Street n - 7 �locktow'n Heights,,N: Y,_ 10598 • .. - -. ` (914) 245 -3203 { Daector: Albert H. Padovani M. T. (ASCP) MILL-.DRILLING'COMPANY.- ��a Putnam Ave ..: q Oft. Brewster, NY 10509. .•.,. LAB N CA.. 0o5203 Date Taken:. Time: _. D.at.e .Rc.! d t 1 I K f - =Date Reported: Collected By:' ll Drilling Co. . Referred By: 1 Sample Location: l)1 L1 pu7n5m 7771--e Phone l' Phone Sample Type:. J Repeat.Test? _ (check one) LABORATORY REPORT ON THE QUALITY OF WATER `;:; INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL.(CFU /100mL) . :Acidity GENERAL BACTERIA Alkalinity Chloride :; Standar,d:: Plate Count .. So. Detergents'MBAS; (CFU /1.OmL).',' }, f `Hardness, 'Total '1.0 , Nitrogen, ` °:Ammonia'.. MEMBRANE F:II;TRATION TECHNIQUE �' Nitrogen,'; Nitrate Phosphate, Total, ` Total Coliform 4 Sulfate h Sulfide Fecal Col iform Sulfite — d _ Fecal Streptococcus' METALS (mg /L) MOST PROBaBLE •NUMBER ` TECHNI'QUE Copper Iron, _Total Col i for m Index • .Lead , Manganese• _`Fecal eoIfform'_Ind'e)t ' Mercury Sodium KEY FOR TERMINOLOGY Potable _ Non- potable STP INF STP EFF Other: !Sample Status : (check eech); . Outgoing _ HNO3 HC1 H2 SO .NaOH Na' 2S2'03�yn Other. t , In 6b M— fn' ,'''' LE 4 °C :.Zinc GT 4 °C N/A = Not'Applicable _ pH LE 2`.' MISCELLANEOUS LT = Less Than ( <) _ pH GE 9• GT = Greater Than (>) pH GE'12 pH'` (units) TNTC= Too Numerous To Count Other: ..Color' '(units) CON = Confluent (= TNTC) Odor* • (TON) NR = Non - reactive Turbidity`(NTU) REMARKS /CO'MMENTS (For Lab Use) Sy • 1 1 -THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS) (VAS N'.T) (N /A ):` OF `A .SATISFACTORY rSANITARY QUALITY' ACCORDING T;0 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 /.') 'MEET THE` ATISFACTORY 'CHEMICAL QUALITY STANDARDS OF, THE NEW YORK'STAT KING, WATER 1 •:C,ODES­,` FOR THE 'PARAMETERS TESTED, AT THE ,TIME OF COLLECTION. x L ::Albert H. Padovani,, M.T. ASCP), Director', 2 /86(Rvsd7 /87)RWE J i FINAL S,, INSPECTION _ te c:. -tea by v TM 'XL OR ut: IVISMIN Izr 'I Yt5° KII cct, I.. 1 y': ' L � rT . V. Vi- a_ as per aL7^.rcyea pla_nS b. T Fi>> sac ticrl - Dc.r-? cf plzc --rent 2:1 barrier . IIGTfi W t I - A G _ DPFFl I c_ j r_yr l soil not s trircea d. Stcne, brush, etc- , 4*r==ta- t`uan 15' f =an SLS area- e- 100 _ft. fran wct r ccur e/ etlands. I SL?u DISPOSAL SYSTEM a_ Sec 'ic t=_nk s_ -e - 1,000 1,250 ' I b. EentiC tcL?k irStal ! ec Lvel c. 10' ird-n i --in Lan foam sticn Q. iz 90, be ^_CS, Cl °.`'_cL'L wit.11'_A 10 fc. C¢ e. DiS RJTICN Er-,X 1. All l cut? e s c sal�,e e-1 eVa,icn - water test =' I J 2. Prot=r —� be-' c°,; r= as z 3. rti *li ilan 2 f. CriCir?=l ScL b ==,vc C sLrf' t= =n .e °I I f. jUCCI'ICN EOX = crcc =-1 v set I I U 1. L= =.c=am: 2.� �11_�= �� �✓ 2- Distance to 3. lzlc -^ 1 1 ac =r.z -i _*= c to plan 4. Dist=..nce c_rite_r to cant-7- 5. Sloe cf trancil accentable 1/16 - 1/32 6. 10 feet f:m l crcc _-_ t7 1? ne - 20 f = - fc =da-t cr= I 7 Dect.:z f: t_anch < 30 inches frail Sp=ace _ 8. Rcan a1 lcwea for erg ^c, cn , 50% 9. Size of crc;;e1 3/4 - 1 ;" Giarneter 10. Eeotn cL c_—a4-Z in trench 12" mirirm- =rcea h. PENT CR McE SYSZ-=m-S 1. Size' of p= G- ,_aTLer 2. Cve_rf aw t ink j I I I 3. Pla an, 4. F.rnln e= sily act= =sible lr`r;l cle to trace 1 ' 5 . Fi rst bc x haff y Ems= t `*1 Deter ` 6 . Cvcle w _ `re_ —a b ran t es t ate flan: p c7cle EGLSc. a- Ecuse lcca teE c-ar a::zrcv lc_-is . I b. NurLer cf b-_2xca._= I I a. hell lcc =tea as CEr acorrovea Dlanss b_ Di-stance fran SLS ma=y ra = =sus ft. I c. C?sinG 18" ahcv=_ otter c_ Surface 2i._.c1P =c= arcund Well cC= =ci?^! e. WIO�sncrT� a. Ecxes rcce_rly c_cut b. All vices partialliv �zcc =ille^ I C. All pi ; f! ush W _ t i =s ite Cif bc-x C.. Eackf ill material cc nta ns scccas. < d't in d.L, _ter I I e. C=tazin d=- in install= ac`crci nc to clar, r_ C'?: �?In CTCiIl CL�c! L Fror-ec-"Ec & Ei .t0 Ev_ici rr` i-c C. FCcti rC ao;+ ,r f =n SEE cry I h. SST fac= war=n vrct l-ticn acs -�_c_ i_ E_r=csicn cant=o! crcvicec cr, sicce=_ c_ te_r John M. Simmons, M.D. DeDU tv..Commisi -s.oner zo NAME ADDRESS 4 "i DIVISION OF ENVIRONMENTAL H .- HEALTH SERVICES. Health `—FIELD .-N-T la,r T PX f Z;;� 'T T-__­__, No. Street 7 Municipality (T)(V)(C) MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED .0--l" R"i Orig. Complain Orig. Request Compliance Complaint Comp Final Croup Illness Construction Reinspection Field, Sampling Only ­_Field Conference Name-and Title Other DATE TYPE FACILITY TIME ARRIVED 1,-z2 'Obo TIME LEFT Explain .FINDINGS: 7— e4 40y 0-f _,4 -40 4�4r_ f -0.,c ;1/1 is 0- P s INSPECTOR: TELEPHONE : Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report ..................... TITLE: Ate. _Oef -_P, -- 40y 0-f _,4 -40 4�4r_ f -0.,c ;1/1 is 0- P s INSPECTOR: TELEPHONE : Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report ..................... TITLE: FINDINGS-' c jr, ' PUTNAM C 0" UNTY HEALTH DEPARTMENT DIVISION _OF ENVIRONMENTAL HEALTH- SERVICES . -M D, John MW -Simmo n s Deputy, Commi's'sioner of. Health FIELD ACTIVITY REPORT- Sheet of INSPECTION NAME Orig,,.*Routine Orig. Complain ADDRESS MW �b bk, p A Orig. Request No i:' ;..'Street ­1pa ity (T) V) (C) 'Munk- 1- Compliance Complaint Comp MAILING. ADDRESS. - W,, ...... Final P,,.O. Box Post ::10ft ice-- Zip. Code. Group Illness Construction, -TELEPHONE:, .Rejnspection PERSON " -,t N CHARGE ' .,Field, Only OR-INTERVIEOED LL &(In a C_ Field Conference Name and Tit e Other peg-r- -regr DATE. j3 F. TYPE FACILITY TIME -ARRIVED... TIME LEFT : Explain FINDINGS-' JM - 5 - :.* PUTNAM COUNTY HEALTH 'DEPARTMENT OF ENVIRONMENTAL - HEALTH SERVICES DIVISION John M.. Simmons, -'M D. Deputy Commissioner of Health, - ..FIELD ACTIVITY- :REPORT Sheet / of / INSPECTION, :,NAME;, D AW49 M /LLS Orig. Routine .. Orig. Complain ADDRESS GAt2Fr�LJ� _ D2lVE _ OA:TI�eSoA/ Orig. Request No. $tree( Munk- ipa,hi,fy . (T).(V) (G) Compliance Complaint Comp MAILING ADDRESS Final ... P`.0. Box' Post Office _. Zxp Code — Group Illness . Construction -TELEPHONE' r _ Reinspection PERSON IN'CHARGE M►t-T w11.50N �N��H i Field, Sampling Only OR INTERVIEWED )ONAt,'D :Mll,l•5 OWNER .. _ Field. Conference Name- and Ti t - Other ?ft oWV*16r4 TEST DATE, $ :S $b °' TYPE FACILITY,_:_ , . TIME ARRIVED g.. 'Am TIME LEFT {,Z., Pnn _ :.' Explain ' FINDINGS fimE OE!'M sm-lEt ITT& MIU. .. `S'nlllt /S7�t� '- �4nR RU1J /ui[ JM - 5 - PUTNAM CUJWY DEPARTMENT OF DIVISION • I• •' ' !E Y• •1 • U• •IS DESIGN DATA SHEET - SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �Oh�A �. /�iLL Address Located at (Street)-, �,qi�,� /F_ L z? "f /21 Vz Sec. Block Lot 7,5 (indicate nearest. cross street) Municipality Watershed SOIL PERCOLATION TEST DATA RDOUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-soaking' Ave, ye Date lof Percolation Test iVO g r ­ -- 14 SOLE i NUMBER CLOCK TIME PERCOLATION PER OLATION 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 °F2t 110,0¢ /0 37 .33 3 6 315' T S'r 2 IU,jOD /4�� - 3 11,;g % 3C. /3 4 5 e 1 io, ip v 2/. .3 3 3C; 3 4 5 1 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 suhmittOd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 DEP'T'H G.L. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. , HOLE NO. 1' 7oR *14 7 b P Z, 21 A 3' d5�9NOr✓ 10.9 S/�i'��/D/�tj 4' 51 61 Al-41i7f A4,117o 71 81 7,6 '�' sliV11 91 10' 11' 12' - 13' 14' • -- .-- ..�_...._... ICATE'LEVEL� Ar WH1(m GROUNDWATER IS�EINCOUNTERED_.......�_. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: Z-, , �i��Z", DATE: 9X -V S_-4' IZ �� DESIGN - a -6760 �1 -t Soil Rate Used // °/j_ Min /l Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type /%Of' ,err2 `/ Absorption Area Provided By L.P. x 24" width trench /� .,/1- %SO 4 Other G -4 .Y_"'_ /--- �"��:air� 3'7� t`tf crra Name (.. %���701y /��L . P o N Signature��` Address )2 - _1- 8/JAff'�iyJ72 /L IV, SEAL °u 1 o o p °o o W o ° I U g ° a- aa THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: *n- °'° ° ° *_*t& � °° ' °V06000O °" Soil Rate Approved sq.ft /gal. Checked by Date P(TIMM COUNTY DEPARTMERr OF HEALTH DIVISICN'OF HEALTH SE MCES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address Located at (Street) Sec. Block Lot X775 (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA RWJIRED To BE suBmiTrm WITH Appmcmms Date of Pre-Soaking 4e Date of Percolation Test 4;10,g HOLE NL14BER C= TIME PERcaLuim PE RODIATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches 2c 1 10.045 1,0 37 39 —2 W47011,16 3 11,1P 4 5 1 33 36; 2 -&o.44- it :o 7, 2 3-3-, 4 5 1 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,rreasurements to be made frcmtop of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. Z HOLE NO.. HOLE NO. G. L. it ZZ 2' �l A 3' 10.9/uf Dy'D/�•'�1 4' 51 61 7f 71 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER -Is INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: C% �Z7a,y 1!/ /C S4h1 DATE: DESIGN - Soil Rate Used //-/j' Min /1" Drop: S.D. Usable Area Provided 1-60 No. of Bedrocros 3 .�/c�. Septic Tank Capacity IeOn gals. Type lWi- o,v2`/ Absorption Area Provided By L.F. x 24" width trench // Other � x Q X P, 1 G'y Name %rL7p f/ &i _P o N Signature n Address /c ' �- ���`�N171`�L %� SEAL THIS SPACE FOR USE BY HEALTH DEPARDOgT ONLY: _.RlEd�j e° IN o��° � '�Jf ° P•� o 0 0 00. e 0 o �o 01 Soil Rate Approved sq.ft/gal. Checked by Date r - LOTS 6773 THROIIG. 6786 "INCLUSIVE,, •AS SHOWN L 1 ON TIGHT H MAP Of PUTNAM LAKE 7N R OF: PATTERSON, PUT;NAM COUNTY; NY' • o DWELLING a `_ It � ' , � ;,� . 1J' ,.5•. TO, COVER _ ' 99.7 ... - W. TO WYER vo SOLB PYC ' 10. 6MTRBUTt sqx . :A: n1 2 3 4 0 O SO41D PYC a TO GALLFA ES (1YP.;)- 12 ;DROP BOX•:1y . 'r { + ',•: . ' r g i.8 8 7 '..:BN :DROP.SM 2 h� dti i tY °' r } tT t + C..ttD^� t4^�, tD y,1h"�'`f2t � DROPBO%9 •t • r rr 94 l i r e B' X +Y +' ���;�Alrtl�iilES ,•�,i Y #y�'2 F.. f1L��D EC1 #SAN /l►Lt:E tES B' l4 �Xw ; GAi LEfitS YA, E, Fa G 325 S. a i , THIS AS- BUILT SYSTEM -•HAS BEEN CONSTRUCTED; ' .. UNDER PUTNAM:CQUNTY'HEALTH DEPT:iPERiNIT #.P' +e DESIGN. DRAWINQ 84: _ C: MILTOIJL�WILS6i4,. E. .. DRAWING'DATED; ?8!27/86, "THIS IS TO CERTIFY.THAT._THE SEWAGE DISPOSAL,,. SYSTEgA WAS CONSTRUCTED BY ME "BEFORE !T *A'S CQVER,ED 6V&.' VER THE SYSTENF WAS CCAISTRUCTE Ii" • , ACGORDANCE'WITH ALL STANDIARD RULES REGUL_'ATJONS OF THE PU fNAM COUNTY' DEPTr HEALTH AWTHE NEW YClRK $fI#TEt,DEPT ' OF `HEALTH ".'. HOUSE LOCATION;AND SURViY•.BY DONALD R. •CALABRESE ASS OCIATES,�INC; , <AS»BUlLT -' : TABLE. R fQM DEPTNTO r , LOC . TtON� A ._ t� 'fit DiN,ELL�NG : - ' • OVER . .. 0 LEFT CORNER�GHT .CORNER SEPTIC TANK 28' = 14 '- -32' : 9" 10" Di$TRiBUT10N 80X 48 2 31' - 2" 20" DROP BO(` 4,1: 4" t e" DROP BOX 2 � � t 'gg 6' ' S0� S 1 T" , Gor - - ' turnam County uepartmeui ul neap.. revision of Environmental Health Servicee approved as noted for conformance with.• .pplicable Holes aid Aogulations of the Ntnam County Health De ent. -: - '' to ^t4219tQNf hri ...A y %'V��Ls/ AS BUILTSANiTARY DiSPtOSA! SYSTEM WYq FOR STIX_ BWLDERS, 4NC t g'og� RFC GARFlELD DRIVE, ;TOWN, OF PATTERSON :scu.e:' !" _ ;20' AePa . BY owiw►i.ar :J l ohm:. 8/ 14/87 ;: JOSEPH ZAREEK I, P'E.,. •'' .. .