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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:
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e° IN o��° � '�Jf ° P•� o
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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 •
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rr
94 l
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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.
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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.,. •'' .. .