HomeMy WebLinkAbout1448DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
34. -2 -36
BOX 13
r
jr
�.
me I NIL me 9
{,
I
r ,;
E , -6
i
-i` ^I .'T -r'^ _ ^. ,s., -r F--- -+aa�' -�-,.- -•cF�^';,a -M, - •r—q r x - a,..,K.x•-^,. � 4 'x.'�"°'_�`.-s^,.;f^,�"x?°q ° rz-_" - }...e. �'��.
J ,. i 1
!ICATE PUTNAM COUNTY _DEPABTMENT OF HEALTH
N,Y 1QSls OF CONSTItUMON COMPLIANCE FOB SEWAGEDISPOSAL •SYSTEM
Located at oT� i/ i'G>� Di- .
Ter : Town or
T n Map Bkpt# Lot
Owur /ipplkaotName F., Vii.• t Tne.Forme>IY S ` Name
iFPAap
174Q. I :# 2t3
Fee Enclosed Amount:.pp -Date'Permit Issued _
separate se*enge sy** Wt by 5.: A . S� �: S,�c vac Aaaress
Consisting of 12 SCS Ganon Septic Tank and 720 L; F. .6-f
Water Supply: Pdbpe Supply From Address
ors Private supply lhNed by P F. . beta i � So�,s� T =� Address � 6. $., x R
$uIldhi nQ'e �.++,�.." ome_ LOt Size as Erosion f nntrnl Roan l`nm= 1 atnA 9 �P�S
Number of Bedrooms Has Garbage Grinder. Been Inetelladt /� a
Other Requirements
I certify that the.syatim(e) as listed.'servinq the above premises were gonatzuc essentially as s on the plans of the completed work f copies
of which are attached), and in accordance with the eiandaids, rules.and regula n .in accordance v tie.filed plan, and the permit issued by the
Putnam County Department, of Health. ,
Oats .,°r, _ 9;a. Ceitflsd by 99 P.E. R.A.
nea.ess 3's0 Vt r ns � snnr7a 144dw , / �ui M License No. n� f38
nkG^ o N x7174
Any person occupying premises served by the above systeni(y shall pro' .. .,take such agtio ss may 01 necessary to revere the correction' of any unsanitary
conditions: resulting fro m -such Yfige Approval of thertdpaistn..^.wwNa�a.syuem pitill,becoTe null a6e'vold'as soon as= a putil;: sanitary sewo beeoma
avllible Intl the a p "M of tha private wale supply shilLtueome null id when • Pub)lt water supply - becomes evallable. `Such approvals we
sublect t tbri or change when in the •judgment of 'tM :Co 1 ef MMlth.,. rNroeatbn, Modification or change N neeew
3/89 oa. 9y Title
i
WELL COMFLETIUDI LV_XUr,1
Office Use Only
mac
DEPARTMENT OF HEALTH
`
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREET AOURESS: TOWN/ViLEXCEICITY TAX GRIO NUMBER:
WELL LOCATION
Windsor Oaks. Fair St . Cannel , NY Lot #28 71-1-1
NAME: AOORESS:
❑ P IVATE
WELL OWNER
Foley Dev. Co.,Inc.983 S.Bedford Rd. ,Mt.Kisco,NY
❑ PUBLIC
USE OF WELL
19RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
1 - primary
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
2 - secondary
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
[]REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [:]ADDITIONAL SUPPLY
DRILLING
VqNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 600 ft. I
STATIC WATER LEVEL 4O ft.
DATE MEASURED 12/20/89
DRILLING
[ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING -'U OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH __ 31^— ft
MATERIALS: Ga STEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE 30 ft-
JOINTS: ❑ WELDED ® THREADED .❑ OTHER
CASING
DIAMETER 6 in.
SEAL: (R CEMENT GROUT O BENTONITE ❑.OTHER
DETAILS
WEIGHT PER FOOT 19 lb./ft.
fl DRIVE SHOE YES ❑ NO
LINER: G YES ®NO
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (1t)
DEVELOPED?
SCREEN
DETAILS
FIRST
O YES ONO
SECOND
HOURS
GRAVEL PACK
❑ YES
GHAVEL
DIAMETER
TOP
BOTTOM
O NO
SIZE:
OF PACK in.
DEPTH ft.
DEPTH ft.
WELL YIELD TEST 11 If detailed pumping
'If more detailed formation descriptions or sieve analyses
WELL LOG are available. please attach.
METHOD: p PUMPED 1 tests were done is in-
DEPTH FROM
Water
well
-M COMPRESSED AIR ; formation attached?
SURFACE
Oia-
FORMATION DESCRIPTION
CODE
O BAILED ❑ OTHER ❑ VES ❑ NO
ing
In
it.
ft
WELL DEPTH
DURATION
DRAWOOWN
YIELD
Surface
15
Drilling
in overburden clay & boul
er
ft.
hr. min.
It,
gpm.
wit
oc at '
600
6
585
.5
15
31
MrAling
in rock,set casing,grout
d.
1
600
lina in ock aranite.
WATER ❑ CLEAR TEMP. _
QUALITY ❑ CLOUDY HARDNESS.
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE WellXtrol 203
CAPACITY 32 GAL.
PUMP INFORMATION
WELL DRILLER NAME P . F . Bea 1 & Sons , In
TYPE submersible CAPACITY_
MAKER Gould DEPTH 560'
ADDRESS PO Box B 1 -
Brewster,NY 10,��
i
MODEL r 0 2 VOLTAGE 2.3DHP �._
4
.Kittinger
Owner or Purchaser of Building
Windsor Oaks Associates
Building Constructed By
Highview Drive
Location - Street
Patterson
Municipality
Residential Frame Construction
Building Type
28
Section Block Lot
2194
Tax Map Number
Windsor Oaks
Subdivision Name
28
Subdivision. Lot
GUARANTEE OF SUBSURFACE SEWAGE.DISPOSAL SYSTEM
I-represent that I am wholly and completely responsible for
the location, workmanship,, 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..guaran -tee -to-the owner, his successors,. heirs, - -or assigns,
to place in good operating condition any part of said constructed
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
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 th ., occ pant of . the building utilizin, the- s
Dated this day o v - 19 Y'O Signature—
V. ?. Fold De Co. of Pat2ti4 on Inc.
^er or Owner - Signature
Wnsor aks Associates S.A.F. Septic
Corporation Name (if Corp. Corporation Name if Corp.
83 S. Bedford Rd., Mt: Kisco, NY 10549 P.O. Box 141 Cross River NY 1051E
Address Address
C
C
Windsor Oaks
_ - - - - — -
-BREW-STER LABORATORIES :.......
Box 224 - BREWSTER, N.Y.
(914) 2794945
WATER ANALYSIS REPORT --
SAMPLE NO., 76
Fol0 TEST WELL
ey Dev.
SOURCE: Windsor.Oaks Lot1128
Fair St.
Carmel, N.Y.
COLLECTED„ 3-21-90
BY:. P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Colilorm Count, MF Mothod
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
3 -23 -90
J;.
ITT .
FINAL SITE, I%,IScrC!' =CV Cat_ d
Ins; by e eav l
,•G1T_ SGN %�AG�,VI CRIER
!J .� --, C94 _ .,,t,TC -•rn„ rrm .� � l/ � J�ln/Y n/Yl ��r /q .,
e.
P Ll CL'r L e _. G _ Saule elel7at_Cn - Wa =r t =s �.•-
ti M i n -, ,; L -- _ cric
% )re' t' , C- t..... .".�^, < 30
t 1•. ^. /,
DISPOSAL AELE
I
1
1
a_ SIDS are-= JC —+— as '" a=roved Dlans
b. P-11 Date of placsn--nt
I
I
I
2.1 baTriEr . I=- . W- =H A�TC_D FT? 'H -AI
.
C_ t'atur- soil r_ct _=trircU
I ---
I
d p= E_5' _`+ ac=ss —Zble rran cle to crace I
d_ Stone, b_rus etc- , cre=_t`r tt'1cn 15' f_cm SDS arEa-
"
I
-
S Firs= hcx h=f=1ed I
I
e. 100 ft_ fro:. ccnr_a /Ye
DISPCG . SYSTEM 1I
-4-
1
a. Sect; c 1,000 1 `
es ti*:'at _^ cN der cy c
a_ Ecuse lcc == rer accrcvea pla-r =s-
I
b. &_uL1C tc:,-k level
C . -La, lILi rl' TIiL -t CLLr: - on
- V- Ono Wi -r1 i r, 10 ft. cf 45'3
I
e.
P Ll CL'r L e _. G _ Saule elel7at_Cn - Wa =r t =s �.•-
ti M i n -, ,; L -- _ cric
% )re' t' , C- t..... .".�^, < 30
Rccn =cr] E`s-, ns i cn, 5� %
Q vlG C C�:Cl 3/A diam
L
c =v e-T- in t=ench 12" mini7a--,l
1. Size of C'.iu,s -
2. C e--=:'lc- tB-TI
I
d p= E_5' _`+ ac=ss —Zble rran cle to crace I
I
-
S Firs= hcx h=f=1ed I
!
I
6 . C4rc1e w _- -- _ � by Hea- ul
es ti*:'at _^ cN der cy c
a_ Ecuse lcc == rer accrcvea pla-r =s-
c -j4 -Z Z cT"Drcve, plans I I
I
b_ D'qt rice =_..-.: .`.L' a= �--
c_ C= =ina 18" jE]2c�e
d_ S..�a�� �� _- �•cr =:c wz? eccect� i e I -- IIf ---III
v__ cvE:7 .. WoRK.LaSrr
b. P -1 ices i�1-� becLi� i I —I� I
c_ P_ pices f �•_`� Wi t_-i inside of bct
d_ E=: ICf; I� Ii. =t_ =� cCr_t? *'n= s`cne=_ < 4" in di "F
e. C= n era; = irs -i1-A accordinc to plan •-�- -�'-1
i. C_*-n d=:. : cwt = =i1 prcte =-'c & d4-.to
c _ r'-ct? na C?'a_ G'_= G ^.GrC° aSvaV t -cCR SDS area I �1
h_ ace wat -- crctec =ica adept° I -I
1. E C_sIcif c_. .=c i crcvid =d cn sicCes creter
GENERAL NOTES
I ® I ® 1. ALL SURVEY INFORMATION TAKEN FROM SURVEY PREPARED BY BADEY 8
® WATSON, SURVEYING & ENGINEERING, P.C., COLD SPRING, N.Y.
• �^ 2. 'AS- BUILT" MEASUREMENTS WERE TAKEN 3/27/90 BY STEVEN J. HYMAN
ASSOCIATES CONSULTING ENGINEERS, RONKONKOMA, N.Y:
DRAINAGE _ N lO'30 32 E _ 150.00'
AREA = 40,537 aF. CONTROL POINT
Q93 Ac STRUCTURE I POINT "A"
® W SEPTIC TANK 1 48.5' i 19.7'
O JUNCTION BOX 2 94.3' 73.6'
JUNCTION BOX 3 93.2' f 76.0'
N / N JUNCTION BOX 4 92.6' 79.1'
® u/e s o' rrr. m ® JUNCTION BOX 5 92.2' 82.1'
N / y JUNCTION BOX 6 92.2 85.8'
JUNCTION BOX 7 92.7' 89.7'
✓UNCTION BOX (TYP,.) JUNCTION BOX 8 94.2' 94.0'
e JUNCTION BOX 9 95.9' 98.6'
O' 7YP
JUNCTION BOX 10 98.4' 103.6'
r POINT 11 132.5' 112.6'
POINT 12 131.9' 114.6'
r POINT 13 131.6' 118.6'
a POINT 14 131.4'
Roe/ 1 POINT 15 31.6' 121.3'
I . SEPTr TANK POINT 16 132.7' 124.8'
/250 GAL
/ POINT 17 133.9' 128.2'
POINT 18 134.7' 131.5'
Putnam County Department of Health POINT 19 138.7' 135.3'
PT. a" Division of Environmental Health Servioan 54.3' 37.2'
3 POINT 20 ,
416' FRAME POINT 21 51.4' 41.2'
DWELL /NG Approved as.noted for oonformanoe with POINT 22 50.7' 47.7' .
N co applioable Rules and Regulations of the POINT 23 50.3' _53.2'
-.b 45.8' N them Co ty Health Departme t. POINT 24 49.6' 59.2'
y _ a o POINT 25 51.0' 84.0'
gyp- Signature do Title Da a POINT 26 52.5' 70.0'
v POINT 27 58.0' 78.0'
wEZt POINT 28 60.0' 82.0'
5.03'38'33" W /50.00' DESIGN INFORMATION
4 BEDROOM HOUSE
HIGHVIEW DRIVE LATE RATE' 30 H REQUIRED- LATERAL LENGTH REOUIRED- 887 LF
LATERAL LENGTH PROVIDED- 720 LF FILED MAP AT Z194, FILED 121.0/86
� F
���oN gc °q FAIR STREET SUBD /VISION
10 SEPh y�4 LOT 28
TOWN OF PA TTERSON i NEW YORK
N Z ' MALVERNE, MY. /
fD/i! 599-3661
Js� R/OQC; N.Y. //961.
THIS 19 TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS (! /sv sa .0-3230
INDICATED ON THIS PUW AND WAS INSPECTED BY A REPRESENTATIVE OF OUR s� aA C>� ALE: ppo%NO,: oAlE: ' SHEET
OFFICE BEFORE R WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN G q wNP 50' 8939 ✓UNE!l990
ACCORDAPICE WRH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY. °FESS
R.� ✓fq,. =�. 'AS -BOIL T" SSDS 8 WELL �?
DEPAR•T*IEW OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH.
i
.-^7
•
V
�--icYs
wa.wa.r + SF Sa1�Jiirisrzj 6lb+:i,.ti
.a`
= Tmallor
A�Nl+.e
i
r
M� I��s� a. ►as
?ors
natP.S
s ulid� vis Ic,ii ,
Fee Enclosed: A,nr,t;nr
�
�"�
o°a vaiaos
PC®eN Wa 1s Y•4�6red Whee P®b
N�Mr .c sae.... Deai�t M4 G P D
a4kad
s.�.a•sar..�.Sr•�aa.rt1 „r' '°72c'
iF. o ��l" 1`,�*► -yr = h�'e�iL.
- T. M •wM .dd b' Adiho"
f
wow s.�y» t•.... � Fe..' � Add... A 4 400
77; 1yb
OOwlty O�YNtrnant ,of "on's and,mwk On c#!!Oetbn the,
M �rbinitt•d-,.to'tMl)aPartennt an0 -;a writtin,YuaaM•ii
t>ys'a'�k+.'Nfaoo oP•►atYM conOltion int+,. Dart- ;ot,_siW sfwaM
arl•. or <tM aPprarat of tha.;Certiftc�te or •Construetbn .Co
Wo be torat•d a. dwww. on e1i.':vwor.e`w.n ana That saie•we
CobntY Ob�ii rtrfrarlt W'- I4•alth.
Otte rJ� 2�
wtlar•s �0�-�- �'r4n�
APP,PROdVEO FOR CONBTfi T10N ThN aOprowl eYONes'.tw
r•rocabl•, for �Uillw or.'maY be fnwrwae o� ro00itiw when eon
requires • �OW UL P AOWowtl for'difpoUl of tlOrMSlle
Rev.
10/88 oete
ntlntent thin` to an0 an aceoreana with tM stanGrtls, rule`s a rpu n} o - m
a'�c.rttfi�aa of Construdbn:Cornpliane•� Ytidaeto►y fo tM Co�imiplohM of HeNthwill
We fufnilll•A the owrW* his 'W mos as: MMS Oi.assyns by. the butkNr, that W builder will
V" iyftNii durinj tM,pMba of two,`(21 Y!!!f NnrnadifitNy followfn�'tMat• of;tM
Nina of "tM yiriai systain o► any rpairt t"Stoc t) that the drilled, will deco OW' abO
Ill be Mttal • with the dandarda; rulu ;and rpu%aiio s of0f•', the.PYtM1n ,.
NI•tl% �- _ P E: R.A.
S,v.i�v M nkos�araa i�1
le OxS)
' t_arq• No
liwe "fro"► tM data' issued . unk" cgnstiuetion -of tna. bifiginy fws :been• undirtakeil aril if
Mi0 11eCefYry` by; tM. COMTipiOM/ Of',MMlth. Any chirps or alteratioe of CpnftruC[bn
it y a«�i+�•. /oi�privab `water suolihy only:
TRIG
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER; CARMEL, N.Y. 10512 (914) 225 -0310
LPPLICATION TO CONSTRUCT A WATER 'WELL
PCHD PERMIT #P�31_47
WELL LOCATION
Street Address /Town /Village City Tax Grid Number
WELL OWNER
Name Mailing Address
FoI e Y, Deve/a p ave f- & . I , G
e3 SO-44-41 "l
mo kis c� � � J S ,)
rivate
O Public
USE OF WELL
- primary
2 - secondary
,RESIDENTIAL
® BUSINESS
®. INDUS TRIAL
OPUBLIC SUPPLY
O FARM
U INSTITUTIONAL
❑AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
13ABANDONED
O OTHER (specify,
AMOUNT OF USE
Y,IELL SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__gal
O REPLE,CE EXISTING SUPPLY ® TEST /OBSERVATION Gb ADDITIONAL SUPPLY
NEW (SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
r'I v e
e�Gr 'r S -
.- dP eI. �v a /llp -►y
I! r ineo,.� S�fG%�Vlsl�cr
WELL TYPE
DRILLED
®DRIVEN
®DUG C]GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME.OF SUBDIVISION: ,Ir
Lot No.
x
WATER WELL CONTRACTOR: Rime r, E. -R,,e ] Address : eeps•}e, All 1050)
IS PUBLIC WATER SUPPLY AVAILABLE.TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: ,V4- TOWN /VIL /CITY
bISTAANCE TO PROPERTY FROM NEAREST WATER MAIN: tiJ
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
�ON SEPARATE SHEET
(date) (signa re)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted Linder 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 appl i cant s.hal 1
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: d9
19 e�rtm t ssui ng ci
Date of Expiration: 19 %f
Permit is Non - Transferrable Mite copy: H.D. File
Yellow, copy: Building Inspector
Rev. 10/88 Pink Copy: Owner
Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division.of Environmental. Health Services
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION- SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
APPENDIX L
TO: Commissioner of Health '
In the matter of application for:
4- i+ee, -- 'Su lod i visr opi
• �'J�d�vldU� [ �S s 41�d ,�ej^ Su /. -_.-f -6y- Lo4 No.
u l fi0 14e
represent that I am an officer or employee of the corporation and am authorized
to act for P i@ �2Ve�p g�4- Co . o- �G'E~�-ei -sow �hC .
(Name of -Corporation)
having offices at e .7_.. ,5OL �'J. �je�'�►'(�. K(�GLt
Whose officers are: )
President:
Vice- President: S4vzrue
83 Sou-41 73,ecl -Ward Raid
r. A44-, e1sco n(-� 10S0
and Address)
nd Address)
Secretary: �C.�liri_ue� ole�4
(Name and Address) g $aLl+l, O�-4d
Treasurer: t'Cf 4 1 i*Sco
-(Nam and 'Address)`. _"_:.::•_'.�._.., r� '- =r.: =�
and that I am and Will be individually responsible for any and all acts of the
corporation With respect to the approval . requested - and all subseauen acts- relating -'
thereto. /7
Sworn to before me this 42?3 _ day Signed.: j f
o£ (_� `� 19 Title: j�rZZ SilJE^'7�
�tl
Notary Public
. -;-
8/84
MARIA HARDMAN
Notary Public, State of New York
No.4934641
Qualified In Westchester Countyip
Commission Expires May 31, .3 9t;
Corvorate Sea
,1
'
-
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division.of Environmental. Health Services
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION- SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
APPENDIX L
TO: Commissioner of Health '
In the matter of application for:
4- i+ee, -- 'Su lod i visr opi
• �'J�d�vldU� [ �S s 41�d ,�ej^ Su /. -_.-f -6y- Lo4 No.
u l fi0 14e
represent that I am an officer or employee of the corporation and am authorized
to act for P i@ �2Ve�p g�4- Co . o- �G'E~�-ei -sow �hC .
(Name of -Corporation)
having offices at e .7_.. ,5OL �'J. �je�'�►'(�. K(�GLt
Whose officers are: )
President:
Vice- President: S4vzrue
83 Sou-41 73,ecl -Ward Raid
r. A44-, e1sco n(-� 10S0
and Address)
nd Address)
Secretary: �C.�liri_ue� ole�4
(Name and Address) g $aLl+l, O�-4d
Treasurer: t'Cf 4 1 i*Sco
-(Nam and 'Address)`. _"_:.::•_'.�._.., r� '- =r.: =�
and that I am and Will be individually responsible for any and all acts of the
corporation With respect to the approval . requested - and all subseauen acts- relating -'
thereto. /7
Sworn to before me this 42?3 _ day Signed.: j f
o£ (_� `� 19 Title: j�rZZ SilJE^'7�
�tl
Notary Public
. -;-
8/84
MARIA HARDMAN
Notary Public, State of New York
No.4934641
Qualified In Westchester Countyip
Commission Expires May 31, .3 9t;
Corvorate Sea
_ pGP�lDL� 3
Fr�r2P:� C✓L 'T r L' ? `TT OF f= —LLI — 0I"1?SICI OF KNVJ ?C`�`TLR.L E3r-,E
Surma °r•I � Su�:,�•cF�r^ ac"c.'u7�" DISi -r �L S"iS���
CAT'_,
! �Y \ .• 1/ ' � C� C a .is ° ��"G, �.,. � � � ,gyp ! I /=`�i ' � !/. Z-E Y : `'.a°��.�..,G._a�—
=''C.vr- % LCcz Cl)
C� .t�TlS I YES I NO I DCC"l r
Plans - T"--,rzc sa s
Design Data Sl:ee: (:. CE )
Dec-z :lcl� Lcc
CCr.S_Stan t- Per:.
Per= ccie Deota
ECL:Sc Plc`!: - TT-ic Se -_
wiel1 E=L =;
Variance Re=,,..:as ,...
vi, cz
RZ;:ULnJ DF ' g CSI
F= Mr 1 �% _ -Cj
C,:.
�l� -_. .,�. - -T I I S =•vcGc S:a�?; ,�iC= . =....! _C c' -C = - -= '.�'- .:__' --_
2r�� Lam_ reScrvCi =,
F-11-1 P -VL -_e & D? cr,c_C :S - Jam, =-•=
s -=ct -c TarfK - Sl ze, Detail
We_,1 Der =.,1, Ser'aice L: i= cc`_
CeS_Gn Da — : per cr'ic c ee_
TT, c-FcCt CcnL-cur: &
Dr:.-';eYaV & Sle_ce- Cat
F'COL?.riC��`.T'__r Ci� =.' Dr =_nc (C_5:�:�r•�=
Perc & De_n Ecles Lcc_
ReDreser-tative C
CH,
S ...��'151CII nrn3 ;SilC;vi? ;Grc�1` ;i :_C`,J�S'1L ;. 5_�c
Pit & D Ecx SlLCWL-1 &
Hcuse - I'TC. CL Ee:d--c.s
Wells & S'S-S's W /:n 200 1-. C= :-tc cs-7
ictl
Ecuse Setzack Ne__ sa_ (
EcuSz Se:ve
Nc BEndss ;
SZPA A"'I1-N,
Fi?IcS
tic); TY7
Pin
Max. Een s 45° w /c_ -�ncu-
DIET =ti=-:Z s?EC_ ^^ C._ PT.�ti
10' t0 P _L. , Dri.'Ve av,
20' to FcL'nCaticn Wc1lS
LLce T'= e—s jc Cr _
100' to We11 ; 200' in D.L.C.D,
100' to Stream, �1c-= r'".JlLSc, -_'G (�r=C.
ii �`-
13' tc Dry i nS C r' n,
35"= GtC:l si:1,5iC'_ -mac ;,01 We --r
10' to at-=r Line
50' int:-
,r CF Of71SIC21 CF �
-Y D
E-c-aze
W.
L- 7
S='CS
R
T DNT =-MT-
c
c
f i c -C
cy.
t Lc cm)
d t�- 1 cal--c-=s
f —7c: Lqcj
"I
P A
&
, - DD
I Z-4--
I D
ol 7: C = == C
--
--------
CeS.=- Cam E:_== 7-, C E
-_,i-7Z- 1.7
ct=!i
4w
S c-,, T-'; a gerc ar.d- d=-=-:-
r=-=7'
E-c-aze
W.
L- 7
S='CS
R
C-L.=-'lrr.F,r-y- er
c
f i c -C
cy.
d t�- 1 cal--c-=s
"I
&
, - DD
I Z-4--
I D
ol 7: C = == C
-�
ct=!i
4w
S c-,, T-'; a gerc ar.d- d=-=-:-
r=-=7'
P= "C-L-acs Lcc:z- -Z E�z
c
C-L.=-'lrr.F,r-y- er
f i c -C
d t�- 1 cal--c-=s
"I
F-zc-zans C-- Are—=;s�-CC
El-
]KC. C-f:
Wel & S S'7-s- s w, n 200
&
-7
10' tz CZ
20' to Fc -L:r. da ti c
in D_r..0
1001 to ',�all; 200'
100, tc
35'
PUrNAM COUNTY DEPARTMENT OF
DIVISION OF ■• •' M is v L HEALTH SERVICES
_...DESIGN _DATA..SHM, SUBSUFACE SEWAGE. •DISPOSAL SYSTEM- - F. -NO
4"z)leY P-evelops4le, #- Co. NqA_?
Owner o-P P t4rsah Iv,G . Address S3 5oufl7 _P_xad'-(�rd 145co nIy �t3s►� `j
Located at (Street) f 41 q view 'Eco r- S+- Sec. -7& Block 1 Lot 1
(in 'sate nearest cross street)
Municipality C J 4erSok Watershed
• ■ • 01• �• •' Y�. • • V.-V . L• ■• �■ • ■ �• • • •
Date of Pre- Soaking Date of Percolation Test
HOLE
NUMBER CL= TIME PERCOLATION
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
2 (!e- 'I0"S e 0Ked
3 6-v - P Okl
4 1 �ec� km'312 Ckld Aeprovc4 er75jkj.eRr1k1'zj
5 C�P'nU_') -'iC S
2
3
4
k
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 measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
REMVED
DEPTH,-- ..:HOLE NO. EHM]l
- -HOLE - NO.
G.L.
'89 AT 29 A 3 :4 4-
21
31
4'
51
61
71
81
91
.10,
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
Soil Rate Used Min/1" Drop: DESIGN S.D. Usable Area Provided"
q teem+'-
No. of Bedroom Septic Tank Capacity/ gals. Type
Absorption Area Provided By _710 L.F. x 24" width trench
Other
Name 13kiltiq kwj di Signature
V
Address k SEAL
/177)
IN.
THIS SPACE FOR USE BY HEALTH DEPARDTM ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
�a
r F
� Q
v 3
o
cV
00
`e
.y
o�
F2
.n �
0
V
h
r �
V
k
C
F
J
V
a
r
0
0
�e
2�
t�j
o
O
O
°j
Q
�a
r F
� Q
v 3
o
cV
00
`e
.y
o�
F2
.n �
0
V
h
r �
V
k
C
F
J
V
a
r
0
0
�e
2�