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Home My WebLink About1477DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 34. -3 -9 BOX 14 01477 r6?j .. �I � r I I I a dorm qL ldw d 1 T. UL 01477 Water Supply: public Supply From Address � or: Private Sapply.;I)rpled by AU 4 Address - /4 TL 3E� AJ ` Building Type r � 1� I _L - 'Has Erosion Control Been Completed? Number. of Bedrooms _3 Has Garbage Grinder Been Installed? .O Other Requirements i certify that the systems) 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, rules and requ tions, in accordance with t fil plan, and the permit issued by the Putnam County Departmentaof Health. Oats Certif ed b1Y t P.E.ZR.A. Address 73 l C ►' A &xos Llcenae No. Any person occupyih9 premises served by tfe above systems) shall promptly take suchaction as may be necessary to secure the correction of any unsanitary conditions 'resulting -from such',usage Approval of the separste,seweraye - ystim shall beco:r►e null'and void as soon as, a pubV_ sanitary sewer becomes available and the approval of the prlvate.water supply`,shall 61coine null and i4oid when a public water supply becomes available. Such approvals are subject to modification or, change when, in, the judgment of the Commissioner of Mealth, 5u;q_Mocajon. modification or change is necessary. WELL t..Vr1rLZ11W'q R�,rVA1 -e DEPARTMENT OF HEALTH Division Of Environmental Health Services` - �'W PUTNAM COUNTY DEPARTMENT OF HEALTH Offic Use Only WELL LOCATION. STREET AOURESS: 'MWNIVILLA J I Y TAX GRIO NUMBER: WELL OWNER NAME: ADDRESS: 6 v PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary YRESIDENTIAL ❑ UBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERRVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE �00 gal. REASON FOR DRILLING eNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTINN�Gjj SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH T fit. STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY rKCnMpRi SED AIR PERCUSSION ❑ DUG ❑ WELL 501NT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE / ® ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH it MATERIALS: ER LENGTH.BELOW GRADE fL JOINTS: ❑ WELDED GKTHREADED ❑ OTHER DIAMETER % in. SEAL: ❑ CEMENT GROUT 16BENtONITE ❑ OTHER WEIGHT PER FOOT . /I _ 1b./ft. I DRIVE SHOE YES ONO I LINER: ❑ YES 9NO SCREEN - DETAILS DIAMETER (in) SLOT SIZE LENGTH (f t) DEPTH TO SCREEN (f t) DEVELOPED? FIRST - �.. _.�..a .__._.... _._ _ �. _.._ ._ ._ _ :... _ :. _ D - _; OYES ❑N: HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in- TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping r M911 , OD: ❑ PUMPED f tests .were done is in- ®'COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER :OYES ❑ NO u1ELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH Faortii SURFACE water Pear- Ing Well Dia- meter FORMATION DESCRIPTION cane, ft. WELL DEPTH It. DURATION hr, min. DRAWOOWN IL YIELD 9Pm. Surface ``t. T' f � n ICY i-a t WATER IffCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OfYES' ❑ NO ANALYSIS ATTACH ED? ❑YES ONO STORAGE TANK: TYPEx�r`c CAPACITY GAL. f j Wiff LWNWATT & SONS, INC. DATE ADDRESS Well Drilling SIGFIMRE n Rte. 311 R.R. 2 Box 171�A,� PATT €RSON, NEW YORK 12.63 �� PUMP INFORMATION / t TYPE S <r L�iUC f-S`d le— CAPACITY MAKER F6<, DEPTH �, — � � MODEL �: �'� �` 1 vOITAGE� BHP PUTNAM COMM DEPARTMENT OF HEALTH DIVISION OF ENVIROMOMAL HEALTH SERVICES AdvA M: Figz _ 96 S4 s10Q01- 7T Owner or.Purchaser of Building _ Section. Block Lot. Building Constructed by yr ...i4 o �--t R o A�b Location - .Street t/ Subdivision Name Municipality, Subdivision Lot.# Building Type _._. GUARANME 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,' I and that it has been constructed as.shcwn 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 approvai of the "Certificate of Construction - Compliance" for the sewage disposal sXstem,�or� any_ repairs made by ine to suci "syste3n; 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 Environirental 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 ! 7 day of MAke,4 19 18 1 Signature Title N General Contractor, -- Sight `/ / 1La %V Corporation Name (if Corp.) s° Corporation Name (if Corp.) Address Address rev. 9/85 mk ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. H PHYSICAL L 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER -WASTEWATER P PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM NAME AND ADDRESS OF PERSON TO RECEIVE REPORT EXREPORT OF�-BACTERIOLOGICALR 'CNEAkitA AA I AifOOF,WAER [Anna Faley R.D.6 Bullet Hole Road Carmel, N.Y. 10512 DATA SOURCE OF SAMPLE Water Supply, Faley Res. Bullet Hole Road Carmel, N.Y. DATE OF COLLECTION Feb. 21, 1988 COLLECTED BY A. Faley Hydrogen ion COLOR TURBIDITY ODOR _T CORROSION INDEX OR DISSOLVED SOLIDS Concentration LAN GEL I ER (PH) NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L NITROGEN Alkalinity as CaCO3 Chlorine Residual CONSTITUENTS Carbonate AS Nitrate Mg/l. Mg /L Mg /L NITROGEN (N) Total Hardness Conductivity as CaCO3 Ammonia Mg /l Mg /L Micromohos /cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter {echnique shall not exceed MEMBRANE FILTER TEST one colony per 100m'I Coliform colonies per standard sample shall not exceed 3 /SOmI, 4 /100.1,..7 /200.1,. -dr 131600.1 Coliform Colonies /100ML .... in. -(a� - T.wo- consacutive samples; (b) More than one -standard sample when less than 20 are examiin6d per month! 'or" (c)` " 0 More than five per cent of the samples when 20 or more are examined per month. AT THE TIME THE SAMPLE WAS SUBMITTED: ® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 2. The results of the analysts of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows 3. This sample was not satisfactory since It did not meet the bacterial requirements for potable water. The presence of organisms of the Coliform group In a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does Indicate that such contamination might survive to the same extent. The presence of organisms of the Coliform group may also indicate that the treatment was not adequate at the time the sample was collected. EJ4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the Coliform group at the time the sample was collected which indicates the water potable, Certified ....`....�............................................ ........:...................... LAURENT ENGINEERING ASSOCIATES, PC. FAIRFIELD -DRIVE _.. PATTERSON, NEW YORK 12563 914.278.6108 RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR.. PE. 0i CONSULTING SITE ENGINEERS March.18, 1988 Putnam County Department of Health ill Old Route 6 Center Carmel, N.Y. 10512 Att: Mr. William Hedges RE: Residential SSDS (Spottl) Bullet Hole Road Patterson, NY Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing S -1 "As -Built SSDS Plan ", dated 3- 18 -88; 2. "Certificate of Construction Compliance for Sewage Dis- posal System ", dated 3- 18 -88; 3. ` Three ^(3J copies of" "`Guarantee"of` "Subsurface Disposal System "; 4. Well Completion and Well Log Report; 5. Water Analysis Report; 6. $25.00 Application Fee. If there are any questions concerning the enclosed, please call. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. /map enclosures cc: Ms. A Failey w/1 copy each IV. V. - vi. APPENDIX C FINAL SITE INSPECTION Dat ;CATION ®'ice /� ��'f f� g / TM # OR SUBDIVISION Un 4 a YF—c NO SEWAGE DISPOSAL AREA a. SDS area located as per a�ov�ed plans --Date b. Fill section of placement 2:1 barrier. . LGTR WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 151 fran SDS area. e. 100 ft. fran water course/wetlands. .S3AAGE DISPOSAL SYSTEM a. Septic tank size 1,250 b. Septic tank installed level C. 10' minimum fran 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. JUNCTION BOX --properly set g.- TRENCHES 1. Length requir - Len install X1 2. Distance to w-atercouEsd measured ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 1/32 " /foot. y _Kz 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum ll.' Pipe ends capped h. PUMP OR DOSE SYSTEMS .-Size-cf-Purp- 2. Overflow tank 3. Alarm, visual /audio 4. PLunp easily accessible manhole to grade 5. First box baffled dl 6. Cycle witnessed by Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as per approved plans b. Distance from SDS area measured ft. C. Casinq 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 41' in diameter e. Curtain drain installed according to-plan f. Curtain drain outfall protected & dir.to exist.watercoursr= 9- Footing.drains discharge away fram. SDS area h. Surface water 25jotection adequate i. Errosion control pr3-v�ided on slopes reater than 15%. a A-'- -rT..- - "''" ,"" k 4 PITlNAM COUM'Y DEPARTMENT OF HEALTH - 4 I d �� ;F� DIvINou d BoyhoomepW'He�IfA.Sesvlea. Carmel. N:Y.105U Epee to Provide Permit i . _ " [. oa CER11FiCATE OF IC ObOLIANC E: :I CONSTIZ o ON PERIYIfP FOR SEWAGE DISPOSAL SYSTEM - - IpcatSed of U I �ti G PiY 'At Sabdlylilon Name r Lot / Tu MAP` % `% Block Z Lot r t r. Renewal_❑ RevWon ❑ Date of,Preylom Approvah a° Malt Addtrou �o (_ti /7Y/l p" 4 T (�.roa. gniWinQ �G S >✓ Lot Arell <�,�G , Fill Sectlon Only Depths Vatlme Deign , - Number d Bedroom• � • ; , Fk►r G P 'D �v f9 6 PCH1D N' u to Regalred When FIR is oomp{eted ,Sepe"ft Sat .e p Syetem to o•aai•t d p �O tic Tebk st? O T U L4 e y° To W oone4uctell by - �O h t OR � �► w, 4 �, Addteea Wetter Supply: Pdblk. S Feom A nPP�f �_Peiv Sa DrWed b ors.,.: PpIY Ot6me Rdmi itementa -1GL c` Mi cs a I ►•present that I am wholly and co pletaly responsiDla torah• tlesign, and location of the proposed systsm(s); 1)' that Me ;separate :sewage disposal system above described will. bay constructed as shown on the:approaia0,am•ndment there to and.in accordance with the standards, rules an regulations o e - _u nom county O•partm•nt of <.MMlth, and that on completion th,area, a 'Cart;heate of Construetion:Compliance" satisfactory to the Commissioner'of Healthwill tf• wbmiftetl to thy. Department, and •a,writt•n quarantae.,will _pi furnisAMaM owner, his successors, heirs or-assigns by the builder, that'said build•► will place in good olMiting condition am .` art of Y tl sawag• disposal system ;rluring.ths period of two (2) years'Iminedlately following „thedat•'of the. Ism- once of 4he' approval of the Certificate of Construction :ComplNnea Of 'the original system or any repairs thereto. 2) that the drilled well described ;above will, ba•►outed �s shown;on the;iipproved pNn an0 That sold wall will D•7nst II in accorelanca with ahe ar s,, ru s and ispu aT of nit ;the .Putnatm County O%•�partm•nt of Nwpltph Oaf•. (JG3_Ir� PE r! RA C .. Address i* 1� Y ` O License No_�� APPROVED FOR CONSTRUCTION Tnis approval akpu•s two yars'.from tha':date- issued vnl•ss' construction of the building has been 'undertaken and is revocable for cause or may be amended of moo#iad,i chin consida!ed natassary by We 'Commissioner of Health. Any change or alteration of co' struction requires as /new Dermmii�t. 'Apprbaed for disposal of.domestic samta►y.�ge,':an a water supply only. . 87 Date / - � G 7 . � � ��.: � /�`�`' -e- {A PLFPNAM COUNTY DEPART INDIsPIDUAI HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES .._ _ FIELD _ IN SP _ION- ,,z > 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 ....................... Will driveway need cut ............................ Must trees be removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed..... ...... .... 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 7-97' Soil Descri tion 0 ft`. 3 ft. '6-f t. 9 ft. i c: — 12 ft S D.H. 2• Lot Depth to G. W. Depth to rock Soil Description ' 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 0 ft. 3 ft. 6 ft. 9 ft. _. 12_f t. 5011 DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS 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. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ........ 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set.... o .... ........... ........ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. ... .. 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� WELL LOCATION 3 Street Ad ress Town Village City Tax. Grid Number a 4 I'41" o 0,- WELL OWNER Name J M tt }ng Address rivate D54 _T1 140 r_/t� r � 0 S Z ❑Public 1'SE OF WELL - primary 2 - secondary SIDENTIAL ®.BUSINESS ® INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify, C3INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD. SOUGHT gpm /# PFOPLE SERVED -4-4 /EST. OF DAILY .USAGE adv gal REASON FOR DRILLING 0 NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION PLACE EX STING SUPPLY O DEEPEli EXISTING WELL DETAILED REASON FOR DRILLING C J d S� WELL TYPE DRILLED ❑DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION EPAATE SHEET cf -pi7 (date) (signa re) 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: 19 Permit Issuin fficia Date of Expiration: 19 Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orancte cony: Well Driller _ .,,�� _ .';+ �fMIV �:I Y,a�w!ry \'�•. +uj; '.''f R�:<. -. j.`L4'✓i�tyt��.{dp].MY. � ` .. •f .%. ti+:w: <.... .. ! -"�% =. iii5i`�fy:. i!w,.;:.'i�c :'!^— `,'P!'L ��<L •�•t"Y ^n :l ::1 L.� .i!?;";�'L. ±�L �'!L.^ .1L ..R'�Y `Yr�•�.• �J ... DEPARTMENT OF WLTH Division Of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y..10512 (914) 225 -3641 APPLICATION TO ABANDON A WATER WELL PLEASE PRINT OR TYPE I WELL LOCATION St� �HE� � � I:X GHU NUAdEH —7 ' u � h a, WELL OWNER NAME Kok �. AOOHESS. �-� - - ;; 5 PUBLIC WELL TYPE DRILLED DRIV =, DGG El GRAVEL OTti'rZ LDEP DATA WELL DEPTH it. STATIC WATER LEVEL it DATE MEASURED. OF WELL ❑ RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED, ,,4E ``q 1 primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION . ❑ OTHER (specify) - secondary p INDUSTRIAL ❑ INSTITUTIONAL ❑ DTAND -BY WATER WELL Name: J Address: CONTR.kCTOR: Te 4j �-rs�* —vN,� t-, ej REASON FOR / ABANDONMENT • x�5�, IU r.L c� l li i� DESCRIPTION OF WORK :,.. TO BE PERFORMED: / lax C-7) ( date) - ignature) PERMIT .. LAURENT ENGINEERING ASSOCIATES, RC. 73- FA►RFIELD DRIVE PATTERSON, NEW YORK 12563 914.278.6108 RANDOLPH W. LAURENT. P.E. HARRY W. NICHOLS JR., PE, CONSULTING SITE ENGINEERS October 13, 1987 Putnam County Department of Health 110 Old Route 6 Center Carmel, N.Y. 10512 Atts Mr. William Hedges Res Proposed SSDS Bullet Hole Road Patterson, NY 12563 Dear Bills Enclosed are the followings 1. Three (3) prints of Drawing S -1 "Proposed SSDS" dated 10 -9 -87; 2. "Construction .Permit for Sewage Disposal System ", dated 10 -9 -87; 3. "Application to Construct a Water Well", dated 10 -9 -87; 4. "Design D;at,a Sheet" 5. Letter of Authorization °, dated 10 -9 -87; 6. Two (2) copies' 'of Residence Floor Plan(s), for "Bedroom Count Only ". 7. Check in amount of $100.00 payable to The Putnam County Health Department 8. "Application to abandon a Water Well ", dated 10 -9 -87. 1 f� We would appreciate your review, a'pptro��.a�,l. ;a;nd issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. 40.xA Harry W Nichols, Jr., P.E. /map CCs Ms. R. Spottl w/1 copy each enclosures: . Jt'tQAM OOUNTY DEPARMOa OF HEd . DIVISION -OF ENVIRCINMERrAL HEALTH SERVICES LL "' DESIGN DATA SHEET= SUB5t1FP►CC SEWAGE DISPOSAL SYSTEM FILE W. - owner NIS. ROSH SP07-7L Address 1206 8061,E7115tC- RD, C,41?A'l/_%G IV y /os,,Z Located at (Street) 9c)L JVv Lt�7 2oA�q Sec. 7 Block Z Lot (indicate nearest cross street) Municipality = �A77,L'/�S� /V Watershed <f90 7-,-))1U" �SOIL.PERCOLATION TEST DATA REQUIRED TO BE SUBMITrM WITH APPLICATIONS Date of Pre- Soaking 11-D6-AC - Date of Percolation Test HOLE NUMBER C = TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In MWIn Drop Inches Inches Inches 9 Z$ 4 5 1 z >z;s9- z �� 4'' 5 2 3 4 WrES: 1. -Tests to.1m. :repeated at same depth until approximately equal 'soil' :rates ` Are obtained at each percolation test hole: "'All data 'to be suhnitted for review.; 2. . Depth measurements to be made from top of .hole. �I CP.V . ' S/85 3' -6,, 4° 5' 6° .71 8' 9° 10° 11' 12' 13° 14° INDICATE LEVEL M WHICH GROUNDG+ IER IS ENOOUNTERED :D INDICATE , LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN00UNTERID DEEP HOLE OBSERVATIONS MADE BY: 1214 Y Ltl+ /I/ /C N dLS s,Q DATE: "DESIGN Soil Rate Used 2 3a Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity T GOO g als. C,o N. c_ Absotption Area Provided By L.F. x 24'° width trench Othe S o G. .. /�- sar A Tj o To2E ,S Naive Ay/UWT /iy�i/✓,Er- /L�,ryc� AJYaV,L.Signature Address RFAT.' COUNT`_' DEPARD1ENT OF HEALTH - DIVISION OF ENVIRCMann HEALTH SERVICES (Nne of Owner) cami ENTS FA- DATER SUPPLY & SUBSURFACE SWAGE REVIEW S'= - CONSTRUCTION PERMIT SYSTEMS r / DATE REV= -- KED (Street Location) YES I NO I DOCUMENTS ?, lii -o /fi n•' v , " /' - V • 1 P7'1 i; I tr anch y requires ,Y 60 ft. max. I x Parelliell to contours I \/ Pezmi.t Anolication Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) - SUEDIVISICN Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Depth cd Ouse_A ans - TWO sets veld permit; P4vS letter Variance Reguest C RiE AL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn /DEC Permit R & D) Data On DDS Plans & Permit Sam RFQUIR:,D DETAILS ON PLANS Sewage Svstun Plan - (north arrow) Sewage Syst.Qn Hydraulic Profile - Gravity Fl. Fill Profile & Dimensions - Volirre D cx;Trench /Ga.11e_y; Puy pit c °tc i is Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: pert and deep res•,:.lts Two -Foot Contours Existing & P_opcsed riveway . &,.Slo-pes ;Cut. _ )' ootin er,Curtain Drains (disc��!yc On; Perc & Deep Holes Located Representative of primary and expansion Expansion Arza.; shown; gravity flcw,s ff. sizE If Pum=ed Pit & D Box Shown & Det: � i led House - No. of Bedroans 3 % ✓�✓- (riells & SSDS' s w /in 200 ft. cT Proposes Sys- Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIC ON PLAN Fields 10' to P.L., Driveway, Large Tree._.s,Top ci 20' to Foundation Walls 00' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e 15' to Drains - Curtain, Leader, Footing 4M,to catch basin, stor'ndrain,vined waterc 1 o - 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well I 15' Well to PL --r tS ii $ d I Vj a LA 5 t�- *OL40 rve Le 19.119% TAtJr- "'00, 1. OP IS- to Mtn I T vJw PA t- if N Q ----------- 7x? VRQ : � 4z, L4 A *Tr- 10 L) L, L, ET HOLE ROAD lit or. 12 Is, T� 0 uicti W�w t� ti Al7r7i-rl ON -7 7- -1 -Y -7+ -2 -2 -7 -2 -2. Z 2 rya "Me 7 of N/� � T -IC�H� � _ 57Z Tl -77 7777-7 A-2 A6 VA %7 r I I PIZ T2 OF, o 7777-7 A-2 A6 VA %7 BEM W%kL� I N PIZ T2 OF, o IM r W '560;- 51 C, .0 PA S�A %7 BEM W%kL� I N T2 OF, PA S�A %7