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HomeMy WebLinkAbout1573DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 34. -5 -15 BOX 15 01573 1 I,. T r 01573 PUTNAM COUNTY DEPARTMENT OF HEALTH ReV.. 3/8 J Division of Environmental Itealth Services, Carmel, N.Y. 10512 Engineer Mast Provide R-14-87. .a � � q • P.C.H.O. Perntlt 11 -- — — CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM T . Patterson owwor'V - - Located at Ice .Pond Road x K Tax Map , _.79•. .TBlock �Iot_.8..11. Cotter Owner /applicant Name., Margaret & Malcolm For nip Subdivision Name Brenner Subdv. Lot IY 1 Mall! ng Address Inland Road, Carmel- NY Zip 10512 Date Permit Issued 3/20/87 Separate. Sewerage System bunt by C i c i 1 Engineering Assoc. Address 8 North .Horsepond Rd., Carmel, NY Conslstblg of 2 x 1000 Gallon Septic .Tank and 400' x 24" wide laterals (toilets)&267'x24" wide laterals (Kitchen /Laundry) Water Supply: Public Supply From Address or X Private Supply Drilled by P.F. Beal &Sons, IncAddress P.O. Box B, Brewster, NY 10509 Building Type Frame Has Erosion Control Been Completed? As required Number of Bedrooms Four Has Garbage Grinder Been Installed? No Other Requirements Intermediate cleanouts I certify that the system(s) 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 regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date 9 May 1988 Certified by P.E. X R.A. Address RD9-Fair St . Car NY. 10512 License No. 29206 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system, shall become null and void as soon as a pub :% sanitary "Wir becomes available and the approvalr of the private water supply shall,become null and void when a public Water supply become$ available. Such approvals are subject tolmodification or change when, in the judgment of she Commissioners Henith, such revocation, modification or change Is necessary. Date / �/ �/ mod® �� — —Title m r: CSA\Crj �l s A r. 1, A A A' I T b LAB # I C:A o 0O66.^,. 4 k town e ica d ordtoryy Inc. 321 Kear Street Date Taken: 2 Time: H PM .Yorktown Heights, N.Y. 10593.,.� _ ... (914) 245 -3203 Date Reported: APR. 01 1988 Director: Albert H. Padovani A9. T. (ASCP), Collected By: Referred By: Lake Carmel Pharmacy f 1• Sample Location: e, C Lake Carmel Pharmacy 4I( d ' 149 Smadbeck Ave .wiz. A-f- .1 ` US-0 Lake Carmel, NY 10512. Phone # Phone # I Sample Type: L J Repeat Test? _ (check one) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL) _ Acidity _ Alkalinity Chloride _ Detergents, MBAS Hardness, Total _ Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total ..Sulfate _ Sulfide Sulfite METALS (mg /L) GENERAL BACTERIA Standard Plate Count [2 0 (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE Total'Coliform Fecal Coliform Fecal Streptococcus 140ST PROBABLE NUMBER TECHNIQUE Copper -Iron. Total Coliform Index .Lead . ._ . . _..:.._ _.. _.. _ ... — ....__ _.__ ..._ _._. _. .. _ ............ . _ Manganese _ FecalrColiform Index _ ;Mercury _ Sodium KEY FOR TERMINOLOGY Zinc MISCELLANEOUS _ pH (units) _ Color (units) _ Odor (TON) Turbiiiity. (NTU ) N/A = Not Applicable LT = Less Than ( <) GT = Greater Than (>) TNTC= Too numerous To Count CON = Confluent ( =TnTC) NR = :ion- reactive REMARKS /COMMENTS (For Lab Use) ` Potable r Non- potable _ STP INF _ STP EFF Other: Sample Status: (check each) Out:e,oine HNO3 _ HC1 H2SO4 _ NaOH ZnOAc Na2S203 Other: Incoming X LE 4 °C GT 4 °C off LE 2 _ pH GE 9 pH GE 12 _ Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF .COLLECTIO . THESE RESULTS INDICATE THAT THE.WATER SAMPLE (DID) (DIDN'T) (N /A) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA. D NKING WATER CODES, FOR THE PARAMETEX TESTED, AT THE TIME OF COLLECTION. IX / t /1*1 �_ � v " V Xc_.j � - V Albert Ha Padovani, M.T. (ASCP), Director 2 /86(Rvsd7 /87)RWE PUTNAM COWEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by -' 4�2,�#4 u_ Porl,4 -To k�,, Location - Street Subdivision Name fmvel Municipality L- 6e d n.ov A-,, Building Type 'Subdivision Lot # GUARANTEE 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 Yo -suc�'sysbEff, '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 day of /, & 9_Rg Signature Title Gen 1 tractor (Owner) - Signature Co ration Name (if Corp.) �_. . Rd - r Address rev. 9/85 mk Address fir' •a APPMIX C F, SITE INSPECTION Date •Inszc--c LTION ' CWNER� �1 � OR 4S7EDIVIS ICY] LOT • Q .. �.. �J NO i. I?. IV . V. `j T SE<.�G^. DISPOSAL, AREA a. SDS area located as per approved Iansf' YES CCi I b. Fill section - Date of place*!q--nt ' 2:1 barrier. LGTH w � = VG. PTH (� I c. Natural soil not stripced I d. Stone, brmslh, etc. , areate-r tin 15' f_an SDS area. e. 100 ft. from water course /wetlands. Sr ;vtCF DISPOSALL SYSTE4 a. S°pt1C taI'i{ SiZe - 1,000 1,250 b. Septic tank ins t —I led leve._ c. 10' minix=, frcn foundation I I d. No 000 bends, cleancut within 10 fz. cf 45" bend I e. DISTRIBLTICN BOX 1. A11 outlets at same elevation - watar test I I 2. Protected below frost I I 3. M? nhrazma 2 ft. original soil between bad and trenches I I I f. JUNCTICN BOX - prcrerly se= c. 1. L•anatn re�--lirei - Le:,.c`h ir-Stal.led L , 2. Distance to watercourse mom, -s-,a e-1-3 f. I 3. L*is ==l l --,-�; accord-in to plan 4. Dista -nce center to c- -nteLr 5. Sicre cf trench accect bie 1/16 - 1/32 "/ =cot. I 6. 10 feet f_ar, rcr.c--,-ty line - 20 fe --t - fcur_daticns 7. Deotn cf t=ancn < 30 inches f_an surface 8. Rcan alia e for e--,r.=sion, 50% 9. Size of gravel 3/4 - 1." diameter 10. Deotn cf cravel in trench 12" miriLmmmm Pero CR LCSE SYSTEMS 1. Size of piam dhamber I 2. Ocerf 1 aw tank I I I 3 Ala-ran, vi_•ual /audio I I 4 PLmn - =si1v accessible xzrfroie to cr_de 5. First bcx baffled I 6. Cycle wi -tressed by He=.1:1h Den's -rtre t I es L. flcw per cvcle I I -_L�� _ . C1 se lcc _--; D-er approver' plans. _. N-L=Le_ or r::e'1 1cC Lem as -e- a:�-zr:vad plans b. cepf_an SnE __ -- x sured = _ //Dist_ c. Carina 18" G ;--C e .TZ:ac:e I C. S'-,r =ace dra'_race arcurnd well accec%'_ =. I a. Baxes prccerly crcu b. A 11 pices cz---ti'' c. All pines f_ush with inside of bcx d. Eackrill mate=rial ccnt iris Stores < 4" in diaiT2ter I I e. Cartai.n drain installed accordinc to cian f. Curtain drain cut =all rotected & dir.to exist.watercours� I g. Footing drains distharcre awav fran SL'S area h. Surface water protection ade;n?ate i. Errosicn cent c provided on sloops c'eate_r thaIl 15$. 17 14 Z:1 I^Jezp_ 491- zo" o fi >v✓ I,I�I ��� �T r'�, 0 0 Get t t i N5 Z r- -5.5z � o `-3¢•¢J/ ' n 7 '�'�•' Ti�IL�ir. n7'C,A• 7& t _g e 55� •00' I' tutnajb County Depammenz of healtn jivision of:Environmental Health Service. ipproved as noted for conformance with ipplicablp Rules and Regulations of the Putnam Cotinty Healt'n partment.• 1 1 y r "AS BUILT" DATA tructure located from survey by surveyor noted below®-_- ell located by: Surveyors survey.- -- ®- -- -- _ Well drillers report -- Englneers mesurements -0- - Tank, boxes, pits, gallories 9 laterals located by:Cortfractor: Enpfnaer: f[ Healthda,pt: C Field Inspection by: Health dept ® dat.e:- U! 87 _- Engineer ® date '�- 8Z- ihrs ie .o .er. rfv that ih. sew`age disposal Sums =n was constn,cted as NOTES: indirarcd on this plan and thac the t.vsten wan toe prct rd by n¢ before.1t was covered over. The systen wag constructed in . accordance withr�ali standard rules and regulatipns of the !'.O. H. U. 6 the N; 1'.S.D -.H. Qppf CSS/ON�� DIMENSIONS yto 'A RF,y,ffc A- 8 _ _ A - H ` -- -.-8 _ H °--- -- -- -- A J ` -- - - 8 J - - -�— - - -- A K - - - -- B _ K -- - - - --- 7 SANITARY SYSTEM DESIGN "AS: BUILT" LOCATIpO.N Street: Town:_L/11 /- /�rLe!c:LO ounty:�L/j/`ii�7_y Stotd SUBDIV'SIO�j Map: �T�ah1 -. - — — Block. �.- — - - -- - - LOT Ns - Buttder:— t��(1v� Surveyor:.�ti= �`_' — ����j/r�'i= �;�'y /,'�/ pC Drawn: LD ate: Scale Job NV y3 J O H N H, P R E N TI S S -P E. CONSULTING ENGINEER T 4V�� 9 �e spy . a,� w.- t } f rp: F ;., °+ F K t., as "`t3 ✓+ eN 1 ,�� ik s � ,,. die a•t �'�f 's.� o e:. ,1 ".-o •-r•-� ,rr sV f'�r, +•:'7 fi�#'iriuh4,`,' }L 'y ,n� •v i ?. - t '1 + ^ ;� wf "Mi t�� ti Cs t it L ;ikiNAM COUNTYrDEPARThfENT OF HEALTH Di�vislon of Envlronmei tWIHealth'Se`r"vices`Carmel, N Y 10512 Engineer to Provide Permit q• ' s r a o ti on CERTIFICATE, ,0. COMPLIANCE' ,`Permit �CONSTRUCTIOIY+PE F R SEWAGE'DISPOSAL SYSTEM Patterpon Located at Ice POlid 1'd ai , t Town or Village _ 7. Snbdivfsion Name Brenner. g C Block Lots 1L MeP . Margaret'& Malcolm Cotter + Renewal` D v° Revision `❑ Owner /Applicant Name + + x> iat a n Datetof Prevlons A royal Inland •Road ' ,n Malliog Addroes (Tows t c gM'i +J)W .Frame L'ot, 3 <85 + ^- Acres Flll Sectlon OuIY o rDepth i Volume, _ Nssmber of Bedrooms :FOU T Design Flow G /P/D' 8 OO t P,CHD NotlHcatlon le'Regalied Wheu FIR le completed M1 �, s • ;r Separate Sewerige System to oonelet of 2X1000r,3non Septtc Task and 480' x 24" ,�t, rip 1 a tern 1S_i tn�eP_� &�� 4 ' r ra�2chen/ " f To beconstruMed W1 a e s IKlL i by Address �+ d ' y Wate "SuPP1J ' Pdblic "Sa 1 Flom ` r Addressn ry • PP Y t � �tn ori{ X Private Sapply I)rWed by _Address' ` Other,Regairemente Nnne x 5 - r g s x µnr + S s i -'' xc c n{ 1 {a +i•4 1 7. s `4. •. II represent that wlFam wholly and',completely responsible forthe design andtilocation of tthe hP�oposed sysferti(s) 1) i;Ehat the separate sewage,,disposal .,syitem. above,. axrlbed!w1ILbe, constructed asishown on the approvetl,emendment there to and lnaccordance with the standards,•rules an regu a ons o e ! .uTnam „': County Department =ofL{ HeaFltti;' and that'dntcompletlon thereof a, Gertdleate of +Construction Complianee satis(actor'y,io. the rimis CoisionePof Health will .be submitted to the Department'' and a;rwritten guarantee wi11 ,be. urnished the owner h1s wclessors heirs or assigns•by tha builder; that 'said builder :will r n , a •:,, a 1'' ... place 'in gooC�operstlnq.condltion any 'gait of said sewage disposal system during the period of, two:(2► years,immedigtely.following the.date of Ilia issu- an�e oyf the 'a royal _of, the Cert ::.. f , of ConstrucUOn •Compliance.v of the original y "stem or any ropairs the►eto; 2) that the d'illad wail; described ,above i?P will Dellocatedas shown,on the approved plan and that said well wiltbe Installed <int accordance with the standards Mules and :requ aT o of: the `Putnari, County Department of rMealth * 5 ! Date 6 March 198] "Signed s • ; P E_ R A 5 Adare :: 9 ,,,Fair` NY 290 Str "&L' 'RD 1051 6 L ien : Ne APPROVED FOR CONSTRUCTION Thir approval'expues "aiala ear fro the 'd A e iss ed un is` co ^struction "`f. th building has` been undertaken' snd is ,; .. :S .-. !. .w _.w «..t t. 4.;• at a. !.• ...R•..!i •... y. 3� E♦ A.�- >...• ( 3 revocable for se orma be a ended or';modlfietl when considered nee sear the Commi i ne of H th -An ehae alterationOf,eOnftrtietlon ng or , requires ew permit. ^.' ppr v disposal of•domestiCSamtary a e n /orb private ' Ee up ly ^I '� '' i ''` ` t d Date gy � 4. T 1e 1 �.....��u�uL.1i, ,!. ..J+•JS'.`J.11�.w.wr�...a. ._ -. au: K .% . M-, T2 WLLL U.UrirLL11UV Anrval DEPARTMENT OF HEALTH Division -Qf -Environmental Health- Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET ADDRESS: ANIL Y TAX '01NUMBER: DLL �i Ice Pond Rd. Patterson, NY WELL LOCATION WELL OWNER NAME: ADDRESS: Malcolm Cotter_, RD 4 Tulaind 128, -pa-rmel,NY 10512 ❑ PEIVATE ❑ PuBtuc USE OF WELL 1 - primary 2 - secondary FLI RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION .0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE- gal- REASON FORT ..D.RILLIRQ,, NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSEERYATION P. REPLACE EXISTING SUPPLY Tj P,,,QEEPEN'-EXIS NG'WELL. DEPTH DATA WELL DEPTH 485 ft.1 STATIC WATER LEVEL _-2_Oft.l DATE MEASURED 11/27/8-7 DRILLING EQUIPMENT UROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING. 129 OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL- LENGTH .51 ft. MATERIALS: [I STEEL 0 PLASTIC 0 OTHER LENGTH.BELOW GRADE 50 fL JOINTS: OWELDED 0THREADED 00THEIR; DIAMETER 6 in. SEAL: M CEMENT GROUT O-BENTONITE 13 OTfflER WEIGHT PER FOOT 19 lb./ft. I DRIVE SHOE. M YES ❑ NO LINEROYES MNO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPE1123 FIRST 0 'YES ONO HOURS-­­- SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH —ft. BOTTOM DEPTH — It. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED i tests Were done is in- (2 COMPAESSEDAIR. ..formation attached? 0 BAILED .0 OTHER ❑ YES 0 NO It more detailed formation descriptions or sieve analyses WELL L08. are available, please attach. DEPTH FROM SUR FAqE, Water ing Well 0 ia- meter In OESCRIP`rlON-', Caw- WELL DEPTH DURATION hr, min, DRAWOOWN ft. YIELD gpm. Lafid ce .Surfa� 3 Irilling in overburden clay & bld3p. HiIt rock at.30' 4851 6 465 5 30 5_ Dr' ling in rock,set casing,grou ed. 51 485 Dr' ling in rock granite. WATER OtLEAR TEMP. W UE� AT QUALITY 0 CLOUDY HARDNESS QUA TY 0 COLORED ANALYZED? 0 YES 0 No ANALYSIS ATTACHED? 0 YES 0 NO [MAKER STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME P.F. Beal .& sons, C.. DATE K12�418 PO Box B ADDRESS 501M Brewster.NY 10509 PUMP INFORMATION TYPE CAPACITY DEPTH_ E VOLTAGE HP IWOO L T2 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 #. WELL LOCATION Street Address Ice Pond Road Town/Village/City Tax Grid Number T. Patterson 79 -3 =8.11 WELL OWNER Name Margaret.& Matthew.Cotter, Address aPrivate Inland Road, Lake Carmel, NY 10512 ❑ Public USE OF WELL 1 - primary 2 - secondary ®: RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 ABANDONED O FARM _ [3 TEST /OBSERVATION ❑ OTHER. (specify b INSTITUTIONAL ❑ STAND -BY 1 AMOUNT OF USE YIELD SOUGHT Five gpm /#' PFOPLE SERVED Eight /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING KNEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON . FOR DRILLING Residential Supply WELL TYPE aDRILLED DRIVEN DDUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: John Brenner Lot No. 4 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ­-DISTANCE-TO -TO -PROPER`PY' FROM -- NEAREST -WATER- MAIN: -Over-one-mile - �-_..._. __.. _ - -- - __....._. ,... __...... ..._..... . LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (See Dwg. No. 1, Job S.0.2393 by John H. []ON REAR OF THIS APPLICATION ❑ ON SEPARATE SHE E Prentiss, P.E.) 17 March.1987 (date) 61 Isign-at'ure)" 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 y t e Putnam County Health Depar meet. Date of Issue: � 19 Date of Expiration: 19 i s i g ci Permit is Non - Transferrable APPLY B PITEINM Cv. UNTY DEPARTM= OF HEALTH - DIVISION OF ENVLRCNMENZAL BFALTH SERVICES LN- DIVT.Lt]AL SUPPLY & SUB -cMF .CE SELF' DISP.AL SYSTEMS f REVIF'ni Sl= -,CONSTRUCTION P_ZMST -� � U (Name of Cw-ner) (Street Location) CCRAY- TS 1 YES DOCUM.ENTs +—i_ I.- LF trenc*i provided reauired 60 ft. rra:c. Parellel to contours Z.: - .. _. "A, DATE VW-ED : l I BY: "' Q Pe_nnit Apolic:.t on Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DCS) Deep Hole lcq s/s Consistent Perc Results (3) Perc Hole Depth House P1 sets Well ni PrIN :Varian ce :V SUEDIVISION Perc - d Fill ca (o' letter C�u'�E'cZPL Legal Subdivision Subdivision P -oDroval Checked -� Ex- approval SSDS Adj . Lots Checked Wetland (Tcwn/DEC Pen-nit R & D) Data On DDS Plans & Per ni t Se p- REQUIFL:D DELAIT-S CN PLANS Saraage System Plan - (north arrow) Se=wage Syst u Hydraulic Profile - Gravity Flea Fill Profile & Dimensions - VolU -Me D or J Box;Tre- ndn /Ga11e_*y; Piro pit details Septic Tank - Size, Detail Well Detail, Service Line if over �Coristructien Notes Design Data: Fero and deep results Tw-o -Foot Contours Existing.& Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge CK) Perc & Deep Holes Located Representative of primary and e`cansion Expansion Area;shcwn;gravity flow,suff. size If PugDed Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's Win 200 ft. of Proposer Systezi Property rtes & Bounds 75 7 House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. g "O; Type pipe . No Bends; Max, Bends 45° w /cleanout SEPARATION DISTANCES SP )C FLED ON PLAN Fields 10' to P.L., Driveway, Large Tree.__s,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L_O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. epa 15' to Drains - Curtain, Ieeder, Footing 351to catch basin, stonrdrain,piped watercour 101. to iti Cer Line (pits -201) . 50' inte=nitte_nt drainage course Septic Tanks 10' fran Foundation; 50' to X11 15'' Well to PL i Jr-l-, _ , wl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,, CARMEL, N. Y. 10512 w M r DESIGN DATA_-�SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.-. Owner �Gi °"" "" j �. �� Address Zee Located at (Street) le-6e, Ti7z Sec.7_At. ___Block_ ' Lot. 61-1 r� Indicate nearest cross s re-e jj Municipality C9 Watershed 610 �H 80IL:PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS . Number CLOCK{ TIME PERCOLATION PERCOLATION .. Run apse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate,. Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 (034- l eK 3o ( vt- % '. 2318 - 4 I fz� Ito 30 2— 110210 r0 30 17. �474- 2/f e fry roe 17 %Y lyy 24 -3o f1 Notes: 1) Tests to be repeated at same depth until app roximatelyy equal soil rates are obtained at each percolation test hole. Al data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G. L. . 6". 12'.' . 18" 3011 361. 42" 4811 X11 .6011 66 7211 78}11 ..8(411 INDICATE - INDICATE TESTS MAI TEST PIT DATA REQUIRED TO BE SUBMITTED WITP APPLICATION DESCRIPTION.OF SOILS ENCOUNTERED IN TEST.HOLES HOLE NO. _�_ HOLE HOLE NO. 3 DESIGN Soil Rate Used Mirvi "Drop: S.D. Usable Area Provided ,, OV o a M + No. of Bedrooms Septic T4nk Capacity ((Do()--- Gals. Type a Absorption Area rov ded By .F. x24" width rent . +801 i e; ),�3 � k¢ R.acooaLryr�� n Other a t_ _ Name bignature Address JOHN N. PRE!17T55, P.E. Sit CARMEI NFN ypRY 30612 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by �fTOE SIN"