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BOX 15
01573
1
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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
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d. No 000 bends, cleancut within 10 fz. cf 45" bend
I
e. DISTRIBLTICN BOX
1. A11 outlets at same elevation - watar test
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2. Protected below frost
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3. M? nhrazma 2 ft. original soil between bad and trenches
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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
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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
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e. Cartai.n drain installed accordinc to cian
f. Curtain drain cut =all rotected & dir.to exist.watercours�
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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
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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
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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"