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HomeMy WebLinkAbout1574DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -16 BOX 15 ME .. 16 �� . 2 I ' T . ,. , 01574 �, r ter. 5 ,. N .. , r i .*..- .....,•- �.;..} ri R' v PUTNAM COUNTY DEPARTIVIENT OF HEALTH Rev 3/`8 Division of Environmental Health S�ervicee, Carmel, N ?:10512 L °•' ?tis `' ' � `� t n:' �� r+" g. _ T _ � uEngin�r Muet Provide P`15 = 8 7 A\ P C.H D Pernik ii 1/ s CE _X. EM .,- CA f)P CQNSTRUC�IQN.GOMPLIANCE FOR SEWAGEyDISPOSAL SYSTEM r. Pa.tters.on ' t Tows or 'Village Ice'?Pond' Road: Ta= Ma'p ' 79 Block 3 Lot_ 8.12 Located s<t Vir�glnia MausForn Owner /applicant Name r Dogwood,Ct , P 0 Bx 104; �MnlLng Address ; ':�Goldens dge;; SeparateSewetageSystem`bWltby Future COtitraetii t 1000 Consisting of < Water Supplyt Public Sapply From - _} ort° X. Private SupplyrDriIIed b Y I i S Ballding Type Frame Has Erosb Namber'of Bedrooms Three Has Garbs %'Othei •Regnliementa e �Y Non W. hcertify that ;the syatem(s) as ldsted serving pthe abpve •pra Sof which are attached) .and Sn accozdanoe with the <atandaida ' ` Putnam C unty Department` Of Neal'thz� t 4 s'Ux i Date 29 January 1988 ;.'c Address AD 9 ;Any person occupying piemises sbrved by the above system(s)�s condlt•fons resultlny Yrom wchusaye ApprovaP _of the separi ':avalyDls +•and the.approval of the ':pr,Ivate�wster supply shalrbec subject ;to motl.iflnt {on qr change when,in the Judgmsnt - irf.r ti y Brenner Subdivielon N@me Brenner'• Subd: Lot q.. 2 _zip 10526 Date Permlt'Isened '2`3 March , 1987 Cor� pd P' 0'. BoX, 473,,E Bedf ord' Hills',:NY 10507 in:Septic Tank and 500' 'x 24" w x 18 beep laterals: aJ ab � Addess' Malon'&hjlk Addies6l, Box 313 Cr' oton., Fal'Ls , NY 10519 a onirol Been Completed? =9s required • r Grinder Been InetailedY NO �s.;were constructed esaentrallyas•_'shovn on,theplana ofthe completed_r+o =k ( copies iTes`and regulat ris in eccordanca`with,.fhe Piledyplan; and the 'permit issued by the r. a err ' ��4 Irk y t s> fied'by °�J P E. -X _ R.A.' Ca NY•- 5 License nio:46 �promptlyr take wch actbns nuy ba neu�iary to secure thi correct{on of any,unsenitary sawerajo.*stem shill become nulfirid vo{d`as soon as a.'•pubt: sanitary sswsir becomes e null Arid ;void wAen a.:publk wat}i supply I)Scomas - available >Sui:h ,approvals are GOmmlisionar' of Health,; uch revoatlon, °•inotllflution or, change Is nicessaPy. s s ; �r , T,Itle WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH _.. Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: [OWNIVILLAULICHY TAX GRID NUMBER: WELL LOCATION WELL OWNER Na; ADDa s . water Bear- iq well Dia- meter FORMATION DESCRIPTION ft. O PUBLICF WELL DEPTH ft. USE OF WELL SIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ AS YI D 1- primary ❑ BUSINESS ❑ FARM O TEST/ OBSERVATION ❑ OTHER (specify) 2 - secondary O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT �— gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE �' ® o gal. REASON FOR W SUPPLY 0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH'--ft STATIC WATER LEVEL � ft. DATE MEASURED DRILLING ❑ ROTARY ❑ESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL 501NT CLQA7E PERCUSSION ❑OTHER (specify): WELL TYPE ❑ SCREENED OPEN'END CASING, ❑ OPEN HOLE IN BEDROCK O OTHER , TOTAL LENGTH ft MATERIALS: L O PLASTIC O OTHER CASING LENGTH.BELOW GRADE tL JOINTS: O WELDED 1210EADED ❑ OTHER DETAILS DIAMETER 60 in 'SEAL: ❑ NT GROUT ❑ BENTONITE OOTHER WEIGHT PEA FOOT lb:/ft DRIVE SHOE ❑ NO UNER: OYES ONO DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN itj DEVELOPEDi �SCREEN . ►RS F _ _.. _ M _...._..:.. _., ....�._ DETAILS .. _ ....... _ SEGO HOURS GRAVEL PACK ❑ YES GRAVEL DIAMETER. TOP BOTTOht ❑ NO SIZE: OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST If detailed pumping WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. METH00: ❑ PUMPED i tests were done Is In- ❑ COMPRESSED AIR formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ONO DEPTH FROM SURFACE water Bear- iq well Dia- meter FORMATION DESCRIPTION ft. ft _ WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YI D Surface D L lAz WATEP LEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZE� YES ❑ NO r ANALYSIS ATTACHED?. ES ❑ NO STORAGE TANK: TYPE �fS PUMP IHF MATT f .� CAPACITY � GAL. TYPE U CAPACITY WELL DRILLER NAME MAKER DEPTH A DORES / SIGi6TURE 0. MODEL' .� VOLTAGHP 3C 0 �� DATE CODE. PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONIMMAL HEALTH SERVICES 79 3 8.12 Owner,, or Purchaser of -Building Section Block Lot Brenner ation - reet Subdivision Name �Q7 2 ic' itv Subdivision Lot # 0 GUARAFPrEE 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 to-such..system, 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. this 2, day, of an. 19 88 Signat _ // Title (Owner) - Signature Corporation Name (if Corp.) Dogwood Ct.,P.O.Bx. 104, Goldens Bridge, NY Address 10526 rev. 9/85 mk Name (if Corp.) ,5 a LAB !B - town Medical Laboratory, Inc. 321 Kear Street Date Taken: - Time: 30,,� Yorktown Heighq, N. Y. 10598 t e �fic_ d _ Time.:. (914)245 -3203 _._. -�_ .. : ported. ..� _ Date Re o Director: Albert H. Padovani M. T. (ASCP) Collected By:. Y1) ry I Ari ,A C pp II// Referred By: Sample Location: !Fl U C e f-- b (A 7 Y. _ Phone # I�� Q Q� lO ej 1' Phone N I Sample Type: L - Z`'`�`' J Repeat Test? _ (check one) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON - METALS (mg /L) MICROBIOLOGICAL (CFU /1OOmL) _ Acidity —Alkalinity Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia ':Nitrogen, Nitrate _ Phosphate, Total _ Sulfate. _ Sulfide Sulfite METALS-(mg /L) Copper _ Iron _ Lead _ Manganese _ Mercury _ Sodium Zinc MISCELLANEOUS PH (units) Color (units) Odor (TON) Turbidity (NTU) GENERAL BACTERIA Standard Plate Count ( CFU /1,. OmL ) MEMBRANE FILTRATION TECHNIQUE I_Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE_NUMBER TECHNIQUE Total Coliform Index Fecal ^C'o'liform Index KEY FOR TERMINOLOGY N/A = Not Applicable LT = Less Than ( < ) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR Non- reactive REMARKS /COMMENTS (For Lab Use) K Potable Non - potable STP INF _ STP EFF Other: Sample.Status: (check each) Outgoing HNO3 _ HC1 _ H2SOh NaOH, ZnOAc _ Na2S203 Other: Incoming kLE 4 °C GT k °C _ pH 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 T NE YORK STATE DRINKING WATER STANDARDS, FOR. THE PARAMETERS TESTED, AT THE OF COLLECnED THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN °T) MEET THE .SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA NKING WATER - CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. X df� 2 /86(Rvsd7 /87)RWE` Ibert-H. Padovani, M.T. ASCP), Director. PUTNAM COUNTY DEPARTMENT OF HEALTH COMPLAINT OR SERVICE REQUEST RECORD, M0699-139-19 I. TOWN KENT DATE November, .1989. -Bill..Hedges TAKEN BY Bill Hedges TELEPHONE CALL IN PERSON LETTER CONFIDENTIAL REQUEST FROM Maus TELEPHONE ADDRESSIce Pond Road, Kent. ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST xxxxxxxxxxxxxxxNew Sewage Disposal System failing. DIRECTIONS: Ice Pond Road from 312— approximately 2 miles on Right. Noma Outsrant. ACTION TAKEN BY Z& :2' DATE y 5 �4 FINDINGS _S -e C" - W-7 FOLLOW UP INSPECTION (s) DATE FINDINGS S e-, --7 DATE FINDINGS PROBLEM ABATED DATE �/ PERSON NOTIFIED a Gs ESTIMATED TOTAL MAN HOURS SPENT 77 JOHN H. PRENTISS. P.E. CONSULTING ENGINEER . K RD 9 - FAIR STREET „ ,CARMEL, N. Y.7-1-030Y- (914) 878 -8170 17 November 1989 Putnam County Department of Health Division of Environmental Services 110 Old Route Six Center Carmel, N.Y. 10512 ATTENTION: William Hedges, APHE Re: Virginia & Paul Maus S.D.S.,Failure Ice Pond Rd., (TM79 - Block 3 - Lot 8.:_;12),'T. Patterson, C. Putnam, N.Y. [PERMIT NO. P- 15 -871 A site investigation was made with respect to a failures `the S.D.S. area. ,�.. The leaching of .sewage was visible at the far end of the 4irst lateral.. After some probing with an iron rod it was found that there was not enough soil cover on top of the trench thus allowing the sewage to surface. " Further probing revealed that at least two other laterals in the. system lacked the required amount of soil cover, a minimum of. 12 inches. To { correct this condition we recommend that additional soil (common fill, no a rocks) be placed over the ends of all the laterals, approximately 911-1211 + deep and 15' in width; (this area will be staked in the field for the contgactor,to follow). toy r is He ry F. Turgati, for John Q. Prent' P.E. CC: Maus R. Mancuso File k i PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 CERTIFIED RETURN RECEIPT REQUESTED PLEASE REFER CORRESPONDENCE TO: Paul b Virginia'Maus NAME: William Hedges Ice Pond Road TITLES Public Health Sanitarian Patterson, NY 12563 PHONE: (914) 225 -0310 ext. 319 DATE: March 21, 1990 SECOND NOTICE OF NON COMPLIANCE a JOHN KARELL Jr., P.E., M.S. Public Health Director YOU ARE HEREBY NOTIFIED that non - compliance with Article III Sectio:i'3 of the Putnam County Sanitary Code where evidence of sewage, discharged. from the vent pipe onto the surface of the ground was found at your residence, On Ice Pond Road, by a representative of this Department on March 21, 1990. It'is believed that you are responsible for correction of this condition. If you are not responsible, you are requested to notify immediately the inspector above indicated. Please be advised that appropriate steps must be taken immediately in order that the sewage overflow cease by arranging for the septic tank to be pumped out and maintained pumped until the proper repairs are made to the system. - Approval -of -proposed repairs must- be- obtained 'frsa this Dep6 teent- prior to -any alteiretion * of rebuilding of existing disposal systems. An application is enclosed. Failure to pump the septic tank by March 30, 1990 and further, to correct this condition by April 7, 1990 will make you liable for additional penalties provided by law, including prosecution on a charge.of committing a violation punishable by a- fine or imprisonment,, or both such fine and imprisonment, as prescribed by law in addition to such other action as may be prescribed. A reinspection will be made. It is sincerely hoped that the above - mentioned further action will not be necessary and that yon will cooperate by securing the correction of this condition. For The Public Health Director V y t ly turs, John Kar 1, Jr., P.E. Director,, Environmental Health Services JK /WH /jp By: William Hedges enc: Permit Applicaton Public Health Sanitarian cc: BI (T) Patterson John Prentiss, P. E. Raymond Mancusco, c/0 Mrs. H. Mancusco, 61 Hudson Dr., Ossining, MY 10562 a. . PUTNAM COUNTY HEALTH-DEPARTMENT, DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Siniions, M.D. Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME o u / ct (�✓ _ orig. Routine Orig. Cmiplain ADDRESS �d -�� G� r Orig. Request No. Street Town TM Noe _ Compliance r.V _ Complaint.Camp MAILING ADDRESS Final P.O. Box Post Office Zip Code — Group Illness _ Construction TELEPHONE Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title Other f 5 �S DATE / / �9 dV TYPE FACILITY TIME ARRIVE; 3 Q :TIME LEFT Explain FINDINGS: INSPECTOR: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: �. PETER C. ALEXANDER SON County Executive 0 ' g_. DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Id Route Six Center, Carmel, New York ,- (914) 225 -0310 CERTIFIED - `RETURN RECEIPT'RE9UESTED --- - - - - -- - - - - -- - - - - - -- --- - - - - -- Paul & Virginia Maus Ice Pond Road Patterson, NY 12563 10512 PLEASE REFER CORRESPONDENCE NAME: William Hedges TITLE: Public Health Sanitarian.'; PHONE: ( 914 ) 225 -0310 .ext. 3.19 DATE: December 19, 1989 F JOHN KAREiLL Jr., P.E. Director OFFICIAL NOTICE OF NQN COMPLIANCE YOU AREtHEREBY NOTIFIED that non - compliance with Article III Section 3 of the Putnam County Sanitary;Code where. evidence of sewage, discharged from the vent pipe onto the surface of the ground was found -;+, your .residence, Maus, Ice Pond Road, by a representative of this -Department on November 17, 1969. As owner; occupant', you are responsible for the correction of this overflow. However, your sewage disposal system is less;t�han two. years old and therefore covered by a "Guarantee of subsurface sewage_disposal_system ". signed, by the general contractor. Please be advised that appropriate steps must be taken immediately in order that the sewage overflow cease by arranging for the ;septic tank to be pumped out and maintained pumped until tht proper repairs are made to the system:- _.-.- ......... ... o. -...�. .� «.....,u _.. :..<.' _- .._..,.. _._........ ._. ._ _......._...._... ....__. -_ . -. . ___ ...►. -.__. ... «..- _... _.. ..... .. -. --. a._......... ... .... -.... .. .».... Approval of proposed repairs must 'be obtained from. this Department prior to any alteration of rebuilding of existing disposal systems. An application is enclosed. Failure to pump the septic tank by December 27, 1989 and further, to correct this condition by January 2, 1989 will make you liable for additional penalties provided by law, including prosecution on a charge of committing a violation punishable by a fine or imprisonment, or both such fine and imprisonment, as prescribed by law in addition to such other action as may be ,prescribed. A reinspection will be made. It is sincerely hoped that the.above - mentioned further action will not be necessary and that yo will cooperate by securing the correction of this condition. JK /WH /kv t enc: Permit Applicaton cc:, BI (T) Patterson Raymond Mancuso c/o Mrs. Helen Mancuso 61 Hudson Watch Drive reV'The Public; Health Director Very truly yours, John Karell, Jr., P.E.. r Env�ental Health Services By:.William Hedges �. Public Health Sanitarian Ae PUTNA QQUNTY. - HEALTH DEPARB EW- _.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - NAME ADDRESS - ­19P No. treet Town TM Noe MAILING ADDRESS P.O. Box Post Office Zip Code WDI N• OLN03- • �I -7.'T CHARGE • • INTERVIEWED BIB Name and Title DATE Y TYPE FACILITY TIMME � TIME IM U 0 Sheet of INSPECTION Orig. Routine Orig. Complain Orig. Request Cmpl iance Ccoplaint Camp Final Group Illness Construction �.. Reinspection Field, .Sampling Only Field Conference Other. Explain _ r Signature and Mt1 ' PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: _- 6/86 TITLE: John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME �,00' Y) Orig. Routine Orig. Complain ADDRESS r' /4?0 eve Orig. Request No. Street Town TM No. Compliance Complaint Comp MAILING ADERESS �" -� 42 A-7 Final P.O. Box Post Office Zip Code Group Illness Construction PERSON IN CHARGE � - - - 00' OR INT RVI.EKED o- W-1IVO 'Nam and Title D ATE -'_'�1'' TYPE FACILITY TIME AWkIVED 12 's � � ���'�' TIME LEVT Reinspection Field, Sampling Only Field Conference Other .i r Explain rIMILIG5: / /0 +. .p. a, AWAM -W PERSON IN CHARGE OR INTERViEGVED: !,l" I ac ge this Pi Act iv ty Report . 6/86 k�31VtCL'ii s � ! -h .% ,` SIC !i /1A,p 1�� dF%`°.� ems" 1' �' ` p� � ��da'ti° .*^mac �� s�Y � � "� -; �� -' r`I`'Ls� /s I Rev p � .,LoLatet e.� t sfilkw Owner,, �L °.fir,�,r' +`Numtii - .Sepsisi WaltCt Ot�18I ' 1 rePie ab'oJe; Count' tiersut Place:,, • ,ance`� i •� will be • Count' • Oate, •APPR r VI11aHo ..., 4 1Z avhslon , .p 10526 1'aterals , '•: J+ n(s) ),'that' the separate sewage- disposal system ie stpndards.' rules en regulations d , e tf n i!, satisfactory to.tAe Commissioner of Health will' ears or assigns, by the builder, that said builder will j •years immetllately followIng jh edate'of the isiu;' is•thereto �2) sdar rest'hentd tlie;tlrilles d:,well tleseiibed utittinoaGmiu aioof !/!7 P.E _'X- R A 5,12 len sa fVO Z9206 Lici a ction of tti building u has been ndertaiccen and is ; le`a,,b i_APil,chpnge, or alteration of:constfuctlon. t DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 _APPLICATION -T.O. WATER WELL PCHD PERMIT WELL LOCATION Street Address Ice Pond Road Town/Village/City Tax Grid Number T. Patterson .79-3-8.12 WELL OWNER Name Address Virginia & Paul Maus Goldens Bridge, NY 10526 OPrivate 13 Public USE OF WELL 1 - primary 2 •secondary URESIDENTIAL 13 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY OAIR/COND/HEAT PUMP OFARM 0 TEST/OBSERVATION 13 INSTITUTIONAL OSTAND-BY 0 ABANDONED 0 OTHER (specify' U AMOUNT OF USE YIELD SOUGHT Five gpm/# PEOPLE. SERVED. Six /EST. OF DAILY USAGE 4DO_gal .REASON FOR DRILLING. NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL OTEST/OBSERVATION DETAILED .REASON FOR DRILLING Residential Supply WELL TYPE DRILLED ODRIVEN [:]DUG 13 GRAVEL DOTHER IS WELL SITE SUBJECT TO FLOODING? YES X, NO IF WELL IS LOCATED IN A REALTY SUBDIVISION,.NAME OF SUBDIVISION: John B-enner Lot No. 2 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 PROPERTY--FROM NEAREST -WATER- MAIN:­ Over one mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (See Dwg., #1, Job # S.O. 2394 by John H. 06N REAR OF THIS APPLICATION [DO PARATE S Prentiss, P.1 .13 March 1987 (date) (signature) 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 withi.n thirty (30) days of the completion of water well construction, the applicant shall: 1. 2. 3. Date of Date of Permit Pump the well until the water is clear. Disinfect the well in accordance with the County Health Department attached to thi Submit a Well Completion Report on a for Health De artment. Issue: Expiration: 19 is Non-Transferrable requirements of the Putnam permit_. p rol idep, by the Pqtn%n County rm CTa PUTNR14 COUNTY DEPARTME N'r OF HEALTH INDIVIDUAL WATER SUPPLY & nk APPENDIX B - DIVISION OF E NVLRMN�L HEALTH SERVICES SUBSURFACE S.CE DISPOSALL SYSTa4S REVIEW Sr:E ET - CONSTRUCTION PF Rk!T' _ DATE REVLrvED: BY: ('we of Cwner) (Street Location ) CyTs YES NO DOCUMEN'!'S Permit Applicaatior. Corporate Resolution Plans - Three sets Engineers Aut<horizati en Design Data Sheet (DDS) Deep Hole Lcg Consistent Perc Results Perc Hole De: un LF trench provided required 60 ft. rr� Parellel to ccn 3 House Legal Subdivis -cn �T �v s/s SUBDIVLSIC Perc : ' = /I 3 Fill _3 Pte_ ca (3) sets FIV-S letter q b K- p� Subdivision Pnorcval Checker _ E�c- approval SSDS PLj . Lots Checked Wetland (Tcwm/DEC Pe=dt R & D) Data On DDS Plans & Permit Szrre REQ=D DEUN-IIS CN PLANS Se-,wage System Plan - (north arrow) Sewage Systa-n Hydraulic Profile - Gravity Flow 'Fill Profile & bLgensions - Volume D or J Box;Trendn /GE—Ole_ry; Pump pit details Septic Tank - Size, Detail Well Detail, -qe vice Line if over Construction Notes Design 'Data: perc °and- deep results . Two -Foot Contours Existing.& Proposed Driveway & Slopes Cut Footing /Gutte_r,Curtain Drains (discharge C•K) Perc & Deep Holes Located Representative of prinery and exFansicn Mcp si.on Area; shc*wn;gravity flow,suff. size tp If Ptmed. Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's Win 200 ft. of Proposed System Property Rtes & Pounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout. SEPARATION DIST ?lam SPSCIr ZED ON PUN_ Fields 10' to P.L., Driveway, large Trees,Top of fi• 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expa 15' to Drains - Curtain, I.�--der, Footing 35'to catch basin,sto=r&- ain,pi crate- rcour. 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks . 10' fran Foundation; 50' to will 15' Well to -, PL` ^ OJO 11 P:1 1 i Y i d'1: 1)C j1Tl ,!: � PUTNAM COUNTY DEPARTMENT OF HEALTH 1 DLVISI ON _ OF ENVIRONMENTAL HEALTH.__U"1Q&$ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 ., ry Motes DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner " D I Yi "Y" Address �GP_ 9414( Located at (Street , f2— Sec. 3? Block .7 Lot-.. 8® � 6dicate'nearest*cross s ree Municipality, �� -��� Watershed Co-� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve .No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches t iWit- IOU 2:j 3 o 4 30 l to Lo to )1z �7 3 r 5 1 Notes: l) 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 from top of hole. , TEST.PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION- OF'-.SOILN- ElgCOUN`.UERED.:_IN,- TES's.- HOLES:.- - - - , - . -- .7 7,- a _ DEPTH HOLE' NO. HOLE NO. y HOLE NO. 6 11 c���f ©�d�; .12'. SPACE FOR USE 18" ONLY: 24" C .3011 Checked by 3611 42" 48" 54" 6o" 72" G ►i .Y Lo 7 it 84" N. yye�vv�� � ' INDICATE. LEVEL -AT. CH...OROUND_ WATT R_..IS ENCOUNTERED No nt INDICATE LEVEL TO WHICH WATER.LEVEL RISES AFTER BEjNG' ENCOU MERE -None TESTS MADE BY 14, F.7: Peres,(Ff.I�T� /TSB %BS' ate - Soil Rate Used 2-(-30 MirVi "Drop: DESIGN S.D. Usable Area Provided 0ge)'0+-_ No. of Bedrooms Septic Tank Capacity p 04L Gals. Type _ Absorption Area Provided By�oL.F.x2411 width renc . Other ure MIN R. PRE_NTISS, P.E. Address RD9 FAIR Sf 911 -87.1-6170 THIS SPACE FOR USE BY HEAI1rH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by H• i in !Irl O 13 -7 1 147at IL)-- 44 4 L 0 Pi �e 4,D - ZO& TY MOP&ME64% cif flag, TA -*'Lvl&l= Of Env1ro.—ental R"dth Serv,066 '"roved as noted for oonformawe'vith 4PP11cable gales and Put-M C-MtY R611th Regultamtelnont.s of the Depu. "AS BUIL -DATA Struc15 ocaled from survey b y surveyor noted belo*ws._ ture. 1, 'Weil located L)y: Surve yot s survey, weii dtliltit%t report Enjineeis inestiferricst5 0 Icnik, boat(ob, pits, galleries 8 lula(cts iocatea oy,.Contrt.Ctilt: E n g i ricer.,. Health da Pt: lJ Field inspection by: Health dopim da 10: ':_.P =._87 - Engineer --7- 4? 7A,T_ 'ibis is ;o ceT�,lfv ghat the sedge , disposai'syStf-M Was C(?n::Lrt­t(!d as NOTES: fnd,icatvd on chis plan, 41111 L113C the svtircam w.,.,s in+ pect,,rl t;.%, me before it "Ve'. I)m <.-%Etvn, WAS In s' 1,mla,d rule& and re :;, 1,, rho ti. N jV A B r A C CP F n A T 07 A E _/az _7 y A F B F A G 0 A M a ,h j j j r r-J:2 a A K -12 a K A !Pet& LOCATION Street: Tdw n-. y late SUBDIVISION: M a Block 'LOT N2_ Z, Bud der, V/ _jQ V�L� Surveyor Drawn: ate: J O H N • H, PR ENTISS -RE, CONSULTING ENGIP4EER I I