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Home My WebLink About1576DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -18 BOX 15 01576 � lK.�� i 01576 PUTNAM COUNTY DEPARTMENT OF HEALTH . ev. 3786 � Division of Environmental Health Services, Carmel; N.Y. 10512' tEngineer Must Provide P21-87 P.C.H D. Permit N a (A CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM I_� Patterson K Town'or Village....._..,.., .. Located at Ice. Pond Road Tax Map' 79 Block 3 Lot 8.14 OwnWapplicant'Name John C.Weizenecker Formerly John Brenner _ Subdivision Name Subdv. Lot # 4 Malang Address Cross Road Patterson, NY Zip 12563 Date Permit issued 1 April 1987. Burdick Contractin $S TD Address Sager Rd., Brewster, NY 10509 Separate Sewerage System. built by - Consisting of 1.000.. Gallon Septic Tank.and 440' x242 W. x 18" Deep Laterals Water Supply: Public Supply From Address or: - 'X Private Supply Drilled by P. F.. Beal & Sons Address Putnam Ave., Brewster, NY 10509 Building Type Frame Has Etoelon Contiol Been Completed? , As required. Number of Bedrooms Three Has Garbage Grinder Been Installed? No Other Requirements R-O -B Fill S ctione', 10" .Deep .x 4800 Sq. Ft. (468 Cu. US.) 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 regulet ens,_ in accordance'with the filed plan, and the permit issued by the Putnam County Department OfHealth'. - Date 21 September 1987 Certified try P.E. X R.A. Address 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 somy6rage system: shall become null and void as soon as a pubt': sanitary sewer becomes available aril! the approval of the ptivate water' suDplY she II'.become null and Vold' when: a public water supply becomes available. Such approvals are subject to' modification or change when, in the Judgment of the Commissi6nitr of Healt , such revocation, modification or change Is necessary. Oats Title i `s. s4�Cra T.TVT T PAMDT UTT11M DVDnDT I Gf! O YY LJLLJ VVLii LL' LiVi`I LtiL VL \1 DEPARTMENT OF HEALTH _._Division Of Environmental Health Services. PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only e WELL LOCATION SiREEi AOURESS: TAX GRID NUMBER: Ice Pond Rd, Brewster NY Lot #4 WELL OWNER NAME: ADDRESS: John. Weize ❑ P8IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary 9 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 160 ft. STATIC WATER LEVEL =ft. DATE MEASURED 9114/87 DRILLING EQUIPMENT ROTARY (Z COMPRESSED 'AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. )9 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 2L fL MATERIALS: CISTEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE 19 ft. JOINTS: ❑ WELDED CXTHREADED ❑ OTHER DIAMETER h in. SEAL: 0 CEMENT GROUT ❑ BENTONITE 0OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE: DYES ❑ NO LINER: ❑YES C21NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? DETAILS _ . _.. FIRST ❑ YES O NO HOURS SECOND - GRAVEL PACK . O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH tL BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping t METHOD: O PUMPED i tests were done is in- 9 COMPRESSED AIR ,formation attached? O BAILED ❑ OTHER ; ❑ YES O NO �IELL 1.0G It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing well Dia' In FORMATION DESCRIPTION COCIE ft. IL WELL DEPTH It. DURATION hr, min. DRAWOOWN it. YIELD gpm. Surface 4 Drilling in overburden clay & bldr , 160 6 140 30 4 20 'Dfilling in rock set casing,groute , 20 160 T)IjJJjng in ragk granite. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES O NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP WELL DRILLER NAME P. F. Beal & Sons , nc , DATE' ADDRESS PO B. �.o /B r. Brewster, 10� C` i s ' ► LAB CA. 005549 / Yorktown Medical Laboratory, Inc. - - - -- • 321 Kear Street Date Taken: 9/28/ Time: 1 =00 Yorktown Heights,.N. Y. 1.0598._. Date R.c! d : g /..28./_ 7_.. Time-:- (914) 245 -3203 Date Reported: OCT. 01 1987 Director: Albert H. Padovani M. T. (ASCP) Collected By : Tu rgati Referred By: TJOHN PRENTISS P.E , Sample'Location: Well_ RD #93 FAIR STREET Weizenecker, Ire . CARMEL, NY, 10512 southEast, ny. Phone # Phone # L J Repeat Test? _ 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) Copper Iron Lead Manganese* _ Mercury _ Sodium Zinc MISCELLANEOUS pH (units) Color (units) _ Odor (TON) Turbidity (NTU) GENERAL BACTERIA X Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE X Total Coliform D Fecal Coliform Fecal.Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform fndex -. 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) Sample Type: (check one) X Potable Non- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing HNO3 _ HC1 H2SO4 NaOH ZnOAc ._ Na2S203 Other: Incoming X LE 4 °C _ GT 4 °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 YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTnDNKING THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF.THE NEW YORK STAT WATER- CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. /X/ �,�t, G�� --� 2 / 8 6 (R v s d 7 / 8 i) RWE Albert H. Padovani, M.T. ASCP), Director " . / PUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROZZMAL HEALTH SERVICES John C. Weizenecker Owner or Purchaser of Building t"M Q, 6VL 1 zyng, Building Constructed by Location - Street Municipality SIT l C_ %VA k::r MG�A Building Type 79 3 8.14 Section Block Lot .,Tom M KN w\ F—R Subdivision Dame Subdivision Lot # GUARANM 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 sysUgm, 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 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 the occupant of the building utilizing the system. Dated this day of&&d 19 b' e _ Gener Contract (Owner) - Si nature Corporation Name (if Corp.) Signature J. "/ dr Title 'I Corporation Na- •. �.1 rev. 9/85 mk e�� !- ._ - -•- /' /F 3 �i/J TNC N ��Y U/�r� S /�.4C E S — '- � - - --- o► J z pe -.1¢ �_ aA' rV /�'�•oo .�!Z'= = ,t� -.3 �. t�.; 3,�,��• 5� r O �� 4z%� �z «��• 44� -emu ; J It f I par fit' I' or l �t� �GG'llor -1 3�'�5c:(� -I' -(cJf, � koj 10, 4" L Pi Pt,� 7 I D t.�rpGl`�I Ix t A. �l tt z. 4� ' \b T -N o8`?2' Zdle 46.5•✓' r � I 4a. 14� 5er) 24•"6 42e "52 Ja'y✓ 40.14 Country Depar ,L ux 11ea;1La,. ►idlslon of Eavirot)aental Health Servia..e .Pproved•ae noted for confo:vlance with Pplicable Rules and Regulation nr +ke I At, tiUILI AIA. Structure located from survey by surveyor noted below - -- _ - - ell located by: Surveyors survey._ -- ❑- - weli drillers report Er P-ee -" mesurements -B. -- uC Tor. k, boxes, pits, galleries 81, laterals located by: Contractor: Enginemr: H e 01th d¢. pt: Field Inspection by: Health dept ® dot e:�- -R-7 Engineer ® dafa'2 � -87 NOTES: 111t� in ro Cl; rr try [hat the'sCwage dispoeai system was constructed as uulir of er) on tht6-plan and that the system was insp-cted by me before q vas covor -1 over. The as consfrurt,d in ac cor tj c,ci `. ti'(`�i9i. uox(a rd r❑lcti th.• P.:. H. U. S iii DIMENSION A - B - _ _ LOCATION Street:- l irq Town:�f'l,'' =,2 j�y� CounIy: � _�?!�` State: ii MaP:_ +:�1J�� __ A E - _ 8 - F � I _f- Surveyor: f5i1 ,C,:;ia�� /Z — — - - -- -- Drown: 4, Date :a Drown: _z 87 Srole :fJ % -�Or I Jo A H ' - --- -8 H A K '-- -- - -B K --- - - - - -- J i' SANITARY SYSTEM DESIGN "AS QUILT' a I o I OWNER:_JOH 11- G •_�L� %= C1r-._Ck 2- - -- LOCATION Street:- Town:�f'l,'' =,2 j�y� CounIy: � _�?!�` State: ' ` /t -!� SUB DIV,1S ION. -_� MaP:_ +:�1J�� __ Block.- _ -_ -' -LOT N4— - -_ T Surveyor: f5i1 ,C,:;ia�� /Z — — - - -- -- Drown: 4, Date :a Drown: _z 87 Srole :fJ % -�Or I Jo .�, JOHN H PR ENTISS PE' wg .W4, APPENDIX C FINAL SITE INSPECTION Date Inspected by O ON' WN 14 # OR SUB MSION LOT # s= i = II. - vi. V. C�- b. Fill section - Date of placment 2:1 barrier. LGTH WIDTH AVG.DPTH � c. Natural soil not stri d. Stone, brush, etc., greater than 15' from SDS area. e. 100 ft-from water course /wetlands. SEWAGE DISPOSAL SYSTE4 a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 450 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. TEN= �- 1. 1,--,lqth required - Length installed 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slone of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet fran property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion , 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum. Pipe- ends -capped - h. Pty OR DOSE SYSTEMS 1. Size of pmp chamber 2. Overflcw tank 3. Alain, visual /audio 4. Pump easily accessible manhole to crade 5. First box baffled o. Cycle witnessed by Health Departme -nt estimated flow per acle 1E U,S House located per approve~ plans. Nim- Ler of bed_rcans Well lccst=-d as per a=rzva<1 plans l b. Distance fran -1--DS ea measured -- c. Casin q 18" above crade. i d. Surface drainace arcutnQ well accept_-_-. OVEPALL WORKNT.SHIP a. Boxes roceriv crcuter b. A11 pipes partially b== e- =i11ed c. All pipes flush wi 1i inside of box d. Packfill material.ccntains stones < 4" in diameter , e. Curtain drain installed accordinq to pian i f. Curtain drain outfall protected & dir.to e_xist.watercours ✓. g. Fcotin drains discharge away from SDS area h. Surface water rotection adequate i. Errosion contro provided on slopes are ter than 15 %. CO[`v'I'S SEWAGE DISPOSAL AREA a . SDS area located as a roved lans I I /� e 1 j /- •- _ _ _ wit � � ' _ 77 73, 777 7 Ir r INSPECTOR: "Signature andTitle . r A , PERSON IN C WaS OR hRTrERVI WED. I acknowledge this Field Actavity Report.' SIGNATURES 6/86 TITLE: ' f • nom. � - PUTNAM OOU M HEALTH. DEPARMW '�,�' - 04�. - DIVIM.N.' OF AL; HEALTH _SERVICES John M. Simons, M.D. Deputy °:Ccmnussoner Hof Health - -. FIELD 'ACTIVITY; REPORT w - `Sheet:` of ECTION 1i� NAME..✓v' - Orig. Routine �! Orig. Cmnplain Request ADDRESS Orig. No. Street Town TK No. Cmaplianve MAILING `— " Cmiplaint Comp Final ADDRESS / _ `P.O.: Booc Posh Offi9P, Zip Code. -. Group Illness Construc`t ion" Z'EI�FIONE Reinspection iN CHARGE PARSON F p�1a, leg pnl y . OR INT-Ma EED L Field Name and Title Other DATE ' TYPE FACILITY F` _.. TIME. ARRIVED <�-- }��'.�•�'.�'�: �' %' -TIME %E�"r Explain - TINDINGSs - _ r - e 1 j /- •- _ _ _ wit � � ' _ 77 73, 777 7 Ir r INSPECTOR: "Signature andTitle . r A , PERSON IN C WaS OR hRTrERVI WED. I acknowledge this Field Actavity Report.' SIGNATURES 6/86 TITLE: ' PUTNAM:COUNTY DEPARTMENT OF HEALTH, Division of Envlromaontal,Hoalth.services Carmel N:Y , 1051? E°Hbeei:to Provide Permit N l _ on CERTEF[CATE OF CO CO CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit # Located at - I C e P'03 d.:. g0 $d : „: • r Town or• vwage _ :. T 'Patter John Brenner 4• 79 Block, 3 .. 8.'14 Subdivision Name, Sabd. Lot N Ta: Map' ' Lot Owner /Appilemt Name John C. Weizenecker enew —p _Revision 61— Date of Previous Approval _411 J 8 7 ' MnWng Address' . Cross Road Town .Patter §on,' NY Zip. 12563 snug TyPe: . Modular Lot A = 1.837. Acres Fur secuoo o yn1Xli. D P� 30 vo►ume468 Cu. Yds. . e Number of Bedrooms Three Design,Flow G P, D .600 PCHI) Notlficadon Is Required When 17111111 completed Sep4ate Sewerage System to consist of. 1000 -Gallon Septic Tank. -and 24,11 wide X 18n deep To'be cons cted by _Arthur Burdick Address Brewster; NY 10509 Water Sappb': Pdbfc'Supply From. Address ' or X Prlvate Supply Dialed by Address Other Reiiai�enietta `R:..O -B Fill :Section": Sq 6 It I represent that I im wholly antl completely responsible for the design ,and location of the, proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown.on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health,-and. that on.cornpieiion thereof-, ;'6rt,i,cita.; of Construction Compliance” satisfactory to the Commissioner of Healthwill be submitted to _the Oeparfinent, and a written guarantee wolf D@ lur,nished the owner his successors, heirs or. assigns by the builder, that'said builder will ...place in good operating Condition any part of laid sewage disposal system during the period of two. Q) years Immediately following the date of the Issu- ance of the - approval` oi- the Certificate of Construction•,Compliance of ,tht original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be ins tied- ' accordance with the st ids, rules' and regulations of - the Putnam County Department of'Heaith.. r Date 31 'August 198`7 signed ' P:E. =X— R.A. Address `RD9 =Fair St , �Ca � _14k 10512 -License No 29206 APPROVED FOR CONSTRUCTION: This approval expires two years: from the date' issued unless construction of the building has been undertaken and is revocable for cause or may be arnended.or modified when considered,necessary'Dy' the Commissioner of Heal h. Any change or alteration of constructlon requires a new permit. Approved for disposal of domestic sanitary. sevAge, End /or . at 'Water supply only. BYE _ Rev: l — 1/87 Date �T� le ante. of the approval will be located ,'a's shosvr County.Qepartment of Date. 27 March (and completely respor steucted_as shown on'thl lealth -_and that pn comi rtment; and a* written; ondition any ,part ;of s he`Certiflcate of,Corist the approved "plan and t 9.87 • vaaareu APPROVED.FOR'COfVSTRUCTlbN _This approval revocable'for cause or may be amentled ormodified7 � requires aaJnew permit. Approved'ffor' disposal of. Datev� f !le for =the design'and location of 'the proposed sYStem(s);. '1' ) .that the•separate..sewage. dispoW system pproved: arnendment there to and. in accordance with. the standards, rules an , regu a :Ons -o e u nam tion'thereof a ICartificate' of Conki'h:- ction'Compliance satisfactory to the Commissionerbf Healthwill &rantee';will be::.turnished_the owner, is successors,,heirsoi ass_igns,by the builder, that said buil8er,will 1 sewage clisppsal system during the period of two (2) yearsammed.1 tely foliowinq'thedate o. the issu- ct�on..Compliance,of the'or,g�nal system or' any repairs thereto; 2) that the drilled: well described "above t'said well will'be,anstalin .accordance itht" a ards, -rules and regu a ions =of - they., Putnam Signed i P.E. R.A. - Fair ' t et Carmel ''N, 10512 29206 ►'.. License No expires ono year rom the' "date issued unless construction, of the building his been undertaken and is y' a Commissioner of'Health. Any change or alteration of construction vhen considered necet",r by th lomestic'sanitary sewage, and /gr private watersupply 'only. _ By '- Title a DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - ..APPLI'CATION' TO CONSTRUCT 'A WATER..'WELL ......:.:....._ _ __ :,:_..,.. PCHD PERMIT # WELL LOCATION Street Address Ice Pond Road Town/Village/City Tax Grid Number T. Patterson 79 -3 -8.14 WELL OWNER Name Address John C. Weizenecker Cross Road, Patterson, NY 12563 QPrivate O Public USE OF WELL 1 - primary 2- secondary ®RESIDENTIAL ❑ BUSINESS 0 INDUSTRIAL ❑PUBLIC SUPPLY QAIR /COND /HEAT PUMP O FARM 0 TEST/ OBSERVATION O INSTITUTIONAL O STAND -BY ❑ABANDONED ❑ OTHER (specify, O AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED_]_X _ /EST. OF DAILY USAGE 4nn gal REASON FOR DRILLING 131NEW SUPPLY []PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING Residential suj�p3y WELL TYPE DRILLED DRIVEN ODUG GRAVEL 0 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' PROPERTY FROM NEAREST WATER-MAIN: ' .. ° _ _ ._ ...... _ . _ _.. _.. _....... ___..___... Over one mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See Dwg. #1, Job # S.0.2396 by John H. ®ON REAR OF THIS APPLICATION []ON SEPARATE SHEET Prentiss, P.E.; 17 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 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: Z ,Z - -19— Date of Expiratiory.`�"/*/ /_19 ermit Issue ffy- Permit is Non - Transferrable Q IQr% A,NAM COUN'T'Y DEPARMYOU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL VOTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE REV • ��- ( Name of Owner) ( Street Location) ° ; --� DOCUMENTS Permit Application { Corporate Resolution - Plans - Three sets s /s. Engineers Authorization - Design Data Sheet (DDS) - SUBDIVISION Deep Hole Log Perc - Consistent Perc Results (3) Fill - Perc Hole Depth cd 101--1100, Ho a Plans - Two sets - permit; PWS letter - ance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume x;Trench/Gallery; Pump .pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results.. Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Glitter,Ciartain Drains' (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown; gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrocros Wells &-SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil: 20' to Foundation Walls 100' to Well; 2001 in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan' 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 10 IMMERSIONS MOM 081001 W LF trench provided required ZZ-60 .Parjej lel INS ' NOW . 1011� �o _. 01110111i 10� �__ .I NE11110 an1 DOCUMENTS Permit Application { Corporate Resolution - Plans - Three sets s /s. Engineers Authorization - Design Data Sheet (DDS) - SUBDIVISION Deep Hole Log Perc - Consistent Perc Results (3) Fill - Perc Hole Depth cd 101--1100, Ho a Plans - Two sets - permit; PWS letter - ance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume x;Trench/Gallery; Pump .pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results.. Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Glitter,Ciartain Drains' (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown; gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrocros Wells &-SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil: 20' to Foundation Walls 100' to Well; 2001 in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan' 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 10 Pt1INAM oouNZy DEPARIlKE]'P oV HFAT,TH DIVISION OF HEALTH SUMCES •'DATA - SHEET- SIJWMCE• owner . o6&% C. UoAe izen a cker Address ace Po "I 2d . Located at ( Street) 64 j lef 0 61e $Zo,* 4 Sec TM 79 Block _ Lot ( indicate nearest cross street) 13re" I , L 4 Municipality Watershed Cr -b,6, Date of Pre - Soaking Ib Ma 19,811 Date of Percolation Test IL MdriG.Y► 19$7 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches -- - Inches Inches I 1 3o 3 -2 1152- 1131 39 3 3 9 F4 3 3 4 13457 K, 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 sutmi.tt�d for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA RDQUIRED TO 'BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. .DEPTH..... .: HOLE. IQ ---HOLE :NOo _ G.L. 1' 2' 3' 4' 5' 6' 7' 8' Z 10' 11' e 12' .. S rew0i .Ky Lo ii v4 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER .IS ENCOUNTERED Nom INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: T DATE:- DESIGN Soil Rate Used 16-7-0 Min /1" Drop: S.D. Usable Area Provided 00 ¢ No. of Bedrocros Septic Tank Capacity Q 00a__ gals. Type Hgje ,v Absorption Area Provided By ___+t 0 )_ L.F. x 24" width trench Other Name a Address JOHN w. PREnT1SS, P.E.70 CARREL, NEU YORK 10312 THIS SPACE FOR USE BY Soil Rate Approved DEPARTMENT ONLY: �i- sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH �3-r� 1� DIVISION OF ENVIRONMENTAL HEALTH SERVICES r s > COUNTY OFFICE BUILDING, CARMEL; N. Y. 10512 r-' -• " Jo n GJe i�ew�FCI�Q� 0,q DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner a , 41 T' -, Address .. P Q nod /eq� Loddted at-(Street) Z SecMT 9 Block ,a Lot gm " •� (indicate nearest cross street) Municipality A_4e4_50h Watershed C-0z4>, SOIL PERCOLATION TEST DATA REO,UIRED TO BE SUBMITTED WITH APPLICATIONS o' Number CLOCK TIME PERCOLATION PERCOLATION.... Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2V-7 14-17 30 1 3,+ 3 31W ( X447 3o 4144.7 (J17 3D ),7 ti/ (6 ^,�„ Z ti7 .3 3 &14 �� 30 ryf N Notes: 1) Tests to be repeated at same depth until approximatelyy 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 *OILS ..ZNC90TERED IN TEST HOLES DEPTH HOLE NO. ��_ HOLE. NO. HOLE N0. �e G.L. 611 1211 -811 2411 3011 3611 4211 4811 5411 6011 .. 7211 78". - 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE- LEVEL-TG -WMCH WATER- LEVEL RISES- AFTER BEING ENCOUNTEREDR1onP TESTS MADE BY DESIGN Soil Rate Used 16-W Min/111Drop: S.D. Usable Area Provided �y 001 r No. of Bedrooms 7 g: Septic Tank Capacity 60b Gals. Typed Absorption Area Proviov dew By L.F.x2411 width rent Other -0- .A W 3 ..,Cti_. I'._ \x Address 1011N N. PPESTISS. P.E. CARHEL�NE►: Y!)uK 10512 �� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: °�' Soil Rate Approved Sq. Ft /Gal. Checked by IP �o. 89a�6 rNE SS�� r 4T r4 , 7TY17N E�' N �. V % NCV tp, off 1p Ila .01 ol • � ;; .� � � � � � I 1. �J ,1 � W 54 "K .�raN..?�`"..i� rte'. :" e: n f Jt,.'d�'3r`tFYle'•�_ -:i '°A'.4:7',d"a .. a 1 r n CD � M � , �' P IQ lo kll ' r 00 �A r� �1 IN � �J Cb IL 1p� \ %10 Q oa