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Rev. 3/86
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Located at
M
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Serviced, Carmel; N.Y. 10512 Q�
- Engineer Must Provide — D
PXX..D. Permit #m —_
FOR
PYARMS ii
Owner /applicant Name rormeny
Melling Address D •G Zip
Separate Sewerage System built
ISPOSAL SYSTEM
ILeT ,. Map
ap CN/
\ _ o�TL' 1
r Subdivision Name_
Date Permit Issued
'Consisting of /,2151) — Gallon Septic Tank and
Town or V e ` /
_B1ockLot (0
Subdv. Lot N�
Water Supply: Public Supply From Address
or: ✓ Private Supply Drilled b? 1L L Plot LU X'IL I A) C Address Pt IA!R 7%1 AV'
Building Type 40651 EA)?_lA-L _Has Erosion Control Been Completed? y.. es
Number of Bedrooms Has Garbage Grinder Been Installed? /v 0
Other Requirements
I certify that the system(s) as listed serving the above premises were
of which are attached), and in accordance with the standards, rules and
Putnam County DepartmentX /Of Health.
Date /�_i(o_ . Certifled by.
Address
essentially as shown on the plans of the completed work ( copies
, in accordance with the filed plgp, and the permit issued by the
i
P.E. / R.A.
License No. 51v
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 awer becomes
available and the approval of the private water supply shall become nu 11 and void when a public water supply becomes available. Such approvals are
subject to modlfl tlon or changes when. In the judgment of the Commisilonor�of:Heal such revocation modification or change Is nocesury.
Date /� �i 7s i5 j �L Title �i/•S
_1
��� . -✓�a
p„ ►�
Y
, WALL lVl"Lr 1rP�11VLV Lw 1. .,�.�
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH-
Office Use Only
+�
WELL LOCATION
DRESS: N /vl 1 Y TAX GRID NUM8gR:
Steinbeck Estates,. Farnn- to= Market Rd., Brewster
WELL OWNER
NAME: ADDRESS:
Monroe Developrient Corp., PO Box 970, Carmel.,. NY
O PUBLIC
USE OF WELL
t - primary
2 - secondary
9k RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST / OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
19 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 465 ft.
STATIC WATER LEVEL 30 ft.
DATE MEASURED 4/11/88
DRILLING
EQUIPMENT
❑ ROTARY 99 COMPRESSED AIR PERCUSSION ❑ DUG
O WELL POINT ❑CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING. >0 OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 46 ft
MATERIALS: fR STEEL ❑ PLASTIC O OTHER
LENGTH.BELOW GRADE 45 ft.
JOINTS: ❑ WELDED a THREADED ❑ OTHER
DIAMETER 6 in.
SEAL AB CEMENT GROUT ❑ BENTONITE OOTHER
WEIGHT
PER FOOT 12. Ib. /ft.
I DRIVE SHOE: IMES ❑ NO
I LINER: OYES ❑ NO
SCREEN
DETAILS
DIAMETER (in)
"SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
°..
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED t tests were done is in-
t
KOCOMPRESSED AIR , formation attached?
O BAILED O OTHER ; O YES O NO
'WELL LOG It more detailed formation .descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear.
ing
well
Oia-
In
FORMATION DESCRIPTION
CODE,
fL
" fL
WELL DEPTH
IL
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm-
Surface
—m
6
Silt, sand. clgy & bm1ders
30..x35
no.
6
Soft brown . weathered bedrock
400
1
30
400..
3 -3/4
to hard r n
& Black rat
465
6
-
460
7
285
348
6
Grey & black granite
348
405
Vbite & black. granite
I
405
.465
Medium to hard grey & pink granite.
WATER O' CLEAR TEMP.
QUALITY AS CLOUDY HARDNESS
O COLORED ANALYZED? M YES ONO
ANALYSIS ATTACHED?x® YES O NO
E±:j
I
STORAGE TANK: TYPE DjAPHRAM
CAPACITY 82 GAL. 26
PUMP MFORMATiON
TYPE Sub - CAPACITY 7
MAKER rani,1 d c DEPTH _2FiL—
MODEL 7 M 0 7 VOLTAGE 2.3.4. HP 3_L_4
pq
WELL DRILLER NAME KUI D TTT r C. 4T%F.25/88
ADDRESS Putnam Avenue s 0
Brewster, NY
PUTNAM COUN'T'Y DEPAR'Il= OF BEALZli
DIVISION OF ENVIRONMENI!AL' -HEALTH : SERVICES
e �rs 7 a 6 . i ✓ VNM'o � '�P
Owner or Purchaser of Building - Section Block Lot
A)Q C Ci6-14 TS 0&E'70r CO. 1--f 72,
Building Constructed by
W-121 IJ 91ti, 2oA7 PA71-2111 - Z�
Location - Street 1r k1- &T
Municipality
Building Type
.S7-C/A)�E5eCIL � L
Subdivision Name
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
-- "Certi -ficate• 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 deternii .nation 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. / n
Dat�this
r
Corporation Name (
day of 1_ 19� • Signature
Owner
-, (0512—
Address
rev. 9/85
mk
Title
Corporation Name Uq Corp.)
Address
ELLIS A. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CHEMICAL WATER - WASTEWATER
PHYSICA L 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 MET HODOLOGY
BIOLOGICAL P.O. BOX 2328 203 - 748 -7903 APHA - EPA - ASTM
REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER
NAME AND
ADDRESS OF
PERSON TO
RECEIVE
REPORT
F Mill Drilling,Inc.
L
DATA
Putnam Ave
Brewster, N.Y. 10509
SOURCE OF SAMPLE
Water Supply Steinbeck Ests.
Lot #1
Patterson, N.Y.
DATE OF COLLECTION July 1, 1988
COLLECTED BY Mill Driling
Hydrogen Ion
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
Concentration
LANGELIER
(pH)
I
RYZNAR
NTU
_]
Mg /L
Alkalinity as CaCO3
Fluoride (F)
Bicarbonate
Nitrite
Mg /L
Mg /L
Mg /L
NITROGEN
Alkalinity as CaCO3
Chlorine Residual
CONSTITUENTS
Nitrate
Mg /L
Carbonate
Mg /L
Mg /L
AS
Total Hardness
as CaCO3
Conductivity
NITROGEN (N)
Ammonia
Mg /l.
Mg /L
Micromohos/cm
F-
Mg /L
I Iron as Fe
Mg /L
Mg /L
Chlorides as CL
Mg /L
Manganese as Mn
Mg /L
Mg /L
Detergent ai MBAS
Mg /L
Sulfate as SO4
Mg /L
Mg /L
The arithmetic mean of all standard samples examined per. month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST
one colony per" 100mt. Collform "colonies per'atartdard `safnOW- "hall not 'exceed 3/50ml, 4 /100ml. 7/200in1, or 13/500m1' Colilorm.Colonies /100ML.
in: (a) Two consecutive samples: (b) More than one standard sample when less than 20 are examined per month: or (c) 0
More than five per cent of the samples when 20 or more ere examined per month.
AT THE TIME THE SAMPLE WAS SUBMITTED:
FX 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water.
2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows:
El3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is
undersirable and, while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The
presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected.
4. This sample was unsatisfactory as a potable water because certain chemical or physical cor "rrents were above acceptable limits. These are as follows:
COMMENTS
The bacterial analysis showed no organisms of the coliform group
at the time the sample was collected which indicates the water potable.
Certified.......................................................... ............................... ..........
II.
FINAL SITE • • Date '
Ins ct
1' �• S� �/
. - - -
t.cmmn 1 S
•SE6vAGE D1SfSAL ARFA .: •. ;- ._..__.._.� <......_� - =: ��,._r::,.:
a. SDS area located as per approved plans_
b. Fill section - Date of placement
2:1 barrier. LGTH WIDTH AVG.DPTH
c. Natural soil not stripped
d. Stone, brush, etc., greater than 15' from SDS area.
e. 100 ft. from water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Se tic tank size - 1,000 1,259
b. Septic tank installed level
c. 10' minimum fran foundation
d. No 900 bends, cleanout within 10 ft. of 450 bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
V/
-2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX -` 0 1 set
g. S
1. Length required - Dength installed
2. Distance to watercourse measured. ft.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet from prcperty line - 20 feet - foundations
7. Depth of trench < 30 inches from surface
8. Roan allowed for expansion, 50$
9. Size of gravel 3/4 - 1 " diameter
10. Depth of gravel in trench 12" minimum
11: Pipe ends capped
h. PUMP OR DOSE SYSTEMS
1. Size-of pump chamber
2
3. Alann, visual /audio
4- Pump easily accessible manhole to grade, ,
5-First box baffled
6 Cycle witnessed by Health Department
estimated flow per cycle
HOUSE -.
a• House located per .approved plans.
b• Number of bedrocns
'ALL
a. We11-- located as per approved plans
b• Distance from SDS area measured ft.
C. Casn 18" above grade.
d•. Surface ins a around well acceptable.
dra
---- L `HKNSHIP
a• �OXes. Ur0DC�r Opted
b; All i "s part
All P�ially backfilled
1 s.,flush with inside of box
• `° Backfill
- material contains stones < 4" in diameter
iri: drain installed according to plan
' rta n drain o --Uall protected & dir.to exist.watercours
_Ebotin wins discharge away from SDS area
urface water Protection adequate
=:� osion,contro rovided on slo s rester than 15$.
LT
1C
above described will'be; constructed as,shown on the,approved
County Department "'of Health`, and,thafon completion ther
be submitted to the 'Department and a written- guarantee
place in good operating condition any ,part'of',said 'sewage
ante of the approval .of. the 'Certificate -:of .Construction Co
will_be located as shown on the approved plan and.that said,Wil
County Department of Health. '
Date
Tx
Atltlress
APPROVED FOR CONSTRUCTION This approval expires
revocable for..tause may a amendetl or modified when'co`n
requires a new pe nit, p roved for disposal of domestic
Date r ® By
9des�gn, andlocat�on :of'the'pr.oposed.system(s), 1). that. the separate sewage disposal system
amendment thereto and;in accordance with'the standards, rules an „regu a. wns o e . u nam
eof a ^.CerLficate of Construction.,Complianca' satisfactory to the* Commissioner',of Healthwill
will -be furnished the oviner; his successor$,, hairs,: or assigns by'the builder. that said, builder will
disposal system,.`during the period of two (2) years immediately following ,the date of the issu-
mplroiice o he 'origma!system of any repairs th eto; )that.the: drilled well described above
1 will be, Ins ed-' m accorda *e with the stand s, : las_ and regu a ions off,/t /he Putnam
Signed "" f P.E. R.A
License 'N t v
am`yearfromthe date iss d unless construction of the building his'been'undertaken and is
seder nec ry. by the' ommission f Healt Any change. or alteration, of construction
san ;ry age; anG /o to a ly ly,
.Title /W //
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL _ b 0
PCHD PERMIT #��
WELL LOCATION
Street Address To Village City Tax Grid Number
'2 °to - � T �Y t256_Z E!>cD --Z- A
WELL OWNER
Name Mailin , 'Address
%( QUF05 Cz-.#LX01
%PY q ?0
L \Y
rivate
0Public
USE OF WELL
0- primary
2- secondary
SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP
0 BUSINESS O FARM 0 TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
O ABANDONED
❑ OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE SERVED(, /EST. OF DAILY USAGE(Ooo gal
REASON FOR
DRILLING
EW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
❑ TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
ffRILLED
DRIVEN
DDUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING?
YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF. SUBDIVISION:)KIQGjL
Lot No. 1
WATER WELL CONTRACTOR: Name "% gE —Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO.SITE: YES ✓ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ,
O ON REAR OF THIS APPLICATION N SEP RAT HEET , j
(date s gnature)
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.
2.
3.
Date of
Date of
Permit
2/87
Pump the well until the water is clear.
Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
Submit a Well Co pletion Report on a form provided b -the, Putnam Cou y
Health Departme r
Issue: W_id- 19 O
rmit ssuing Of ficia
Expiration. It 19
i White copy: H. D. File
s Non - Transferrable
Yellow copy: Building Inspector
Pink Copy: Owner
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date AU CA S-T
Re : Property of Hop, ,QE7E b IGk-CS Qa)E s- .{E 3,i-r LQ, , L7CO
Located at
Section Block z. Lot
Subdivision of
a
Subdva Lot # 1 Filed.Map # ZZ57 Date
Gentlemen:
This letter is to authorize \Aj. t JIC!-&:)LS
a duly licensed professional engineer or registered architect
@i
(Indicate
to apply for a Construction Permit for a. separate. sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by.the Commissioner of the Putnam County <<�
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
_ _.�sys,e_ or. �sy.t.ems::.:in.- c.onformity� -- with - the- prowisions`of Ar"t cle 145" or
147, Educatibn Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned
PeEo, R*A >, #
-l�, N(CHO<
No.5Gf24
\OFESSION��
�3 ' .L OZC =iELO
Address
Telephone
Very truly.yours,
l�1 on R 06 #616175 j5it 1W PM6 r C-Oi irk
Signed � - AUZ`� C (/
Owner of Property
,,60 x Ad26)
dress
� ,2 iY1 �2 cCJ ys� v
Town
Telephone
PUnM4 OX INV: DEPARMEM OF HEALTH
DIVISION OF ENVIRCREN'= HEALTH SERVICES*
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.'
Owner Address _2b)( q-70
Z,
Ir 4 .216 0, iZ 6-r
Located at (Street) - r-ba raqj-Q0
Sec. Block i
(indicate nearest cross street)
Municipality
Watershed CO�N_4
4
SOIL _PERCO=CN TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre-soaking -7 !l5 18`7
Date of Percolation Test 76('A-7
HOLE
.
NC24BM CLOCK TIME
PERCOMMION
PERCOLATION
Run. Elapses Depth to Water Frcm,
Water Level-
No. Time Ground Surface
In Inches Soil Rate
-Start-Stop Min. Start
stop
Drop In Min/in Drop
Inches
Inches
Inches
Li I-Z'-3-14C)-/ • go Z 4
_C61/'
1 zo
21 0&-1:38 SO
3 Z. oq 3o.. Z4
4
5
2
1I13 0�
Z4
3 1.43 --Z :17 136
- 7_�6 Y5 - - -, - t '15 IZ6
Z;
3
4
5
Tests to be *repeated at same depth until approximately . equal soil rates
are cbtained.at each percolation test hole. - All data to be. submitt?ad
'2 for review.....
.-' Depth reasurweftts to, be made from top of hole.
4
5
2
3
4
5
Tests to be *repeated at same depth until approximately . equal soil rates
are cbtained.at each percolation test hole. - All data to be. submitt?ad
'2 for review.....
.-' Depth reasurweftts to, be made from top of hole.
TEST PIT DATA RDQUIRED TO BE SUBMITTED WITfi
3'
4'
5'
79
$p
90
10'' '
11' .
12'
13'
14'
-- INDICATE LEVEL AT WHICH GROUNDWATER IS ENC70UNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEPM
DEEP BOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil. Rate Used Min/1" Drop: S.D. Usable Area Provided -,'"��
Noe of Bedrooms A Septic Tank Capacity gals. Type
Absorption Area Provided By 4U(� L.F. x 24" width trench
Other Z F 1 LL
Name t.�uo5t, ' 6 SIN mG -'kSSc7c. ;?C. Signat
Address Dzl u C— SEAL z w' i? ;, W
PA-C-fE.XL���I r a.l Y
:" -THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sgoft /gal, Checked by Date
n ..
1r
14'
-- INDICATE LEVEL AT WHICH GROUNDWATER IS ENC70UNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEPM
DEEP BOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil. Rate Used Min/1" Drop: S.D. Usable Area Provided -,'"��
Noe of Bedrooms A Septic Tank Capacity gals. Type
Absorption Area Provided By 4U(� L.F. x 24" width trench
Other Z F 1 LL
Name t.�uo5t, ' 6 SIN mG -'kSSc7c. ;?C. Signat
Address Dzl u C— SEAL z w' i? ;, W
PA-C-fE.XL���I r a.l Y
:" -THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sgoft /gal, Checked by Date
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT - C_ ORPORATE OWNER APPLICATION
_ .._.� .... r Ca ...- r •. . :- ♦t'•+ .. - ... u. v.. v- .,,. -�__ . _'- .-- ._. -•�. «.. n. .... _._n... ... r...e r_ ..- � ..s .._..... N.. . .. v .._rv- _ - _-..•r v.v
FOR PERMIT. APPLICATION SUBMITTED TO -
PUTNAM COUNTY •}[EALTH DEPARTMENT.
If*
Tb: Commissioner of Health - In the matter of application for °
n
represent
that I am an officer or employee of the corporation and arm authoriied
to act for ,X'LD�ll ��vGl.�i�Y1��✓ %�_� L
(name of corporation) -
having offices at
Whose officers -are
President ,LOG��, � anr4-�1 _ ��Cc, ST�' kJ
_(Name d Address) %•'-
Vice- President �}} Cl 1 C (o G[� -7
(Name and Address) - '-
Secretary _� 1 r� _ GLoGG_O- stvt7/ _ Gr�2 CJs
• (Name and Address)
• _ . (Name• and Address) '- - '- �' -' - "
and that I am and will be individually responsible for any*or all;acts ;
ofithp corporation with•res'pect to the approval requested and all _ sub -,.
se4uent act9 relating. * tliereto.'
Sworn to before me this day Signed
of;. 1987 Title
•otary Public
ANNE B. COhRiDAN
P ftosw arw■Y*t
My CommhN� E "z�.�„�
wroh � u 4q
Red r4ja)d
:. Lt488-7,4 3�
4 �FvE�A
`)
o .
�,
Corporate, Seal
W0011 0
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRCNMENML HEALTH SMVlCES
INDIVIDUAL WATER SUPPLY & SUBSURFACE S39M DISPOSAL SYSTEMS
SHEET - CONSZRUCTION PERMIT
._._. _:$DATE
(Name of Owner) (Street Location) �(-
COMMENTS YES NO DOCIDENTS (OT I
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
LF trench provided W
required
60 ft. max.
Parallel to
A
House P1 -Two sets
Well permit; PWS
Variance Request
s/s
SUBDIVISION
Perc
(3) Fill
cd
letter
GENERAL -
Legal Subdivision
Subdivision Approval Checked.
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
'Sewage Sys -- e - Gravity Flow
Fill Profile Dimensions -- Volume
D or J Box;Trench pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes) 1�
.Design Data: - �perc.- and de9P_- 47�D--
,, c
tt 7 Foot 6A 6=rs Existin�"
Driveway & Slopes Cut
Footing/Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; shown; gravity flow,suff. size
If Pmped Pit & D Box Shown & Detailed
House - No. of Bedrooms
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 fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (i.nc. expan)
15' to Drains - Curtain, Leader, Footing
351 to 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
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