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01610
Comp T a int Information
Complaint Received December 27, 20( ' Received,--By.-Vatsh, Christina
Rcvd via Time Received Assigned To Hedges, William
omplamant (Person maKing complaint)
❑ Anonymous
First William Last Korr
Address 7 Indian Hill Rd
City Patterson State NY Zip 12563 Phone 845 - 278 -0823
rvngiiNSOUrce of Complaint
Origin /Source Debra Samad
Address 3 Indian Hill Road
Phone
Location
Operation Type Complaints not associated with a eHIPS Facility
Category A condition, action, activity, place or area that is and
laint is
Complaint - General
Facility Address
Sub -LHU
Risk Level No risk assigned
Nature of Sewage exposure Complaint Needs Investigation Date
Complaint Status Resol ved
Description �_ I ActionTaken
Leaking septic
' G.� ,�H •�ts� 6:.'./ // � �%"'ji �.. v1�d'd�.4 �err:. �dAr � �FU, irf��i .fRy..�"'
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�d 5
Page 1 of 1
Date Printed December 30, 2004
W
®'�anCon Excavation Inc.
3 Mawk R*e Cane
Srewster, New York 1050g
(545) 279 -0039
-Tidy 19, 2005
De66ie 3arnad
3 Indian Md Road
Brewsten New York i wg
Date `Work Zedarmed
7105 Instaffed i25 feet of new septic trenching
Misisting of two (2), f6et wide With folir (4)
inch.perforatedyT- e sucrrounded by :9 inch
washed'graveC
$2,200.00
{ - .Tnstaffed cur -tc$in dr -ai ?. on %over -, part -of
pro
.perty by road two W eet wide. gravel
andptpe approxbnateCy twentyfve feet
IMW
j,600.00
7DZ- .tr DUE ............. ............................... ......................53,300.00
Thank you for your bwiness!
0
AM' c�
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENV, IRONMENTAL HE kT— L H SERVICES
FIELD.ACTIVITY REPORT
N A MR • - Tel.
Street Town ,`.. State Zip
PERSON -IN CHARGE
(1R TNTF.RVTF.WRT): DatPC
., Name and Title
TYPE OF FACILITY:
FINDINGS:
C �-ai
3_.
e-
, - II
E
SHERLITA AMLEP M D, MS, FAAP
'Commissioner of Health
LORETTA MOLINARI, RN, IiMSN
Associate Commissioner of Health
t U
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
To: Carl Lodes, County Attorney
CC: Sherlita Amler, MD, Loretta Molinari, William He ges
From: Michael J. Budzinski, Director of Engineering
Date: March 17, 2005
Re: Premises of 3 Indian Hill Road, Town of Patterson
ROBERT J. BON ®I
County Executive
Attached please find a letter, dated March 10; 2005 from Keith Labis to this Department
regarding the above referenced property. This Department is requesting your review of
the letter and guidance on future proceedings. This office is available to meet, if
necessary, with a representative of your staff.
--- - _._._._.:.Should. - you- have.anyquestions concerning- this - matter-; please contact.hisoffice. -- -- - --
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
Q Z
L. LQgil
>.�.:- =�::. -. ... , .. -.v'/ �P21ZEL�'_�.ra��W:.... .ro-... .%rte;• .r.� _ .. - � - ' - - - - - . .�� ....
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2435'
BZewitim, --New q
fo
J 10509
4,•'•„ r: �{ �,e, ;'; :::? �! 9eL': (545 279 -7432 • '3az: (845 )279 -7461
i.'.:iiLt;:'.` %;tc. '5�1 !i`q;.� t'!.;i�' �i-i" r��E;;;(;;T' ,'.r. 134y`•" �;T ji:ir:�•� i�?:'',Q�t;?:. °=;' - .Cf!!; t ?T'`J�: =: C;.:c
Mr. William. Hedges,
Senior Public Health Sanitarian
Putnam County Board of Health
1 Geneva Road
r Brewster, New York 10509
Be: Premises 3 Indian Hill Road
Town of Patterson
Dear Mr. Hedges:
Pursuant to our telephone conversations, this letter will serve to confirm that I
have been consulted by Debra Samad, the owner of the above - referenced premises,
concerning the septic system installed on the property. ,,Ms.,., Samad;-,.reports having
numerous difficulties with the system. As result of these problems, your office was
called to inspect the property.
Ms. Samad is the third owner of the premises. After contacting both prior
owners, it was .determined that both prior owners had similar problems with the septic
- - sym e - repoha-z t t wy •never- madean-�-changes.to the = system . - --. - .- ...'..:_:,- --.
Ms. Samad had O'Hanlon Excavation excavate the area, in order to determine the
reason for the septic system failure. The excavation revealed that the pipes from the
residence did not lead into the septic junction boxes (that were installed pursuant to the
"as built" plans). The pipes from the residence were diverted under the driveway and
into two (2) 35 -foot leach pits. The excavator clearly stated that the driveway was never
torn up or breached, leading. him to believe that the original builder had installed this
system without the necessary Board of Health approvals and in contravention to the
approved septic plans. p3
I am requesting a meeting with your offices, th e; County Attorney's Office and
with Ms. Samad, in order that we may discuss whether there exists sufficient evidence to
pursue this matter against the original builder. Would you kindly inform me whether
your office would consent to such a meeting.
Ve truly yours,
V
Keith L. Labis
KLL: lbc
cc: Ms. Debra Samad
CARL F. LODES
County Attorney
Keith L. Labis, Esq.
Middlebranch Offices
2435 Route Six
Brewster, New York 10509
Re: 1 remises•
Dear Mr. Labis:
DEPARTMENT OF LAW
3 Indian Hill Road
Town of Patterson
April 4, 2005
JENNIFER A. WISSELL
Confidential Secretary
Paralegal
Your letter of March 10, 2005, addressed to William Hedges, has been referred to this
office for a response.
At the present time, there does not appear to be any basis for meeting with you and your
client to discuss the possibility and advisability of your client commencing civil litigation against
al in-interest.
-.14e.,ofigin buildu,and any—othei-party.
Very truly -yours,
Cap 4, 60
Carl F. Lodes
County Attorney
CFLjw
cc: illiam. Hedges
� lliai
Health Department
48 GLENEIDA AVENUE - CARMEL, NEW YORK 10512
(845) 228 - 0480 Ext. 263
n.
i
AESHOENTTAt BUILDING SECTION SW15/Sm/LD MAP
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ILAN VIEW Scale 1"-;o'
as noted for conformance wit':
,c,:,plicahle Rules and Regulations of the
Yttnam County Hoa3 12
_.th Department.
"71nis is to certify the,,
the sewage disposai syste—n was ccast-ructed as indicated ah this plan ani.
that the system was inspected by me before it was covi-red over. Th6
syst•n was constructed in accordance with all standard rules and'
regulations of the Pu6iam County Department of Health and the New York'.
State Deparbi—ent of Fealth."
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as noted for conformance wit':
,c,:,plicahle Rules and Regulations of the
Yttnam County Hoa3 12
_.th Department.
"71nis is to certify the,,
the sewage disposai syste—n was ccast-ructed as indicated ah this plan ani.
that the system was inspected by me before it was covi-red over. Th6
syst•n was constructed in accordance with all standard rules and'
regulations of the Pu6iam County Department of Health and the New York'.
State Deparbi—ent of Fealth."
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Person Makinjz Complaint
First /Last
Representing:
St. No./Name
City /St. /Zip
Phone # l 7 I ad; �f 0 �o y 0 e
273-.33
Origin of Complaint S P
Origin 2 K/ P �� J'"l.0 —5 �'� c- e-
St. No./Name 2'— n oe� /4,/,/
City /Town �✓o f .c. - _. .. Source, Zip _ -
Phone # / f
f� y
. 7/T °� 7
Nature of Complaint: (Briefly describe)
go
41 It-42 lzxed-�
todgged-By"
Dite Complaint
How Received
Received By:
Received
i.e. Phone, letter
etc.
-sG �.' , ...,. -
Person Makinjz Complaint
First /Last
Representing:
St. No./Name
City /St. /Zip
Phone # l 7 I ad; �f 0 �o y 0 e
273-.33
Origin of Complaint S P
Origin 2 K/ P �� J'"l.0 —5 �'� c- e-
St. No./Name 2'— n oe� /4,/,/
City /Town �✓o f .c. - _. .. Source, Zip _ -
Phone # / f
f� y
. 7/T °� 7
Nature of Complaint: (Briefly describe)
go
41 It-42 lzxed-�
17'
Al
,52
C) e
31,
71
SITE LOCATION
OWNER'S NAME _
MAILING ADDRESS
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OFFICIAL USE ONLY
Zz
PERSON INTERVIEWED
'06
3V
PHONE
11!ilo�dl
PCHD Complaint
a�cuaa�. w a \VaQNV4JLa�I `a.Vy aava� w.a....y ..w.�
DATE TYPE FACILITY /� ✓cL�. �2 &,3
PROPOSED INSTALLER C% < °�% ��'���� PHONE 4:, 07 — S`Y�
0 � T_IM
REGISTRATION#
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location
may require submittal of proposal from licensed professional engineer or registered architect.
V
-P�
I, as owner, or reported agent of owner agree to the conditions stated on this foiln.
SIGNATURE TITLE
s,-- 4411
r
DATE
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name
b. Site Street Name, Town and Tax Map number.
C. Location of installed components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99NE
DATE
2--3
so
/� � / /'ice �C9 � � � °7 �.P�a,� � a�i'a,9%L✓i9G,/z"��
J
Peir.' 3186
CERTIATE OF
"IZ
14,471 'Vol
L.cated at-
Ovinei/appHimist Name
Malling Ad
PUTNAWCOUNTY DEPARTMENT OF HEALTH
Division of Envijonimental Health SeMcii; torniel," N.S. -16512
Enghs'ee, Must Provide
UCTION COMPLIANCE PLIANCE FOR SEWAGE DISPOSAL SYSTEM
Town-or 9
Bloci— Lot
Tai Map 2>
-f--Subdv. Let #
0WV Subdivision Name gkb�A_l
ZIP Date Permit Issued
n
Consisting of Galion Septic Tank and
Water SU001y: ftfiRc Supply From Address
or: Private Supply Drilled by Address
B I Wiling Type j�yil'au E*g!!f e—, Hes Eirosl6uto0iiol Been Complet4? LY
Number of Bedrooms —Hai Garbage Grinder Been Installed?
Other Requirements
I certify that'thesysiem(s).as Bated
serving the above premises were constructed as _t Ij as th�#�� f.the completed work I copies
of which are attac and in a:c ordahce with the standards,rules and regula on if: . r n' i f i1bd pl and,the permit issued by the
tm..� c - . . . . "I , .. .1 . . .
Putnam County De Of Health.
Date 2. Certified ky_ R.A.
'o
55 License
Addn
ure the
Any person occupying premises served by'.th , 9'abo've iystem4ji) shall prornptly'taki such action S" t* correction of'•Oriy unsanitary
conditions . resulting: from such usage. Approval . of the separate sevve. 7' s , t n as a publ:: unitary WWW• becomes
available and,the private water. suoply.shall become null and viold'When 1jr water y becomes available. Such approvals are
a ..approval of the 'e'r of such, revocation, modification or change is nec"Miy.
subject tc , V mod If lent . Ign, or change,when, in..4he'.'Jydgrr4nt of the Commission
Date _ �,�— Y /'/ Title- _—JC:=
lu
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy.Commissioner of Health - FIELD ACTIVITY REPORT -
Sheet of
-r-� i ! _ TAiRDFYvPT(lAi
X11•
vAj
MAILING ADDRESS ! 0 7Y P- -�2 O �7
P.O. BCx Post Office Zip Code
LMT om
PERSON IN CHARGE ✓
OR INTERVIEWED
Name and Title
DATE TYPE FACILITY
TIME ARRIVED
TIME LEFT
Orig. Routine
Orig. Complain
Orig. Request
Campl iance
Complaint comp
Final
Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
Explain
FINDINGS:
Zed` -� -11�7 Z c3c7 5;,'
.�•'��. ��� - - ._ .rig- _ a
INSPECTOR: TELEPHONE:
Signature and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
=iBREWSTER LABORATORIES °:..., .:.:« .. ..., � .. ..., ....
Box 224 - BREWSTER, N.Y.
(914) 855 -1930
- WATER ANALYSIS REPORT -
SAMPLE NO. 8523 TEST WELL
SOURCE: Crompound Contracting
Steinbeck Hill Lot #2
COLLECTED: 8/29/94
BY: P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
8/30/94
Thomas Me Kr
Director
0 per 100 ml.
"I"
Crompond Cont..
office use only
DEPARTMENT OF HEALTH
Division Of Environments,
OF HEALTH
PUTNAM COUNTY DEPARTMENT
SIREET ADORESS: TAX GRID NUMBER:
Lot
wrw
ADDRESS: Box 451
Crompondo MY 10517
'm
�11 r n I: I I
,�,,USE.!OF. WELL
19 RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED
I primary
0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify)
UNT OFME
YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE
REASON'FOR
[]REPLACE EXISTING SUPPLY []TEST/OBSERVATION []ADDITIONAL SUPP LY
DRILLING
g]NEW.SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
_`PEPTH DATA
205, 150
ft. STATIC WATER LEVEL
WELL DEPTH D
DATE MEASURE
-ft.
DRILLING
M COMPRESSED AIR PERCUSSION
99ROTARY 0 DUG
OUIPMENT
0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify):
W.
LL TYPE,
0 SCREENED 0 OPEN END CASING 13 OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH 40 tL
ER
'BELOW
LENGTH GRADE _____Ig ft.
JOINTS: 0 WELDED 50 THREADED 0 OTHER
BETA
DIAMETER
SEAL: RCEMENT GROUT OBENTONITE 0 OTHER"
REEN
DIAMETER (in)
'SLOT SIZE
LENGTH (11)
DEPTH TO SCREEN (11)
DEVELOPEDT
FIRST
13 YES El NO
:0 ILS
ARAVEL PACK
13 YES
GRAVEL
DIAMETER TOP
BOTTOM
0 NO
SIZE.
OF PACK In. DEPTH ft.
DEPTH — IL
'WELL YIELD TEST If detailed Pumping
'WELL LOG
if more detailed formation descriptions or sieve analyses
are available. please attach.
.'METHOO: "13 PUMPED i tests were done is in-
DEPTH FROM
'Water
well
i'VOR.COMPRESSED AIR formation attached?
SURFACE
Bear-
Dia-
FORMATION DESCRIPTION
COW
meter
In
YIELD
Land
3
DrIlling
in overburden clay boulders
3
H14
rack
at 31
140
15
40
205
Dr
11qng
In rock granite
WATER 0 CLEAR TEMPi
QUALITY.': 0' CLOUDY HARDNESS
ANALYZED? OYES ONO
weal REM WUM
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE
ION
44 galTuns
CAPACITY
CAPACITY
Gould
DATE
utnam AVG. 00/
AXER DER
DEL. VOLTAGE HP
ADDRESS Brewster, NY 10 !%VTU
—
e..m.� »w�..- .. -_... _..._.._.. .... ......... ,....._ ..... ... _ . ..... �...._.. ._...� . ...__._.- ..._,.,. »....,,... -. acv ,r�+mcnaMmnT +sx�T��6n.*, ±^nt^', .
Crompond Cont.
�PMCp��
WELL COMPLETION REPORT
�l
office Use Only
DEPARTMENT OF HEALTH
Division Of Environmental Hearth��Services=
PUTNAM COUNTY DEPARTMENT OF HEALTH
%ry ; t is S1AEEi AOORESS. NI 1 TAI GRID NUrMBEiL'
WELL LOCATION
Lot 02, Bteinbeck Hill, Brewster, NY
t.yt,., `11I
PRIADRE: Box 451 NAME: VATE. ELL OWNER Crompond Contractin g Corp. Crom and . NY 10517 Q
PUBLIC`''
USE..OF WELL ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP O ABANDONED
<;.. ❑TEST /OBSERVATION ❑FARM v- ;primary O BUSINESS O OTHER (specify)
:secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
s{,
• <;y MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
thii A• ... t
REASON TOR []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY,.
- ARILLING . ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL. `
' QEPTN DATA WELL DEPTH 20g / it. STATIC WATER LEVEL 151 it. DATE MEASURED 5/2/94
xek' DRILLING IN ROTARY 9) COMPRESSED AIR PERCUSSION ❑ DUG
'
:'EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION ❑OTHER (specify):
is S .
' y WELL.TYPE O SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH MATERIALS: II STEEL O PLASTIC 0 OTHER
f CASING LENGTH BELOW GRADE 39 ft. JOINTS: O WELDED (M THREADED O OTHER
DETAILS DIAMETER 6 in. SEAL: W CEMENT GROUT O BENTONITE 0OTHER
WEIGHT PER FOOT 19 Ib. /ft. I DRIVE SHOE ® YES ❑ NO LINER: 0YES 9) N0
DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (Il) DEYELOPEOf
SCREEN FIRST
DETAILS _ o YES ONO
r. .:.` SECOND HOURS
GRAVEL PACK 0 YES GRAVEL DIAMETER TOP BOTTOM
O NO SIZE: OF PACK in. DEPTH tL DEPTH fl.
It more detailed formation descriptions or sieve analyses
gWELL YIELD TEST If detailed pumping 1�FLL LOG are available, please attach. p Y
,gwx. =METHOO: O PUMPED 1 tests were done is in- ;
tw DEPTH FROM waler well
COMPRESSED AIR formation attached? SURFACE Dia- - *y CM
®:;, Bar• FORMATION DESCRIPTION
a;0 BAILED O OTHER I ❑YES 0 NO It ti ing meter
In
" ?l 'WELL DEPTH DURATION DliAwoowN YIELD $Uf1iCe 3 Dri 111 g in overburden clay b . boul rtA
It. 9R
hr. ' min, m.
3 Hiq rolck at 31
.205 6 140 15
3 40 Dr ll g in rock, set casing, grow d'
40 205 Dr ll g in rock granite
?`,* ;`•WATER;'; :O CLEAR: TEMP,
UAUT ,., 0 CLOUDY HARDNESS
O,COLORED ANALYZED? OYES ONO
Well r0
4±k '; .ANALYSIS ATTACHED? O YES O NO STORAGE TANK : TYPE
44 g a
U ,1 R
IPUMP;INFORMATION CAPACITY GAT,. »_
tYPE' subm ®rBible CAPACITY 7 WELLDAIU N E
&IAIII
6 /94 foul . 160' Putnam Ave. r
MAKER' d DEQTIib__._ _ ADDREss Brewster, NY 10519►t9TUW1
ZL33
r' ;MODEL'. VOLTAGE HP
F
Owner bir 'Purchaser of Building'
A -&. L
Subdl,Adion Name
/9
Subdivision Lot
GUARANTEE OF SUBSURFACE SFAAGE DISPOSAL SYSM4
UX represent that Ut W 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, rales 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 ( which fails to
operate for a period of two years immediately following the date of approval-of the
"Certificate of (fonstruction-Compliance for the'sewage- disposal system, or any
repairs made by �6 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 ;es
caused by the willful or negligent ct of the occupant of the bi:®r
li
the system. i J •' A. F-,
Dated this (/) , day of \,x'1.9 ( t Signat
rev. 9/85
mk
Title (.a n d 1 LV
Corporation (if Corp.)
, 0 , (3 "J
Ad&ess
c'v1CrS
0
,qia �":sq _ !Ql'IIAM CODlQ'Y DBFA OF HBALTH .. � . , .
Dlel u d B:t> IigW Healab Soeilom�. Qn�d. N.Y ltll? w � TE OF OO
b . C6MjpW*N rater FOR sw!98 OW.". . STUZN Feat
Leaded fat A ff "M or vub" ,
NMMp rr .Let Z "'
Renewal— 0 Re hkn v � d
Owtsar /ApNent Naaae (� 0/�!/�dLlh(�J C- Gil //c�11i�1
Date of Prevlou ApprovvJ
Me" A"fies Town ZIP
natg Subdivisiioon ARproved Fee'EnclosedEF Amntinr .7017•
e.i`It 'lyP•
Numbw d III, g.�� ? -� — Dialpi Flow G F. D
Sepals% Seweny S"isis to'wales d46W Ulm Sq* Toot and _(L
To be ansk. obll by ( /d�1►./%d�jne/ ��dl /� Ad�eq
wear Sop*; Poft Super Fnon
an y°rt.ete SWb D by l� 4411.,...
Fm Secdws o *'. DqO Valaoe
FCHD Nodladlon Is EegWmd When FM Is cow~
/i tv ✓'
1 represent that I am responsible y-and completely re for the design and location of the pro led
above dsecribed will be Constructed as shown on the approved amendment there to and in accordance l
County Department Of ,Nwlth,'and that on completk►n tnaaof t "Certificate of Construction Co
be submitted to the O"Bilment, and a written olurantee will be furnish".the owner, his w
place' in good ope ► sting ;condition any part 'of said sawalle disposal system duriiq the pe►k►d
ante of the approval of the Certificate of Construction Complianc* . of the original system or a
wits be located as ihoww on the approved plan W that Mid well wili4i�lnstal i eeo will
county Overtimm.cf. health. <
Date % Sig, .
Addresst�
APPROVED FOR CONSTRUCTION: This approval expires two years from the data• issued unloss
revocable for cause or, may W amended Or modified,when considered necessary by the Commissio
mquNes /• /�Je._-�. It. �Apotow" for disposal of domestic wnHary s"We and /o wat
•`•tee L�-��G mac-: F '_� BY—
y
or
,oi Z) that the
:rules and to
ssionar of Meatshwill
that said builder will
the dote of the lavu-
Well deso►iMd 1060,
a of - the Putnam
con=tructtln.'of4he buikllnp:has Wen undertaken and is
nor Oi"+jortif Any change or alteration of construction
or wppl .. ly ..
Title
�I
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New -York 10509
(914) 278 -6130
_.. `APPLICATION TO- `CONSTRUCT p►` WATER `61EhL _r_..
PCHD PERMIT #-3
ALL LOCATION
Street Address Town Vi
a e City
Tax Grid Number
WELL OWNER
N e Mailing Addres
c
CIWIvate
Public
USE OF WELL
1 - primary
2 - secondary
SIDENTIAL 0 PUBLIC SUPPLY
0 BUSINESS 0 FARM
0 INDUSTRIAL E3INSTITUTIONAL
Q AIR /COND /HEAT PUMP ® ABANDONED
0 TEST /OBSERVATION 0 OTHER (specify
0 STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm/# PEOPLE SERVED /EST.
® LACE EXISTING SUPPLY 0 TEST/ OBSERVATION
ErfjEEWW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL
OF DAILY USAGE gLI
12-ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
Date of Expir tion 19,�
Permit Issuing 0 icial
Permit is Non - Transferrable
White
WELL TYPE
RILLED
®DRIVEN
®DUG ®GRAVEL OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name eP®I / Address: 4�4_1_7 �
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
[]ON SEPARATE SHEET
(d to (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.
During all well drilling operations, the
applicant
shall take appropriate action to
assure that
any and all water or waste products from
such well
drilling operations be contained
on this
property and in such a ma er as not to
degrade or
otherwise contami .te surface or
groundwater.
Date of Issue: 19
Date of Expir tion 19,�
Permit Issuing 0 icial
Permit is Non - Transferrable
White
copy: HD File Pin copy: Owner
3/89
Yellow copy: Bldg. Insp. Orange copy:
Well Driller
Rnmm COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF EWIRONMENML HEALTH SERVICES
DESIGN DATA SHEET. SUB/SJUFACE SEWAGE_. DISPOSAL ,SYSTEM FILE. N0. ..,
Owner Address
Located at (Street) Sec. Block Lot
( indicate nearest cross street) � L
Municipality %� Watershed
SOIL PERCOLATION TEST DATA RBQ IPM TO BE SUBMiTIED WITH APPLICATIONS
Date of Pre - Soaking Date of Percolation Test
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
1
2
3
4 z /l . i.
5
1
2
3
4
5
1
2
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 submitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA RBQUMED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO.
G.L.
21
31
41
51
lot
61
71
81
91
10,
121
13'
141..
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used Min/1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity �%/ —gals. Type
Absorption Area Provided By- -2,Ij-- L.F. x 0 'width trench
Other 2, / / fAr'll / * -,) %G, C ef —lZe ;, We
Name Signt
S: uf,
Address Troy La. Be ford, N. Y-
THIS SPACE FOR USE BY HEALTH DEPARTMEN'T' ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
�.., - r �.y r• �n- n-.�.- -5--�- r' --.7 �—,�¢r?t s-' y ^x777
pUTNAM CODNTY-DEPARTMENT OF HEALTH
\� J Div sidb al Ettvhdnme iw He" Serv". Cannel. MY 10512 , by Provide Pmmlt N
CATE OF COMPLIANCE
CON ON.PzRW FOR SEWAGE DISPOSAL SYSTEM
Located at lJ own
MSabdlvlsloo pa Eli P1 �3 C— " f L{_- ¢ubd Lot N _ 2+' . Ta= mv 00':'
Lot 26 i 1
-I�bl� eon: ttrrtt�, H-1 s
Owner/ N eo b :V lQ P M hGn� 7 Gh l..Zb 8enewN_ O RevWoo._
Date d Previous Ap bill q 3O
Town GJ4AM 6,.. � X � o r � .Z
Address ,
Llaudm� Type; q6.5i n 6:17i q Loe Area Ir 244- A a Fur sectlen Doty
B O �P`�z .
o PCHD Not&". L Beq,uh* When I Namber•at Bedeoowa i61V Flow�G, P b
7
li olimpl
MUM Seporate Ses►txnQe System
a[� GiUon ,Soptb Tmh aua IBS D i2:1° T /O nl T/2k'- h%4�1'1% t
To be oosistiaoted by JUOAi t2ax �i O i 1g'D)o R % D Gardc {K t o n L Address
Wrier Stsppk. P supply Fwm Adams
ers Private Suyply Dndh d by MI'U (teaUJ( }%i77N�,+, Iti.l 6 "Aj 57tr�n
Other Regtdremeut. .I L.Z (Z l�!t� U hn44
1 represent that Cam wholly and'completetyri"Iisible tor' the design and location of the proposed systom(s); l) that the separate sews a dis sal s stem
above described with be constructeo,as shown on the approved amengment thereto antl in,accordance with the standards, rules an regu a ions o • u nam
County Department. of Health, and that on completion, thereof,a •Cert�fiuta `of Construction Compliance • satisfactory to the Commialone►;I ,Hglthwill
be submitted ;to tha- 0 fitment
�V.! , _and a -written ;guarantee will bq furnished the owner, hil.sucassors, "heirs or;assipni- by'the,buildai, that said builder will
place in good ope►atin9 :eoedition ."any part ,o/ said Sowe9e diaposel system d_ using ths.pa►fod of_ two (2) yaars immedlitely'followinp thedati`ot the {ssu
ance of tM <approval,of, toe Certifieata ,o!,.Constructton..Compliance of the• riyinal system.orany repairs tn' a ;2j tMt tha drilled welldetcriOW a0ow
,will be locttad'as thorvn' in the app►oved.Plan and that aid well will be ",install ' ' n accordance; ith the afaridard ub red ' u anions;, .of the Putnam
• �.�,�h
County Dopartment of MMItA.
Sionea - P.E. .,Ri.A.
Address D Ij
r: _ Icensa No
APPROVED FOR CONSTRUCTION, This:approval,expnes, two yaars'from the :date ,issued unless constructs -'of the buildieiq has been undertaken and Is
revopDle for cause or .may be amended or modified'when'eonsidered . neeessar ',by e''. mmissi f th. Any change or alteration of construction
re0uirei a new / permit. Approv to_r:disposal oR. -0omestic sanitary; /or ", Io -
Date BY / Tills
m
F/7
r
LAURENT ENGINEERING
ASSOCIATES, PC.
73' FAIRFIELD**"DRIVE
PATTERSON, NEW YORK 12563
914.278-6108
RANDOLPH W. LAURENT, P.E.
HARRY W. NICHOLS JR.. PE. CONSULTING SITE ENGINEERS CJ
January 1.1, 1989
Putnam County Department of Health
110 Old Route 6 Center
Carmel, New York 10512
Att: John Karell., Jr., P. E.
RE: Steinbeck Hill
Lot * 2
Farm To Market Road
Patterson, N.Y.
Dear John;
Enclosed are the following:
1. Four (4) prints of Drawing SS-2, "Proposed SSDS-
Lot 2", revised 1-11-69;
2. Four (4) prints of Drawing SS-2F, "Preliminary
Design for fill placement acement only-Lot 211, revised
1-11-69;
3. "Construction Permit for Sewage Disposal System",
revised 1-11-69;
4. "Design Data Sheet", revised
We would appreciate your continued review, approval and issuance
of the Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harr Jr., P. E.
HWN/mt
Encl.
cc: Mr. David Cioccolanti w11 copy each
/• •O DEPARIMERr
•
• HEALTEV
DIVIS1,4 OF EWI1nZE= FMALTH
.
°DESIGN DATA. SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE I: M
Owner DE�,�JE�j . --�p H5 ess?a -70 aetwt6-
�-�Cb- L:fo. Addr q
Lo•ated at (Street)'4. VbC,C�&, ,z) ►,-j F-0. *Sec.' � Block
(indicate nearest cross street)
Municipality -T'oUJQ OF- Watershed
SOIL PERCO=CN = DATA PIXYJIPM TO BE SUBMITTED WITH APPLICATIONS
Date of Pre-Soaking -71 I h , 6-1 Date of Percolation Test /S-7
HOLE
NL14BM C= ME
PERCOLATION
PERCOLATION
Ran Elapse-
Depth to Water Fran
Water Level
i
No. Time
Ground Surface
In Indies
Soil RAe
Start-Stop Min.
Start stop
Drop In
:Ibrop.
Inches Inches
Inches
Z7
7
2 10 i I Z8 13-10
-z4 --t(o
3.1 j,4q -1_ -50
7/�
7/6
4
5
2 4"Zfo - 4'4� Iq V Z-7
C3 4!4 (a -6: c)& -Z& Z-7
4
5
2
3
4
5
Tests t6 bei 'repeated' at same depth until approximately ec
xual soil rates
are cbtiined at each percolation test hole. All data to' be. submitt?ad
for review,,,
Depth measu:rendnts:to be made fran top of hole.
(L o 7 Z TESTTPPI " -,ATA - RDQuIpm xo BE SUBMITTED T S APPLICATION
nFS:- rnTTom nF soTr S Fma7NT* pm 7N - HnT FS f
l0,
114. .......
124
134
14°
... INDICATE LEVEL AT WHICH GROUNMTER IS ENOOUN'1' M
INDICATE LEVEL TO WHICH WATER LEVEL. RISES AF M -BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used (o -ZD Min/116 Drop: S.D. Usable Area Provided ! p o0
No. of Bedreans. A Septic Tank Capacity 1Z&9 gals. Type CO N C-
`Absorption Area Provided By E�`f(D L.F. x.24° width trench
Other 3' 9 L L ,{1. t it 8`t nF NEB
Name L,11,UK K-kIr
Signature
Address '`7:S
� hMC7(6�-
SEAL
1 z6GS
THIS SPACE MR USE BY:FMALTH DEPART ONLY
Soil Rite Approved sgoft/galo
4L
C' 1
�'�► No. 56924
Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512-014) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL +
PCHD PERMIT
WELL LOCATION
Street Address
" 6 1A
Town illage City Tax
�R>o -
Grid Number
z -- Z&
WELL OWNER
Name
(1 -JW
Mailing Address F O. zoy q-to
, Go. (_ . C c
®'Private
O Public
E OF WELL
Uprimary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION.
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YI LD SOUGHT
gpm /# PEOPLE SERVED A:: /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
MNEW SUPPLY []PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
❑ TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
— Q�
WELL TYPE
DRILLED
DRIVEN
ODUG
EI
GRAVEL
❑
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES v/' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION) NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name .(� 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: 1`IA
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID D
ON REAR OF THIS APPLICATION ON S A SHE
S %b-7 LAAA
(date) ig ture
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 rovided b the Putnam County
Health Departme t.
Issue: 19
Expiration: 19 a m i t ssuing 6 ffi is
is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orancre copv: Well Driller
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT. CORPORATE
- OWNER A.PPL.ICATI.ON._
FOR PERMIT. APPLICATION SUBMITTED TO -
., PUTNAM COUNTY HEALTH DEPARTMENT. ! ;
Tb: Commissioner of Health - In the matter of application for `
_: L� Di1.1eD E if r 6-�Zs E v Go,�rY16VT_ . 0_R_P -.,v,V�, -
I9 J1 Li e — --- ... - -. —.o represent
that I am an officer or employee of the corporation and arh authorized:
to act for�tvR4C_�.1 '��{`� ���Gd•i1'�it/ %�`� L_�.� _ _ _ i
(name of corporation) -�
having offices atQ(,(r� �_ �1���_?�p �l>�
Whose- officers -are
President p5 fi C �,OGC� �,� _ f��Ecv_STE _
(Name and Address) .�
(o GC S � ,N 71 ) G_ f — Vice- President — �Ngme and Address
Secretary —� G o GGO � _ ill
.�� - -L- -- - "7_� ---
(Name and Address) ,
_..._._._._.._._..__.� __. __ ....� a.._ -..,m. ,,..._.
— . (Name• and Address)
a.nd that I am and will be individually responsible for any or all; acts
of the corporation with-respect to the approval requested and 611•sub-
sequent acts relating • t}iereto o ' ! '
Sworn to before me this day Signed _ _
/
of
Az�
190 Title L �e_�t 'N( _ _
iy
otary Public
U
ANNE B. MiRIOAN
�Ce ,d MM vat
lyC�)saw r rw
Cbrth?9 9 9 4q '
Red 04
L�488743� ;
)
t
L
0
Corporate Seal
0** pi
PuTNAm COUNTY 31• 'M 131 OF HEALTH - DIVISICN OF nM13r W :( • Y: SMWCES
INDIVIDUAL MM SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
-
REVIEW SHEET , CONSTRUCTION.PERMIT
BY:
of Owner)
COMMENTS I Y(Street NO I DOaMUS / _ -
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
House Plan .- Two sets
Well permit; PWS
Variance Request
s/s
SUBDIVISION
Perc 'Z-.
(3) Fill -37
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 System H aul-G -P Gravity Flow
Fill Profile & ns - Vol
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design Data: perc and deep r
Two-Foot Contours Existing & T roposed
Driveway & Slopes Cut
Footing/Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shcwn;gravity flow,suff, size
If Pumped 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
SEPPd TION 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 (inc. ern)
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�Foundation; 50' to well
15' Well to PL
LAURENT
ENGINEERING
ASSOCIATES, .C.
- 73" FAIRFIED' D IVE " - -
PATTERSON, NEW YORK 12563
.' 914.278.6108
RANDOLPH W. LAURENT, P.E. '
HARRY W. NICHOLS JR.. P.E. CONSULTING SITE ENGINEERS
September 01, 1987
Putnam County Department of Health
110 Old Route 6 Center
Carmel, N.Y. 10512.
Att: John Karell, Jr., P.E.
Re: Steinbeck Hill
Lot No. 2
Farm To Market Road
Patterson, NY
Dear Mr. Karell:
Enclosed are the following:
to Three (3) prints of Drawing SS -2 "Proposed SSDS -
Lot 2 ", dated 8 -12 -870
2, "Construction Permit for Sewage Disposal System ",
dated 8- 14 -87;
3. "Application to Construct a Water Well ", dated 8- 14 -87;
40 "Design Data Sheet"
50 "Letter of Authorization ", dated 8 -11 -870
6. Two (2) copies of Residence Floor Plan (s), for "Bedroom
Count Only".
7e $100000 Filing Fee submitted under separate cover by
client.
8. "Affidavit - Corporated Owner Application ", dated
8- 11 -87.
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nichols Jr., P.E.
/map
CC: Mr. Dave Ciocciolanti w /1 copy each
enclosures:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-... - - ..... Date �llGl� Si I ► ���7
R e : Property of
Located at
(T) ' ""�- Q,S�ti( Section ?Dn Block z Lot Z�O•
Subdivision of ST�1►JEzIC.
Subdv. Lot # Filed Map # �ZZ� % Date � 3 V%
Gentlemen:
i
This letter is to authorize- �A'�?�y�CI -�jL_S
a duly licensed professional engineer Vlor registered architect
(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
system or systems _in- ,conformity'with.
the .pro•vi.sions of Arti-cI-e-'1745`
147, Education Law, the Public
Health Law, and the Putnam County Sani-
tary Code. .��OF pEWrp
N(CyC� 9�
;
±
Q sv 4E
Very truly yours, i
M on R of ffE /�� TS 1]�t/Pi1n�►t r co; t-TTI
Signed U
Countersign `��,, o. a �`
gOFESSIONP
Owner of Property
o
P.E., R.A., #
Address
Address
QTown
Telephone
Telephone
MM' DEPAIZU41M • HEALTH
PU11COUM
DIVISION OF ENVIMMMM FMLTH SERVICES"
DESIGN DATA SHEE- SUBSUFACE SS-17CE DISPOSAL SYSTEX F= NO.
Owner DE-Nel-L-)p . !Lt;- AddressPD. Zcx q-70
Located at (Street) -j VbC�,6,1t-L-Ttyj►,j ZO. 'Sec.' &D Block Z lot
(indicate nearest cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA MX= TO BE SUBMITTED WITS APPLICATIONS
Date of Pre-Soaking —7 /1 Date of Percolation Te st
HOLE
Nmm CU= TIME
PERCOLATION
PERCOLATION
Run Elapse,
Depth to Water Fran
Water Level
No. Tim
Ground Surface
In Inches
soil Rlte
Start-Stop Min.s
Start ar- t stop
Drop In
Inches Inches
Inches
Z7
k <' , 210:5f�>— 11'.
-7 -7
3 SO
4
5
-L' 2 4ZG - 4'
14 Z4 Z-7 -5
3 4,4(0-6:C)& -ZA Z-7
4
5
2
3
4
5
N=S: - Tests to be 'repeated at same depth until apprmiwately.eqml soil rates
are cbtAined at each percolation test hole. All data to' be.'Suhdttbd
for review....
Depth measurements to be Made fran top of hole.
TEST PIT DATA �
DEPTH HOLE NO..
jv-. i-opsH
21
31
.41
79
8'
go
BE SLMMITTED WITH APPLICATION
IN TEST
HOLE NO. HOLE NO...
.10,
.121
131
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS RMUNTERED
INDICATE I= TO WHICH - WATER LEM RISES, AFTER BEING Eb=MiTERED
DEEP HOLE OBSERVATIONS MADE BY:'- DATE:
DESIGN
Soil Rate Used I (a —ZD Min/11' Drop: S.D. Usable Area Provided SOCX:)
No. of Bearoaus A gp ticTank capacity i -Z60 gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other Z" I L_L__ NEW
Name- (,JNU r
� ZNG-. 4ssx, IF.C. Signature Z Ift
ru
LU
Address _-73 S.
No. 5 124
Y
�Jy
FE 10
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft/cral. Checked by Date
I.
7:
,1.
(D
f l
Y�j \\
T
E
48':
- - 0,
BATN �
1 �
BEDROOMS DRESSING .
y,5•..
12'0*' _
BEDROOM]. IN
1].,0.. • 10.,x.. �� I'
_7
Y,. cLOS er
1, MASTER BEDROOM
O N
PE - 17'0 ■ 18'B"
BEDROOM ] 1
r .— '- 17,,0.E � li.,bir.• __ � .. __ - "..n•,�e+.ia" ._ __ _- ._"._ _ -.. ...
1
STUDY 1
M. BATTHH O
O W.I.C.
MASTER BATH
W /GARDEN TUB
SECOND FLOOR 4828 = .'1344SF
48'
IOU
-'�i
KITCHEN
DINING ROOM MORNING ROOM
13' 0" x 12,•0" l':.
28'
ABOVE '
LIVING ROOM , ur FAMILY ROOM,
. .1 J.,0.. • 18.,0.. � 17.,0.. t 17..0.. ,
FOYER �.
FIRST FLOOR 4828 = 1344SF.
ALL FLOOR' PLANS AND ROOM SIZES ARE APPROXIMATE
NORTH AMERICAN HOUSING CORP. ..p,o, b. °X•,145 i point of,rocks, maryland 2177.7 .
/ (301j 94.8- 8500.• (301), 694- 9.100 • (301) 442- 141:0•
j
Plans, Prices And Specifications Subject To Change Without Notice Copyright 1985 (See.Reverse Side)
rzol
4 '
Pt _
0:1_41 --
1
51TE )ALAN
SGAI.E:: I "a gyp'
SITE
5r-
PATT E
5e
DL
li
S5 D�r-_
DF_SIGN FL
01�DRXIY
SOIL. PAiE i
,AP.PLICA,10
ABsORPTI(
PROP• ;z5auIR1
well.
PROVIDE
TEST
HOLE I ;
L
P
w.y. t r.o• R
RSV I - I I • B9' I
IZBV. 5 -lip •80
120J. �•2�i'•d'j
PP.OJECT
Building- Type ) . Ctrl._ - , Lot Area I , 2A � • .4 FW Sectlon Only Depth ` Volume .
Ntmiber of Bedrooms
�'1 Design Flow. G /P /D. PCBD Notl9cstlon Is Required When Fill Is completed
Separate Sewerage System to consist of Gallon Septic Tack end
0CL
To, be constructed by-50' s{ N+C Address
Water Suppb': °Pdbltc Supply From Address
ors °� Pilvate:Sap'
ply
Drilled by J3Sr4QLtAIL CW-Address
Other Regdlrementa
10 present that -1. am wholly and completely responsible for the- desmgmand- location of the proposed. system(sl• •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 an regu a ions o e u nam
County Department of Health, and that'oncoin plot ion thereof a,•Certiikate of,Construction,COmplinncd'l satisfactory to the Commissioner of Healthwill
be submitted to the. Department, and a written' guarantee -Will be furnished' the owner, his successors, heirs of assigns by the builder, that said builder will
place in good operating condition any 'part of said 'sewage disposal system tluring the periotl o1 two (2) years Immediately following the date of the luu-
ance of the ipprd4ai.of the .'Certificate of'Construction'Compliance Of,',tn original syStern or any repairs her o; 2) that the drilled well described above
will., be located as shown on the - approved plan and 'that said Well will be instill in accordance with the standar ru and regu a ons of the Putnam
County Department• /4f.Health. ✓/
Date k i l/' 9 LJ , « Signed P.E.- R.A.
• ±yJ r�aaress ��
APPROVED FOR CONSTRUCTION:. This approval expuerIM
revocable for cause or may be amended of modified when consid
requires a new permit. Approved for disposal of domestic sa
V License No 17-4
ar from the date: is ed unless construction of the building has been undertaken and Is
d necessary • y t ' Co issioner of Health., Any, change or alteration of construction
❑y sewag , an r Dfi wa P lY•
Title ��l✓