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HomeMy WebLinkAbout1682DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -3 -21 BOX 15 1 , }� , WIN me IN NO III N IN .� � T to r )INN No 1 T,V I r-, ■ , 01682 ai _.. ; p p "AS BUILT" DATA. Structure locotedtrom survey by surveyor noted ti�iow®__ - - -- '� Well located by. Surveyors survey.- -- rrm-t� _ ;:.,_ - __..._. _' - Well drillers report -- _y1_ �- ' E O - -- - W Engineers mesurements -O- '' 7 J� � ... Tank, boxes, pits, galleries 81 laterals located by:Contractor: +� ' Erigtneer Health dapt: Field Inspection by: Health dep1'❑ dote:,- L1 Enganear ❑ data _ P, This is to certffy.tliat thci se,3age- . . " . d-is -posal sys -ted was: c,onst.ructed as,! i. NOTES: indi( -.d on this Plan "a nd.t1lati tlie, �7 it 1 _ p - sys,trm was inspecteii by mec. before ,it,:! Q W./ was Cov,rad over. ;Thecsvrt wns c�nstrurted in accordance with aril . i .y 'T• - - -_ r _ sta c ul s andegnlaticns Of . 1 a rd i E the 1 C. It. D: 6 the N Y S.D.N. Puts County De a enD�ttamlenHea ea th h ro 1 S oo !. vi nm n Divisio of � . a DIME NSONS eppro ee noted for -oonfortpanoe Ivit /, a le EultY If 8ulationa o th� _ ` _� ��9 - C -�Y - C7ly en = ,a /3t� O € SiBaat,_ d% E6 A D ? r. - -7%9 - D =_ / i QaapcsslON�i eN �. ,. y / .. _ &Title at - E-���i 0._ g _ :.E o . : %rJ7._� t °��N aRtroTS� %r�� - r-.G2.rH 'Q u f-G✓r- cIJ l� • ' 1 H a Q f-G✓ A _ J'N 6 J' f s Q \ _ / OF IHE ST i lT A, 4 �x �tAL. SANITARY SY,5TEM " DESIGN A 1' ULI \ �ci:i /G \' 4„ 4 h(sif'I�IG [7a1jKi LOCATION StreCt. -f /. Town 1��County:� -r -U� Stott , f-=' -- 2;�1 TO-T& L, �\ SUBDIVISION' y \i °�� /�L— .�.LZf _— -o ld� " �\ �_� 6 �' Map: �� _ — .. -"�? Block•. _._ --_- LOT N2--5, -- - -t d J•t11= c'ilvl�.,, Bullder:��TrS/ %aXoyr J O Surveyor•:�.r?t- f'L'r:_�1 -._yL \ Drawn: Date :rU /Z SC41e:�f (,72,16;47 W al >4 JOHN H PR E N T I S 9 PE g a t 1 s• WLLL UV1v1rLL11VN ]NZXUAI CAW DEPARTMENT OF HEALTH 0 PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET ADDRESS: TOWN/ YTILACK/Cl I Y TAi GRID NUMBER: Big Elm Rd. Brewster,' NY WELL OWNER NAME: ADDRESS: Amos Noabh,c/oLamothermic Co.rp.Rte 312,Brewster,NY 1ID50 C1 PBIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary EI RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE — gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY E3NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 105 ft. STATIC WATER LEVEL 30 DATE MEASURED 11/27/84 DRILLING EQUIPMENT 99KROTARY X3XOMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING aOPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 30 -_ ft- MATERIALS: 8 STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH BELOW GRADE 29 ft. JOINTS: OWELDED MTHREADED OOTHER DIAMETER` 6_in. SEAL: f10EMENT GROUT OBENTONITE OOTHER WEIGHT PER FOOT � Ib./ft. I DRIVE SHOE. Q YES ❑ NO LINER: OYES [RNO SCREEN BETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (It) DEVELOPED? FIRST ❑ YES ❑ NO .SECOND GRAVEL PACK 11 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK — in. I TOP DEPTH —ft. BOTTOM DEPTH — It. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- tl COMPRESSED AIR formation attached? ❑ BAILED ❑ OTHER ❑ YES 0 NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing well Oia- meter In FORMATION DESCRIPTION cooe ft . ft. WELL DEPTH ft, DURATION hr, min. DRAWOOWN ft. YIELD 99'... Land Surlace 5 Dmilling in overburden clay & bldr3. H4t r,ock at 5 feet. .* 105L 6 85 7* 5 30 4D'3' Eiffil. in g in rock ,set'casing,groutel. --13wo— j_Uing in -rock ranite. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO ITYPE STORAGE TANK: TYPE Clayton Mark 80-03 CAPACITY 38 GAL PUMP INFORMATION "subritotsible CAPACITY .7 9 MAKER Gould I -_ DEPTH =Gr MODEL 7-EH03412— VOLTAGE-L3AP WELL DRILLER NAME P . F. Be a 1 & S ons , I E ADDRESS PO Box B SIGhMR1E go Brewster,NY 105 r .31 by 4_1 Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights. N. Y. 10598 245 -2800 z _ Director: Albert H. Padovani M. T. (ASCP) r � JOHN PRENTISS,P.E. RD9,FAIR STREET CARMEL, NY. 10512 L -g LAB . _ ' "' -' ? L ' Date Taken: 10/18/90 Time: 5-,30 Date Re'd: 10/18420 Time: 10;50am Date- ..Renort.ed :_ _ 990. *.. Collected By: Amos N 0 a c h n PO /Client # Referred By: Prentiss,P.E Sampling Site:. Kitchen Tap R.R. 6 Big Elm Rd. Patterson.NY. REPORT ON THE QUALITY OF WATER Phone ( )279 -3229# INORGANICS (mg /L) MICROBIOLOGICA 1O mL Alkalinity Standard Plate Count Chloride (CFU /1 mL) _ Copper NA = Not Detergents, MBAS Membrane Filtration Method — _ Hardness; Calcium TNTC = Too Hardness, Total � Total Coliform _ _ Iron Lead — Fecal Coliform _ Manganese Fecal Streptococcus _ Mercury — Nitrogen, Ammonia Most Probable Number Method — Nitrogen, Nitrate _ Nitrogen, Nitrite Total Coliform _ Phosphate, Total _ Fecal Coliform Silver --- _ Sodium Fecal Streptococcus _ Sulfide Presence /Absense `(PA) _ Sulfite _ Zinc Total Coliform P A PHYSICAL/MISCELLANEOUS KEY FOR TERMINOLOGY pH (S.U.) — Color (Units) Conductance (uhms /c) _ Odor (TON) Turbidity (NTU) CFU = Colony Forming Units IT = < = Less Than GT = > = Greater Than NA = Not Applicable SA = See Attached TNTC = Too Numerous To Count REMARKS OMMENTS For ab se (For Lab Use) SAMPLE TYPE: (Check One) Potable Non- potable OUTGOING: (Check Each) HNO HC13 _ H2SO4 . _ NaOH ZnOAc _ Na2S203 _ Other: INCOMING (Check Each) LEVOC GT 4 /LE 2000 GT 200C pH LE 2 pH GE 12 ` Other: NYS ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY-ACCORDING-TO YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE IME OF SAMPLE CO_ CTIONo THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA MEET THE SATISFACTORY CHEMICAL QU LIT STANDARDS OF THE NEW YORK STATE C DRINK- ING WATER CODES, FOR T P TERS TESTED, AT THE TIME OF SAMPLE COLLECTION. 7 /87(Rvsd1 /90)RWE -n,. I ,. Director PUI'NAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENrAL HEALTH SERVICES Amos Noach Owner or Purchaser of.Building Owner Building Constructed by Big Elm Road Location — Street T. Patterson Municipality Contemporary Building Type . 71 2 5.1 Section Block Lot Sanborn Subdivision Name 1 . Subdivision Lot U GUARANM OF SUBSURFACE. SEWAGE DISPOSAL SYSTEM I represent that I am whelk and -.eel 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 �;e.- -the. _failure- to_,.o Pxate. _ ro e.r i. 5 -re�irs- :�;.de - -by- .^�^ - -te - nf�cf3-- s yst�,.., px_cept kho � _ � p_. ... p p.....y. ' ....:...... 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 2 r day of dc_-Ea r19_jQ A:22== M/ Gen al Contractor Owner - Signature Corporation Name (if Corp.) Big Elm Road, Brewster, N.Y. 10509 Address rev. 9/85 mk Signatur Title President Tyndall Septic System, Inc. Corporation Name (if Corp.) Ivy Hill Road Brewster, 1050 °I ess vlro 1 eSt (914) 562-0890 �. , 234 BROADWAY NEWBURGF;, NEW YORK 12550 Laboratories, Inc. RACTERIOLOGI` A EXAMINATION . VH TER p �- F M }zY f€ � Satxle: Na Q3tP COU'd Tlme ' Tihjial ubm t]ed Lab No.: W -. '� Lab No sEnt Time Set Tests Requested's Refrigerated ?F Coll'd. by r . �°- > Agency;Coll'd for. Coll'd. from, Name t b ' Q Address Ku1xf� — (St .Rd.) (City�Town, yikare ( jp Pod el, -,---(Count y) Telephone Idenfificatiorrof Source )= Number Sampl'ih Point _r Supply ;Chlorinated when sampled Yes ❑ . No ❑ "Free Comb pH� r RESULTS-OF EXAMINATION OFWATER:- - •Standard Plate Count Bacteria per ml MPN /100 ml. �a - Membrane Method /100 b" Coliform - Group Total Coliform - ' `Feca[sCoWform ;� x. F c i oliform - e a C These results indicate Sample as was not) of esatisfacfory sanitary Quality when the sample ='• �; ;was - collected CHEMICAL AND - PHYSICAL zEXAMINATION OF WATER CHEMICAL EXAMINATION (Results in Mil(igrams`Per Liter.).•' ° F :. - ❑ Ammonia Free las N) _ ❑ Arsenic F: ❑ MBAS IDetergentsl' ' NltFltes las Nl:', _ Barium.: , -' ❑i ?a Nitrates (as N) ❑s :Cadmium ❑ r ❑'.._ t Chromium ❑ Co Apr t ❑ Sodium ❑ Iron ❑ t Dy Sulfates f i'; ..p Lead > ❑ l ❑ Fluorides ❑ Mariganese y k PHY$ [CAL •EXAM tNA ION Chlorides ❑ ^ LMercury Dolor v nits Q` Hardness Total 1aSCaCO 1 ❑ Selenium e - ❑ U ' Turbidity` Units Alkalinity lasCaCo, ❑ ❑Odor Units pH �' Zinc ham` The chemical ' parameters •tested (were were not).,, witfi h Reported by =� DATE REP fhe - limitations` of "the -:New York State tidunking water. f z stantlar ds`. vuhen the sample was collected The °results � RONALD -A BAYER LABORATORY DIRECTOR. circled repeseiit those�inrezcess of the limitations _ } R 3� PxEr.,n c71.1!JkJ J c ST. Date: INITTAL SI'L'T InSPECTT.ON � � Yes No Comment.-) Property lines or corms found . . . . . . e e . , Can estimate house location -- Will driveway need cut Must trees be removed -note these Is deep hole representative of entire SDS Brea Additional deep holes needed. Sufficient SDS area available considering. driveway cut, house location, separation . distances, etc. DEEP HOLE MTA Dspth: Water elevation: Rock elevation: - Soils descr.i-,Ai on: Date: j - r,IN.nL SI _E, TI SPBICHrjI . Insp. by: - -- House located i- iher.-, *shoi-.,n on approved plan SDS located Un-re approved . . . . . ... . . _ 'Iength of trench mcasurod Width of trench average Slope of the line and trench. acceptable e . ._._ _ ._....._ .... _a - -. -� _., Raom__a1.1��.zvd -. fQr- .- •E�;��,.ns,.. ail - .trine ?- ics=._�e. �;...,, __ - �. -...e . Over 50 ft. from swamp,watercour•se e e e e e liatural soil r_ot . stripped or SDS area - - unnecessarily graded e . e o_. 10 Pt. maintained from prop.line and 20 ft. from house e e e e e . e e a Separation of trench from house, well -- -- etc.. -follows plan - -- hturnber , of bedroomis checlts e o . . . . . . Stonc: , brush, • stur.:ps, rubble, etc . greater than 15 ft. from nearest trench e . . . o . 15 Pt- . of peripheral soil horizontally from ., trench O ... . . . 0 . e e e e 0 e . e* e . e . Junction boxes properly set Could surface run off from driveway, roads, • gr ound surface, etc. channel near SDS areao o e e o e o a s • 0 0 0 . . o o Does lot• drainage app-ear 0. K. J.n area of SD. FINAL GRADING OF SITE ACCEPTABI -B a _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 ..r+. u._wwae+re+++. w .v ao4 a.. .iv. e.-. r. ..r •.s -..- �^s�itl :s_ vim. n -.r. sY . ..s -r-.. s .f_..v..h.w�— w...r..__.• u.a ..<. ar ..... e. �...c2u -a���. _ r...�_. ..v "wC'rna• -.s.. _. �_ .+ . DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner_ArnnS 1ja.jyCh Address gin FEW Radyd Located at- Street r"'% -m ., et a kw 71 Block 2 Lot_��� at- ( Street cross street) Municipality '-Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS. _ Hole Number CLOCK TIME PERCOLATION PERCOLATION Run giapse, Depth to Water a er eve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop . Drop.in Min. /in drop Inches Inches Inches Notes: 1) Tests to be-repeated at same depth until approximate) equal soil rates are obtained at each percolation test hole. All data to e submitted for review. 2) Depth measurements to be made from'top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L,. 12" 18" &ib led VV 241' 36" 42" 5'+ 60" 66" M NO Le 6,o cAi . INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Nome _ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /U'o vq� V TESTS MADE BY ��/,�. �,�.% /� i'�' ,�o�k ( Tp Date el.,i DESIGN Soil` Rate.. -Used !_1V1in /—:L Drop _ _;. S:D: - Usable..Area - PPojxided. ~.t� .¢. No. of BedrQoms �Septic Tank Capacity. /U e U Gals . e Absorption Area Provided By_�L.F.x24" nch, ��• _ a THIS .SPACE FOR USE BY HEALTH DEPARTMNI T ONLY: Soil Rate Approved Sq. Ft /Cal.... Checked by �pTNE S7RZ� ,o Date_ ._ -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 6 June 1984 Re: Property of Mr. Amos. Noach Located at Bid Elm Road (T) Patterson Section 71 Block 2 Lot 5.1 Subdivision of Sanborn Subd. Subdv. Lot # 1 Filed Map # Date Gentlemen: This letter is to authorize John H. Prentiss, P.E. a duly licensed professional engineer XX or 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 - __ °.6y.wt^;:� ©r- s;,s +�ma ir: ccr_for;*:z- y.wif.h...i,n r�._rntri51032c Cif .t1rtiC1_A.. �4rj Or .,., 147, Educ �0 1G-Rt the Public Health Law, and the Putnam County Sani- O , PRE;v •Fy6i t a ry C v� O�� N Very truly yours, � x �4 Signed F�si. N Ate. `` Owner of Property . E . , XXXMX , # 29206 RD #9, Fair St. Address Lamothermic Corp., Rte. 312 Address Brewster, N.Y. 10509 Town Carmel, N.Y: 1,0512 ' A, 278 -6118 ,rn i ` `t„ca "sueue Telephone 914 -878 - 6170•; Telephone 4 t I �° U "`a?� y K. r Js O eeC *S LITE W /PULL - A% I � �cLppoo�ET �d \ cell N Caste ��) p 0. r N U � CF � � b' itl L nr E>J J J L_ Off% 6vt efs 01 • FOL. P 3 " I ��J< PG. N �Z CL M�1 ,etLP �5h sTro &L M- ATM Zpl� ;4 w 8I'q v . tj y v COAD FLOOR Is�n a 1/4"z I ' . 0' CLO 0 r r i v� % 1),rer— Beikaoovl ..4 I Q iq �� c keP ;4 8I'q I. CLO - — �s►+G�r�aoo c� , _1_j.T N u d ( I Q5Ti r % 1),rer— Beikaoovl ..4 I Q iq �� c >�i�fOS yll�A REVIEW Citi?.CK SHEET (Meets Std. i eY s No House plans O.K. Design data sheet Peres resoaked? Kin. 30" pert test depth. I Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for other° than individual Authorization for engineer, Letter from Water Supply if applicable If variance requested -such noted on plans & apps.: D, ,TAILS if change is proposed,) Existing contours shown show new contours) Slopes for driveway cuts,-etc. shown � Mater service line location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit.location' SeUtic tank size and conformance to std.i 3 B.R. house minimum House setback shown" I Distribution box ftg. below frost All water within 50 ft. of'PL shown Remark t I j k• ( 10b(CA-Ts17 L l I 1 u©; sy&tW 1A.),Ss1bS i Plan and profile SDS �. �..._... All other - '' shoran or reference made ! Property boundaries (metes and bounds- clearly .shown) —; -- 7- CO .Pro =(,' EPARATION DISTANCES SPECIFIED ON PLkN D to P. L. J' to Fouhdat i on walls J' to Nearest well )' to stream, march, lake., etc. incl . ex 5' to Curtain drain )' to water line (pits -20 ) ' to storm drain ?' ' to large trees )' froItl foundation to .septic tank i' to pipe from leader drain & , foo ing y X on �r i _�< 9 r1lsT,D CJ- 1EC'tc L1' )T. . Date: '.Trap P. by INTTTt1L SITE T.Ti �I'rC�TJ���' r y ye �� N No C Comment. ,Property lines or corn:•r3 found . . . . . . . .. _ _ Can eUtimate house location . . . . . . . . o Will driveway need cut . . . . . . . . . . . -_- Must trees be r -moved -note these . . . . . _ _ - SufS'iciF:rrt SDS area available consi.derin driveway cut, house location, separation etc. . � ,,,- •• -��_� DEEP MOLL DATA w :HEAL N� tNAM'.COU Y,:DEPARTMENT-OF :.Yl ........... Y" b vision, o. Carmel ­N. 'X:1,051 p CONSTRU 0 -ttL -SEWAGE. -DkSPCkS a rson R.. Town or village 0, 71 Block Subdivision 7 6t Job':SOI 759! 6 si TI eXPer Address .74�, it L Of NY -14, rame F" 1 .105 TYPe �g B ild�� -To al - H WO '6 ,,Bed�oorris, T 360+ 1 600 Number ow abitable -91�ice Square Feet pf� P-Mcin .Separate Sewerage y em tto -'Ton( t&: 66 constructed. by., ? Water r v Add lOther *Requirements N one , at'l-am.Wholly ar described ',will 6ii-66i4s tr County oye, T' ounty,,,De-pa be submitted .to,'the Ddpartirr place in, .good .,operating: conc ce-0 the'� a An Poriiya�l, of fhe 'Wlll'be lodted,as ikh*�h:pqthe County Date .'APPROVED FOR CONSTRUC .�revou I raeo �s le,IAxaus e, or may,,' be' Pei PP I ... ain, sist of Gal Septic Tank and •• % Address impletelyirespons�ble for the tlesign antl location of the W pp sed system(s); 1) thatiie separate . sewagi disO 6sal system as'sho%Ain_oA 'th67`apOi64ed amendment there n, accordance '--with '-'the 'standards -rules an r ulations ?f the Putnam Ii. r , - rid thation thereof m plej, ionj, . is red &.1-,.Cerilfi6iii� 0 hi� o �'M,l e Ith,will, and awntten c_,j;9jstrpjptipn il islo ner of H a successors t said -will tp,e- 'il heirs or assign ,,w. 6.,i e ild r�, that id builder 1� d of-t- M-, , uring.thepe�j6iti�� wo, immediately following Ilb i any, part of said sewage -4 isp'6 9��per�. is years I 1 0 1 the date of the issu. icate.of,Constr,uction,Cohipli�nce:,o .�th-e--origiiiai"..i�item-or-o�ny.ria ir r to; 2) that the'drilled well deicr lbed.. above roved ­ . , - ­­, - s, r plar d '. . �zl. "i�i id well will`b6 r 66 s and r"ulT.on,-' o. !.�and installed-. or ance, Wf6­th' i the .Putnam. '17 p.E ,A -4-Y R.A. lies •& License -No. 29206. N.- s: ap' provakq*pi rd! m t h' ate issue unless construction of t h e building, has be en undert, akeW and' is nded 6 who onsid �d_ 6'ece-is-a `b ioner,of Hiilth. A*ny cha r .-alteration.of construction -.f§r;di.sp . sews 9i. a , ater -supply only g9eQo ,qsal�p. do 0 �4 Title Ni FIELD CIECK LIST r Date: 90G Jl , /9 7 ans p by : Ge0,1t) INITIAL SITE INSPECTIONi _ Yes No Comments Property lines or corners found . . . . . . . . Can estimate house location . . , . . . . . . . Will drive%.iay need cut . Must trees be removed. -note these . . . . Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . . ✓ . Sufficient SDS area available considering driveway cut,house location,separation , distances, etc. DEEP HOLE DATA Depth: O Water elevation:C�l Rock elevation:0 Soils description: SotaO Date: 'FINAL SITE INSPECTION Insp. by: _ House located where shown on approved plan. . —. SDS located where approved . . . . . . . . . . _ Length of trench measured Width of trench average Slope of tile line and trench acceptable Room allowed for expansion trenches . . . , . _ Natural soil not stripped or SDS area unnecessarily graded. . . . . . ... . . . . 10 Ft< maintained from prop.line and 20 ft. from house . . . . Separation of trench from house, well etc. follows plan . . . . . . . , . . . Number of bedrooms checks . . . . . . . . . . . Stones, brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . . . . < . 15 Ft. of peripheral soil horizontally from trench. . . . . . . . . . . . . . . . . . . Junction boxes properly set Could surface run off from driveway, roads, 'ground surface, etc. channel near SDS .. , area. . . . . . . . . G . . . Y Does lot-drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE t D,--,ign data sh °et P"res presoaked? hin. 30" perc test depth . Const. results for 3 runs D. :Tole log O.Y. Corporate Affidavit for other than individu Author•izatlon for engineer Me •ts •Stri . Remarks .Intter f. rorn ,-later Supply. if applicable Who j f If vari.arce requested -such noted on plans & apps.: u_% DET jjIInS ' if charge is proposed, ) Existing co-tou y s shorn show new contours) ✓ Slop -s for drivleway cuts, etc. shoe.,n Vater service line location Footirg,• drain, etc. location i kOor Top slope, bottom slope of fill AI /; ! Percolation tests and deep test pit location Septic tank size and conformance• to std. _ ✓ I. I 3 B.R. hcuse minimum House setback shown I xi1 va.t;er- wi'cnln ,u it. oi, rig 6nown -� -- - -- -`-`- � � L7' _ '_ Plan and profile SDS .... _....... L... . �....... (....... _ ..... All other wells and SDS closer 200' :.. •. -.shown or reference made Property boundaries (met.es and bounds- clearly shown; 3EP RvATIO1`1 DISZANCES SPECIFIED ON PLAN LO' to P. L. 20' to Foundation walls )0' to.Nearest well )0' to stream, march, lake, etc. is L5' to Curtain drain LO' to water lire (pits -20' L5' to storm drain LO' to large trees LO' from foundation to septic tank L5' to pipe from leader drain & foo cl . exparision v I � I i I i T r ` .. PUTNAM COUNTY DEPARTKENT OP HEALTH A Gentlemen: Date 28 July 1977 Re: Property of Donald & Ira thleen Sanborn Located at Big Elm Road, Sanborn Subd., T..Patterson. �4X A. ` 7/ Block Lof.l (Part Plan) . - This letter is to authorize John -H: Prentiss, P.E. a duly licensed professional engineer X or. 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 th-is matter and to. supervise the construction of said system or systems in conformity with the provisions of Article 145 or 1.47 Education. Law, the Public Health. -Law, ...and..the Putnam. - County Sani- tary Code. Very truly yours, m h Signed ri4CL�� LOr il) l ., i !�l) mp.) Owner of Property Sun Valley Drive ountersign Croton Falls, NY 10519 Address P.E. R.A., 914 =277 -4305 P.D. a, 01ox 3 -3 Telephone Address - Telephone '*0m �0""NE STAj��� 0 to t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Address rS; k Located at (Street - - Aw. 5MZ� 7/ Block a.- Lot X; I. n ica -e nearest-cross s ree -j Municipality . Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3. 36 0 ,q.. 1360 f 2 /pill )4 3 1013 /0 3¢ 5. 1 2 m Notes: 1) Te' is " t0' be repe'at ' d at same rates are obtained . at each percolation for review. 2) Depth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. Hole Number CLOCK TIME PERCOLATION PERCOLATION Rand Elapse .No. Time Start -Stop Min. Depth to.Water From Ground Start Inches Surface Stop Inches Water Level in Inches Drop in Inches Soil.Rate Min. /in drop 1 /03.8 /D >-•9' / � �' 2 14 �! ,...1 l 3 /®�o ion/ 5 � „ 2 /pill )4 3 1013 /0 3¢ 5. 1 2 m Notes: 1) Te' is " t0' be repe'at ' d at same rates are obtained . at each percolation for review. 2) Depth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. a DEPTH G.L. 6" 1211 18" 24" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO._ I 30" 361 421 e 11 `t8 5411 60" 66" 7211 78'• .._ 841, If INDICATE LEV& AZTeVWqBCCdHe&GROUND WATER IS ENCOUNTERED 71XJ 17 2 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BYft r'i. A 9: ✓.. pp ) 7,/�/9 9 �ae.&,,97.-Date /L7, Soil Rate Used "Drop : S.D. Usable Area Provided No. of Bedrooms 7 e Septic Tank Capacity` /0 ®O Gals. Type d Absorption Area Provided By ?L.F.x2411 6,-- 3b" width trenc Other Name ) �YtZ�S, p Signature ,. 4 �. Address R p, a Box 1353 9 r� Idea ,ie Fds c,�'J�� 1�1. PR.��'s+�V.b�`�� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: I j Soil Rate Approved Sq. Ft /Gala Chec 1 y !c '!Date NO 392�0b �. FOE vot