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HomeMy WebLinkAbout1702DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -23 BOX 15 01702 y„ 9L L, , . .. 01702 -,x c. 3�z ^7..rpwy.'^ 'f'"''°4'• ^.s: T `3c:r- T, rFrF"eL'G•ri s rlr',q*fi -'-v --n I • O m PUTNAM COUNTY DEPARTMENT OF HEALTH a _ REV . 3 86 ro . Divlsloh' f Environmental HeWtb Services, Carmel, N:Y 10512 ` a :En'gineer Mast Provide c c� Cik AR's. nF CONSTRUCTION COMPLIANCE FOR. SEWAGE DISPOSAL SYSTEM Owner /pppllcant N Malling'Addrese - •Y -472 Tax Mapsl Lot 3 Formerly Stibdivislon Name LV . SnQbdv. Lot q Zip / !/! �.. Date Permlt Issued v .Separate Sewerage• System ballt'byONIC -y f %i %%- �CV �L ( LT%7Address 110 , I ✓0 l.J d, f �� /)T/4 Consisting of JCU Gallon Septic Tank and d & fi- &S �QI'/ �� ' WCA)61� Water Supply: public Supply From Address �1, or: ' Private Supply Drilled by. l U� ��G� LL �) 4dtdfrees r %TJIi Avg, 0/ L%S V� M Building Type Hue Erosion:Contiel Been Completed? / �5 Nttmber of Bed Hue Garbage,Griader Bee n Installed? Other Requirements I certify that the syetem(s) is..listed serving the above premises were constructed essentially as shown on the p s of the completed,work ( copies of which are'attached),'and in accordance wth'the standards, rgles` and regal eibns, in accordance w the fil d pl and the permit issued by the Putnam County Depa iment of th. V// Oats / � r1 Con if led by l P.E. R.A. Address V WE Q"" / leena No. Any person occupying premises served by; the above systems) shall promptly tak0,such action as may be necessary tosecure the correction of any unsanitary conditions - resulting from such usage. Approval 'of the. separate seweiageisystam ihall becpine null'and void as soon as a pubs :sanitary siwer becomes available Ad.-the approval of ;the, p-rivato watei'auliply shall become;hull and'vold:,when a` public" Watar supply becomes availabla.. Such approvals are subject t�Naon hahg e wh en, in the)udgment of theConimisioner of .Health; su revoeatiori, modifieation or ehanga h rncassa►y. Date �J G— is Date �� tij 0� WDJjij LPa11VL4 L\LJL %JL%L DEPARTMENT OF HEALTH grtal.= HPalfin_Serviw.s PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only IWELLLOCATION STREET ADDRESS: wNlVl / 1 Y TAX GRID NUMBEri: Steinbeck Estates, Farm -to- Market Rd.., .Patterson, NY Lot 6 WELL OWNER NAME: ADDRESS: Monroe Heights Development Corp., PO Box 970, Carmel,NY PRIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary PRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.JHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. 1N0. PEOPLE SERVED -3. to�5 / EST. OF DAILY USAGE 500 gal'. REASON FOR DRILLING UNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA -30-5 DEPTH 3 0 5 ft. STATIC WATER LEVEL 2 0 ft. DATE MEASURED 6/14/88 DRILLING EQUIPMENT ❑ ROTARY x1RkCOMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING, x9kOPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH . 71 ft. MATERIALS: xgMTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 70 fL JOINTS: ❑ WELDED IcTHREADED ❑ OTHER DETAILS DIAMETER 6 in. S EAL:)a CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. I DRIVE SHOE OYES ❑ NO LINER: ❑ YES ❑ NO SCREEN SCREEN G. DIAMETER (in) 7SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST - — - ❑ Y* ES.- O NO- ...... -a _ SECOND _... _ _. __....._,. Fi0UH5 `- ._. ..._ _ 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 tests were done is in- 92xCOMPRESSED AIR , formation attached? O BAILEO O OTHER ; ❑YES ONO It more detailed formation descriptions or sieve analyses WELL LAG are available, please attach. DEPTH FROM SURFACE water Bear- ing Well O'3- mete FORMATION DESCRIPTION cooE_ ft. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD 9cm• Surface 60 Hardpan ou & blders ' 60 3.05 Medium to hard granite 200 1 - 200 2 -1/4 305 6 250. 25 WATER � CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? XWES ONO ANALYSIS ATTACHED?XQ .YES O NO STORAGE TANK: TYPE di a hr� ate_ CAPACITY 82 GAL. 26 WELL DRILLER NAME MILL DRILLI , NC . DATE ADDRESS SIG- R 7/20/88 Putnam Ave. o Brewster, NY R ert M. M1 1,' esident PUMP INFORMATION TYPE spbm nible CAPACITY . 0 MAKER _ids DEPTH 200. 10EJ07412 30 3/4 MODEL VOLTAGE' HP e ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 PHYSICAL BIOLOGICAL P.O. BOX 2328 203 - 748 -7903 NAME AND ADDRESS OF PERSON TO RECEIVE REPORT WATER - WASTEWATER METHODOLOGY APHA - EPA - ASTM a -r• w �_ .'. _. .�. .� KtrOk i 'vi= is �ti:. i r:r�ivLOGi�.f+: NU Ci iMICAL t� iiAi ivr Oi= iiR7ti� Mill Drilling Inc. Putnam Avpnup Brewster, N.Y. 10509 DATA SOURCE OF SAMPLE Water Supply Steinbeck Estates Brewster, N.Y. , Lot #6 DATE OF COLLECTION 7/22/88 COLLECTED BY Mill Drilling Inc. Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (pH) RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L NITROGEN Alkalinity as CaCO 3 Chlorine Residual Carbonate CONSTITUENTS Nitrate Mg /L Mg /L Mg /L AS Total Hardness Conductivity NITROGEN (N) as CaCO 3 Ammonia Mg /L Mg /L Mlcromohos /cm Mg /L I Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as 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 par- 100n1. Coliform colonies per standard sample stall not -exceed 3/50ml, 4i100ml, 7/200ml. or .3 /SOOmI coliform Colonies /100ML _ in: (a► Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) More than five per cent of the samples when 20 or more are examined per month. 0 AT THE TIME THE SAMPLE WAS SUBMITTED: ® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 0 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: 3. 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 constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sainple was collected which indicates the water potable. r / PUTNAM COUNTY DEPAPMMU OF HEALIH -.. D- TWMION :. -OF ENcIIRO r FiFALT VHS - - a665�- r�� rs 7��u�rr�r gym. Owner or Purchaser of.Building- illDA)aDv1�- d r6+T5 T%VCL,0 762L)T OW, L-M • Building Constructed by ALL Location — Street Municipality Building Type 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 I'rert.i " -Lcate of _.(;�nstructi4n Compliance "...tar. the.._sewage dist�osal..syste. or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirnntal 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 o,. the building utilizing the system. B 117 this day of 19 • Signaturej Title t Corporation Name . .. 'T LO ,-./a rev. 9/85 mk II. IV_ V. VT. FINAL SITE LySPE'CTICN Date '7/-z o hr •;CAT: rON ° 1-4 �/• �/ TM a OR _- ';[MDIVISICN lOr 4 a . pr _.. _ _.�.. .... _ _ ._ ._�; �..... w - r...._....: - =...1r IVIi�..K....'......... - .mac. Sr AMA DISPOSAL P REA a. Si,S area lccatr as per approved 21ans i b. Fiil section - Date of placement 2:1 barrier. Iii wit�TH AVG. DPT -H c. Tctural soil nct strirmed d_ Steve, bnusch, etc_, creates than 15' fran SDS area_ e_ 100 ft. fran water course /wetlands. S vfC DI-SPOSIAL, SYSTEM a. Sentic tan'.•, size - 1,000 1,250 I y b. Sentic tank installed level c.. 10' ndn mian fraa foundation d. No 90° bends, cl er=rcut within 10 ft. of 45° bird e. DISTRIBL'TICti BOX 1. All out! et= at same elev ti on - wGC-er tes=ted -BOOS: 2. Protect- below frost I 3. Mil i ui 2 f-. cricrinal soil between box and trEhc ^es f. JUNCTION KX -- prcrerly set g. 2' S ' i 1 LehcLh L-_c°`h ins—L---"e^ 2. Distance to wate_rccurse measix u ft. 3. InstaL =—,�` acccrdinc to plan (✓r, - I. 4 Distancs csnt�r to canter 5. S' cre cf t_ nch accen_table 1 /16 - 1/32 " /foot. _ I 6. 11,0, f=ete f_an prcre_ri,r line - 20 feat - four_Eaticns I I 7. De'JLh C.1 l -anc_h < 30 inches gram surface I ' 8. Rcan al? ched for exr_ansicn, 50% I i) 1. Size of ca=ve 3/4 - 1V' ' diameter 10. Depth of =ve> in trench 12" miniman 11. Pi re E,ar c Iced h. Pr,_-rp OR- Das-E -s!=, -5 lm Size of Uum C'1c7i1'L`�r ' 2. Ove-rflca t: Ek 3. Alamn, vis-c ` /audio AV 04A",Q a pap ersi i v accessible manhole to grade, 5. First box oaf =led I 6. Cycle wit_.esSed by Health Demart-n ent I I estimat =1C%q c,7cle HOUSE a. Ecuse lcx~tw r—c-- annroved plans. I b. NL -tug of beer oars I I I YT4 dA a_ a . Well local e-az as per anDroved plans I b. Distance fr=' SDS area rne?sured f t. c. Casing 18" above crade_ d. S'. -rlace dra, race around well acceptable. OValMllb WORMMIA.SH— z a. fixes 2rocerly crcuted b. Ati> pines martially backfilled I J/ c. A:L! pines flush with inside of box d. Backfill rrtte_ri all contains stones < a" in diameter l e. O Lain drain installed accordi.nq to plan I I I/ t) E- 0-1-tain drain cutfall protected & dir. to exist.wa.terccurs� 9_ Fcatinq drains disc'iarce awav frcxn SIDS area- h. Surface wata_r Prot =mien adequate - i. E..=osion cyriLOi provided on slopes greater t'�ah 15 %. 1 I — I PUTNAM COUNTY HEALTH DEPART DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME Orig. Routine G� c _ Orig. Complain ADDRESS -/ �/� t°c `7 �%�� �/ _ Orig. Request No. Street Town TM No. _ Compliance Complaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip.Code _ Group Illness Construction c Reinspection PERSON IN CHARGE �� F' , Sampling Only OR INTERVIEWED / / �` � � 'iel Conference Name and Ti ,-/ Other DATE "Z `� TYPE F LITY TIME ARRIVED % < TIME LEFT Explain FINDINGS: ?o %1 INSPECTOR: ULU PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: { \\�s1•i 1. � l jj i'f - L } 3 !�` ,r. p�TNAM COiJ NTY DEPARTMENT OF to Peovlde Peemlt M h u , F OF CO Division of Fbvkonments! HeaN6 Servkea..Carmel N.Y 1061? CONSTRII , ON PERM[r FOSsSEWAPEDLSPOSAL SYSTEM _ own or S6bdivlaton Nnme STF /%✓.QEGk. /�I� ~T� �t} Blocb Z f �Sad>Id ;Lot M � Alt'. I � l APP anew RevieMn ' ❑ . ' b. Prevloae ro '- f� n Date of val • ` � Address / f' Town- ZIP Mailing ....,., ............ .. ...__. ,.... , C BaUding Type ��S /Q�CE lot Ares' 7 AG FM Section Only y Depth, r Vdttme Nditi i Bedroome Design Flow G P D YCHD NOW— w le Required Wben FS le completed t ,i.. BoYckj. Lf A.dsa.�T/ Div' Tc.0 %! a Soparate Sewerage System to�eottelst of :GaU�Sep— Tank and Tn be ooust vdW by Address Aaiwm taster S _ oPPh P�Uc Sapply'From . ors�Ptivtte SoDP�I'.De1Ued by �� /� � - Address `S Other Regairemente r 1 represent hat I am wholly anQ, completely responsible for „the despn and location of "the +,proposed systems) 1) .that the rseparate "sews a ,disposil'.iystem above descr�Uetl will bt ±,constructed si shown On the aDDroved amendment there, to and m accordance with the standards rules,a regu a ions of. ' e u nam County Oepartmerit'of Hsalth and that on�comQlehon thereof a Certificate' of ConstiuctlontComDhancs satisfactory to 'the Commissioner of Health N' b subm�ttsd to the; +Department and a'' wntten 'yuarantee will De furnished the owner hrs wccesiors, heirs or assigns;by the builCer; that safd, buHdfr wilt• l . plate' in yooq oDeraUrtg condition any ;part of Vseid sewage disposal system °dunng the period; of two.(2) years_ImrneAfitely fdllowirq the date of the itsu- f anee: qof th• approval. of the Cartifipte�;ot ;Construet,on':Compliencer o -t *-or, yinal, system or�any replin heieto 2) that the'diilled.well , desttfiaeA spow ,• . , ' e will bs located as shown on the_approved. plan aneltMt said well will iii, 11 m accordance with the sta art's ru ano repu a IT�Ions of; the Putnam County Department of Health L/ Oats; �Z /Z7 /7 j /J' S�9ned` PE_/ RA 7�fA���t�� /ter✓/ /� G�/ License Atldress � �• i APPROVED FORYCONSTRUCTION This approval. expires ` two years from the "date.. issuetl u esf construCGOn'Of `the building has'been undertaken and is reJO`uDle`ior cause or Tay D`e. amended of mod�Ued when considereC nec nary, tha.Co loner of H Itn, A change or elterstion '.of construction ... _.� _ ..:. DEPARTMENT OF HEALTH Division of Environmental Health Services 10 COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION-TO C5 NSTRUCT- A4WATER" WELL -) PCHD PERMIT # _'� �(5 WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address �� vX �i7d [private /i�/a/�/��,� /f ICrHTl p � a M�ii/T C, LTA C/� /`7,EG /V y -O Public USE OF- WELL 60- primary 2 - secondary RESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER. (specify, O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED/ /EST. OF DAILY USAGE oy gal REASON FOR DRILLING UREW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL DETAILED REASON FOR DRILLING N� G-r- WELL TYPE LODRILLED ODRIVEN "DUG ®GRAVEL ® OTHER 'IS WELL SITE SUBJECT TO FLOODING? YES L,-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S Lot No. 41, WATER WELL CONTRACTOR: Name Z V. Address: - IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: IVA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF -THIS APPLICATION ' ON SE ARA SHE Zz98 (&a-teY 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 s.hal.l : 1. Pump the well 2. Disinfect the County Health 3. Submit a Well Health Depart Date of Issue:_ Date of Expiration: until the water is clear. well in accordance with the Department attached to this Completion Report on a form anent. -- 19 19 requirements permit. provided b,$ of the Putnam Permit is Non - Transferrable ate COQ` Yellow Dopy: 2/87 Pink Copy` Orange copy: H. D. File Building Inspector Owner Well Driller j�T t• �1' •JI t� �. DIVISION .OF ENVnIONKRML HEMTH -SERVICES. DISPOSAL SYSTEM—_ _. a-..,�:..;,�. .dDJE. SIGN :;DAT�k- ;SE3F�'�:�SIIk'A,�.:.:• x -- ' owner DE'r/,E��i�X� �j Cc:,aT12 Address jbooX 97o, C,4AA -1Z:z- A/ Y. /V_572 I41?M T_ itl;A1241_7 Located at (Street) JaC1ei /i✓4 701-' Sec. So Block z- . Lot ZG./ (indicate nearest cross streetY Municipality' 7v wAl az- IP47, z�Os Watershed C fo Ta %V SOIL PERCOLF CN -•TEST DATA RDQUIRED TO BE..SE&mn7ED WITH APPLICATIONS Date of Pre- Soaking 7 2-9197 Date of Percolation Test 7 Zg b 'HOLE NUMBER QA( C .TIME PEROQLATION Pm00LATION Run Elapse ! Depth to Water �rcm water Level No. Time I Ground Surface In Inches •Soil Rate .. Start-Stop Min. Start Stop Drop In Min/In Drop. C Inches Inches � Inches Y8 z 2 S- �'� "07 Z 27 3 0, z ;o s "6v 4 .. -. .3 C9r63 s W, 11 Z Z 3 :o 4 5 2 3 4 NMS: 1. Tests to be repeated' at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be suhmitted;. for review. r 2. Depth measurements to be made -fran top of hole. rev. 9/85 s, DEPTH HOLE -NO. d / HOLE NO. ppypO�-E NO Y6W.iY 6W0 ca>.:.. wwy ...i_- �..u.....- ...`- .. -w.a�. y.iti ..n....¢..�.r,•x- ,i,..c uzr.z z.. ,.. e. - •:.'.. _ .. - .. r_:... -.� .r..r- -v- :. ■�:e� /� rr .... ...... .. ... ...,rer.«r.....- r:.na+'r rt:..........w..a.- .ts r. •ry -..W. s:. F+. -.:. >_.:_< _'.. ... VODO �d/�SvI 1° 2 ° S 9 /VIP 3° Ga% 6° 8° 9° 12 . 13° 141 INDICATE %EVEti A WHIQi GFtOUNU?_Vi ft IS. ENOOtINTERED /��%. r INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEEtID /1/1�, DEEP HOLE OBSERVATIONS MADE BY DATE: DESIGN Soil Rate Used 6-8 Min/1'° Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /Z SO gals. Tripe c �i ✓c: Absorption Area Provided By 6/yL> L.P. ,x 24°0 width trend Other ell I- Name Gib Am N /VGI��� ���'Y /ZF.E2 %�jSc:K; ,:.0 C Signature Address SEAL " ;1 r L L C LUI • /� TT. � Sow /c�! �/ _ %�L �G 3 � ��� 1�; eF ® No. THIS SPACE FOR USE BY MALTH DEPART. ONLY: °��FESSla' Soil Rate Approved sgoft%galp Checked by Date O Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT..-.--CORPORATE,-.OWNEPZ APPLICATION_ FOR PERMIT•APPLICATION SUBMITTED TO PUTNAM COUNTY.11EALTH DEPARTMENT TO: Commissioner'of Health In the matter of application for 06 > n 6 6 7b 1 Lie Q L0 L &LT_ - - - - - -- --- - -_ + represent that I am an officer or employee of the corporation and am authorlzed,-., to act for (name, of carporari n) having offices at tYtt 32 officers are 4J-�- _ Whose President Vice - President 6t0CC,9Lj"-7j G nl) czC_ Secretary GJy- -_2 ee-- (Name and Address) Treasurer — — — — — — — — — — Address) — — — — — --- — — — — — — — — (N�me- and and that I am and will be individually responsible for any or all, acts • of the 'corporation with -res'pect to the approval requested and all. 6ub- sequeht acts rel* a 9 tin' . tliereto.' Sworn to before me this _day Signed 7 of 198/ Title 'Rotary Public ANNE B. COWDAN k4r4mcaunty Ir • 0�� My FR"441"d � e C16� peu QU Corporate Seal U22-Dik"11 0-14U. PUTNAM COUNTY DEPAKTMENr OF HEALTH - DIVISION OF ENVIRONMWAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ( o Owner) REVIEW SHEET = CONSTRUCTIONT PEI2MZT:: p i n a. - - - DA BY (Street Location) DOCUMEM Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth Milo s/s SUBDIVISION Perc _ (3) Fill cd -- House Plans - Two sets Well permit; PWS letter Variance 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 D or J Box;Trench /Gallery; Putmp.pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes. (grinder rater---- - Des gn Liata: perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shoran; gravity flow, suf f . size If Pwped Pit & D Box Shown & Detailed House - No. of Bedroams 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 pine No Bends; Max. Bends 45° 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 (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin, stonndrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 Ii 920 POSED � 1Y,t/ I I I, I I I 1' J \ - \ \\ \\ \J PRSPO 5 D � PROPOSED P WISHED GRADE 2 o Z a t N o D O n � h Z Z Z elLElj 'vr =r Y � ' - - - -- (54. (54c) PLAN 1" = 30'