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BOX 16
17-2
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IN
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01831
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J.p 1 PUTNAM COUNTY DEPARTMENT OF•HEALTH
Uip l Division of Environmental Health Seivlces. Carmel. N.Y. 10512 Engineer to Provide Permit N
*.
on CERTIFICATE.OF COMP CE
Permit g r�
CONS CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Patterson1► --
IAatted st Old Route 22 Town or village
Subdivision Name APp-51,
?e "Hill Developme ta. Lot a Tax Map. 69"" sioc� 64
p t Renewal_ ❑ Revision p
Owner /AppucantName Loft Corporaion
Date of Previous Approval
Mfg Adder Pump House ;Road , ..rei�ster , NY Tewn zip
Building ape Single family resice�n. 109,809 S.F. Fw secnon oily. Depth vohtme
3 .600 PCHD Notification Is Required When Fill Is completed
Number of Bedrooms Design Flow G P D
arate.Sewe 1000. 380 Lin Ft. Disposal Trench
se
p rage System consist of Gallon Septic -Tank and
To be constructed by Art Burdick. Adams Joes Hill .Road
Water So Patbllc Supply Flom Address
X" Herir-y Boyd . 'Route 52, acme ,' NY
or•, . Private Supply Drilled by _Address .
Other Requirements
1 represent that.l am wholly and completely .responsible for.the design and location of the proposed system(s); 1) that the separate sewage disposal - system
above described will be Constructed as shown on the approved amendment there to and in accordance with'the standards, rules an regulations o e' Putnam
County - Department .of.,' Health;.. and that on complotion.theieof a "Certificatb of Construction ComD�isnce" satisfactory to the Commissioner of Healthwill
be wbmittetl to the Department, and ,a,writton yuarantee.wRl be furnished the owner, his successors, heirsor assigns by the buildar,4hat said buJtler`v4i11
place 'in good operating condition any part (if. said t soWige disposal system_ during the period of two (2) Years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the.onginal system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said uvelt will b6'instalI '. i actor c 'with the standards, rules and regulations of the Putnam
County ge913/ t5 / i Health. X
.Date 4/ Sgn'ed P.E. R.A..._
10 Galloway Heig s Warwick, NY 10
Address License No
APPROVED FOR CONSTRUCTION: This approval expires two years. from the date "issued unless •construction of the building has been undertaken and is
revocable for cause or*may be amended or modified when considered n essa by a Commissioner. t Health. Any change or alteration of construction '
requires a newt . per /. roved for disposal of ddme'stic . sanitar e , 'an i r uppiy only. //�� `,QJ,/J�� ,
/v / %t(!/ Title ;6/ft _" r
/187 Date (' By
Rev. 3
U�
CERTIFICATE OF CONS
_ "Located a.
Owner /applicant Name w
Melling Address
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512 j
Engineer Must Provide
0&_1 —T. C.H.D. Permit
;UCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM .
�,Lv
Tax
Subdivision
Date Permit Issued
Separate Sewerage System built by &AN C',ea vr." Address
Consisting of j �d Gallon Septic Tank and 7g so f B 'zoo
Water Supply: Public Supply From Address
or: r Private Supply Drilled by Aj Address
A
Building Type - ��'�` t'�' Has Erosion Control Been Completed? PV
Number of Bedrooms 3 Has Garbage Grinder Been Installed? N 0
Other Requirements
I certify that the system(s) as listed serving the above premises weAructed n ial y as s wn he plans of t he completed work (, copies
of which are attached), and in accordance with the standards, rules cc dance th he lied plan, and the permit issued by the
Putnam County De rtme tt Of Health.
Date ` 8 Certified br P.E. � R.A.
Address — `1
;V51b License No. X67 3L
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 pubt;: sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available.. Such approvals are
subJect /t�o7/ /I�odif)cation or change when. in the Judgment of the Commissioner'Gof Hea revocation, odHlutlon or change,ls necessary.
Date �� �i /� �V By✓��/ Title�ejd
WEIGHT PER FOOT _-12 Ib_ /ft_
DRIVE SHOE--'RfYES ONO LIiVER: O YES MO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
0 YES ONO
OU
.SECOND.
GRAVEL PACK
0 YES
0 NO
GRAVEL
SIZE.
DIAMETER
OF PACK in.
TOP
DEPTH tl
BOTTOM
OEM tt.
WELL YIELD TEST 1 If detailed pumping
METHOD: 0 PUMPED i tests were done is in-
0 COMPRESSED AIR , formation attached?
0 BAILED 0 OTHER :OYES ONO
�p�ELL LOG If more detailed formation descriptions or sieve analyses
Yy are available, please attach.
DEPTH FROM
SURFACE
water
Bear.
ing
Well
Dla'
meter
FORMATION DESCRIPTION
CODE.
It.
tt.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
it.
YIELD
g0m-
Sudice
y
I.
:3
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
WELL DRIL NAME `�y�, D�F`
AoDRE `3�/� �ttfitlRE
��
PUMP INFORMATION
TYPE C PACITY
MAKER � DEPTH
MODEL VOLTAG HP
u
i
f
f,
1
f
O
G
S �
14
.� 3
I
3
hb
h
SEPARATION DISTANCES IN FEET
r 2 K14 d 7 8 9 10 ►1 12 r3 14 ?s 14 22 29 110 11% jlL )Is
19 S3 44 45 4t 118 12S 130 12�
C 39
AS —BUILT SEPTIC PLAN
prepare-d for
0
WI.L IAM PESATURE
APPLE HILL RD. SCALE : I °=100
t TOWN OF PATTERSON 5:/1/88
PUTNAM COUNTY, N.Y. M 69 B 4 L. 64
z
WrILJL WrLrLzLiun r%.zrUr%..L
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOURESS: 1ZWN/VT0a1CII?' TAX GRIO NUMBER:—
APPLE HILL ROAD PATTERSON, N. Y.
WELL OWNER
NAME: BOMAR . HOMES ADDRESS:
@ PBIVATE
❑ PUBLIC
USE OF WELL
I - primary
2 - secondary
S 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 o gal.
REASON FOR
DRILLING
,11 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft. I
STATIC WATER LEVEL A""ft. AfDATE
MEASURED
DRILLING
EQUIPMENT
/1k ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING A—OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 3 tL
MATERIALS: kSTEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE 3e)LYft.
JOINTS: ❑ WELDED CRTHREADED ❑ OTHER
—DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE MOTHER
WEIGHT
PER FOOT Ib./ft_
DRIVE SHOE dYES ONO LINER: OYES 0110
1
SCREEN
DIAMETER (in)
-SLOT SIZE
LENGTH
(It)
DEPTH To SCREEN Q
DEVELOPED?
DETAILS
❑ YES ONO
:SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE-
DIAMETER
in.
OF PACK —1
TOP
DEPTH —ft.
BOTTOM
DEPTH — It.
WELL YIELD TEST If detailed ptimping
METHOD: ❑ PUMPED tests were done is if.-
• COMPRESSED AIR formation attached?
• SAILED ❑ OTHER IOYES ONO
It more detailed formation descriptions or sieve analyses
'WELL LOG are available, please attach.
DEPTH FROM
SURFACE
ear-
Vng
Well
Oia-
meter
in
FORMATION DESCRIPTION
CODE
tt.
ft
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
gpm.
d
S Lanurface
-2 )--1
2- -1—
3
[WATE� ❑ CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
❑ COLORED ANALYZED? 0 YES ❑ NO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE
CAPACITY GAL.
WELL DRI NAME DATY—,
/4A�oq_ --
-i - L LIJ
-fG
AOOR 10ftPe
I
PUMP INFORMATION
TYPE C PACITY —
MAKER DEPTH
M KER DX
MODEL VOLTAG, HP
M: 0 L
I
9 'b
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
Director: Albert H. Padoveni M. T. (ASCP)
T- FALK, ROBERT
RD #2, WILLIAMS WAY
STROMVILLE, NY. 12568
C. *A. 006796
LAB
Date Taken: 4/26.188 Time: gam
Date Rc'd: �0 Time: ;?5am
Date Reported: ._ X88... ......
::.... <_ _
Collected By: balK
Referred By:
ggample Location:
App e Hill Rd,
Phone N
Phone # I Sample Type:
L I Repeat Test? _ (check one)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL.(CFU /100mL)
Acidity
_ Alkalinity
Chloride.
_ Detergents, MBAS.
.__ Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
_ Sulfate
_ Sulfide
Sulfite
METALS (mfr /L)
Copper
_ Iron
Lead
_
_ •-Mangane s e
_ Mercury
_ Sodium
Zinc
MISCELLANEOUS
pH (units)
Color (units)
Odor (TON)
_ Turbidity (NTU)
GENERAL BACTERIA
X Standard Plate Count 3
(CFU /1..OmL)
MEMBRANE FILTRATION TECHNIQUE
X Total Coliform to
Fecal Coliform
Fecal Streptococcus
MOST PROBABLE NUMBER TECHNIQUE
Total Coliform Index
Fecal Coliform Index -
KEY FOR TERMINOLOGY
N/A = Not Applicable
LT = Less Than ( <)
GT = Greater Than (�)
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
NR = Non - reactive
REMARKS /COMMENTS (For Lab Use)
X Potable
Non- potable
_ STP INF
_ STP EFF
Ot "her :
Sample Status:
(check .each)
Outgoing
_ HNO3
_ .HC1
H2SO4
_ NaOH
ZnOAc
Na2S203
Other:
Incoming
X LE
4 °C
GT
4 °C
_ pH
LE 2
pH
-GE 9
_
pH
GE 12
_ Other:
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS))(WASN'T) (N /A) OF A .
SATISFACTORY SANITARY QUALITY ACCORDING TO TH f4 YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTIO
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) N DNKING MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAT WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
X I -%I
Albert'X. Padovani, M.T. ASCP), Director
2 /86(Rvsd7 /87)RWE
lG
PUTNAM COUNTY DEPART OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
lk %ka ''t om f f �. peS
Owner or Purchaser of Building
%BAR 1J,nv---eS
Building Constructed by
Loca i.ot - Street
10 1 ek P S
Municipality
Building Type
61 1' a
Section Block Lot
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
... "Cprtificate_..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 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 was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this day of 19
QA
Gen al Contractor (Owner) - Signature
Co ration Name (if Corp.)
0-�A f Zg'?—
am
rev. 9/85
mk
Signature
Title
Corporation Name (if Corp.)
jocz, 411' �V /i/ /�
Address
s ti
JOHN LEHMAN, P.E., P.C.
CONSULTING ENGINEER
.. 10 GALLOWAY "F'iTS. '. -
WARWICK, N.Y. 10990
914 -986 -7737
August 28, 1987
Mr, John Karell Jr., P.E,, Director
Environmental Health Services
Putnam County Department of Health
110 Old Route 6 Center
Carmel, P1ew York 10512
Re: Apple Hill Development
SSDS Application
Lot ff 5, Lot # 12
Dear Mr. Karell:
Enclosed are three revised plans for both Lot #k 5 and Lot #r 12. The plans
have been revised based on the copies of Appendix B, dated August 8, 1987,
that you sent us. The following changes have been made:
Lot #r 5
1. The hydraulic profile now shows the depth of fill required. A
typical fill detail is also located on the left hand side of the
.s.heet,
2. The grinder note is located below the plan view of the typical
concrete septic tank detail, as per our telephone conversation on
August 26.
Lot ;# 12
1. The grinder note is located below the plan view of the typical
concrete septic tank detail,
2. The future expansion area has been moved to the downhill side of
the septic system.
Sin zly y urs,
John Lehman, P.E.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A.WATER WELL-
.__-
PCHD PERMIT #
WELL LOCATION
Street Address
Old Route 22
Town /Village /City Tax
Patterson, NY 69
Grid Number
WELL OWNER
Name
Loft Corporation
Address
Pump House Road Brewster, NY
Private
❑ Public
USE OF WELL
1 - primary
2 - secondary
d RESIDENTIAL ❑
❑ BUSINESS 0
❑ INDUSTRIAL U
PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
FARM ❑ TEST /OBSERVATION
INSTITUTIONAL ❑ STAND -BY
❑ ABANDONED
❑ OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT 5
gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 600 gal
REASON FOR
DRILLING
NEW SUPPLY
❑REPLACE EXISTING
❑ PROVIDE ADDITIONAL SUPPLY
SUPPLY ❑DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
New Single Family
residence
WELL TYPE
DRILLED
DRIVEN
ODUG
GRAVEL
OTHER
IS WELL SITE.SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Apple Hill Development. Lot No.
WATER WELL CONTRACTOR: Name Henry Boyd Address: Route 52, Carmel, NY
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY - -FROM NEAREST WATER MAIN: - --
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
OON REAR OF THIS APPLICATION SEP TE SHEET
7/13/87
(date) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam gounty
Health Depart m t.
Date of Issue: 16 19
Date of Expiration: 19 Pe#fit Issu'ng Official
Permit is Non - Transferrable
puMM Ca= DEPAFIMM OF HEALTH •' OF 81 P • ' 181 Y• 31 • C 81•
i D
It h A T 8i• •• • M a I le 1 *- • y
REVIEW SHEET - CONSTRUCTION PERMIT...
DATE REVIEWED
u.
BY: -
_ of -` r) (Street Location) p ,'
COMMENTS YES NO DOCUME�TT.S Lo
Permit Applicationl'
Corporate Resolution
Plans - Three sets s/s
Engineers Authorization
- --' c- Design Data Sheet (DDS) SUBDIV
U Deep Hole Log ;- c
Consistent Perc Results 3) 2^ Fill _
- Perc Hole Depth' c —
required
60 ft. max.`
Parellel to
FILL
new
House Plans - Two sets
Well pem t; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tewn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DELULS ON PLANS
Sewage System Plan - (north arrow)
} Sewage Sys 1'oi - Gravity 1
Fill Profile Visions - of
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Servi dine eve
Construction Notes ( inder not ,sY
Desi � c and deep, r�ilt c = =s. Existing
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 Bedroans
Wells & SSDS's w /in 200 ft. of Proposed Syst
Property Metes & Bounds .
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of
20' to Foundation Walls
100' to Well; 200' in D.L.C.D, 150' pits
100' to Stream, Watercourse, Lake Unc. eN
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain,piped wa.tera
10' to Water Line (pits -201)
50' intermittent drainacte course
Septic Tanks
10' from Foundation; 50l to well
15' Well to PL
O y /
JOHN LEHMAN, P.E., P.C.
CONSULTING ENGINEER
1O GALLOWAY HTS.
WARWICK, N.Y. 10990
914 - 986 -7737
I
September 29, 1987
Air. John Karell, Jr., P.D., Director
Environmental health Service
Putnam County Dept. of Health; " ~n
110 Old Route 6 Center
Carmel, NY 10512
Re: Apple Hill Development
SSDS Application
Lot „5
Dear Mr. Karell:
Enclosed are three revised plans for Lot ;r5. The plans have been revised
based on the copies of the Appendi.. D and the plan you made notes on dated
September 9, 1987, that you sent us. The following changes.have been
made:
Lot ;1-5
_ .. ............. . 1. The depth of fill__has. been..shown.. on -,both .the plan view and .the_.:.._. .- ... -.
— hydra-u1'ic prof ile.' The volume- of "rill "bias "Cilso "been shovhl in `the
hydraulic profile.
2. Clay barrier has been shown on the typical fill detail shown on
the left side of the sheet.
3. The new construction notes were added.
n. A note was added in regard to the depth guages.
5. The final contours were added its plan view through the fill area.
Sincerely yours,
John Lehman, P.E.
PIJT14AM COU171'Y DEPARTMEN'..1' OF I- EAL'.1'II
DIVISION OF ENVIRONMENTAL I-11KAIJ.P -I SERVICES
COUNTY OFFICE BUILDING CARNII?;L,Z_N. Y. 10512
DESIGN DATA S , -T- SEPARATE SEWAGE DISPOSAL SYS'T'EM FILE, N0:
OwnerI. tAOUgs Address o.L SLR -sue
Located at (Street S� 9 e� c.c�-- Sec . &z3 Block Lot_ ..,if -
lndica -e nearesf_ cross sUi7 e�
Municipalit Watershed
SOIL PERCOL.�ITION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
—2 19.E � - 1
?:1S.. _ 17C
iVumber rj CLOCK TIPS
PERCOI -ATION
PERCOLATION
Run Elapse
L 51)th to Tamer Water 1r°vei
IVo. Time
from Ground Suri'ace
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop
Inches Inches
Irlches
5A 1 I I :SA - 1112 7 -4 so
2$
30
_24 -2 yz
2 Vz
5
—2 19.E � - 1
?:1S.. _ 17C
3
zlz�7 7-0
77
J
0- TQPQ11._��- 1�" C�A�II �21�L6�_L li-.'35�'►.�1�V L�?� —
1
2
3
5
Idotes : 1) Tests to be repeated at sarr: deptli until a,p proximately equo.l. sail.
mates are obtained cit each percolation test hole. Al data to be submitted
for review.
2) Depth measurements to be unde from top of' hole.
DEPTH
G.L.
6"
12"
18lf
21411
30"
36"
42"
4811
5 �4"
60
IMS
7211
7811..
8V sAacrr --
INDICATE I - L AT WHICH GROUND WATER IS ENCOUNTERED
IPIDICATE LEVEL TO 14IIICII WATER LEXEL RISES AIPTER DEING ENCOUNTERED
TES`T'S .Nl.�1DE BY - .._..__.- - -
DESIGN
Soil Rate Used 12 KLi-V1 "Drop: S. D. Usable Area Provided��
No. of Bedrooms Septic Tank Capacity 1,po Gals
Absorption Area Provided By ?,-t5 L.l?.x2 14 3 ~ ;;'�tiit�?� ch.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITi-i APPLICATION
DESCRIPTION OF SOILS ENCOUX.VERED IN TEST HOLDS
HOI;E -NO. HOLE N.O.: HOLE-
:.NO:: _
TOP wit.. _
so�sca� L --
GLXY L 15-1LT
Itianle .��lA����_ �I�L+\ �C• �� 1(�11�re ✓�.: y,
+.t i= 11'11° � 7_ •::.. �, r,, '�-
'* l
Address_L c !�
+0,F
THIS SPACE FOR USE BY I. EAU.PH DEPARMENT ONLY:
Soil Rate Approved_ Sq. Ft /Gl1. Chocked ley Uate
PUTHAM COUNTl7Y DEPARTMEWT OF ITJEAL'.l'II
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING- CARMET,, N. Y. 1051 -2
DESIGN DATA S - iT- SEPARATE SEWAGE DISPOSAL SYSTEM FILE, NO:.
Owner'_a t� oa�(�,�c.6a _ Address g. ),_p
Located at (Street�SPe�y ! ., Sec:. � lock -Lot ` -_-
�ricilca e nearesf, CrosJ s7r 6et
P9unicipality Watershed.
:TOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
TI-0 re—
- --
Number rj CLOCK TIPS PERC0LATION PERCOI•ATION
1= Eiapsse D31` 15 -fi o W-aE_e-r - -wa- e Lr°vet -- --
IVo. Time Prom Ground Surface in Inches Soil. Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Irlclies
_5A 1 I I :S4 - 1,2: ?4 O 24
1 :00 - 1: Z�o— 0 24 2Ke Yz 2 %
5
Rol 41 : Ao - f 1: Sce -,lR 2Z
-- 3 12:IZ - 12:3 -i 70 24_ - -T -_
0 -b°, rt'aP �?►� �_! _�.E��LI. I t +l�Sl'+ C 1 - .:t �l�?��' "°�t _
1
2
3
h
Notes: 1) Tests to be repeated at salt:., deptll until e,pp??�.roximatel� equa.'. soil
rates are obtairied'.(vt each percolation test hole. A1.1 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
DEPT!1
6"
1.211
18"
2411
�
0"
3611
4211
48"
51111
60"
66"
7211
7811
TEST PIT DATA REQUIRED TO BE SUBMITTED 1�J7:TIi APPLICATION
DESCRIPTION OF SOILS 1ENCOUMUERED IN TEST HOLIES
.,HOLE.. NO- 5
TOP t�O 1 �.
INS! 1?5i
• 71 .A
-HOLE NO:
84" s�crr >L�1v�� r3 -coy
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LTXEL TO 1411ICII WATER LEVEL RISES_ AFTER B EING..ENCOUMERED
TES` S 1�1;r1DE.: X ;_1
DESIGN
Soil Irate Used m i'Wl "Drop: S. D. Usable Area Provided_ 5,gc
No. of Bedrooms 3 Septic 'I'anlc Capacity I,occ) Ca is�E c71
Absorption Area Prov.-Wed By ?,-tom L.F.x2lI" j `� j crlc�t i� cti.
g
..-
Addre s s_o C,t u,,
aIAL
_�ldlir3 _v _1 Mly.
THIS
SPACE FOR USE BY f.LCl1L'.PH DEPARTMENT
ONLY:
Soil
Rate Approved_ Sq. Ft/Gal.
Chec -od
15 Dote
�t
K...
%7)
n r
h�
:? rn
Ce
?iy�E
I
PUTNAM COUNTY DEPARTMENT OF HE-AUL-11
DIVISION OF ENVIRONMENTAL I-IFMUfH SERVICES
COUNTY OFF-ICE BUILDING CARMEL,-N. Y. 1051-2
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYS'T'EM FILB NO'.
0,viner
Address rra_
Located at (Street
"Q Sec. J31ock _4 Lot
nate neaF6sf__cross ai7&_e_tY
Municipalit ;=,A,-T-Tar,, aou Watershed,
SOIL PERCOLATION TEST DATA REQU-111ED TO BE SUBMITTED WITH APPLICATIONS
_e
TI-0 I
lqiimber CLOCK
TIME'
PERCOLATION
PERCOLATION
1=
EI-Epy-se
—Ne TTE-E5-Wa-C-e -r ---VYFe -37-175 v e I
—
ho.
Time
From Ground Surface in Inches
Soll Rate
Start-Stop
Min.
Start Stop Drop in
Min./in drop
Inches Inches Ii4ches
5A I J II 12:24 s0
24
GIs
2• 2!(e Y2. -2,/z
4
z2e> IL i I
2
3 lz..Z;7 7_0
2Z
C) -
2
�3
14otes: 1) Tests to be repeated at saq; cteptil I'll-Itil e roximatel� equal soil
rates are obtained at each percolation test hole. UY data to e submitted
for review.
2) Depth measurements 'to be made from top of hole.
"I.- _�
T.1' D WITIT APPLICATION
TEST PIT DATA REQUIRED TO BE SUBMI E
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE
HOIF, N-0 _'___-HO1
G. L. -TO? 1950 1 t-
6
1211
2)[11 _'SAhjT>Y LP61A
36
42"
4811
51111
6011
6611
7211
811
7
84
$—Am Y WDAM Wk99MVev_ -vc�o d-0
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LF�, l L TO WKICH ITATER LEVEL RISJ_-,',03 AFTER 131E-,ING.._..ENCQ1JNTERED
-Date:--
DESIGN
Soil Rate Used I?- T1111VI"Drop: S.D. Usable Area Provided5,gc�_.
14o. of Bedrooms 3 Septic Tank Capacity %,C)C)c) Gal (91 IN C-xz =r`97z_
Absorption Area Provided By_g�q_ L.F.x 36":_//,� Ot T..
21111
0
/ 01' ut IIIEVI�
§4_
1-amM&M. P.Q. Signature
Address_Lp 3 1' L
G
THIS SPACE FOR USE BY 11EATIVII DEPARTMENT OPJTY:
Soil Rate Approved Sq. YltlGal- Checl%-Od by
Date
cn
rn
P'l
Date