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PUTNAM COUNTY DEPARTMENT OF HEALTH -
Rexi. 1186 Division of Env6umental Health Services. Carmel, N.Y. 10512 Engineer to Provide•.Permlt #
n a CERTIFICATE OF COMPLIANCE
CONSTRUCTION PERMIT FOR AGE DISPOSAL SYSTEM permit
V
Located at )E t51 �RlAfZii 4�),I, v A h Town or Village
A Subd. Lot # Tax Mao
Subdivision Za t.ZL 12,
Renewal— ❑ Revislon—b
Owner/AppllcantNamie )1!2��1CA �AA(-Z-to
Date of Previous Approval
Mailing Address C21a Town Nrcy_a_so,� 71p AS-k 75
Ballding .e Area A Fill Section Only Depth volume
Number of Bedrooms Design Flow G/P/D 19 Q6 PCEW *Notification Is Required When FIR Is completed
e
Separate Sewerage System to consist of 11066 Galin Sptl. Tank ands /7-
To be constructed by consist �_V&Xb�SJ_f V6 ::S'� Address i 4 01b /UY
Water Supply:, Public Supply From Addtese
or: Private Supply Drilled Address puzow Aw-,
Other Requirements
I represent that I wholly and completely responsible for the design and location of the.proposed system(:); 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 andregulations of the Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of H.althwill
be submitted to the Department, and a written guarantee 'will befurnished the owner, his successors, heirs or assigns by the builder, that said'builder will
place in good operating condition any part of said sewag . e disposal system Auring the period of two (2) years Immediately following theclate of the issu-
ance of the approval 'of the Certificate of Construction Compliance of the original system or any re I well deqfibed above
_pairs thereto; 2) that the drIllec
will be located as shown on the approved plan and that said well will be Ink4lied in ac d nc with th anclards, rules and r h Putnam
tment f H e`ural�lon_so�/ e
County Depa ealth.
Date Z� Signed P.E.— R.A.
Address 2% 4�N. LIc... No G) q
APPROVED FOR CONSTRUCTION: This approval expir ne yea rom t e i\,j6.d unieVsVconstr'uction of the building has been undertaken and is
revocable for or ray be amended or modified when idered he •Conlnissid—nir of Health Any change or alteration of construction
taus 'r r
it
w m
requires new r Ag1proved for disposal of do. e sa itar sews d/o privalp water hpp",
Date— By Title
804E.5
JOSEPH ZARECKI, P.E.
c
Consulting Engineer
3 East Main. Street
Pawling, New York 12564
to
GENTLEMEN:
WE ARE SENDING YOU Attached ❑ Under separate cover via
• Shop drawings Q Prints Plans .
• Copy of letter O Change order ❑
[LETTIEM OF CTRUSEOIMQ[.
DATE
S�� Flo
JOB NO.
ATTENTION '
AE
the following items:
Q Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
a 16G
o s o �N�1E s �, O�
THESE ARE TRANSMITTED as checked below:
O For approval
g, For your use
❑ As requesters
❑ For review and comment
&FOR BIDS DUE
REMARKS
COPY
• Approved as submitted
• Approved as noted
❑ Returned for corrections
O _
R
• Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
19 ❑ PRINTS RETURNED AFTER LOAN TO US
SIGNED:
11 enclosures are not as noted, kindly nobly us et tce .
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner :S �* Address F.f N
r� Located at ( Street�Indicate Q��c� 3' Sec. $ (� Block 'Lot \I, la .13,1q
, nearest cross sErreet) —T�T'—
i
Municipality R Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
3 �
•�����03:. -��..`) d
`f 3 1�
alb a`F 3 ►`f
Number
CLOCK
TIME
PERCOLATION
-
PERCOLATION
Run
Elapse
Depth to Water
Water Level
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
1
'1 01 .��
I q
18
N 20
Aq
3
�.. .
2
0 0
3
S Qy2
S X10
3 0
al ��
of
3
J
5
11 0�
ji: i _0
14
N "A'
04
1 f, -18 \ - -s : &rj ya )e 1� I aI+ .3
2 s 13
A
Q�* -.14T7 ) I M alu Q1 3 5
Notes: 1) Tests to be repeated at s4:4he depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
3 �
•�����03:. -��..`) d
`f 3 1�
alb a`F 3 ►`f
2
-
3>
Notes: 1) Tests to be repeated at s4:4he depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be 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..
G. L. o
6"
12"
18"
3011
36"
42"
48"
5411
60"
66"
7211
7811
84"
HOLE NO.
\o�SOIL.
HOLE NO.
INDICATE LEVEL AT WHICH-GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY SoS� Date
DESIGN
Soil Rate Used 11-15 Min/l "Drop : S.D. Usable Area Provided .1000 SAC
No. of Bedrooms Ji Septic Tank Capacity, 1660 Gals. Type`� 0. lhs o c ECE
Absorption Area Provided By, oo L. F. x24 "j '—_- 0`' wi th trench.
n cE ►'o..
Address 3 EAS\ SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
a
Soil Rate Approved Sq. Ft /Gal. Checked by "" '''Date
�i
t
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
�1�•V� o� \ 1 \ U �o
Re: Property of
r
Located at EAS'C
Section Block Lot
3
' Subdivision of
Subdv. Lot # Filed Map # Sly Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer r"' 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
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
: ":'-."'Very tT y yours,
Si ned,4
Countersigned:
Owner of Prope ty
>:
R.A. ,#
`ra Address
Address Town
- ?c- �t/��.v� c� T? - 7`379
TdIephone
Telephone
(Name of Owner)
INITIAL SITE INSPECTION
Wetlands on /or proximate to property ............ J
Property lines or corners found .................
Can estimate house location ......................
Will driveway need cut ..........................
Must trees be removed - note these...............
Deep holes representative of entire SDS area...
Additional deep holes needed .................
Sufficient SDS area available considering driv
cut, house location, separation distances,etc
Adjacent wells /septics..........................
(Street Location)
I YES I NO
D.H. 1 Lot
Depth to G.W.
Depth to rock
Soil Descri tion
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil De cri tion
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE+f - - 15 S — '-S..&
INSP. BY:
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
Soil Descr
DATE: LIZ t
FINAL SITE INSPECTION INSP.BY:
YES
NO
CCMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........:
Room allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.............................
10 ft. maintained fran property line and
20 ft. fran house .... ........ .... .o-........
Distance well to SSDS (ft.)......:/ ................
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench .... ...........
'
15 ft. of peripheral soil horizontally
fran trench— ... ...............................
Boxes properly set ...............................
�.
,
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
�—
FINAL GRADNG OF SITE ACCEPTABLE..
�`INDJVIDCIAL MT?. SUPPLY SUBSLUTACE SEKNZE DISPOSAL Y?
REVIEW f71 CaiSMUCIrION • E1`
DATE REVIEWED. 05 i
winy `' +.'
M ?. • NO
MM
MM
�r
MM
MMMERAPP,
.'
Ms
�r
MM
M-MMM
MM
MM
MM
WAM
e�
Sol
ion
DOC: ENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization'
Design.Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS� - Letter
Variance Request "
PM UIRED DETAILS ON.. PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Fla.
Fill Profile & Dimensions - Volume
D.,or J Box Tren hJG- allery; P-t= pit details
Septic Tank Size, Detail
Well Detail; Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area ;shown;gravity flow,suff. size
If 'Pumped. Pit & D Box Shcwn & Detailed
House _No of Bedrooms
Wells . &: SSDS's w /in 2Q0 ft r = <of Property Lte3 •-'
Property Metes
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 .
20 r *to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake ( inc. ev-- -an).
15' to Drains - Curtain, Storm, Leader, Footing
25' to Catch Basin
101 to Water Line (pits -201)
Septic Tanks
101 from Foundation
50, to Well
151 Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
-PURIAM COMM
a. SEP= • K •E=
oTi 72!- Icw inlet
2. Mninn 3" •E• •f •Ea 9awl
3. F&Ijim dqth oE ho-rid 4'
4. je• - nmmrrLm Mee w-i•ffi to mm a= fcur
tfires widdlL
5. M2•inm 12 ccler.
6. Imatim st• �--
7. bbd-&e - qDa*lg - mini= 23" in d)mter
8. B�fr-1 P ecter�d 20% cf 1 io iid dqq-t abae ligiid
level, 0-41, 6=5�1b-12'5.
9. if lejgffi G.T. 9 feet - use 2 corparbnmts.
10. Mi1 tark capdty 1000 •al/3 baa*c• - 1200
•aIA balmcm-.L34 • bdan;161 cf,/4 ••m
11. Asj�-�tic coatirxg fcr reinfmoEd cm=rabe-
12. teqf. ■aa 16" bela4 f Lcw lim-
23. Q±let te- • ■a - 18" bE!cw flcw lin-
. .- --Zx..- A' " per .•• irdn. (2%)
15. IraLt pipe cast imn, 41!u&L
16.
• -&1 d pipe sl•pe 3/8" par t•• rdn. GV
17.
♦a r• • f•• mnitaLy tees.
b. EMMM= EIX DMkUS
1. Jhlct- irwert min. 2!' abcve oatlp-t irmmt.
2. NI C±Iets at I ele�etiaL
3. Cutlet 1!' to 5" ab7.-- tank bcttcnL
4. Minirrm 12" b953i Clem SSUIL Cr Fm 9zva-
5. Milet hef EL--
6. mmdnm 12" cwer.
7. Femxdiae corer far.
8. -cao ai pipe jaints (asjtaltic cr e3jal)
9. SLCP-- Cxtdets at 1/8! irvf t. (1%)
10. R
1. sicce 3/16 in./ft- to V32 in. (0.5% to 0.25%).
to lill cnnljEd strne •r was he c-=vd
aggrII•ate-
3. 4" nuimimn
4. T mimimm aggrup-te o;er lateral.
5. G'ffdnimm agg M•- t- u-d--I lateral.
6. utret-ed bAlding pacer cr 2" -cf sttzw cuer
aggnf-te-
7. 6" irdiiinim, 12" rrEodnun eerth beckfill.
I
a. O;erfM to al'kw fcr settling,
9. 2 lmi ■ =a tre-rh bottm • N%RbeC-5f+-9cBd2
10. Trvin.f= trerx:h bottan to iffPm:vicQS
7 ft. gmde.
11. Tm-rh qmai==in.6'0-C.(24"trerh).
.12. Lb=m�- I- •aral e-& mist, be p4rjqEd.
sl••es
nin. 10, bwaxi tce�.
dq:th:3Pumc.a?er xock+;2nBx.Cer vaber
CL WaL MAM
I'- I TV Cf Ming is" abuxa- 9m -A
2. Tzp cf aising 21 abov-- I-M cc uaterticht.
3. - MLu�= 20' aLRing cf steel cc vxu#t i=
4. 10, vL-iir= gmt into nzk.
5. 03ELet 41 balow aG. rrin.
• S3nitzy mals
7. Gmx)d ••• • a-ay frcm well.
1-- Oxn±M to allrw fcr I ing: 4"-.6"
mb--rua s• a J:Ee:3djn.
3. Utfea-ted bEading
4. ill
• 11" clean 9mvel • stcm.
• 5. Min. 4" peddratEd pip--
Pipe imert 6'-' off bott4m
7. 18 - 241, wia-- tra-rh.
8- DT-th -da?mte-
9. SePuatim frcm SMS arEa 151 rdn.
.6 - 0-07:4[40 -
to = w Oki - -0 • -
ZINZ
.t •-
..a,ie• s
CONSTR=ON N=S
SERVING SUB=ACE SEWAGE DISPOSAL SYSTEMS & WELL KkM SUPPA
t !LE FAMILY RESIDENCES
Basic Required Notes -
1. All trees within 10 feet of the proposed SSDS shall be removed_
2. SSDS to be inspected by the design engineer /architect and the Putnam
County Health Department after construction and prior to backfill.
3. No trucks, machinery, building materials, nor excavated earth shall be
allowed in the sewage disposal area. Construction of SSDS to be in
accordance with these plans, any revisions thereto, and the rules and
regulations of the permit issuing governmental agency.
4. Minimum well yield of 5 gpm is required. Yields less than 5 gpn will be
immediately reported to the Putnam County Department of Health.
Notes Required When Fill Proposed
1. Fill must be allowed to stabilize for 60 to 90 days following place --it
and be inspected by the Putnam County Department of Health for acceptance,
prior to installation of the sewage system. Date of placement must be
reported to Putnam County Department of Health.
2. Run of bank fill shall be suitable for sewage absorption, be free of fines
or other unsuitable material and shall have an in -place percolation rate
at least equal to that in the natural soil after. the required
stabilization period. The engineer /architect shall perf orm a final
percolation test my the fill after stablilization.
3. Impervious fill, clay barrier, shall be a dense clayey soil with little o=
no sewage absorption capacity.
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