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631- 589 -8100
41.09 -1 -3
BOX 20
.? IN Ir
MANI
.,
aNg
16 .`
10.1y IN
i
Rev.4 3186 WN
Located at
Owner /applicant
Melling Address
PUTNAM COUNTY DEPARTMENT OF HEALTH
nn of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide PV — 1,1
P.0 -u_n_ n.,rm!t u—
3
FIANCE FOR SEWAGE DISPOSAL SYSTEM
Separate Sewerage System built by r
Consisting of Gallon Septic Tank and
Ell_4AM VA lle,
Town or VMMe
TaxMap Block Lot
,Q 0 qd
Subica slon Nallhe 17J _Subdv. Lot #
Date Permit Issued ���
Pr
Water Supply: Public Supply From Address
or., Private Supply, Drilled by r Address ZWA ! _,_ ki a �
Butldfng.Type f SE.O AAACI I Has Erosion Control Been Completed? /
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constru ease tie s shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and req ti a, n ac rd' ce with the filed plan, and the permit issued by the
Putnam Count De rtment Of Health.
Date Ce►tif d by P.E. R.A�.-
Address License No.�lo�
Any person occupying premises served by the above systems) shall
conditions resulting from such usage. Approval of the separate
available and the approval of the private water supply shall become
subject to mopificqion or change when, in the judgment of the
Date J By
pr ptltaka such acttofi as may be neuaasry to soeure the correction of any "unsanitary
is rage system shall be a null and voitl as soon as a pubt ?z sanitary sewer becomes
n 1 nd v wh a p bite water supply becomes available. Such approvals are
C issio r o4 1 , h r ocatibnL m"fleation or change Is
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMI #
ON CERTLFICA MP NCE.
3� Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT #
CONSTRU TION PERMIT FOR SEWAGE DISPOSAL SYSTEM / oWM, 01 ��1'j�401 IU4V
/ / /r/�, I Town illage
Located at a-SAkE -C 904r> Tax Map / sock tot
Subdivision /° i5gcw-
owner/Address STA �°�./ � l � -^e4}IG�W�
Building Type ® ' Lot Area
Number of Bedrooms 2— Design Flow G /P /D e
Separate Sewerage System o consist of 100,
To be constructed by
Cam.
Water Supply: Public Si
Private S
Address
Other Requirements
Renewal _0 Revision _
Date Of Previous Approval
Fill Section Only ❑-
P.C. H. D. Notification u:. I
Caul. Septic Tank and ZS2 f77 ` wibre° rfi°'4
Address S
1.
1 represent that I 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 and regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage 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 original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be install in act an ith the andards, rules and regu aTf o s of the Putnam
County Dgpartfnent of Health.
Date
r Address L1 'w— W
APPROVED FOR CONSTRUCTION: This app oval expires
revocable for cause or may be amended or modified when cc
requires a new pormit. I Approved for disposal of do es
Signed P.E. `Z R.A.
icense No. 06V
n r from. h date issue nless c struetion of the building has been undertaken and is
a nece ry by missioner Of Healt Any change or of construction
wry s ge, an to wat r supply nly.
Z. �J�JA Titles
WELL LOCATION
WELL OWNER
USE OFVELL
1 - primary
2 - secondary
AMOUNT OF USE
REASON FOR
DRILLING
DEPTH DATA
DRILLING
EQUIPMENT
WELL TYPE
CASING
DETAILS
SCREEN
_:;:;- DETAILS _.
, U.
WELL COMPLETION REPORT
Office Use Only.
DEPARTMENT OF HEALTH�
siop_ pf.,,Envirormental Health_ Services
UTNAM COUNTY DEPARTMENT Ot.HEALTH
TAX'GRIO NUMSER:,-
IVATE
ESIOWAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP L,/6' ABA hOONE'D
0 Ell'
USI
USINESS 0 FARM ❑ TEST /OBSERVATION 0 OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY 0
YIELD SOUGHT gpm./NO. PEOPLE SERVED BEST. OF DAILY USAGE
%NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION
N
0 0 C
EP LACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
WELL DEPTH ft. STATIC WATER LEVEL _�ZJDATE MEASURED 4AP2
�KROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
P,
• SCREENED O,OPEN END CASING. )RrOPEN HOLE IN BEDROCK 0 OTHER
TOTAL'LENGTH
DIAMETER
WEIGHT PER FOOT
DIAMETER (in)
FIRST
GRAVEL PACK
1
0 YES
❑ NO
I GRAVEL
SIZE.
WELL YIELD TEST
If detailed pumping
MffHOO: 0 PUMPED
t tests were done is in-,
)I�COMPRESSED AIR
formation attached?
0 BAILED ❑ OTHER
❑ YES 0 NO
WELL DEPTH
DURATION
I
DRAWDOWN
YIELD
It.
hr. min.
It.
gpm.
WATER . CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
PUMP i RMATJON
TYPE CAPACITY
MAKFR.09) Z!,�OEPTH
MODEL _40LTAGE130/tv 2-1
4—
ft- MATERIALS: )EtSTEEL. 0 PLASTIC ❑ OTHER
HER
ft. JOINTS* 0 WELDED JZ H
THREADED 0 OT ER
in. SEAL: ❑ CEMENT GROUT 0 BENTONITE ETHER
lb./ft- DRIVE SHOE� ES ONO LINER_ QYET,-QNO
SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED?
D?
'
OYES ra, U NO
I DIAMETER Imp
m
OF PACK DEPTH BoTra
OEM It.
WELL LOG
WALL more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM 'W,t,, Welt
SURFACE Pear- Dia- FORMATION DESCRIPTION CODE
ing meter
land
Surface -4
STORAGE TANK: TYPE _4�,�-,Y-,;��--W-#-
CAPACITY r PAL.
WELL DRILLER NA941 DATE
ADORES Sl GFIMRE
L/
THESE RESULTS INDICATE THAT.THE.WATER SAMPLE.L('WAS ) (WAS NOT) (NOT APPLICABLE)
OF .A SATISFACTORY�SANITARY QUALITY - ACCORDING. THE NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, A TIME OF COLLECTION.
Albert H. Padovani; M.T. (ASCP), Director
LEGEND
'RDS = Recommend Disinfect -
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
_
Yorktown Medical Laboratory, Inc.
LAB IY
--
321 Kear Street
„ Collec.tion.Station Used:
_ Heis! N Y 1Q598
Yorktown ght
Carmel Peek
Peekskill
— —
(914) 245 - 3203.
Director: Albert H. Padovani M. T. (ASCP)
Date! Taken:,'
Date. Received c _2s
d / /u
Date Reported- 3 -�22_�
a
Collected .B
3 (�/j2%r'�L L cS'
Referred By
�%p AIJ�C%YL j / v �/ .J
Sample . Source:
GU
,.
L
LABORATORY REPORT ON BACTERIOLOGICAL
QUALITY OF :WATER
GENERAL BACTERIA.
Standard
_ Plate Count per 1.0 ml.
6.(�
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
V Total C.oliform ml
rer, 100
THESE RESULTS INDICATE THAT.THE.WATER SAMPLE.L('WAS ) (WAS NOT) (NOT APPLICABLE)
OF .A SATISFACTORY�SANITARY QUALITY - ACCORDING. THE NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, A TIME OF COLLECTION.
Albert H. Padovani; M.T. (ASCP), Director
LEGEND
'RDS = Recommend Disinfect -
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
..
Owner or Purchaser o Building— Muni ipality
Bu ilding Constructed Sir Section
,44jei SW4P- !mil l� : (.V�ilT �G��/�irlc3 6941 k- 1'4fie�6
Location - Street Block
Building Type rot
GUARANTY OF SEPARATE SEWAGE 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 guaranty to the owner, his succes-
sors, 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 initial use.of'the sewage disposal
system, or any* repairs :Wade by me to such system, except where the failure
to operate properly is caused by the willful or negligent. act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the.Director of the Division of Environmental Health 5er
vicas of the Putnam County�_De artment- of Health as t,o; whether_ or _notw,w
Pa Zure of the system towoperate was caused+ by the wil fu i egligent }
act of the occupant of the building utilizing the sys emm �
Dated this day of 19 Signature
Title /JJ1 L-d I
(If c rporat on,— give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmen
Mahc
,
N4 Department. of Health
A.CIONSTRUCTi ®N 6NC.
��
tion ®Trucking o:Equipment Hauling
•jSepUc�Systems- Specialist
�p,Soil o Fill'a Gravel ®Black�Top ;
shollow�Ri9r��- RFD�9�$�Boxx4,7�4 �; „, �� ��
ac`New York 10541 x(914) 62135738 1
-------------
APPENDIX C
o -.7 a FINAL., SITE INSPECTION
ION ER
f_ r MIT TM #^ OR SUBDIVISION LOT #
IV.
V.
Vi.
Y E-c:
14 C
CONIS
.SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
. Fill section - Date of placement
2:1 barrier. LGTH WDM AVG.DPTH
c. Natural soil not stripped..
d. Stone, brush, etc., greater than 15' fran SDS, area.
e. 100 ft. fran water course/wetlands.
SEWAGE DISPOSAL SYSTEM .......
a. Septic tank size,,--'1,000 1,250
b. Septic tank ins eve1
c. 10' minimum fran foundation
d. No 900 bends, cleanout within 10 ft. of 45.0 bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX properly set
g. TRENCHES
,1.,Length requi Length installed—)
2. Distance to watercourse measured: ft.
3. Installed according to plan
,4.' Distance.center to center 6
.�5. Slope of trench acceptable 1/16 1/32
6. 10 feet from property line - 20 feet - foundations
.7. Depth of trench < 30 inches from surface
8. Room allowed for expansion, 50%
9. Size of igravel 3/4 - 11" diameter
10.-De th of qravel in trench 12 minimum
`11. Pipe--ends' -tapped= -------
----------
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber-
2. Overflow tank
3. Alarm, visual audio
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrooms
WELL
a. Well located as per-approved plans
AAJ J k,
b. Distance from SDS area measured J ft.
C sin �g 18" above grade.
�
d. Surface drainage around well acceptable.
C -e-
.OVERALL WORKMASHIP
a. Boxes properly grouted
c- cc -p-,1 C-6 1 e
b.- All pipes partially backfilled
C. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e:. Curtain drain installed according to plan
1 -CA e 8
f. Curtain drain tected & dir.to
outfall pro exist.watercourse
9. Tcot'inq drains discharge away from SDS area
h. Surface water protection adequate
io RFrosion controi provided on slopes greater
e,
' PUTNAM COUNTY DEPARTMENT.OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re.: Property of
Located at
Date
g-- S/46 tZE - )e4lz'
(T) Section / Block 19 Lot
Subdivision of ic�04?-4XI4 8zoo< .
Subdv. Lot # 42dj Filed Map #Q.� Date 2
Gentlemen:
This letter is to authorize
a duly licensed professional engineer 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
systerri _or;- systems' 'iii' conform�t it,!h..the
provisions. ;o;f "Article_ 145_.
147, Education Law, t%' Health Law, and the Putnam County Sani-
tary Code.
Cokftl
pOIIAP' � truly yours,
s ®1.
Signed
Countersigned: r Owner of Prope ty
�2��
P.E., R.A., # Address
Ci C g=LAi Ltd ei Ci JO /C /O U�
Address Town
OAtkr
J
Telephone J
43j
Telephone
44'0"
14'5* 7 *4 I. 3.0� 17'3
10*6" 21 *0' 3$.0.
C' PLUMB WALL !
BATH s +
•
'.'yr
T". si .
11 e°b 0 O
F -- l
•
Iy .
il <
�MN
N
•
F-
3. 0
DROP
�tILiN
N 0
CCB_Al O
D ❑p C ;, HALL
�.. I
6.7a 5.0�
BEDROOM t2
2.10 7.1
10.0" 2.0�
;•� KITCHEN / DINING
BAT +1
• fff���111 O iX 01.
CATBiDRAL CSILING
i•
r
O I •
1
1 _ 73� 10,0 i.
ShlOKB. DZTZC70Ti
CATBYD2AL CRILING
LIVJN.G ROOM
F.
f ,
i
iO 11
loo
FLOOR PLAN
•
b
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n
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PUTNAM COUNTY DEPAR MENr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEDGE DISPOSAL SYSTEMS
(Name of Owner)
REVIEW SHEET - CONSTRUCTION PERMIT
DATE REVIEWED: 31 �D (SCP
(Street Location)
DOCUMENTS
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
REQUIRED. DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump 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 /Glitter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;.shown;gravity flow,suff. size
If Pumped Pit & D Box Shown • & .Detailed
House = Nb: of 'Bedrooms'
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout.
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' 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
Ctrtt aztlet ln" above latecat
b. DMIKO M B7k IET M
1. Inlet kr ext min. 2" aboie cutlet invest.
2. All valets at sane elo aticn.
3. Outlets 1" to 5" above tank bottan.
4. Minimum 12" bey irrg clean sand cr pea gel.
5. Inlet baffle.
6. Mmdm n 12" cover.
7. Fen able cover fcr as Mss.
8. Smisd pipe joints (as#a.lti.c cr equal) .
9. Mcpe attlets at 1/8 inv/ft. (1 %)
. cutlEt.
3.. Iatemis fly with bottom.
4. TiGht joints pipes bat em bcxLs.
1. Slcpe 1/16 in. /ft. to 142 in. (0.5% to 0.25%).
2. 3/4" to 11" crushed strxe cr wad% gravel
aggz:eqate-
3. 4 minim n lateral di.a Teter.
4. 2" mini = ate over lateral..
.5. 6" minimm aggregate urr-r lateral.
6. Ub atted building paper Ter 2" cf sbzw over
aggrE�te.
6" minimm, 12" rmximm Earth badsfill.
8. Overfill to allcw fcr settling, 4" -6 ".
9. 2'minizrLm from trer� bottom to water- 5ft.gra3e
10. 5'min.h= t mmh bottan to #=vices
7 ft. gmh.
11. Mimc:h gzcinx3:min.610.C.(24 "tnmnch).
12. . UMMSCted lateral a-Os mist be plujgEl.
13. Fill - 2:1 slq:es
min. 10' be2ad trey .
dEPth:3Pmax.aer rock +;21max.cver Hater
Inlnle borers.
PUTNAM CUUNXx 1)C:YtiiCll"ACdYl yr 1Ai:A -.Uiii ,.�.
e. S
.
SSDS/WS PZnE,W S
SHEET - D
DETAILS .
a. SE= TAM TES d
d. WELL EEMM
1. O
O,dPt- 2" below inlet 1
1. 2
2bp cf casing 18" above gra.arl.
2 N
N,inimm 3" bed cf pea gruel 2
2 2
2' above F VL cr t.
3-." .
.irurmsm doh aE� a�ud:.yA' . r
r.. -
- casing cf Hscu,ut
4. l
length - minunxn twice width to maxicnm fair -
4. 1
10, nurulmxn grout
totes width. 5
5. Q
Qi1et 4' below O.G. Mn.
5. M
Ma ru 12" air. 6
6. S
Sanitary ssels
6. I
Iocatim stake. 7
7. G
GnrA grackd avay fine well.
7. N
Nladnle - cooing - minimum 20" in shorter _
dLmmsirn. e
e. CI MUN MAIN DMUS
8. R
Riffle E�±t 20% cf liquid depth abom ligiid 1
1. O
Overfill to allrw fcr settling: i ng: 4"-6„
level UW , b=10 ", &5',b,22"). 2
2. -: 6
6" . -12" natural sail badcfill.
9. I
If le3gth G.T. 9 f - use- 2 WLL-MLt1(t-11tS. 3
3. L
LY7trmted biildirrg gaper.
10. `
` Miniinn tarn capacity 1000 cpl/3 man; 1200 4
4. "
" to 11" clean gmwl cr stone.
ga2/4 be3rcan:134 cf/3 bdm;161 cf/4 b1m 5
5.' M
Min. 4" pa fdated pipe.
11. P
Pq±altic coating frr xein6cxced. cu=ete. 6
6• P
Pipe inve t 6" off bottarL
12. I
Inlet tse� 16" below flow line. 7
7. 1
18" - 24" wicb trench.
13 • Q
Qul-let to mMe 18" belaa flcw line. 8
8. D
Dspffi te-
14 I
Inlet pipe slrpe 1" per foot min. (2%) . 9
9. , S
Se armtirn fron S9CS arEB 15' min. .
15. I
Inlet pipe cast iron, 4'hiin.
f. IITP CR JCIq= Bak IM, P,T! Iq
16. O
O.itlet Pipe slope 1/8" per foot min. (A). 1
1. P
PeTurable bcx cover.
17. Q
Q ullad joints far sanitary tees. 2
2 (
(Xn C
b. DMIKO M B7k IET M
1. Inlet kr ext min. 2" aboie cutlet invest.
2. All valets at sane elo aticn.
3. Outlets 1" to 5" above tank bottan.
4. Minimum 12" bey irrg clean sand cr pea gel.
5. Inlet baffle.
6. Mmdm n 12" cover.
7. Fen able cover fcr as Mss.
8. Smisd pipe joints (as#a.lti.c cr equal) .
9. Mcpe attlets at 1/8 inv/ft. (1 %)
. cutlEt.
3.. Iatemis fly with bottom.
4. TiGht joints pipes bat em bcxLs.
1. Slcpe 1/16 in. /ft. to 142 in. (0.5% to 0.25%).
2. 3/4" to 11" crushed strxe cr wad% gravel
aggz:eqate-
3. 4 minim n lateral di.a Teter.
4. 2" mini = ate over lateral..
.5. 6" minimm aggregate urr-r lateral.
6. Ub atted building paper Ter 2" cf sbzw over
aggrE�te.
6" minimm, 12" rmximm Earth badsfill.
8. Overfill to allcw fcr settling, 4" -6 ".
9. 2'minizrLm from trer� bottom to water- 5ft.gra3e
10. 5'min.h= t mmh bottan to #=vices
7 ft. gmh.
11. Mimc:h gzcinx3:min.610.C.(24 "tnmnch).
12. . UMMSCted lateral a-Os mist be plujgEl.
13. Fill - 2:1 slq:es
min. 10' be2ad trey .
dEPth:3Pmax.aer rock +;21max.cver Hater
Inlnle borers.
_.,.._._ _ ." .. CONSTRUCTION NO
SUBSURFACE SEWAGE DISPOSAL SYSTEMS & WELL WATER SUPPLIES
SERVING SINGLE 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 gp. 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 placement'
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.
3.
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, perform a final:
percolation- test.-in the fill after stablilisatibri:
Impervious fill, clay barrier, shall be a dense clayey soil with little or
no sewage absorption capacity.
/ (zj
------ -COW
93._ ',F ex
41
ot,
J
J
U! 46 %_. -A
A.) /I 69AXA- IVA 4A
- -- -- ---------
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.
Owner Address 3/ � �, �/cs6jKE2S � . \/ _
Located at (Street Cnv Sec. Block Lot_
�7ndlcate nearest cross s AeW
Municipality. j �y 41M ,114 -Lt k �% , Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number' CLOCK TIME PERCOLATION PERCOLATION
Run ...h-Lapse
aeptn.to.water
water Level
No. Time.
From Ground
Surface
in Inches.
Soil Rate.
Start -Stop Min.
Start
Stop
Drog in.
Min. /in.. drop
Inches
Inches.
Inches .
3 �-� 0
5. �
1.
2
hiTy
DEPT,
Notes: 1) Tests to be repeated at same 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.
Name 0 _- S Signature_
Address SEAL
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Soil Rage Approved Sq. Ft /Cal. C c y