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Home My WebLink About2552DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -139 BOX 22 02552 � v is rA ir }� Ir r. �. 02552 ' PUTNAM COUNTY DEPARTMENT OF HEALTH d '>.a V 3/ 86 Division of Environmental HesltL Servlceei Carntel,'N.Y.105 �j glneer not Provide ', P C H D PermitN_ — RTIFICATE OF CONSTRUCTION COMPLUNCE TOR 'SEWAGE DISPOSAL SYSTEM v.�ri/�YJ �' � '444 -..._ _ Town 'or Village :? Loted at "G �_ p so�G f "� 1,- Tan Map 3 :: Block yet' 7 Lem . �. Y►n o f" +b Formerl Subdivision Name Subdv Lof' # Owner /applicant Namit y % J Zip /6 Date Perm ling it IsenedJ �S l %d �o�io g5 Mai Address Separate Sewerage System ballf by old 4.- Address_ r p'l li Gallon Septic Tank and Consisting ol`. _ P- . Water Supply: Public Supply From • . Address or.- Private Supply Drilled by/ C� : /9 Address Has Erosion Control.Been Complete Bdilding Type dY pf IIE Number of Bedrooms . Has Garbage Grinder Been InetaU Other Regalrements_ b1,� R _ a I certif that t - system(s) as listed serving the above premises were construe �tia- s ah t plane of the completed `work .(:,,copies Y of which are attached), and in accordance with the standards, rules and reguldt so. a wi e f led .plan, and the. permit issued by the Cm Putnam County Department Of Health. /� �►? ¢T P.E. Date 7 3. /1 ifie by Cart d �� _. Address � « i �J 7/ e�1,! ° License -No A! � � e s,. Any person ,occupying premises served'by the above system(si shall promptly take such ac n ryto curs the correction 'of any ungnitary conditions ,refulting- fiom such usage.: Approval of the separate.* sewerageaystem shall be id as loon is a pub sanitary sewer beeonies . r` available and'•;the; ?approval of: the private water supply shall become n void'- when.a.publkGwater supply'pedomes available. Such approvals` are subJact, to modification or change: when in the .Judgment of -the ommis - neP of "Health h revocation, motllflhtisin or chango is nscnsary, Date .� 8Y Title =� \` F QAliiidn of Environmi N :CONSTRUCTfC)N PERMIT ,FOR SEW GE.DISPOSAL Loted• at r G ca s. =Subdivision 5C "_ 1 - 0 /!��/y� 1 SW k. «.Owner /Address ��s�/� 1...J' ��(� J',�.�4✓'� �� 'guilding Number;•of Bedrooms • _ Design�Flow'�O /P /D iderage System to consist of ' r- l .�► ructed• y ` �ublic .Supply From =� r $ eriiate :Supply ,to De drilled by; Atldress "`" y � T w 45 - �at.l'arn holly and .completely responsible for the di fed :wilhba const►uctetl as shown on "ahe`app`rq,16 -Bins ailment _'ot: Health, 'and that_on completionafiereof' i 'to the Department and a written:,guarantee' will: operating condition any :part of. said, •sewage ' <di7 approval -of •the Certificataof Construction 'Comp id as'shoyyn on the approved plan and that Said well wi rrtment of Health j- `& _ Address *' rs Ik in Town or Y 5 5 :rr 4 r STRUCTION This approval7expires ^pne yea %from the date ;issued less constiuciion of the tiwlding',has been undertaken and is- n' amended or modified when considered necessary by the i oner of Health: Any,''chan r alteration of const►uetion Approved for tlisposal of -dome nit y se age and /or' riv eater, I�/ PUTNAM COUNTY DEPARTMENT OF HEALTH `ENGINEER TO PROVIDE PERMIT # ON:.CERTkFICAT F C MPLIAN E. Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT C CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM. /h g -ri7 �,/ %W Town or village Located at ") / /�C/ /� C' �'! Tax Map 3, 4 Block 2 lot 7. O'Z Subdivision Subd. Lot N Renewal -0 Revision _ - Owner /Address 1 ,17 .17 �- all vi�' Building Type �1�� Lot Area ^ Number of Bedrooms Design Flow G /P /D Separate Sewerage System to consist of / 7--0 p Gal. Septic Tank To be constructed by Date Of Previous Approval Fill Section Only 0_ .P.C. H. D. Notification Required and Address Water Supply: Public Supply From A Gl Private Supply to be drilled by ✓I ►i "L Address Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of above described will be constructed as shown on the approved amendment there. to a County Department of Health, and that on completion thereof a "Certifi414� be submitted to the Department,, and a written guarantee will be furniplace in good operating condition any part of said sewage disposal sysance of" the, approval of the Certificate of. Construction Compliance of will be located as shown on the approved plan and that said well will be Insta County Department of Health. Date Signed Add a APPROVED FOR CONSTRUCTION/is approval expires one year from revocable for cause or may be amend modified when considered neces! requires a new permit. Approved for disposal of domestic unitary saw. Date By the roposed system(s); 1) that the separate sewage disposal system with the standards, rules and regulations of e Putnam list ct o lance" satisfactory to the Commissioner of Health will ` heirs or assigns by the builder, that said builder will d ) years immediately following thedate of the issu- 1 system 0 e s thereto; 2) that the drilled well described above d wi st ards, rulas and regu a Ions of the Putnam e P.E. R.A. License. No. y 9W eyeless ruction of the building has been undertaken and is ?p of Health. Any change or alteration of construction if#agx,w r supply only. Title C T. FUtham COuntY bepartmen-f of HealU,. Division q JPq�irondental Health -Servicoa- — w. !PProved as noted for conformance with 5c "le IPplicable Rules and Regulations Of the county al De sgeut 4" sv. /)-,J It-x A9 tv If 4--0 0 A-1 s.Jas 0 o AR. Well G U pG /C 1 I f IFX f b a 0 A 1�'� PUTNAM ' C'OUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,'CARMEL, N'. Y. 10'512-''- _ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM /FILE NO. � Owner Address Located at (Street) Sec. Block 2 Lot // 9/a kin ica e nearest cross s ree Municipality o o A 97 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION Run apse 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 2� 2: 2 5 5 1 5 Notes: 1) Teets to be repeated at same depth until aroximatelyy equal soil rates are obtained at each percolation test hole. All pp data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST ,?IT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION `DESCRIPTION OF SOILS LNCOUNT.�;RED .IN__TEST . HOLES; .._.z. DEPTH HOLE NO. I' HOLE NO. Z_ HOLE NO. G.L. �d / %r ✓ "�� 6�� 12" _ 18 "u 24" 30" 36" 42" 48" 5411 60" 66" 7211 78" 84'► INDICATE LEVEL AT WHICH.GROUND WATER IS ENCOUNTERED U �:- `� INDICATE+ LEC � Ti`�uWHICH WA`T'ER LEVEL RISES° AFTER" BElN'G "ENCOUNlERED—_. TESTS MADE BY �"�' c�, 1 i t.+ Date DESIGN Soil Rate Used_MirVl "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capac't Gals. Type /pp e,4a,&P ' Absorption Area Prov{tcl d- L.F.x24- width trend a o"�'� ew Other ame 0 .za . le pal V. PV ture Address ; . z", L44 f,,-`.,--,3, .0 _Ale ' THIS SPACE FOR USE �BY,,. PARTMENT ONLY: a Soil Rate Approved Sq. Ft /Cal. Checked by Date w/ M l.()\ 10 � vi; a * ,F - WELL U1J11,VLh11U1N rP,rl r,.' DEPARTMENT OF HEALTH D vis- ion - O£..Environmental .Health. Services _ PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only ", ji STRE' DURESS: wl t Y - TAX GRID NUMBER: _ , WELL LOCATION WELL OWNER NAM • ADDRESS:OF O PUBLICS USE OF WELL 1 - primary 2 - secondary PRESIDENTIAL O PUBLIC.SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED""'" " " : "' ~` O BUSINESS O' FARM• ' O TEST /OBSERVATION ❑ OTHER (specify). ❑ INDUSTRIAL Q INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE�� gal. REASON FOR DRILLING ANEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /08SERVATION O REPLACE EXISTING SUPPLY O.DEEPEN EXISTING WELL DEPTH DATA ` WELL DEPTH �� r ft. STATIC WATER LEVEL -DAT E MEASURED DRILLING EQUIPMENT 12-ROTARY ❑ COMPRESSED AIR PERCUSSION O DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH ft. MATERIALS: II- .STEEL O PLASTIC D OTHER LENGTH.BELOW GRADE ft. JOINTS: O WELDED ®,THREADED O OTHER DETAILS DIAMETER l in: SEAL: ❑ CEMENT GROUT O BENTONITE XOTHER WEIGHT PER FOOT 1 1b./ft. I DRIVE SHOE: &YES ❑ NO UNEA: ❑YES ]KNO SCREEN _ . pETAlL _ DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH To SCREEN (it) DEVELOPED? FIRST ❑ YES ❑ NO -H . _..... OURS' . SECOND_'..:...... _._..... _..._ .... _ ... ,.__ _.�. _ _._._._..._...... � GRAVEL PACK O YES O NO GRAVEL SIZE . DIAMETER OF PACK in. TOP DEPTH -ft.DEPTH BOTTOM It. WELL YIELD 'PEST It detailed pumping METHOD: O PUMPED tests were done is in- COMPRESSED AIR ; formation attached? O BAILED O OTHER :OYES ONO WELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE s al�r ing Well Dia- Inv - FORMATION DESCRIPTION coos, It. IL WELL DEPTH It. DURATION hr. min. DRAWOOWN It, YIELD gpm. Land Surface Ap A a o' WATER CLEAR TEMP. QUALITY O CLOU13Y HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY I >'D GAL. PUMP INFORMATION i TYPE �� CAPACITY `5 MAX ' DEPTH MODEL VOLTAGE�3(5 HP �y WELL DRI LEQ NAME OAT ADORES �� SIGtt11fTURE Yorktown Medical Laboratory, a LAB 321 Kcar Street Yorktown Heights. N. Y.lOS98 Collection Station Used: ,c9142dS� =p� _, Carmel _ Peekskill _ Director: Albert H. Padowni X T. (ASQ) T- Date Taken: Ole Date Received: �I� /�v Date Reported: Collected By: AV�eS' baaa1PJ ,/ C, Referred By: L �`�/V/6�"rn vX l Sample Sourc e i /7 sal-"--n sal-"--ne 1.5ZA 426 V,4 j LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml OJ (Agar plate @ 35 °C) MEMBRANE.FILTRATION TECHNIQUE (MFT) ,ZTotzal Coliform per 100 ml 0 Fecal Coliform ner 100 ml _ Fecal Streptococcus per 100 ml '!r"7 °A03APT r NUMBEP. TFCHNIAUF (MPN) T'ctal' Col'i form.:. -14 P X lr dex_- -ner 100 -m-1 Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) AS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED,. AT THE TIME.OF.COLLECTION. Albert H. Padovani, M.T. ASCP), Director LEGEND ADS a Recommend Disinfect - ing Water Source < a less than - TNTC a Too Numerous Too A .. a PU NAM COUN`T'Y DEPARTMENT OF HEALTH -DIVISIOIIq OF -ENVIRONMENTAL HEALTH SERVICES Owner or.Purchaser of Building iJ Building Constructed by Location - Street Municipality Building Type 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 servin 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`twa_years._immediately_ following -the date of approval..of,._the..., Certi:Eicate of Construction Compliance for the "seiaage cisposal - system; or ariy' 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 19C/ Signature ,- ,,,,rc•� c Title ell J General Contractor (Own - Signature Corpora 'on Name (if Corp.) rev. 9/B5 mk Corporation Name (if Corp.) �A Address PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of /,-*e�,i,11,,) ,*---5 4 Located at 57; A/ e C%2 6?0 e W (T), �:/LW ",Section -3-01 Block Lot 2 Subdivision of Subdv. Lot Filed Map # Date 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 s stem or `s s vents in-conformi,ty-Wit7h.-thed... 147, Education Law,'the Public Health Law, and the Putnam County Sani- tary Code. Dr-7 ountersi-en P.E. Address vs, e Telephone Very truly yours, Signed AL� Owner of Property R - 0 - -3 2& -T 614L Address I Town T (Telephone . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN I Y OFFICE ,BUILDING, CARMEL, N . • Y . ' 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner?, -, S 2 rayf Address .,x,� Located ai'� ( Street �j, i/ �eel Sec.. Block IX Lot Ind. arer cross s ree / i / -: Municipality N l tv Y r4 ,111 Watershed .SOIL PERCOLATION TEST DATA REQUIRED'TO.;BE SUBMITTED.WITH APPLICATIONS Hole Number/. CLOCK,TIME PERCOLATION PERCOLATION Elapse 4, Depth to Water ` a er Level No. Time ;:'From.. Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Iriches;,,f Inches Inches , 2 % Z �� %Z 3 �=,� % - 4 l C3 3 y J3�✓� 1147- 5. 3 ` 5 Notes: 1) Tests to be repeated at same depth until approximdtelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review.; �) Depth measurements to be made from top of ho'Ie. -, P= DEPTHt G. L. 611 V J 12" 18" 2`11 30" 36" 42" 48" 5411 60'" 66" 7211 7811 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO.— ' i HOLE NO. HOLE NO. 84 � INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE._.LEVEZ- --0 1�FEL�CH :WAT = , ..EL RISES .AFT_ER._.BEING ENC.OLTIVTERL3__� °� �_ _ TESTS MADE BY ` 5 dt )) i ✓ t ! Date //, S DESIGN Soil Rate Used Min/1 "Drop: S.D. Usable Area ProvidedU U No. of Bedrooms Septic Tank Capacit. Type Absorption Area Provided a u' L.F. x24 " t o pro° 60 ° width trench Address THIS SPACE FOR USE BY HEALTH DEPARTPEM ONLY: Soil Rare Approved Sq. Ft /Cal. r �E5S1Q a� .,: • y , Checked by Date_ 7)6 :�V_i) to REVD CIMCK SI ; .T . . / LLE-FG ' tt ry . 4Mcets Std . f Remark.. v `apt es- No House plans 0. K. Design data sheet Peres presoaked:' I,Li n. 30" perc test dept Const. results for 3 runs Vz- D. Hole lob; 0. K. Corporate Affidavit for other than individual O_ � £ Authorization for engineer letter from Water Supply if applicable i N If variance requested -such noted on plans & apps.: DETAILS ` if change,is proposed,) Existing contours shown show new-contours) Slopes for driveway cuts, etc.. shown later service line location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location S --Dtic tank size and conformance to std. 3 B.R. house minimum House setback shown Distribution box ftg. below frost All water within 50 ft . of PL shown Plan and profile SDS All .other wells anal 9S..closer shoved or :" "refdrence ^made Property boundaries (metes and Is�t��l dal Rip i )ands- clearly sho ,PARATION DISTANCES SPECIFIED ON PUN to P. L. ' to Foundation walls ' to Nearest well ' to stream, march, lake, etc. incl.expansion ' to Curtain drain r ' to water lane (pits -20 ' to storm drain to larce trces frol", foundation to septic tank to pipe from leader drain &.1'o—of—in t rain I PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE: INSP. BY: INITIAL SI'Z'E INSPECTION (YES I NO ( CC'S Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ............................ Must trees be removed - note these ................ Deep hole representative of entire SDS area....... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D. H. 1 Lot D. H. 2 Lot Depth to G.W. Depth to G.W. Depth to rock Depth to rock Soil Description Soil 0 ft. 0 ft. F 3 ft. 1 1 3 ft. 6 ft. 1 1 6 ft. 9 ft. 9 ft. 12 ft.1 I 12 ft. FINAL 3ITE INSPECTION ...- -DATE: - - INSP.BY: YFS NO J D.H. - Deep Hole House SSDS located per approved plan ............. G.W.- Groundwater Length of trench measured Width of trench average Lot Slope of tile line and trench acceptabl ,. ..... to G.W. Depth Roan allowed for expansion trenches .............. Over 100 ft. fran swamp, watercourse ............. Natural soil not stripped or SDS area unnecessarly graded ............................ 3 ft. 10 ft. maintained fran property line and 20 ft. fran house .............::............... Distance well to SSDS (ft.) ...................... 9 ft. Number of bedroans checks ........................ --- Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... ✓ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... 11 ./ Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE................ ... .7 rev /9/85 mk 12 ft. _ COMMENTS zeti lsrL i2 -23 D.H. - Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. _ COMMENTS zeti lsrL i2 -23 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRODIIAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SE kGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT - ( of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CCMMENTS Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut....... ................... Must-trees be removed - note these................. _ Deep holes representative of entire SDS area...... Additional deep holes needed..... .... .. /00 Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/septics ... ...... Access to proposed well location for drilling..... t D.H. 1 'Got Depth to G.W. -- Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. J�L 9 -ft; 12 fi 81 D.H. - Deep Hole G.W.- Groundwater D.H. 2 Lot D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to rock. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. boll 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. boll Lescrl DATE: FINAL SIT3 INSPECTION INSP.BY: YES NO CCNMENI'S 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 from property line and 20 ft. i_ran house... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ......................... Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ..... .......................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE... ... ... PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEVV,GE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT . ...._ ..:. :.... .. .._- .:.:.....: -. .:_....,.__ _.._..__ _. _ ...... .. _. .... . ..:. BATE _ - � R�"VI' : t ti OBI F}►.{ c �iLLP�'_K p1 D V BY: — (Name of Owner) (Street Location) - DOCUMENTS Permit Application �'EU- TO �> E,2�t I j Corporate Resolution (� l.� 4D -84 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 Galle 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 /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown; gravity fl, ,puff..::size .: : -If Putrtpad'- Pit G D- BUk Shavn & "Detailed' ..... _..... ,...... House - No. of Bedroams Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds O R QOTE-� 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 (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from 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 AW 12 -�� e IEN 0� AW 12 -��