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HomeMy WebLinkAbout2582DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -26 BOX 22 02582 ., L -, � Eli' 4r�. ; r C' Ir �I ,., " ■ J r or i • 02582 .. 4 ' ( PUTNAM COUNTY DEPARTMENT Off' HEALTH I� TIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PC CONSTRUCTION PERMIT # 97 Located at L2�s Carvlall 1�6?'ad i Town or Village 417111t,7 �` /max Owner/Applicant Name /Pa) Tax Map -5--> Block >- Lot 2-Z Formerly Mailing Address Subdivision Name Subd. Lot # 46 Date Construction Permit Issued by PCHD / UZ A4 r 7' e- Zip Jos °7 Separate Sewerage Svstem built by Jl �-� a31 -��1� Address Consisting of /06',v Gallon Septic Tank and 3®0 4,—' of "' W�Ze Other Requirements: Water Supply.: Public Supply From Address, or: t-' Private Supply Drilled by /"' 10V�� z1 Address -Build' T ;% �f��c r� Hays eiosior� control been completed? Number of Bedrooms Has garbage grinder been installed? M I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Count) D nt of Health. r a�rr._ Date: Certified by — Address i'7� 0�-�r 17 C/ -,:-SO 7 Any person oixupying premises served by the above system(s) P.E. -" R.A. # zv � 95- such action as may be necessary to secure the correction of any unsanitary conditions resulting from siiEs. Approval of the separate sewage treatment system shall become null and void as soon as a public 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 to modification or change when, in the judgment of the Public Health Director, such revocation, modification or c ge is necessary. Bsy:'xf -� .-- Title Date: White copy - IiD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form . W 1 l+VlLrit L11VD4 Rr•rvAl DEPARTMENT OF HEALTH - -- .Division - -4f -Env ronmer -t!l Health Services PUTNAM COUNTY DEPARTMENT ' OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WWRYVIL Y TAX GRIO NUMBER: ADDRESS: E: gIVATE ❑ UBLIC WELL OWNER USE OF WELL 1 - primary 2 - secondary " )9 RESIDENTIAL ❑ PUBLIC-SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE z dO gal. REASON FOR DRILLING ;-NEW SUPPLY ❑ PROVIDE. ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL D ft. DATE MEASURED. DRILLING EQUIPMENT J21- ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. [ OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 3 ft MATERIALS: -OSTEEL p PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE .9,/./ JOINTS: ❑ WELDED. ,® THREADED O OTHER ,DIAMETER � in. SEAL: 0. CEMENT GROUT ❑ BENTONITE 0OTHER. WEIGHT PER FOOT lb./ft. DRIVE SHOE: ® YES ❑ NO LINER: OYES I9NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH.(ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS.; FIRST O YES :ONO! -HOURS ' SECOND _ .._ ... :: GRAVEL PACK ° Y O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft- BOTTOM DEPTH It. WELL YIELD TEST If detailed pumpingELL METHOD: O PUMPED i tests were done is in- jRaCOMPRESSED AIR , formation attached? O BAILED O OTHER ❑ YES O NO LAG It more detailed formation descriptions o� sieve analyses Vare available. please attach. DEPTH FROM SURFACE water Pear- ing Well Dia• lmeter FORMATION DESCRIPTION coofa, tt. IL WELL DEPTH It. DURATION hr. min. DRAWDOWN ft. YIELD gpm. Surface 011// WATER LEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. - PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAM DATE / p AOORES� S7 slGrnMRE O PUTNAM ( )UNTY DEPARTMEN i HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM h 4i2�: fUZv F�i+/TI c5v� / .0 (N uG cry �o Owner or Purchaser of Building Tax Map Block Lot Build` J nstructed b TownNilla e 1� Y g scccmt u,r - e_r ks 01111e�l%clo?" KO625bs Location - Street Pu AJ --4-1 U &c46z-- '-J f Subdivision Name i Building type' Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that. is 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 "Certificate of Construction Compliance" for the sewage treatment 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 Public Health Director 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. Contractpr (Owner) - Signature Corporation Name (if corporation) ,� Address: T�� k, 2)Z•U &_ SOZO -Z96 14 L 6 Signature: Title: i r � ' Corporation Name (if corporation) Address: �!� 7 CL State �. `S O L 'A'N 'S.LH'J13H NMO ❑A AA 92ALU -W2j ZL6 tate ,Zip L6) 0512 2,7m 6-g r `-p '3'd `NVAi -11nS 'd Hd3SOP Form GS -97 =`[%]MMENTS: ) . T THESE RESULTS INDICATE THAT THE WATER WAS-NOT)' OF A ' SATISFACTORY SANITARY OUALITY ACCORDIN(i _ - T_ NEW ._.- ~.'.'E 'AND EPA FEDERAL�DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. , ' ' � � *� ^, ���� �— �7 /' ' � - ED BY: ' Albe �. Pado 7v `i, M.T.(ASCp) Director ` ELAP# 10323 -_- Kear Street Yo r k tpyp,kWA ~--_,'--- ' -. � TY141 845-2800' Albert H! Padovani, Director PER: 32.421143 CLIENT Q 0351 NON STAT PROC PAGE 1 ------ ----------- '-----~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 12/14/97 09:30 DATE/TIME REC'D: 12/19/97 10:55 ` REPORT DATE: 12/22/97 . PHONE: (914)-526-2339 LING SITE: ` 72 OSCAWANA HEIGHTS RD, PUTNAM VALLEY SAMPLE E..: POTABLE : HOLDING TANK PRESERVATIVES: NONE` jjf.BYk SAME TEMPERATURE6.: ' ,.: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~ ' COLIFORM METH: MF ' ~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE ' ' RESULT NORMAL RANGE METHOD _ 1209191 ' . MF T. COLIFORM, ABSENT /100,ML ABSENT .1008 =`[%]MMENTS: ) . T THESE RESULTS INDICATE THAT THE WATER WAS-NOT)' OF A ' SATISFACTORY SANITARY OUALITY ACCORDIN(i _ - T_ NEW ._.- ~.'.'E 'AND EPA FEDERAL�DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. , ' ' � � *� ^, ���� �— �7 /' ' � - ED BY: ' Albe �. Pado 7v `i, M.T.(ASCp) Director ` ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by_ jg4Lt Street Location warm e;a►h' Road - Owner - o �. Town Va. ey Permit # `P 1 — 9- —_q 7 TM # Subdivision Lot # 1. Sen•age System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3A barrier Lgth._2-� Width 7V Avg.Dpth le c. Natural soil not stripped .................................................. d. Stony°, brush, etc., greater than 15' from STS area.......... e. 100' from water. course/ wetlands ...... ............................... II. Sewage System a. Septic tank size -(('0'6 ......... 1,250 ......... other ................ b. Septic tank install—e —level .l ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box IA, outlets t etr s at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 .ft.Original soil between box & trenches Junction Box - properly set ................ .................:............. �ZengtFi required Boo Length installed 2. Distance to watercourse measured -4— Ft.,-hm... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... -- :_ -- Pum o or Dowd. Systems .. F-SIze o pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ......... ....................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a .House located per approved plans ... ............................... b Number of bedrooms ....................... ............................... IV. Nell a. Well located as per approved plans ..... ;,........ ............... b. Distance from STS area measured /OCR ft........... c. Casing 18" above grade . ............................... d. Surface drainage around well acceptable .................... V. Overall 'Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercoursc g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ....................... :.......... i. Erosion control provided ................. ............................... Rev. 1/97 APPENDIX 3 PUTNAM COUNTY'DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS- .._T..y....:.._.._...:. _....... _.::�.:_... REVIEW.'SHEET' for -CONSTRUCTfON- PE'IMT...: �.—._-..- '-.—:...-...._. .. _.,.. STREET LOCATION( 1 LC cis �'� NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE MAP # DOCUMENTS. . Y PERMIT APPLICATION Ellfpc-1 ' VELL PERMIT M PWS LETTER ENGINEERS AUTHORIZATION m DESIGN DATA SHEET(DDS) m CORPORATE RESOLUTION m PLANS THREE SETS m HOUSE PLANS - TWO SETS m VARIANCE REQUEST El�SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED RC RATE FILL REQUIRED DEPTH m CURTAIN DRAIN REQUIRED mSTANDPIPES GENERAL EX- APPROVAL SSDS ADJ. Y . AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE :JMPED PIT & D BOX SHOWN & DETAILED JIOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM METES & BOUNDS SETBACK NECESSARY (TIGHT LOT) SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE LZI NO BENDS; MAX. BENDS 450 W /CLEANOUT FILL SYSTEMS LAYBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES ILL CERTIFICATION NOTE EPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME m FILL IN EXPANSION AREA WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH DATA ON DDS PLANS & PERMIT SAME W F TRENCH PROVIDED m60 FT MAX PRE- 1969 - NEIGHBOR NOTIFIFICATION PARALLEL TO CONTOURS LETTER BUDA ❑� 1 0 YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) m SSDS HYDRAULIC PROFILE m GRAVITY FLOW m CONSTRUCTION NOTES (GRINDER NOTE) m DESIG A ND DEEP RESULTS m -FOOT CONTOU EXISTING & PROPOSED m D SLOPES CUT m FOOTWG /GUTTER/CURTAIN DRAINS m EROSION CONTROL; HOUSE,WELL, SSDS m EROSION CONTROL NOTE m PERC & DEEP HOLES LOCATED m REPRESENTATIVE OF PRIMARY AND EXPANSION m LOCATION MAP SEPARATION DISTANCES SPECIFIED ON PLAN FI DS UIL 0' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL WX1,6L TO FOUNDATION WALLS 15' WELL TO P.L TO WELL, 200' IN D.L.O.D., 150' PITS §IYO TO STREAM WATERCOURSE LAKE (INC.EXPAN) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 'TO WATER LINE (PITS -20') 5Woh TERMIT TENT DRAINAGE COURSE 2 T. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. 10' FROM FOUNDATION; 50' TO WELL COMMENTS: BRUCE R. FOLEY, R.S. Acting Pulilic`Flealth Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 February 7, 1997 ;Frank Sullivan .2972 Ferncrest Drive 'Yorktown Heights, NY 10598 Re: Proposed SSDS: Contemessa Oscawana Heights Road (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The consteuction of this sewage disposal system may be subject to local wetlands regulations. 'You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and Regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1. Erosion control measures for the house and well is !o )e shown on the plan. - _ 2. Proposed contours are to be shown on the plan. :3. The amount of ROB fill required appears -to be incorrect.` 1M y calculations indicate 446 " c.y. of fill is required. 4t. The fill is to clearly be noted as sloping 3:1 to grade. lel .5. Sewer line is to note a minimum slope of 1 /4 " /ft. Upon receipt of a submission, revised to reflect the above, this application will be considered j(`urther. V yours, Robert Morris, P. E. Public Health Engineer IRM/jp i .f•,t ,'' `F:'_^. 7. vl�pFT a ,..7 .s, :+.,- ^- �V/YIIB Y'� ' ®Y mll6liWII�t r dam otR - IIIIs;trtss�:'." 4[. II® -` p 4 m _ 7 OF ft Aye SdAvmm Films ManiO p . Omar/Applei 4,e% moms pp: Date Subdivision Annroved d /�� Fee Enclosed [j7M swifts TY0Z Let A, Seedillio 0* J «r ep 3 P G r D a P� lo Wbm, rfl e Sy g eemploted Jt O f•�th; ac/ 1 0 � Adds wea m Sept ' . s SEPAY oil= Requiregasaft 1 reprasent --that I om whoily..and complritely re' nsiblo.Por thO.desig� and• location, of tho .proposed system(" ; 1) that the .Separate 'sewago .disposal stem allows described arili be constructed as'sPiown on the app!obad amendmont there to "and in aec ' /` he standards, rules a regu. tons o County Department of licaPth. anA that on' Completion thorooP,a'•CertiPicsto of Constr ��� sitisfactory.to,tlio ca iisslo. of Healthwill W submitted to 4he,Do®oatioiz+nt, and.a arvittoii guarantee wiil.be furnished Oho own s; assigns by the bul0ua "het.taid builds trill place: in 4abd opsvating.eoriditlon any part'.aP'salo;agiago disposal system during siminNiately foilowiPq the date of the issu- ance of tho, approval of tho.certifieato oP Construction 'Compliance of t1►o origi o► an r s oto; 21 that. the drilled well described allow will be located as evosrn on the a®prore d pion and that mid wall will bo Installed in a 10 „a rulep and roi si of the - Putnam County Ds art 'of HrkUtli, a Oats �(✓/ Signed P E R.A. . . Adds ©si _ - icerlBO..N•+�iv(J7� . APPROVED FOR CONSTRUCTION Thls approWll expires ,two y„ Pr the date iss of the building .bas' been undertaken and is revocable, for la, use pr �bd. amo ri or, modified when conisW ry by ili ;C It . Any change o alteration of construction requires o permit, ppr od for dispowl of dornastie sen ar of o pply only. Rev. 1��88 Date ®y "�� Ti410 PG -1 . r . b °✓ PUTNAM COUNTY DEPARTMENT OF HEALTH `- APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL TEM 1. Name and Address of Applicant: Q /'�" /! �`� - j 2. Name of Project: Jr >�. �- 3. Location T /V /C: � / te,/ 4. Project Engineer: 5. Address: License Number: "dam � Phone: Lz yz '�,f 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision other (specify) 7. Is this project subject to State Environmental Quality Review (.SEQR)? /i149 Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. MR 9. Has DEIS been completed and found acceptable by Lead Agency? ........... IV114' 10. Name of Lead Agency &14— 11 Is this- project - in - -an area under the control of local- planning, zoning,. or other offlciaTs; ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by'such authorities? W l Date Granted 14. Type of Sewage Disposal System Discharge....,.. Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ _ 16. Waters index number (surface) ........................ A10 17. Is project located near a public water supply system? .................. A U .� Distance to water supply 18. If yes, name of water supply, 19. Is project site near a public sewage collection or disposal system ?..... Ala 20. Name of sewage system ' Distance to sewage system'�� 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ...... X.a� .......................... 11/93 ' Y , 2 . 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 14/1V 25. Has SPDES Application been submitted to local DEC Office? ................ 26. Is any portion of this project located within a designated Town or State wetland? ................... ............................... ............. 41,0 27. Wetland ID Number ........................ ............................... I A 28. Is Wetland Permit required? ............................................. A49 Has application been made to Town or Local DEC Office? .................. 10.4 29. Does project require a DEC Stream Disturbance Permit? 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO %�l✓ 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ............... YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... g.4 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal.,_areas in excess of 15% slope? Ala 35. Tax Map ID Number .. ................... _ . .................... .......... 36. Approved Plans are to be returned to: ................ Applicant r Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. _ 1 _ SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: DEPARTMENT OF HEALTH Di,,ision of Environmental Health . -vices 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 AI'MACATI0Nl TO "CO'NSTRUCT'..A' WATER- WELL PCHD PERMIT��� —� WELL LOCATION Street Address /� Town Villa City '� Tax Grid Number WELL OWNER Name Mai ring Address ^Private v ,d c / %fVvei rL za, iAi1u %1 O Public USE OF WELL 1 - primary 2 - secondary IBUSINESS RE IDENTIAL 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT P 0 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify CU INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT"' gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGEe�vy gal O REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13 ADDITIONAL SUPPLY ZMW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING, DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG 13GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES !% NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Off'eepVls"t�' iY✓'c�' r Lot No. WATER WELL CONTRACTOR: Name /I�v.-yW a Address: ,0drf' IS PUBLIC ITATER SUPPLY AVAILABLE TO SITE: YES j/ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE• TO. PROPERTY .FROM NEAREST . WATER. MAIN:::.... /GIs .. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET 111'.41Y 7 ( da e) (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 County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril ng operations be contained on this property and in such) %a manner as not to degrade or other i contamina surface or groundwater. Date of Issue: / 19 qq / Date of Expiration C1- G 19 Z Permit Issuing Official Permit is Nan - Transferrable White copy: HD File , Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 6 PUT, COUNTY DEPARTMENT OF HE! jili DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of �� �"/ y (saw ��✓-'� �j%�� Located at vSCOWV4;114 Iq �� Section Block Lot Subdivision of Subdv. Lot # ,Filed Map # X2-3 Date Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply fora 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 Co. unty 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" "br sy "skeins in tanforntity with the provisions of Article 145-or •- 147, Education Law, the Public Heaalth Law, and the Putnam County Sani- tary Code. Very truly, .yours, Sir n d 40� e$ !9 f er of Property Countersigne �g NEW y P.E., R.A. g Address 72- 14 Address Town Y.111 /Ar 11F Telephone Telephone Fl M CaRUY DEPARTMENT OF HEAT DI`. -SIGN OF MrBUMML HEALTH S] =— _-. DESIGN DATA - SHEET- SUBSUFACE .SEWAGE DISPOSAL .SYSTIH .- ... FILE IAA.. r Owner , 14-Gi^/'f r 1 Address .�geJ e Located at ( Street)S Sec., Block :Z Lot �✓ (indicate nearest ross street), Municipality /�� iLl A Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test j.9g7 is �+• « •� 12 1UNIM41ftylsts • �+• •• • Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 4 `1 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/135 nc- TEST PIT DADA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH -HOLE I�0. G.L. 2' 0"*� 31 4' 5! 61 71 81 91 10, 121 13' 4W /W -777 HOLE 'oot INDICATE LEVEL ATMHICH GROUNDRATER. IS ENCOUNTERED 44 ee INDICATE LEVEL TO'WHICH WATER LEVEL RISES A= BEING ENCOUNTERED IVIA DEEP HOLE OBSERVATIONS MADE, BY: DATE: Y7 DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 670 we 116.,$ wad gals. Type Absorption Area Provided By pd L.F. x 24" width trench Other 141-:11 Name oTl W'41;)Ime — Signa Address 2,.9,y 2,- sg THIS SPACE PIOR USE BY HEALTH, DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date I �.. �..� v •. l 24.04 AC. CAL. 4.23 AC. e• 'Oa• i `e • .2 . ++• r I- ..�•.� ^� 51•i9 4.72 AC. 7.8 aT�•� ��q 6.36 AC.508 AC. 74 •s +'� °�.� �:: • c t '•. 5.95 AC. i 10.21 AC g i � I 50 4O �•• r � n�0 1 -159�' 0 53.35 AC. CAL. e' r °• Zp' &62 AC t 7.86 % AC. 49 +? 48 tj•� tf1� tl 5.26 AC . . y sqa i 5.2 AC \4i 3 I_ 12 Ira 40 c° 7.68 AC. t a` 7.82 AC. 46 �'r /' `. 80.73 AC. CAL. 5.67 AC ° 13 : rota 8.23 AC. j '� •6 44 r e ».0 Ali` z, r I �.y� �•�a �. 2 5.14 J 471 14 39 $4 �+q ' 41. 63 AC. $ e, Nq v 8.50 AC n M: .32 A AC ° i 43 x 55. 5 ' +` 7 v tdDt a„ 3.22 9 . / sig �fi 15 Q tH� -s 38 �' ti mss. q9 7 to AC as o zoa wso ` I &82 AC. CAI.. e eb. 57 4� 287 ys y a5 o w . ,�N'/•'a` '11 mess too ROAD 22 12 TSOISI 16 34 4.88 AC. .'1" rb s s, �o�} 17 t 8.20 AC. CAL y:4 13 1.95 iti 9 � 32 50 AC s 34.39 AC. CAL. 36 y ,� s �� . AG 6.51 AC. If t s sn �. °� ✓ 35 .' 14• s u10 t .�P� 5B\:t� 15 23 /� .. wt w g.. 5 e `ydl P 3.26 AC �. s�"`>• 18 Qp i x.. x �•� 3.01 uto AC. .40 AC ti �� cc 1 q • * �� ,� w ° IN.seS AC. •d n.. j 4►g6•; AC. `'T'd a a�� 5 +� r' 14 • 19 3'' �`ti is g nTa 3,4F �e° 9 23.85 AC. CAI.. C s a 24 26 W +r a0o11c32'�% J? AC. .• 13.12 AC. 4� su• ••, w'• •• Oy 1a° O �28 � �� � 1�•i � 33 �' � '°'.+ .��'' • .p �� I1c - :. Z �� + t 5.12 AC. +.� $ i.p ? I ° 24 • � t.o.e� +' AC 27 2.66 29 30 31 �V� IT � 18 l vex r• 3 S • 12.48 AQ OSCAWANA 20.69 AC: CAI. 5.67 AC. CAI. ��o� 6.35 AC. ^1$ 1 , a• ' % sy' - `• ` q ' J `,�r .�'' IoWtT # . sat K 4 w4 r caiL� Tc �` cr r N at act 's' '�� c \ 25 �E o . 98e ACr It sp 1 21t i q,�C" 11.29 AL .. nla" w.13 �a �•�� I z5e5aE: cr 20 a v063 -2- - - - - -- - � � e �P /0 6.61 AC 32 6 _ 63.2-30 - -- e..j.i 58- =- - - � � NOTE: No LOT 3-50 ' ..._.;.T__. I TION VISIONS SPECIAL DISTRICT INFORMA q RE ICI - -- STATE LINE N N 601100. -501- PUTT Mt V NT d FOR ASSESSMENT PURPOSES ONLY -- _ _ -- -- _ _: - - • •ter n••••�e •eew. C0161fT liNE - - .- _ .. .._ _ �- _. ..... - __.CNeEI !XI 6781 .•. � ■ NOT TO BE USED FOR CONVEYANCES • •> • -u.a w* ur• a+ •" m - _ - 7M LIE -- %x rltrAdm 6f . 26••1•x1vmwze •ew= •/IM me FIdE :. NTNW VALIET 116E /dowellON DISTRICT VILLAGE LINE �•t• •tiea� a.s••>:•••me�•• �•e ••m 0.6Cd LIMIT Y i JAMES W. SEWALL COMPANY , - , �1e1e ... L1E 147 CENTER STREET, OLD TOWN. MAINE • ■•-• ■•■e+e• '"'• g11°11a1 lai udE ow ` A tie? 72 it. 0 saw '00 owl WOO oolf MEW 0 on A lot gaink AWL VAN `