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HomeMy WebLinkAbout2652DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 53. -3 -2 BOX 23 02652 r r� JL ' T IIki I I' IL 'i ' T 1 � ' L7 I 1 02652 PUMM CODNR DWAl DAW OF MALIN tb Faovlda lraea9t 1 Dhbft d wkdataeala" Hssdii Sw1, Caved, K.T.1an C8 P PIM SWAM DISPOSAL D9 LMabd at ' Gc..r- f�I �. FEZ v-e 700,, v.�- w C�l'l1FICA18 OP OO1dQfIAN P it r Qq— C09 -0_1 Town W VMNIP Sm i ON= YAM . Tit: lap ..1 a ,.. Bud -r ILNraard �ls+rmlae ❑ pa�gdAppisaat Nafaa 1''�A:uRI GE �.�r�� -► E Ft Da ov6s 11,[3o/S� . bs d o.Appaoval MdbaA46M 9!0^ . 90ao Town f%j-r=A6►,!1 -Zip 14551q Date Subdivision Annroved Fee Enclosed ® Amnt,ni w++r8 Tyr ► ft2 Let Aaea 93q t AG: Iii'PCHDNoOmdmbReqdmdWb=PMboompbpbd Sudm 0 Depth Votaata Nl�I d Hsiaaes � Dt�t Flow G P D 600 � Spa�aD. s�ota. b e.ad.t d lD40 � � 1>� ..,t 3� L, F 2 `),.I IbE. �S�R�C'C10 T�►•.I�i -1 ly b. IV VLr�R.Mll.ifa� Adtheaa wow up* Pule &P* Ft A &vw an__ AI bit Smpbb DeOsd TL��ZM1w.lt�b �a�� o"l�in�....ba Qur'►P PT iQooc�►L ©v��.,J Tl►.(.AI� �t.� hl111�i 1 represent'.that 1 am wholly and' completely responsible foi the design and location of the proposed system(s)1 1) that the s• rate per di salt stem .Rl1•�:P above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rage ns o Oounty Department of Maelth, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of MMlthwill M submitted to the Department, and a written guaf intes will be furnished the owner• his succasaers, heirs or assigns by the bulkier, that said bulkier will plan in pod .operating condition an�I part of old sewage disposal system during the period of two (2) yMrs Immediately following thadate of the Issu- 80011 of the approval of. the Certlf=, of Construction Compliance of the original system or any repairs theretoi 2) that the d►Illed well described allow Wilk be located as shonaill on the approved plan and that saki well will be Installed In accordance with the standards, rules and raeuMMS OOf the Putnam County Department of MMlth. Data (01',W Sighed .�'`� �' " ' P.E. 2!L— A.A. AOOresa loo CWSR1N At6&-_ t lc* No 6IR3% APPROVED FOR CONSTRUCTION: This approval eNPi►es two years from the date Issued unless construction 6f the building .has been undertaken and N revocable for cause or may be amnew- or modified when Considered necessary by the Commissioner of MMlth. Any Change or alteration of construction reslufres a !"qW 1perrmit, Appr�% for�(Isposal of domestic sanitary Nw01M. and /a to Ater supply only. Rev. Clete e! " 47 tG+ . / �J / By `� vttN 10/88 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 Tax Grid Number 15- - W APPLICATION TO CONSTRUCT A WATER'WELL 11 Wrivate ® Public PCHD PERMIT # FALL LOCATION Street Address Town/Village/City l-l.ab'i Tax Grid Number 15- - W WELL OWNER Name -e Mailing Address Wrivate ® Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS INDUSTRIAL 0 PUBLIC SUPPLY ® FARM 0 INSTITUTIONAL ® AIR /COND /HEAT PUMP 0 ABANDONED O TEST /OBSERVATION O OTHER (specify 0 STAND -BY AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED) MM, /EST. 0 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL OF DAILY USAGE�al 13-ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED�� REASON FOR DRILLING WELL TYPE DRILLED I P9 DRIVEN ®DUG ®GRAVEL ®OTHER IS TELL SITE SUBJECT;TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: B-I/,b Lot No. WATER WELL CONTRACTOR: Name 'T 2 KKR � �c�1C Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES -_K_NO NAME OF PUBLIC WATER SUPPLY: t-A TOWN /VIL /CITY w w -DISTi WCE 'TO ' PROPETt1Y "FROM NEAREST" WATER 'MAIN':" LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 10ON SEPARATE SHEET Ova - _ (at ) < PERMIT TO CONSTRUCT A WATER 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 shirt; (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 drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �' C�v 19 Date of Expiration 19� Permit Issuing Officio Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DESIGN DATA SHEEIII- SUBSUFACE SEWAGE ' DISPOSAL SYSM ,. • .. .... ._. _. . .. _ .. ,.i w vim... iac FILE No. owner' Address SKI . v.1 fn, -r. AA m VA4-, c, Located at (Street) ',r,�wu_ IpL-1.010.l I;c� . Sec. I e Block 1 Lot jo (indicate nearest cross street) Municipality �u- �-�.,1 p.t�1 �/,ed�.E�� . Watershed. �1zc�rro� som PERa LATICN TEST DATA RDQU.IRED TO BE mild mm WITH APPLIWICNS Bate of Pre- Soaking to �,. --- -' Date of Percalatioa Test IOBI��F, -7 HOLE NUMBER CLa:K TIME PEROO ATION PFROOLATIQN Run Elapse :Depth to Water From Water Level No. "Time Ground Surface In Inches Soil Rate Start -Stop Min. ".Stmt Stop . Drop In ` Min/In Drop Inches Inches Inched 2 1 :111- 1:-IC,' Z► Z-0 . 23 3 -7 31' 4 3 4 Z:03 -Z.-M 2( 2'.� 3 Z 5 2 1•: 2� - It45 2! Zt 2� , 3 -I 3 I:4c. _2 -07 �1 2- t 21 3 -1 , q 2 - -2 =Zq ?-) 2l 29 3 -7 5 1, • 2 3 NOTES :: 1. 2. Tests.to.be repeated' at same depth until approximately equal soil rates are obtained at each percolation test Yule. All data'to'be submitted for review. Depth measurements to be made from top of hale. . rev -9185 • . NOTES :: 1. 2. Tests.to.be repeated' at same depth until approximately equal soil rates are obtained at each percolation test Yule. All data'to'be submitted for review. Depth measurements to be made from top of hale. . rev -9185 • . TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IN TEST HODS - DEPTH. HOLE-NO.'' OLE -NO. . HOLE Noo 12. HCmm. t•. r. i G.L. oe 2° 39 41 Lo�f� P Lot 60 7° 8° g° 10° � m 11° < © m -, 12 ,o 13° N INDICATE LEVEL AT WHICH GRMMD1QTER IS ENOWNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEMG ENOOUNIERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min/I" Drop: S.D. Usable Area Provided Se�c= No. of Bedrooms Septic Tank Capacity loco gals. Type 1" L4r 4gy Absorption Area Provided By _Asx::, L.F. x 24" width trench Other �c� r.lt� �' lgc��LC� 3 P lc.ze )eaui P%m 6 4Z �LrO J OyEgf? W Name G441c•.1�- - .r_��-�S �L•. Signature Address J! cV% r,�- SEAL i • E THIS SPACE FOR USE BY, -HEALTH •DEPARMENT ONLY: Soil Rate Approved sq. f t,/ga.l. Checked PUTNAM COUNTY = DEPARTMENT OF HEALTH " R 3/ S 6 Divislon of Environmental Health Services Carmel N Y 1051? Engineer.to Provide Permit p. on CERTII7CATE OF COMPLIANCE - ,•Permit . IY ONSTRUCTION PERMIT FOR SEWAGE. DISPOSAL SYSTEM peetCSrctt_� 1�ot_t.avJ 1�p,�D Located at - . Town oe Sabdlvlslon Name I.i Snbd. Lot N Ta: Map I8• $lock I -Lott 20 Renewal_ ❑ Revlelon, Owner /Applicant Name- mat 1QttJB. 5^t°o.rJE. Dato of:Prevloae Approval MaWng Address iZ� ..:1 1 6EKS K L�: �-�O �-�-o vJ rCo AO Town�rrNAt.w Vs l.t: e�/ Zip _! c S'`I °J ' Baildin H P Rizl sl aklrlft Lot Aiea 't FIR ,e _ .Sectlon Depth .. Volttme ' Number of Bedrooms 3 "Design Flow G /P /D o O PCHD. Notification Is Regalrod When Fill is completed Separate Sewerage System to consist of ' y o m o Gallon Septic Tank and 300 / ' F ABSo taF�-i'1`o f. i. 717th " `T� Btz .. �i�TBRi:n( To, be cons trdeted by Address *ate! SnPPb PdbHc Su." 1 Flom Address �. . PP.Y. or r • %� Prlyate Supply` Drilled by :T� ; 9 Add�ese' Other lReqdire mente Tau M P 1�t T' represan t a • 1 am wholly anC completely responsible for ,the tlevgn and location of, the proposed systems) 1); that the separate; sewage disposal system above descr1bed will;be constructed as'shown on the approveq amendment'' there' to and in accoida,nca with;the standards, rules an regu a ons o e: u nom County 'Department of `Health, and that o i completion thereof a "Certificate of to'ih ruction ComDlianee satisfactory to,the, Commit of'Healthwill be submitted. •to the Depaitnient, and' a written guarantee will be - furnished ,the owner, hit succeswrs, heirs or assigns by'the'Duilder, that said builder will place in 'good operating condition. any 'part of acid sewage disposal system during:, the period -'of two ,(2) years ImmeGiately following theddte of the issu- once. of the •approval ,of the' Certificate .of Construction' Compliance of the original system oi. any'- repairs thereto; 2,)'that the drilled wolf deserlbed above will':be located as shown on the approved ,plan and that said well wJl be; installed in accordance with they. tandard rules and `regu p ons' of 'the, Putnam 166 County Department of• Flealth "' YY`' � �I-� PE1 R.A. Date �. Si9netl t t:c/s�'� � /1 Address P. Nl►, OC E S CJ> Llcense.No • ' _ APPROVED•FOR CONSTRUCTION , This approval; expirefe� gear from the �date..issue nless construction - of.the building has been undertaken and Is revocable for' cause or may, be.amended' or. mod ifiedwhen considered ^.necessary. :Dy the,. :Commissioner of Health. Any change or alteration of construction reduires s new permit.. _ AOpic;4edifor disposal of•domest s taarry _sewag ,'snd/ r nvata water supply only: cc r Date I� By `�� Title V ....._�.... .._Y a _..... ._._... ,_ - _ . �.. _..o. __... _w �...�. _.......' ..._:.,...._ - �_ .... .......... .,..:'� is m Ff LIZ I IL a _ -, v -- _ I 16 T FRONT ELEVATION ��9 11 Oa X111 I -- •.. I �. I 06�Ci1L JB17a82 -'!T may 70R RIGHT SIDE ELEVATION LEFT SIDE ELE.V.AT•ION r— _._.___ —._ ____ _ -- Pv 1 • eisv +�JG ivG+e .U. � ; ' . - , . • •-t C..m.e•.a ee�sa. =.e sse a1� .. /• QP V6JT ~� r �~ �� � / ( v♦� ±Ally .�I} b�A a.o eseew 4 r ' 8:000. vex-. --•.ra o.1 es...+ar L HO aTa w v+ .. :.785. - L as►w�LT sM�uClL6S .— _ .� . _ n., 4.10 K.YiO� 0.4 R 'a29 .iWvmwvmm MAUI - o �18Q g9AAQa��DP2 ' - � - � �y 3 At 7 -p�FA• �'•5Fi i'a�i•S•iA1'. i.•�. __ - G'-3' ?7+a• 2 -.5• F• -d — 'J':It>'a• _ L S -✓ — 1 Vf•Sa _I i V9) 1 �4 ♦fIDJ2 L6 i V1 SO v4 'JS - `�5 5i � . ' I . r� ..li <1L �i♦ - -� —- B�vwl 1 6.14 1•I. -6. !- � . ' - l 1 w - c•+ecwua �ILR auLT - - ROOM BEDROO j BEDROOYl1ViNG ETN I 111 .;•f \ �•I' : ;[ • s y _ �'• I - _ -� .,e 3.Le- K2, 2. :. DINING R Y 1 �a.y O 0 •Y . B- . i] 1 . - �SSi L • I � ' rl. i -o11 - ,31-54' 1►/+C.T.- a .W cios. 's I cios.1=, T ; enn•.x '�- ,' x n N A L L. .L. i,CL � - , - • � � t t Q.Yr.1Y bf 9l � i` S 6. If{ e:.,_ LIMY fe d KITCHEN 1 AI C'.l °� sv - -- I �zo K20 CLOS. _ '. 'I �i A B T E R ' NI •E` iwl BEDROOM C F 100 A P L• N 1i. 1 -O• ; ` *'S•� �.JIj 1 - ...... :( ricerQv j k 1 _ iN.wvla ,.w . y yd,4 d.t.wl +u I ff A. —c 1 •• a'11W —� •.4h .hf 1.1. 1A, • 1 +1 • •�. {� = 14.E w. LID,N, •tFl• • i _ ..D yyh'a S1 •... •,a •1_I a• a.w •• • Fl,h� l:�•511 wFD ` PAGE: li 'hi•1f 1w(n hw•.hL ,f4..'1+OClID•hGS w.,.K o'IC� SEC,ION: 110 et- ?v C. W:�,^!Oa -•�J ' CONTEMPORARY SERIES i THE CHAMPLAIN D. P. C. k i . COUNTY DEPAMMi -T OF HEALTE - DI-V-ISION OF ENVIRC1,2Mq'I'AL I ALTH SL: ,V 1.r' 5 INDIVIDUAL WTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL (Name of Owner) CCMMMENTS PEVIEW SHEEP - CONSTRUCTION PERMIT // DATE REr �►v �� �� -Af - Lesel. A 0 4W BY YES NO DOCUMr'IV`I.'S P�--mit Application Czar-,-,orate ,_,orate Resolution I Pans - Three sets I I Engineers Authorization i --- cn Data Sheet ( DDS ) I +Deep Hole Lot, I Consistent Perc Results Perc Hole Dep Ln LF trench provided ,tea required 'S as 60 ft. max. Parellel to contours House Plans - Two sets Well L44,j per, smit; PWS V?a+ria+�!7� TT e Request + s/s SUED v�SION (3) Fil - c: le -Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Check -- Weetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Sarre REQUIRED DETAILS ON PLANS Se=wage System Plan - (north arrow) 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: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes._Cut.._,-. _ , , _ -, ., Footing /Gutter; Curtain "Dra'i-ris-*- (discczarye -OK) ._ Perc & Deep Holes Located Representative of primary and exr,..ansion Expansion Area; shown; gravity flow,ssff. size If Pumped Pit & D Box Shawn & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds -douse Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pi--P- No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fiL 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, Leader, Footing 35'to catch basin,stormdrain,pined watercourse 10' to Water Line (pits -20') 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 10 WULV 1 S Ll,CL9L\11.1L' LV 1 Vt iz •'"` • •1u - Lt V 1J1VLY Vl 1:.LV V 1RlJ1Vl'1GLVlt�l� n �'�+� �ln JL•LlV 1�..CJ �^ r:y4�; i- 'it��a��:'�•'iq:�'i�1Ny :� «�!.'f �4n.�ryi�)����:.^1j �`1�3iY5� M At.,V t, f Sft . -A-Name-of _Owner) , -1a REVIEW SHEET - CONSTRUCTION PERMIT - f)� DATE 1&C 1 I V 116 0 >catiQn) ..._- B „ ...._.. _ . - r�r;tmn�°nipt�`' _ Permit Application Corporate Resolution - Plans - Three sets s /s. Engineers Authorization - Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc - Consistent Perc Results (3) Fill - Perc Hole Depth cd House Plans - Two sets Well LJ9.0 permit; PWS letter - VariaiUe Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) 4 =s. Data On DDS Plans & Permit Same r REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) ' F Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench Galle ` / ry; Pump�.pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut FootinGutter, Cuan Drans(dischar OKg / Perc & ) Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells &-SSDS's w /in 200 ft. of Proposed Systems 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 HE 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, Leader, Footing . 35'to catch basin,stonrdrain,piped watercourse - IF trench provided 400 required 410 60 ft. max. _�_Parellel to con urs Z7 7­ a..._.... .._ . ;' ., rw . 10' to Water Line (pits -20') . 50' intermittent drainage course Septic Tanks 1 10' from Foundation; 50' to well t I 15' Well to PL 9 i 1 /1 I 0 cashin associates, p.c. design professionals route 52 carmel, new York 10512 (914) 225 -8088 TO �wrwAM CoutilTY V.A> =a%_TH Ito ot_U TZouTE G L-T-0 C't,'P_,MEL �.jEW Y0let< 10512 wE ARE SENDING YOU 4,Attached ❑ Under separate cover via the following items: ❑ Shop drawings X Prints Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ LETTER OO F TRAfV�i��iTTAL DATE JOB, NO. ATTENTION 2 . RE: ® CE SToJ•LE SS 1."75 COPIES DATE NO. DESCRIPTION 4 `1 30 8'1 SIDS THESE ARE TRANSMITT ED'as checked below: X For approval ❑ Approved as submitted REMARKS ❑ For your use • As requested • For review and comment • FOR BIDS DUE • Approved as noted • Returned for corrections • Resubmit copies for approval ❑Submit copies for distribution • Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US ��.f ►`1. P � T V E'7'".A I �- 1R//�S I�i..e.�^o.ED o /`/ � a� 1�+.:..o.r./ � WITH Cor2��Pon/Dl►.l� 1�.�..-r,A /1 \A.10LJ L1_`� M COPY TO: SIGNED: If enclosures are not as noted, kindly notify us at once. DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ..... _._..._ .. APPLICAThON, TOY=CONSTRU'C- - -A7 ,WR'I'ER- 'WE2-L : "; .:.. -_ /.ry. .. PCHD PERMIT # 1; V "G"1 74 WELL LOCATION Street Address Town Tax Grid Number PeII�KSKIL+�- �- 10�..� -CVO/ Rte. PLiTI�IAM VAL.L -�Y 1�3' (' ZO WELL OWNER Name Mailing Address M�1R�CE S-towle: Qe'+t I�eetcsk���. .1 -�0�.0 2y. ®Private '13 Public USE OF WELL 1 - primary 2 - secondary 10 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS. O FARM O TEST /OBSERVATION O INDUSTRIAL C3lNSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT M%q g gpm /# PEOPLE SERVED I r.#,M /EST. OF DAILY USAGE goo gal REASON FOR DRILLING ARNEW SUPPLY. ❑PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL OTEST OBSERVATION DETAILED REASON FOR DRILLING 'i�QS�v�1.► lAl. 5�.►PP4. WELL TYPE DRILLED aDRIVEN DUG GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: to A. Lot No. WATER WELL CONTRACTOR: Name To B a D�"P. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES `x NO NAME OF PUBLIC WATER SUPPLY: I,4 TOWN /VIL /CITY .:_ . .. - -- - - - - _:. -.:.: -- .- _:.- -...,. ,.,�; . -:_ .. - .. - .__ _ _ , •..�- ms's. �.: - . _..,,_ ,... , ..: �IBTAi�ICE TO' PROPERTY FROM--NEAREST LOCATION SKETCH &.SOURCES OF CONTAMINATION O ON REAR OF THIS APPLICATION 3 Sic P'1 ed (date) PROVIDED © ON S PARATE SH T (sign e) 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. 2. 3. Date of Date of Permit 2/87 Pump the well until the water is clear. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. Submit a Well Completion Report on a form prov' by the Putnam County Health Department. // Issue: 30 19 � , 6 Expiration: / a 19 8q Perm-it Issuing Official White copy: H.D. File is Non - Transferrable Yellow copy: Building Inspec Pink Copy: for Fun;Am oouaiY;DEPARmkd & HEALni --DIVISION OF',.ENVIE2I� TTA _-HEALTH-.SMVI(XS Date a Re: Property of I-AA-L.-A e_% LE Located at LL_ Block .(T) Section Subdivision of Subdv, Lot .is Field Map. Da Gentlemen%' This letter is to authorize a duly licensed Professional.Engineer ... or-Registered Architect to CA E) apply fot 44 Mnstkiqtion'Permit for a separate sewage system, to serve this above noted pr6perty in accordance with the standards, -rules-or regulations as. pmc�Agatod by the Cbmnissioner of the Putnam CoLpty -Departh-int of Helath, and to sign all necessary papers apers on mybehalf.in connection with this wetter and to w4ervise the.. Constriictidn of said system or system in conformity with the tprow_ isions, of .Article 14.5 or-147-e .Education Law­-'-- the Public Health Law, and the Putnarn County Sanit ary Code. Countersigned, 4. P.E.D' 'ROA' V, ' F'6urrez . kdclr e a a Telepfio-Fe- Very. truly yodre, Owner 4of QrOapbrty AWreSS 44 aelephom DIVISION OF FOAM SE MC ES rr.r•s. r, anal h.AV'cY..• .... , ••4 .. ++P.d.: -J •I,. .: an.:. tn'ra. ••-> . Z' •.y�L4.y DESIGN DATA SHkE'I%.-SUBSUFACE _SPWAGE ' DISPOSAL 'SYSI'FM FIDE NO. Owner 'c '�c-ov -1 E Address czy '' 1 V�Fxatc��.� �-�`� zt, ��+�► •• Located at (Street) \AoVL.ou./ PC, -.17 Sec. e> Block I• Lot Zo (indicate nearest cross street).. Municipality .Watershed ac�TO►�1. SOIL PEROO=CN TEST DATA 'RBWIRM TO BE SUBMITTED WITH APPLICATICNS Date of Pere - Soaking 8 • Zo • s-7 Date of Percolation Test 8 • zl • 8`1 HOLE 3 % . 4 �o i� -10 3�. Numm a= TIME SON ZI PE RCO AMCN Run Elapse . Depth .to' Water From' ' . Water %rel. No. ".Time Ground Surface . In Inches Soil Rate Start-Stop Min. Start .....' ' Stop ' Drop In _ Min,/In Drop Inches Inches. Inches zo Z3 3 1 3 10:11- 10,32 2. q1 -.9 :59 18 IS�i . .: z CA. 3 6. 4 1 o :'33 - 10 SCI z 1 Zo 3•.IO :op- io:iS 18 18 z1 3 % . 4 �o i� -10 3�. ►S i8 ZI 3 G _ 5 _9:3n. =: SAS_ 2 -,10:.10 Z 1 zo Z3 3 1 3 10:11- 10,32 ZI Zo 4 1 o :'33 - 10 SCI z 1 Zo Z3 3 -7 5 - - -- 2 3 - 4 5 NOTES: ' 1. Tests to be repeated at same- depth until apprmimately equal soil rates - are obtained ,at. each percolation test hole. All data to' be s%ihdtted for review. 2. Depth measurements to be made from top of 'hole. rev. 9/85 ; TEST PIT DATA REQ DEPTH. MOLE -NO. G.L. 1° 2° 3 4° 6° 701- 8a 9° 10° HOLE mq Z HOLE' NO. 3 12° 13! 14 °9 INDICATE LEVEL AT WHICH GROUNDWATER, IS. ENOM :.. INDICATE IZ'VE:LL TO . WHICH. ' WATER LEVEL RISES . AFTER BEING E NOOUNTERE D DEEP HOLE OBSERVATIONS MADE BY: C c3 t-N DATE: 8 • z i • 87 6ESIGN Soil Rate Used 6,--1 Min/1" Drop: S.D. Usable Area Provided �ooa.d►. No. of Bedroans q Septic Tank Capacity i -t5o gals: Type Absorption Area Provided By q oo L. F. x 24' width trench g� INAI Ejy Oth er t..." � Z" � 1 � l( 1 ' ' v fib' �'• cq fiF • c Name C,�.s, a� ►..f ,dssoc.►,c,-r S1g�ature Address moo: j-rt= 5 Z THIS SPACE FOR USE BY HEALTH DEPARZrIF.NT ONLY. Soil Pate' Approved sq.ft/ga1., Cher d by Date pUImm COUNTY DEPAFaHM OF iiMTB DIVISIM CI' DESIGN DATA ME M%- -SUMUFACE SBO.GE DISPOSAL SYSTEM- F=. NO. Owner 1� \AI��IC.E Add.reSS IS.�KILL- `OLLO,./ cP.. �4Th�/►1'• U1►li�y I•.ocated at (Street) Block I Lot -i ' (indicate nearest cross - street) rsunicipatity, �u-r/.iA. �.�.��E -! Watershed. ire- ,J SOM PEROOLA=CN TMT OATH REQUIRM TO.- BE WIT$ AMa(: AP=CNSS ' Date of Pre -Soaking 10- 1-4 e-7 Date at. Plercolation Test o'•.15 HOLF- Nu— CI1= TIIHE PERcac, I TCN P TICN. kun Elapse. Depth to Water Fri Water Level No. "Time Ground Surface In 'Inches Soil Rate y4'hy ?x.10 .. Start =Stop Min. Start gtaP Drop.In Min/In Drop Inches Inches Inches Zo r 2 i ��.- P:AO z Zp 2,3 3 , 5 3 21 Z� 3 4 i 4 1. Tests to be repeated at same depth until approximately.eT al soil rates are obtained at each percolation • test :hale.- All data to' be mjhnitted �. for review. • . ... 2. Depth measurements to be made frbm top of hole. D ION DEPTH HOLE -NO. G.L. 1' 2' 3' 4' 5' 6' HOLE. NO.'' 7- , r I �a�•a�o 1�� La / � -ro N es $ Q • .wj„ o. go 10.' BQ 11' . 12 130 140 .INDICATE LEVEL AT WHICH GROUNDWATER IS EN 3L/o �l is INDICAT& LEVEE# TO WHICH WATER LEVEL RIB ' BE= &XM4TERM u IA DEEP HOLE OBSE VQ TIONS CADS BY: CA DATE: (0: Zi p DESIGN . Soil hate Used 6--7 Min/1- Drop: BAI, Usable Area •Provi&A 500o 4 No. of Bedrooms 3 Sept.ia . C;apac�q. gals. .Type Absorption Area Provided By �aoo L.Fo 2411 width trench Comer Name �a s. ►� ^I .�. sso�►.sT� s . �? G' signaturl Address 52 SEAL td r.:. CIEI��{ 1 f. S•� ZaoOY�aµ IJ ~� r .. - —_ - - v Liao _ _ ��i i _ -- '�'•° THIS SPACE FOR USE, HX' HEALTH -DEPARZA ENT CZYg Soil Rate Approved -4q' ft/c , ChsdcOd by..'y. . , , Date ' f hj