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BOX 23
61 INNS i,yti
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02676
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WLLL UUr1rLZ11U0 AzsruAl
61 DEPARTMENT OF HEALTH
..Division.Of.Envirohmentai Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
'STREET ADDRESS: TOWNIVILUGUCHIr W*GRIO NUMBER:—
Canopus Hollow Rd., Putnam Valley,NY
WELL OWNER
NAME: ADDRESS:
Michael Beali's, 17 N.Brae Ct.,Tenafly,NJ 0$678
0 PBIVATE
0 PUBLIC
Foo
USE OF WELL
1- primary
2 - secondary
0 RESIOENTIAL• 0 PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED
O.BUSIN �§S 0 FARM 0 TEST /OBSERVATION ❑ OTHER (specify)
❑ IND68 01AL � INSTITUTIONAL 0 STAND-BY ❑
AMOUNT OF USE
\J
YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR',
'DRILLING
[3 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
0 REPLACE EXISTING SUPPLY O. DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 420
35 STATIC WATER LEVEL t
8/10/87
DATE MEASURED
DRILLING
EQUIPMENT
0 ROTARY (a COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. CkOPEN HOLE IN.-BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 184 ft
MATERIALS: IRISTEEL 0 PLASTIC .0 OTHER
LENGTHRELOW GRADE 183 ft.
JOINTS; 0 WELDED MtHREADED 0 OTHER
DIAMETER —fi- in.
SEAL: EICEMENT GROUT ❑ BENTONITE 0 OTHER
WEIGHT
PER FOOT 1.9— Ib./ft.
DRIVE SHOE: El YES ❑ NO
LINER: 0 YES ERNO
SCREEN
DETAILS
DIAMETER (in)
*SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (it)
'DEVELOPED?
FIRST.
OYES ONO
HOURS
Snow
GRAVEL PACK
❑ YES
0 NO
GRAVEL
SIZE:
OIAMETER*
OF PACK in. I
TOP
DEPTH —ft.
BOTTOM
-DEPTH — It.
WELL YIELD TEST If detailed pumping
METHOD: 0 PUMPED i tests were done is in-
(31. COMPRESSED AIR_ formation attached?
0 BAILED ❑ OTHER 0 YES -0 NO
'WELL' LOG " mare detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE,
Water
Bur-
Well
Dia-
inater
In
FORMATION DESCRIPTION
CODE.
WELL DEP71i
ft.
DURATION
hr. min.
DRAWOOWN
it.
YIELD
gpm.
L 'd
s2Nrt,c'e_
50
Di
ill'
ng in overburden clay & bldrs.
Hj
t rvek
at 501
4201
06
400
10+
50
18L
Iril
ing ifa rock,se.t.__ casing,grouted.
181
42(
IrilL
in in rock granite.
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE WX 302.
CAPACITY q C, GAL.
WELL DRILLER NAME DATE.
ADDRESS SIGN
PUMP INFORMATION
TYPE .4111 brue - q i b I - - CAPACITY —, �_,10 9
MAKER Gould DEPTH 380
IOEJ95412
MODEL VOLTAGE 230 HP
J�
-:., F.-,. �. s.....,- e».,,, r,a.- .•-- .- .v.�-- r.�.,- °'?,..� -'.'^^. -z - c-: - x ..u�.-":�a.�:.....�'a'y a°.., �- --1-� ^ *'" � .r-- s.-- --.•-' -�,, -
P[JTNAAI COUNTY DEPARTMENT OF HEAL
Rev. 3/86 Dlvisiot of Envlgotintentat wealth Seevlc®e, Caren ®t, N.Y.
Englnaer >(ust Provide gl/
P.C.B$ D. Peimit.H=
CERTFCATE OF CONSTRUCTION COiPLIAACE' FOR SEWAGE DSPOSAH SYSTEM 04
h //}yt � L/
Town -oral e
V UlL � lI O i G° Tag l�i[a ,
Located at / P- Block �e f Lot •�
Odvnee /appllcant'Naime lG/ ( -r .:Foroprly Subdivision R)mme — Stibldv. %t N
taiantn Write I O!!7 �7 Y�C Zip Date Peimit Issued �•�i�•� /�' (Yd
Consisting of
L
Gallon Septic Tanta and
TT
V 4 14
V 8, . e ® y „
Water Supply. Public Supply From a Address
ors Prlvafe, Supply Drilled by Adds® ®s (r
r r�
Building Typ® �"' 7�Y�r� Has Erosiob Control Boon Completed?
Numher.of Bedroopia. Gsrbege Griad ®r Been In ®talledY �
Other Regalre ®ents
I certify that the ayetem(s) as`;i!,"d serving"the above,premises.were constructed ease tiall as shaven on the plans -of the completed work ( copies
Y
of which are'attachedl, dud in',agcdrdance with tne:atandarda; "rules and regulatidns,A ' accordance wi file tan, and Elie permit'dssued by the
Putnam County rtment Of Health r
�:.
Date �/ Y�a�, Certified by P.E.R.A.
Address �c 1
-•� Iconsa wo
Any person occupying premises 4rrd by the above tystem(6) shall promptly talte such action,os may be nocestiary to eacure the correction of any unsanitary
conditions resulting from such usage... Approval of the separate , age, system shall b ®co null and vold as boon as a pubs':, sanitary muter becomes
avallatile and the appro6af of, the p►.)vate. water. supply shall`b ®comer 1 end' v twv an, a io,a!ator- supply bocornos available. Such approvals are
subject to rmo��f�1U�f+t1n hangs" when, in 4he, )udgmenY Hof the�� - (sale 04 M t aurev tloii, Ificatlon or change Is noc ►y.
�k� -m"- F>-- t n
TItto
Data _ BY
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
. .. u.Cb6 r't� - �•. .. .. , �t. - .. r .. .i ��_- i.v.♦_,+a .. R +... i..Kb4�� Y ..� --� ... -`or v✓•n .. ....�t.. .. a.v
- WATER ANALYSIS REPORT -
SAMPLE NO. 6806
SOURCE: Dr. Beals
Canopus Hollow Rd.
Putnam Valley, NY
COLLECTED: December 1. 1987
BY: P.F.Beal & eons, Inca
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Hardness 3gpa-
Iron Omg/1
PH 6.9
hose bibb -well
0 per 100 ml.
This ,result indicates the . source of the sample was
of satisfactory sanitary quality when the sample was collected.
December 3, 1987
Roy ickwit P.E.
Director
In
PIflNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES _-
Owner or.Purchaser of Building
Building Constructed by
lea f -
Location - treet
A%'a. 1(-114' ��Iz
Municipality
Goy �a
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARAF7= OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS
I represent that I am wholly and completely responsible for the location,
wor}ananship, 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 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 Construo_t-ion: Compl- fiance" .for_�the- secvage disposal 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 Director of the Division of Environmental 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 19 �$'� Signature
Title
Ge eral Contractor ) - Signature
Corporation Name (if .Corp.)
Corporation Name (if Corp.)
Address
Address
rev. 9/85
mk
pUrNAM COUNTY DEPARTMENT OF. HEALTH
_ DIVISION OF ENVIRON1RV=AL HEALTH SERVICES
.... ... u rr r. .. ... t•!+• n..nlnitt..s. ..w .. ..a t .. (. .. � ... .0 ..V .i ..i Ybr .. r.... ��.w V. ... n`+ ���r.v ..
Owner or Purchaser of Building
Building Constructed by
CG �.ab /,� /ldL/ X cz
Locate Street
f vkL
Municipality
G d
Building
Section Block Lot
Nz f
Subdivision
Subdivision.Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
. . „ ..I
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 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
'"Cer-tificate of- Construction: Compliance'. for the sewage disposal system, or any
repairs made by me to iii6h- 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 determinaticn of
the Director of the Division of Environmental 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 19 Signature
Title
General Contractor ( ) -- Signature
Corporation Name (if Corp.)
& «-, cl,4 t (e
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Address
ante of the approval 'of, the` Certificate of. COnsirUcti Compliance;, of the ong{n 1 system or any repair thereto;•2) that the drilled well described above
will'be locatedss shown`on the approved plan ano that said well will be. install ed. �n ordance with the . _' arils" rules, end. re9u a ons of 'the Putnam
..
County Departmiyent of((��Health +:,; • '
Date E RA
��GCA 6/�� &�VI�1i utPfBUfi��. n�1�
AdG►eu License No
APPROVED FOR CONSTRUCTION ThisaDP!ovel •expves one'year from the date issued unless reconstruct ion of ,t he bu{ldmg has been undertaken and is
revocable for `cause or'may be amended o!:modifieff when con;�deredrnecessar Dy the Commissioner of;Health ' -Any change or alferation of, constiuction
requires a new permit
Approved for d� p- of domest¢.'san{tar�aewage and /or ivate w6 er wDDly only
Date 8 Title ° --�
IE
Date
Engineer
Dear ( "� 'L /')CJ 0,441-'V {
Re:
Avyfl,ydyUV� (o Gi.cr,.�/
76�-�---
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:
/) 4,,� - 6 1-4 v 4
(5 a V r&vl G-s 7-;*- C 2 r b f V "-C'
1
�) Levovo
�GV1 G�U--� S�.�r�Svn. S�✓�� /J ?S�GS� //��
Upon receipt of a submission, revised to reflect the above comments,
this application will be considered further.
Very truly yours,
Lawrence C. Werper
Assistant Public Health-Engineer
LCW:
D!A,QUffNO and DONAHU E
CONSULTING ENGNEERS
❑ John V. D'Aquino, P.E. Daniel J. Donahue, P.E.
314 Oscawana Lake Road 200 Breckenridge Road
- Putnam.. alley,. N.Y. 10579... , :- Maiiopac, N.Y -. 10541
914 -526 -2039 914- 628 -7576
j 11) �
TO ''A 01n G/V Jf� t G'7�Xleel7`i�
_ WE ARE SENDING YOU X Attached ❑ Under separate cover via
❑ Shop drawings
❑ Copy of letter
[LC VUEB OF MUSHOUM11.
DATE
JOB NO.
ATTENTION
RE.
Ca,.%�j �zc� f� d�Gsa�,•%���� �f�� /mot
I� _ 4 I.1'
C[? % G•.4 ` -e G''I �ir.�.j•�'yr� ' �'r:- /!�i %.rz...Z,
e following items:
❑ Prints. ❑ Plans ❑ Samples ❑ Specifications
❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION
,(
C[? % G•.4 ` -e G''I �ir.�.j•�'yr� ' �'r:- /!�i %.rz...Z,
r
�INaX_
THESE ARE TRANSMITTED as checked below:
(' For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE 19
REMARKS
❑- Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
COPY TO
SIGNED: -�
If enclosures are not as noted, kindly notify us at once.
............. ......... _
D'AQUINO and DONAHUE
.CONSULTING ENGINEERS
❑ John V. D; kquino, P.E. Daniel J. Donahue, P.E.
314 Oscawana Lake Road 200 Breckenridge Road
y
..Putnam: Valley, N.Y. 10579 Mahopac, N.Y. 10541
9,114( -526 -2039 � 914- 628 -7576
TO /�U /�lG�'► C41,2' T"� /•cz
LIEUTEM ors MUSEDUMU
DATE f r
JOB NO.
NO.
'RE: e
�� ! c� O T Cth�• �"yo �� r�
/'u ' 7 6 7 Cot %f
4 a vl'
t+
_, WE ARE SENDING YOU ❑ Attached ❑ Under separate. cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION '
t+
°THESE ARE TRANSMITTED. as checked -below - -
❑ For approval
• For your use
• As requested
❑ For review and comment
❑ FOR BIDS DUE
REMARKS
• Approved as submitted ❑ Resubmit copies for approval
• Approved as noted ❑ Submit copies for distribution
• Returned for corrections ❑ Return corrected prints
19 ❑ PRINTS RETURNED AFTER LOAN TO US
COPY TO
SIGNED:
If enclosures are not as noted, kindly notify us at once.
L1
� �����.� .. C�� }� � � �-- • APPENDIX c G
G
• FINAL SITE INSPECTION Date
Inspected b
LGq�TION
OWNER
OR �ffto VISION ,I,OT #
.r
IV.
`% .
VT.
YES
Na
COM_�'DfiS
Sr'TKAGE DISPOSAL AREA
a. SDS area located as per approved la_*i t.
b.
Fill section - Date of placement
2:1 barrier. LGTH WDYrH VG.DPTH
c.
Natural soil not stripped
d.
Stone, brash, etc., greater than 15' r"_on SDS are--.
e.
100 ft. from water course/wetlands.
SF , v,G✓ DISPCSAT, SYST I
a. Septic tan'.•t size - 1,000 1,250
I
b.
Septic tarn K installed level
c.
10' mini= from foundation
d.
No 90° bends, cleaneut within 10 ft. of 45° bend
e.
DIST TjTICN BOX
1. All outlets at same elevation - water tested
I
I
2. Protect- below frost
3. Mini an, 2 ft. original soil between bcx and trenches
f.
BOX - procerly se=
�
(JUNCTION
1. Lenc-"L-i re ai red - 0-(7" Lerch ; ns- li ei
2. Distance to watercourse meas•,ir u f,-.
3. Installed according to plan
4. Distance center to center
5. Sloce cf trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet f_cm roperty line - 20 fit - foundations
7. Denth cf t_ench < 30 inches fran surface
8. Roan allowed for ex-cansion, 50%
9. Size of gravel 3/4 - 1 " diameter
10. Depth of gravel in trenc�-i 12" minima
11. Pipe
Pr3- T OR SYSTE.S
1. Size of pLTTiID chamber
2. Over- -lcw tank
3 . Aia* -i, viva
sl /audid
4 PtnnD easily access Able manhole to c_ade
5. First bcx baffled:
I
-
6. Cvcle witnessed by He=1--ch DennarLrert I
estirrat--: flow per cycle.
�. =cuse lccy cer aDprcver plans. t
_.
N:L=Ler of bez -cars
c�'Ne
l l lcc t - as plan-
G.
Distance fry. SD-c -- T ?sured --
--
c.
Casing 18" ahcve
d.
Sur-ace drainage around well acc °pt= *-_: I
�
I
CVERAL , WORKMTC- 1P
a. Boxes rcceriv crc�at a
b..
A11 pipes partially
c.
All pipes fiusi, with-inside of box
d.
Back -ill rrate�rial ccnta ins stones < 4" in diarrate_r
e.
Curtain drain installer accordinc'to pia_n
f.
Curtain drain cut:all rotacted & dir.to exist_watercours
I
9.
Footing drains disc:-iarQe awav fran SDS are
h.
Surface water prote& cn ade uate
i.
'Errosion ccntrci provided on slopes cra-=ter t-..an 15 %.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512.(914) 225 -3641
APPLICATION. TO..CONSTRUCT -A WATER..WELL.._.._.
_ _ .... _...........___�. _.... . -� . PCHD PERMIT •.#
a
tLL LOCATION
Street Address
C�
To Village City Tax Grid Number
/ /mod A4 Za 11 .s'- - 3- -
u ELL OWNER
Na e
;AX-C / V z
rivate
// Address rpublic
/S o (� L -1 X ,�9Q-
,,USE OF WELL
_e- primary
2- secondary
RESIDENTIAL
BUSINESS
0 INDUSTRIAL
❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP D ABANDONED
O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT��gpm /�� - SEVED /EST. OF DAILY USAGE d gal
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
REPLACE EXISTING SUPPLY D DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
4a' 4 C10% {d 2 S u r u r {ri
WELL TYPE
DRILLED
DRIVEN
ODUG
GRAVEL OTHER
IS WELL SITE SUBJECT TO FLOODING?
YES
NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: /V 6
Lot No.
WATER WELL CONTRACTOR: Name 10 bR d e ��irn ' h,,c, d Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES t/ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
- °--DIST.ANCE
TO-PROPERTY-FROM NEAREST WATER MAIN: - - °� - -
LOCATION SKETCH & SOURCES OF CONTAMINATION
❑ ON REAR OF THIS APPLICATION
( ate) o
PROVIDED
PERMIT
RI ON SEPA SHEET
(signature)
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 withi.n 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.
Date of Issue: x 19_ A
Date of Expiration: A? ti219 �Y� Permit Issuing idal
Permit is Non - Transferrable
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services.
December 1, 1986
Mr. Daniel Donahue
RFD #11, Box 20.0
Breckenridge Road
Mahopac, New York 10541
RE: Proposed SSDS
Beals
.Canopus Hollow Road
(T) Putnam.Valley
Tax Map # 57 -3 -71
JOHN SIMMONS, M.D. _
Deputy Commissioner
Dear Mr. Donahue:
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:
provide greater separation between end of'trenches'and driveway
" "show Tinvert "'df"' `overf lbw from pufiip' "chamber 7t6 second" D -Boy "on
profile
confirm with NYSDEC if a stream protection permit will be
necessary to cross stream with driveway
note should be added that all electrical work in pump chamber
should be to NEC codes
Upon receipt of a submission, revised to reflect the above comments,.
this application will be considered further.
Ver truly yours,
Anne i tner
AB:pt Asst. Public Health Engineer
cc:AB .
JK
File
TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL'HPALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
` DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owne
Address /17 Alae -f 4
Al,c�
Located at (Street
C�!oPOr fia /low
6dicate �► ate, d Sec . S 7 Block 3 Lot �
neares cross street)
2 15 9 `��
Municipality, u ..-h
dd,..; v4, //r
Watershed 1�e.{�4,�� / ��.
2. A5, / S'
SOIL PERCOLATION TEST DATA
REQUIRED TO BE SUBMITTED WITH APPLICATIONS
�ly. bL � Via'
Foe
Number CLOCK TIME
PERCOLATION
PERCOLATION
RLM
apse
Depth to Water- Water Level
No.
Time
From Ground Surface in Inches
Soil Rate .
Start -Stop
Min.
Start Stop Drop in
Min. /in drop
Inches Inches Inches
29 �1. 51 _rf
3/
410
3is
3, a
2 15 9 `��
2. A5, / S'
a2 h
�ly. bL � Via'
3
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 hale.
i
T=T PIT DATA RFQUn=- TO BE SUFK'i`TED tdZE APPLICATION
DESCRIPTION OF SOILS EyCOUNrMED IN TEST HOLES
DE71M HOLE NO. HOLE NO. HOLE NO. HOLS NO.
61°
120
18,9
240
3099
36,
142Q9
48M
540
60"
66'°
?2w
?8°°
84w 4 1 -
a�zc.A ,E L= AT wEIcH GRow wATm IS =OUc= �1 aN2
aMICATE L= FOR WEICH WATER LEVA RISES AFTER BEING Err � � b N �
. STS MOE � DAB , � l J . � ®�� l N� Pe E�� ?G
DE;slc�r
3oi.l. Rate Used NWI b Drop: S.D. Usable Area Provided 7. b 6�
do. of Sedrooffis_=�_ Septic Tam CapacityA 08 6 Gals. Masonry Metal®
lbso rption Area Provided by 240 x 369 , JWi'�
. \. her d
�.
lam
lddress Fy
/ \j9T -0. 4 h3� ,0" ;
9
1, /b.,0 GC JUG% 16 FO(=NE�j�
Plj T#,+pl CoLm 7 Health Department �
1 Rate Approved Sq.Ft. /Gal, Checked by
Date
i
�I
PUT�IAM COL]I�rY DEPAR'QEW OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
• INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
�
' REVIEW SHEET - CONSTRUCTION PERMIT
`(y DATE REVI l� _
(Name of Owner) (S eet Location)
CON'S YF5 NO � DOCUMEfFrS
Permit Application
N Corporate Resolution
Plans - Three sets Vs
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3). Fill
30" Perc Hole cd
Other
House Plans - Two sets
If PWS - Letter if wellipermi.t
Variance Request
LF trench provided REQUIRED DETAILS ON PLANS
required Sewage Systen Plan
60 ft. max. 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 r< .
Two- Foot.Contours Existing & Proposed.
' ' ?;Driveway &` Slopes ' Cut
- Footing /Gutter. - Curtain Drains
,Perc .& Deep',Holes Located.
Representative:of.Sewage'& Expansion Area
' Expansion' Areashown ;gravity,flow,suff.'size
mped
-Showi:.:. &:=Detailed' . _ :_.. ,..__..._.
:House No: of :Bedrocros ;
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 45° w /cleanout
SEPARATION DISTANCI S SPECIFIED ON PLAN
Fields
f �JU4
.10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D,. 150' pits
1 ,_Z 100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,.Leader, Footing
351to catch basin,stonr rain, i watercourse
10 ',to Water.Line (pits -20')
50' intermittent drainage course
S2aicc Tanks
10 1 tram Foundation; " 50 to well. .
15' Well to PL.
GENERAL
;Legal Subdivision
_ Subdivision Approval..Checked 1
Ex= approval SSDS Adj.-Lots Checked
IIK .Wetland - (Town/DEC Permit -R & D)
;Data DDS -Plans & Permit Same
w.e
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date hHl-
Re: Property of
Located at Gfq /1) 0)001/
(T) Section Block Lot
Subdivision of
Subdv, Lot # Filed Map # Date
Gentlemen:
This letter is to authorize aauwo 4 p)-N Dow n utdc
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
- stem
-or-* s stems •-•iii conformit with -- th6 rovisions 70f, Article i or
y' Y • P 5.....
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
Sign
Countersigned: Owner of Property
P - E. , R. A. , #
Address
r-) I'# R -W_6o RJ
Address
M %
q (0'
J& v 96
Telephone
r6 0 A _FG f- N J e) %C'7C>
Town
9L O 1 S 6 9- -'7 If o'� 2-
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS .
F INSPECTION REPORT _
..DATE:
INSP. BY:
(Name of Owner) .(Streot Location)
INITIAL SITE INSPECTION YES NO COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location.... ................
Will driveway need cut ............................
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed.......................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc... X
Adjacent . .... ....... ......
. wells /septics....... . ....
Access to pr000sed well location for drilling..... Se
D. H. 1 Lot
Depth to G:W.
Depth to rock
Soil De,
0 ft.
3 ft.
6 ft.
9 '.ft.
12 ft.
D. H. 2 Lot
Depth to.G.W.
Depth to rock
Soil Descrintioi
0 ft.
3 ft.
6 ft.
_...:..__ ... -712. ft.
u.n. - ueeY ncu(--
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
Soil Descri tion
.0 ft.
3 ft.
6 ft.
9 ft.
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per.approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roam allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded............ .... ........
10 ft. maintained fran property line and
20 ft. fran 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 ........... .......... ........
2buld surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
)oes lot drainage appear Min area of SDS.:.....
[
�
FINAL GRADNG OF SITE ACCEPTABLE:..
DAQUINO and DONAHUE
CONSULTING ENGINEERS
10 "fe
I,
❑ John V. D'Aquino Daniel J. Donahue
RD 2 Box 17 Breckenridge Road
Put. Valley, N.Y. 10579 Mahopac, N.Y. 10541
526 -2039 628 -7576
t
i
�.i�L.. ,1.�1_
4V
WE ARE SENDING YOU 'A Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order Cl
DESCRIPTION
tt
�lduaL-
�.'._.. TN.ESE-.ARE_ TRANSM1TTED• -as ihecked- -below: -
A<For approval ❑ Approved as submitted ❑ Resubmit copies for approval
0 For your use ❑ Approved as noted ❑ Submit copies for distribution
-- ❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ ,For review and comment ❑
❑ FOR BIDS DUE /19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS 11 A / u•, s'
j A)_ J A..)}i i / 7J `'W �/ at /-� �r �/ r% C, k- �•f/�� i 2 �7 7rj Lr/ �z r � c.� L -e
Cal
It
COPY TO
P1 q
co r
SIGNED:
If enclosures are not as noted, kindly notify us at once.
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Soil Map-Putnam County, New York
Map ..Unit Legend
USDA Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
2/5/2015
Page 3 of 3
Aw
AW, 4 rf
i
'1P
ChB.
Charlton loam, 2 to 8 percent
18.5
14:6%
slopes
ChC
Charlton loam, 8 to 15 percent
5.0
4.0%
slopes.
ChE
Charlton loa m, 25 to 35 percent
1.0
0.8%
CIC
Chariton loam, 8 to 15 percent
10.1
7.9%
slopes, very stony
CID.
Charlton loam, 15 to 25 percent
13.4
10.6%
-slopes, very stony
CIE
Chariton loam,;25 to, 3.5 percent
2.7'
2.1%
slopes,. very *stony
CrC;
Charlton Chatfield complex,
0.2
01%
rolling, * Very rocky
csb
Chatfi6ld-Chartion qomplex'.
5.7
•4.5%
hilly, very'.:rocky - -
Ff
riuvaquentsUdifluvents;
8.3
14.4%
complbx': frequently flooded.
Fr
F red'on s'ilt',Ioam
3.6
.2.8%
HnB --------
Ily!oam
kh&ley grave y sand, 3
0.6
0.5%
168 percent slopes,
HrF
Hollis k o ck outcrop . complex, m0ex
3.1
2A%
..v6rysteep
PnC.
he sandy-,Ioam,-8 tbrl 5-
15-.6
percent s160&s
PnD
Paxton fin . 6 sandy lo . am, 15 to
7,3
-5.k-
'25perceritslopes
PoD
Paxton Me- sandy, loam, 15 to
6.5
5.1%
25 percent slopes, very stony
Ra
Re yn.h6m silt 16am
1.3
.1.0%,
RhA
Riverhead- foam, 0 to 3 percent
3.9
... - 3.1%
slopes -
RhB
Riveffieid-loam, .3 to 8 percent
7.5
slopes
Water
0.9
0.7%
WdC
Woodbridge loam, 8 to 15
1.8
1.4%
percent slopes.
Totals for Area of Interest
127.0
106.0%
USDA Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
2/5/2015
Page 3 of 3
Soil Map—Putnam Countv, New York
PUt1*nCounV,-N'ewY,6rk#Mq),
Nlap UnitNmft
Aq"JUAOU,----
rcent of A_ OI
ChB
Chadton1loam, 2 to 8 percent
4.8
16.4%
slopes
ChC
Chariton loam, 8.to.15 percent
2.1%
slopes
-0.6
CIC
Charlton loam, 8 to 15 percent
.0.4
1.5%
slopes, very stony.
CID
Chariton loam, 15 to 25 percent
1.9
6.5%
slopes, very stony
CIE
Charlton loam, 26 to 35 percent
4.3%
slopes, very stony
Ff
Fluvaquents-Udifiuvents
11.0.
complex, frequently flooded
Fr
Fredon silt loam*
3.4
11.6%
HnB
Hinckley gravelly loamy sand, 3
0.6
2.1%
to .8 percent,slopes
P.nC
Paxton fine sandyloam, 8 to 15
0.1
0.4%
percent slopes_
PnD
n
Paxton fi e,sandy loam, 15 to
6.2
oz%
25 percent slopes
Ra
Raynha.rn silt loam.
3.7%
RhA
Riverhead loam, 0 t 3 percent
....
4.4%
slopes..
-RhB...
Riv*erhe4c-loeimi3Lto;8-rpercent----��--�.-�---
:-:-: -. I.T.
W
Water.
0.9.
3.1%
WdC
Woodbridge-loam, 8 to 15
0.5 -
1.8%
percent slopes
Totals for Area of Interest
2r 9.1
100.0%
USDA Natural Resources
280 Conservation Service
Web Soil Survey
National Cooperative Soil Sur-Vey
2/5/2015
Page 3 of 3
i
t '
Soil Map — Putnam County, New York
i
E
Natural Resources Web Soil Survey
Conservation Service
i National Cooperative Soil Survey4 s
I. i
2/5/2015
Page 2 of 3
P
MAP- LEGEND
MAP INFORMATION
Area of Interest (AOI)
Spoil Area
?
The soil surveys that comprise your AOI were mapped at 1:24,000.
[�
Area of Interest (AOI)
Stony Spot
Warning: Soil Map may not be valid at this scale.
Soils
0
Soil Map Unit Polygons
Very Stony Spot
Enlargement of maps beyond the scale of mapping can cause
Wet Spot
i
misunderstanding of the detail of mapping and accuracy of soil line
Sol Map Unit Lines
placement. The maps do not show the small areas of contrasting
.13
Sbil Map Unit Points
Other
t
e
soils that could have been shown at a more detailed scale.
it=
°'
Special Line Features
Special
point Features
; ~
Please rely on. the bar scale on each map sheet for map
V
Blowout
Water Features
measurement.
Streams and Canals
i
Borrow Pit
of.Map: Natural Resources Conservation Service
Transportation
s
Web Soil Survey URL: httpJ /websoilsurvey.nres.usda.gov
� .
oClay Spt
.Rails:
Coordinate System: Web Mercator (EPSG:3857)
0.
Closed Depression'
ati
Highways
Interstate Hi hwa s
Maps from the Web Soil Survey are based on the Web Mercator
Gravel Pit-
US Routes
'
projection,. which preserves direction and shape but distorts
!
distance and area. A projection that preserves area, such as the
Gravelly Spot .
Major Roads
i; ;
Albers equal -area conic projection, should be used if more accurate
Landfill
.:.1.
calculations of distance or area .are required.
Local Roads
Lava Flow
Background
4
. This product is generated from the USDA -NRCS certified data as of
the version date(s) listed below.
Marsh or swamp
®-
Aerial Photography
{'
Soil Survey Area: " Putnam County, New York
'..
Mine or Quarry
! ;
.SurveyArea.Data: Version 11, Sep 16, 2014
Miscellaneous Water.
Soil map units are labeled (as space allows) for map scales 1:50,000
Perennial Water
Or larger: .
Rock Outcrop
Date(s) aerial images were photographed: Mar 26,201 I—Apr 16,
2012
..
Saline Spot'
r
The orthophoto or other base map on which the soil lines were
e
Sandy spot .
compiled and.digitized probably differs from the background
@.
_ severely Eroded Spot
" :
+
imagery displayed on these maps. Asa result, some minor shifting
f '
of map 't boundaries may b e ident
urn e evident.
Sinkhole
Slide or Slip ' `..
Sodic Spot
E
Natural Resources Web Soil Survey
Conservation Service
i National Cooperative Soil Survey4 s
I. i
2/5/2015
Page 2 of 3
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