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Home My WebLink About2679DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -1 -34 BOX 23 02679 _ . k ji t _ ` l PUTNAM COUNTY DEPARTMENT OF HEALTH R v 3186 Division of Environmental Health Servlces 'Ca mel, N.Y. 16512 w ^e Engineer Mast Provide . P `C.H D. Permit q - -� ¢�� - 'ool ..CE ATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM __.:.._. - - - - 'T cv on e - 7. Located at c9 %/ �C%% v /i`7 /�+ �n Tai MapBiocli ' Lot X �,y �� .1 %fir Former) Subdivision Name Sabdv. Lot p Owner /applicant Name � Y .- _ ,, Mailing Address X �s / G 2-- G Zlp ��' 3 3, Date Permit issued Z/ `�/ � -J JS /I dU Separate Sewerage System built by 7 /7 Address Consisting of �� jam' - -? J Gallon Septic Tank and ��F �r � '' t'�� ' � � '- Water Supply: Public Supply From '° `� ^-_ // Address `p /i� ! A4 a1 t. -t c-" Address 134 f:4 "� �' 1 . Al �. ors Private Supply Drilled by Building Type i �3 Has Erosion Control Been Completed? Number of Bedrooms -3 Has. Garbage Grinder Been Installed? Other Requirements vrV I certify that the system(s) as listed serving the above premises were constructed essentially as "ej�ovm on the plans of the {completed work ( copies of which are attached), and in accordance.with.the standards, rules and regulations fin�?acbordaece`Nith the filed plan, and the permit issued by the Putnam County.Department Of Health, u 01 177 P.E. R.A. Date -11 A Certified t/Y Add reu License No. 4t, IA Any person occupying premises served by thVlabbo. .system(s) shall promptly take such action s may.be`neeessary. to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall became null and:void as soon as a pubs:-. unitary sewer becomes available and -the approval of the private water supply shathbecome null and vo)dv when a pu&ic",wat'iriupply becomes available. Such approvals are subject to mo station or change hen, in .the Judgment, of the Commissioners nFeelth, g�htirn, modification o► change it me fury. T�� `If r , Date (` By . Title PUTNAM COUNTY DEPARIMENr OF HEALTH DIVISION OF EN`IR01NMEMAL HEALTH SERVICES Owner or Pbrchaser of Building Building Constructed by Location [1- Street Municipality Building Type 5 7 3 Z! // 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 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 Construction Compliance" for the sewage disposal system, or any repairs made by me to .such. _sy stem, except...whete. the failure. to o .prate P 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 G day of 19 Signature Title ner ntr r (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) Address i(orktown Medical Laboratory, Inc LAB I 02931 q; , � 321 KearScreec Collection Station Used.: Yorktown Heights, N. Y. 10598 Carmel Peekskill: (914245.1203 — • 4.i.I4.sr H Pgdge►mne _ �.C�rec,t4r• _ -.._. Mt. Kisco _ Nev City _ r _ .::n: �.,n•.= Date _Taken `•y1 71� N� Date Received: /- S'- /feS -- !-� Date ,Reported: G�✓�7/ d> 3 �S collected By: e;V C boiU•Vey Referred By: L A?. J' . Sample Source: ItIf % _R i LABORATORY RE OT ON- BACTERIOLOGICAL QUALITY OF WATER. GENERAL BACTERIA .,Z'Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) YEMBRA?7E FILTRATION TECHNIQUE (MFT) ,/Total Coliform ter 100 ml Fecal Coliform ner 100 ml Fecal Streptococcus per 100 ml `'.OST PROBABLE NUMBER TECHNIQUE (MPN) O Total Coliform: MPN Index ner 100 ml — Fecal Coliform: MPN Index per 100. m1 OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPL�'•'(WAS) (W NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORD ING -XO-T EW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED,.AT THE TIME OF COLLECTION. -� 11 Albert.H. Padovani, M.T. ASCP). Director LEGEND ADS w Recommend Disinfect- ing Water Source < a 'less than TETC a Too Numerous Too Count �j0 W>';LL I,VJ"1rL1S11V1V icGrVicl DEPARTMENT OF HEALTH - -- — Division -.Of Emvir.onm?ntal_ Health Services .. PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - STR ET AOURESS: TAX GRID NUMBER: WELL LOCATION WELL OY. R ADDRESS: 2 3 ��J ,� � __- � Rr+81VATE PUBLIC USE OF WELL 1 - primary 2 - secondary SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND.IHEAT PUMP O ABAAONED 0 BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT � gpm. /N0. PEOPLE SERVED ---'7' EST. OF DAILY USAGE gal. REASON FOR DRILLING (NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA '.WELL DEPTH �3 0 ft. STATIC WATER LEVEL t:a ft. DATE MEASURED DRILLING EQUIPMENT , ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER . CASING DETAILS TOTAL LENGTH fit. MATERIALS: OSTEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE ft. JOINTS: O WELDED ;'THREADED O OTHER DIAMETER ? '` in. SEAL: ❑ CEMENT GROUT ❑ BENTONITCKOTHER WEIGHT PER FOOT Ib. /it. DRIVE SHOE.*ES ONO LINER:OYE NO DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN FIRST _ - 0 YES_ ONO. . _...... _.. _ OURS _ SECOND . � ..._.. ._ ... _.... _..... _... _ ...._.. _ .... __. - ....... _. .__ .._....- - - -- � -- _._ _ .. ........H GRAVEL PACK 0 YES 0 NO GRAVEL SIZE:. OIAMETEA OF PACK in. TOP DEPTH _Tf . BOTTOM DEPTH It. WELL YIELD TEST 11 If detailed pumping METHOD: O PUMPED i tests were done is in- COMPRESSED AIR , formation attached? O BAILED 0 OTHER ; ❑YES ONO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water WeII pear- Dia- in9 peter FORMATION DESCRIPTION CODE ft. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gCm Land Surface f y'.. C. WATER CLEAR TEMP. QUALITY CLOUDY HARDNESS 0 COLORED ANALYZED? DYES ❑ NO ANALYSIS ATTACHED? 0 YES O NO STORAGE TANK: TYPE CAPACITY - GAL. PUMP INFORMATION TYPE CAPACITY MA KEA DEPTH MOOEL VOLTAGE HP WELL DRILLER NAME ;vy'y �,� /' OAT ADORES" slGPlftTURE ,. t - f ENGINEER TO PROVIDE PERMIT # PUTNAM COUNTY DEPARTMENT OF HEALTH ON CERT FICA 0 PLIA CE, Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # � CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM "ltr 'Y��+f�• .- Town or Village ....�:�'OxMap Lo � ., :.Buick. .. ..«,,.. .�t Subdivision 1 L /e/L��d Y✓_S Subd Lot # $� Renewal _0 Revision _ GS Owner /Address �/^�` Building Type d Lot Area -�2 .1% 1441 Number of Bedrooms Design Flow G /P /D Separate Sewerage System to consist of Z Gal. Septic Tank To be constructed by ---Jr Water Supply: Public Supply From Private Supply to be drilled by Date Of Previous Approval Fill Section only I]_ P.C. H. D. Notification Required and Address Address Lam': Other Requirements A; °1 I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); s`j,that the• separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rulei:an ►egu a ions OT e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction 'satisfactory to "the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, hi c r 'ssigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the �tp ojAvA)),dJ mediate�ly following thedate of the Issu- ance of the approval of the Certificate of Construction Compliance of the original s e fir° o I flair t 2) tfha4:;the drilled well described above will be located as shown on the approved plan and that said well will be installed in accor nc�9 th the sta rr es and: regu a7ons of the Putnam County Department of Health. b >, ,;.x....+ Date�� 1 l✓ ,,I,�'w m o v �/r T Signed P.E. p R.A. Address / � .y o a� 8911 - License No. APPROVED FOR CONSTRUCTION: T approval expires one year from the. date issu, `►esst,,pn t�+°bSn °df >]�e building has been undertaken and is revocable for cause or may be amends or modified when considered necessary by the Co,i►tts3me�a9th$, any change or alteration of construction requires a new permit. Approved or disposal of domesti sanitary swag and r private ver °bt�lntyti� 'i /7 1 `1 Date � By � °trf°ewfu°-j I Title l:: Rev. 6/85 PUTNAM COUNTY DEPART OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS . FIMD INSPECT ON REPORT . INSP-e I3Y-- (Name of Owner) CStreet location) INITIAL SITE INSPECTION YES NO COMKDM Wetlands on /or proximate to property................. - Property liries or - corners found.. .............. Can estimate house location.. .:..................: Willdriveway need cut ..................... ..... Must trees be re*noved - 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... Adjacent wells/ septics .......................... 'A,, -occ +-n nrnm¢ar1 wP11 1 rx^ntion for drillincr..... F--1 D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft: 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock D.H. - Deep Eole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock. 0 ft. House SSDS located per approved lan ...........:. Length of trench Treasured ; 6 60) Width of trench average c-D Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not .stripped or SDS area unnecessarlygraded............................. 10 ft. maintained fran property line and :;N ft. fran house. ........H � L3, V-i"' .... . 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 fran driveway, ..roads,._. ground surface, etc., channel near. SDS area.... Does lot drainage. appear OK in'area of SDS.'o...;. Soil Description PI'S L' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL,T N. Y. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address /5-7007 .,* ,.boa- 2 3 45' Jam. Y. Located at ( Street Sec Block 3 Lot Indicate neares cross s ree Municipality .w`a :ra X-_`//`` rJ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WI7 APPLICATIONS oe Number CLOCK TIME 5 PERCOLATION PERCOLATION RM Elapse 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 5 1 . .2 3 5 Notes: 1) Tests to be repeated at same depth until apppproximatelyy 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. 5 5 1 . .2 3 5 Notes: 1) Tests to be repeated at same depth until apppproximatelyy 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. v 5 1 . .2 3 5 Notes: 1) Tests to be repeated at same depth until apppproximatelyy 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ;.._.:DP�SCRIP`�'T�-ON::_Or DEPTH HOLE NO.`S/ _ HOLE NO.� HOLE NO. ::5 ;r G.L. 6" 12" t 18" 24" 3011 3611 `t2" - 48" 5 H 60" 66" 72,. 78" 84" _INDICATE LEVEL_ -AT ; WHICH GROUND. WATER IS . ENCOUNTERED. INDICATE LEVEL TO WHICH 'WATER LEVEL RISES AFTER BEING ENCOUNTERED. TESTS MADE BY _�, $ y ,.� ,� Date DESIGN Soil Rate Used :f _Min/l "Drop: S.D. Usable Area Provided '"` gi No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area Pro ded By L.F.x24" width trench. v o Other Address > .' r ✓� :.:-� %� . THIS SOCE FOR USE BY HEALTH DEPAFA4E ]Z Soil, Rate Approved Sq. Ft /Gal. .gnature ONLY: Checked by Date JOSEPH F. SULLIVAN, P.E. 2972 FEANCRE8T DRIVE YORKTOWN HEIGHTS, N. Y. IOS98 (914) 962-4248 Z/-" � /y7e!r "4 . / ��,'�. ..-�i��.. ` oar ��'� .� �C�/ ��" �,�':� .� M. PUTNAM ��LJ�'f�l ®�iPAR�1��1�1II O]E ]Eg]EAII.'II�d ,PROVIDE RERMIT # ,TF nle roMPLIANCE, Division of Environmental Health Services Carmel 'JU..Y - 905.12 - PERMIT' iF COftISYPi,UCYIOf!!' PERNAIi FOR.SEIAIAGE :DISPOS,4L Sy[ EfVI r'.p�.jL� y, o _ • ' ' . - . -,,- ... _ pp i9lock o wn or Villa Li3l.Nt6d di t.. g Tax 'M Subd.:Lot R Renewal _ 0 - Revision _ Q Subdivision Owner /Address �! , -'✓ � .I. X.a -: _d !' D O pp royal ate f Previous A Building Type " Lot Area Fill Section only Number of Bedrooms Design Flow G /P /D P.C. R. D., Notification Required / Separate Sewerage System to consist of / �.4:p C., Gal. Septic Tank and s ' E 2 -� To be constructed by Address Water Supply: blic Supply From Private `Supply to be drilled by Address sf - Other Requirements I represent that am wholly and completely:. responsible for thedesign.and locet j # f � ' el k ion�oftthefproposed system(s�),i;l) that the separate sewage disposal system X58 above'descr,bed will, be constructed as shown on ttie`approved amendment thereto and in a dance *with the standards, rules an r u a ions'o e u nam €'. e9 County Department of.'.heatth, and that -on completion thereof a Certificate;,• of; n�g t pt,ance' satisfactory to the' Commissioner of Health will be submitted to the. Department; and 'a :written guarantee wjll•'be furn�shed't e., is� ce" ,.:heirs or assigns by the`buiider, that said builder will place . in good operating condition any part of said sewage; disposal, system" _got ° 6� 2) years Immediately following the dais of the issu- ance or, the approval of the Certif,cate of Construction Compliance of thn on io Ir c . e 'rs`ttiereto; 2) that the drilled.weli described above wilFbe,locafed,as shown on the approved plan and.that said well will.be' install €�n ' rdance wI st Bards,. rules and regulations-. of . the Putnam County Department of Health, y ®" v Date y% Signed P. E.ra✓ R.A. .ra c e Address YL.° °' License No. APPROVED FOR CONSTRUCTION: I This approval,expues one year from th sdll ction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary'; t rsbsslbnei4dpf, Health. Any change .or alterafion of construction requires a new � mit. 'Approved fo'r dislosal of :domestic sang r''y sewage, an r �b8spply only. �0 Feb A Date ey Title Rev. 6/85 'i F. ... ....... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,._ COi7NI`3� �OFF��F•' BUILDING,- 'CARMEL;,..N, °. Y. �._,— �:05.�2 _ ... .. -. ..- DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner � e/ Address / , .3 Located at ( Street J`rL- ��c��/ ° Sec . S'° Block 3 Lot. Indicate nearest cross s ree Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME Run Elapse No. Time Start -Stop Min. PERCOLATION Depth to Water From Ground Surface Start Stop "Inches Inches Water Level. in Inches Drop in Inches PERCOLATION Soil Rate Min. /in drop T , y v 2 .3103 �s / 1✓ L3 5 , /, /Y /�; 5 1 2 T -- K Lf E PEP]'. idiCf:r"iL R/ Notes: 1) Tests to be repeated.at same depth until approximatelyy 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. r � TEST PIT DATA REQUIRED'TO BE SU13MITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. 17— HOLE NO f G.L. 6" 1211 18" 24" 3011 36" 42" 48" 5411 6011 .. 7211 in �fG. Y6> �" �r i% ✓ 511 Cr' 6=°a�`�(t'jl� B� F.'�S+vf /�fiZJ� 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED !A :...:...Iia1lDIDA.TE :LHVE -TT WHICH WATER L EL. RISES AFTER BEING.:ENCOUNTERED TESTS-MADE BY Date l C DESIGN Soil Rate Used t:� Min/1 "Drop: S. D. Usable Area Provided"�c No. of Bedrooms 3 Septic Tank Capacity f Gals. Types -`� E r Absorption Area Pro d By !L,d L.F.x2411 width Trench. / Other. Addres s� THIS / PACE FOR USE BY HEALTH Soil Rate Approved I Sq. Ft /Gal. ONLY: �X V�. Checked by��t4 °�'� Date PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL Tn1km SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT - - -- - - _. _.. .DATE: INSP. BY: Mme of Owner) (Street Location) INITIAL SITE INSPECTION e 6.. S YES NO COMMEM Wetlands on/or proximate to property .............. Property lines or corners found................... Can estimate house location. ....... — ...— o .... Will driveway need cut ............... . ... oo — ..... 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... Adjacent wells/ septics ............................ D.H. 1 Lot Depth to G. W. Depth to rock Soil DescriAti( 0 ft. 3 ft. r '6 9 ft. D.H. 2 Lot Depth to G. W. Depth to rock Soil Descriotia 0 ft. 3 ft. 9 ft.a D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. a .....f t M boil i)escrl 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......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............ .............. 10 ft. maintained fran property line and 20 ft. from house .. • ... ................... Distance well to SSDS (ft.) ...................... Numberof bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from 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....... A FINAL GRADNG OF SITE ACCEPTABLE.. ... r� { PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /.•�� - -r Re: Property of AC q ./1 el, Located at ,j �i��t /: ae C." G (T) p Sections Block Lot Subdivision of AG G� /e��.�-/�, Subdve Lot , Filed Map # J�f� ` Date Gentlemen: This letter is to authorize c7 ell 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 system: or.. systems -in conformity -, with _tlie.. pr-ovi,sions.:of Article- .245 -.or - 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. P.E. u 2 2 Addre s Telephone Very truly yours, Signed er of roperty KR-/ A''X' Address C- /K. <- Town 'Y `5 C6' Telephone PUTNAM COUNTY DEPAFMMU OF HEALTH - DIVISION OF ENVIRONMER L HEALTH SERVICES ' . nDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE v� k i1. i Ll._. (Name of Owner) (Street Location) DOCUMENTS Permit Application Corporate.Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size, If Pumped Pit & D Box Shown & Detailed House _ No. of .Bedrooms Wells & SSDS's 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 DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls i 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Stom,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 O� ' 090MEN10051 0� 0� 0� 0� 0� e■ m� DOCUMENTS Permit Application Corporate.Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size, If Pumped Pit & D Box Shown & Detailed House _ No. of .Bedrooms Wells & SSDS's 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 DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls i 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Stom,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 a P ihE � M I