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Home My WebLink About2695DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -1 -57 BOX 23 02695 or T J6 oil 1111 ; I�` , , F � , 1 or I L '� .�� arm a �� . :1 mv?l, +L 02695 . �►1 • ®oI. 'ry Office Use Only DEPARTMENT OF HEALTH -Env -i .onmq;nta1 ,Hea]:th Services--.---. PUTNAM COUNTY DEPARTMENT OF HEALTH, 5 EET ADDRESS: TO LLAUICI I Y TAX GRID NUMBER: WELL LOCATION WELL OWNER NAME ADDRESS: a 21 PRIVATE Q ❑ PUBLIC USE OF WELL Ja RESIDEdYIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ;ABANDONED 1- primary . ❑ BUSINESS O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S�' gpm. /N0. PEOPLE SERVED: - / EST. OF DAILY USAGE, gal. REASON FOR 'S NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL. � , ft. DATE MEASURED DRILLING ❑ ROTARY ❑ COMPRESSED AIR PERCUSSION O DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING Iff OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH A _ fL MATERIALS: J'STEEL O PLASTIC D OTHER CASING LENGTH.BELOW GRADE ft,; JOINTS. ❑ WELDED &THREADED ❑ OTHER DIAMETER P • in. SEAL: O CEMENT GROUT ❑ BENTONITE XOTHER DETAILS WEIGHT PER FOOT Ib. /ft. DRIVE SHOEZ YES ❑ NO LINER: ❑ YES 19 NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST _. N DETAILS SECOND - _ _____ -�. _ . _ _ ........ _._ .. d. , ... _.. _. HOURS" " GRAVEL PACK P YES GRAVEL DIAMETER j1nOEPT P BOTTOM ❑ NO SIZE: OF PACK H ft. D EPTH It. WELL YIELD TEST If detailed pump ing�LL LAG If more detailed formation descriptions or sieve analyses are available. please attach. METHOD: O PUMPED tests were done is in- COMPRESSED AIR , formation attached? DEPTH FROM SORFACE wafer. Bear - weD 0ia- O BAILED ❑ OTHER ; ❑ YES' `O NO i "9 In FORMATION DESCRIPTION CaoE_ tt. tt. WELL DEPTH, DURATION DRAWOOWN YIELD Surface D° ft. hr, min. ft. e 71: 14 OV W MO agav Vva WATS O CLEAR TEMP. W QUALITY O CLOUDY HARD ESS XO COLORED ANALY ? ES O NO PROFESS0P� ANALYSIS ATTACHED? O NO STORAGE TANK: TYPE jeJc(_ PUMP INFORMATION CAPACITY AL • � TYPE CAPAC MAKER L DEPTH a h WELL DRILLER NAME AOOR X03 059"S,�,, ICFt wii / MODEL VOLTAGE d HP • 1 � rV- fown A.4 A; 1 L b I LAB e e ica a oratory, nc. 321.Kear Street Date Taken: Time: Yorktown Heights, N Y 10598 Date Rc' d: Time: _� i9141.245 -3203 , ...._ - -Y�, IIa t R.e Albert N. AadovaniM. T.(ASCP) Collected By: y Director: M Referred By: G'/loSS S /.6�X;7�� Sample Location: _joarnp �3 ZAS .S � Phone # �- ,, Phone # I Sample Type: L S'vt-4-7_11 .5h2ALM J Repeat 'Test? _ (check one) LABORATORY REPORT ON.THE QUALITY OF WATER INORGANIC NON- METALS. (mg /L) MICROBIOLOGICAL (CFU /100mL) _ Acidity _ Alkalinity Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total _ Sulfate _ Sulfide Sulfite METALS (mg/L-) _ Copper _ Iron _ Lead _ .Manganese _ Sodium Zinc MISCELLANEOUS pr. (units) . Color (units) Odor (TON) Turbidity (NTU) GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) MEMBRANE.FILTRATION TECHNIQUE Total Coliform Fecal Coliform _ Fecal Streptococcus* MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index . Fecal== Col-iform Index KEY FOR TERMINOLOGY CFU' Colony Forming. Units N /A'= Not Applicable LT = ' Less Than (< ) GT = Greater Than ( >) TNTC= Too Numerous To Count CON = Confluent (= TNTC). NR = Non- reactive REMARKS /COMMENTS (For Lab Use) _ ✓Potable _ Non - potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing _ HNO 3 _ HC1 _ H2SO4 _ NaOH ZnOAc Na2S203 Other: Incoming, LE 4 °C _ GT 4 °C _ pH LE 2 _ pH GE 9 pH GE 12 Other: ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WA ) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY. ACCORDING. TO T N YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) ODR EET THE S ATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Ix/ 2 /86(Rvsd7 /87)RWE Albert H. Padovani, M.T. ASCP), Director a� s' WLLJL L.Ur1rLr,11UV1 .AGrUAl Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION ST.HEEi ADDRESS: L TOWNTY10mclir r TAX GRID NUMBER: �. WELL OWNER NAME.'/?` `y ADDRESS: PRIVATE O PUBLIC USE OF WELL ^ID. RESIDENTIAL . O PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP O ABANDONED 1 - primary O BUSINESS ❑ FARM 0 TESTIOBSERVATION ' ').0 OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND-BY, ,❑ MOUNT OF USE YIELD SOUGHT -:} ` m. /N0. PEOPLE SERVED / EST. OF., DAILY USAGE � gal. • REASON FOR - El NEW SUPPLY '0 PROVIDE ADDITIONAL SUPPLY ' 0 TEST /OBSEERVATION O` REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL .DRILLING �., DEPTH DATA ' WELL DEPTH r' D ft. STATIC WATER LEVEL it..'DAM.MEASUAED - f DRILLING ❑ ROTARY O COMPRESSED AIR PERCUSSION '\p DUG. EQUIPMENT O WELL•POINT y0 CABLE PERCUSSION D OTHER (Specify). p EN WELL TYPE 0 SCREENED OPEN END CASING. WOLE IN,,EDR C} ❑OTHER .0 . TOTAL LENGTH ft.. MATERIALS: - „EI`STEEL ❑ PLASTIC D OTHER CASING ... LENGTH.BELOW GRADE '`ice Eft: JOINTS ;'} pt:WELDEO ” " ". HEADED ❑OTHER : DETAILS ,, DIAME7 €R ` in: - SEAL: ❑ CEiNENT GROUT ::O BENTONITE QOTHER WEIGHT PER FOOT 1b./ft. I' DRIVE SHOE -0 YES : ❑ •N0, .. LINER: OYES. ONO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST o Yt ❑ Na DETAILS . _ SECOND _.__.. .... _.. _ _ _ _ _ _. �_ ... _. .HOURS• .'GRAVEL. PACK YES GRAVEL DIAMETER TOP BOTTOM • O NO SIZE: OF PACK in. DEPTH" ' ft. ;DEPTH, It. WELL YIELD TEST ' If detailed pumping 'a��LL LOG • .11f more detailed formation descriptions or.sieve'analyses tlY are available, please attach. METHOD: O PUMPED 1 tests were done is to attached DEPTH FROM water Welt El- COMPRESSED AIR ,, ormation ,. BAILED 0 OTHER i O YES D.N0 SURFACE. Bear- Dia- .peter gMAT1oNQESCflIPTION poE, ft.. • ' f� ..�ng., ,0 WELL DEPTH . DURATION DRAWOOWN YIELD YIELD Sumac it. hr. min. it. I y ,1 - k ` W-1141 �. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS �/ '10: STORAGE TANK : TYP E /' �-•(� RoFESS!o" '' O COLORED ANALY ED? ,/O YES ONO ANALYSIS ATTACHED? OED, O NO. ~ PUMP UIFORMATIOf1" -� CAPACITY , ,GAL._ Q TYPE C�U,�• CAPACITY WELL DRILLER NAME $%.Yjy_ s , .. ; , .( :2> •crsy- , t, DAi e � "-ADDRESS! MAKER 1� DEPTH "" i '� - ;:�- 'SfGttA7URE � MODEL VOLTAGE � HP i Hpvel HOM. Jac: "Owner or Purchaser of building Section . hovel Notes. Inc. :Tuildi- ne..Constructed .by_ _ ... BIock. ;. _.,,... ,-. _ . ... .... WoM Hollow Road Location -.Street Lot Allen R. HBPr'W &. NanCY H. C.rUtc�Ski � & : fttnn valley Arthur .L., Herr0W : , Municipality Subdivision Name Single -Fami ly 3 Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success - ors, heirs or assigns, to place in good operating condition any part�'of saiFd :system constructed by, me. which fails to operate for a period of two years immediately following the date of initial use of the sewage 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services _ of: :tho%,Putnarri-County-Department of.- Health as to whe.ther°;or -not.: the ,:fail- s. ure of the system to operate.was caused by the w 1 or, ne,g 'gent act of the occupant of the building utilizing the s st m Dated this day of.00"Wr 198 Signatur Title Py(Z S y� c—j_1-C `4 vJP Vy�:)ME2� N C Corporation Name if corp. Address ��Tt�✓ —— — — — — — — — — — — — — — — — — — — — — — — — — —— — 1QSR0 - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. T GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PgJT1V AM COUNTY DEPARTMENT. ®F HEAg..'1[['H ' , Permit Division. of Environmental Health' Services, Carmel, N.. �Y..1o5i2 me�r-�y #P'V38 =87) CONSTRUCTION PERMIT FOR SEwAdE DISPOSAL SYSTEM PUt66 in, :Vdl.ley'. Town or Vi lags . _S Located at 'Ca'nopUS n1�11Ow� Rdad �~ Tax Map eiock a lot '{ sLtidtvgs�nG. Harrow &Nancy =;Ho _Crukowskis;tu. -L. Har>�ia1_ Revision' _❑ owner /Address Hovel Homes, Inc., Box. 4, Lake Peekskii`-1,,N.Yeate o£,Previous Approval .1'1.a�• 26 +.. -198'7 Building Type Single - Family. Lot Area 2+ acres Fill section only CX. RA R_ -� + Number of Bedrooms —4 Design Flow G /P /D P.C. H. D. Noti£icatiorF,tt Qiz Separate Sewerage. System to consist of 1200 Gel. Septic Tank and 40 1J. x 24" wide trenches To be constructed by S.A.F. Septic Systems, iNc. Address Pe O. Box 141; Cross River, N.Y. Water Supply: Public Supply From X _ Private Supply to be drilled by jorlish Address Kaple'-Ave,, Armonk., N.Y. Other Requirements 3'i' RAJ'- fill over. entire SSDA & '50% expansion area. I represent that 1 am wholly and completely responsible for, the design and locAo above described will be constructed as shown on the approved amendment th . County Department of Health, and that on completion thereof a "Certifi e^ be submitted to the Department, and a written guarantee will be :furni ed place in good operating condition any part of said sewage disposal s e ,1 ance of the approval of the. Certificate of Construction Compliance o) if c will be located as shown on the approved plan and that said well will be Ins $11 County Department of Health. Date August 11., 1987 signed Address 186 Ka'tonah Ave:; APPRO�VEO FOR CONSTRUCTION: This aDPCOVaI expires year:. m_4 revocable for tau or ma be amended.or Modified when eo red es I requires a new_ rmit. Approved for disposal of domesti" itar :sewa , Date By 1 Rev. 9 -81 am(s); 1) that the separate sewage disposal system the standards, rules and regulations o e u nam jd.rd'. " satisfactory to the Commissioner of Health will rs or assigns by. the builder, that said builder will years immediately following the date of the issu- thereto, 2) thatthe drilled well described above rules and regu W ons of the ' Putnam w P.E._ R.A. 1053.6 51251 License No. onstruction of the building has been undertaken and is T rof Health. Any change or alteration of construction onl ^ "Title lye PETER C. ALEXANDERSON County Executive ENID L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS, M.D. tr t y Deputy Commissioner JOHN KARELL Jr., P.E. DEPARTMENT OF HEALTH Director Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 October 12, 1988 Salvatore Rinna Valley Pond Road Katonah, New York 10536 Re: Compliance SSDS - Hovor Homes Inc. Canopus Hollow Road (T) Putnam Valley Dear Mr. Rinna: 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: 1) Plans must include a legend, which reads as follows: "This is to certify that the sewage disposal system was constructed as indicated on this plan and...that the-= systeut was- by me. before it was covered over.. The system was.. _ constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health." 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 /jz PUTNAM COUNTY DEPARTMENT OF HEALTH D IVI SION. -OE-..EN-VIRONMENTAL-'HEALTli.-.SER.VICES.. Date August 11, 1987 Re: Property of Hovel Homes, Inc. Located at Canopus Hollow Road (T) Putnam Valley Section Block Lot Subdivision of Allen G. Harrow & Nancy H. Crukowski.& Arthur L. Harrow Subdv. Lot # 3 Gentlemen: Filed Map # Date This letter is to authorize—Salvatore V. Riina, P.E. a duly licensed professional engineer X or registered architect (IndicateT_ 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 a.s promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf 0 connection with this.-Imatter and -the- construction of-said system or systems in conformity with the provisions of Article 145 or 147, Educat tary.Code Countirsigne P.E,e, R.A., # � Elb* W Public Health Law, and the Putnam County Sani- 0. OFESS100' 51251 186 Katonah Avenue Address Katonah, New York 10536 Very "Ny yours G C_ Signe= Owner of Property 477� Address 1 1)'V'-e Pe C.- K I row Town 1 14 -Wog Telephone 232-7408 Telephone APPENDIX B PUTNAM COUNTY DEPARTMM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ - INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMGE DISPOSAL SYSTEMS ' ".. tFia �;IT SHEET CONSTRUCTION . PERMIT _ V BY: 1 (Name of Owner) (Street Location) COMMENTS YES LF trench provided required 60 ft. mex. Parellel to contours _L NO DOCUMENTS Pe nit 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 permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) .Sewage System Hydraulic Profile - Gravity Flora 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 Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pmped Pit & D Box Shown & Detailed House - No, of Bedroans Wells & SSDS's w /in 200 ft, of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe . No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Iarge Trees,Top of fi 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expa 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercour. 101. to Water Line (pits -201) - 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL Well A P;1J'C- ,lT,c);! 111 71' - � ..r ° 11 .-_.-..,.:.. ar': uR: Li. w• M�l: � ::fai::::Y�hilnMld�wNri+li�.t�a4 - '• ' � rn.�_...- -�.. -. BATH 5' 6" - 40' 0" LOWER LEVEL PLAN! # 502 0 ALEXANDRIA ® 28, X 40 - 28 X 40 0'4 BR - 21/213 iq UPPER LEVEL TWO STORY 2240 SQ. F1'. "= BEDROOM! 3 12'0 "X13'3" i .. I 'I -iRUrr KITCHEN s sort BATH 5' 6" - 40' 0" LOWER LEVEL PLAN! # 502 0 ALEXANDRIA ® 28, X 40 - 28 X 40 0'4 BR - 21/213 iq UPPER LEVEL TWO STORY 2240 SQ. F1'. "= BEDROOM! 3 12'0 "X13'3" i .. I 'I DESIGN.DATA- SHEET- SEPARATE SEWAGE-DISPOSAL-SYSTEM FILE NO. - .Owner. John: Zarcone °Address P:-O -Box 498-5 Putnam Valley, N.Y. 10579 Located at (Street Canopus - Hollow �R(tec.: Block Lot' Sub. #3 Indicate neares cress street) Municipality Putnam Valley (T). Watershed New York City SOIL PERCOLATION TEST.DATA REQUIRED.TO HE SUBMITTED WITH•APPLICATIONS ... ALL TEST'HOLES WERE-PRESOAKED-PRIOR TO RUNNING TESTS.... oe _........... Number CLOCK TIME PERCOLATION PERCOLATION Elapse .o..Water :. ..Depth Water, " Ve : _ . No. Time From.Ground'Surface in Inches Soil:Rate Start-Stop, ... -Min. . 7Start.:-;.....:_.....-- Stop.. Drop "in Mari: /in drop Inches Inches Inches 1 2:30/2:41 11 18, 21 3 4'. 2 2:42/2:54. 12 18 ..21 3 4 - 3 2:55/3 :08 13 17: ..20 3 4 1, 2-:45/2:X56' ' 11-. 1.6 4' n,. ._.. :2:57/3.10 13. ..,.. .1.7 .... 20 ........ 3....... .4 3 3:11/3:22 14 17 20 3. 4 . f 1 2 1. 1.1/2 21:' ip�;`4 1.8; _ 21.... 3_ ._.._.. 3 . � 1, �• ,} `�} •�; :' 2 2.22%2.30 8 ,_ 17 _.2U 3... 3 3_i.3112-41.' 10 .. �y._ ... -16.. ... ..:..19 .3 1 5. ._._... a . 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. TEST PIT DATA REQUIRED TO BE SU3MITTED,.;14ITH,:APPLICATION DESCRIPTION OF.SO Ito .ENCOUNTERED IN TEST:HOLES:s. q mot; ... �.. �p : +.�,DEP.TH:- . +'m -r a410rd.KI'z,-n..LMbv -.:{- .y Cr!x'..- c"'t. -•�wF �HOL�YJ4YLl�Vf -tl. .•t- .,.:W.:O. r...._... .a�. ia'+wn � v.^K,x. -.: �1N 4.. .+..Wr..ac :r..4a+uc+. G.L. Blk. organic Blko, organic _. Blk'o. organic 611 topsoil topsoil topsoil,. 12 "- sandy loam sandy loam.. sandy loam, THIS SPACE FOR USE BY HEALTH DEPARTM' " T ONLY: Noa 512yti Soil Rate Approved Sq. Ft /Gal. Checked by �pROFESStoN to P� John Za"cone �, TEST PIT DATA REQUIRED TO TO BE WITH,APPLICATION d DESCRIPTION OF..S.O.ILS._ENC,OUNTERED •.ZN" TEST HOLES' d THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: .. .. 4:rF ^'0 5 Soil Rate Approved Sq..Ft /Gal1251 . Checked by e HALE DT_ 13... g G.L. Blk. organic ;Blk organ -6 ::: ..' .:..:.. Blk. organic 6" topso,iI topsoil topsoil 12" sandy loam sandy -loam sandy loam 18" 30" (-sandy,-. gravel ly... ....,;, ,,.. ' " andy ,gravel ly ::. - .....- sandy gravel iy 36�� subsoils . subsoils'": . ' subsoils r. 48" gam, wtr_ 54. 6011 66" 72" . :... ... „ . ....78" ..... . 84" INDICATE .LEVEL. AT WHICH .GROUND, WATER..TS..ENCOUNTERED ....:... ..INDICATE LEVEL TO WHICH WATER..LEVEL RISES AFTER BEING ENCOUNTERED Salvatore V. Ri i na., P.. E-___.-_ Date Mai J, _.1987_ :... . Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic'Tank Capacity Gals. Type p By Absor ton.Area.Prov e L. F x24" �bj `''- _ ......... width trench. d THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: .. .. 4:rF ^'0 5 Soil Rate Approved Sq..Ft /Gal1251 . Checked by e PUTNAM:COUNTY DEPARTMENT OF.HEALTH. \OUNTY VISION-_ OF_.ENiIIRONMENTAL_ .HEALTH SERVICES OFFICE BUILDING CARMEL N. Y. 10512 DESIGN DATA S T- SEPARATE SEWAGE DISPOSAL SYSTEM FT 0. -Owner. Address Located at (Stre t Sec. Block Lot 6dicate nearer cross s ree Municipality Watershed SOIL PERCOLATI TEST DATA REQUIRED TO.BE S MITTED WITH APPLICATIONS o. e.Number CLOCK TIME PERC TION PERCOLATION >a se p o Or Water ve No. Time From Gro d Surface in Inches Soil Rate Start: Stop-- Min. Start`: ` ' Stop Drop in Min. /in drop Inches Inches Inches 1 2 3 Notes: 1) Tests to be repeated at same depth until proximately equal soil rates are obtained at each percolation test hole. 1 data to be submitted for review. 2) Depth measurements to be made from top of hole. PUTNAM COUNTY DEPARDENT_OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY/ SUBSURFACE SEWAGE DISPOSAL SYSTEMS YNSPxVI i ( P _ - -FIELD 0�7 2 ,R � T ' _ , .•:- _ .,- �,. -.; .., .,x; ;. - ..a. _ , Q. 4&40 DATE. 4 1" 3.NSP. BY: (Name of Owner) (Street 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... -5 ty V Adjacent wells/ septics ............................. D.H. 1 Lot- _...__ Depth to G.W. -' Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9,ft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 _ Lot Depth to G.W.v._ Depth to rock soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: • FINAL SITE INSPECTION INSP.BY: YES NO CO MaM 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. fran house .:.. ......................... Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally fran 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::......_. FINAL GRADNG OF SITE ASTABLE:............... 1 LL_ 0 � r � np 1=�0 �> W 31-t VN -Z 111 1 w 3 W m � O 11 IH 2 lla-! _ Xn a °Oq tia��gyy C Q� a ... qR�1 41ro+t W W� h JZ y�QW p �. Na \mmm h o mIn ago �4ou O e �o Om� 4 ro�� 4� 4 ? � y,0 Dom y� NN J z �WU �OL v V y� A 7 Z _ _ 1 LL_ 0 � r � np 1=�0 �> W 31-t VN -Z 111 1 w 3 W m � O 11 IH 2 lla-! _ Xn a °Oq tia��gyy C Q� a ... qR�1 41ro+t W W� h JZ y�QW p �. 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